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Chen F, Shao B, Liu Z. Biomechanical effects of mandibular deviation on the temporomandibular joint in patients with mandibular prognathism under incisal occlusion. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:102100. [PMID: 39357809 DOI: 10.1016/j.jormas.2024.102100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 09/29/2024] [Indexed: 10/04/2024]
Abstract
PURPOSE The aim of this study was to investigate the biomechanical effects of mandibular deviation on the TMJ in patients with mandibular prognathism before and after orthognathic surgery using three-dimensional finite element analysis. METHODS Eight patients with mandibular prognathism without deviation, eight patients with mandibular prognathism with deviation and sixteen normal subjects were recruited. Three-dimensional models of the maxillofacial were reconstructed using MIMICS. Nine muscle forces were used to simulate incisal occlusion and contact was used to simulate fossa-disc-condyle interactions. RESULTS Before surgery, the stress in the TMJ was generally greater in the Pre-MD&MP group than in the Pre-MD group; it was much greater in both groups than in the control group, ranging from about 2 to 12 times as great in the Pre-MD group and from about 5 to 64 times as great in the Pre-MD&MP group. After orthognathic surgeries, the stresses in the Post-MP&MD were significantly reduced by approximately 21.7 % to 93.4 %. And in the Post-MP group, the stresses were reduced by approximately 1.4 % to 51.1 %. CONCLUSION Mandibular deviation exacerbated the abnormal stress distribution in the TMJ of patients with mandibular prognathism. Orthognathic surgeries could improve the stress distribution in patients with mandibular prognathism (with and without deviation). TMD was closely related to the stress levels of the TMJ.
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Affiliation(s)
- Fei Chen
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China; Sichuan University Yibin Park, Yibin Institute of Industrial Technology, Yibin, China
| | - Bingmei Shao
- Sichuan University Yibin Park, Yibin Institute of Industrial Technology, Yibin, China; Basic Mechanics Lab, Sichuan University, Chengdu, China
| | - Zhan Liu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China; Sichuan University Yibin Park, Yibin Institute of Industrial Technology, Yibin, China.
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Bourne G, Kinard B. Current Orthognathic Surgery Practice Patterns Among Academic OMS. Cleft Palate Craniofac J 2024; 61:986-996. [PMID: 36692966 DOI: 10.1177/10556656231151722] [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] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Currently there is variation in perioperative care of orthognathic surgery patients and limited clinical practice guidelines. The current orthognathic surgery practice patterns among US academic OMFS training centers have not been described. The purpose of this study is to describe the practice patterns among US academic OMFS training centers. DESIGN The study design is cross-sectional. Data was collected through a survey of the sample. SETTING OMFS programs in the US. PARTICIPANTS Academic OMFS. 573 surgeons were contacted and 85 responses were received. MAIN OUTCOME MEASURE Descriptive and bivariate statistics were reported. RESULTS Respondents were 87% male and worked in full-time academic (80%), part-time academic (19%), or military settings (1%). Thirty-one percent have practiced for 30 years or more and then 29% with 11-20 years, 18% with 21-30 years, 12% with 6-10 years and 11% with 1-5 years. Twenty-six percent of respondents perform 20-40 orthognathic surgeries a year, 22% perform less than 20 surgeries a year, 21% perform 40-60 surgeries per year, and 19% perform more than 100 surgeries per year. Intraoperatively, 48% of surgeons request a mean arterial pressure of 60-64 mmHg, 25% utilize tranexamic acid (TXA), 85% report a blood loss of less than 400 milliliters, and 93% report a blood transfusion rate of <1%. CONCLUSION There are variations in orthognathic surgery practice patterns with limited clinical practice guidelines. Only 13 of the 32 survey questions had a single response holding a simple majority. This study demonstrates the need for further research and evidence-based protocols and decision making.
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Affiliation(s)
- Graham Bourne
- University of Alabama at Birmingham School of Dentistry, Birmingham, Alabama, USA
| | - Brian Kinard
- Department of Oral and Maxillofacial Surgery, Department of Orthodontics University of Alabama at Birmingham School of Dentistry, Birmingham, Alabama, USA
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Luo GM, Yao ZS, Huang WX, Zou LY, Yang Y. Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve. World J Clin Cases 2024; 12:1728-1732. [PMID: 38660071 PMCID: PMC11036467 DOI: 10.12998/wjcc.v12.i10.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/15/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve (IAN). AIM To proposes a method for the partial grinding of an impacted mandibular third molar (IMM3) near the IAN to prevent IAN injury during IMM3 extraction. METHODS Between January 1996 and March 2022, 25 patients with IMM3 roots near the IAN were enrolled. The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3. After 6 months, when the root tips were observed to be away from the IAN on X-ray examination, the remaining part of the IMM3 was completely removed. RESULTS All IMM3s were extracted easily without symptoms of IAN injury after extraction. CONCLUSION Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.
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Affiliation(s)
- Guang-Ming Luo
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
| | - Zhang-Shun Yao
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
| | - Wei-Xiang Huang
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
| | - Lei-Yan Zou
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
| | - Yan Yang
- Kunbaida Outpatient Department, Kunming Medical University School and Hospital of Stomatology, Kunming 650106, Yunnan Province, China
- Yunnan Key Laboratory of Stomatology, Kunming 650106, Yunnan Province, China
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Valls-Ontañón A, Kesmez Ö, Starch-Jensen T, Triginer-Roig S, Neagu-Vladut D, Hernández-Alfaro F. Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing. Oral Maxillofac Surg 2024; 28:345-353. [PMID: 36959345 DOI: 10.1007/s10006-023-01148-4] [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: 05/20/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars. MATERIAL AND METHODS A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6 months prior to BSSO (control group), comprising at least 1 year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique. RESULTS A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7 min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020). CONCLUSION The results obtained support concomitant molar extraction with BSSO as a feasible option.
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Affiliation(s)
- Adaia Valls-Ontañón
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain.
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
| | - Özlem Kesmez
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - David Neagu-Vladut
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain
| | - Federico Hernández-Alfaro
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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Grillo R, Borba AM, da Silva YS, Brozoski MA, Miloro M, Naclério-Homem MDG. Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:101-112. [PMID: 38155010 DOI: 10.1016/j.oooo.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery. STUDY DESIGN We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression. RESULTS Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence. CONCLUSIONS An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Alexandre Meireles Borba
- Research Program in Integrated Dental Sciences Department, Faculty of Dentistry of the University of Cuiabá, Cuiabá-MT, Brazil
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
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Bagourd T, Varazzani A, Dugast S, Guyonvarc'h P, Corre P, Bertin H. Radiological evaluation of inferior alveolar nerve displacement after removal of impacted mandibular third molars prior to sagittal split osteotomy. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101658. [PMID: 37866504 DOI: 10.1016/j.jormas.2023.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/05/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION We hypothesize that the removal of mandibular third molars (M3) 6 months prior to a bilateral sagittal split osteotomy (BSSO) could allow the displacement of the inferior alveolar nerve (IAN) in a favorable lingual position. This study aimed to radiographically compare the position of IAN before and after M3 removal in patients with Class II malocclusion. MATERIALS AND METHOD The CBCT images of 30 randomly selected patients (mean age 15.5 years, 19 females and 11 males) were segmented regarding the mandibular bone and the IAN canal. Mandibles were then superimposed and compared using 3D slicer (www.slicer.org). An orthonormal system was constructed, and the coordinates of IAN were assessed in the x- (horizontal axis), y- (depth axis), and z- (vertical axis) directions. RESULTS The mean changes in x- and z-values were 0.37 %, -0.09 % for the right IAN, 0.07 %, and -0.10 % for the left IAN, respectively. Y-axis was the dimension the most impacted by the M3 removal with a mean variation of -11.96 % for the right IAN, and 0.45 % for the left nerve (p1=0.74 and p2=0.04, respectively). Three patients presented a change in the IAN position superior to 1 mm on at least one coordinate axis. We observed a more important change in x-values of the right IAN in male than in female (p = 0.04), and no significant modifications regarding the other dimensions. Finally, there was no correlation between the age of the patients and the changes in IAN position. CONCLUSION This study confirms the absence of influence of mandibular third molar removal on the inferior alveolar nerve route prior to BSSO.
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Affiliation(s)
- Thomas Bagourd
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Nantes, Nantes Université, Nantes F-44000, France
| | - Andrea Varazzani
- Chirurgie Maxillo-Faciale, Chirurgie Plastique, Stomatologie et Chirurgie Orale, Hospices Civils de Lyon, Lyon-Sud Hospital - Claude-Bernard Lyon 1, 165 Chemin du Grand-Revoyet, Pierre-Bénite 69310, France
| | - Sophie Dugast
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Nantes, Nantes Université, Nantes F-44000, France
| | - Pierre Guyonvarc'h
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Nantes, Nantes Université, Nantes F-44000, France
| | - Pierre Corre
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Nantes, Nantes Université, Nantes F-44000, France; Nantes Université, Oniris, UnivAngers, INSERM, Regenerative Medicine and Skeleton, CHU Nantes, RMeS, UMR 1229, Nantes F-44000, France
| | - Hélios Bertin
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Nantes, Nantes Université, Nantes F-44000, France; UnivAngers, INSERM, CNRS, CHU Nantes, Nantes Université, CRCI2NA, Nantes F-44000, France.
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Khaleel AA, Bede SY. Evaluation of the Lingual Splitting Patterns and the Lateral Bone Cut Ends Following Mandibular Bilateral Sagittal Split Osteotomy Using Cone Beam Computed Tomography (CBCT). J Craniofac Surg 2023; 34:e728-e731. [PMID: 37316983 DOI: 10.1097/scs.0000000000009477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/25/2023] [Indexed: 06/16/2023] Open
Abstract
The bilateral sagittal split osteotomy (BSSO) is the most popular orthognathic procedure performed by maxillofacial surgeons to treat skeletal class II and class III and to correct mandibular asymmetries. The study aimed to evaluate the lingual splitting patterns and lateral bone cut end (LBCE) in bilateral sagittal split osteotomy (BSSO) and their relation with the ramal thickness and the presence of impacted third molars using cone beam computed tomography (CBCT). This prospective observational study included patients with mandibular prognathism who were treated with BSSO with or without Le Fort I osteotomy. Cone beam computed tomography was used to measure the ramal thickness preoperatively and to evaluate the LBCE, and the lingual splitting patterns postoperatively. Twenty-one patients (42 sides) were included in this study. The most commonly observed lingual splitting pattern was type III (47.6%), while the most common LBCE was type B (59.5%). The bad split was encountered 8 times on 42 sides (16.7%). A nonsignificant relationship between the ramal thickness and bad splitting was observed ( P =0.901). Impacted third molars were present in 16 of the 42 sides (38.1%) and had no significant effect on the occurrence of bad splitting ( P =0.063). Type III lingual splitting pattern and type B LBCE were the most commonly observed patterns. No direct association was observed concerning the presence of impacted mandibular third molars and the thickness of the ramus with the occurrence of bad splitting.
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Affiliation(s)
- Ameen A Khaleel
- Al-Yarmouk Teaching Hospital, The Iraqi Board for Medical Specializations
| | - Salwan Y Bede
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad and The Iraqi Board for Medical Specializations, Baghdad, Iraq
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Nussi AD, de Castro Lopes SLP, De Rosa CS, Gomes JPP, Ogawa CM, Braz-Silva PH, Costa ALF. In vivo study of cone beam computed tomography texture analysis of mandibular condyle and its correlation with gender and age. Oral Radiol 2023; 39:191-197. [PMID: 35585223 DOI: 10.1007/s11282-022-00620-3] [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: 03/19/2022] [Accepted: 04/24/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Texture analysis is an image processing method that aims to assess the distribution of gray-level intensity and spatial organization of the pixels in the image. The purpose of this study was to investigate whether the texture analysis applied to cone beam computed tomography (CBCT) images could detect variation in the condyle trabecular bone of individuals from different age groups and genders. METHODS The sample consisted of imaging exams from 63 individuals divided into three groups according to age groups of 03-13, 14-24 and 25-34. For texture analysis, the MaZda® software was used to extract the following parameters: second angular momentum, contrast, correlation, sum of squares, inverse difference moment, sum entropy and entropy. Statistical analysis was performed using Mann-Whitney test for gender and Kruskal-Wallis test for age (P = 5%). RESULTS No statistically significant differences were found between age groups for any of the parameters. Males had lower values for the parameter correlation than those of females (P < 0.05). CONCLUSION Texture analysis proved to be useful to discriminate mandibular condyle trabecular bone between genders.
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Affiliation(s)
- Amanda Drumstas Nussi
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), Rua Galvão Bueno, 868, Liberdade, São Paulo, SP, 01506-000, Brazil
| | - Sérgio Lucio Pereira de Castro Lopes
- Department of Diagnosis and Surgery, Science and Technology Institute, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | - Catharina Simioni De Rosa
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, SP, Brazil
| | - João Pedro Perez Gomes
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Celso Massahiro Ogawa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), Rua Galvão Bueno, 868, Liberdade, São Paulo, SP, 01506-000, Brazil
| | - Paulo Henrique Braz-Silva
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, SP, Brazil
- Laboratory of Virology, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Andre Luiz Ferreira Costa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), Rua Galvão Bueno, 868, Liberdade, São Paulo, SP, 01506-000, Brazil.
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