Journal of Oral and Maxillofacial Surgery - Articles in Press

Arthrogryposis Multiplex Congenita in Association With Bilateral Temporomandibular Joint Hypomobility: Report of a Case and Review of Literature - Corrected Proof

Thomas P. Nordone, Paul Li — 2010-03-15

Arthrogryposis is a physical sign observed in many specific medical conditions. The Greek language translates arthrogryposis as “curved joint.” Arthrogryposis multiplex congenita (AMC) is currently classified under a heterogeneous group of disorders featuring multiple congenital joint contractures. AMC can be classified into 3 main groups: disorders with mainly limb involvement, disorders with limb involvement together with involvement of other body parts, and disorders with limb involvement and central nervous system dysfunction. AMC is seen in approximately 1 in 3,000 to 10,000 live births without any gender predilection. Family history and pregnancy history are considered to be plausible contributors but not definitive. Intellectual underdevelopment tends to vary from patient to patient. Reports of mental underdevelopment range from nonexistent to an incidence as high as 10%.

Custom-Made Radiographic Template, Computed Tomography, and Computer-Assisted Flapless Surgery for Treatment Planning in Partial Edentulous Patients: A Prospective 12-Month Study - Corrected Proof

Sakineh Nikzad, Abbas Azari — 2010-03-15

Purpose: It was proposed that technologies derived from computer-aided design (CAD)/computer-aided manufacturing (CAM) and computed tomography may be useful for flapless implant treatment procedures. However, most of the studies examining the effectiveness of this method were performed in fully edentulous patients, with little or no attention paid to partially edentulous patients. The aims of this study were 1) to evaluate the concept of computer-assisted implant placement including a treatment planning procedure based on computed tomography scan images by use of a flapless surgical approach in partially edentulous cases and 2) to validate the reliability of this concept in a prospective 12-month clinical study.Materials and Methods: Sixteen patients with partially edentulous areas in their mandibles were included in this study. A total of 57 implants were inserted by use of a CAD/CAM drill template, specially designed for flapless implant surgery. To assess the degree of pain and discomfort, the patients were examined at 2 days and 1 week after surgery. Patient satisfaction and implant functionality were further evaluated at follow-up intervals of 1, 3, 6, and 12 months postoperatively. A specially designed visual analog scale was used for data acquisition.Results: The mean pain score on the visual analog scale at follow-up was within the range for little or no pain. Two implants failed early in 1 patient. All of the other implants were in a good functional state throughout the study. The mean marginal bone loss after 1 year of follow-up was 0.6 mm (SD, 0.2) mesially and 0.5 mm (SD, 0.1) distally.Conclusion: This prospective study showed that the use of CAD/CAM technology and flapless implant surgery may be considered reliable for partial edentulous patients.

Closure of Oroantral Communications: A Review of the Literature - Corrected Proof

Susan H. Visscher, Baucke van Minnen, Rudolf R.M. Bos — 2010-03-15

An oroantral communication (OAC) is an open connection between the oral cavity and maxillary sinus. The maxillary sinus takes up a large part of the body of the maxilla, generally extending into the alveolar process bordering the apices of the posterior teeth.

Maxillary Sinus Septa: A Cadaveric Study - Corrected Proof

2010-03-15

Purpose: The goal of this study was to investigate the incidence, location, and height of antral septa and to offer the clinician, through an accurate investigation of the anatomy of the maxillary sinus region, the tools to carry out sinus-lift procedures under safe conditions.Materials and Methods: The study consisted of 60 sinuses from 30 human cadavers with an age range of 59 to 90 years. Only septa measuring 3.0 mm or greater in height were considered in our analysis.Results: A total of 20 incomplete septa were found, showing an incidence of 33.3%, and no more than 1 septum per sinus was identified. All septa were located in the anterior-lateral wall and were either sagittal or transversal. Of the septa, 6 (30%) were located in the anterior region of the antral wall (between the second premolar and first molar roots), 8 (40%) were in the middle region (between the first and second molar roots), and 6 (30%) were in the posterior region (distal to the third molar roots). Antral septa height showed great variability, with a mean value of 8.72 mm (SD, 4.26; range, 3.7-18.4 mm). Our study also showed that 40% of our specimens (12 of 30 maxillas) have bony septa that can partially divide the sinus, and they were symmetric in 8 of 12 cases.Conclusions: A sound knowledge of the maxillary sinus anatomy and of the possible anatomic variations is essential to prevent complications during surgical interventions involving this region.

Management of Atrophic Mandible Fractures: Are Bone Grafts Necessary? - Corrected Proof

Joseph E. Van Sickels, Larry L. Cunningham — 2010-03-15

Management of patients with atrophic mandible fractures has been a challenge for maxillofacial surgeons for years. Techniques that have been used are splints, external pins, split ribs wire osteosynthesis, and rigid fixation. Results with each of these techniques have had variable success depending on the amount of atrophy that the patient underwent before injury. There has been an evolution of treatment over the years in which closed techniques have been gradually replaced by open techniques. In 1976, Bruce and Strachan suggested that closed reductions should be tried first and that if an open reduction was required, wire mesh was preferable to a bone plate. In 1979, Marciani and Hill, after reviewing 33 well-documented cases, recommended that a closed reduction of fractures of the atrophic mandibular body be done. In the second Chalmers J. Lyons Academy study, published in 1993, Bruce and Ellis noted that 81.5% of the 104 patents had an open reduction and internal fixation with a bone plate. In 1996, Luhr et al presented their results in 84 patients with atrophic edentulous mandible fractures treated with compression bone plates. In 2006, Wittwer et al reviewed their outcomes of the treatment of 30 patients treated with different plating systems. They concluded that the more atrophic a fractured mandible is, the more rigid the fixation of the fracture needed to be. Tiwana et al, in 2009, suggested that for ideal healing of edentulous, atrophic mandible fractures, bone grafting is needed in addition to a large reconstruction plate and a bone graft.

Bone Healing in a Rabbit Mandibular Defect Using Platelet-Rich Plasma - Corrected Proof

Michael Miloro, David J. Haralson, Valmont Desa — 2010-03-15

Purpose: To evaluate the effect of platelet-rich plasma (PRP) on bone healing in an osteotomized defect of the rabbit mandible.Materials and Methods: Twelve adult female New Zealand White rabbits were randomized to 1 of 2 treatment groups: group A had an osteotomy with the addition of a bone graft, and group B had an osteotomy without a bone graft. Regardless of treatment group, 1 side in each rabbit was randomly selected to receive PRP as an internal control. Bilateral 1.0- × 0.5-cm mandibular inferior border osteotomies were performed in each animal, 0.5 cm anterior to the antegonial notch to create mandibular defects. The osteotomy sites were evaluated by histologic and radiographic analyses for bone healing at 1, 2, and 3 months after surgery.Results: A 4-point ordinal scale was used to compare healing, based on radiographic density, radiographic height, and histologic height of new bone formation. Group A rabbits showed significantly shorter healing times compared with group B rabbits. A pairwise analysis indicated that the addition of PRP did not increase the overall score of any measured parameter, at any interval (P > .9).Conclusions: In the rabbit osteotomy model, bone grafting (group A) significantly improved healing in comparison with no bone grafting (group B). In defects of the mandible, an increased radiographic and histologic bone density and height were seen at 1-, 2-, and 3-month intervals in the bone graft group; however, the addition of PRP did not appear to provide any statistically significant benefit to healing in either group.

Access for Repair of Gunshot Wound to the Neck Using the Modified Attia Approach in a Combat Setting - Corrected Proof

Tate L. Viehweg — 2010-03-15

Numerous studies describing parapharyngeal and pterygomandibular access using double-mandibular osteotomy techniques have been reported, with several recently published. A recurring theme of these reports has been the elucidation of access for tumor resection. Multiple tumor types have been resected using the described techniques, including salivary gland tumors of the deep lobe of the parotid, carotid body tumors, and carcinomas of the lateral pharyngeal wall, to name a few. Excellent access has been noted, with minimal morbidity demonstrated in both recovery and esthetics postoperatively.

The Tent Pole Splint: A Bone-Supported Stereolithographic Surgical Splint for the Soft Tissue Matrix Expansion Graft Procedure - Corrected Proof

Joseph E. Cillo, Nicholas Theodotou, Marc Samuels, Joseph Krajekian — 2010-03-15

This report details the use of computer-aided planning and intraoperative stereolithographic direct-bone-contact surgical splints for the accurate extraoral placement of dental implants in the soft tissue matrix expansion (tent pole) graft of the severely resorbed mandible.

Addition of Mesenchymal Stem Cells to the Scaffold of Platelet-Rich Plasma Is Beneficial for the Reduction of the Consolidation Period in Mandibular Distraction Osteogenesis - Corrected Proof

Yun-Jung Hwang, Jin-Young Choi — 2010-03-12

Purpose: Platelet-rich plasma (PRP) is a wonderful scaffold to induce osteogenesis. In this study, we investigated whether the combination of mesenchymal stem cells (MSC) with PRP has advantages over PRP for the reduction of consolidation period in mandibular distraction osteogenesis.Materials and Methods: After osteotomy, an external distraction device was fixed in both mandibles of 38 rabbits. After a 5-day latency period, a total of 6.3 mm was distracted for 6 days. PRP gel with or without MSC was injected into the distracted area on day 1 of the consolidation period. Healing tissues were analyzed histologically, radiologically, and mechanically on weeks 1, 2, 3, and 4 after consolidation.Results: In week 1, the MSC/PRP group was 34%, 20%, 21%, and 32% higher than the PRP group in the result of histomorphometry, radiodensity ratio of new bone/host bone and new bone/adjacent tooth, and microhardness test, respectively. Consolidation period was reduced by 6.6 and 5.1 days at 80% and 90% new bone/host bone ratio through regression analysis, respectively.Conclusion: The addition of MSC in PRP scaffold significantly (P < .05) increased new bone formation, mineralization, and mechanical property compared to the PRP-only group. These results indicate that the combination therapy of MSC and PRP is more effective for reducing the consolidation period of distraction.

Application of Calcium Sulfate in Surgical-Orthodontic Treatment of Impacted Teeth: A New Procedure to Control Hemostasis - Corrected Proof

2010-03-11

Purpose: Calcium sulfate (CaS) is a simple, biocompatible material with a very long, safe clinical history in several different fields of medicine. CaS is a rapidly resorbing material that leaves behind a calcium phosphate lattice, which promotes bone regeneration and hemostasis. The aim of this study was to perform a clinical evaluation of a possible hemostatic effect of calcium sulfate hemihydrate (CaSO4), commonly known as plaster of Paris, in the surgical and orthodontic treatment of impacted teeth.Materials and Methods: Forty-three patients with 66 impacted cuspids and premolars were enrolled in this study. The gap between teeth and bone was filled with several layers of CaS cement. Each layer was put in place and was compressed with a dry gauze. The outer layer was then hardened with a potassium sulfate solution. After hardening, the CaS excess was removed, and a bracket was applied to the surface of the tooth.Results: In no case was a separation of the bracket by the surface of the tooth observed.Conclusions: These results seem to confirm the usefulness of the hemostatic effect of CaS in this procedure.

Is It Possible to Anesthetize Palatal Tissues With Buccal 4% Articaine Injection? - Corrected Proof

İlker Özeç, Ufuk Taşdemir, Cesur Gümüş, Orhan Solak — 2010-03-11

Purpose: The aim of this study was to evaluate the presence of probable diffused local anesthetic solution at and anesthesia of palatal tissues after buccal injection of 4% articaine hydrochloride (HCl) with 1:100,000 epinephrine or 1:200,000 epinephrine at the premolar and molar region.Materials and Methods: Thirty volunteers received maxillary buccal injections of 4% articaine HCl with 1:100,000 epinephrine or 1:200,000 epinephrine bilaterally to the first premolar or first molar. Magnetic resonance images were obtained before and 5 minutes after local anesthetic injections, and a visual evaluation was done to determine the presence of local anesthetic solution at palatal tissues. Anesthesia of palatal tissues after buccal injection was assessed by needle-prick stimulation pain with a visual analog scale (VAS). The Kruskal-Wallis test was used for comparison of the VAS values.Results: The visual evaluation of the magnetic resonance images did not show any signal change as an indicator of the presence of local anesthetic solution at the palatal region. Most of the volunteers described moderate or severe pain with needle-prick stimulation. The mean VAS score for needle-prick stimulation was 86.33 ± 39.45 mm (1:100,000 epinephrine) and 87.0 ± 36.28 mm (1:200,000 epinephrine) in the first premolar region and 57.20 ± 46.69 mm (1:100,000 epinephrine) and 75.53 ± 49.78 mm (1:200,000 epinephrine) in the molar region (P > .05).Conclusion: We could not establish the presence of anesthesia or 4% articaine HCl at the palatal tissues after buccal injection. Maxillary tooth removal without palatal injection requires further objective investigations.

The Influence of Mouth Opening on Oropharyngeal Leak Pressure, Intracuff Pressure, and Cuff Position With the Laryngeal Mask Airway - Corrected Proof

2010-03-11

Purpose: The aim of this study was to investigate the influence of mouth opening on oropharyngeal leak pressure, intracuff pressure, and cuff position of the laryngeal mask airway (LMA).Patients and Methods: Fifteen patients who were scheduled for elective oral surgery were recruited into this study. A single, experienced LMA user inserted the LMA according to the manufacturer's recommended technique. Oropharyngeal leak pressure, intracuff pressure, and fiberoptic assessment of the LMA position were documented under 3 mouth conditions: neutral position (1.4-cm distance between upper and lower incisors), mouth open (5- to 6-cm distance between upper and lower incisors), and return to the neutral position. Any ventilation difficulties under the 3 mouth conditions were recorded.Results: Oropharyngeal leak pressure with the mouth open was higher than in the neutral position (P < .001). Compared with the neutral position, intracuff pressure was also higher with the mouth open (P < .001). Both measurement values returned to control levels when the neutral position was once again assumed. The LMA position observed by fiberoptic bronchoscopy was unchanged by mouth opening and was similar in the 3 mouth conditions (P = .998). Although ventilatory difficulties occurred after mouth opening in 8 of 15 patients (P < .001), it did not occur when the neutral position was reassumed.Conclusions: This study showed that mouth opening led to substantial increases in oropharyngeal leak pressure and intracuff pressure of the LMA, warranting caution because gastric insufflation, sore throat, and ventilation difficulties may occur.

Analgesic and Anti-Inflammatory Effects of Oxaprozin and Naproxen Sodium After Removal of Impacted Lower Third Molars: A Randomized, Double-Blind, Placebo-Controlled Crossover Study - Corrected Proof

İsa M. Kara, Serkan Polat, Fatih İnce, Cesur Gümüş — 2010-03-08

Purpose: In this study, oxaprozin, a long-acting nonsteroidal anti-inflammatory drug, and naproxen sodium were compared in terms of their effects on edema, pain, and trismus after surgery for impacted mandibular third molars.Materials and Methods: Thirty healthy patients with bilaterally impacted mandibular third molars were included in this randomized, cross-over, double-blind, placebo-controlled study. Patients were assigned randomly to 1 of 3 surgery groups and received postoperatively 1,200 mg oxaprozin, 550 mg naproxen sodium, or a placebo. Postoperative edema was measured with ultrasonography performed before and after surgery. Trismus was measured by comparison of preoperative and postoperative maximum interincisal mouth opening measurements by caliper. Pain was assessed by a visual analog scale (VAS) and by recording the number of rescue analgesic pills taken.Results: After removal of impacted third molars, the patients administered oxaprozin and naproxen showed superior results over those given placebo in terms of pain parameters (P < .05), but these treatments had no statistically significant effect on facial swelling. Comparing the oxaprozin and naproxen groups, there were no differences in the mouth opening measurements, but naproxen showed a statistically superior effect over the placebo (P < .05). Although not statistically significant, oxaprozin showed a more pronounced effect in reducing trismus than did the placebo (P = .07).Conclusions: Administration of either oxaprozin or naproxen sodium during the postoperative period is effective and has similar effects in reducing pain but questionable benefit for the management of trismus. However, neither agent has clinical benefit in terms of reducing edema.

Intranasal Ketorolac for Pain Secondary to Third Molar Impaction Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial - Corrected Proof

George M. Grant, Donald R. Mehlisch — 2010-03-08

Purpose: This randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of intranasal (IN) ketorolac in patients who had third molar extraction surgery with bony impactions.Materials and Methods: After surgery, patients were randomly assigned to receive IN ketorolac 31.5 mg (n = 40) or IN placebo (n = 40). Safety was assessed from spontaneously reported adverse events and measurement of vital signs. Efficacy assessments included pain intensity, which was measured on a 0- to 100-mm visual analog scale, total pain relief, and global pain evaluation up to 8 hours after dosing or until patients required rescue analgesia. The primary efficacy variable was the summed pain intensity difference score over the first 8 hours after dosing.Results: Summed pain intensity difference values ± SE were significantly higher (indicating better analgesia) in the ketorolac group compared with placebo (136.7 ± 33.0 vs −105.2 ± 29.1, P < .001). Total pain relief scores were significantly higher (P < .001) in the ketorolac group compared with placebo at all times. A larger proportion of subjects in the ketorolac group reported good, very good, or excellent pain control compared with the control group (60% vs 13%). Times to perceptible (21.5 minutes) and meaningful (66.0 minutes) pain relief were significantly shorter and the time to rescue analgesic use was significantly longer in the ketorolac group (P < .001). Eight patients in the placebo group and 3 in the ketorolac group had adverse events, none of which was serious. The 3 events in the ketorolac group were reports of mild headache.Conclusion: A single IN ketorolac 31.5 mg dose was well tolerated and provided rapid and effective pain relief in oral surgery patients for a period up to 8 hours.

Hydrodynamic Ultrasonic Sinus Floor Elevation—An Experimental Study in Sheep - Corrected Proof

Angelo C. Troedhan, Andreas Kurrek, Marcel Wainwright, Siegfried Jank — 2010-03-08

Purpose: The aim of the present study was to evaluate the pressure forces appearing to elevate the sinus membrane by comparing the hydraulic and pneumatic pressure. Also, the relation between the time and volume of the applied liquid and the achieved lift-volume were determined.Materials and Methods: A total of 190 fresh, half sheep heads were used for the present investigation. An ultrasound surgical device (Piezotome; Acteon, Bordeaux, France) was tested to evaluate the pressure increase at different flow rates. The elevation volume at different flow rates and activation times of the ultrasound hand piece were measured.Results: To detach the sinus membrane pneumatically from the sinus floor, a mean average pressure of 29.54 millibars was required. Using the hydraulic technique, a mean average pressure of 19.8 millibars was determined. Comparing the different flow rates, the elevated volume increased to 0.52 mL when a flow of 60 mL/minute was used. Using an activation time of 20 seconds, a lifted volume of 3.92 mL could be measured on average. If the flow was set to a maximum of 60 mL/minute, the created volume increased to 5.58 mL. A comparison using the χ2 test showed a significant correlation (P = .03) between the application time and the created sinus lift volume. Even at high flow rates of 60 mL/minute of the activated Piezotome for a 20-second period, no rupture of the sinus membrane of the sheep heads occurred in 190 experiments.Conclusion: From these results, we have concluded that hydrodynamic ultrasound could be used as an alternative method for sinus floor elevations of any size and volume with a mere 3-mm-diameter transcrestal approach, if findings from clinical investigations confirm the results of the present animal study.

Bell's Palsy and Dental Infection: A Case Report and Possible Etiology - Corrected Proof

Len Tolstunov, Gary A. Belaga — 2010-03-08

Bell's palsy is the most common acute facial paralysis with unclear causes (Sir Charles Bell, a 19th-century Scottish surgeon, was the first to describe the condition in 1821). It is idiopathic, mostly unilateral (<1% of cases are bilateral), and of sudden onset. The pathogenesis is unknown, and the incidence is about 23 per 100,000 persons annually, affecting men and women equally at any age, but it commonly occurs between 15 and 60 years of age. The incidence of Bell's palsy appears to be slightly higher in persons of Japanese descent (30 per 100,000 persons). The cause has been effectively shown to be (in cases formerly labeled as “idiopathic”) viral with associated ischemia and compression of the facial nerve in the narrow confines of its course through the temporal bone. Herpes simplex virus type 1 (HSV-1) was identified by Burgess et al in an elderly man who died 6 weeks after the onset of Bell's palsy. The polymerase chain reaction technique amplifies viral genomic sequences and has been used to identify HSV-1 in 11 of 14 cases of Bell's palsy that were surgically decompressed because of the severity of their syndromes.

Change of Lip Cant After Bimaxillary Orthognathic Surgery - Corrected Proof

Young Ho Kim, Juhong Jeon, Joan Thomas Rhee, Jongrak Hong — 2010-03-04

Purpose: The purpose of the present study was to investigate the correlations between lip cant change after bimaxillary orthognathic surgery and the ratio of lip cant change and occlusal cant change after surgery.Patients and Methods: The subjects for the present study were obtained from a group of 25 patients who underwent bimaxillary orthognathic surgery for occlusal cant correction at the Department of Oral and Maxillofacial Surgery, Samsung Medical Center (Seoul, South Korea) from January 2000 to December 2005. To be included, a patient's chart had to contain a resting frontal facial photograph in the natural head position and a corresponding posteroanterior cephalogram in occlusion on the same day before surgery and postoperatively 6 months later. The lip cant change was assessed by the angle of each labial commissure and the bi-pupillary reference line. The occlusal canting change in the frontal plane was assessed with the angle between each maxillary first molar occlusal surface and the bi-frontozygomatic suture reference line.Results: With the angular measurement, the average occlusal cant change was 3.09° (standard deviation [SD] 1.05°), and the average lip cant change was 1.56° (SD 1.05°). With the linear measurement, the average occlusal cant change was 2.41 mm (SD 2.75), and the average lip cant change was 1.18 mm (SD 0.43). The lip cant correction ratio to occlusal cant correction was 51.5% ± 8.4% in the angular measurement and 48.8% ± 9.1% in the linear measurement. With Pearson's correlation analysis, the Pearson correlation coefficient was 0.869 for the angular measurement and 0.887 for the linear measurement. A high correlation was shown between the occlusal cant change and lip cant change.Conclusions: Bimaxillary orthognathic surgery can correct lip cant and occlusal cant. The average amount of lip cant correction and occlusal cant correction in our study was 51.5% ± 8.4% and 48.8% ± 9.1%, respectively.

Cell Response of Titanium Implant With a Roughened Surface Containing Titanium Hydride: An In Vitro Study - Corrected Proof

Feng Zhang, Gou-li Yang, Fu-ming He, Li-juan Zhang, Shi-fang Zhao — 2010-03-04

Purpose: The purpose of this study was to investigate the effect of surface chemistry of a sandblasted and acid-etched implant (with and without titanium hydride [TiH2]) on cell attachment, proliferation, and differentiation of preosteoblasts (MC3T3-E1).Materials and Methods: Sandblasted and dual acid-etched titanium discs comprised the test group, whereas sandblasted, acid-etched, and heat-treated discs comprised the control group. Both groups' discs were sent for surface characterization. MC3T3-E1 cells were cultured on these 2 groups' discs, and then cell attachment, cell proliferation, and cell differentiation were analyzed.Results: Scanning electron microscope analysis showed that the titanium discs in the 2 groups shared the same surface topography; however, x-ray diffraction examination showed that the TiH2 diffractions only appeared in the test group. Cell attachment and cell proliferation were much better in the test group than in the control group at all time points investigated (P < .05). The expressions of alkaline phosphatase and osteocalcin were significantly higher in the test group than in the control group for both protein and transcription level at every time point (P < .05 or P < .01).Conclusions: These results suggested that surface chemistry played a significant role in cell response to the sandblasted and acid-etched surface and the presence of TiH2 might promote the attachment, proliferation, and differentiation of preosteoblasts.

Ultrasonographic Evaluation of Disc Displacement of the Temporomandibular Joint Compared With Magnetic Resonance Imaging - Corrected Proof

Nilüfer Çakır-Özkan, Başar Sarıkaya, Ünal Erkorkmaz, Yeliz Aktürk — 2010-03-02

Purpose: We compared high-resolution ultrasonography with magnetic resonance imaging (MRI), as the gold standard, to evaluate lateral and anterior capsule-condyle distances to detect disc displacement of the temporomandibular joint.Materials and Methods: This study included 28 patients (19 female and 9 male; age range, 16-51 years; mean age, 32.82 years), and in total, 56 joints were assessed with ultrasonography and MRI. Measurements were obtained for anterior capsule-condyle and lateral capsule-condyle distances in both open- and closed-mouth positions with high-resolution ultrasonography. These findings were also compared with those of MRI taken as reference. Receiver operating characteristic curve analysis was performed to assess our results. We assessed sensitivities, specificities, accuracies, and positive and negative predictive values for both open- and closed-mouth positions.Results: Diagnostic accuracy of ultrasonographic anterior capsule-condyle distance in the closed-mouth position to detect MRI-positive disc displacement (area under receiver operating characteristic curve, 0.689; P = .015) was the highest.Conclusions: The measurement of the distance between the most anterior point of the articular capsule and the most anterior point of the condyle can be used to assess disc displacement in diseased joints. However, it is necessary to determine the most accurate threshold value and to set cutoff values. These findings need to be confirmed by further research in a large number of patients to test the interexaminer agreement and the reproducibility of this method.

Simultaneous Oral Antral Fistula Closure and Sinus Floor Augmentation to Facilitate Dental Implant Placement or Orthodontics - Corrected Proof

2010-03-02

Several techniques have been used to treat the oroantral fistula with similar rates of success and failure. Some of them frequently present anatomical disadvantages. They can reduce vestibular depth, cause lack of support bone, or cause fusion of the Schneiderian and mucosal membranes. In this report, we present 3 cases of orosinusal fistulas successfully treated with a simultaneous closure of the communication and sinus floor augmentation. At the same time, this technique enables the restoration of the alveolar process with enough bone volume, which facilitates later implant surgery, prosthetic rehabilitation, or even some orthodontic treatments.

Morphologic and Bony Structural Changes in the Mandible After a Unilateral Injection of Botulinum Neurotoxin in Adult Rats - Corrected Proof

Chi-Yang Tsai, Rouh-Yi Huang, Chi-Ming Lee, Wen-Tien Hsiao, Liang-Yo Yang — 2010-03-02

Purpose: Previous animal experiments showed how reduced masticatory function plays an important role in the craniofacial and mandibular regions in the growing period. However, articles focusing on the effects of reduced masticatory function in adult animals are quite scarce. The purpose of this study was to evaluate the effects of reduced masticatory muscle activity on the jaw bones of adult rats.Materials and Methods: Botulinum neurotoxin type A (BTX-A) was injected into the left masseter muscle to reduce masticatory muscle function, and sequential changes in the jaw bones were investigated. Ten male 60-day-old Sprague-Dawley rats with a mean body weight of about 300 g were used. The following procedures were performed on each sample: 25 U/mL (0.3 mL) of BTX-A was injected into the left masseter muscle, whereas the right masseter muscle received an equal amount of sterilized saline solution. Ninety days after the procedure, the rats were sacrificed, and the weights of the masseter muscles were recorded. Meanwhile, direct anthropometric measurements were taken, and the cortical thickness, trabecular thickness, and bone mineral content of the skull and mandible were measured. All measurements were evaluated with statistical software.Results: There were significant differences in all measurements on the BTX-A side compared with those on the control side. The differences included a decreased ramus height, increased gonial angle, and increased crown height of the posterior teeth on the injection side. Significant decreases in the muscle weight, bone mineral content, cortical thickness, and trabecular thickness were also seen on the paralyzed side compared with the non-injection side.Conclusions: We found that reduced masticatory function in adult rats affected the weight of the masseter muscle and the bony structure and dentition.

Prevention of Mandibular Fractures Caused by Difficult Surgical Extractions: Report of a Borderline Case - Corrected Proof

Roberto Pippi, Marco Solidani, Silvia Broglia, Maria Paola Cristalli — 2010-02-26

Intra- and postoperative mandibular fracture is one of the major complications associated with difficult surgical extractions in the lower arch. Adult age, male gender, deep inclusion, tooth ankylosis, and associated cystic or other pathological lesions are usually considered predisposing factors of mandibular fracture related to surgery.

Investigation of Transmigrated and Impacted Maxillary and Mandibular Canine Teeth in an Orthodontic Patient Population - Corrected Proof

Mevlut Celikoglu, Hasan Kamak, Husamettin Oktay — 2010-02-26

Purpose: The objectives of the present study were to determine the frequency and gender difference of transmigrated and impacted canines and to evaluate the characteristics and treatment protocols in a Turkish orthodontic patient population.Materials and Methods: We designed a retrospective study composed of pretreatment and post-treatment dental casts, intraoral photographs, and full mouth periapical and panoramic radiographs of 2,215 patients (1,275 females and 940 males). Observations were made regarding impacted mandibular and maxillary canines, retained deciduous canines, patient gender and age, side and number of transmigrated canines and associated pathologic features, and treatment of the impacted canines and transmigrated canines. The Pearson χ2 test and Fisher's exact test were used to determine the potential differences in the distribution of canine impaction and transmigration when stratified by gender.Results: The frequency of patients with impacted and transmigrated canines was 5.1% and 0.3%, respectively. None of the patients with a transmigrated mandibular canine had any pathologic changes; however, the maxillary transmigrated canine was associated with impacted mesiodens. All transmigrated canines were unilateral and impacted. Four canines migrated from the left to right, and 2 migrated from right to left. Of 6 patients, 2 had retained primary canines and 4 had exfoliated primary canines. Three of the transmigrated mandibular canines were type 1 and 2 were type 2. In the treatment protocol, 4 impacted mandibular canines and 78 maxillary canines were surgically exposed for orthodontic treatment, 4 of 6 transmigrated canines were surgically removed, and 2 were observed periodically.Conclusions: If the diagnosis of canine impaction and transmigration in patients is made earlier, it is possible that the tooth might have been in a better position for orthodontic eruption into the arch. Careful patient selection and preparation are therefore essential, as is cooperation between the orthodontist and oral surgeon.

Bisphosphonate-Induced Osteonecrosis of the Jaw 32 Months After Interruption of Zoledronate in a Patient With Multiple Myeloma - Corrected Proof

2010-02-25

Bisphosphonates prevent, reduce, and delay cancer-related skeletal complications in patients with multiple myeloma or metastatic cancer. Thus, the therapy is commonly prescribed to patients with multiple myeloma. Bisphosphonates are extremely effective in reducing the symptoms and complications of bone lesions and have been shown to have a profound effect on the quality of life of patients with multiple myeloma. However, in the past few years, several reports and recommendations have been published about bisphosphonate-induced osteonecrosis of the jaw (BRONJ) since the first reports were published in 2003 as a potential adverse effect of Zometa (zoledronic acid; Novartis, East Hanover, NJ). It was observed that the major risk factors are dental extraction and the therapy duration with zoledronic acid. BRONJ was often diagnosed during or after therapy (range, 1 to 13 months). We report an extensive case of BRONJ that was clinically evident more than 32 months after the suspension of zoledronic acid.

A Case of Inferior Alveolar Nerve Entrapment in the Roots of a Partially Erupted Mandibular Third Molar - Corrected Proof

Roberto Pippi — 2010-02-25

Inferior alveolar nerve injury is one of the most feared complications of mandibular third molar surgery. A careful preoperative radiographic evaluation is mandatory to precisely define the relation between third molar roots and the inferior alveolar nerve.

Long-Term Results of Radiation Prophylaxis for Heterotopic Ossification in the Temporomandibular Joint - Corrected Proof

Ashley W. Jensen, Christopher F. Viozzi, Robert L. Foote — 2010-02-25

Purpose: To assess the long-term efficacy and toxicity of radiation therapy (RT) for postoperative prophylaxis of recurrent heterotopic ossification (HO) in the temporomandibular joint (TMJ).Patients and Methods: Twelve patients (18 joints) with bony ankylosis of the TMJ from HO were referred to undergo RT after arthrotomy with osseous recontouring, gap arthroplasty, or costochondral grafting. Treatment consisted of 10 Gy in 5 daily fractions to a field encompassing the TMJ with an adequate margin. RT was initiated 1 to 3 days postoperatively. Response to therapy was assessed by routine x-ray films obtained preoperatively, immediately postoperatively, and at follow-up by use of the Turlington-Durr grading system. Treatment efficacy was defined as freedom from HO re-formation requiring further surgical intervention. Efficacy and toxicity data were obtained from review of the medical records and were augmented by telephone interview of patients when possible (6 patients, all with follow-up >16 years). Efficacy rates by patient were estimated by the Kaplan-Meier method.Results: The median follow-up after RT was 16.4 years (range, 2.5-19.2 years). Symptomatic re-formation of HO requiring further surgery occurred in 5 patients (7 joints). Treatment efficacy rates were 71% (95% confidence interval [CI], 44-99) at 5 years and 48% (95% CI, 15-80) at 10 years. Of the 6 patients contacted regarding late toxicity, 2 had clinical xerostomia (grade 1, CTCAE v3.0) attributable to RT; no other late RT-related toxicities were noted. None of the 12 patients had malignancy attributable to RT.Conclusions: Postoperative RT prevented re-formation of TMJ HO in 50% of treated patients long term. Late toxicities from RT were mild and infrequent.

Desflurane Versus Sevoflurane to Reduce Blood Loss in Maxillofacial Surgery - Corrected Proof

2010-02-16

Purpose: In our study, desflurane was hypothesized to reduce blood loss more than sevoflurane, both used with targeted mild controlled hypotension.Patients and Methods: A total of 20 American Society of Anesthesiologists Class I patients undergoing maxillofacial elective surgery for maxillary and mandibular osteotomies were randomized to a desflurane group or a sevoflurane group. Anesthesia was performed with an end tidal value of the inhaled agent to obtain a bispectral index value <30 but without burst-suppression patterns (minimal alveolar concentration age-corrected between 0.7 and 0.9). Remifentanil was administered at a dose of 0.5 μg · kg−1 · min−1 to obtain analgesia and a <2 surgical field level in Fromme's modified scale. Sodium-nitroprusside was administered on demand to have a surgical field level of <2 when the anesthesia plan was not sufficient to achieve this target. The minimal value of the mean arterial pressure achievable was 60 mm Hg.Results: In the desflurane group, blood loss was more restricted. The hypotensive drug was used in 8 patients in the sevoflurane group and 2 patients in the desflurane group.Conclusions: Anesthesia with desflurane can reduce blood loss and could give an acceptable surgical field with mild controlled hypotension and with a substantial reduction in the vasoactive drug requirement. These data need to be assessed with an enlargement of the statistical sample.

Maxillary Sinus Elevation With an Alloplastic Material and Implants: 11 Years of Clinical and Radiologic Follow-Up - Corrected Proof

Giuliano Garlini, Marco Redemagni, Matteo Donini, Carlo Maiorana — 2010-02-16

Purpose: The aim of this retrospective study was to determine the clinical and radiologic results, over an 11-year period, of resorbable hydroxyapatite used as a bone substitute in maxillary sinus elevation.Materials and Methods: Between 1996 and 2007, we treated 26 patients with maxillary sinus elevation (27 sinuses) using resorbable hydroxyapatite and simultaneous insertion of 47 titanium implants. Patients were recruited, screened, and accepted or rejected sequentially based on specific inclusion/exclusion criteria. Ten months later, 2-stage surgery and prosthetic rehabilitation were performed.Results: During the 11-year follow-up period (mean, 6 years), all the implants appeared clinically and radiologically integrated. The cumulative survival rate was 100%. During the observation period, the resorption of the graft apically to the implant was 1.8 mm on average.Conclusion: The posterior area of the maxilla often represents a challenging clinical situation because of either the lack of alveolar bone or the structural characteristics of the trabeculae in that specific area. The high survival rate of the implants and the stability of the mineralization of the graft confirmed that resorbable hydroxyapatite was a suitable material for sinus grafting.

Temporomandibular Joint Condylar Abnormality: Evaluation, Treatment Planning, and Surgical Approach - Corrected Proof

2010-02-16

The cartilage of the mandibular condyle is located beneath the fibrous articular layer and undergoes atrophic changes, assuming endochondral bone growth or adaptive growth, according to the absence or presence of functional demand. Normal condylar growth follows a sequence of transitory stages that are defined by molecules synthesized by undifferentiated mesenchymal cells and differentiating chondrocytes. For example, Sox 9 transcription factor is expressed by cells in the proliferative layer and chondrocytes. It is a potent activator of type II collagen, the main type of collagen that forms the framework of the cartilage matrix in the growing condyle. Type X collagen is expressed only by hypertrophic chondrocytes, and its expression precedes the onset of endochondral ossification. It is involved in the growth, development, and remodeling of the articular cartilage. Vascular endothelial growth factor is expressed by hypertrophic chondrocytes, and its maximal level of expression precedes the maximal level of bone formation. It regulates the neovascularization of the hypertrophic cartilage and influences the removal of the cartilage matrix. The invading blood vessels bring osteogenic progenitor mesenchymal cells into the mineralization front that later differentiate into osteoblasts that engage in osteogenesis.

Inhibition of Necrotic Actions of Nitrogen-Containing Bisphosphonates (NBPs) and Their Elimination From Bone by Etidronate (a Non-NBP): A Proposal for Possible Utilization of Etidronate as a Substitution Drug for NBPs - Corrected Proof

2010-02-16

Purpose: Nitrogen-containing bisphosphonates (NBPs) have powerful anti–bone-resorptive effects (ABREs). However, recent clinical applications have disclosed an unexpected side effect, osteonecrosis of the jaw. We previously found in mice that etidronate (a non-NBP), when coadministered with alendronate (an NBP), inhibited the latter's inflammatory effects. However, etidronate also reduced the ABRE of alendronate. The present study examined in mice the modulating effects of etidronate on the inflammatory and necrotic actions of zoledronate (the NBP with the strongest anti–bone-resorptive activity and the highest incidence of osteonecrosis of the jaw) and on ABREs of various NBPs including zoledronate.Materials and Methods: NBPs were subcutaneously injected into ear pinnas of mice and ensuing inflammation and necrosis at the site of the injection were evaluated. ABREs of NBPs were evaluated by analyzing sclerotic bands induced in mouse tibias.Results: Coinjection of etidronate reduced inflammatory and necrotic reactions induced by zoledronate, and also reduced the amount of zoledronate retained within the ear tissue. When both agents were intraperitoneally injected, etidronate reduced the ABRE of zoledronate and those of other NBPs. Notably, etidronate reduced the ABRE of zoledronate even when this non-NBP was injected 16 hours after the injection of zoledronate. Bone scintigram indicated that etidronate reduced the amount of zoledronate that had already bound to bone.Conclusions: These results suggest that etidronate may 1) inhibit the entry of NBPs into cells related to inflammation and/or necrosis, 2) inhibit the binding of NBPs to bone hydroxyapatite, 3) at least partly eliminate (or substitute for) NBPs that have already accumulated within bones, and thus 4) if used as a substitution drug for NBPs, be effective at treating or preventing NBP-associated osteonecrosis of the jaw.

Inferior Alveolar Nerve Paresthesia Secondary to Orthodontic Tooth Movement: Report of a Case - Corrected Proof

Roseanna Noordhoek, Robert A. Strauss — 2010-02-16

Temporary or permanent paresthesia of the areas innervated by the inferior alveolar nerve (IAN) can be caused by multiple conditions. These include neoplastic disease, infection, orthognathic surgery, endodontic treatment, and secondary to the removal of mandibular third molars. Significant signs on plain films that indicate a tooth root may be in close proximity to the IAN include darkening of the tooth root, narrowing of the tooth root, interruption of the white lines, and diversion of the canal.

A Novel Surgical Approach to Impacted Mandibular Third Molars to Reduce the Risk of Paresthesia: A Case Series - Corrected Proof

2010-02-16

Purpose: Extraction of impacted mandibular third molars (M3s) may cause temporary or permanent neurosensorial disturbances of the inferior alveolar nerve (IAN). Although the incidence of this complication is low, a great range of variability has been reported in the literature. Several methods to reduce or eliminate this complication have been proposed, such as orthodontic-assisted extraction, extraction of the second molar, or intentional odontoectomy. The purpose of this series of cases is to present a novel approach for a riskless extraction of impacted mandibular M3s in contact with the IAN.Materials and Methods: Nine consecutive patients (4 male and 5 female; mean age 24.9 years, range 18-43 years) required the extraction of 10 horizontally or mesioangular impacted mandibular M3s. In all cases the M3 was in contact with the IAN with a high risk of nerve injury. A staged approached was proposed and accepted by the patients. This approach consisted in the surgical removal of the mesial portion of the anatomic crown to create adequate space for mesial M3 migration. After the migration of the M3 had taken place, the extraction could then be accomplished in a second surgical session minimizing neurological risks.Results: All M3s moved mesially within 6 months (mean 174.1 days, range 92-354 days) and could be successfully removed without any neurological consequences.Conclusion: This technique may be considered as an alternative approach to the extraction of horizontally or mesioangular impacted M3s in proximity to the IAN.

Computer-Assisted Surgery in the Edentulous Jaw Based on 3 Fixed Intraoral Reference Points - Corrected Proof

2010-02-16

Purpose: In computer-assisted implantation surgery, the transfer of prosthodontic-guided planning to the operative site is usually based on a registration template. The precise repositioning of the registration template is crucial for high accuracy and is compromised in edentulous jaws. The purpose was to determine the in vitro registration and targeting accuracy for surgical navigation in the edentulous jaw based on 3 fixed intraoral reference points.Materials and Methods: Edentulous maxilla and mandible cadaver specimens were provided with 3 fixed reference-point screws. A resin template with matrices for the fixed reference-point screws was produced and connected to a Vogele-Bale-Hohner registration mouthpiece and external registration frame with a snap-lock system. Surgical implants were planned on computed tomographic data and the corresponding dental stone casts were drilled under guidance of an optical navigation system. For evaluation of the registration accuracy, fiducial registration error was recorded and application accuracy was evaluated by fusion of postsurgical computed tomographic scans of the drilled dental stone casts with the presurgical planning computed tomogram.Results: In 9 maxillas and 5 mandibles, 14 registrations and 104 stone cast drillings were performed. The mean fiducial registration error was 0.49 ± 0.14 mm (0.37 to 0.9 mm). The mean total error at the tip of the borehole was 0.88 ± 0.65 mm (0.0 to 4.24 mm). The mean lateral errors were 0.51 ± 0.49 mm (0.0 to 2.80 mm) at the base and 0.46 ± 0.34 mm (0.0 to 1.5 mm) at the tip of the borehole, respectively. The mean angular error was 0.83 ± 0.60° (0.0 to 2.5°).Conclusion: Three fixed intraoral reference points successfully support a registration mouthpiece and provide in vitro registration and targeting accuracy that is comparable to tooth-supported registration templates or bone marker registration.

Diagnosis and Management of Upper Airway Obstruction Due to Lingual Hematoma: Report of a Case - Corrected Proof

2010-02-16

The tongue is a highly vascular structure with a propensity for brisk hemorrhage as a result of trauma. Hemorrhage within the tongue can result in lingual hematoma formation and subsequent upper airway compromise. Such cases require rapid identification and management to ensure optimal patient outcomes. We describe the management of an expanding lingual hematoma via extraoral ligation of the lingual artery.

Evaluation of Temporomandibular Function After High Partial Condylectomy Because of Unilateral Condylar Hyperactivity - Corrected Proof

2010-02-11

Purpose: The purpose of this study was to assess temporomandibular function after condylectomy because of unilateral condylar hyperactivity (UCH) by means of standardized diagnostic criteria. The results were compared with those obtained in a control group.Patients and Methods: In this study, 33 patients with UCH who underwent condylectomy and 31 controls matched for age and gender filled out a history questionnaire and underwent a clinical examination as part of the research diagnostic criteria for temporomandibular disorders. Data analysis was performed by use of the Fisher exact test for 2-by-2 tables.Results: Patients and controls did not differ significantly regarding myofacial pain (P = .131), disc displacement (P = .516), and depression (P = .34). The groups differed significantly concerning arthralgia, osteoarthritis, and osteoarthrosis (P = .003), as well as pain with low disability (P = .022).Conclusions: In patients with UCH who underwent condylectomy because of progressive mandibular asymmetry, more joint-related temporomandibular problems as well as more postoperative pain developed when compared with age- and gender-matched controls. However, these problems did not lead to more severe disabilities in daily life.

Osteonecrosis of the Jaw in a Patient on Denosumab - Corrected Proof

Tara L. Aghaloo, Alan L. Felsenfeld, Sotirios Tetradis — 2010-02-11

Osteonecrosis of the jaw (ONJ) presents clinically as exposed, necrotic bone in the maxilla or mandible of at least 8 weeks' duration, with or without the presence of pain, infection, or previous trauma in a patient who has not received radiation to the jaws. Although necrotic bone exposure has been reported in the jaws of a variety of patients not receiving bisphosphonates (BPs), the number of BP-related ONJ cases has continued to increase steadily since the first report in 2003. To date, a direct causal relationship between BP use and ONJ has not been established. However, many retrospective and prospective analyses have identified cases of ONJ in which BP therapy, especially the more potent intravenous preparations, was the only consistent variable, strongly suggesting that BPs play a significant role in ONJ pathophysiology.

Endoscopic Observation and Strategic Management of Obstructive Submandibular Sialadenitis - Corrected Proof

Chuangqi Yu, Chi Yang, Lingyan Zheng, Daming Wu — 2010-02-11

Purpose: Obstructive submandibular sialadenitis is a relatively common disease in the clinic. The present study explored the cause and strategic management of chronic obstructive sialadenitis using sialoendoscopy and surgery.Patients and Methods: From January 2005 to October 2007, 128 patients with obstructive symptoms in the submandibular gland were diagnosed using sialoendoscopy and occlusal films, and the obstructions were removed using interventional sialoendoscopy, surgery only, or combined techniques, depending on the size, shape, site, and quality of the sialolith in the duct. The shape and structure of the hilus of the submandibular gland was observed using sialoendoscopy.Results: In the submandibular gland, the histologic features of 128 cases were identified endoscopically and radiographically. The endoscopic findings were of 3 types: sialolith in 114 (89%), mucus plug in 8 (6%), and stenosis in 6 (5%). Of 51 obstructions treated surgically, 47 were removed successfully, for a success rate of 92%. Of 63 obstructions treated using interventional sialoendoscopy, 52 were removed directly by sialoendoscopy, for a success rate of 83%. The unsuccessful cases were treated using sialoendoscopy or surgery. The obstructive symptoms were relieved in 12 of 14 patients without stones using dilation and irrigation under sialoendoscopy. Of the 114 patients with a stone, the sialoliths of 67 (59%) were located in the distal region (behind the first molar). The results showed that the more posterior the stone, the more difficult it was to remove. Three patients with treatment failure ultimately underwent resection of the gland. A basin-like structure in the hilus region was found in 86 (67%) of the 128 patients by sialoendoscopy. Finally, 5 patients were found to have a foreign body (fish bone) surrounded by a sialolith.Conclusions: Sialoendoscopy is a useful new technique, not to only detect the cause of obstruction in a submandibular gland, but also to treat the obstructive submandibular sialadenitis more effectively if incorporated with conventional surgical approaches.

Increased Levels of Soluble Cytokine Receptors in the Synovial Fluid of Temporomandibular Joint Disorders in Relation to Joint Effusion on Magnetic Resonance Images - Corrected Proof

Keiseki Kaneyama, Natsuki Segami, Hiroshi Yoshimura, Miho Honjo, Noboru Demura — 2010-02-11

Purpose: The purpose of this study is to clarify the significance of joint effusion (JE) on T2-weighted magnetic resonance images of the temporomandibular joint (TMJ) in comparison to various soluble cytokine receptors in the synovial fluid of patients with temporomandibular disorders (TMDs).Patients and Methods: Magnetic resonance imaging of 55 TMJs of 55 patients with TMD was performed, and synovial fluid samples were obtained on the same day. The grade of JE was evaluated on a scale from 0 to 3, with grade 0 indicating the absence of JE and grades 1 to 3 indicating the presence of JE. Correlations were measured between JE and the concentrations of soluble tumor necrosis factor receptors I and II, interleukin (IL) 6 soluble receptor, IL-1 soluble receptor type II, and IL-1 receptor antagonist and protein in the synovial fluid samples.Results: The mean concentrations of cytokine receptors in the synovial fluid were significantly higher in the 30 joints with JE than in the 25 joints without JE. There were no correlations between the JE grade and the level of any mediators.Conclusion: Increased levels of cytokine receptors are likely to influence the expression of JE and may play important roles in the pathogenesis of TMD. These results also suggest that JE may reflect synovial inflammation of the TMJ.

Bisphosphonate-Related Osteonecrosis of the Jaw: Is pH the Missing Part in the Pathogenesis Puzzle? - Corrected Proof

2010-02-08

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a side effect of bisphosphonate therapy, primarily diagnosed in patients with cancer and metastatic bone disease and receiving intravenous administrations of nitrogen-containing bisphosphonates. If diagnosis or treatment is delayed, BRONJ can develop to a severe and devastating disease. Numerous studies have focused on BRONJ, with possible pathomechanisms identified to be oversuppression of bone turnover, ischemia due to antiangiogenetic effects, local infections, or soft tissue toxicity. However, the precise pathogenesis largely remains elusive and questions of paramount importance await to be answered, namely 1) Why is only the jaw bone affected? 2) Why and how do the derivatives differ in their potency to induce a BRONJ? and 3) Why and when is BRONJ manifested? The present perspective reflects on existing theories and introduces the hypothesis that local tissue acidosis in the jaw bone offers a conclusive pathogenesis model and may prove to be the missing link in BRONJ.

Use of Panoramic X-Ray to Determine Position of Impacted Maxillary Canines - Corrected Proof

2010-02-08

Purpose: To evaluate the position of impacted maxillary canines in the alveolus using panoramic radiographs.Materials and Methods: The present study was a retrospective chart review of 102 patients with 130 impacted maxillary canines from the University of Illinois at Chicago College of Dentistry and private practice. Of the 130 impacted maxillary canines, 59 were impacted buccally and 71 were impacted palatally. The inclination of the impacted maxillary canines to a horizontal line from the mesiobuccal cusps of the maxillary molars was measured. We used these measurements to predict the position of the tooth and correlate this prediction with the actual approach used during surgery.Results: The mean angulation of the buccally impacted maxillary canines was 75.1° ± 18.2° (range, 8° to 111°). The mean angulation of the palatally impacted maxillary canines was 51.3° ± 15.3° (range, 12° to 91°). The mean difference between the angulation of the impacted maxillary canines as measured on the panoramic radiographs was statistically significant (P < .001). From a receiver-operator characteristic curve and using a logistic regression model, impactions greater than 65° were 26.6 times more likely to be buccally impacted maxillary canines (P < .001).Conclusions: Panoramic radiographs are useful for predicting the location of impacted maxillary canines and the subsequent surgical approach required for exposure and orthodontic appliance attachment when computed tomography is unavailable or unnecessary otherwise. The use of panoramic radiographs for determing impacted maxillary canine position has a high sensitivity and specificity, with angulations greater than 65° associated with buccal impactions.

Sodium Hyaluronate Improves Outcomes After Arthroscopic Lysis and Lavage in Patients With Wilkes Stage III and IV Disease - Corrected Proof

2010-02-08

Purpose: Among patients with Wilkes stage III and IV disease undergoing arthroscopic lysis and lavage, does the use of an intra-articular injection of sodium hyaluronate (SH), when compared with Ringer lavage, result in better postoperative pain control and temporomandibular joint (TMJ) function?Patients and Methods: We designed and implemented a randomized, double-blind, pilot controlled clinical trial. The study sample was composed of patients with middle Wilkes stage (late stage III and early stage IV) disease. Subjects were randomized to 1 of 2 treatment limbs. The treatment group received Ringer lactate plus an injection of 1 mL of SH after arthroscopy, whereas the control group was given Ringer lactate during arthroscopy. The primary outcome variables were pain and TMJ function measured by use of visual analog scales. Appropriate descriptive and bivariate statistics were computed. A P value less than .05 was considered statistically significant.Results: The study sample was composed of 40 patients with 20 subjects enrolled in both treatment groups. There were no statistically significant differences between the 2 groups in terms of demographics and preoperative variables. Postoperative analgesia was statistically significant in the treatment group with respect to the control group on the visits on days 14 and 84. No statistically significant differences were observed between the 2 groups in the maximum interincisal opening and tolerance.Conclusions: An intra-articular injection of SH after arthroscopic lysis and lavage is effective in reducing pain in patients with TMJ dysfunction, enhancing postsurgical recovery. The analgesic effect of treatment with SH is maintained in the long term.

Osteonecrosis or Metastases of the Jaw or Both? Case Report and Review of the Literature - Corrected Proof

Sven Otto, Kirsten Schuler, Stephan Ihrler, Michael Ehrenfeld, Gerson Mast — 2010-02-08

The first description of bisphosphonate-related osteonecrosis of the jaw (BRONJ) was published by Marx in 2003. BRONJ is currently a well-known and serious side effect of bisphosphonate treatment that is still poorly understood. According to the American Association of Oral and Maxillofacial Surgeons task force on BRONJ, diagnosis is made by the presence of exposed bone in the maxillofacial region over a period of 8 weeks in patients with a history of current or previous treatment with bisphosphonates and no history of radiation therapy to the jaws.

Frequency of Bleeding Following Invasive Dental Procedures in Patients on Low-Molecular-Weight Heparin Therapy - Corrected Proof

2010-02-08

Purpose: The purpose of this study was to determine the frequency of bleeding complications after invasive dental procedures in patients on low-molecular-weight heparin (LMWH) therapy.Materials and Methods: A chart review of patients who underwent invasive dental procedures while on LMWH therapy was conducted. The following information was obtained: demographics, medical history, social history, medications, relevant laboratory values, postoperative bleeding events, and use of local hemostatic agents and blood products.Results: Forty-one patients (21 men) were identified with 42 dental appointments. The mean age was 48 years (range, 16 to 78 years). Thirty-seven patients (90%) were on LMWH therapy for deep venous thrombosis prophylaxis. Thirty-one patients (76%) were on concomitant medications that may potentiate bleeding. Multiple dental extractions (range, 2 to 14 teeth) were performed during 19 dental appointments. Twenty-one appointments were for single-tooth extraction and 2 were for soft tissue biopsies. Three patients (7%) had postextraction bleeding events. All 3 patients were on LMWH (enoxaparin) and warfarin therapy concurrently. One patient had persistent bleeding after extraction of 4 teeth (international normalized ratio, 1.6), which was successfully controlled with topical thrombin, administration of vitamin K and fresh frozen plasma, and discontinuation of enoxaparin and warfarin. Postoperative bleeding in the other 2 patients was managed successfully with local hemostatic measures and home care instructions.Conclusion: Our study suggests that, although postoperative bleeding in patients on LMWH therapy alone is rare to nonexistent, patients on warfarin and LMWH may be at increased risk of bleeding after invasive dental procedures.

Scintigraphic Evaluation of Osteoblastic Activity in Extraction Sockets Treated With Platelet-Rich Fibrin - Corrected Proof

2010-02-08

Purpose: To evaluate the effect of platelet-rich fibrin (PRF) on the early bone healing process with bone scintigraphy based on technetium-99m methylene diphosphonate uptake in third molar extraction sockets.Patients and Methods: Fourteen patients with bilaterally soft tissue impacted third mandibular molars were included in the study. The right and left impacted third molars were surgically extracted in the same session. PRF was randomly administered into one of the extraction sockets, whereas the contralateral sockets were left without treatment. Four weeks after surgery, scintigrams were obtained to evaluate scintigraphic differences between PRF-treated and non–PRF-treated sockets. After completion of the clinical study, PRF samples were evaluated by light and scanning electron microscopy.Results: The average increase in technetium-99m methylene diphosphonate uptake as an indication of enhanced bone healing did not differ significantly between PRF-treated and non–PRF-treated sockets 4 weeks postoperatively (P > .05). Abundant fibrin and inflammatory cells were observed by light microscopic examination of PRF samples. Scanning electron microscopic analysis of PRF revealed the existence of platelet aggregates in a fibrin network and crystalline particles on the outer surface of PRF.Conclusions: PRF might not lead to enhanced bone healing in soft tissue impacted mandibular third molar extraction sockets 4 weeks after surgery. PRF exhibits the potential characteristics of an autologous fibrin matrix. However, whether the presence of crystal-like particles on the outer surface of PRF alters bone healing should be investigated further.

Cryptogenic Stroke and Parotid Tumor Surgery: A Case Report - Corrected Proof

2010-02-01

Parotid tumor surgery has been rarely complicated by cerebral vascular accidents, and the occurrence of a stroke after an operation of the parotid gland for the removal of a tumor seems to be a very unusual complication, having been reported in the literature only once thus far.

Effects of Postoperative Radiotherapy for Temporomandibular Joint Ankylosis After Gap Arthroplasty: An Animal Study Using Sheep - Corrected Proof

2010-02-01

Purpose: The aim of the present study was to examine the effects of postoperative irradiation on reducing heterotopic bone formation after gap arthroplasty release of temporomandibular joint ankylosis.Materials and Methods: Five sheep underwent induction of right temporomandibular joint ankylosis. After 3 months, the ankylosis was released by gap arthroplasty. At 24 hours after the release, they received a single radiation dose of 10 Gy. All sheep were sacrificed at 3 months after gap arthroplasty release. The body weight, jaw opening amount, and radiographs were measured at key intervals, with histologic assessment after death. The findings were compared with those in a control group treated with gap arthroplasty without irradiation.Results: The clinical measurements, radiographs, and histologic findings all revealed less evidence of reankylosis in the irradiated sheep.Conclusion: The results of the present study have shown that a single radiation dose at 24 hours after gap arthroplasty for temporomandibular joint ankylosis inhibits heterotopic ossification.

Aneurysmal Bone Cysts of the Jaws: Analysis of 17 Cases - Corrected Proof

Zhi-Jun Sun, Yi-Fang Zhao, Rui-Li Yang, Roger A. Zwahlen — 2010-01-28

Purpose: Aneurysmal bone cysts (ABCs) are benign osteolytic lesions that occur relatively rarely in the jaws. The aim of the present study was to investigate the clinical and radiographic characteristics, pathologic features, and treatment results of ABCs of the jaws (JABCs).Materials and Methods: A retrospective analysis of a 20-year database, including 17 cases of JABC, was performed.Results: A total of 17 patients, 9 males and 8 females, aged 7 to 47 years (mean 20.4, median 14), were included. Of the 17 lesions, 15 (88.2%) were located in the mandible and 2 (11.8%) in the maxilla. A painless (12 of 17, 70.6%) or painful (3 of 17, 17.6%) swelling was the most common clinical finding. The pathologic analyses revealed that 13 JABCs (76.5%) were secondary in nature, including 11 cases associated with ossifying fibroma. Radiologically, the lesions frequently presented as multilocular (58.8%), well-defined (70.6%) radiolucencies (82.4%). Two lesions (11.8%) recurred.Conclusions: Our results suggest that most JABCs are secondary in nature and frequently associated with ossifying fibroma. The patients with JABCs presented with various clinical and radiographic features and therefore often posed a diagnostic dilemma. Resection is the preferred treatment of JABCs.

Frequency of Agenesis, Impaction, Angulation, and Related Pathologic Changes of Third Molar Teeth in Orthodontic Patients - Corrected Proof

Mevlut Celikoglu, Ozkan Miloglu, Fatih Kazanci — 2010-01-25

Purpose: The objectives of the present study were to investigate the frequency of impaction, agenesis, angular position, and related pathologic changes of third molar teeth in a group of orthodontic patients.Materials and Methods: Our sample included the panoramic radiographs of 351 orthodontic patients aged 20 to 26 years (mean 22.8). The descriptive characteristics of agenesis, impaction, angular position, and pathologic changes of third molars were recorded. The χ2 test was used for analysis.Results: The proportion of third molar agenesis was 17.3% with no statistically significant gender differences (18.4% for women and 15.8% for men). The frequency of impacted third molars (ITMs) was 35.9% (24.2% in men and 45.0% in women; P < .05). The frequency of maxillary ITMs was 43.2% (192 of 444 teeth), and the frequency of mandibular ITMs was 56.8% (252 of 444 teeth). The position observed most often was mesioangular inclination, with a frequency of 50.0%. Only 10.4% of the ITM teeth were affected by any pathologic changes, and most of these changes were associated with the horizontal position.Conclusions: The present results showed that agenesis accounted for 17.3% and impaction for 35.9% of the pathologic features in this group of Turkish orthodontic patients aged 20 to 26 years of age. Mesioangular inclination was seen in 50.0%, and a small proportion (10.4%) had pathologic changes of the ITMs.

Comparison of Titanium and Biodegradable Miniplates for Fixation of Mandibular Fractures - Corrected Proof

2010-01-25

Purpose: The purpose of the present study was to compare the use of biodegradable miniplates and titanium miniplates for the fixation of mandibular fractures.Patients and Methods: BioSorb FX biodegradable plates and screws and titanium miniplates were used in 91 patients (65 males and 26 females; age range 11 to 69 years) for the treatment of mandibular fractures. The clinical and radiographic findings were recorded at 1, 3, 6, and 12 months after surgery.Results: The overall complication rate was 4.41%. In the biodegradable plate group, infection occurred in 2 cases (4.26%) and was resolved by incision and drainage and antibiotics. In the titanium plate group, infection occurred in 1 case and plate fracture in 1 case (4.56%). The fractured plate was removed, and a new titanium miniplate was applied using a trocar. The infection was resolved with antibiotics. No adverse tissue reactions, malocclusions, or malunions occurred during the observation period.Conclusions: Our results have shown that the rate of morbidity is very low with the use of biodegradable plates and titanium plates, suggesting that biodegradable and titanium plates have the potential for successful use in the fixation of mandibular fractures.

Unilateral Parotid Gland Involvement With Synchronous Multiple Basal Cell Adenocarcinomas: Case Report and Review of the Literature - Corrected Proof

Jingzhou Hu, Zhiyuan Zhang, Jiawei Zheng, Weimin Ye, Zhen Tian, Hanguang Zhu — 2010-01-25

Salivary gland tumors account for about 3% of all head and neck neoplasms. Basal cell adenocarcinoma (BCAC) is a rare malignant neoplasm of the salivary glands that most commonly affects the major salivary glands. Since its inclusion in the World Health Organization classification of salivary gland tumors in 1991, the description of the entity is relatively new, with about 100 cases reported.