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Objectives: The consecutive case series accesses the results and experiences of ridge augmentation using an umbrella screw tenting technique. Method and materials: In total, 279 patients were treated between 26 May 2015 and 16 June 2021, including horizontal and vertical ridge defects. Sex, age, smoking behavior, jaw, graft material, soft tissue thickness, extent of horizontal/vertical augmentation, resorption rate, and occurrence of early/late exposure were evaluated. Bone gain was determined by resorption at the screw head. Only cases without premature screw removal were evaluated metrically (n = 201). All other augmentations were evaluated according to whether implantation was possible with or without further augmentation (n = 27). A target performance index was calculated, which should enable evidence-based comparability of different augmentation methods in future. Results: In total, 54 wound dehiscences (39 early, 15 late exposures) occurred, which corresponds to 24.08% of the augmented sites; 42 umbrella screws were removed prematurely. In all cases an implantation was possible at the desired position afterwards. Cases with a vertical augmentation component showed a higher prevalence of exposure (early, P = .000; late, P = .024). The extent of the vertical augmentation was only relevant for early exposure (P = .048). Mean bone gain of 4.23 ± 1.69 mm horizontally and 4.11 ± 1.99 mm vertically could be achieved. Regression analysis showed that there was no limit in horizontal/vertical direction. Mean percentage target performance index was 75.90 ± 20.54 for vertical and 82.25 ± 16.67 for horizontal portions. Conclusion: The umbrella technique is an effective augmentation method, which can be applied to any defect morphology. [ABSTRACT FROM AUTHOR]

The article describes the case of a one-day-old female born at term with arthrogryposis multiplex congenita evaluated by the Pediatric Genetics service after whole exome sequencing on amniocentesis identified a de novo pathogenic ZC4H2 variant associated with ZC4H2-related neurodevelopmental disorder with multiple congenital anomalies. Topics include pregnancy complication suffered by the infant's mother, findings on echocardiogram, and characteristics of ZC4H2-associated disorders.

Background: Cerebro-costo-mandibular syndrome (CCMS) is a rare congenital syndrome consisting of the main features of micrognathia and posterior rib gaps. Due to multiple abnormalities, patients almost have difficulty breathing with upper airway obstruction, decreased thoracic capacity, spina bifida, and scoliosis. Case presentation: We describe a case of a late preterm neonate boy presenting with low Apgar, respiratory distress, and complicated orofacial anomalies that had a poor outcome. His radiographic findings showed mandibular hypoplasia (micrognathia), chest deformity, multiple posterior rib gap defects, and abnormal costotransverse articulation. Based on physical examination and radiologic findings, the diagnosis of CCMS confirmed for the patient. Conclusion: Physicians should always consider the diagnosis of CCMS in all infants with micrognathia and rib-gap defects. These infants need careful respiratory function monitoring. Early airway management improves growth and development. In addition, their physical and psychological development should be assessed regularly. [ABSTRACT FROM AUTHOR]

Orthodontic treatment for patients with dentinogenesis imperfecta (DGI) can be risky because of the fragility of their dental hard tissue. Although the Invisalign (Align Technology) clear aligner system should be a suitable orthodontic appliance for patients with DGI, to the authors' knowledge, there has been no related research. A 28-year-old woman with DGI sought treatment with a 1 mm open bite, edge-to-edge occlusion of the central incisors, and a bilateral Class III cusp-to-cusp molar relationship. Invisalign was applied for her treatment, and after 3 and one-half years of orthodontic therapy, a normal overjet and overbite were achieved, accompanied by retraction of the lower lip as well as a bilateral Class I molar relationship. In addition, there was no iatrogenic injury to the patient's teeth. The Invisalign system may be a suitable orthodontic appliance for patients with DGI because clear aligners lessen the tensile stress to the teeth, decrease the number and area of bonds to the teeth, and offer protective effects through a full wrap of plastic that covers the crowns of the teeth. [ABSTRACT FROM AUTHOR]

To describe the role of body posture and skeletal class in the symmetrical activity of chewing muscles. Descriptive study with association. Skeletal class measured by the Steiner method. Postural analysis through APECS mobile application for forward head posture and shoulder discrepancy, and surface electromyography with Biopac® device. The skeletal class, forward head posture, and shoulder discrepancy presented statistical association with the symmetrical electromyographic response of digastric muscles and masseter muscles during swallowing. This study exhibited a positive relationship between digastric muscle symmetry and skeletal class during swallowing. The compensation of the hyoid system explains these results, showing that skeletal Class III has better electromyographic balance. In contrast, masseter muscle symmetry during swallowing presented a negative relationship with skeletal class. The stabilization role that this muscle plays during swallowing explains these findings, caused by the different lengths and direction of this muscle in skeletal Class III. [ABSTRACT FROM AUTHOR]

Copyright of Mersin Üniversitesi sağlık Bilimleri Dergisi is the property of Mersin University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Increased daytime sleepiness is a frequently reported symptom in patients with pronounced dysgnathia. Objectives: This study investigated possible correlations using home peripheral arterial tonometry (PAT) and oropharyngeal airway volume determination in patients with dysgnathia and daytime sleepiness. Methods: Twenty patients (13 male, median age 27.6 ± 6.8 years) with abnormal sleep history and 10 skeletal neutral configured controls (6 male, median age 29.5 ± 4.2 years) with normal sleep history were examined. Patients and controls were evaluated for apnoea–hypopnoea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), snoring volume (dB), total sleep time (TST) and REM‐percentage (REM). Airway volumetry was measured via CBCT. Individual user experience for PAT was assessed using the User Experience Questionnaire (UEQ). Results: Patients had significantly higher respiratory scores than controls. AHI increased 4.6‐fold (p =.006), RDI 2.5‐fold (p =.008) and ODI 6.4‐fold (p <.001). Oropharyngeal volumes showed a 30% decrease (p =.003). dB, TST and REM showed no significant differences. AHI (r = −.51; p =.005), ODI (r = −.60; p <.001) and RDI (r = −.45; p =.016) correlated negatively with pharyngeal volume. Wits appraisal correlated negatively with oropharyngeal volume (r = −.47; p =.010) and positively with AHI (r =.41; p =.03) and ODI (r =.49; p =.007). dB and TST (r = −.49; p =.008) and REM and RDI (r = −.43; p =.02) correlated negatively. UEQ‐KPI (2.17 ± 0.24) confirmed excellent usability of PAT. Conclusion: Patients with mandibular retrognathia and abnormal sleep history showed significantly higher respiratory indices and smaller oropharyngeal volumes than neutrally configured controls. The dygnathia severity directly influenced the risk of obstructive sleep apnoea. [ABSTRACT FROM AUTHOR]

Copyright of Necmettin Erbakan University Dental Journal (NEU Dent J) is the property of Necmettin Erbakan University Dental Journal (NEU Dent J) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The purpose of this study was to clarify the panoramic image differences of cleft alveolus patients with or without a cleft palate, with emphases on the visibility of the line formed by the junction between the nasal septum and nasal floor (the upper line) and the appearances of the maxillary lateral incisor. Materials and Methods: Panoramic radiographs of 238 patients with cleft alveolus were analyzed for the visibility of the upper line, including clear, obscure or invisible, and the appearances of the maxillary lateral incisor, regarding congenital absence, incomplete growth, delayed eruption and medial inclination. Differences in the distribution ratio of these visibility and appearances were verified between the patients with and without a cleft palate using the chisquare test. Results: There was a significant difference in the visibility distribution of the upper line between the patients with and without a cleft palate (p<0.05). In most of the patients with a cleft palate, the upper line was not observed. In the unilateral cleft alveolus patients, the medial inclination of the maxillary lateral incisor was more frequently observed in patients with a cleft palate than in patients without a cleft palate. Conclusion: Two differences were identified in panoramic appearances. The first was the disappearance (invisible appearance) of the upper line in patients with a cleft palate, and the second was a change in the medial inclination on the affected side maxillary lateral incisor in unilateral cleft alveolus patients with a cleft palate. [ABSTRACT FROM AUTHOR]

Objective: To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. Design: Prospective, observational, and cross-sectional study. Setting: Tertiary reference hospital for the rehabilitation of craniofacial anomalies. Participants: Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. Results: The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. Clinical Parameters: Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤.05). One patient presented with mild OSA (apnea–hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. Conclusions: A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia. [ABSTRACT FROM AUTHOR]

Cherubism is a rare disorder characterized by proliferative fibro-osseous lesions that result in bilateral bony hyperplasia of the face. Management varies based on symptom severity and includes longitudinal follow-up, pharmacotherapy, and/or surgical debulking. Off-label treatment with denosumab, a human monoclonal antibody that binds RANKL and inhibits osteoclast function to reduce bone resorption, can be beneficial in suppressing the proliferation of bone to minimize the need for surgery and to control postoperative reproliferation. Close follow-up is needed to maintain appropriate electrolyte levels. The present case demonstrates the achievement of symptomatic control with denosumab in a child with severe refractory cherubism. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between perception of craniofacial deformity, geometric head features, and 3D head shape analyzed by statistical shape modeling (SSM). Patients: A total of 18 unoperated patients with scaphocephaly (age = 5.2 ± 1.1m)—6 were followed-up after spring-assisted cranioplasty (SAC) (age = 9.6 ± 1.5m)—and 6 controls (age = 6.7 ± 2.5m). Main Outcome Measures: 3D head shapes were retrieved from 3D scans or computed tomography (CTs). Various geometrical features were measured: anterior and posterior prominence, take-off angle, average anterior and posterior lateral and horizontal curvatures, cranial index (CI) (cranial width over length), and turricephaly index (TI) (cranial height over length). SSM and principal component analysis (PCA) described shape variability. All models were 3D printed; the perception of deformity was blindly scored by 9 surgeons and 1 radiologist in terms of frontal bossing (FB), occipital bulleting (OB), biparietal narrowing (BN), low posterior vertex (LPV), and overall head shape (OHS). Results: A moderate correlation was found between FB and anterior prominence (r = 0.56, P <.01) and take-off angle (r = − 0.57, P <.01). OB correlated with average posterior lateral curvature (r = 0.43, P < 0.01) similarly to BPN (r = 0.55, P <.01) and LPV (r = 0.43, P <.01). OHS showed strong correlation with CI (r = − 0.68, P <.01) and TI (r = 0.63, P <.01). SSM Mode 1 correlated with OHS (r = 0.66, p <.01) while Mode 3 correlated with FB (r = − 0.58, P <.01). Conclusions: Esthetic cranial appearance in craniofacial patients is correlated to specific geometric parameters and could be estimated using automated methods such as SSM. [ABSTRACT FROM AUTHOR]

Hemifacial microsomia (HFM) patients may benefit from extended temporomandibular joint replacements (eTMJR) to improve function and quality of life. A cross-sectional survey was sent to surgeons who place alloplastic temporomandibular joints regarding their experience with and complications encountered when placing eTMJR in patients with HFM. Fifty-nine responded to the survey. Thirty-six (61.0%) reported treating patients with HFM and 30 (50.8%) of those reported placing an alloplastic temporomandibular joint (TMJ) prosthesis for patients with HFM. Twenty-three of the 30 surgeons (76.7%) placing alloplastic TMJ prostheses reported using an eTMJR in patients with HFM. The average maximum inter-incisal opening (MIO) after an eTMJR in HFM patients was repor ted as> 25 mm by 82.6% of the participants, and between 16 mm and 25 mm by 17.4%. No participants reported MIO < 15 mm. To avoid condylar sag and open bite changes postoperatively, over 70% reported using some form of modification to stabilize the occlusion. Respondents reported good functional outcomes for eTMJR in patients with HFM with relatively few complications. Therefore, eTMJR could be considered a viable option in the management of this patient population. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare single- and double-layer digital template-assisted genioplasty for the correction of jaw deformity resulting from temporomandibular joint ankylosis (TMJA). Thirteen patients with jaw deformity resulting from TMJA who underwent lateral arthroplasty, costochondral graft, or total joint replacement combined with single- or double-layer digital template-assisted genioplasty were included. Computed tomography data were obtained for the preoperative design. Digital templates were designed and manufactured using three-dimensional printing to assist with the chin osteotomy and repositioning in single- or double-layer genioplasty. Of the 13 patients included, seven underwent single-layer genioplasty and six underwent double-layer genioplasty. The digital templates precisely reflected the osteotomy planes and repositioning of the chin segments intraoperatively. The radiographic evaluation showed that the patients who underwent double-layer genioplasty exhibited more chin advancement (11.95 ± 0.92 mm vs 7.50 ± 0.89 mm; P < 0.001) with a slightly larger mean surface error (1.19 ± 0.14 mm vs 0.75 ± 0.15 mm; P < 0.001) than those who underwent single-layer genioplasty. This indicates that double-layer genioplasty better promoted chin advancement and improved the facial shape, but was accompanied by more surgical error compared with the preoperative design. Furthermore, hardly any nerve damage was observed. Digital templates are useful for assisting in surgical procedures. [ABSTRACT FROM AUTHOR]

Objective: Functional appliances are used in orthodontics to bring about correction of mandibular retrognathism by forward positioning and eventually remodeling the condyle- glenoid fossa to retain this new position. Research has shown that these appliances have a significant effect on pharyngeal airway of patients. The aim of this study was to evaluate changes in volume and minimum constriction area in the pharyngeal airway using CBCT imaging after correction of mandibular retrognathism with an Advansync2 Class II corrector. Methods: This single-center study consisted of 20 Class II patients (mean age 14.8 years) who required correction of mandibular retrognathism. The patients were treated with the Advansync2 Class II corrector for an average of 26 weeks. CBCT records were taken at T0 (beginning of treatment) and T1 (end of functional phase). The airway was segmented into lower nasopharynx, velopharynx and oropharynx and analyzed for changes in partial volume, total volume, and minimum area using a CBCT software [NewTom 3GTM (Newtom- Cefla S.C., Verona, Italy)]. Results: The partial and total volumes were significantly larger at T1 than at T0 (p =.003,.001). In addition, minimum area also improved in each part of the airway (p =.005,.022,.001). Conclusion: The Advansync2 fixed functional appliance can be used in Class II patients requiring improvement in their airway dimensions. However, additional long-term studies are recommended to confirm these findings. [ABSTRACT FROM AUTHOR]

A neonate, with complete fibrous congenital alveolar synechiae and amniotic band syndrome affecting the upper and lower limbs, was posted for surgical release of synechiae under anaesthesia. A neonate with no mouth opening poses many anaesthesia challenges. The surgical and anaesthesia plan was discussed with ear, nose and throat surgeons. Topicalisation of airway, small aliquots of intravenous (IV) ketamine and propofol and sevoflurane inhalation helped achieve adequate depth of anaesthesia to carry out flexible intubating video endoscope-guided nasotracheal intubation successfully. Post-surgery, a check laryngoscopy with D-Blade of C-MACR (Karl Storz Video Macintosh Laryngoscope) video laryngoscope revealed a Cormack Lehane view of grade IV. The trachea was not extubated on table and the baby was shifted back to the neonatal intensive care unit with pressure support ventilation and followed by tracheal extubation next morning. Rest of the course for the baby was uneventful. Anticipation, planning, preparedness, vigilance and team work during anaesthesia management led to a successful outcome in this case. [ABSTRACT FROM AUTHOR]

Marcus Gunn jaw wink phenomenon or Trigeminal oculomotor synkinesis, is a congenital disorder in which the upper lid moves synkinetically in response to jaw movement during chewing. The term synkinesis describes the simultaneous movement or a coordinated sequence of movements of muscles, which are supplied by different nerves or by separate peripheral branches of the same nerve. Although it rarely manifests bilaterally, it is typically unilateral. In 1883, Dr Robert Marcus Gunn, a Scottish Ophthalmologist described a 15-year-old girl with a peculiar type of congenital ptosis that included an associated winking motion of the affected eyelid on the movement of the jaw. It is known to affect both men and women equally. This phenomenon has been reported to be a similar phenomenon affecting 2-13% of all cases of congenital ptosis. It can be congenital or acquired, for example through trauma. The Congenital Marcus Gunn jaw wink phenomenon is thought to arise from the connection between the branch of the trigeminal nerve (responsible for chewing) supplying the middle or lateral pterygoid muscle and the branch of the oculomotor nerve supplying the upper superior levator ocular defect. Here we present a case report of Marcus Gunn's Jaw-Winking Synkinesis in congenital ptosis. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to present comprehensive skeletal, dental and facial aesthetic outcomes and long-term stability of maxillary anterior segmental distraction osteogenesis (MASDO) for the treatment of maxillary hypoplasia in CLP. Materials and methods: Six patients with maxillary hypoplasia treated with MASDO by a miniscrew assisted intraoral tooth-borne distractor were included. Cephalometric radiographs were obtained before distraction (T1), after the consolidation period (T2) and after orthodontic treatment or before orthognathic surgery (T3). Thirty-one cephalometric variables (12 skeletal, 9 dental, and 10 soft tissue variables) were used to evaluate changes in the dentofacial structures and the soft tissue profile. Friedman and Wilcoxon tests were applied to identify significant differences in hard and soft tissue changes during the T1–T2, T2–T3, and T1–T3 periods. Results: All patients successfully underwent MASDO without serious complications. From T1 to T2, forward movements of ANS and A (FH ⊥ N–A, VRL–ANS and VRL–A) were significant (p < 0.05). Significant increases in SNA and ANB were noted. Significant upward movement of points ANS (CFH–ANS) and A (CFH–A) was observed (p < 0.05). After distraction, a significant decrease in overjet and an increase in overbite were obtained (p < 0.05). Anterior tipping of the upper incisors (U1/ANS–PNS and U1/SN) was observed (p < 0.05). The soft tissue points of Pn, Sn, Ss, and ls showed significant anterior movement (p < 0.05). In addition, a significant increase in the nasolabial angle was measured (p < 0.05). All of the above data showed no statistically significant changes between T2 and T3 (p > 0.05). Conclusion: MASDO using a miniscrew assisted tooth-borne distractor presented significant maxillary advancement and favorable long-term stability in treating CLP patients with maxillary hypoplasia. [ABSTRACT FROM AUTHOR]

The objective of this case report is to describe the treatment of a dentofacial and temporomandibular joint (TMJ) deformity by means of reconstruction with a customized TMJ prosthesis and orthognathic surgery. The article discusses the therapeutic approach and the importance of functional and esthetic rehabilitation of the patient. A 22-year-old man displayed sequelae of osteomyelitis diagnosed at 6 years of age, including facial asymmetry, laterognathism, unsatisfactory occlusion, and mandibular retrognathism. Computed tomography revealed a deformity of the left mandibular condyle, ramus, and fossa. The patient underwent 1-stage surgery that involved bimaxillary orthognathic surgery and mentoplasty in conjunction with reconstruction of the left TMJ with a customized prosthesis. Postoperatively, substantial improvement was observed in the patient's facial pattern and masticatory function, and the beneficial changes have been maintained through 2 years of follow-up. The positive outcome in this patient suggests that TMJ reconstruction using a customized prosthesis in combination with computer-guided orthognathic surgery can be a satisfactory approach to correct a mandibular defect. The advantages of 1-stage surgery for the surgeon include shorter treatment time and more predictable results, while the benefits for the patient are good esthetic and functional results and improved quality of life. [ABSTRACT FROM AUTHOR]

Purpose: The double coronoid process (DCP) is a very unusual feature in patient. The literature, which briefly describes just only one case. Being this a very unusual feature, the aim of the paper is to describe the finding, discuss the anatomic, radiological, and clinical characteristics of a DCP. Methods: A 61-year-old-woman with no significant medical history, extraoral and intraoral examination was unremarkable. Following panoramic radiography (PR) for assessment of periodontal support and pre-implant planning suspicious radiopaque area in the mandibular notch on the left side was observed. Cone-Beam Computed Tomography (CBCT) and Magnetic resonance imaging (MRI) were subsequently performed. Results: No signs and symptoms of syndromes or medical records with a relevant contribution to the DCP existence and the patient denied any type of facial trauma. CBCT image showed the structure found on the PR was indeed a DCP and it was not superimposed on the mandibular notch area, MRI was performed to investigate soft tissue components and temporomandibular joint (TMJ) or other alterations. Conclusion: DPC is extremely rare with the only case reported in the literature within the same comparison parameters. In this case images revealed the muscles, articular surfaces and articular disc were well preserved, and no other alterations were found. [ABSTRACT FROM AUTHOR]

Background: Skeletal nongrowing class II patients with retrognathic mandible are often at risk of developing obstructive sleep apnea (OSA). This skeletal discrepancy, when severe enough, is often addressed by surgical mandibular advancement which not only achieves aesthetics, structural balance, and functional efficiency but also improves the airway function. Objective: The aim of the study was to evaluate the effectiveness of surgical mandibular advancement on airway dimensions, in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA. Materials and Methods: The sample consisted of 8 patients with skeletal class II due to retrognathic mandible associated with OSA. Screening was done with functional outcomes of sleep questionnaire (FOSQ) score and confirmed with polysomnography. Pretreatment and posttreatment airway dimensions/volume were assessed and calculated on cone beam computed tomography (CBCT). Three months post surgery, oxygen saturation was recorded. Results: A statistically significant improvement in mean oxygen saturation level was observed from 87.62 ± 7.70 to 97.75 ± 0.46 and mean increase in airway volume was from 48.60 ± 7.17 to 69.48 ± 26.22. The smallest cross section increased from 137 ± 74.37 to 253.75 ± 76.67. Anteroposterior dimensions increased significantly from 6.17 ± 1.78 to 9.33 ± 2.07 and transversed from 24.56 ± 6.41 to 30.14 ± 3.35. FOSQ score improved from 9.37 ± 2.61 to 15.25 ± 0.88. Conclusion: Surgical mandibular advancement is an effective treatment option in improving airway dimensions in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA. [ABSTRACT FROM AUTHOR]

Congenital fusion of the jaws (syngnathia) is a rare facial malformation with an unknown etiology. This disease may vary in severity with adhesion of soft tissue and bony fusion. It can be anterior fusion, unilateral or bilateral fusion, and complete fusion. The main problem of these patients is the difficulty of airway maintenance and feeding, and the most common postoperative complication is the relapse of bony fusion. Here, we report a young male patient with bony syngnathia, involving bilateral fusion of the ascending ramus and body of the mandible with the maxillary complex. We performed bone isolation by computer-assisted preoperative planning and used an insertional temporalis flap to fix the wound surface to prevent refusion of bone. [ABSTRACT FROM AUTHOR]

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Purpose: To report retro-prospective, long-term data on the prevalence of implant failures related to maxillary and mandibular arches and to different implant surfaces in a large number of edentulous patients.Materials and Methods: Altogether, 3,493 and 1,092 edentulous arches were consecutively treated with implants with turned (1986-2002) or moderately rough (2003-2015) surfaces, respectively, during two time periods at one referral clinic. All implant failures were consecutively identified during routine follow-up, and a multivariate logistic regression analysis was performed to analyze implant failure related to arch and implant surface.Results: Overall cumulative survival rates (CSR) for arches treated with turned surface implants were 75.7% and 94.6% for the maxilla and mandible, respectively. The corresponding 10-year CSRs for arches treated with implants with a moderately rough surface were 91.9% and 96.1%, respectively. The strongest significant association (P < .05) with risk for implant failure was the maxilla, and this was more pronounced for implants with a turned surface. Age at surgery, implant surgeon, calendar year of surgery, and time of follow-up also had significant associations with risk of implant failure (P < .05).Conclusion: Risk for implant failure was significantly higher for treatment in the maxilla, but this risk was decreased significantly when using implants with a moderately rough surface. The impact of surface was not so obvious for treatment in the mandible. Risk for late implant failures after the first year was lower for implants with a moderately rough surface in the maxilla, but this risk seemed to be comparable for the different surfaces in the mandible. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the stability and complications of mandibular anterior subapical osteotomy (ASO) in the treatment of bimaxillary dentoalveolar protrusion by way of a retrospective study. Materials and methods: One hundred and twenty patients who received orthognathic surgery at a single center between 2008 and 2017 were included. Relapse was assessed by serial tracings of lateral cephalograms which were obtained pre-operatively (T1), within 6 weeks after surgery (T2) and at 2 years after surgery. The changes between T2 and T3 represented stability and were tested using the paired t test. The relationship between the extents of surgical repositioning (T2–T1) and relapse (T3–T2) was investigated using the Pearson correlation coefficient. The associations between the variables and the occurrence of relapse and complications identified the risk factors and were evaluated using the χ2 test or Fisher's exact test. When r > 0.80, clinical correlation was considered significant; and statistical significance was set at P < 0.05, while confidence interval was set at 95%. Results: There was a mean uprighting of L1-MP by 12.7°. At 2 years after surgery, 96.7% of the patients experienced a mean relapse of L1-MP by 2.9°. The extent of surgical repositioning was only weakly correlated with that of relapse and no specific factor that increased the risk of relapse could be identified. The most frequent complications were blood loss requiring transfusion, wound dehiscence or infection, gingival recession, and periodontal bone loss, involving 25.8 to 43.3% of the patients. The remaining complications included tooth root damage, fixation hardware exposure or infection, lingual mucosal laceration, and tooth devitalization. There were no cases of avascular necrosis or nonunion. Conclusions: Although relapse occurred in most of the patients after 2 years, the actual extent was small (2.9°) which was not likely to be clinically significant. Trial registration: HKUCTR-2964 Clinical relevance: Although ASO may be valuable in correcting mandibular dentoalveolar protrusion, the procedure brings with it risks and complications and should be reserved for severe deformities. [ABSTRACT FROM AUTHOR]

The goal of this study was to describe a series of orthognathic surgery cases in which a clear aligner system was used for orthodontic treatment. A total of 16 cases were undertaken. A majority of the patients were female (68.75%), and the mean age of the patients was 26.78 years (SD 10.85 years). The most frequent malocclusion was Class II (56.25%), mainly caused by mandibular retrognathism (80.00%). Most of the patients were treated with single-jaw surgeries (56.15%). Orthodontic buttons and elastics were used for maxillomandibular fixation in 81.25% of the patients. The mean (SD) treatment period was 19.00 (1.11) months, and the postsurgical follow-up varied from 6 months to 10 years. Good results were achieved with orthognathic surgery and the adjunctive use of clear aligners, and no damage was noted during the orthosurgical treatment. Since clear aligners provide an esthetic, removable appliance and may be more acceptable to patients than conventional orthodontic appliances, the use of clear aligners in orthognathic surgery is a promising alternative to traditional orthodontics. [ABSTRACT FROM AUTHOR]

Introduction An orthodontist's primary objective is to diagnose and describe the characteristics of any particular malocclusion. It has been reported that when the anteroposterior dimension of the maxilla is either reduced or increased, the measured dentoalveolar and skeletal parameters gets affected in other dimensions also. Aim This study aims to assess and compare the dentofacial characteristics in individuals with different skeletal morphology (normal, retrognathic, and prognathic maxilla). Materials and Methods A total of 194 individuals in the age group of 18 to 32 years were grouped as group I (34 males, 33 females) with normal maxilla, group II (30 males, 32 females) with retrognathic maxilla, and group III (34 males, 31 females) with prognathic maxilla. The measurements of N-A and anterior nasal spine to posterior nasal spine were the basis for selecting the individuals. The dentoalveolar characteristics were assessed using 17 lateral cephalometric and 08 posteroanterior (P-A) cephalometric parameters. Results The data of the study when analyzed statistically using sample "t" test (p < 0.05), revealed significant differences between the genders within the groups. All 08 characteristics measured in the P-A cephalogram showed had significant differences. Pairwise comparison between the groups was performed using the Tukey post hoc test (p < 0.05) and significant differences in various dentoalveolar characteristics were observed between the groups. Conclusion Dentoalveolar and facial parameters showed a significant degree of sexual dimorphism associated with maxillary morphology in all three groups of individuals. The majority of the parameters showed male dominance, and the differences were statistically significant. Statistically significant differences were observed in dentofacial characteristics in individuals with different skeletal morphologies [ABSTRACT FROM AUTHOR]

Introduction: Difficult laryngoscopy (DL) was established as the most accurate determinant of difficult intubation. Here, we sought to assess the diagnostic value of various bedside tests for predicting DL. We also aimed to create a regression model in this context. Methods: 137 patients were included in the study. Demographic features and eight diagnostic variables were evaluated for DL predictivity. These were retrognathia, presence of buck teeth, modified Mallampati test (MMT), upper lip bite test (ULBT), sternomental distance, interincisor distance (IID), thyromental distance, and neck circumference. DL was identified by Grade III-IV view during laryngoscopy according to the Cormack-Lehane classification. Results: The frequency of DL was 27% (n=37) in our sample population. Among predictive tests, IID was lower in patients with DL, while mean MMT score, frequency of retrognathia, and that of Grade 3 in ULBT were significantly higher. According to the results of logistic regression analyses IID (Odds Ratio [OR]: 0.504, Confidence intervals [CI] 95% [0.260-0.978], p=0.043), MMT score (OR: 2.001, CI 95% [1.159-3.454], p=0.013), and presence of retrognathia (OR: 0.108, CI 95% [0.019-0.613], p=0.012) were determined as independent predictors of DL. Our predictive model (two out of three factors: IID =4 cm, MMT score=3, and retrognathia) anticipated DL with a sensitivity of 35.1%, a specificity of 91%, a negative predictive value of 79.1%, and an accuracy of 75.9%. Discussion and Conclusion: None of the bedside tests or their dual combinations had considerable success for predicting DL in our study. Considering this fact and variation of the predictive performance of bedside tests for DL among different ethnicities, we composed a distinctive regression model. This model anticipated DL with reasonable specificity and accuracy rates. [ABSTRACT FROM AUTHOR]

Introduction Skeletal Class III is one of a complex sagittal interjaw relationship. It is the result of malrelation in sagittal position of one or both jaw bones or disproportionate ratio of their length. Objective This study was carried out to assess the effective mandibular and maxillary bases length in developing Class III malocclusion with high and low mandibular plane angles. Materials and methods Cross-sectional study was carried out on a selected sample of 75 lateral cephalometric radiographs of orthodontic patients of both sexes with age ranged from 6 to 12 years old. They were divided into three equal groups. Group 1: normal ANB and mandibular plane angles as a control group, group 2: skeletal Class III with low mandibular plane angles, and group 3: skeletal Class III with high mandibular plane angles. The sample was collected from patient record files at the clinic of the Orthodontic Department, Faculty of Dentistry, Tanta University, Egypt. Results A statistically significant difference was found in the effective maxillary length between group 1 and group 2 and 3. While effective mandibular length showed no statistically significant differences between the three groups. Conclusion Short maxillary base length is the main etiological factor for skeletal Class III malocclusion. While prominent mandibular base length has minimal effect in development of skeletal Class III malocclusion. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare the indications and outcomes of the total inferior border ostectomy and T-shape genioplasty. A retrospective study was conducted using the clinical notes and records of patients who underwent total inferior border ostectomy (group 1, n = 42) and T-shape genioplasty (group 2, n = 60). The outcomes were evaluated by assessment of computed tomography images combined with medical records and photographs. Lower facial height, chin width, chin symmetry, and facial proportions, as well as patient satisfaction and complications were investigated. The data were collected preoperatively and 6–24 months postoperatively. All 102 patients showed an improved lower facial contour. No severe complications were observed during the follow-up period. Although the postoperative lower to midfacial height ratios were similar in the two groups (P = 0.080), both the preoperative and postoperative chin width to lower facial height ratios were lower in group 1 (both P < 0.001). A larger amount of chin narrowing, as well as better chin symmetry were observed in group 1 (P < 0.001). In conclusion, compared to the T-shape genioplasty, the total inferior border ostectomy is well suited for a longer, wider, and more asymmetrical chin. The surgical options should be considered and chosen quantitatively to achieve aesthetically pleasing results. [ABSTRACT FROM AUTHOR]

Purpose: In class III, skeletal patients with high plane angle, counterclockwise rotation of maxillomandibular units is necessary. The study was aimed to evaluate the long-term stability of the change of mandibular plane in patients with class III deformity. Materials and Methods: This is a retrospective longitudinal clinical study. Patients with class III skeletal deformity and high plane angles who underwent maxillary advancement and superior repositioning with mandibular set back were studied. The change of mandibular plane (MP) was predictive factors of the study. Age, gender, the amount of movement of the maxillary advancement, and mandibular set back following orthognathic surgeries were variables. The amount of relapse at the A and B points 12 months after orthognathic surgeries was outcomes of the study. Pearson correlation test was used to determine any correlation between relapse at the A and B points following bimaxillary orthognathic surgery. Results: Fifty-one patients were studied. The mean of MP changes immediately after osteotomies was 4.66 (1.64) degrees. The horizontal relapse at B point 12 months after surgeries was 1.08 (0.81) mm, and the vertical relapse was 1.38 (0.44) mm. There was a correlation between the horizontal and vertical relapse with MP change (P = 0.001). Conclusion: It seems that the counterclockwise rotation of maxillomandibular units in patients with class III skeletal deformity and high plane angle may be associated with the vertical and horizontal relapse that was noticed at the B point. [ABSTRACT FROM AUTHOR]

Aim: Some obstructive sleep apnea (OSA) patients may have mandibular retrognathia (ANB > 4.7° and SNB < 76.2°). Currently, there are no studies that have compared the effectiveness of continuous positive airway pressure (CPAP) versus mandibular advancement device (MAD) in severe OSA patients with mandibular retrognathia. We explored the efficacy of CPAP versus MAD for the treatment of severe OSA patients with mandibular retrognathia. Methods: A total of 105 patients were enrolled. Outcomes were assessed by using polysomnography, Epworth Sleepiness Scale (ESS), Snore Scale (SS), Self-rating Anxiety Scale (SAS), and compliance, before treatment and after 6 and 12 months of treatment. Results: Continuous positive airway pressure was superior to MAD in improving polysomnographic outcomes and SS score, but reported compliance was higher on MAD. There is no significant difference between the 2 treatments in terms of ESS score and SAS score. Obstructive sleep apnea patients with mandibular retrognathia showed greater improvement than those without mandibular retrognathia in terms of apnea-hypopnea index and oxygen desaturation index after MAD. Conclusion: Continuous positive airway pressure and MAD are both effective in treating severe OSA patients with mandibular retrognathia. Mandibular advancement device is a good alternative to CPAP in severe OSA patients with mandibular retrognathia. Mandibular advancement device is more effective in treating OSA patients with mandibular retrognathia than those without. Trial registration: ChiCTR2000032541. [ABSTRACT FROM AUTHOR]

Our finding reinforces the evidence that maternal and paternal exposure to pesticides is associated with a higher occurrence of cleft lip and palate. We believe that our study makes a significant contribution to the literature because the population of Mato Grosso is among the most exposed to the contaminants used in Brazilian agriculture. Objective: To investigate the association between periconceptional environmental exposures and the occurrence of cleft lips and palates. Methods: This case-control study analyzed 150 mothers of children with cleft lips and palates living in the same city as 250 mothers whose children did not present with this malformation (controls). Environmental exposure data were gathered through a questionnaire (Latin American Collaborative Study of Congenital Malformations methodology). Results: Multivariate analysis revealed that monthly income below minimum wage, having another malformed child, other diseases in the first gestational trimester (urinary infection), use of pesticides in home gardens, and pesticide use in farms close to the home were risk factors associated with the malformation, whereas taking vitamins was a protective factor. Conclusion: Maternal and paternal exposure to pesticides is associated with cleft lip and palate in Mato Grosso State, Brazil. [ABSTRACT FROM AUTHOR]

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Purpose: To evaluate whether 5.0 × 5.0 mm dental implants with a novel nanostructured calciumincorporated titanium surface could be an alternative to implants of at least 10.0 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. Materials and methods: Forty patients with atrophic posterior (premolar and molar areas) mandibles with 5.0 mm to 7.0 mm bone height above the mandibular canal, and 40 patients with atrophic maxillas with 4.0 mm to 6.0 mm below the maxillary sinus, were randomised according to a parallel group design to receive between one and three 5.0 mm implants or one to three at least 10.0 mmlong implants in augmented bone at two centres. All implants had a diameter of 5.0 mm. Mandibles were vertically augmented with interpositional bovine bone blocks covered with resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers, and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cement metal-ceramic or zirconia prostheses were delivered. Patients were followed to 3 years post-loading and the outcome measures were: prosthesis and implant failures, any complication, and peri-implant marginal bone level changes. Results: Seven patients dropped out before the 3-year evaluation (two short mandibles, one short maxilla, two augmented mandibles and two augmented maxillae). In mandibles, two grafted patients were not prosthetically rehabilitated because of multiple complications and two implants failed in the same patient (the second was a replacement implant) vs one patient who lost a short implant and crown 2 years after loading. In maxillas one short implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses (difference in proportion = 0.001; 95% CI: -0.12 to 0.13; P = 1.000) and implant failures (difference in proportion = 0.00; 95% CI: -0.13 to 0.13; P = 1.000) up to 3 years after loading. Significantly, more complications occurred at mandibular grafted sites: 17 augmented patients were affected by complications vs eight patients treated with short implants in mandibles (difference in proportion = 0.43; 95% CI: 0.13 to 0.64; P = 0.008). In the maxilla, six sinus-lifted patients vs two patients treated with short implants were affected by complications; the difference not being statistically significant (difference in proportion = 0.21; 95% CI: -0.05 to 0.45; P = 0.232). Patients with mandibular short implants lost on average 1.10 mm of peri-implant bone at 3 years and patients with 10.0 mm or longer mandibular implants lost 1.39 mm. Patients with maxillary short implants lost on average 1.04 mm of periimplant bone at 3 years and patients with 10 mm or longer maxillary implants lost 1.43 mm. Longer implants showed a greater bone loss up to 3 years after loading than short implants both in maxillae (mean difference: -0.39 mm; 95% CI: -0.70 to -0.07 mm; P = 0.017) and in mandibles (mean difference: -0.29 mm; 95% CI: -0.53 to -0.05 mm; P = 0.020). Conclusions: Three years after loading, 5.0 mm × 5.0 mm implants achieved similar results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, 5- to 10-year post-loading data are necessary before making reliable recommendations. [ABSTRACT FROM AUTHOR]

Objective: The treatment of orthodontic patients who survive head and neck tumors is challenging because of dentoskeletal deformities and other unexpected dental and facial complications. This case report describes the case of a 26‐year‐old woman who presented with mandibular retrognathia after survival from osteosarcoma. Clinical considerations: Camouflage orthodontic treatment was chosen instead of combined orthodontic‐orthognathic surgery after primary reconstructive surgery with an iliac bone graft. Genioplasty distraction osteogenesis (DO) was performed to achieve an optimal facial profile. Although unexpected condyle dislocation and epithelial hyperplasia occurred during treatment, a favorable facial profile and optimal skeletal and dental relationships were accomplished after 32 months of treatment. Conclusions: The patient underwent genioplasty DO and experienced unexpected left condyle dislocation. However, the treatment achieved esthetic goals after intermaxillary elastics were applied. [ABSTRACT FROM AUTHOR]

Background: The Advanced Mandibular Spring (AMS) was newly developed as a dentofacial orthopedic appliance in conjunctive use of clear aligners to treat Class II malocclusion with mandibular retrognathia in adolescents. This study aimed to launch a biomechanical assessment and evaluate whether the stress patterns generated by AMS promote mandibular growth. Methods: A three-dimensional finite element model was constructed using images of CBCT and spiral CT. The model consisted of craniomaxillofacial bones, articular discs, retrodiscal elastic stratum, masticatory muscle, teeth, periodontal ligament, aligner and AMS. Mechanical effects were analyzed in three types of models: mandibular postural position, mandibular advancement with AMS, and mandibular advancement with only muscular force. Results: The stress generated by AMS was distributed to all teeth and periodontal ligament, pushing mandibular teeth forward and maxillary teeth backward. In the temporomandibular joint area, the pressure in the superior and posterior aspects of the condyle was reduced, which conformed to the stress pattern promoting condylar and mandibular growth. Stress distribution became even in the anterior aspect of the condyle and the articular disc. Significant tensile stress was generated in the posterior aspect of the glenoid fossa, which conformed to the stress pattern stimulating the remodeling of the fossa. Conclusions: AMS created a favorable biomechanical environment for treating mandibular retrognathia in adolescents. [ABSTRACT FROM AUTHOR]

Background. Class II malocclusion is one of the most common malocclusion with varied prevalence. Functional therapy with appliances like Twin Block or Fixed functional appliances forms the mainstay of treatment in growing Class II patients. These patients might demonstrate narrow airway due to the retrognathic position of the mandible. This study investigated the effects of twin block and fixed functional appliance therapy (Forsus™ FRD) on the pharyngeal airway space in skeletal Class II patients. Methods. Forty patients with Class II malocclusion were selected and divided into two equal groups of 20 patients each for both Twin block and Forsus group. Lateral cephalograms were obtained before and after the functional appliance therapy. Evaluation was done for changes in hyoid bone position, pharyngeal airway dimensions and tongue position. Results. The variables of the study showed better hyoid position in both the groups. In Twin Block group, an increase in hy-apw2 and hy-PoFH suggested anterior positioning of hyoid and a decrease in H-MP and hy-ML indicated superior positioning. In Forsus group an increase in H-H’, hy-FH, hy-ML, hy-NL, hy-NSL and hy-OL suggested inferior positioning of hyoid, while an increase in hy-apw2, hy-CVT, hy-PoFH, hy-RL and hy’-tgo indicated anterior positioning of hyoid bone after functional therapy. Conclusion. Both the twin block and Forsus™ FRD improved the position of the hyoid bone after the functional appliance therapy however the changes were not statistically significant. Twin block and Forsus™ had similar effect on the hyoid bone position, pharyngeal dimensions and the tongue position. [ABSTRACT FROM AUTHOR]

Tardive dystonia is one of the extrapyramidal syndromes that start after long-term use of dopamine receptor antagonists. Tardive dystonia is underdiagnosed and often misdiagnosed; some of the treatment possibilities are hardly known among psychiatrists and are notorious for being resistant to treatment. Here, we present a set of two cases who had come with neuroleptic-induced tardive dystonia, initially given oral tetrabenazine and injectable botulinum toxin, but they did not respond. They got better after treatment with the combination of oral baclofen and electroconvulsive therapy (ECT). ECT is thought to prevent the super sensitization of postsynaptic dopamine receptors that contribute to the development of tardive states. Baclofen is a presynaptic gamma-aminobutyric acid receptor agonist primarily used to treat spasticity. Both may have acted synergistically to treat the dystonia. Tardive dystonia needs to be ruled out in patients with a history of long-term antipsychotic medication use. Consultant liaison with psychiatrists will be of paramount importance in the timely management of these cases. The combination of ECT and baclofen may be an effective choice for patients of schizophrenia with tardive dystonia developed in the course of neuroleptic treatment. However, further controlled studies are needed to develop and refine the guidelines for managing it. [ABSTRACT FROM AUTHOR]

Skeletal malocclusions are common phenotypes in humans and have a strong influence on genetic factors. Transforming growth factor beta (TGFβ) controls numerous functions of the human body, including cell proliferation, differentiation, and migration. Thus, this study is aimed at evaluating whether genetic polymorphisms in TGFB1 and its receptor TGFBR2 are associated with mandibular retrognathism in German children and adolescents. Children and teenagers older than 8 years in the mixed or permanent dentition were included in this study. Patients with syndromes and facial trauma and patients with congenital alterations were excluded. Digital cephalometric tracings were performed using the anatomical landmarks point A, point B, sella (S), and nasion (N). Patients that have a retrognathic mandible (SNB < 78 °) were selected as case group, and the patients with an orthognathic mandible (SNB = 78 °– 82°) were selected as the control group. Genomic deoxyribonucleic acid (DNA) from saliva was used to evaluate four genetic polymorphisms in TGFB1 (rs1800469 and rs4803455) and TGBR2 (rs3087465 and rs764522) using real-time PCR. Chi-square or Fisher exact tests were used to compare gender, genotype, and allele distribution among groups. Genotype distribution was calculated in an additive and recessive model. Haplotype analysis was also performed. The established alpha of this study was 5%. A total of 146 patients (age ranging from 8 to 18 years) were included in this epidemiological genetic study. The genetic polymorphism rs3087465 in TGFBR2 was associated with mandibular retrognathism. Carrying the AA genotype in the rs3087465 polymorphism decreased the chance of having mandibular retrognathism (odds ratio = 0.25 , confidence interval 95 % = 0.06 to 0.94, p = 0.045). None of the haplotypes was associated with mandibular retrognathism (p > 0.05). In conclusion, we found that the genetic polymorphism rs3087465 in the promoter region of the TGFBR2 was associated with mandibular retrognathism in Germans. [ABSTRACT FROM AUTHOR]