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Temporomandibular joint (TMJ) reconstruction with customized alloplastic implants has become a safe and effective treatment option of TMJ end-stage pathology with excellent outcomes reported in the literature. The purpose of this study is to report 5 cases of severe TMJ pathology and customized alloplastic reconstruction using a combined intraoral approach and extraoral approach. Four patients with TMJ involved for benign tumor and one patient with severe TMJ resorption were enrolled. Compromised joints were replaced with customized prosthesis under general anesthesia using an association of intraoral approach/extraoral approach. An implant handpiece with adapted drills for bone drilling and the insertion of screws was used to fixate the mandibular component intraorally; the fossa component was inserted via preauricular approach. The hemimandibulectomies/codilectomy with safety margin were successfully performed and for 2 patients Orthognathic Surgery was also required. Follow-up period was from 15 to 28 months (average 22 months), with no history of surgical site infection or damage to the prostheses. Occlusal relationship and function, as well as facial symmetry were kept stable in all patients. The combination of an intraoral and extraoral approach for total TMJ replacement with customized prosthesis may be an alternative and reliable strategy for pathologic reconstruction, keeping function and reducing aesthetic damage.

Introduction It has been suggested that alveolar corticotomies may accelerate tooth movement, broaden the scope of malocclusion types that can be treated orthodontically, decrease the need for extractions, and support long-term stability. Several techniques have been proposed, although the indications, ideal design and technical characteristics, potential complications, and objective clinician and patient satisfaction remain unclear. This systematic review aimed to provide scientific support to validate alveolar corticotomies as a reliable approach to accelerated orthodontics. Material & methods A literature search was conducted using MEDLINE (via PubMed), Cochrane, and EMBASE electronic databases until December, 2016. Articles written in any language other than English, Spanish, French, German, and Portuguese were excluded. Randomized controlled trials, controlled clinical trials, and case series involving healthy adult patients, with a sample size of at least 5 patients, and using alveolar corticotomy techniques were included. Two reviewers extracted the data independently. Results Three randomized clinical trials, 2 prospective randomized clinical trials, 6 case series and 1 randomized controlled split-mouth study were included. No clinical trials were retrieved. Mean total treatment time in corticotomy-facilitated orthodontic cases was 8.85 months (range, 4–20 months); control groups treatment duration was 16.4 months (range, 7.8–28.3 months). Complications such as pain, swelling, and dentin hypersensitivity were reported. Few studies mentioned patient/clinician satisfaction. The faster and less invasive procedures appeared to be well tolerated. However, the methodological quality of the selected studies was low, with only low to moderate scientific evidence. Conclusions Corticotomy-facilitated orthodontics resulted in decreased treatment time. Few complications and low morbidity were found. More solid evidence-based research is required to support these results.

Introduction : Dans le cadre d'une chirurgie de Le Fort 1, il est important d'anticiper les effets indésirables qui peuvent se produire dans la région naso-labiale. Des facteurs peropératoires tels que l'étendue de la dissection chirurgicale, le type de fermeture et de reconstruction des tissus mous péri-nasaux semblent influencer la réponse des téguments. Ces dernières années, plusieurs techniques ont été proposées pour tenter de contrôler ces changements. Matériels et méthodes : Les auteurs présentent ici une alternative peu invasive. Il s'agit d'une technique chirurgicale permettant de contrôler à la fois l'élargissement de la distance qui sépare les ailes du nez et le raccourcissement des lèvres.

The aim of this study is to verify the soft tissues changes in the nasolabial area after Le Fort I osteotomy using a cone-beam computed tomography (CBCT) evaluation of three- dimensional (3D) volume surfaces in preoperative, early postoperative (1 month) and late postoperative (1 year) periods. Many authors have described the undesired soft tissue changes following the Le Fort I osteotomy, as well as many different techniques to prevent and control these changes. However, few studies have attempted to perform a 3D analysis of the nasolabial complex. The subsequent lack of standardized measuring method hinder the performance of comparisons among studies. By doing a systematic review of the literature in this topic, our objective is to list the main adverse effects associated to Le Fort I osteotomy and to list the most effective available techniques of alar dimension control. A specific technique of alar cinch suture will be described and further analyzed whether it is effective or not in controlling alar base widening. To this effect, a clinical retrospective research will be performed in 80 patients who have undergone a Le Fort I osteotomy and received the aforementioned alar cinch suture technique. All patients were operated by the same surgeon (FHA) at Instituto Maxilofacial – Teknon Medical Center - Barcelona. All the data regarding the selected patients will be anonymized, analyzed and measured by the same observer (APSG) and supervised by the same investigator (RGM). The CBCT volumes of these patients will be superimposed and measured in three different periods of treatment using the Dolphin® Orthognathic Surgery Planning software. A specific protocol to superimpose the 3D images using the Voxel Based Registration (VBR) is going to be developed and validated. At the Instituto Maxilofacial, CBCT acquisition is part of the routine diagnostic protocol of every patient undergoing orthognathic procedures. The study can be performed without modifications in this protocol.

Objectives The primary objective of the present study was to find the gold-standard accuracy of voxel-based superimposition of cone-beam computed tomography (CBCT) datasets with a protocol developed for the Dolphin Imaging 3D software. The secondary objectives were to analyze reproducibility and efficiency of this protocol. Study design Twenty-five CBCT datasets of patients with dental implants present were selected. Each Base Volume dataset was duplicated to create a second volume. Subsequently, both volumes were superimposed with a voxel-based protocol consisting of 3 successive steps "Side-by-side Superimposition"; "Overlay Superimposition"; and "Export Orientation to 2nd Volume". The protocol's accuracy was evaluated by measuring the mean distance between the apex of each dental implant on the Base Volume and second volume datasets. Efficiency was given by the mean time needed to complete all superimposition steps. Reproducibility was analyzed by calculating the intraclass correlation coefficients. Results Mean time needed to complete the protocol was 198 seconds. The protocol had a rotational accuracy of 0.10° to 019° and a translational accuracy of 0.20 to 0.24 mm. Intra-observer and inter-observer reproducibility were 1 and 0.921 to 1, respectively. Conclusions The protocol is accurate, precise, reproducible, and efficient. The validation of this method enables unbiased analysis of surgical outcomes based on a single, user-friendly software product that is widely available in academic and clinical settings.

A systematic review was conducted to investigate the three-dimensional (3D) effect of Le Fort I osteotomy on the nasolabial soft tissues. The literature search was conducted using the MEDLINE (accessed via PubMed), Embase, and Cochrane electronic databases until January 2018. A total of 333 studies were identified (PubMed, n = 292; Embase, n = 41; Cochrane Library, n = 0). Seventeen met the inclusion criteria. The studies were essentially retrospective. The risk of bias was considered high in 15 studies, medium in one study, and low in one study. 3D soft tissue analysis was performed at least 6 months after surgery (mean 8.3 months). The main image acquisition technique reported was cone beam computed tomography (CBCT), associated or not with 3D photography. Approximately 50% of the studies performed two-jaw surgery, 25% performed maxillary surgery only, and the other 25% included heterogeneous intervention groups. The most reported nasolabial changes were anterior and lateral movements of the nasomaxillary soft tissues and upper lip, together with anterior and superior movement of the nasal tip. The alar cinch suture and V–Y closure technique seemed to have little effect in counteracting the undesirable postoperative nasolabial changes. CBCT superimposition presented a reliable 3D assessment for simultaneous measurement of skeletal and soft tissue changes.

Adverse effects in the nasolabial region should be anticipated after Le Fort I osteotomy. Intraoperative factors such as the extent of surgical dissection, type of closure and perinasal soft tissue reconstruction seem to influence soft tissue response. Attempts to control these changes have been made over the years and several techniques have been proposed.The authors present a minimally invasive alternative surgical technique to control alar base widening as well as lip shortening.

This study evaluated the long-term stability of bilateral sagittal split ramus osteotomy fixed with a single miniplate with 4 monocortical screws and 1 bicortical screw (hybrid technique [HT]) using 3-dimensional (3D) analysis and an objective measuring tool, cone-beam computed tomography (CBCT).Sixty-four patients who underwent bimaxillary surgery with mandibular advancement fixed with the HT were selected from 2 different institutions and enrolled in this retrospective study. All patients underwent CBCT preoperatively, 1 month after surgery, and 12 months after surgery. To estimate the long-term stability of the HT, volumetric comparisons were performed using the following measurements: distance between the gonion and the B point in the sagittal plane; distance between the right and left gonion transversally; and the angle of the line connecting the mandibular notch and the gonion and the line connecting the gonion and the B point vertically.Statistical analysis showed no relevant relapse (1 mm or1°) when using the HT. However, a positive correlation between the amount of advancement and the amount of postoperative relapse was observed.The HT produces stable postoperative 3D results after 12 months.