Minimal treatment options with one-piece implants

The aim of this publication is to present case reports to show what is possible with pterygoid implants for the rehabilitation of edentulous space in the jaw (maxilla) while avoiding sinus lifts and bone grafting procedures. In addition, the added value of one-piece implants for screwed retention is elucidated

Neuropathic pain after bilateral sagittal split osteotomy: management and prevention

Neuropathic pain is characterized by spontaneous and provoked pain and other signs reflecting neural damage. Aberrant regeneration following peripheral nerve lesions leaves neurons unusually sensitive and prone to spontaneous pathological activity, abnormal excitability and heightened sensitivity to stimuli. This review covers the current understanding of neuropathic pain after bilateral sagittal split osteotomy (BSSO) of the lower jaw. The reported incidence of neuropathic pain after mandibular osteotomies is less than 1%, while the incidence in patients with iatrogenic inferior alveolar nerve (IAN) injuries during BSSO can be as high as 45%. The factors which modulate the healing process toward neuropathic pain during or after nerve damage have not yet been elucidated. Patients at highest risk for developing post-BSSO neuropathic pain are older than 45 years and have undergone procedures involving IAN compression, partial severance, or complete discontinuity of the lingual nerve with a proximal stump neuroma, patients with nerve injury repair delayed longer than 12 months and patients with chronic illnesses that compromise healing or increase risk for peripheral neuropathy. Although neuropathic pain tends to be long-lasting, some patients can recover completely. Preventive measures include risk assessment prior to surgery, prevention of nerve damage during surgery, and early repair of nerve injury

Wound Healing Problems in the Mouth

Wound healing is a primary survival mechanism that is largely taken for granted. The literature includes relatively little information about disturbed wound healing, and there is no acceptable classification describing wound healing process in the oral region. Wound healing comprises a sequence of complex biological processes. All tissues follow an essentially identical pattern to complete the healing process with minimal scar formation. The oral cavity is a remarkable environment in which wound healing occurs in warm oral fluid containing millions of microorganisms. The present review provides a basic overview of the wound healing process and with a discussion of the local and general factors that play roles in achieving efficient would healing. Results of oral cavity wound healing can vary from a clinically healed wound without scar formation and with histologically normal connective tissue under epithelial cells to extreme forms of trismus caused by fibrosis. Many local and general factors affect oral wound healing, and an improved understanding of these factors will help to address issues that lead to poor oral wound healing

Condylar Resorption After Orthognathic Surgery

The aim was to postoperatively evaluate a conservative treatment approach to bilateral condylar resorption after orthognathic surgery. A retrospective study was carried out on 730 consecutive patients undergoing sagittal split osteotomy, 2013 to 2016. The mean follow-up period was 2.29 years. Clinical and radiographic findings of patients with postoperative bilateral condylar resorption were searched. Syndromic patients and patients with juvenile rheumatoid arthritis were excluded from this study. Of the 730 patients, 6 (0.82%) required treatments because of bilateral postoperative condylar resorption but had no surgery at the temporomandibular joint (TMJ). Five patients with TMJ symptoms because of postoperative condylar resorption were managed with conservative treatment. About 2 of the 6 patients were successfully retreated with orthognathic surgery in the upper jaw to close the open bite. The TMJ symptoms can successfully be managed with conservative therapy, whereas skeletal relapse can be retreated with orthognathic surgery in the upper jaw, depending on the amount of overjet. Patient undergoing orthognathic surgery may develop bilateral condylar resorption though the frequency is <1%, most of these patients can be managed conservatively.status: publishe

Wide Intraoral Surgical Access to the Inferior Alveolar Nerve During Cryotherapy at the Infratemporal Fossa: Technical Modification

Trigeminal neuralgia is characterized by unilateral pain in the region supplied by the sensory distribution of the fifth cranial nerve. Pharmacologic therapy is an adequate initial treatment option in 75% of patients. When the Jannetta surgical operation is not available or not indicated and when conservative treatment fails to relieve the pain or the medication has to be discontinued because of side effects, one of the remaining surgical options is cryosurgery in the peripherally distributed nerves that emanate from the trigeminal nerve. This technical note describes a perioperative method for exposing and mobilizing the inferior alveolar nerve (IAN) from its bony canal. This approach provided easy access to infratemporal fossa structures during cryotherapy. This technique represented a further development of the technique previously described by the authors. This method ensured direct visualization of the IAN and wide access to theinfratemporal fossa during IAN cryotherapy.status: publishe

The accuracy of image-guided navigation for maxillary positioning in bimaxillary surgery

The aim of our study was to evaluate the accuracy of image-guided maxillary positioning in sagittal, vertical, and mediolateral direction. Between May 2011 and July 2012, 17 patients (11 males, 6 females) underwent bimaxillary surgery with the use of intraoperative surgical navigation. During Le Fort I osteotomy, the Kolibri navigation system was used to measure movement of the maxilla at the edge of the upper central upper incisor in sagittal (buccal surface), vertical (incisor edge), and mediolateral (dental midline) direction. Six weeks after surgery, a postoperative CBCT scan was taken and registered to the preoperative cone-beam computed tomography scan to identify the actual surgical movement of the maxilla. Student 2-tailed paired t test was used to evaluate differences between the measured result from navigation system and actual surgical movement of the maxilla, which were 0.44 ± 0.35 mm (P = 0.82) in the sagittal, 0.50 ± 0.35 mm (P = 0.85) in the vertical, and 0.56 ± 0.36 mm (P = 0.81) in the mediolateral direction. Our finding demonstrates that intraoperative computer navigation is a promising tool for measuring the surgical change of the maxilla in bimaxillary surgery

Attachment rate of the inferior alveolar nerve to buccal plate during bilateral sagittal split osteotomy influences self-reported sensory impairment

This study was aimed to investigate a modified buccal osteotomy technique and whether the integrity of the lingual part of the lower border influences the attachment of the neurovascular bundle to the proximal segment of the mandible during a sagittal split osteotomy without increasing the number of bad splits. The presence of self-reported sensibility disturbance in the lower lip at the last follow-up visit was assessed. This study included 220 and 133 patients with bilateral sagittal split osteotomy undergoing the classical and the new modified buccal osteotomy techniques, respectively. In the new technique, the lower border is divided into a lingual fragment that remains incorporated in the tooth-bearing fragment and a buccal fragment that comes with the proximal fragment (buccal plate). In the classical technique, the inferior alveolar nerve was attached to the proximal segment of the mandible in more than one third of operation sites (36.36% on the right and 40.91% on the left) compared with less than one fourth of the operation sites using the new technique (9.73% on the right and 23.01% on the left). The overall figure of self-reported changed sensibility was 09.40% (12/128) in the new technique compared to 15.12% in the classical technique. We present a suitable improvement to the classical buccal osteotomy technique that allows less manipulation and injury of the inferior alveolar nerve with consequent reduction in self-reported postoperative changes in lower lip sensation