Mandibular repositioning in adult patients - an alternative to surgery?: A two-year follow-up

Abstract Background Adult patients presenting with skeletal discrepancies may refuse surgical intervention. Materials and methods Thirty-two patients who declined orthognathic correction of their maxillo-mandibular dysplasia and who were without signs of temporomandibular dysfunction (TMD) were offered mandibular repositioning as a non-invasive alternative. Simulating a skeletal correction, it was explained that the approach was based on results described in case reports. Before commencing treatment, initial records, lateral and frontal head films, study casts and photos were obtained (T0) and the mandible was repositioned to camouflage a retrognathic skeletal discrepancy or a mandibular transverse asymmetry by means of an occlusal build-up using Triad™ gel. Results Three months later (T1), 23 patients had adapted to the new occlusion reflected by an absence of functional disturbance and without fracture of the composite occlusal build-up. Mandibular position in these patients was maintained by additional orthodontic treatment and an adjustment of the occlusion to the built-up postured position (T1). The skeletal changes occurring during repositioning were assessed on sagittal and frontal head films while intra-articular changes occurring during a two-year follow-up period (T2) were evaluated on images constructed from CBCT scans. No significant change, either in the direction of relapse or in the direction of further normalisation of condylar position, were observed during the two-year observation period. Conclusion Mandibular repositioning is a non-invasive intervention that may be considered a valid alternative to surgery in selected patients. Morphological variables from the radiographs taken at T0 and the results of the initial clinical evaluation of dysfunction yielded only vague and insignificant indicators regarding the predictability of the adaptation. A CBCT scan at T0 might have contributed to the identification of the patients who would likely accept the repositioning

Bioactive nano-fibrous scaffold for vascularized craniofacial bone regeneration

There has been a growing demand for bone grafts for correction of bone defects in complicated fractures or tumors in the craniofacial region. Soft flexible membrane like material that could be inserted into defect by less invasive approaches; promote osteoconductivity and act as a barrier to soft tissue in growth while promoting bone formation is an attractive option for this region. Electrospinning has recently emerged as one of the most promising techniques for fabrication of extracellular matrix (ECM) like nano-fibrous scaffolds that can serve as a template for bone formation. To overcome the limitation of cell penetration of electrospun scaffolds and improve on its osteoconductive nature, in this study, we fabricated a novel electrospun composite scaffold of polyvinyl alcohol (PVA) - poly (ε) caprolactone (PCL) - Bioceramic (HAB), namely, PVA-PCL-HAB. The scaffold prepared by dual electrospinning of PVA and PCL with HAB overcomes reduced cell attachment associated with hydrophobic poly (ε) caprolactone (PCL) by combination with a hydrophilic polyvinyl alcohol (PVA) and the bioceramic (HAB) can contribute to enhance osteo-conductivity. We characterized the physicochemical and biocompatibility properties of the new scaffold material. Our results indicate PVA-PCL-HAB scaffolds support attachment and growth of stromal stem cells; (human bone marrow skeletal (mesenchymal) stem cells (hMSC) and dental pulp stem cells (DPSC)). In addition, the scaffold supported in vitro osteogenic differentiation and in vivo vascularized bone formation. Thus, PVA-PCL-HAB scaffold is a suitable potential material for therapeutic bone regeneration in dentistry and orthopaedics

Mise au point sur l'orthodontie de l'adulte. Quelles en sont les limites ?

Le propos du présent article est d'énumérer et d'expliquer les facteurs responsables de la limitation du potentiel biomécanique des patients adultes, et de faire le point en les illustrant, sur les traitements orthodontiques de cas limites. Quelques sujets controversés comme le redressement et l'ingression sont abordés. Le besoin de nouveaux concepts de traitement est souligné

Indications d’ancrage squelettique en orthodontie

L’ancrage squelettique a été présenté comme une solution de choix aux problèmes de l’orthodontiste en cas de manque de coopération du patient pour éviter les effets indésirables sur les unités d’ancrage, ou, tout simplement dans les cas où le nombre de dents ne permet pas de constituer un ancrage suffisant. L’ancrage squelettique se présente sous des formes très différentes : on trouve des suspensions chirurgicales insérées dans un trou qui traverse la crête infra-zygomatique, des mini-plaques, des vis d’ostéosynthèse, et des implants ostéointégrés ou non. Cet article présente le mini-implant Aarhus® et ses indications. Les réactions tissulaires à la mise en charge, étudiées expérimentalement sur des singes, nous montrent qu’une mise en charge immédiate est recommandée. Un plan de traitement méticuleux, comprenant une étude des vecteurs de force nécessaires doit être élaboré avant la mise en place des implants. L’ancrage squelettique possède ses propres indications, exposées ici. Il n’est pas destiné à remplacer les formes traditionnelles d’ancrage. Les problèmes liés à la conception de la vis, son implantation, sa mise en charge et sa dépose sont également développés dans cet article

Entretien avec Birte Melsen

Dr Birte Melsen est née à Aabenraa, au Danemark, le 9 Juin 1939. Elle fait ses études dentaires au Royal Dental College à Aarhus, Danemark (1964). Elle est professeur et chef du Département d’Orthodontie à l’Université dentaire, à Aarhus, depuis 1975 et traite exclusivement des adultes en pratique privée à Lübeck, en Allemagne (temps partiel depuis 1986). Birte Melsen est l’auteur de plus de 350 articles et publications, dans des domaines aussi variés que la croissance et le développement cranio-facial (recherches sur cadavres humains), la biologie osseuse et les réactions tissulaires, la distraction osseuse, les implants dentaires, les traitements adultes, les asymétries, la stabilité à long terme, sans oublier les mini-vis orthodontiques d’ancrage temporaire, les attaches auto-ligaturantes et l’imagerie

Kieferorthopädie bei Parodontitispatienten : Worauf sollte man Acht geben? [Orthodontic Therapy in Periodontitis Patients: What Should be Taken Care of?]

Objective To provide an overview on "orthodontic therapy in periodontitis patients" by addressing the following three questions: (1) At which time point can orthodontic treatment start in periodontitis patients? (2) What should be considered during orthodontic treatment? (3) Can teeth with a reduced periodontium be maintained after orthodontic treatment? Results In general, the scientific evidence on this topic is mainly based on preclinical, retrospective studies, and case series; controlled clinical trials are scarce. Nevertheless, it is clear, that orthodontic tooth movement should be performed only in periodontally healthy (i.e., non-inflamed) tissues, otherwise further attachment loss might occur. Therefore, cause-related periodontal therapy should always precede orthodontic treatment and supportive periodontal treatment should be continuously provided during orthodontic therapy. Yet, up-to-now, there is no clear treatment recommendation regarding the time-point and type of any surgical intervention before orthodontic treatment. In relation to treatment of patients with vertical defects it is, however, not clear whether an open flap debridement is sufficient or application of any additional regenerative material will improve the prognosis. The results of orthodontic treatment can be successfully preserved on the long-term – also on a reduced periodontium – if sufficient stabilization and periodontal maintenance is provided. Conclusion Orthodontic therapy has no negative influence on teeth with a reduced but healthy periodontium and the results can be maintained for a large period of time. Hence, cause-related periodontal therapy should always precede orthodontic treatment to establish inflammation-free conditions, but up-to-now there is no clear recommendation regarding the time-point and type of periodontal surgical interventions.