Is There a Correlation Between Airway Volume and Maximum Constriction Area Location in Different Dentofacial Deformities?

Purpose The purpose of the present study was to correlate the airway volume and maximum constriction area (MCA) with the type of dentofacial deformity in patients who required orthognathic surgery. Materials and Methods The present retrospective cohort study included orthognathic surgery patients selected from the private practice of one of us. The selected cases were stratified into 5 different groups according to the clinical and cephalometric diagnosis of their dentofacial deformity. The preoperative airway volume and anatomic location of the MCA were calculated using the airway tool of the Dolphin Imaging software module (Dolphin Imaging and Management Solutions, Chatsworth, CA) and correlated with the diagnosed dentofacial deformity. Differences in the pretreatment airway volumes and MCA location were compared among the deformities. Results The MCA location was more often the nasopharynx for maxillary deficiency and the oropharynx for mandibular deficiency deformities. The nasopharynx volume was significantly smaller statistically ( P .005). Conclusions The location of the airway MCA seems to have a strong correlation with the horizontal position of the maxilla and mandible. The MCA in maxillary deficiencies (isolated or combined) was in the nasopharynx, and the MCA in mandibular deficiencies (isolated or combined) was in the oropharynx. Clinicians should consider these anatomic findings when planning the location and magnitude of orthognathic surgery movements to optimize the outcomes

Group 5 ITI Consensus Report: Implant placement and loading protocols

ObjectivesWorking Group 5 was convened to discuss and find consensus on the topics of implant placement and loading protocols associated with single missing teeth in the anterior maxilla (aesthetic zone). Consensus statements, clinical recommendations, patient perspectives and future research suggestions were developed and presented to the plenary for discussion and approval.Materials and MethodsTwo systematic reviews were developed and submitted prior to the conference. The group considered in detail the systematic reviews and developed statements, clinical recommendations, patient perspectives and future research suggestions based on the findings of the reviews and experience of group members. Definitive versions were developed after presentation to and discussion by the plenary.ResultsFive consensus statements were developed and approved from each systematic review. Twelve clinical recommendations were developed by the group based on both reviews and experience. Three patient perspectives were developed, and five suggestions made for future research.ConclusionsBased on the findings of the systematic reviews and experience of group members, the Type 1A protocol (immediate placement and immediate loading), when utilized in the anterior maxilla under favorable conditions, is considered predictable and is associated with high survival rates. The procedure is considered clinically viable and is associated with aesthetic outcomes, although surgical, technical, and biological complications can occur

Treatment of Mandibular Non-union Using Patient Specific Crib Cage Plates and Cellular Bone Allograft: A Case Report

A gunshot wound to the mandible frequently creates a comminuted fracture that can be debilitating for the patient and challenging for the surgeon. In some instances, immediate open reduction and rigid fixation is not possible, and closed reduction with intermaxillary fixation is employed. This may lead to non-union or mal-union of the segments. This case report describes the management of mal-union of bilateral comminuted mandibular angle fractures secondary to a gunshot wound injury. The mandibular fractures were repaired using virtually planned patient specific reconstruction plates that included a specially designed crib cage to contain a bone graft. A cellular bone allograft—Vivigen (DePuy Synthes, Warsaw, IN)—was chosen as the bone grafting material. The patient was followed up for 7 months with normal functional status and mouth opening and without pain or signs of infection. This report demonstrates that using a virtually planned crib cage plate with cellular bone allograft can optimize surgical repair and bony healing of comminuted mandible fractures

Round and flat zygomatic implants: effectiveness after a 1-year follow-up non-interventional study

Introduction: There are few zygomatic implants (ZI) designs available. The objective of this non-interventional study was to report the effectiveness of two new site-specific ZI, selected and placed following the zygoma anatomy-guided approach (ZAGA). Materials and methods: Consecutive patients presenting indications for rehabilitation using ZI were treated according to ZAGA Concept recommendations. Implants were immediately loaded following the manufacturer's instructions. Success criteria regarding prosthetic offset, rhino-sinus status, soft tissue condition, and implant stability were additionally used as outcome parameters. Results: Twenty patients were followed for a period of 12 to 28 months (average 18.8 months). Ten received 2 ZI plus regular anterior implants; One received 3 ZI plus regular implants and nine received 4 ZI. In total, 59 ZI were placed, 34 (58%) Straumann ZAGA-Flat design, and 25 (42%) ZAGA-Round. Forty-nine percent of the sites were classified as ZAGA-4 type and 27% as ZAGA-2. Four patients (20%) presented discontinuities of the sinus-nose floor before surgery and 15 patients (75%) presented previous sinus opacities. All implants bar one reached more than 45 N.cm of insertion torque. No surgical complications were observed. After 1 year, the modified Lund-Mackay score was negative in 17 patients. Seventeen sites in 11 patients exhibited decreased opacity when pre-surgical imaging was compared to 1-year post-surgical CBCT. All implants and prostheses remained stable and in function. Conclusions: The study concluded 100% implant/prosthesis survival rates and low complication levels. Within the limitations of the sample and observation period, results suggest that even in cases of extremely resorbed maxillae (as per cases in this study), ZAGA-Flat and ZAGA-Round ZI are viable treatment options when restoring atrophic maxillae following the ZAGA protocol

Comparação entre duas técnicas de fixação rígida por meio de ensaio mecânico de compressão

The present study tries to evaluate in vitro, the resistence of rigid fixation with self-tapped bicortical screws, and the displacement of the bone fragments through a compressive mechanical testing, applyng an artificial compressive load to the segments of two groups of sagittal split osteotomies perfomed in fresch sheep mandibles. Osteotomies fixed with therr screws, at a 90 degrees angle to the lateral cortices, in a linear array were significantly more rigid than those fixed with two screws, at 60 degrees angle to the lateral cortices, in a linear array.O presente trabalho visa avaliar in vitro, por meio de um ensaio mecânico de compressão, a resisténcia da fixação rígida através do uso de parafusos bicorticais auto-rosqueáveis, e o deslocamento dos fragmentos ósseos submetidos á aplicação de uma carga artificial, em dois grupos de osteotomias Sagitais do Ramo realizadas em mandíbulas de carneiro frescas. As osteotomias fixadas por trés parafusos no padrão de posicionamento horizontal, com angulação de 90° com a cortical vestibular foram estatisticamente mais resistentes do que as fixadas por dois parafusos no padrão de posicionamento horizontal, com angulação de 60° com a cortical vestibular

Comparação entre duas técnicas de fixação rígida por meio de ensaio mecânico de compressão

The present study tries to evaluate in vitro, the resistence of rigid fixation with self-tapped bicortical screws, and the displacement of the bone fragments through a compressive mechanical testing, applyng an artificial compressive load to the segments of two groups of sagittal split osteotomies perfomed in fresch sheep mandibles. Osteotomies fixed with therr screws, at a 90 degrees angle to the lateral cortices, in a linear array were significantly more rigid than those fixed with two screws, at 60 degrees angle to the lateral cortices, in a linear array.O presente trabalho visa avaliar in vitro, por meio de um ensaio mecânico de compressão, a resisténcia da fixação rígida através do uso de parafusos bicorticais auto-rosqueáveis, e o deslocamento dos fragmentos ósseos submetidos á aplicação de uma carga artificial, em dois grupos de osteotomias Sagitais do Ramo realizadas em mandíbulas de carneiro frescas. As osteotomias fixadas por trés parafusos no padrão de posicionamento horizontal, com angulação de 90° com a cortical vestibular foram estatisticamente mais resistentes do que as fixadas por dois parafusos no padrão de posicionamento horizontal, com angulação de 60° com a cortical vestibular