Upper incisor to Soft Tissue Plane (UI-STP) : a new reference for diagnosis and planning in dentofacial deformities

Planning in orthognathic surgery has been and still is an open issue. We have evolved from 2D classical cephalometric hard-tissue planning to 2D soft tissue planning, and finally to 3D and hard and soft tissue evaluation. This, to our knowledge, is the first description of a new Soft Tissue Plane (STP) and its relationship with the anterior position of the upper incisor (UI). Profile photographs of 110 ?attractive individuals? with lips at rest or smiling and with upper incisor shown were used. The photographs used were of 65 professional models from two international agencies and 45 individuals considered most attractive in the internet forums, which included catwalk models and actors. In 86 cases (78.18 %), the incisor was located in front of the STP (A). In 15 cases (13.63%), it was on the plane (N); and in the remaining 9 cases (8.18%), it was behind (P). Despite the limitations of this study and based on our series, we can conclude that the upper incisor is located at or in front of the Soft Tissue Plane (STP) in 91.81% of the attractive facial profiles studied. On the other hand, the relative position of the upper incisor to the soft tissue plane (UI-STP) could be a useful diagnostic and planning tool in orthodontic and surgical management of dentofacial deformities

Transalveolar screw: : a new concept for orthodontic anchorage

The purpose of this article is to describe the use of a new trans-alveolar screw (TAS) as a temporary orthodontic anchorage device for the posterior maxilla, to intrude overerupted maxillary molars. To date, five consecutive patients have been treated with these newly designed screws. Intrusions achieved ranged from 2.1 and 6mm (mean 4.7mm). The TAS is cheap, easy to place and remove by the orthodontist, has bicortical anchorage, and is loaded on both sides. The main advantage of TAS is that when placed in the maxilla to intrude upper molars, it allows application of intrusive force from both buccal and palatal aspects simultaneously, so that the line of force in relation to the center of resistance of the posterior segment, permits an in-mass intrusion, avoiding buccal tipping or rotations. Moreover the surgical procedure for inserting and removing the bicortical screw is simple and does not require any surgical flap, so complications are minimal and screws can be loaded immediately, without requiring any waiting healing period of time

Blood absorption capacity of different xenograft bone substitutes. An in-vitro study

Commercially available xenograft blocks, claim to have adequate characteristics to interact with biological media and thus permitting biological fluid absorption. The objective of this in vitro study was to compare the blood absorption capacity of four different xenograft block materials of different composition of collagen and porosity. Four brands of xenograft block materials were used (NuOss®, Bio-Oss®, Osteobiol® and Smartbone®). Five samples of each brand were analyzed, making a total of 20 tests. Human blood was used as the absorption liquid for the present experiment. The time period, in which the block remains in contact with the blood, was registered at 30 seconds (T1), 60 seconds (T2) and 5 minutes (T3). The xenograft blocks were evaluated according to their absorption capacity. The absorption capacity of the different biomaterials were statistical significant different (p<0,001) at T1, T2 and T3 time points. At 30 seconds, Smartbone® absorbed significantly less blood than NuOss® and Bio-Oss®, however, without differences comparing with Osteobiol®. The NuOss®, Bio-Oss® and Osteobiol® did not register any significant difference between them. At 60 seconds, the Smartbone® absorbed significantly less blood than the other biomaterials. The NuOss® was significantly superior than Osteobiol®, but without differences relatively with Bio-Oss®. Also the Bio-Oss® and Osteobiol® did not register any difference between them. At 5 minutes, the Smatbone® continued to significantly absorbed less blood than any other biomaterial, nevertheless, NuOss®, Bio-Oss® and Osteobiol® not register again any significant difference between them. Despite of small sample size, it can be concluded that NuOss® was superior, in terms of blood absorption capacity, comparing with the other block biomaterials at 30 seconds, 60 seconds and 5 minutes. However, more investigation in a clinical setting are needed to know the clinical implications of the absorption capacity of such biomaterials

Improving accuracy of the intermediate splint in substantial intermaxillary sagittal discrepancies using an extra anterior anchorage point:technical note

To describe a technical feature that increases the stability of the intermediate splint in patients where bimaxillary surgery with great maxillary/mandibular advancements are planned. Prospective evaluation of the intermediate splint dental vertical penetration in patients undergoing bimaxillary surgery where great sagittal discrepancy occur in the anterior sector between the upper and lower jaws when the intermediate splint is placed by adding an extra intermaxillary fixation (IMF) screw (2x9 mm) placed between the central incisors of the maxilla and fixed to the most anterior aspect of the intermediate splint following the direction of the sagittal maxillo-mandibular discrepancy from January to September 2018. The postoperative evaluation comparing the accuracy of conventional fixation versus fixation with an extra anterior anchorage point through photographic assessment and intraoral digital scanner demonstrated better dental penetration, and therefore improved intermediate splint precision with the latter in all cases Our results suggest that this is a simple and safe technique that can be easily reproduced and optimizes the outcomes by increasing the accuracy of translation of the planned surgical movements to the operating room

Envelope approach for onlay bone grafting : preliminary surgical and prosthetic results

Minimally invasive surgery principles have been applied to preprosthetic-implant surgery, and an adequate presurgical planning reduces morbidity in both harvesting and stabilization of the bone grafts. Objective: A new ?envelope? approach for onlay bone grafting at the alveolar process is presented, this avoids releasing incisions yet allowing adequate reconstruction of the defective site. Study design: To be included in the study the patient had to have an antero-posterior defect of the alveolar crest. Patient age and sex, location of the defect, type and size of graft, and complications appeared during follow up were recorded. Results: Ten consecutive patients (4 men and 6 women) have been succesfully treated with this technique between June/2006 and February/2008. Eight defects were located at the anterior maxilla (between canines), and the remaining two at the anterior mandible (between canines). Four patients received bone grafts harvested from the chin, and the remaining six patients received bone grafts from the mandibular body. Mean size of the graft was: width 11,5mm (range 8 to 17), height 14,7mm (range 9 to 18), depth 4,3mm (range 3 to 6). Conclusion: This technique improves vascularization of the mucoperiosteal flap and avoidance of releasing incisions which has an aesthetic impact in patients with gingival smile

Orthognathic surgery and aligners. A comparative assessment of periodontal health and quality of life in postsurgical orthodontic treatment with aligners versus traditional fixed appliances:a randomized controlled trial

Removable clear aligners have become very popular in the last few decades, but they are still little used in the field of orthognathic surgery (OS). The objective of this study was to compare periodontal health and quality of life (QoL) associated to postsurgical orthodontic treatment. Patients with dentofacial deformities undergoing OS were randomly allocated to receive postsurgical orthodontic treatment with either fixed orthodontic appliances or Invisalign. The main outcomes were periodontal health and QoL. Plaque index, probing depth and bleeding on probing were assessed as periodontal health indicators. QoL was assessed through the Orthognathic Quality of Life Questionnaire (OQLQ-22) and the Oral Health Impact Profile (OHIP-14). Data were analyzed before surgery and end of treatment. Total duration of treatment was also recorded. Twenty-eight patients were randomized, (16 women, 12 men). Periodontal assessment showed better outcomes for the Invisalign group: bleeding on probing (p=0.013), plaque index (p=0.001) and probing depth (p<0.001). The QoL questionnaires showed significant differences in favor of the Invisalign group: OHIP-14 (p=0.004) and OQLQ-22 (p=0.002). Total duration of treatment was similar in both groups (p=0.575). Compared to traditional orthodontics with fixed appliances, patients managed with clear aligners after OS (surgery-first approach) had better periodontal health and QoL outcomes

Current state of dynamic surgery. A literature review

Recently, dental implant technology has been widely used for oral reconstruction. Dental implants are the treatment of choice for those patients with dental absences. An optimal implant placement is based on the prosthetic driven concept in order to achieve an aesthetic and functional restoration with a long-term prognosis. There are two types of guided implant surgery that are described in the literature: Static Guided Surgery (SGS) and Dynamic Guided Surgery (DGS). The aim of this study is to be aware of the current state of dynamic surgery and compare in the literature the discrepancies between planning and placement of dental implants. The study consists of a bibliographic review on the topic. The research has been performed in the Medline/Pubmed of articles published by different professional associations and societies in the international context. Twenty two studies out of 100 articles from the initial search were finally included. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. Dynamic navigation shows a better accuracy and precision of implant placement. To corroborate the results of this review as well as to evaluate the different variables that could influence the accuracy of this technique, future randomized control trials will be needed

Peri-implantitis and maxillary sinus membrane thickening: A retrospective cohort study.

OBJECTIVE The objective of this study is to investigate the association of peri-implantitis (PI) and sinus membrane thickening and to assess the resolution of membrane thickening following intervention (implant removal or peri-implantitis treatment) aimed at arresting PI. MATERIALS AND METHODS Forty-five patients with 61 implants in the posterior maxillary region were retrospectively included in the study. Twenty-four patients were diagnosed with peri-implantitis (PI) and 21 had peri-implant health (PH). Cone-beam computed tomography (CBCT) scans were evaluated to assess maxillary sinus characteristics, including membrane thickening, sinus occupancy and ostium patency. The CBCT scans taken 6 months after intervention aimed at arresting disease (implant removal or treatment of PI) in the PI group were also appraised and compared to baseline scans. RESULTS At baseline, all parameters evaluating membrane thickness disorders yielded significant differences between groups (p < .001). Patients with posterior maxillary implants diagnosed with PI were 7× more likely to present membrane thickening compatible with pathology when compared to patients with healthy implants (OR = 7.14; p = .005). Furthermore, the likelihood was 6x greater in implants diagnosed with PI to exhibit moderate membrane thickening (OR = 6.75, p = .001). The patients receiving interventions aimed at arresting PI experienced significant enhancement in all radiographic parameters related to the sinus cavity at the 6-month follow-up (p < .001), though these variations were similarly independent of whether treatment consisted of PI treatment or implant removal. CONCLUSIONS Maxillary sinus membrane thickening and the permeability/obstruction of the ostium are frequently associated with the presence of PI in posterior implants. Interventions targeting disease resolution effectively reduce membrane thickness to levels compatible with maxillary sinus health

Immediate implants following tooth extraction. A systematic review

Objectives: The aim of this article is to review the current state of immediate implants, with their pros and contras, and the clinical indications and contraindications. Material and Methods: An exhaustive literature search has been carried out in the COCHRANE library and MEDLINE electronic databases from 2004 to November 2009. Randomized clinical trials and clinical trials focused on single implants placed in fresh extraction sockets were included and compared. A meta-analysis could not be performed due to heterogeneity of the data. Results: Twenty studies out of 135 articles from the initial search were finally included, which summed up a total of 1139 immediate implants with at least a 12-month follow-up. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. Discussion: Immediate implants have predictable results with several advantages over delayed implant placement. However, technical complications have been described regarding this technique. Also, biomaterials may be needed when the jumping distance is greater than 1mm or any bone defect is present. Conclusions: Few studies report on success rates rather than survival rates in the literature reviewed. Short-term clinical results were described and results were comparable to those obtained with delayed implant placement. Further long-term, randomized clinical trials are needed to give scientific evidence on the benefits of immediate implants over delayed implant placement. © Medicina Oral S. L

Acellular dermal matrix in soft tissue reconstruction prior to bone grafting. A case report

When hard tissue augmentation is scheduled as a part of an oral rehabilitation, prior to the treatment, it is important to assess if the quality of the underlying gingiva at the recipient site can support the bone grafting procedure. The most frequent complication during autologous onlay grafts are wound dehiscences in the recipient site, so the integrity of soft tissues is a basic aspect of successful reconstructive and plastic surgical procedure. Connective tissue grafts can improve the quality and quantity of soft tissue in oral sites where a hard tissue reconstruction is going to take place. However, particularly when large grafts are harvested, the autogenous donor site can present significant postoperative morbidity, such as necrosis of the palate fibromucosa and bone exposition, pain and bleeding. Another important limitation with the use of autogenous grafts is the limited supply of donor connective tissue. If a large site needs to be grafted, more than one surgical procedure may be required. An Acellular Dermal Matrix (ADM) graft has become increasingly popular as a substitute for donor connective tissue, eliminating the disadvantages described for the autogenous donor graft. The amount of tissue harvested is unlimited, so it gives an option for treating patients that have inadequate harvestable tissue or that present a large defect to be treated. The outcome of using ADM as a matrix for soft tissue reconstruction 12 weeks before bone grafting can reduce the risk of exposure and failure of the bone graft