Journal of Oral and Maxillofacial Surgery

Tooth Decay

Leon A. Assael — 2010-02-01

An ER physician 110 miles away, calling the OMS on call on the STAT transfer line: “This young boy came to the ER two days ago with a toothache and minimal swelling. He was placed on Clindamycin and his parents were instructed to take him to see a dentist. His parents did not have the money for that visit so it did not happen. He now returns with trismus, difficulty swallowing, change in voice, inability to handle secretions, white count of 25 K, and temp of 39º C. CT scan shows an impending Ludwig's angina. Oh, and we do not have an oral and maxillofacial surgeon here on call and our surgeon says it is out of his area of expertise.”“It sounds like he is too sick to transport by ground. We'll call for helicopter transport. Forward the CT electronically into PACS,” came the reply.

20-Year Follow-Up Study of Disc Repositioning Surgery for Temporomandibular Joint Internal Derangement

Shelly Abramowicz, M. Franklin Dolwick — 2010-02-01

Purpose: The purpose of this study was to assess the outcomes of temporomandibular joint (TMJ) disc repositioning as a surgical treatment for TMJ internal derangement (ID).Materials and Methods: By retrospective chart review, all patients who had TMJ disc repositioning for treatment of TMJ ID from 1984 to 1990 were identified. Attempts were made to locate these patients, and they were sent a TMJ questionnaire. The questionnaire provided subjective (pain and diet consistency) and objective (mandibular function) data.Results: The chart review yielded 153 patients. Complete TMJ questionnaires were obtained from 18 patients (36 joints). Analysis of data showed a reduction in pain scores, an improvement in diet consistency, and an increase in mandibular range of motion. The majority (94%) reported an improvement in quality of life.Conclusions: Outcome data presented show that TMJ disc repositioning is an effective and successful surgical treatment for TMJ ID. This success has been maintained for 20 years in this specific patient population.

Prevalence of Osteonecrosis of the Jaw in Patients With Oral Bisphosphonate Exposure

2009-07-03

Purpose: Osteonecrosis of the jaw (ONJ) is a serious complication associated with bisphosphonate therapy, but its epidemiology in the setting of oral bisphosphonate therapy is poorly understood. The present study examined the prevalence of ONJ in patients receiving chronic oral bisphosphonate therapy.Materials and Methods: We mailed a survey to 13,946 members who had received chronic oral bisphosphonate therapy as of 2006 within a large integrated health care delivery system in Northern California. Respondents who reported ONJ, exposed bone or gingival sores, moderate periodontal disease, persistent symptoms, or complications after dental procedures were invited for examination or to have their dental records reviewed. ONJ was defined as exposed bone (of >8 weeks' duration) in the maxillofacial region in the absence of previous radiotherapy.Results: Of the 8,572 survey respondents (71 ± 9 years, 93% women), 2,159 (25%) reported pertinent dental symptoms. Of these 2,159 patients, 1,005 were examined and an additional 536 provided dental records. Nine ONJ cases were identified, representing a prevalence of 0.10% (95% confidence interval 0.05% to 0.20%) among the survey respondents. Of the 9 cases, 5 had occurred spontaneously (3 in palatal tori) and 4 occurred in previous extraction sites. An additional 3 patients had mandibular osteomyelitis (2 after extraction and 1 with implant failure) but without exposed bone. Finally, 7 other patients had bone exposure that did not fulfill the criteria for ONJ.Conclusions: ONJ occurred in 1 of 952 survey respondents with oral bisphosphonate exposure (minimum prevalence of 1 in 1,537 of the entire mailed cohort). A similar number had select features concerning for ONJ that did not meet the criteria. The results of the present study provide important data on the spectrum of jaw complications among patients with oral bisphosphonate exposure.

Skeletal and Dental Stability After Maxillary Distraction With a Rigid External Device in Adult Cleft Lip and Palate Patients

2010-02-01

Purpose: To evaluate skeletal and dental stability in adult cleft lip and palate patients treated with a rigid external distraction system at the end of distraction and during the postdistraction period.Patients and Methods: Lateral cephalograms of 7 patients were obtained before distraction, at the end of distraction, and during the postdistraction period. The mean age before distraction was 21.56 ± 4.73 years. The mean follow-up was 37.3 ± 12.4 months.Results: The assessment of findings showed that skeletal maxillary sagittal movement was achieved in a superoanterior direction. The maxillary depth angle and effective maxillary length increased significantly (2° and 9 mm, respectively) after distraction, whereas the palatal plane angle increased by 8°, resulting in an anterior movement of the maxilla with a counterclockwise rotation. The lower facial height showed no significant changes after distraction. The sagittal movement of the upper incisors and the angulation of the upper first molars increased significantly (4.5 mm and 5.5°, respectively). During the postdistraction period, the maxilla showed a slight relapse (22%). The effective maxillary length decreased by 2 mm. The palatal plane angle almost returned to its original position, showing 7° of clockwise rotation. The lower facial height remained stable. The upper incisors moved anteriorly and the upper first molars showed a significant mesioangular change during follow-up.Conclusions: After distraction, significant maxillary advancement was achieved with a counterclockwise rotation. The upper incisors moved labially, and the upper first molars angulated mesially. After 3 years, a 22% relapse rate was seen in the maxilla. The counterclockwise rotation of the maxilla was returned to its original position. The upper incisors moved more anteriorly.

Effect of Intermittent Systemic Administration of Recombinant Parathyroid Hormone (1-34) on Mandibular Fracture Healing in Rats

2010-02-01

Purpose: To establish a rat mandibular fracture model and investigate the short- and long-term effects of recombinant parathyroid hormone (PTH 1-34) on mandibular fracture healing in rats.Materials and Methods: A controlled unilateral mandibular fracture was created surgically in 29 male Sprague-Dawley rats and then stabilized using an external fixation device. The rats were divided into 2 groups: 1 group received daily subcutaneous injections of 10 μg/kg of PTH(1-34) and 1 group served as the vehicle control. The rats were killed on postoperative days 7 and 21, and radiographic densitometry and histologic evaluation of new bone formation were performed.Results: A novel unilateral mandibular fracture model was established that has significant differences from previously published models, both in the location of the osteotomy site and in the rigid external stabilization device. The PTH(1-34) treated rats showed a statistically significant difference (P < .05) in callous formation compared with the control animals. Radiographic densitometry evaluation of the injury site revealed an increase in bone density, apparent at day 7 in the experimental group. Visual inspection of the histologic sections stained with Masson's trichrome blue showed an apparent increase in new bone formation at 21 days in the PTH-treated group compared with the control group.Conclusions: Intermittent systemic administration of PTH(1-34) might enhance the healing of mandibular fractures in the early phase (7-day period). Long-term administration (21-day period) showed no statistically significant differences between the control and experimental group by radiographic densitometry.

Prognostic Factors Influencing Contralateral Neck Lymph Node Metastases in Oral and Oropharyngeal Carcinoma

2010-02-01

Purpose: The prognostic influence of different clinicopathologic factors in contralateral lymph node metastases of oral and oropharyngeal squamous cell carcinoma (SCC) has been rarely described in the literature. Prediction of these contralateral metastases may be of relevance because this factor is strongly associated with poor prognosis. This study analyzed the relationship between predictor factors and the development of contralateral metastases in oral and oropharyngeal SCC.Materials and Methods: A series of 402 cases of oral and oropharyngeal SCC were analyzed retrospectively. Unilateral neck dissection was carried out in 190 patients, bilateral neck dissection in 101, and tumor resection without neck dissection in 111. The log-rank test was used for survival analysis of contralateral metastases. Correlation between different clinicopathologic factors and the presence of contralateral metastases was studied with the χ2 test for univariate analysis and logistic regression for association of these factors and contralateral metastases in the multivariate analysis (P < .05).Results: Of the patients, 20 (5.1%) had primary positive contralateral metastases in neck dissection specimens and 19 (4.8%) had contralateral recurrences at follow-up. When the 2 groups were taken into consideration, the rate of contralateral metastases of the series was 9%. Gender, tumor location, homolateral positive nodes, tumor extension across the midline, histologic grade, margin status, pattern of growth, and perineural spread were correlated with contralateral metastases in the univariate analysis (P < .05). However, homolateral lymph node metastases and extension across the midline were the most important predictors of contralateral metastases (P < .01) on multivariate logistic regression analysis. Positive contralateral metastases showed a strong correlation with a poor prognosis for survival in this study (P < .05).Conclusion: Oral and oropharyngeal carcinomas with homolateral positive lymph nodes and tumor extension across the midline are at higher risk of contralateral lymph node involvement. Prediction of contralateral metastases may be useful in planning more aggressive therapies in patients with head and neck SCC with poor prognostic criteria.

Modern Sialography for Screening of Salivary Gland Obstruction

Oscar Hasson — 2010-02-01

Purpose: To revisit and reintroduce sialography as an important tool for the assessment and diagnosis of salivary gland obstruction.Patients and Methods: A sample of 30 consecutive patients undergoing sialography was selected. Parotid sialography was performed in 22 patients (12 females and 10 males). The patients undergoing parotid sialography presented with bilateral or unilateral enlargement or swelling. Submandibular sialography was performed in 8 patients (all males) who had presented with swelling and pain in the affected gland.Results: Parotid sialography revealed 6 cases of sialolithiasis without significant duct narrowing, 3 of narrowing and strictures of Stensen's duct without a sialolith, 3 glands with gland sialectasis, 1 parotid gland with intraglandular cyst-like duct degeneration, 1 of a parotid mass displacing Stensen's duct, and 1 gross dilation of duct. The findings of 7 parotid gland sialograms were normal. Submandibular gland sialography revealed the presence of sialolithiasis (single and multiple) in 4 patients, narrowing of the duct in 2, and normal findings in 2.Conclusions: Sialography is a simple technique and an important tool for the assessment of salivary gland obstruction in patients presenting with sialadenitis.

Closure of Oroantral Communications Using Biodegradable Polyurethane Foam: A Feasibility Study

Susan H. Visscher, Baucke van Minnen, Rudolf R.M. Bos — 2010-02-01

Purpose: The aim of this study was to assess the feasibility of biodegradable polyurethane (PU) foam for closure of oroantral communications (OACs).Patients and Methods: Ten consecutive patients with OACs (existing <24 hours) were treated with PU foam. Standardized evaluations were performed at 2 weeks and 8 weeks after closure of the OAC.Results: In 5 patients, the OACs were closed successfully without complications. Three patients developed sinusitis, which was conservatively managed with antibiotics in 2 cases. In 1 case the sinus was reopened for irrigation, after which a buccal flap procedure was performed. In 2 patients the OAC recurred and was surgically closed with a buccal flap after thorough irrigation.Conclusion: In this feasibility study, closure was achieved in 7 of the 10 patients without further surgical intervention. Complications of the procedure using PU foam may be related to the fit of the foam in the socket and the size of the perforation. In general, closure of OACs with biodegradable polyurethane foam is feasible and has the potential to spare a large number of patients with OACs a surgical procedure. Furthermore, in case the treatment with PU foam fails to close the OAC, the attending physician can always fall back on the standard surgical procedure.

Comparative Study Between Resorbable and Nonresorbable Plates in Orthognathic Surgery

2010-02-01

Purpose: The purpose of the present study was to evaluate the clinical application of resorbable and nonresorbable plates for correction of facial asymmetry.Patients and Methods: A total of 272 patients who had undergone orthognathic surgery were enrolled. The site of osteotomy was fixed using a nonresorbable plate in group I (n = 152) and using a resorbable plate in group II (n = 120). The postoperative complications included postoperative anterior open bite, infection, temporomandibular joint dysfunction, and postoperative relapse. The incidence of all complications was examined.Results: The surgical outcome was successful in 269 patients (98.89%). Of the 152 patients with a titanium plate, 13 (8.6%) developed complications. Of the 120 patients with a resorbable plate, 22 (18.3%) developed complications. A greater degree of postoperative open bite and a trend toward relapse were observed in patients' cases in which an absorbable fixation plate was used. Postoperative infection occurred in patients with an absorbable fixation plate.Conclusion: On the basis of these data, we have concluded that an absorbable fixation plate should be used instead of a titanium fixation plate in indicated patients.

Facial Trauma: How Dangerous Are Skiing and Snowboarding?

2010-02-01

Purpose: The aim of this study was to investigate maxillofacial injuries sustained in both skiing and snowboarding accidents and correlate injury mechanisms and patterns evaluating a large population.Materials and Methods: Between 1991 and 2003, all patients with maxillofacial injuries due to skiing and snowboarding accidents (1,393 cases) were reviewed and statistically analyzed according to age, gender, type of injury, cause of accident, location of trauma, and associated injuries.Results: Skiing accidents resulted in a total of 1,250 injuries, and snowboarding resulted in 143. In this study 686 skiers presented with 1,452 facial bone fractures and 80 snowboarders sustained 160 fractures of the face. Skiers had dentoalveolar trauma in 810 cases and 1,295 soft tissue injuries, whereas snowboarders had 88 dental injuries and 187 soft tissue lesions. Mechanisms of injury included 542 cases due to skiing and 85 falls due to snowboarding (a 1.79-fold higher risk for snowboarders). The gender distribution showed a male-female ratio of 3:1 in skiers and 5.5:1 in snowboarders. In both groups male patients were more prone to have a facial bone fracture than female patients. Snowboarders aged between 10 and 29 years had a 2.14-fold higher risk of sustaining a maxillofacial injury than skiers.Conclusions: In both groups facial bone fractures occurred more often in male patients, and they were more likely to result from falls and collisions with other persons. Young snowboarders had a higher risk of maxillofacial injuries (especially soft tissue lesions) than skiers, whereas for children and old persons, skiing posed a much higher risk. Wearing a helmet while skiing and snowboarding should be mandatory to prevent serious trauma to the head.

The Effect of NELL1 and Bone Morphogenetic Protein-2 on Calvarial Bone Regeneration

2010-02-01

Purpose: Most craniofacial birth defects contain skeletal components that require bone grafting. Although many growth factors have shown potential for use in bone regeneration, bone morphogenetic proteins (BMPs) are the most osteoinductive. However, supraphysiologic doses, high cost, and potential adverse effects stimulate clinicians and researchers to identify complementary molecules that allow a reduction in dose of BMP-2. Because NELL1 plays a key role as a regulator of craniofacial skeletal morphogenesis, especially in committed chondrogenic and osteogenic differentiation, and a previous synergistic mechanism has been identified, NELL1 is an ideal molecule for combination with BMP-2 in calvarial defect regeneration. We investigated the effect of NELL1 and BMP-2 on bone regeneration in vivo.Materials and Methods: BMP-2 doses of 589 and 1,178 ng were grafted into 5-mm critical-sized rat calvarial defects, as compared with 589 ng of NELL1 plus 589 ng of BMP-2 and 1,178 ng of NELL1 plus 1,178 ng of BMP-2, and bone regeneration was analyzed.Results: Live micro–computed tomography data showed increased bone formation throughout 4 to 8 weeks in all groups but a significant improvement when the lower doses of each molecule were combined. High-resolution micro–computed tomography and histology showed more mature and complete defect healing when the combination of NELL1 plus BMP-2 was compared with BMP-2 alone at lower doses.Conclusion: The observed potential synergy has significant value in the future treatment of patients with craniofacial defects requiring extensive bone grafting that would normally entail extraoral autogenous bone grafts or doses of BMP-2 in milligrams.

Influence of Primary and Secondary Closure of Surgical Wound After Impacted Mandibular Third Molar Removal on Postoperative Pain and Swelling—A Comparative and Split Mouth Study

Anil Kumar Danda, Murali Krishna Tatiparthi, Vinod Narayanan, Avinash Siddareddi — 2010-02-01

Purpose: The purpose of the present study was to compare the influence of primary and secondary closure of the surgical wound on postoperative pain and swelling after removal of impacted mandibular third molars.Materials and Methods: A total of 93 patients with bilaterally impacted mandibular third molars were included in the present study. All the patients underwent surgical removal of the bilaterally impacted teeth at the same appointment. Primary closure (group I) was performed on 1 side and secondary closure (group II) was performed on the other side. All the patients were assessed for pain and swelling using the visual analog scale, and the data were collected and analyzed with the paired t test after 7 days.Results: The swelling in group I was greater than that in group II, with a statistically significant difference (P < .001). The pain was worse in group I than in group II; a difference that also was statistically significant (P < .05). Alveolar osteitis occurred in 4 patients (4.3%) in group I and 3 patients (3.2%) in group II.Conclusion: Our results have shown that the patients in the secondary closure group had a significantly lesser amount of pain and swelling postoperatively than the primary closure group.

Sialoendoscopic Secondary Intervention After Failure of Open Sialolithectomy

2010-02-01

Purpose: Traditionally, sialoadenectomy was always indicated when open sialolithectomy failed. The aim of the present study was to investigate the role of sialoendoscopy as the secondary intervention after failure of open sialolithectomy.Patients and Methods: A consecutive series of 15 patients with obstructive salivary gland disease with failure of open sialolithectomy were prospectively recruited for our study. All these patients underwent sialoendoscopy under local anesthesia. The reasons for the failure of open sialolithectomy were analyzed, and secondary interventions were performed using sialoendoscopy.Results: Failure of open sialolithectomy resulted from 4 main causes. Small stones could not be found after the duct was incised (n = 3); the stones were pushed posteriorly during open surgery (n = 4); the stones located in the anterior part of the duct were removed, but the hilar stones were left untouched (n = 5); and radiolucent stones were missed (n = 3). All the patients were treated successfully by sialoendoscopy. No symptoms or signs of recurrence developed during a median follow-up period of 16 months.Conclusions: Sialoendoscopy can be recommended as an effective secondary intervention after failure of open sialolithectomy.

Use of Therapeutic Laser After Surgical Removal of Impacted Lower Third Molars

2010-02-01

Purpose: To evaluate the effectiveness of a therapeutic laser in the control of postoperative pain, swelling, and trismus associated with the surgical removal of impacted third molars.Patients and Methods: A double-blind, randomized, controlled clinical trial was conducted in 2 groups of 15 patients each undergoing surgical removal of impacted lower third molars under local anesthesia. The experimental group received 4 J/cm2 of energy density intraorally and extraorally, with a laser with a diode wavelength of 810 nm and output power of 100 mW in a continuous wave. The control group received only standard management. The degree of postoperative pain, swelling, and trismus was registered for both groups.Results: The experimental group exhibited a lower intensity of postoperative pain, swelling, and trismus than the control group, without significant statistical differences. Patients of both groups required rescue medication; however, the time lapse between the end of the surgery and the administration of the medication was shorter for the control group.Conclusion: The use of therapeutic laser in the postoperative management of patients having surgical removal of impacted third molars, using the protocol of this study, decreases postoperative pain, swelling, and trismus, without statistically significant differences.

Third Molars and Periodontal Pathology in American Adolescents and Young Adults: A Prevalence Study

2010-02-01

Purpose: To assess the association between visible third molars and the prevalence of periodontal inflammatory disease of non–third molars.Patients and Methods: Subjects aged 14 to 45 years with 4 asymptomatic third molars were enrolled in an institutional review board–approved study. Subjects were classified based on whether at least 1 third molar was visible or all third molars were not visible. Full-mouth periodontal probing depth (PD) data, with 6 sites per tooth, were obtained as a measure of a subject's periodontal status. At least 1 non–third molar PD of 4 mm or greater was indicative of periodontal inflammatory disease. Outcomes for the respective groups were compared by use of Cochran-Mantel-Haenszel row mean score statistics. The level of significance for differences was set at .05.Results: The 342 subjects in the visible group were significantly older, with a median age of 26 years (interquartile range, 22.4-32.2 years), as compared with the 69 subjects in the not visible group, with a median age of 21 years (interquartile range, 18.8-24.9 years) (P < .01). The proportion of males and females was not statistically different between groups (P > .05). Most subjects were white. Significantly more subjects with at least a college education were in the visible group than in the not visible group (P < .01). The rate of tobacco use was low and did not differ between groups. Subjects in the visible group were significantly more likely to have at least 1 PD of 4 mm or greater on non–third molars than those in the not visible group: 59% versus 35%. In both groups, first/second molars were more affected than nonmolars when we controlled for differences in age between groups.Conclusions: The visible presence of third molars in adolescents and young adults was significantly associated with periodontal inflammatory disease of non–third molars.

A Randomized Clinical Evaluation of Ultrasound Bone Surgery Versus Traditional Rotary Instruments in Lower Third Molar Extraction

2010-02-01

Purpose: The purpose of this study was to investigate and compare, in a randomized and controlled clinical trial, the use of ultrasound bone surgery devices and the use of rotary instruments in lower third molar extractions.Materials and Methods: We selected 26 patients (12 women and 14 men) for this study; the mean age was 31.2 years (range, 24-45 years). A randomized clinical trial was planned. Patients in the control group received treatment with the conventional rotary instruments; patients in the test group received treatment with the ultrasound bone surgery tools. Twenty-six third molars were allocated to the test and control groups according to a computer-generated randomization list. All the surgical procedures were performed by the same surgeon. Pain, trismus, cheek swelling, and number of analgesics taken were evaluated at baseline (before surgery) and at the first-, third-, fifth-, and seventh-day visits.Results: Pain levels (evaluated on a visual analog scale) were higher in the control group when compared with the ultrasonic group; however, no statistically significant differences were found. On the contrary, the number of analgesics taken in the test group was significantly lower when compared with the control group. The occurrence of trismus was significantly higher in the control group when compared with the test group. The clinical values of cheek swelling were higher in the rotary group when compared with the ultrasound group at the fifth-day visit.Conclusion: This study showed that the use of ultrasound bone surgery for third molar extraction significantly reduced the occurrence of postsurgical trismus, the occurrence of swelling, and the number of analgesics taken after surgery.

The Nature and Frequency of Bisphosphonate-Associated Osteonecrosis of the Jaws in Dental Implant Patients: A South Australian Case Series

Alastair Goss, Mark Bartold, Paul Sambrook, Peter Hawker — 2010-02-01

Purpose: To determine the number of bisphosphonate-associated cases of dental implant failure in South Australia.Materials and Methods: All general and specialist dentists who place dental implants in South Australia were contacted and asked to provide information on the total number of implants placed over the decade to December 2007. Cases of bisphosphonate-associated implant failure were identified.Results: All 46 practitioners involved in implant placement and the management of bisphosphonate-associated osteonecrosis of the jaws in South Australia were identified. Approximately 28,000 implants had been placed in 16,000 patients. We identified 7 cases of oral bisphosphonate–associated implant failure, with 3 cases of failure of osseointegration and 4 cases of successful implants losing integration after being placed on oral bisphosphonates. There were 5 women and 2 men, and the mean age was 65.7 years (range, 49-75 years). Only 1 was medically compromised, with steroids and diabetes. No cases of implant failure in intravenous bisphosphonate cases were identified. On the basis of the assumption that 5% of the patients were taking an oral bisphosphonate, 1 in 114 (0.89%) had implant failure.Conclusion: In patients taking oral bisphosphonates, a failure to integrate or subsequent loss of integration may occur when oral bisphosphonates are started after successful implant placement. The rate of failure is low, at less than 1%.

Single-Dose Versus Single-Day Antibiotic Prophylaxis for Orthognathic Surgery: A Prospective, Randomized, Double-Blind Clinical Study

Anil Kumar Danda, Abdul Wahab, Vinod Narayanan, Avinash Siddareddi — 2010-02-01

Purpose: The purpose of this study was to evaluate the prophylactic value of single-dose antibiotic prophylaxis on postoperative infection in patients undergoing orthognathic surgery, compared to single-day antibiotics.Materials and Methods: One hundred fifty patients were included in the study; 57 males and 93 females were divided into 2 groups with 75 in each group. Group 1 received a single dose of antibiotic prophylaxis and group 2 received a single day of antibiotic prophylaxis. These patients were assessed for rates of infection postoperatively after orthognathic surgery.Results: Seven patients (9.3%) in group 1 developed infection, whereas 2 patients (2.6%) in group 2 developed infection. The difference in rates of infection in both groups was of interest but not statistically significant (P > .05).Conclusion: The results from the present study show that there is a clinically significant difference, but no statistically significant difference, between single-dose antibiotic prophylaxis and single-day antibiotic prophylaxis in reducing the rates of infection in orthognathic procedures. We recommend further studies with a larger sample size to determine whether there truly is no statistical difference between both groups.

Combined External Lithotripsy and Endoscopic Techniques for Advanced Sialolithiasis Cases

Oded Nahlieli, Rachel Shacham, Ami Zaguri — 2010-02-01

Purpose: To assess a combined external lithotripsy-sialoendoscopy method developed for advanced salivary gland sialolithiasis.Materials and Methods: A total of 94 patients (43 males and 51 females) underwent these treatment methods. Of these 94 patients, 60 had pathologic features in the submandibular gland and 34 in the parotid gland. A miniature external lithotripter was used, combined with multifunctional sialoendoscopes and endoscopic-assisted techniques, to achieve effective removal/elimination of the stones in these difficult cases.Results: Total elimination of the stone using lithotripsy alone was achieved in 32% of the cases; in 29%, intraductal endoscopic assistance was needed. In the remaining 39%, the removal of a stone was achieved with the help of an endoscopy-assisted extraductal approach (37 cases). At 6 months of follow-up, all patients who had undergone lithotripsy or lithotripsy plus intraductal endoscopy had an absence of symptoms. Of the 37 patients who had undergone an endoscopy-assisted extraductal approach, 35 (95%) remained asymptomatic.Conclusions: Lithotripsy plus intraductal or extraductal endoscopic treatment of sialolithiasis is a highly effective surgical method of eliminating/removing salivary stones, especially those attached to the surrounding tissue and in the secondary ducts. This method helps to avoid resection of the salivary glands and represents an additional development of minimal invasive surgical techniques.

Three-Dimensional Computed Tomographic Analysis of Airway Anatomy in Patients With Obstructive Sleep Apnea

2010-02-01

Purpose: To identify abnormalities in airway size and shape that correlate with the presence and severity of obstructive sleep apnea (OSA).Materials and Methods: This was a retrospective case series of patients undergoing treatment of OSA who had preoperative computed tomographic (CT) scans of the upper airway available. Patients who had undergone CT scanning for nonairway pathologic features during the same period served as the controls. Digital 3D-CT reconstructions were made and 12 parameters of airway size and 4 of shape were analyzed. The posterior airway space, middle airway space, and hyoid to mandibular plane distance were measured on the lateral cephalograms of the patients with OSA. Bivariate analysis was used to identify the factors associated with the presence and severity of OSA as measured by the respiratory disturbance index (RDI). Multiple regression analysis identified the factors that correlated with the RDI.Results: Of the 44 patients with OSA, 15 (10 men and 5 women) had pre- and postoperative CT scans available. In addition, 17 patients (11 men and 6 women) were used as controls. The airway length was significantly increased in the patients with OSA (P < .01). On bivariate analysis, the length, lateral/retroglossal anteroposterior dimension ratio and genial tubercle to hyoid bone distance were associated with the RDI (P < .03). On multiple regression analysis, length (P < .01) had a positive correlation and the lateral/retroglossal anteroposterior dimension ratio (P = .04) an inverse correlation with the RDI.Conclusions: The results of this study indicate that the presence of OSA is associated with an increase in airway length. Airways that were more elliptical in shape and mediolaterally oriented (greater lateral/retroglossal anteroposterior dimension ratio) had a decreased tendency toward obstruction.

Three-Dimensional Computed Tomographic Analysis of Airway Anatomy

Zachary R. Abramson, Srinivas Susarla, James R. Tagoni, Leonard Kaban — 2010-02-01

Purpose: To test the reliability of a 3-dimensional computed tomographic (3D-CT) analysis of airway size and shape and to correlate the 3D-CT findings with lateral cephalometric measurements.Materials and Methods: Fifteen pairs of preoperative maxillofacial 3D-CT scans and digital lateral cephalograms of patients treated for obstructive sleep apnea were used in the present study. Digital 3D-CT reconstructions were created and 12 measurements of airway size and 4 of shape were analyzed. The posterior airway space (PAS), middle airway space, and hyoid to mandibular plane distances were measured on the cephalograms. We then randomly selected 5 CT scans and 5 cephalograms which were analyzed blindly on 5 separate occasions by 2 investigators (Z.A., J.T.) to establish the intraclass correlation coefficients for inter- and intraexaminer reliability. All 15 pairs of images were used to compute the Pearson correlation coefficients to establish the relationship between the CT and cephalometric measurements.Results: The intra- and interexaminer reliabilities were high for all CT (0.86 to 1.0 and 0.89 to 1.0, respectively; P < .001) and cephalometric measurements (0.84 to 1.0 and 0.91 to 0.99, respectively; P < .001). The CT measurements retroglossal anteroposterior dimension and distance between the genial tubercle and hyoid exhibited a positive correlation with the PAS (r = .60, P = 02 and r = .54, P = .04, respectively), and the lateral/anteroposterior dimension demonstrated an inverse correlation (r = −.68, P = .01) with the PAS.Conclusion: The results of the present study indicate that the 3D-CT and lateral cephalometric measurements we selected are reliable and reproducible. The only cephalometric measurement that exhibited any correlation with the CT parameters was PAS.

Stability of Le Fort I Osteotomy in Bimaxillary Osteotomies: Single-Piece Versus 3-Piece Maxilla

2010-02-01

Purpose: The aim of the present study was to investigate the effect of segmentation on the stability of Le Fort I osteotomies in bimaxillary procedures.Patients and Methods: One hundred twenty patients undergoing bimaxillary osteotomies (60 single-piece maxilla, 60 3-piece maxilla) were included in the study. Cephalometric analysis was performed before surgery (T1), immediately after surgery (T2), and after a follow-up of 12 to 15 months (T3). The positional changes of 6 angles (angle of nasion-sella line to A point-nasion line, angle of nasion-sella line to B point-nasion line, angle of nasal line [plane] to nasion-sella line, angle of mandibular line [plane] to nasion-sella line, angle of upper incisor to nasion-sella line, angle of lower incisor to mandibular line [plane]) and 4 maxillary landmarks (upper incisor edge, mesial cusp upper first molar, anterior nasal spine, posterior nasal spine) were measured by superimposition of radiographs. Paired t test was run to evaluate surgical changes (T2-T1) and postsurgical stability (T3-T2). Differences between the 1-piece maxilla group and the 3-piece maxilla group were analyzed with 2-tailed t test. Pearson correlation coefficient was calculated to determine relations among the magnitude of maxillary advancement, superior and inferior repositioning and postsurgical changes of angle of nasion-sella line to A point-nasion line, and the respective landmarks.Results: The study variables (T1), surgical changes (T2-T1), and postsurgical changes (T3-T2) showed no significant differences between groups with single-piece and 3-piece maxilla. However, a tendency for more relapse was observed in the 3-piece maxilla group in the vertical direction. A significant inferior movement of the upper molar (mesial cusp upper first molar) was seen in the single-piece maxilla group (0.5 mm) and the 3-piece maxilla group (0.4 mm). In both groups and all directions, the T2-to-T3 changes had no significant correlation with the T1-to-T2 changes. No differences were observed between superior and inferior repositioning.Conclusions: Segmentation of the maxilla does not provoke major skeletal or dental instability and should be considered whenever indicated. Adequate bone grafting provides good stability in anterior and inferior repositioning of the maxilla.

The Changing Personal and Professional Characteristics of Women in Oral and Maxillofacial Surgery

Farzaneh Rostami, Anwar E. Ahmed, Al M. Best, Daniel M. Laskin — 2010-02-01

Purpose: In 1994, Risser and Laskin surveyed practicing female oral and maxillofacial surgeons and those in oral and maxillofacial surgery (OMFS) residency programs to determine the factors that attract women to the field, their attitudes toward the various aspects of the specialty, their current practice patterns, and any biases that they may have encountered. The purpose of this study was to determine whether there have been any changes since that report was published.Materials and Methods: Invitations to participate in an online survey were e-mailed to all practicing female oral and maxillofacial surgeons and female OMFS residents in the United States.Results: One hundred fifty-six of the 281 practicing surgeons (56%) and 60 of 111 residents (54%) responded. Fifty-eight percent of residents were single, whereas 63% of practitioners were married. Most residents were childless (88%), but only 46% of practitioners had no children. Residents were more racially diverse—only 58% Caucasian versus 75% for practitioners. Both residents and practitioners agreed that they were satisfied with the selection of OMFS as a career choice, 91% and 87%, respectively. The major attractions to the field in both groups included liking surgery in general, the combination of dentistry and medicine, and the challenges offered in the specialty. Both practitioners (61%) and residents (60%) still reported a bias against women in their residency. Twenty-nine percent of residents and 38% of practitioners also reported experiencing sexual harassment.Conclusions: Since 1994, there has been a definite increase of women in both residency programs and practice. There is also greater diversity in both groups. The factors attracting women to the field continue to be relatively unchanged. However, there continues to be bias against women in the field, sexual harassment is not uncommon, and there is no evidence this has improved since 1994. Time commitment and social compromises remain the largest deterrents for women entering the specialty of OMFS.

Prolonged Recovery Associated With Dexmedetomidine When Used as a Sole Sedative Agent in Office-Based Oral and Maxillofacial Surgery Procedures

2010-02-01

Purpose: Office-based oral and maxillofacial surgical procedures that require sedation are popular. Dexmedetomidine has the advantages of having a minimal effect on respiration and an antisialogogue effect that could make it a good choice for dental procedures.Materials and Methods: We performed a prospective pilot study in which patients undergoing office-based oral and maxillofacial surgical procedures received dexmedetomidine as a sole sedative agent. The loading dose of dexmedetomidine (1 μg/kg infused over 10 minutes) was followed by a maintenance dose (0.2 to 0.8 μg/kg/hour) to achieve a Ramsay sedation score of 2 to 3. The demographic data were collected, and the pre- and intraprocedural vital signs and Ramsay sedation score were recorded every 5 minutes. The duration of the procedure, recovery time, and patient and surgeon satisfaction were documented.Results: No statistically significant changes were found in the heart rate, respiratory rate, or oxygen saturation during the procedure when compared to baseline. However, we noticed a significant decrease in the heart rate at the end of the loading dose, and statistically significant change in the blood pressure between baseline and during the procedure (P < .05). The initial local anesthetic injections were recalled by 26% of the patients, and 73% had some recollection of the procedure. Nevertheless, the patient satisfaction score (range 1 to 10) was 8.6 ± 2.3, and 86% of the patients would recommend this type of sedation. The surgeon satisfaction score (range, 1 to 5) was 3.9 ± 1.3. The recovery time was prolonged (82.2 ± 24.3 minutes) when compared with the total procedure time (44.6 ± 27.9 minutes).Conclusions: Dexmedetomidine has demonstrated hemodynamic and respiratory stability when used as a sole sedative agent. Despite the discomfort on injection and the lack of reliable amnesic property, patient and surgeon satisfaction were high. However, the prolonged recovery time makes this drug unsuitable for busy office-based practices. We believe it should be reserved for patients with a high risk of respiratory complications (eg, obese patients or those with a history of sleep apnea).

Simultaneous Immediate Loading of Implants and Occlusal Rehabilitation: A Sophisticated Treatment Approach

Abbas Azari, Sakineh Nikzad — 2010-02-01

The concept of immediate loading has been well discussed in the literature. It was advocated that for success in immediate loading of implants, it is a prerequisite to know the bone quality/quantity as well as the biomechanical environment in which the implants are to be placed. In recent years, several attempts have been made to overcome the inherent inaccuracies of immediate loading by computer-assisted design/computer-aided manufacturing technologies. The purpose of this article is to introduce a novel approach for immediate treatment of a patient's mandible in accordance with correction of an occlusal scheme by using a series of specially designed appliances and principles of computer-assisted surgery/implantology.

Feasibility Study of a Partially Hollow Configuration for Zirconia Dental Implants

Jinwen Zhu, Dong-Wei Yang, Fai Ma — 2010-02-01

Purpose: To assess the feasibility of a new shape configuration involving a partially hollow and porous lower part for dental implants.Materials and Methods: Cylindrical zirconia dental implants coated with bioactive glass were fabricated in the laboratory. Each implant has a solid upper part and a partially hollow lower part. It is open at the bottom with holes through the lower cylindrical walls. This hollow and porous configuration permits bone growth into the lower part of the implant that, over time, forms an interlinked network to lock the implant into the alveolar bone. Biomechanical properties of the new design were evaluated through material testing and experiments with dogs.Results: Mechanical testing of bending strength, hardness, fracture toughness, and fatigue life indicated that zirconia implants with the proposed partially hollow configuration can be fabricated to have structural properties comparable to or exceeding the usual requirements for implants. Animal testing suggests that there is appreciable improvement in lock-in strength and osteointegration due to the hollow and porous configuration.Conclusion: The new shape configuration is biomechanically feasible and further research is warranted to improve the design for human use.

Use of Tilted Implants in Treatment of the Atrophic Posterior Mandible: A Preliminary Report of a Novel Approach

Franklin Pancko, John Dyer, Stephen Weisglass, Richard A. Kraut — 2010-02-01

Purpose: Restoration of the atrophic partially edentulous posterior mandible with implant retained prostheses has proved to be problematic, with no ideal treatment modality. The purpose of this report is to offer a novel method of treatment using tilted endosseous implants.Materials and Methods: A total of 64 patients with edentulous spans of the mandible and less than 9.5 mm of alveolar bone overlying the inferior alveolar nerve had implants placed. The implants were placed in a bicortical manner with the porous hydroxyapatite placed subperiosteally if more than 1 mm of the apex of the implant was placed beyond the lingual cortex of the mandible. These implants were allowed to osseointegrate for 3 to 5 months and restored using custom-angled abutments.Results: A total of 196 implants were placed in 64 patients from March 2003 through July 2008. Two implants were lost owing to a lack of osseointegration. No implants were lost because of prosthodontic failure. No damage to the neurovascular structures or permanent paresthesia was noted.Conclusions: Our initial results have shown that the use of tilted implants combined with custom abutments is a viable treatment modality for patients with atrophic edentulous mandibular spans that lack the required alveolar height for traditional dental implants.

Influence of Diameter and Length of Implant on Early Dental Implant Failure

2010-02-01

Purpose: To relate diameter and length of implants with early implant failure.Patients and Methods: Implants with a cylindrical design and surface treatment by removal of titanium via acidification from 3 different manufacturers were used in this study. Two surgical procedures for submerged implants were evaluated—the placement of the implants (first surgical phase) and the procedure for reopening (second surgical phase)—before the installation of the prosthetic system. The length of the implants was classified as short (6-9 mm), medium (10-12 mm), or long (13-18 mm), and the diameter was classified as narrow, regular, or wide. The statistics were computed with SAS statistical software (SAS Institute, Cary, NC). Step-wise and χ2 analyses were used, in addition to univariate and multivariate logistic regression.Results: In this retrospective study, 1,649 implants (807 maxillary and 821 mandibular) were placed in 650 patients (mean age, 42.7 years) in different areas: anterior maxilla (458), posterior maxilla (349), anterior mandible (270), and posterior mandible (551). The early survival rate for all 1,649 implants was 96.2%. Regarding diameter, the largest loss was observed in narrow implants (5.1%), followed by regular (3.8%) and wide (2.7%) implants. Regarding length, the largest loss was observed in short implants (9.9%), followed by long (3.4%) and medium (3.0%) implants. Early loss occurred in 50 implants, 31 (4.3%) of which were installed in anterior areas and 19 (2.8%) in posterior areas. According to step-wise analyses and the χ2 test, short implant (P = .0018) and anterior installation of implant (P = .0013) showed associations with early loss.Conclusion: A significant relationship of early implant loss was observed with short implants. No relationships between early loss of implants and the osseous quality or diameter of implants were observed. These findings may be attributed to the operator's experience with different implant designs, learning curves, or changes in technique and indications for the use of short implants from 1996 to 2004.

Biomechanical Comparison of Biomimetically and Electrochemically Deposited Hydroxyapatite–Coated Porous Titanium Implants

Guo-li Yang, Fu-ming He, Ji-an Hu, Xiao-xiang Wang, Shi-fang Zhao — 2010-02-01

Purpose: The purpose of this study was to investigate the effects of biomimetically and electrochemically deposited hydroxyapatite on the fixation of an implant with bone tissue.Materials and Methods: Implants were separated into 3 groups: roughened group, biomimetically deposited calcium-phosphorus (BDCaP) group, and electrochemically deposited hydroxyapatite (EDHA) group. We randomly inserted 90 implants into the femurs of 45 rabbits. After 2, 4, and 8 weeks, the femurs were retrieved and prepared for removal torque tests (RTQs) and field-emission scanning electron microscopy observation.Results: During the test period, the EDHA group showed significantly greater RTQ values than did the roughened group and BDCaP group. The BDCaP group failed to increase the RTQ values compared with the roughened group. Field-emission scanning electron microscopy observation showed that the amount of attached bone tissue on the EDHA-coated implant surface was more than that on the roughened and BDCaP-coated implant surfaces during the test period.Conclusion: The electrochemical hydroxyapatite coating contributes to the fixation between bone and implant compared with the roughened surface, whereas the biomimetic calcium-phosphorus coating has little effect on the fixation.

Screw “Tent-Pole” Grafting Technique for Reconstruction of Large Vertical Alveolar Ridge Defects Using Human Mineralized Allograft for Implant Site Preparation

Bach Le, Michael D. Rohrer, Hari S. Prassad — 2010-02-01

Purpose: The purpose of this study was to evaluate the effectiveness of using titanium screws in combination with particulate human mineralized allograft, in a “tenting” fashion, to augment large vertical alveolar ridge defects for implant placement.Materials and Methods: This prospective case study evaluated augmentation in consecutive patients with large (>7 mm) vertical alveolar ridge defects. Vertical ridge augmentation was performed using mineralized allograft placed around titanium screws to tent out the soft tissue matrix. The ridges were clinically evaluated 4 to 5 months after augmentation, and implants were placed at that time. Bone cores were harvested from all patients for histologic evaluations.Results: Fifteen patients were treated in this prospective case study, and the mean vertical augmentation was 9.7 mm. Two patients had wound dehiscence resulting in loss of graft and requiring secondary grafting before implant placement. Five patients required 2-stage grafting procedures to achieve ideal ridge height before implant placement. Clinical evaluation of the grafted sites upon re-entry revealed uniform ridge anatomy. Histomorphometric analysis of 7 specimens revealed a mean bone content of 43%. A total of 32 implants were placed into grafted sites in 15 patients. All implants were integrated and successfully restored. Mean follow-up was 16.8 months after implant placement.Conclusions: Tenting of the periosteum and soft tissue matrix with titanium screws maintains space and minimizes resorption of mineralized particulate allograft. This technique offers predictable functional and esthetic reconstruction of large vertical defects without the use of autogenous bone and is capable of osseointegration. More studies are needed to evaluate the stability of vertically grafted bone after long-term loading.

Anterior Mandibular Swelling

2010-02-01

A 35-year-old white man presented to the Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Pernambuco, in May 2006, complaining of crowding and mobility of his teeth in the region of the incisors and canine on the right side, in addition to a painless swelling in the anterior mandible that had been present for 2 years. The patient's medical history was otherwise not significant. He denied any history of trauma to the area and also denied using tobacco and ethanol.

Staged Removal of Horizontally Impacted Third Molars to Reduce Risk of Inferior Alveolar Nerve Injury

2010-02-01

Damage to the inferior alveolar nerve (IAN) during third molar extraction is a major concern for patients and clinicians. A wide range of the incidence of temporary and permanent neurologic disturbances of the IAN as a consequence of mandibular impacted third molar extraction has been reported in the literature. The incidence of IAN injury reported in the literature ranges from 1.3% to 5.3%. The risk of this complication depends mainly on the position of the impacted tooth in relation to the inferior alveolar canal. To reduce this risk, several approaches have been proposed. Some authors advocated orthodontic-assisted extraction of the impacted mandibular third molars. Others introduced partial odontectomy, that is, the surgical removal of the anatomic crown leaving the roots in place. This case report describes a novel approach to the extraction of horizontally and mesially inclined impacted third molars with the root apexes in close contact with the IAN.

Central Adenoid Cystic Carcinoma of the Mandible With Multiple Bone Metastases: Case Report

2010-02-01

Adenoid cystic carcinoma (ACC) is a malignant epithelial neoplasm originating in the salivary gland. ACC arising centrally within the mandible is extremely rare, with only 17 previously reported cases. ACC typically presents with slow, indolent growth, but there is a high incidence of local recurrence and metastasis, which results in the low long-term survival rate. A recent case of ACC of the mandible with aggressive multiple bone metastases that caused death 1 year after its first treatment is presented.

Epidermal Choristoma of the Oral Cavity: Report of 2 Cases of an Extremely Rare Entity

Angela C. Chi, Ian L. Mapes, Tariq Javed, Brad W. Neville — 2010-02-01

Although considered somewhat of a curiosity, it is well-established that adnexal structures typically found in the skin may also occur within the oral mucosa. For example, sebaceous glands frequently can be found within the lip vermilion and intraoral mucosa, with a reported prevalence of greater than 80% to 90% of adult populations according to various large-scale clinical studies. Such oral sebaceous glands are referred to as “Fordyce granules” or “Fordyce spots” and are so common that many consider them to be a variation of normal. Typical sites include the lip vermilion and buccal mucosa, whereas sites less frequently involved include the retromolar region, alveolar mucosa, gingiva, tongue, floor of mouth, and palate. Unlike sebaceous glands in the skin, the overwhelming majority of sebaceous glands in the oral cavity are not associated with hair follicles and thus are considered “free” sebaceous glands.

Oral Manifestations in Ellis-van Creveld Syndrome: Report of a Case and Review of the Literature

2010-02-01

Ellis-van Creveld syndrome (EVC), initially called chondroectodermal dysplasia, was first described in 1940 by the pediatricians Richard Ellis and Simon van Creveld. It is a rare recessive autosomal disorder characterized by chondrodysplasia, postaxial polydactyly, ectodermal dysplasia, and congenital malformations, most frequently an atrioventricular septal defect, which is observed in 60% of patients. Even though these 4 features classically define the syndrome, a variable spectrum of clinical manifestations is often present.

Retrobulbar Hematoma After Third Molar Extraction: Case Report and Review

Parviz Goshtasby, Reza Miremadi, Ronald Warwar — 2010-02-01

A 19-year-old man was evaluated for extraction of third molar teeth. He was healthy with no history of medical problems or bleeding disorders, and he was not taking any medications. The preoperative panoramic radiograph was unremarkable (). He underwent uneventful extraction of all 4 impacted third molar teeth under local and deep conscious sedation.

Pathogenesis and Diverse Histologic Findings of Sialolithiasis in Minor Salivary Glands

Li-Tzu Lee, Yong Kie Daniel Wong — 2010-02-01

A sialolith is an apatite structure with condensations of calcium phosphate and calcium carbonate. Around the amorphous nucleus, laminar layers of organic and inorganic substances accumulate; their content varies within a single sialolith. Sialolithiasis is a common disease of the major salivary glands and is caused by formation of sialoliths, which are calcified masses that develop in the intra- or extra-glandular duct system. Sialoliths form as a result of mineralization of debris that has accumulated in the duct lumen. This debris may include mucous plugs, bacterial colonies, exfoliated ductal epithelial cells, foreign bodies, and so on.

Hybrid Odontogenic Tumor With Features of Ameloblastic Fibro-Odontoma, Calcifying Odontogenic Cyst, and Adenomatoid Odontogenic Tumor: A Case Report and Review of the Literature

2010-02-01

Case reports in the literature describe odontogenic neoplasms that present as a combination of established lesions. These have been referred to by other researchers as “hybrid” or “combined” lesions. The components of hybrid odontogenic neoplasms are often histologically identical to other odontogenic tumors such as ameloblastoma, adenomatoid odontogenic tumor (AOT), ameloblastic fibroma (AF), and ameloblastic fibro-odontoma (AFO). Their clinical presentation is a continuum ranging from noninvasive cysts or hamartomas to benign and malignant neoplasms that vary greatly in their tendency for expansion and aggression. Hybrid odontogenic neoplasms often contain features of one of these odontogenic tumors in combination with either a calcifying odontogenic cyst (COC) or a calcifying epithelial odontogenic tumor.

Cervicofacial Cavernous Venous Malformation With Massive Macroglossia: Novel Surgical Treatment With Harmonic Scalpel

Paul V. Joseph, Vinod B. Nair — 2010-02-01

Vascular malformations are common in the head and neck area, accounting for 7% of all benign tumors. Although the head and neck constitute only 14% of the total surface area of the body, approximately 50% of all vascular malformations occur in these areas. Venous malformations are soft, nonpulsatile, and compressible masses with rapid refilling. A venous malformation can cause devastating cosmetic and significant functional problems, depending on the site and size of the lesion. Various treatment options are available, including oral or intralesional steroids, sclerotherapy, radiotherapy, photocoagulation, circumferential ligation, and surgical resection. Although these lesions are a surgical challenge, surgery will provide more predictable results.

Retrieval of a Displaced Third Molar Using Navigation and Active Image Guidance

Andrew Campbell, Bernard J. Costello — 2010-02-01

Displacement of a third molar tooth during routine surgical extraction is a rare event and well-documented in the literature. Even the most experienced surgeons may have this occur on occasion. Maxillary third molar teeth can be displaced into a variety of locations including the buccal space, infratemporal fossa, maxillary sinus, or other tissue planes. We report a technique of easy retrieval using an active navigation image guidance system. This specific indication has not been well reported, and it is important for dentoalveolar surgeons to be aware of the capabilities of the latest technology.

CTX and its Role in Managing Patients Exposed to Oral Bisphosphonates

Thomas B. Dodson — 2010-02-01

Among individuals exposed to oral bisphosphonates (BPs), a small, unpredictable proportion will develop bisphosphonate-related osteonecrosis of the jaws (BRONJ). Since the first reports of BRONJ, investigators and clinicians have been seeking factors to help identify patients likely to develop BRONJ. Although some variables such as BP type, duration of exposure, and dentoalveolar procedures may be risk factors for BRONJ, none have been valuable to identify specific patients likely to develop BRONJ.

In reply

Alastair Norman Goss — 2010-02-01

This letter makes a number of excellent points but unfortunately does overlook some of the carefully described clinical issues included in our report. First and foremost, our study indicates that the C-terminal cross-linking telopeptide (CTX) is an aid to the clinical decision process but is not an absolute determination of the individual risk of development of bisphosphonate-associated osteonecrosis of the jaw (ONJ). Few things in health are absolute but the point that the CTX value is independent of the other risk predictors, eg, age, gender, duration of dose, and comorbidity, is an important finding. Thus, not all patients respond in the same fashion to a similar dose and duration of oral bisphosphonates.

In reply

Robert E. Marx — 2010-02-01

Sally Fields tells a television audience “I know my bones are getting stronger” and “I not only stopped my bone loss but reversed my bone loss” because she takes the once-monthly oral bisphosphonate Boniva (ibandronate). The reality is that Ms Fields does not know that either is true and neither does Roche Pharmaceuticals, the manufacturer of Boniva. The only way to know bone strength is to measure the force it takes to break the bone, and the only way to know whether bone loss has been reversed is to take a sample biopsy before and after taking the drug, measure the contents, and compare the difference. I doubt either was done for Ms Fields. Both parties and all manufacturers of oral bisphosphonates make similar claims according to the findings from dual energy x-ray absorptiometry (DEXA) scans and the numeric value of bone mineral density (BMD). The problem with the DEXA scan is that it has great interdevice error, great interoperator error, and an arbitrary normal value related to a healthy white woman aged 22 years. Moreover, BMD does not measure bone strength or even the bone mass at all and, therefore, does not directly correlate to either osteopenia or osteoporosis. One may now ask, what does this BMD test have to do with the morning fasting C-terminal telopeptide (CTX) bone turnover suppression test about which Dr Dodson has requested more data. The simple answer is everything. They are both surrogate tests that do not directly measure the intended problem. Therefore, each must be correlated to clinical findings, just as the report by Kunchur et al has done and our original report in 2007 did. The main difference is that the BMD has been accepted as the benchmark for osteopenia and osteoporosis with much less correlation to clinical osteopenia/osteoporosis than the CTX has for bisphosphonate-induced osteonecrosis of the jaws.

Staphylococcus Species Bacteria in Oral Cavity: A Potential Risk for Prosthetic Hips and Knees

Arthur H. Friedlander — 2010-02-01

A recent editorial in the Journal (J Oral Maxillofac Surg 67:1789-1790, 2009) about the need or lack thereof to provide antibiotic prophylaxis for patients with prosthetic hip and knee joints in place for more than 2 years and needing invasive dental treatment likely to cause a bacteremia with risk of infection and need of removal was intellectually stimulating. My specific concern was the clause “colonization at the time of (joint implant) surgery with Staphylococcus aureus and Staphylococcus epidermidis … remain(s) the primary source of infection (and that these) are gastrointestinal or cutaneous organisms.” The implication of this statement is that these bacteria are not found within the oral cavity, are not involved in dentofacial infections, and that the maxillofacial surgeon's manipulation of tissues is without risk of causing a late hip or knee joint infection. As a surgeon who obtains cultures from all incision and drainage procedures, I frequently receive from the laboratory a report that identifies a mixed infection containing 1 or both of the these micro-organisms.

Inter-Radicular Adenomatoid Odontogenic Tumor of the Anterior Mandible

Fumio Ide — 2010-02-01

Upon reading the recent report of adenomatoid odontogenic tumor (AOT) that was located between the roots of an erupted mandibular canine and first premolar by Gouvea et al, I would like to complement their case with one of my cases, which I have followed up for 14 years, to support the consistently benign behavior of this hamartomatous tumor and to re-emphasize the importance of smooth sclerotic margins and fine calcifications for radiographic diagnosis of this tumor type.

The Past, Present, and Future of Oral and Maxillofacial Surgery—Some Details in Europe

2010-02-01

We read with keen interest the article by Dr Daniel M. Laskin. The author delineated the oral and maxillofacial surgery (OMS) education in various countries, including the European region. We would be pleased to discuss some information that should be added and some that should be corrected.

News and Announcements

2010-02-01

Nearly 1,500 oral and maxillofacial surgeons, (F1) allied dental specialists, their staffs and guests arrived in Chicago December 4-6 to discover the latest advances in dental implants at the 2009 AAOMS Dental Implant Conference. With its highly anticipated surgical techniques courses, expert faculty, comprehensive curriculum and a skills lab specifically for OMS assistants, this year's sessions carried the mark of excellence for which this annual AAOMS conference has come to be known.

2009 Reviewers

2010-02-01

Reader's Circle Continuing Education Program

2010-02-01

Masthead

2010-02-01

Editorial Board

2010-02-01

Notice to Contributors

2010-02-01

AAOMS Author Disclosure Forms

2010-02-01

Journal of Oral and Maxillofacial Surgery

Tooth Decay

20-Year Follow-Up Study of Disc Repositioning Surgery for Temporomandibular Joint Internal Derangement

Prevalence of Osteonecrosis of the Jaw in Patients With Oral Bisphosphonate Exposure

Skeletal and Dental Stability After Maxillary Distraction With a Rigid External Device in Adult Cleft Lip and Palate Patients

Effect of Intermittent Systemic Administration of Recombinant Parathyroid Hormone (1-34) on Mandibular Fracture Healing in Rats

Prognostic Factors Influencing Contralateral Neck Lymph Node Metastases in Oral and Oropharyngeal Carcinoma

Modern Sialography for Screening of Salivary Gland Obstruction

Closure of Oroantral Communications Using Biodegradable Polyurethane Foam: A Feasibility Study

Comparative Study Between Resorbable and Nonresorbable Plates in Orthognathic Surgery

Facial Trauma: How Dangerous Are Skiing and Snowboarding?

The Effect of NELL1 and Bone Morphogenetic Protein-2 on Calvarial Bone Regeneration

Influence of Primary and Secondary Closure of Surgical Wound After Impacted Mandibular Third Molar Removal on Postoperative Pain and Swelling—A Comparative and Split Mouth Study

Sialoendoscopic Secondary Intervention After Failure of Open Sialolithectomy

Use of Therapeutic Laser After Surgical Removal of Impacted Lower Third Molars

Third Molars and Periodontal Pathology in American Adolescents and Young Adults: A Prevalence Study

A Randomized Clinical Evaluation of Ultrasound Bone Surgery Versus Traditional Rotary Instruments in Lower Third Molar Extraction

The Nature and Frequency of Bisphosphonate-Associated Osteonecrosis of the Jaws in Dental Implant Patients: A South Australian Case Series

Single-Dose Versus Single-Day Antibiotic Prophylaxis for Orthognathic Surgery: A Prospective, Randomized, Double-Blind Clinical Study

Combined External Lithotripsy and Endoscopic Techniques for Advanced Sialolithiasis Cases

Three-Dimensional Computed Tomographic Analysis of Airway Anatomy in Patients With Obstructive Sleep Apnea

Three-Dimensional Computed Tomographic Analysis of Airway Anatomy

Stability of Le Fort I Osteotomy in Bimaxillary Osteotomies: Single-Piece Versus 3-Piece Maxilla

The Changing Personal and Professional Characteristics of Women in Oral and Maxillofacial Surgery

Prolonged Recovery Associated With Dexmedetomidine When Used as a Sole Sedative Agent in Office-Based Oral and Maxillofacial Surgery Procedures

Simultaneous Immediate Loading of Implants and Occlusal Rehabilitation: A Sophisticated Treatment Approach

Feasibility Study of a Partially Hollow Configuration for Zirconia Dental Implants

Use of Tilted Implants in Treatment of the Atrophic Posterior Mandible: A Preliminary Report of a Novel Approach

Influence of Diameter and Length of Implant on Early Dental Implant Failure

Biomechanical Comparison of Biomimetically and Electrochemically Deposited Hydroxyapatite–Coated Porous Titanium Implants

Screw “Tent-Pole” Grafting Technique for Reconstruction of Large Vertical Alveolar Ridge Defects Using Human Mineralized Allograft for Implant Site Preparation

Anterior Mandibular Swelling

Staged Removal of Horizontally Impacted Third Molars to Reduce Risk of Inferior Alveolar Nerve Injury

Central Adenoid Cystic Carcinoma of the Mandible With Multiple Bone Metastases: Case Report

Epidermal Choristoma of the Oral Cavity: Report of 2 Cases of an Extremely Rare Entity

Oral Manifestations in Ellis-van Creveld Syndrome: Report of a Case and Review of the Literature

Retrobulbar Hematoma After Third Molar Extraction: Case Report and Review

Pathogenesis and Diverse Histologic Findings of Sialolithiasis in Minor Salivary Glands

Hybrid Odontogenic Tumor With Features of Ameloblastic Fibro-Odontoma, Calcifying Odontogenic Cyst, and Adenomatoid Odontogenic Tumor: A Case Report and Review of the Literature

Cervicofacial Cavernous Venous Malformation With Massive Macroglossia: Novel Surgical Treatment With Harmonic Scalpel

Retrieval of a Displaced Third Molar Using Navigation and Active Image Guidance

CTX and its Role in Managing Patients Exposed to Oral Bisphosphonates

In reply

In reply

Staphylococcus Species Bacteria in Oral Cavity: A Potential Risk for Prosthetic Hips and Knees

Inter-Radicular Adenomatoid Odontogenic Tumor of the Anterior Mandible

The Past, Present, and Future of Oral and Maxillofacial Surgery—Some Details in Europe

News and Announcements

2009 Reviewers

Reader's Circle Continuing Education Program

Masthead

Editorial Board

Notice to Contributors

Table of Contents

AAOMS Author Disclosure Forms