Surgery Versus Nonsurgery Option for Scissors Bite Treatment.

BACKGROUND: This article compared the use of temporary skeletal anchorage devices (TSADs) and orthognathic surgery for scissors bite correction. METHODS: To correct the scissors bite without orthognathic surgery, a cross-type titanium miniplate was placed with 3 miniscrews (1.5 mm in diameter and 5 mm in length) in the midpalatal area, without a surgical incision and under local anesthesia. In addition, a 1 miniscrew was placed on the buccal alveolar bone to avoid molar extrusion during uprighting. In the surgical case, a 3-piece Le Fort osteotomy was performed to decrease maxillary arch width for transverse correction, and to close the extraction space by anterior retraction. The maxilla was stabilized with 4 L-shaped plates at the zygomatic buttresses and the pyriform aperture, as well as 2 straight plates between the 3 segments. RESULTS: After 15 months of treatment in the nonsurgery case, the scissors bite was successfully resolved by decreasing maxillary arch width and uprighting the molars. In the mandibular arch, correction of the crowding was aided by extraction of # 41. In the surgery case, after 24 months of treatment in the orthognathic surgery case, the bilateral scissors bite was successfully resolved and the facial asymmetry was corrected. The molar occlusion finished in Class II and the facial profile was improved. CONCLUSIONS: In scissors bite cases, a good diagnosis will help the clinician to decide whether treatment should involve orthognathic surgery. The authors have shown a case that was corrected with surgery and a case that was corrected using TSAD anchors. Treatment planning must include evaluation of the basal arch width of maxilla and mandible in class I occlusion, any skeletal asymmetry concomitant with a mandibular shift, the inclinations or atypical eruption degree of the posterior teeth, and the number of teeth involved in the scissors bite.

Primary intraosseous squamous cell carcinoma mimicking periapical disease: a case report.

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare carcinoma, which arises within the jaws without connection to the oral mucosa and presumably develops from a remnant of odontogenic epithelium. We present a case of solid type PIOSCC in a 52-year-old male patient complaining of dull pain on his left lower molar. In this case, early stage PIOSCC mimicking a periapical lesion might lead to a one-year delay in treatment due to the misdiagnosis of osteomyelitis after extraction of the third molar. The clinical, radiological, and histologic features are described. In this case, there was initial radiographic evidence for PIOSCC mimicking a periapical lesion. Incautious radiographic interpretation and treatment procedures had delayed the correct diagnosis and resulted in extensive bony destruction during the patient's disease progression.

Accuracy of a cone beam computed tomography-guided surgical stent for orthodontic mini-implant placement.

OBJECTIVE: To validate the accuracy of a cone-beam computed tomography (CBCT)-guided surgical stent for orthodontic mini-implant (OMI) placement by quantitatively evaluating the difference between CBCT-prescribed and actual position of mini-implants in preoperative and postoperative CBCT images. MATERIALS AND METHODS: A surgical stent was fabricated using Teflon-Perfluoroalkoxy, which has appropriate biological x-ray attenuation properties. Polyvinylsiloxane impression material was used to secure the custom-made surgical stent onto swine mandibles. CBCT scanning was done with the stent in place to virtually plan mini-implants using a three-dimensional (3D) software program. An appropriate insertion point was determined using 3D reconstruction data, and the vertical and horizontal angulations were determined using four prescribed angles. A custom-designed surveyor was used to drill a guide hole within the surgical stent as prescribed on the CBCT images for insertion of 32 OMIs. The mandibles with a surgical stent in place were rescanned with CBCT to measure the deviations between the virtual planning data and surgical results. RESULTS: The difference between the prescribed and actual vertical angle was 1.01 ± 7.25, and the horizontal difference was 1.16 ± 6.08. The correlation coefficient confirms that there was no intrarater variability in either the horizontal (R  =  .97) or vertical (R  =  .74) vectors. CONCLUSIONS: The surgical stent in this study guides mini-implants to the prescribed position as planned in CBCT. Since the statistical difference was not significant, the surgical stent can be considered to be an accurate guide tool for mini-implant placement in clinical use.