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Ntovas P, Grybauskas S, Beiglboeck F, Kalash Z, Aida S, Att W. What comes first: teeth or face? Recommendations for an interdisciplinary collaboration between facial esthetic surgery and dentistry. J ESTHET RESTOR DENT 2024. [PMID: 38949070 DOI: 10.1111/jerd.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/13/2024] [Accepted: 05/11/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE The aim of the present study was to provide recommendations in order to facilitate communication between dental professionals and surgeons who are collaborating in the field of dentofacial esthetics. CLINICAL CONSIDERATIONS Smile esthetics are beyond the scope, both of the surgeons who are collaborating with facial esthetics and of the dentists, as a wide range of treatment options from both sides is available. It can be difficult for the surgeon or the dentist that first comes in contact with the patient to conduct an individualized global treatment plan, in order to find out how the various phases of the treatment can be sequenced, as a workflow for an efficient interaction between facial surgery and dentistry still does not exist in the scientific literature. CONCLUSIONS Facial cosmetic procedures and dental treatment have to be planned as individual elements of the whole dentofacial esthetic rehabilitation. The treatment has to be initiated with the design of the smile and the intraoral mock-up, followed by the required surgical interventions, and to be finished with the delivery of the definitive dental restoration. CLINICAL SIGNIFICANCE Dentofacial esthetics require comprehensive communication between surgeons and dentists. Following the proposed recommendations, an individualized interdisciplinary treatment plan can be conducted, defining the role of each specialty.
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Affiliation(s)
- Panagiotis Ntovas
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | | | - Fabian Beiglboeck
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, Münster, Germany
| | - Ziad Kalash
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Wael Att
- Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Private Practice, The Face Dental Group, Boston, Massachusetts, USA., Bonston, United States
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Sanz D, Ângelo DF, Maffia F, Marques R, Cardoso H. A case series on a new reference in mandibular angles harmonization: the Frontozygomatic-Infraorbital Line (FZ-IOL). J Craniomaxillofac Surg 2024:S1010-5182(24)00199-9. [PMID: 38890025 DOI: 10.1016/j.jcms.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 04/01/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024] Open
Abstract
the aim of this paper, is to propose a new reference line: the Frontozygomatic-Infraorbital Line (FZ-IOL). This reference line can guide the surgical team planning mandibular angle harmonization, based on the patient's skeletal proportion. The Frontozygomatic-Infraorbital Line has been adopted for symmetrization surgery, masculinization surgery, and in unsatisfactory results of previous orthognathic surgery. From March 2021 to December 2022, 3 patients were treated for severe facial asymmetry affecting mainly the lower third of the face. All cases were planned with the reference FZ-IOL. Patients were treated in the same center, at the Orthognathic Surgery Department of the Instituto Portugues da Face, Lisbon, Portugal. The Frontozygomatic-Infraorbital Line is designed virtually using software to reconstruct a 3D image from a digital imaging and communications in medicine (DICOM) file obtained from a cone beam computer tomography (CBCT). , connecting the two orbital rims. Then, a vertical line, the frontozygomatic line perpendicular to the IOL and passing through the outmost lateral portion of the frontozygomatic suture is drawn. The proposed line demonstrated how establishing appropriate reference lines is crucial for the success of the surgery. The selection of reference lines should be based on the patient's anatomy, the symmetrization process's complexity, and the surgery's desired outcome. The Frontozygomatic-Infraorbital Line represents an adequate reference line for managing mandibular angle lateral projection, improving lower third of the face symmetrization.
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Affiliation(s)
- David Sanz
- Instituto Português da Face, Lisbon, Portugal
| | - David Faustino Ângelo
- Instituto Português da Face, Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Marinha Grande, Portugal
| | - Francesco Maffia
- Instituto Português da Face, Lisbon, Portugal; PhD Program of the Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
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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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Liu JY, Li GF, Tang Y, Yan FH, Tan BC. Multi-disciplinary treatment of maxillofacial skeletal deformities by orthognathic surgery combined with periodontal phenotype modification: A case report. World J Clin Cases 2022; 10:8980-8989. [PMID: 36157638 PMCID: PMC9477038 DOI: 10.12998/wjcc.v10.i25.8980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Maxillofacial deformities are skeletal discrepancies that cause occlusal, functional, and esthetic problems, and are managed by multi-disciplinary treatment, including careful orthodontic, surgical, and periodontal evaluations. However, thin periodontal phenotype is often overlooked although it affects the therapeutic outcome. Gingival augmentation and periodontal accelerated osteogenic orthodontics (PAOO) can effectively modify the periodontal phenotype and improve treatment outcome. We describe the multi-disciplinary approaches used to manage a case of skeletal Class III malocclusion and facial asymmetry, with thin periodontal phenotype limiting the correction of deformity.
CASE SUMMARY A patient with facial asymmetry and weakness in chewing had been treated with orthodontic camouflage, but the treatment outcome was not satisfactory. After examination, gingiva augmentation and PAOO were performed to increase the volume of both the gingiva and the alveolar bone to allow further tooth movement. After orthodontic decompensation, double-jaw surgery was performed to reposition the maxilla-mandibular complex. Finally, implant placement and chin molding were performed to restore the dentition and to improve the skeletal profile. The appearance and function were significantly improved, and the periodontal tissue remained healthy and stable.
CONCLUSION In patients with dentofacial deformities and a thin periodontal phenotype, multi-disciplinary treatment that includes PAOO could be effective, and could improve both the quality and safety of orthodontic-orthognathic therapy.
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Affiliation(s)
- Jia-Ying Liu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Gui-Feng Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Ya Tang
- Department of Preventive Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Fu-Hua Yan
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Bao-Chun Tan
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
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Miao MZ, Wang B, Wu D, Zhang S, Wong S, Shi O, Hu A, Mao L, Fang B. Temporomandibular joint positional change accompanies post-surgical mandibular relapse-A long-term retrospective study among patients who underwent mandibular advancement. Orthod Craniofac Res 2017; 21:33-40. [DOI: 10.1111/ocr.12209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/16/2022]
Affiliation(s)
- M. Z. Miao
- Department of Oral and Craniofacial Health Sciences; UNC School of Dentistry; Chapel Hill NC USA
| | - B. Wang
- Department of Oral and Craniomaxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - D. Wu
- Department of Biostatistics; School of Dentistry; Department of Periodontology; UNC School of Public Health; Chapel Hill NC USA
| | - S. Zhang
- Department of Oral and Craniofacial Health Sciences; Center for Oral and Systemic Diseases; UNC School of Dentistry; Chapel Hill NC USA
| | - S. Wong
- Department of Oral and Craniofacial Health Sciences; Department of Orthodontics; UNC School of Dentistry; Chapel Hill NC USA
| | - O. Shi
- Shanghai Jiao Tong University School of Public Health; Shanghai China
| | - A. Hu
- Department of Oral and Craniofacial Health Sciences; UNC School of Dentistry; Chapel Hill NC USA
| | - L. Mao
- Department of Oral and Craniomaxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - B. Fang
- Department of Oral and Craniomaxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
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Miao Z, Wang XD, Mao LX, Xia YH, Yuan LJ, Cai M, Liu JQ, Wang B, Yang X, Zhu L, Yu HB, Fang B. Influence of temporomandibular joint disc displacement on mandibular advancement in patients without pre-treatment condylar resorption. Int J Oral Maxillofac Surg 2017; 46:328-336. [DOI: 10.1016/j.ijom.2016.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 08/06/2016] [Accepted: 08/17/2016] [Indexed: 12/19/2022]
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The Effect of a Condylar Repositioning Plate on Condylar Position and Relapse in Two-Jaw Surgery. Arch Plast Surg 2017; 44:19-25. [PMID: 28194343 PMCID: PMC5300918 DOI: 10.5999/aps.2017.44.1.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/11/2016] [Accepted: 10/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Numerous condylar repositioning methods have been reported. However, most of them are 2-dimensional or are complex procedures that require a longer operation time and a highly trained surgeon. This study aims to introduce a new technique using a condylar repositioning plate and a centric relation splint to achieve a centric relationship. METHODS We evaluated 387 patients who had undergone surgery for skeletal jaw deformities. During the operation, a centric relation splint, intermediate splint, final centric occlusion splint, and condylar repositioning plate along with an L-type mini-plate for LeFort I osteotomy or a bicortical screw for bilateral sagittal split ramus osteotomy were utilized for rigid fixation. The evaluation included: a physical examination to detect preoperative and postoperative temporomandibular joint dysfunction, 3-dimensional computed tomography and oblique transcranial temporomandibular joint radiography to measure 3-dimensional condylar head movement, and posteroanterior and lateral cephalometric radiography to measure the preoperative and postoperative movement of the bony segment and relapse rate. RESULTS A 0.3% relapse rate was observed in the coronal plane, and a 2.8% relapse rate in the sagittal plane, which is indistinguishable from the dental relapse rate in orthodontic treatment. The condylar repositioning plate could not fully prevent movement of the condylar head, but the relapse rate was minimal, implying that the movement of the condylar head was within tolerable limits. CONCLUSIONS Our condylar repositioning method using a centric relation splint and mini-plate in orthognathic surgery was found to be simple and effective for patients suffering from skeletal jaw deformities.
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Biosse Duplan M, Komla-Ebri D, Heuzé Y, Estibals V, Gaudas E, Kaci N, Benoist-Lasselin C, Zerah M, Kramer I, Kneissel M, Porta DG, Di Rocco F, Legeai-Mallet L. Meckel's and condylar cartilages anomalies in achondroplasia result in defective development and growth of the mandible. Hum Mol Genet 2016; 25:2997-3010. [PMID: 27260401 PMCID: PMC5181594 DOI: 10.1093/hmg/ddw153] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 02/07/2023] Open
Abstract
Activating FGFR3 mutations in human result in achondroplasia (ACH), the most frequent form of dwarfism, where cartilages are severely disturbed causing long bones, cranial base and vertebrae defects. Because mandibular development and growth rely on cartilages that guide or directly participate to the ossification process, we investigated the impact of FGFR3 mutations on mandibular shape, size and position. By using CT scan imaging of ACH children and by analyzing Fgfr3Y367C/+ mice, a model of ACH, we show that FGFR3 gain-of-function mutations lead to structural anomalies of primary (Meckel’s) and secondary (condylar) cartilages of the mandible, resulting in mandibular hypoplasia and dysmorphogenesis. These defects are likely related to a defective chondrocyte proliferation and differentiation and pan-FGFR tyrosine kinase inhibitor NVP-BGJ398 corrects Meckel’s and condylar cartilages defects ex vivo. Moreover, we show that low dose of NVP-BGJ398 improves in vivo condyle growth and corrects dysmorphologies in Fgfr3Y367C/+ mice, suggesting that postnatal treatment with NVP-BGJ398 mice might offer a new therapeutic strategy to improve mandible anomalies in ACH and others FGFR3-related disorders.
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Affiliation(s)
- Martin Biosse Duplan
- INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France.,Service d'Odontologie, Hôpital Bretonneau, HUPNVS, AP-HP, Paris, France
| | - Davide Komla-Ebri
- INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Yann Heuzé
- UMR5199 PACEA, Université de Bordeaux, Bordeaux Archaeological Sciences Cluster Of Excellence, Université de Bordeaux, Bordeaux, France
| | - Valentin Estibals
- INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Emilie Gaudas
- INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Nabil Kaci
- INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | | | - Michel Zerah
- Neurochirurgie Pédiatrique, Unité de Chirurgie Craniofaciale, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Ina Kramer
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | | | - Federico Di Rocco
- INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France.,Neurochirurgie Pédiatrique, Unité de Chirurgie Craniofaciale, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Laurence Legeai-Mallet
- INSERM U1163, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Paris, France .,Service de Génétique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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