Le fort I osteotomy with or without concomitant removal of upper third molars: A prospective cohort study of intraoperative findings, related complications, and level of pterygomaxillary separation after down-fracture

The main objective of our study was to assess the clinical implications of concomitant intraoperative removal of maxillary third molars (M3M) with the Le Fort I osteotomy 'twist' technique (LF1twist). A prospective comparative study was carried out regarding the necessity of bone trimming around the pedicle, intra- and postoperative complications, surgery time, and the level of pterygomaxillary junction (PMJ) separation following LF1twist with concomitant intraoperative removal of M3M (test group) versus LF1twist alone (control group). Outcome parameters were assessed from clinical and radiographic measurements. In total, 100 surgery sites were included (50 in each group). The mean surgery time was 53.4 ± 7.8 min, with nonsignificant differences between groups. The frequency of intraoperative complications was negligible, with no significant differences between groups - though all bleeding events (n = 4) occurred when M3M was not removed concomitantly. No postoperative complications were recorded. Percentages of disarticulations occurring at the PMJ were similar in both groups. In conclusion, the results demonstrate that removal of M3M in conjunction with LF1twist does not imply additional surgery time, or differences regarding the level of PMJ separation or perioperative complications. Furthermore, the concomitant procedure reduces the amount of maxillary and palatal bone in the disjunction area, which facilitates down-fracture and field clearing for maxillary repositioning.

Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing

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.

Accuracy of Orthognathic Surgical Planning using Three-dimensional Virtual Techniques compared with Conventional Two-dimensional Techniques: a Systematic Review

Objectives

The objective was to assess the accuracy of orthognathic surgical planning using three-dimensional virtual planning compared with conventional two-dimensional planning.

Material and Methods

MEDLINE (PubMed), Embase and Cochrane Library search combined with hand-search of relevant journals was conducted to identify randomized controlled trials (RCTs) published in English through August 2^nd, 2022. Primary outcomes included postsurgical accuracy of hard and soft tissue. Secondary outcomes included treatment planning time, intraoperative time, intraoperative blood loss, complications, financial expenses, and patient-reported outcome measures (PROMs). Quality and risk-of-bias assessment were evaluated by Cochrane risk of bias tool and GRADE system.

Results

Seven RCTs characterised by low, high, and unclear risk of bias fulfilled inclusion criteria. Included studies disclosed conflicting results regarding accuracy of hard and soft tissue as well as treatment planning time. The intraoperative time was shortened, and financial expenses were increased with three-dimensional virtual surgical planning (TVSP), while no planning-related complications were revealed. Comparable improvement in PROMs were reported with TVSP and two-dimensional planning.

Conclusions

Future orthognathic surgical planning will indisputable be performed by three-dimensional virtual planning. The financial expenses, treatment planning time, and intraoperative time will therefore probably decrease due to further development of three-dimensional virtual planning techniques. The hard and soft tissue accuracy between planned position and achieved surgical outcome seems to be improved by three-dimensional virtual planning compared with two-dimensional planning, although results are inconsistent. Further development of three-dimensional virtual planning involving cutting guides and patient-specific osteosynthesis plates are therefore needed to improve the accuracy of orthognathic surgical planning.

Oral symptoms and pathologies in Danish patients with chronic kidney disease- a pilot study

The aim was to investigate oral health in randomly selected patients with chronic kidney disease (CKD). Data obtained by structured interview (self-reported lifestyle, oral symptoms and regularity of dental visits) and oral examination of patients with CKD from the Copenhagen University Hospital. Fourteen patients with CKD were screened. Only half of the patients reported regular dental visits and poor dental status was registered in half of the patients. Oral mucosal changes were registered in thirteen patients (93%). Eleven patients (79%) had gingival inflammatory disease. Twelve patients (86%) were carriers of Candida, and three (21%) had oral candidosis. Six patients (43%) had low whole saliva flow rate. Twelve patients (86%) reported at least one oral symptom. Overall, there was no differences in oral symptoms or findings related to kidney transplanted or not transplanted patients. The small sample size most likely influences the results. However, the vast majority of patients with CKD reported oral symptoms and only half consulted a dentist regularly. Poor dental status, oral mucosal changes and gingival disease were prevalent findings. Patients with CKD need focus on daily oral healthcare and regular dental visits. Interdisciplinary cooperation could encourage patients with CKD to focus on oral health.

Virtual surgical planning in orthognathic surgery with the use of patient-specific plates compared with conventional plates. A systematic review focusing on complications, financial expenses, professional and patient-reported outcome measures

Background

Orthognathic surgery is a well-known surgical procedure for correction of facial deformities. The surgical procedure is performed by the use of conventional plates and by patient-specific osteosynthesis plates (PSOPs). The aim of this study is to investigate any differences in complications, financial expenses, professional and patient-reported outcome measures (PROM) in orthognathic surgery performed by conventional plates and by PSOPs.

Material and Methods

A MEDLINE (PubMed), Embase, and Cochrane Library search was conducted. Human studies published in English through August 27, 2020 were included. Grey literature, unpublished literature as well as other databases like Scopus, Google Scholar, or Research Gate were also included in the search strategy of the present systematic review. Randomized and controlled clinical trials were included. Risk of bias was assessed by Cochrane risk of bias tool and Newcastle-Ottawa Scale.

Results

Five studies with unclear risk of bias and moderate quality were included. Meta-analysis was not applicable due to considerable heterogeneity. There was no significant difference in intra- and postoperative complications or professional and PROM with the two treatment modalities, although higher tendencies to reoperations were observed with conventional plates. Financial expenses were significantly higher with PSOP, but treatment planning and intraoperative time were shortened by approximately one third compared with mock surgery and conventional plates.

Conclusions

No significant differences were observed in complications, professional and PROM. Higher financial expenses were recorded in orthognathic surgery performed with PSOP. Treatment planning and intraoperative time were shortened with the use of conventional plates. Although further randomized trials are needed before definite conclusions can be provided about beneficial use of PSOPs in orthognathic surgery from a professional and patient perspective.

Key words:Orthognathic surgery, systematic review, virtual planning.