Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population.

BACKGROUND: Pediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. METHODS: The translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4-18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. RESULTS: The factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. CONCLUSIONS: Cultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.

The accuracy of photographic soft-tissue profile analysis to determine Class II and vertical skeletal relationships in children.

BACKGROUND: Lateral cephalometric analysis (LCA) is the reference standard for identifying common skeletal relationships in orthodontics, such as Cl II and hyperdivergent skeletal discrepancies, but it entails radiation exposure. Therefore, photographic soft-tissue profile analysis (PSPA) could be a useful alternative for these diagnoses, particularly for paediatric patients. This study aims to estimate the accuracy of PSPA for determining common skeletal discrepancies in children. METHODS: Cephalometric radiographs and profile photographs of a consecutive series of 100 children (8.0-17.6 years old) made on the same day were included. The validity of PSPA was verified against comparable LCA. First, by assessing the Pearson correlation and then estimating the sensitivity, specificity, receiver operating characteristic (ROC) curves and area under the curve (AUC) in sample A (n = 50). After external validation in a new sample B (n = 50), the ROC-AUC, diagnostic odds ratio, best cut-off points and discriminative validity were assessed in the total sample. Interrater reliability was estimated using the intraclass correlation coefficient, the standard error of measurement and Bland-Altman plots. RESULTS: The measurement properties of the PSPA angles A'N'B', Gl'-Sn-Pog, N'-Sn-Pog', and N'-Tra-Me' were valid (ROC-AUC > 0.7) and reliable (ICCs > 0.92). The angles A'N'B', Gl'-Sn-Pog', and N'-Sn-Pog', with the respective cut-off points ≥7.7', ≥12.8', and ≤163.5', were accurate values for determining Cl II discrepancy. The N'-Tra-Me'-angle (≥63') was an accurate estimate for a hyperdivergent discrepancy. CONCLUSIONS: These validated PSPA angles could be used in clinical settings as a minimally invasive diagnostic tool to screen children suspected of having skeletal Cl II and hyperdivergent discrepancies.

Bisphosphonate therapy in chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible: Retrospective case series.

This study aims to evaluate short-term and long-term results of bisphosphonate therapy in patients with diffuse sclerosing osteomyelitis/tendoperiostitis (DSO/TP) of the mandible. Eighteen patients (12 female, 6 male) aged 34.8 ± 22.2 years with DSO/TP of the mandible that were treated with bisphosphonates were included. In 16 patients, the bisphosphonate treatment led to remission with decrease of symptoms (pain, swelling of the cheek, trismus, tenderness of masticatory muscles) with a follow-up period of 4.5 (0.8-11.9) years between start of bisphosphonate treatment and latest follow-up consult. Of these, three patients were still in need of regular bisphosphonate therapy. Two patients were lost to follow-up. Bisphosphonate therapy is a treatment option for DSO/TP of the mandible that is associated with a high chance of remission of symptoms. Within the limitations of the study it seems that this treatment might be an effective second step in DSO/TP refractory to conservative treatment.

Fracture of the tibia after a fibula graft for mandibular reconstruction: A rare complication, report of a case.

A tibia fracture after a fibula harvest is a rare and serious condition; however, when treated adequately, it has a good outcome. The possibility of a fracture should be kept in mind and other pathology and/or metastasis should be ruled out.

Dental implants as risk factors for patients with medication-related osteonecrosis of the jaws (MRONJ).

An increasing number of patients with medication-related osteonecrosis of the jaws (MRONJ) has recently been reported. It is still being debated whether the presence or placement of dental implants can lead to MRONJ, so the aim of this study was to find out whether dental implants are a risk factor for MRONJ. From January 2003-January 2019 180 patients with MRONJ were seen at the Leiden University Medical Center. Luxating moments for the onset of MRONJ were calculated retrospectively. We collected clinical data and details of antiresorptive medication and found 22 patients with both dental implants and MRONJ. In 18 patients the implants were in the region of the MRONJ and they were included in this study, 14 who had had implants before using antiresorptive drugs and four who had had antiresorptive drugs before or at the time that the implants were placed. The median times between the placement of implants and the diagnosis of MRONJ in these two groups were 24 months and 6 months, respectively. Among the 47 implants, 30 were located in the necrotic region, and all 30 were either lost spontaneously or had to be removed during treatment of MRONJ. Our results show an increased risk for developing MRONJ in patients with dental implants. Both peri-implantitis around previously placed implants, and insertion of dental implants, are risk factors. Prevention of peri-implantitis and caution when inserting dental implants in patients who take antiresorptive medication are therefore important.

Density of the mandibular ramus (cancellous:cortical bone volume ratio) as a predictor of the lingual fracture pattern in bilateral sagittal split osteotomy.

The aim of this retrospective cohort study was to evaluate the relative amount of cancellous bone in the mandibular ramus as a predictor of lingual fracture patterns after bilateral sagittal split osteotomy (BSSO). The study including 78 consecutive patients (156 osteotomy sites). In preoperative cone-beam computed tomographic (CT) scans, the volumes of cancellous and cortical bone in the BSSO surgical field were estimated. Patients were divided into two groups based on the cancellous:cortical bone ratio. We studied postoperative cone-beam CT scans for lingual fracture lines and subcategorised them according to the lingual split scale (LSS). Generalised linear mixed models (GLMM) were estimated to evaluate the association between the cancellous:cortical bone ratio and the lingual fracture pattern. There was a significant association between the cancellous:cortical bone ratio of the mandibular angle and the lingual fracture pattern after BSSO. Mandibular angles with a relatively small amount of cancellous bone showed significantly more LSS3 fracture lines (OR=1.990, 95%CI 1.043 to 3.796, p=0.043). These mandibular angles also showed more unfavourable fractures (LSS4), although this was not significant (OR=2.352, 95%CI 0.748 to 7.392, p=0.143). The relative amount of cancellous bone in the mandibular angle is significantly associated with the lingual fracture line after BSSO.

Outcome of different treatments for chronic diffuse sclerosing osteomyelitis of the mandible: a systematic review of published papers.

Treating chronic diffuse sclerosing osteomyelitis (DSO) is challenging and many treatments have been reported. However, we know of no standard protocol or guidelines. In this systematic review of relevant publications we provide an overview of the different treatments used. We made an electronic search of PubMed, Medline, Embase, Web of Science, and the Cochrane Library databases, for papers that described the treatment of DSO of the mandible. The search yielded 48 papers that applied to all inclusion criteria, resulting in 16 case reports, 13 case series, 18 retrospective clinical cohort studies, and one randomised controlled trial. Reported treatment options included different operations; the use of antibiotics, anti-inflammatories, and antiresorptive medication; conservative treatment; and hyperbaric oxygen. Surgical treatment resulted in a low success rate and was associated with higher morbidity than other treatments. Conservative treatment, and that of bisphosphonates, yielded more promising results, so conservative treatment and bisphosphonates seem to be the most promising therapeutic options. However, because of the high risk of bias, no firm conclusions can be drawn, and larger studies with clear inclusion criteria and specified endpoints are needed.

A comparison of the cone beam computed tomography findings in medication-related osteonecrosis of the jaws related to denosumab versus bisphosphonates: an observational pilot study.

OBJECTIVE: The aim of this study was to compare the radiographic abnormalities on cone beam computed tomography (CBCT) in patients with medication-related osteonecrosis of the jaws (MRONJ) related to denosumab use versus bisphosphonate use. STUDY DESIGN: The study included 34 consecutive patients with MRONJ who had a history of exclusive use of denosumab (n = 17) or bisphosphonates (n = 17) and had undergone CBCT for determination of extent of disease. Demographic data of the patients were collected. Differences in radiologic characteristics between patients with denosumab-related osteonecrosis of the jaws (DRONJ) and those with bisphosphonate-related osteonecrosis of the jaws (BRONJ) were scored and studied on CBCT. RESULTS: In patients with DRONJ, sequestra (P = .015) and lysis of the cortical border of the jaw (P = .033) were significantly less common than in patients with BRONJ. Subperiosteal bone formation did not differ between the groups (P = .545). There was no association between stage of disease and duration of drug therapy or duration of symptoms for either medication group. CONCLUSIONS: The radiologic features of DRONJ may be different from those of BRONJ with regard to the presence of sequestra and cortical lysis and might, therefore, be improperly diagnosed. Underestimation and undertreatment of DRONJ may potentially lead to progression of disease and, thus, make treatment more difficult.

Autotransplantation With a 3-Dimensionally Printed Replica of the Donor Tooth Minimizes Extra-Alveolar Time and Intraoperative Fitting Attempts: A Multicenter Prospective Study of 100 Transplanted Teeth.

PURPOSE: Three-dimensional (3D) autotransplantation is a technique for surgical transposition of a tooth to another site within one patient, using 3D printed replicas of the donor tooth. In this study, we evaluated intraoperative experiences during 3D autotransplantation of teeth. MATERIALS AND METHODS: A multicenter prospective clinical study was implemented. All procedures were performed using preoperative cone-beam computed tomography imaging and computer-assisted design with computer-assisted manufacturing resulting in a 3D replica of the donor tooth. RESULTS: The 100 autotransplantation procedures (79 patients) included canines, premolars, molars, and 1 supernumerary tooth. In 82% of the procedures, the transplantation was performed with an extra-alveolar time of less than 1 minute and an immediate good fit of the donor tooth. In 14%, the extra-alveolar time was 1 to 3 minutes or multiple fitting attempts were necessary. In 4%, the extra-alveolar time exceeded 3 minutes. Difficulties during the procedures were caused by movement artifacts on the preoperative cone-beam computed tomography imaging, a long interval between the imaging and the procedure, or insufficient bone volume at the recipient site. CONCLUSIONS: The use of a 3D printed donor tooth replica during autotransplantation procedures minimized the extra-alveolar time and intraoperative fitting attempts of transplants. This facilitated a quick and reliable treatment and enabled more difficult procedures.

Non-surgical treatment of adults with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible.

Non-surgical therapy has proved to be effective in chronic diffuse sclerosing osteomyelitis (DSO) of the mandible in children. Therefore we aimed to investigate the effect of non-surgical therapy in adult DSO patients. We included consecutive patients with DSO who received non-surgical therapy in our center. They all received occlusal splint therapy, counselling about the disease, and/or physiotherapy by a specialised team. The use of analgesics, preferably nonsteroidal anti-inflammatory drugs, was advised for symptomatic control during periods of exacerbation. Sixteen patients (11/5 female/male) aged 39.9 ± 15.0 years with DSO of the mandible were included. The mean duration of symptoms was 39.7 ± 26.3 months before referral to our center. Patients were treated with a broad range of treatments before referral. All patients underwent non-surgical treatment. In 12 patients this led to remission. Four patients still had complaints after 12 months of non-surgical therapy and started with intravenous bisphosphonate therapy. In our center, DSO of the mandible was successfully treated with non-surgical therapy, despite a long duration before referral and extensive pre-treatment. Considering this high success rate, we recommend this non-surgical approach as the first treatment option for DSO of the mandible. In case of persistence, alternative treatments such as bisphosphonates should be explored.

Long-term outcomes 1-20 years after autotransplantation of teeth: clinical and radiographic evaluation of 66 premolars and 8 molars.

In this retrospective study we investigated the long-term survival of autotransplanted premolars and molars with incompletely developed roots. The presence of the transplanted teeth and their outcome after autotransplantation was ascertained from clinical and radiographic evaluation by a maxillofacial surgeon or dentist. Kaplan Meier survival curves were estimated for the total population and for the two groups (premolars and molars). Fifty-one patients with 74 transplanted teeth were included, and the median duration of follow-up was 10 (range 1-20) years. Four of 66 premolars and one of 8 molars were removed and the cumulative survival was 95.4% (95% CI 90.3 to 100). The difference in survival between the premolars and molars was not significant. These results show that the long-term survival of autotransplanted teeth is good. Replacement of a single tooth by autotransplantation should therefore always be considered and is preferred when a suitable donor tooth is available.

Root Elongation After Autotransplantation in 58 Transplanted Premolars: The Radiographic Width of the Apex as a Predictor.

PURPOSE: Autotransplantation of premolars with incomplete root development is a reliable treatment option for tooth replacement. Nevertheless, little is known about root development after transplantation of teeth. The aim of this study was to evaluate preoperative root development stage and radiographic width of the apex as predictors for root elongation after autotransplantation. MATERIALS AND METHODS: A retrospective cohort study was implemented and composed of patients who underwent autotransplantation of at least 1 premolar. Using panoramic radiographs (orthopantomograms), calibrated measurements were taken to record the root development stage of the donor tooth, width of the apex, and root length of the transplanted tooth. RESULTS: Forty-five patients (58 transplants) were included. Mean follow-up time was 12 months (range, 4 to 26 months). Fifty-three transplanted teeth (91.4%) showed root elongation. Mean root elongation at end of follow-up was 1.9 mm (range, 0.0 to 4.3 mm). A wide-open apex before transplantation was significantly associated with root elongation after autotransplantation (P < .01). Root development stage (P = .82) did not show significant associations with root elongation. CONCLUSIONS: A wide-open apex (>2.0 mm) is an important predictor of root elongation after autotransplantation of premolars. This might be a better predictor for root development than preoperative root development stage.

Radiographic characteristics of chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible: A comparison with chronic suppurative osteomyelitis and osteoradionecrosis.

Diffuse sclerosing osteomyelitis (DSO) of the mandible is a poorly understood chronic disease. It is assumed to be a form of chronic osteomyelitis. Other forms of chronic osteomyelitis are chronic suppurative osteomyelitis (CSO) and osteoradionecrosis (ORN). This study aimed to investigate radiographic characteristics of DSO and compare these findings with the radiographic characteristics of CSO and ORN in order to radiographically distinguish these three diseases. In this retrospective study, 33 patients were clinically diagnosed with DSO (13), CSO (6), or ORN (14). The panoramic radiographs, computed tomography images, and magnetic resonance images of these patients were evaluated. Osseous and soft tissue changes were analysed. Patients with DSO showed extensive cortical and medullary sclerosis combined with subperiosteal bone formation, condylar process deformation, and hypertrophy and oedema of the masseter muscle. DSO patients showed no pathological fractures or sequestra, which were observed in patients with CSO and ORN. The radiographic characteristics that differentiate DSO from CSO and ORN include subperiosteal bone formation, condylar process deformation, masticatory muscle changes, and the absence of sequestra and pathological fractures.

Treatment of pathologic fractures of the mandible in stage III medication-related osteonecrosis of the jaw-an observational study.

PURPOSE: The treatment of pathologic fractures in stage III medication-related osteonecrosis of the jaw (MRONJ) remains challenging. The treatment in the literature is controversial, varying from extensive and aggressive surgery with resections and musculocutaneous free flap reconstruction to conservative treatment with only mouth rinses and/or antimicrobial treatment. The purpose of this study was to analyse the results of the treatment protocol in the Leiden University Medical Center in the Netherlands. MATERIALS AND METHODS: Between 2003 and 2017, a total of 15 consecutive patients were seen with pathologic fractures in stage III MRONJ. Patient characteristics and treatment were studied. RESULTS: Seven patients were dentate, and were all surgically treated according to protocol, with 3 additionally undergoing intermaxillary fixation. Eight patients were edentulous of whom 6 were surgically treated: 2 with osteosynthesis and the rest with a soft diet post-operatively for several weeks. One patient showed healing in a later stage and was not treated. Two patients were treated with antimicrobial treatment and a soft diet. Eleven patients (73%) showed complete healing of the fracture or a pseudarthrosis and were free of complaints and able to function. CONCLUSION: These results show that a relatively simple (surgical and/or antimicrobial) approach, combined with intermaxillary fixation on occasion, can lead to consolidation and/or a pseudarthrosis with a remaining and acceptable function of the jaw.

[Replacing heavily damaged molars with the use of 3D-techniques]. / Vervanging van ernstig beschadigde molaren met behulp van 3D-technieken.

Seriously damaged molars can be replaced by autotransplantation with the help of 3D techniques. In the present case, involving an 18-year old patient, 18, 38 and 48 were used to replace, respectively, 14, 36 and 37. Preoperatively, the width of the crowns and the root development of 18, 38 and 48 were analysed using 3D imaging. During the autotransplantation procedure, the new alveoli are formed with the help of replicas of the donor molars printed in 3D, in order to prevent iatrogenic damage to the actual donor molars.. The extra-alveolar time was less than 2 minutes for all donor molars. Postoperative follow-up showed physiologic integration of the transplanted molars. There was no ankylosis. Autotransplantation with the help of 3D techniques makes it possible to perform complex procedures with good results.

[Incision of the third molar in the Netherlands. Incision tech-niques for the removal of impacted third molars in the mandible.] / Incisietechnieken bij verwijdering van geïmpacteerde derde molaren in de onderkaak.

Various incision techniques to remove impacted third molars in the mandible have been described, for example, the flap incision, the envelope incision, the distal incision and the modified envelope incision. The aim of this study was to record the incision techniques used by oral and maxillofacial surgeons in the Netherlands for the removal of impacted third molars in the mandible. All members of the Dutch Association of Oral and Maxillofacial Surgery (NVMKA) received a questionnaire. In this questionnaire, the surgeons specified their standard incision technique for the removal of, respectively, mesially impacted, upright, or distally impacted mandibular third molars. Of the 323 questionnaires sent, 172 were returned (53,3% response rate). The flap incision and the distal incision were the most frequently used incisions by oral and maxillofacial surgeons (including residents) in the Netherlands. The academic centre seems to have a lasting impact on the preferred way of removing an impacted third molar. It also seems that an oral and maxillofacial surgeon more frequently removes a third molar in the mandible from a sitting position than a resident.

Conservative treatment of children with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible.

Chronic diffuse sclerosing osteomyelitis (DSO) of the mandible is a rare disease of unknown aetiology. It has been suggested that overuse of the masticatory muscles, tendoperiostitis (TP), is a contributing factor for DSO. Therefore, we tested this hypothesis by treating consecutive children with conservative therapy. All patients were treated with conservative therapy, comprising occlusal splint therapy, physiotherapy, and/or disease counselling. Pain intensity on a visual analogue scale (VAS) and pain frequency in number of days per 3 months were recorded before the start of treatment, and at 3, 6, and 12 months after treatment initiation. Eleven children (seven girls, four boys, mean age: 11.55 ± 1.97 years) were included in this study. Six patients showed a decrease in pain intensity and pain frequency over time and they continued with conservative therapy. For the remaining five patients, bisphosphonate administration was initiated because of persistent severe pain - one after 3 months of conservative therapy, and the other four after 1 year of conservative therapy. The pain complaints of patients with DSO/TP decreased with conservative therapy, and 55% did not require additional therapy. This suggests that DSO/TP of the mandible is precipitated by muscle overuse.

Autotransplantation of teeth using computer-aided rapid prototyping of a three-dimensional replica of the donor tooth: a systematic literature review.

This systematic review provides an overview of studies on autotransplantation techniques using rapid prototyping for preoperative fabrication of donor tooth replicas for preparation of the neo-alveolus. Different three-dimensional autotransplantation techniques and their treatment outcomes are discussed. The systematic literature search yielded 19 articles that satisfied the criteria for inclusion. These papers described one case-control study, four clinical observational studies, one study with a clinical and in vitro part, four in vitro studies, and nine case reports. The in vitro studies reported high accuracy for the printing and planning processes. The case reports all reported successful transplantation without any pathological signs. The clinical studies reported a short extraoral time of the donor tooth, with subsequent success and survival rates of 80.0-91.1% and 95.5-100%, respectively. The case-control study reported a significant decrease in extraoral time and high success rates with the use of donor tooth replicas. In conclusion, the use of a preoperatively designed surgical guide for autotransplantation enables accurate positional planning, increases the ease of surgery, and decreases the extraoral time. However, the quality of the existing body of evidence is low. Further research is therefore required to investigate the clinical advantages of this innovative autotransplantation technique.

Replacing Heavily Damaged Teeth by Third Molar Autotransplantation With the Use of Cone-Beam Computed Tomography and Rapid Prototyping.

This article describes the autotransplantation of third molars to replace heavily damaged premolars and molars. Specifically, this article reports on the use of preoperative cone-beam computed tomographic planning and 3-dimensional (3D) printed replicas of donor teeth to prepare artificial tooth sockets. In the present case, an 18-year-old patient underwent autotransplantation of 3 third molars to replace 1 premolar and 2 molars that were heavily damaged after trauma. Approximately 1 year after the traumatic incident, autotransplantation with the help of 3D planning and rapid prototyping was performed. The right maxillary third molar replaced the right maxillary first premolar. The 2 mandibular wisdom teeth replaced the left mandibular first and second molars. During the surgical procedure, artificial tooth sockets were prepared with the help of 3D printed donor tooth copies to prevent iatrogenic damage to the actual donor teeth. These replicas of the donor teeth were designed based on the preoperative cone-beam computed tomogram and manufactured with the help of 3D printing techniques. The use of a replica of the donor tooth resulted in a predictable and straightforward procedure, with extra-alveolar times shorter than 2 minutes for all transplantations. The transplanted teeth were placed in infraocclusion and fixed with a suture splint. Postoperative follow-up showed physiologic integration of the transplanted teeth and a successful outcome for all transplants. In conclusion, this technique facilitates a straightforward and predictable procedure for autotransplantation of third molars. The use of printed analogues of the donor teeth decreases the risk of iatrogenic damage and the extra-alveolar time of the transplanted tooth is minimized. This facilitates a successful outcome.