Dental Implants Can Facilitate Orthognathic Surgery in a Patient With Severe Maxillary Atrophy

Mandibular propulsion and dental implant rehabilitation for an edentulous patient with class II malocclusion and severe obstructive sleep apnea

Introduction: Orthognathic surgery can be a treatment for occlusal, oro-facial functional disorders and esthetics discrepancies as well as for obstructive sleep apnea. It is often practiced after an orthodontic preparation, but in edentulous patients, the preparation can be replaced with implant supported prosthesis to simulate the final occlusion. Observation: A patient presenting severe obstructive sleep apnea, vertical and sagittal insufficiency of the lower third of the face and poor dental health was treated with a guided mandibular advancement and an almost complete implant supported prosthesis rehabilitation. At first, the implants were placed and immediately loaded, giving the patient a class 2 occlusion. Then, an orthognathic surgery was performed, giving the patient a class 1 occlusion, and then the final prosthesis was made. Commentaries: The interest of this case is the combined treatment of the obstructive sleep apnea, the dental and facial deformities by mandibular retrognathia and the edentulous jaws. The gold standard for obstructive sleep apnea is a maxillary and mandibular advancement. In this case, for esthetic and anatomic reasons, a mandible propulsion alone has been performed, showing a positive and stable result for the treatment of obstructive sleep apnea. The use of surgical guide permitted to plan the treatment with more accuracy. Conclusion: This case combines a fixed prosthetic rehabilitation, which permitted to guide the orthognathic surgery and the treatment of obstructive sleep apnea.

Nerve growth factor-chondroitin sulfate/hydroxyapatite-coating composite implant induces early osseointegration and nerve regeneration of peri-implant tissues in Beagle dogs

Background

Osseointegration is the premise of the chewing function of dental implant. Nerve growth factor (NGF), as a neurotrophic factor, can induce bone healing. However, the influence of NGF-chondroitin sulfate (CS)/hydroxyapatite (HA)-coating composite implant on the osseointegration and innervations is still not entirely clear.

Materials and methods

NGF-CS/HA-coating composite implants were prepared using the modified biomimetic method. The characteristics of NGF-CS/HA-coating implants were determined using a scanning electron microscope. After NGF-CS/HA-coating implants were placed in the mandible of Beagle dogs, the early osseointegration and innervation in peri-implant tissues were assessed through X-ray, Micro-CT, maximal pull-out force, double fluorescence staining, toluidine blue staining, DiI neural tracer, immunohistochemistry, and RT-qPCR assays.

Results

NGF-CS/HA-coating composite implants were made successfully, which presented porous mesh structures with the main components (Ti and HA). Besides, we revealed that implantation of NGF-CS/HA-coating implants significantly changed the morphology of bone tissues and elevated maximum output, MAR, BIC, and nerve fiber in the mandible of Beagle dogs. Moreover, we proved that the implantation of NGF-CS/HA-coating implants also markedly upregulated the levels of NGF, osteogenesis differentiation, and neurogenic differentiation-related genes in the mandible of Beagle dogs.

Conclusion

Implantation of NGF-CS/HA-coating composite implants has significant induction effects on the early osseointegration and nerve regeneration of peri-implant tissues in the mandible of Beagle dogs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-020-02177-5.

Implant-supported provisional prosthesis facilitated the minor revision of occlusion and incisor exposure after orthognathic surgery of extended oligodontia in maxilla

Background

The congenital oligodontia in maxilla could result in a significant skeletal jaw malformation such as atrophic maxilla and severe skeletal class III malocclusion. Since there is no referable dentition in anterior maxilla, the orthognathic surgery and oral rehabilitation for those patients becomes more challenging and less predictable.

Materials and methods

We hereby present a new sequencing of interdisciplinary treatments, including calvarial bone grafting, installation of implant-supported provisional prosthesis, bimaxillary orthognathic surgery, and the final installation of dental implants and the fixed prosthesis.

Results

The facial esthetics and function of the permanent prosthesis were satisfactory, with a remarkable improvement in the maxillomandibular relation, adequate horizontal and vertical repositioning of the maxilla, and appropriate incisor exposure.

Conclusion

Although more surgeries and longer treatment period may be required due to the interdisciplinary treatment plan, better aesthetic and functional outcomes may be acquired by this reported procedure in the long-term for young patients.