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Buch FO, Stokbro K. Accuracy and stability of the condyle position after orthognathic surgery: A retrospective study. J Craniomaxillofac Surg 2024; 52:240-245. [PMID: 38172014 DOI: 10.1016/j.jcms.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/21/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
The purpose of this study was to evaluate the accuracy and stability of condylar positioning in patients treated with bimaxillary procedures compared with patients treated with maxillary procedures alone. All patients had undergone treatment at Odense University Hospital and were treated with inferior maxillary procedures. The primary outcome was changes in condyle position and the primary predictor variable was time: pre-operative (T0) measurements to 1-week post-operative (T1) and 1-year post-operative (T2) measurements. Condyle movement was measured using dual voxel-based alignment. Sixteen patients were included. Seven patients underwent solitary maxillary procedure and 9 patients bimaxillary procedure. Bimaxillary procedures overall showed a condyle positional change in pitch from T0 to T1 and T1 to T2 compared to maxillary procedures alone. Condylar translation was stable despite large differences in positioning. Compared to solitary maxillary procedures, bimaxillary procedures showed a statistically significant anterocranial rotation at 1-week follow-up movement (3.95° vs. -0.95°; SD 3,74 vs 1,05; P value = 0.000) and an additional statistically significant anterocranial movement at 1 year after surgery (4.89° vs 0.60°; SD 3,82 vs 0,92; P value = 0.000). In conclusion a need for greater anterocranial stability of the sagittal split osteotomy than that provided by 3 bicortically fixated screws alone might be indicated.
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Affiliation(s)
- Frederik Ohm Buch
- Department of Oral and Maxillofacial Surgery, Odense University Hospital, Denmark
| | - Kasper Stokbro
- Consultant Surgeon & Head of Research, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Oral and Maxillofacial Research Department, Clinical Institute, University of Southern Denmark, Denmark.
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Sánchez-Ayala A, Sánchez-Ayala A, Kolodzejezyk RC, Urban VM, Lagravère MÓ, Campanha NH. A three-dimensional method to calculate mechanical advantage in mandibular function : Intra- and interexaminer reliability study. J Orofac Orthop 2023; 84:321-339. [PMID: 35254453 DOI: 10.1007/s00056-022-00378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Masticatory muscles are physically affected by several skeletal features. The muscle performance depends on muscle size, intrinsic strength, fiber direction, moment arm, and neuromuscular control. To date, for the masticatory apparatus, only a two-dimensional cephalometric method for assessing the mechanical advantage, which is a measure for the ratio of the output force to the input force in a system, is available. This study determined the reliability and errors of a three-dimensional (3D) mechanical advantage calculation for the masticatory system. METHODS Using cone-beam computed tomography images from teenage patients undergoing orthodontic treatments, 36 craniofacial landmarks were identified, and the moment arms for seven muscles and their load moment arms (biomechanical variables) were determined. The 3D mechanical advantage for each muscle was calculated. This procedure was repeated by three examiners. Reliability was verified using the intraclass correlation coefficient (ICC) and the errors by calculating the absolute differences, variance estimator and coefficient of variation (CV). RESULTS Landmark coordinates demonstrated excellent intra- and interexaminer reliability (ICC 0.998-1.000; p < 0.0001). Intraexaminer data showed errors < 1.5 mm. Unsatisfactory interexaminer errors ranged from 1.51-5.83 mm. All biomechanical variables presented excellent intraexaminer reliability (ICC 0.919-1.000, p < 0.0001; CV < 7%). Interexaminer results were almost excellent, but with lower values (ICC 0.750-1.000, p < 0.0001; CV < 10%). However, the muscle moment arm and 3D mechanical advantage of the lateral pterygoid muscles had ICCs < 0.500 (p < 0.05) and CV < 30%. Intra- and interexaminer errors were ≤ 0.01 and ≤ 0.05, respectively. CONCLUSIONS Both landmarks and biomechanical variables showed high reliability and acceptable errors. The proposed method is viable for the 3D mechanical advantage measure.
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Affiliation(s)
- Alejandro Sánchez-Ayala
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Alfonso Sánchez-Ayala
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil.
| | - Rafaela Cristina Kolodzejezyk
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Vanessa Migliorini Urban
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Manuel Óscar Lagravère
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Nara Hellen Campanha
- Orthodontic Graduate Program, University of Alberta, 116 St & 85 Ave, T6G 2R3, Edmonton, Alberta, Canada
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Barone S, Muraca D, Averta F, Diodati F, Giudice A. Qualitative and quantitative assessment of condylar displacement after orthognathic surgery: A voxel-based three-dimensional analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:685-690. [PMID: 34763135 DOI: 10.1016/j.jormas.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/17/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to evaluate the morphometric changes in the position of the mandibular condyles before and after orthognathic surgery. METHODS A retrospective single-center cohort study was conducted and included patients with a presurgical (T1) and postsurgical (T2) Cone Beam computed tomography (CBCT). The primary predictor variable was the orthognathic surgical treatment. Pre-operative and post-operative CBCT scans were superimposed using voxel-based registration. Semitransparent overlays of the models of condylar regions at T1 and T2 were created for the qualitative analysis. The primary outcome variable was the quantitative displacement of condyles (CoR; CoL) analyzed in X, Y, Z axis and the 3D distances. Descriptive and bivariate statistical analysis was performed, setting α=0.05. RESULTS The study sample included 33 patients (mean age: 25.33±2.49 years) affected by skeletal class III malocclusion with or without skeletal asymmetry. The X-axis showed a mean movement of 0.25 ± 0.17 mm for CoR, and 0.52 ± 0.51 mm for CoL. The Y-axis showed a mean movement of 0.29 ± 0.2 mm for CoR, and 0.51 ± 0.8 mm for CoL. The Z-axis was 0.33 ± 0.2 mm for CoR, and 0.5 ± 0.49 mm for CoL. No statistically significant difference was calculated comparing the movement of condylar surface between asymmetric and not asymmetric patients (p = 0.26 for CoR; p = 0.13 for CoL). No statistically significant difference was found in intercondylar distance between T1 and T2 (p = 0.39). CONCLUSION No statistically nor clinically significant condylar displacement are recorded in orthognathic surgery patients at 12 to 18 months of follow-up.
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Affiliation(s)
- Selene Barone
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Danila Muraca
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Fiorella Averta
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Federica Diodati
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Oral and Maxillofacial Surgeon, Professor, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa 88100 Catanzaro, Italy.
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Jo H, Ohe JY, Lee JW, Lee BS, Jung J. Posterior bending osteotomy: An effective measure to secure facial symmetry in orthognathic surgery. J Craniomaxillofac Surg 2021; 49:538-544. [PMID: 33581956 DOI: 10.1016/j.jcms.2021.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/30/2020] [Accepted: 01/31/2021] [Indexed: 11/28/2022] Open
Abstract
This study aimed to compare the effectiveness of posterior bending osteotomy and grinding techniques for orthognathic surgery in patients with facial asymmetry. Patients who had undergone Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, and who presented with a menton shift and setback difference exceeding 4 mm, were enrolled. Cone-beam computed tomography was performed before surgery (T0), immediately after surgery (T1), and 6 months after surgery (T2). Overall, 38 patients were included and divided into posterior bending osteotomy (n = 23) and grinding (n = 15) groups. Significant differences were observed between the posterior bending osteotomy and grinding groups on the treated side. In the grinding group, the gonion on the treated side was displaced slightly outward, resulting in a significant difference between both sides (non-treated side: 50.52 ± 4.20 [T0] and 48.67 ± 4.37 [T2]; treated side: 50.88 ± 4.55 [T0] and 51.00 ± 3.95 [T2]; p = 0.038). In the posterior bending osteotomy group, bilateral inward movements of the gonion were observed, and the distance from the midsagittal plane to the gonion did not differ significantly between the sides (non-treated side: 46.74 ± 4.41 [T0] and 45.54 ± 3.95 [T2]; treated side: 47.43 ± 4.93 [T0] and 45.18 ± 3.52 [T2]; p = 0.224). The yawing movement of the proximal segment was greater in the grinding group than in the posterior bending osteotomy group (non-treated side: p = 0.839; treated side: p = 0.025). Posterior bending osteotomy is recommended over the grinding method for patients with severe facial asymmetry, in order to ensure a symmetric and esthetic facial profile by allowing passive adaptation between the mandibular segments.
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Affiliation(s)
- Hyunmi Jo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea; Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Joo-Young Ohe
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Baek-Soo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Junho Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea.
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Chang YJ, Lai JP, Tsai CY, Wu TJ, Lin SS. Accuracy assessment of computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS). J Formos Med Assoc 2020; 119:701-711. [DOI: 10.1016/j.jfma.2019.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/19/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022] Open
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Quantitative assessment of condyle positional changes before and after orthognathic surgery based on fused 3D images from cone beam computed tomography. Clin Oral Investig 2019; 24:2663-2672. [DOI: 10.1007/s00784-019-03128-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022]
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Vale F, Francisco I, Scherzberg J, Guimarães A, Caramelo F, Maló L. Condylar response to large mandibular advancement combined with maxillary impaction and counterclockwise rotation: A computed tomographic study. J Clin Exp Dent 2018; 10:e891-e901. [PMID: 30386522 PMCID: PMC6203919 DOI: 10.4317/jced.54933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022] Open
Abstract
Background This study aims to analyze the effectiveness of cone-beam computed tomography (CBCT) in the evaluation of the condylar position, angulation and intercondylar distance and assess the changes in these parameters before and after bimaxillary surgery, preformed with the critical movments of Le Fort I osteotomy (for impaction of the maxilla and conterclockwise rotation of the upper occlusal plane) and Bilateral Sagittal Split Osteotomy (BSSO) for mandibular advancement (> 8mm). Material and Methods Twenty class II patients successfully treated with BSSO of the mandible, in conjunction with Le Fort I osteotomy, were studied to evaluate the condylar changes before and after surgery. The position of the condyle was classified according to the Pullinger & Hollender’s formula in both phases. A MANOVA analysis followed by post-hoc tests were conducted to ascertain if there were statistically significant differences between pre and post surgical variables under study. The agreement of the condylar position’s classification was evaluated resorting to the Kappa statistics. Results There were no statistically significant differences between the values of the position and angulation of the condyles and intercondylar distance before and after surgery. There was an increase of the axial angle of the left condyle and the frontal angle of both condyles, while there was a decrease of the axial angle of the right condyle, the sagittal angle of both condyles and intercondylar distance. Conclusions The CBCT is a useful method for assessing variations of condylar position in detail. It was verified that the critical movements of maxillary impaction associated with the mandibular advancement do not produce significant alterations in the mandibular condyles, however, these tend to perform a posterior and inferior movement. Key words:Cone-Beam computed tomography, orthognathic surgery, mandibular condyle, osteotomy, le fort, temporomandibular joint.
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Affiliation(s)
- Francisco Vale
- DMD, MSc, PhD. Professor and Chairman - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
| | - Inês Francisco
- DMD, MSc. Postgraduate student - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
| | - Jessica Scherzberg
- DMD, MSc. Postgraduate student - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
| | - Adriana Guimarães
- DMD, MSc. Postgraduate student - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
| | - Francisco Caramelo
- MSc, PhD. Professor - Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine - University of Coimbra
| | - Luísa Maló
- DMD, MSc, PhD. Professor - Institute of Orthodontics, Faculty of Medicine - University of Coimbra
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Study of condylar positional changes after sagittal split osteotomy for mandibular advancement: A prospective cohort study. J Craniomaxillofac Surg 2018; 46:1079-1090. [PMID: 29773499 DOI: 10.1016/j.jcms.2018.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To analyse the possible morphologic and positional changes of the mandibular condyles after orthognathic surgery. MATERIAL AND METHODS A prospective cohort study was performed. Patients with mandibular retrognathism were surgically treated to advance the mandible. The study group included seventeen patients (34 condyles) treated with sagittal split osteotomies alone (4 patients) or in combination with maxillary osteotomies (13 patients). Only condyles located on the mandibular side that advance during surgery were studied, therefore only 25 condyles entered this prospective study. Beside it, a group of 6 patients undergoing maxillary surgery as only procedure, maxillary group, was also studied to determinate the influence of maxillary surgery on condylar displacement. Computed tomographies and lateral cephalometric radiographs were performed two weeks before surgery and one year after the surgical procedures. Different variables which analyse the position and morphology of the mandible were studied. The data obtained were analysed statistically by computing R2 values. RESULTS In the maxillary group they were small displacements in magnitude and not significant. In the study group, 8 condyles showed morphological changes with alteration on reference points. In the remainder 17 condyles different displacements were noted after surgery. Several of these positional changes were predictable and did not affect postoperative mandibular stability. CONCLUSIONS condylar displacements that occur after sagittal split osteotomies for mandibular advancement show significant correlation with the degree of mandibular advancement and can be defined by mathematical formulae. Maxillary osteotomies do not seem to influence condylar position when bimaxillary procedures take place.
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Kuehle R, Berger M, Saure D, Hoffmann J, Seeberger R. High oblique sagittal split osteotomy of the mandible: assessment of the positions of the mandibular condyles after orthognathic surgery based on cone-beam tomography. Br J Oral Maxillofac Surg 2016; 54:638-42. [DOI: 10.1016/j.bjoms.2016.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 03/20/2016] [Indexed: 11/16/2022]
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Nogami S, Yamauchi K, Satomi N, Yamaguchi Y, Yokota S, Abe Y, Takahashi T. Risk factors related to aggressive condylar resorption after orthognathic surgery for females: retrospective study. Cranio 2016; 35:250-258. [DOI: 10.1080/08869634.2016.1201886] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shinnosuke Nogami
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Norihisa Satomi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yoshihiro Yamaguchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Sou Yokota
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yoko Abe
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Méndez-Manjón I, Guijarro-Martínez R, Valls-Ontañón A, Hernández-Alfaro F. Early changes in condylar position after mandibular advancement: a three-dimensional analysis. Int J Oral Maxillofac Surg 2016; 45:787-92. [DOI: 10.1016/j.ijom.2016.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/10/2015] [Accepted: 01/06/2016] [Indexed: 11/30/2022]
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Freehand Condyle-Positioning During Orthognathic Surgery: Postoperative Cone-Beam Computed Tomography Shows Only Minor Morphometric Alterations of the Temporomandibular Joint Position. J Craniofac Surg 2016; 26:1471-6. [PMID: 26163838 DOI: 10.1097/scs.0000000000001781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Purpose of this study was to evaluate changes in the temporomandibular joint (TMJ) position after bilateral sagittal split osteotomy (BSSO) of the mandible by the help of pre- and postoperative cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS A collective of n = 78 patients was investigated between 2009 and 2011 before and after BSSO of the mandible in mono- or bimaxillary orthognathic surgery procedures. No intraoperative fixation of the condyles was administered. CBCT scans were performed in all patients before and immediately after surgery with the KaVo 3DeXam device in the position of terminal occlusion. Subsequently, all scans were analyzed by help of the eXam Vision program and the ImageJ image processing software. Alterations of the TMJs were quantified by determining pre- to postoperative differences of the intercondylar distance, the mandibular angle on both sides, and the condylar angles in the transversal plane. RESULTS The difference between pre- and postoperatively ascertained values was minimal (means: lateral condylar distance -0.17 mm; distance of condylar centers -0.32 mm; medial condylar distance -0.49 mm; left mandibular angle +1.06°; right mandibular angle +2.06°; condylar angles in relation to a reference line: left -2.93, right -0.75; angle of cutting +3.42). There is no apparent tendency toward a positional change in any of the 3 examined planes. Between bi- and monomaxillarily operated patients there was no difference either, except for the osteotomy plane. CONCLUSIONS A 3-dimensional analysis of CBCT data of the TMJ seems to be appropriate to determine the condylar position pre- and postoperatively. Performed by an experienced orthognathic surgeon, BSSO of the mandible does not effectuate any relevant changes of the TMJ-position, thus making an intraoperative condyle-fixation unnecessary.
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Koerich L, Ruellas ACO, Paniagua B, Styner M, Turvey T, Cevidanes LHS. Three-dimensional regional displacement after surgical-orthodontic correction of Class III malocclusion. Orthod Craniofac Res 2015; 19:65-73. [PMID: 26521755 DOI: 10.1111/ocr.12114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate how displacements of maxillo-mandibular structures are associated with each other at splint removal and 1 year post-surgery following 1-jaw and 2-jaw surgeries for correction of Class III malocclusion. SETTING AND SAMPLE POPULATION Fifty patients who underwent surgical correction with maxillary advancement only (n = 25) or combined with mandibular setback (n = 25) were prospectively enrolled in this study. METHODS Cone-beam computed tomographies were taken pre-surgery, at splint removal and at 1 year post-surgery. Three-dimensional cranial base superimpositions and shape correspondence were used to measure the outcomes from pre-surgery to splint removal (surgical changes) and splint removal to 1 year post-surgery (post-surgical adaptations). Pearson's correlation coefficients were used to evaluate the association between the regional displacements. RESULTS Both surgery groups presented mandibular clockwise rotation with surgery and post-surgical adaptive counterclockwise rotation. In patients treated with maxillary advancement only, the surgical changes of the maxilla were significantly correlated with chin changes. The amount and direction of chin autorotation were significantly correlated with right and left ramus autorotation. Right and left condylar displacements were significantly correlated. One year post-surgery, adaptive displacements and bone remodeling of both rami were correlated with the chin and condylar changes. For the 2-jaw group, the few correlations between the positional and remodeling changes in the anatomic regions of interest observed due to the surgery were different than those observed after post-surgical adaptations, suggesting that these changes occurred independently. CONCLUSION Our results indicate that surgical displacements and post-surgical adaptations are often correlated in one-jaw surgery and are, in general, independent in two-jaw surgery.
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Affiliation(s)
- L Koerich
- International Dental Program, Virginia Commonwealth University, Richmond, VA, USA
| | - A C O Ruellas
- Department of Orthodontics, University Federal of Rio de Janeiro, Rio de Janeiro, Brazil
| | - B Paniagua
- Departments of Psychiatry and Computer Science, University of North Carolina, Chapel Hill, NC, USA
| | - M Styner
- Departments of Psychiatry and Computer Science, University of North Carolina, Chapel Hill, NC, USA
| | - T Turvey
- Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - L H S Cevidanes
- Department of Orthodontics, University of Michigan, Ann Arbor, MI, USA
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Abstract
Similar to Medicine, digital communication, information processing, and x-ray imaging have changed the face of dentistry. The incorporation of digital systems into medical and dental practice has necessitated development of a standard that allows reliable transmission of information between the devices taking the images, devices storing the images, and devices displaying the images. This standard is termed as DICOM. The following article briefly reviews how DICOM came about, how dentistry is involved, the various elements that are part of the DICOM system, and how DICOM is currently used in dentistry.
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Affiliation(s)
- Jeff Burgess
- (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates, USA
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An SB, Park SB, Kim YI, Son WS. Effect of post-orthognathic surgery condylar axis changes on condylar morphology as determined by 3-dimensional surface reconstruction. Angle Orthod 2014; 84:316-321. [PMID: 23944223 PMCID: PMC8673793 DOI: 10.2319/052113-387.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/01/2013] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE To evaluate the effect of postoperative condylar axis changes on mandibular condylar remodeling by comparing the condylar head in three-dimensional (3D) surface reconstructions before and after surgery in skeletal Class III deformities (one-jaw [mandibular setback] or two-jaw surgery), and also to determine the relationship between condylar inward rotation and condylar surface remodeling after orthognathic surgery. MATERIALS AND METHODS A retrospective analysis was conducted of 30 patients with skeletal Class III deformities who had received orthognathic surgery. Group 1 underwent one-jaw surgery (10 men, five women, age 22.4 ± 3.3 years), and group 2 underwent two-jaw surgery (10 men, five women, age 22.3 ± 2.2 years). Sixty condyles were reconstructed and superimposed pre- and postoperatively to compare the changes of condylar surfaces. The relation between the condylar axis change and the surface change using the Pearson correlation were investigated from the 3D image software. RESULTS Condylar surface changes before and after the surgery were significant. The postoperative inward rotation of the condyles was correlated with the average absolute deviation of the condyles, regardless of the surgery type (one- or 2-jaw surgery; r = .70, P < .05). CONCLUSION After orthognathic surgery, condylar surface changes occurred, and condylar inward rotation was closely related to changes of condylar surface.
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Affiliation(s)
- Soo-Bum An
- Postgraduate student, Department of Orthodontics, School of Dentistry, Pusan National University Dental Hospital, Yangsan, South Korea
| | - Soo-Byung Park
- Professor, Department of Orthodontics, School of Dentistry, Pusan National University Dental Hospital, Yangsan, South Korea
| | - Yong-Il Kim
- Assistant Professor, Department of Orthodontics, School of Dentistry, Dental Research Institute, Pusan National University Dental Hospital, and Biomedical Research Institute, Pusan National University Hospital, Yangsan, South Korea
| | - Woo-Sung Son
- Professor, Department of Orthodontics, School of Dentistry, Pusan National University Dental Hospital, Yangsan, South Korea
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Franco AA, Cevidanes LHS, Phillips C, Rossouw PE, Turvey TA, Carvalho FDAR, Paula LKD, Quintão CCA, Almeida MAO. Long-term 3-dimensional stability of mandibular advancement surgery. J Oral Maxillofac Surg 2013; 71:1588-97. [PMID: 23769460 DOI: 10.1016/j.joms.2013.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate 3-dimensional changes in the position of the condyles, rami, and chin from 1 to 3 years after mandibular advancement surgery. MATERIALS AND METHODS This prospective observational study used pre- and postoperative cone-beam computed tomograms of 27 subjects with skeletal Class II jaw relation and normal or deep overbite. An automatic technique of cranial base superimposition was used to assess positional and bone remodeling changes that were visually displayed and quantified using 3-dimensional color maps. Analysis of covariance with presence of genioplasty, age at time of surgery, and gender as explanatory variables was used to estimate and test adjusted mean changes for each region of interest. RESULTS The chin rotated downward and backward 1 to 3 years after surgery. Changes of at least 2 mm were observed in 17% of cases. Mandibular condyles presented with displacements or bone remodeling of at least 2 mm on the anterior surface (21% of cases on the left side and 13% on the right), superior surface (8% on right and left sides), and lateral poles (17% on left side and 4% on right). Posterior borders of the rami exhibited symmetric lateral or rotational displacements in 4% of cases. CONCLUSION In the hierarchy of surgical stability, mandibular advancement surgery is considered one of the most stable surgical procedures. However, 1 to 3 years after surgery, approximately 20% of patients had 2- to 4-mm changes in horizontal and vertical chin positions or changes in condylar position and adaptive bone remodeling.
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Affiliation(s)
- Alexandre A Franco
- Department of Orthodontics, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Seeberger R, Thiele OC, Mertens C, Hoffmann J, Engel M. Proximal segment positioning with high oblique sagittal split osteotomy: indications and limits of intraoperative mobile cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:731-6. [DOI: 10.1016/j.oooo.2012.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
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Kim YJ, Oh KM, Hong JS, Lee JH, Kim HM, Reyes M, Cevidanes LH, Park YH. Do Patients Treated With Bimaxillary Surgery Have More Stable Condylar Positions Than Those Who Have Undergone Single-Jaw Surgery? J Oral Maxillofac Surg 2012; 70:2143-52. [DOI: 10.1016/j.joms.2011.08.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 08/18/2011] [Accepted: 08/21/2011] [Indexed: 10/15/2022]
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Dicker G, Tuijt M, Koolstra J, Van Schijndel R, Castelijns J, Tuinzing D. Static and dynamic loading of mandibular condyles and their positional changes after bilateral sagittal split advancement osteotomies. Int J Oral Maxillofac Surg 2012; 41:1131-6. [DOI: 10.1016/j.ijom.2012.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
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CBCT-based predictability of attachment of the neurovascular bundle to the proximal segment of the mandible during sagittal split osteotomy. Int J Oral Maxillofac Surg 2012; 42:308-15. [PMID: 22925443 DOI: 10.1016/j.ijom.2012.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/03/2012] [Accepted: 07/03/2012] [Indexed: 11/20/2022]
Abstract
Injury to the inferior alveolar nerve (IAN) during surgery is an important complication of bilateral sagittal split osteotomy. With cone beam computed tomography, the course of the nerve and its relationship to the surrounding structures can be assessed in three dimensions. This study aims to determine whether tomography can predict attachment of the neurovascular bundle to the proximal segment of the mandible during sagittal split osteotomy (SSO). Bilateral linear measurements were taken on cross-sectional tomography images. During osteotomy, it was noted for each patient whether the neurovascular bundle was attached to the proximal segment during the split. If attached, a bone-cutting instrument or a blunt instrument was needed to free the nerve. The nerve was attached at more than one-third of operation sites (170 sites). Of these, over 65% of attached nerves (108 sites) required a bone-cutting intervention to free them from the mandible. After correcting for confounding factors, the linear distances from the buccal cortical margin of the IAN canal to the inner and outer buccal cortical margins of the mandible were important predictors of whether the IAN will be attached to the proximal segment of the mandible during SSO.
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