Factors associated with quality of life before and after orthognathic surgery

PURPOSE

Evaluate which factors compromise patients' quality of life who have undergone orthognathic surgery in the pre and postoperative period of 2 years.

STUDY DESIGN

In this longitudinal prospective study, 46 adult patients undergoing orthognathic surgery were evaluated. The primary outcome variable was quality of life, assessed using the overall score of the orthognathic quality of life questionnaire (OQLQ) in the pre and 2-year postoperative periods. The predictor variables were axis I (temporomandibular dysfunction) and axis II (psychosocial) RDC/TMD diagnoses, assessed preoperatively and 2 years postoperatively; profile, asymmetry, and open bite preoperatively; and orthodontic treatment active 2 years postoperatively. The covariables were age and sex. The OQLQ score was compared preoperatively and postoperatively using the Wilcoxon test and with the other variables using the Mann-Whitney and Kruskall-Wallis tests.

RESULTS

Preoperatively, higher OQLQ scores were associated with myofascial pain (P = .012) and severe depression (P = .030). Two years after surgery, there was an improvement in overall OQLQ (P < .001), myofascial pain (P = .012) and chronic pain (P = .001). However, higher OQLQ scores were associated with individuals who had myofascial pain (P = .012), active orthodontic treatment (P = .007), and other nonspecific physical symptoms including pain (NSPSIP) (P = .049).

CONCLUSION

Quality of life was affected preoperatively by myofascial pain and depression, and although it improved significantly 2 years after surgery, it continued to be affected by myofascial pain, NSPSIP, and active orthodontic treatment.

Is Intraoral Scanning Accurate to Evaluate Dental Implant Position? An In-Vitro Study

PURPOSE

The position of dental implants is generally verified through imaging exams, even though its use exposes patients to radiation. Intraoral scanning (IOS) may be a suitable alternative to using radiographic imaging to verify implant position. Using polyurethane jaw models, the purpose of this in-vitro study was to measure and compare implant positions determined by IOS and cone-bean computed tomography (CBCT).

METHODS

One hundred twenty implants were installed in 30 edentulous polyurethane jaws, 4 dental implants in each prototype. Four scanbodies were attached to the implants, and a scanning of each mandible was acquired using an intraoral scanner (CS 3600). All prototypes were also submitted to CBCT. Then, the 3D scan files in STL (Standard Tessellation Language) format were superimposed on the DICOM (Digital Imaging and Communications in Medicine) images of the tomographic mandibles. The accuracy of IOS was evaluated by the metric analyses of deviations between the position of the implants projected by the IOS versus the detected tomographically, in which CBCT served as the gold standard, using a free software for digital planning (Bluesky 4 - Grayslake, IL, USA). The following measures were analyzed: radial deviations at the shoulder (Xc) and at the apex of the implants (Xa), height deviation (Xh) and axial deviation. Bland-Altman and a paired t-test were applied to verify the reproducibility between measurements and a t-test for a mean was applied to compare the measurements with zero value.

RESULTS

The results showed Xc and Xa deviation means of 0.14 ± 0.09 mm and 0.12 ± 0.12 mm, respectively. The Xh mean was 0.2 ± 0.12 mm and the axial deviation mean was 0.71° ± 0.66°. T-test showed a statistically significant difference when the 4 means were compared to zero value, represented by the CBCT (P < .0001).

CONCLUSIONS

There was a statistically significant difference IN the scanned measures compared to CBCT as the standard, but the differences may not be clinically significant. The IOS utilization to evaluate the position of dental implants is a radiation-free and reproducible method, with the advantage of not generating metal artifacts. Further clinical studies are needed to validate this new method of postoperative evaluation.

Assessment of Resorbable and Non-resorbable Fixation Systems in Sagittal Split Ramus Osteotomy: An In vitro Study

Objective

The internal fixation has been purpose of study for many years, but there is still no consensus on the best method of fixation in relation to resistance for bilateral sagittal split ramus osteotomy (BSSO) using plates. Therefore, the aim of this study was to assess five different methods of osteosynthesis using resorbable and non-resorbable plates and screws in simulated sagittal split osteotomy (SSO) of the mandibular ramus.

Materials and Methods

SSO was performed in 25 polyurethane synthetic mandibular replicas. The distal segments were moved forward 5 mm, and the specimens were grouped according to the fixation method: Inion resorbable plate, KLS resorbable plate, standard four-hole titanium miniplate (Medartis), two standard four-hole titanium miniplates (Medartis) and an adjustable titanium miniplate (Slider/Medartis). Mechanical evaluation was performed by applying compression loads to first molar using an Instron universal testing machine up to a 5 mm displacement of the segments. Resistance forces were obtained in Newtons (N), and statistical analysis was performed using the software R v. 3.5 with significance level of 0.05. Linear mixed models were used to compare the force required to move each type of plate.

Results

The results showed that the resistance of SSO was better accomplished using two titanium miniplates and KLS resorbable plate showed the least resistance. However, both titanium and resorbable plates behaved similarly in small displacements, which are most commonly observed in BSSO postoperative time.

Conclusion

It can be concluded that both resorbable and non-resorbable systems might offer suitable mechanical resistance in the procedures where there are no mechanical postoperative complications.

Association of the estrogen receptor gene with oral health-related quality of life in patients with dentofacial deformities

This study aimed to evaluate the associations between oral health-related quality of life (OHRQoL) and patient-associated factors and polymorphisms in the estrogen receptor 1 (ESR1) and 2 (ESR2) genes in patients with dentofacial deformities (DFD). This cross-sectional study included 234 adult individuals. Data such as age, sex, and the type of facial profile (I, II, or III), were collected, and the short-form oral health impact profile 14 (OHIP-14) questionnaire was used to assess their OHRQoL. DNA was collected from oral mucosa cells, and the polymorphisms in ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) were evaluated using real-time polymerase chain reaction. The data were subjected to statistical analysis at a significance level of 5%. Individuals over 28 years of age exhibited worse OHRQoL (p = 0.003) than individuals aged less than or equal to 28 years. Women had worse OHRQoL than men (p < 0.001). Profile II individuals had worse OHRQoL in the social disability domain than profile III individuals (p = 0.030). Genetic analysis showed that rs9340799 was associated with OHRQoL in the functional limitation domain, and GG individuals exhibited worse OHRQoL than individuals carrying the AA/AG genotypes (p < 0.030). In the social handicap domain, individuals with GG genotype in rs9340799 exhibited worse OHRQoL than AG individuals (p < 0.043). Collectively, our results reveal that factors including age, sex, and type of facial profile, are associated with OHRQoL in patients with DFD. In addition, individuals with the GG genotype in rs9340799 (ESR1) may experience a negative impact on OHRQoL in the functional limitation and social handicap domains.

Quality of Life and Temporomandibular Disorders in Patients With Skeletal Class III Malocclusion With Cleft Lip and Palate

OBJECTIVE

The aim of the study was to assess the quality of life (QOL), oral health-related QOL (OHRQOL), temporomandibular disorders (TMDs), and psychological factors in patients with skeletal Class III malocclusion with cleft lip and palate (CLP) and without CLP.

DESIGN

Case-control.

SETTING

Primary care, institutional practice.

PATIENTS

One hundred thirty-six patients with skeletal Class III malocclusion with CLP (n = 68) and without CLP (n = 68).

MAIN OUTCOME MEASURES

QOL and OHRQOL were assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and the Oral Health Impact Profile-14 questionnaire, respectively. TMDs and psychological factors were assessed using the Research Diagnostic Criteria for TMD (RDC/TMD).

RESULTS

No differences in QOL were found between the groups (P > 0.05). Patients with CLP reported a better OHRQOL (P = 0.025) in the physical pain, physical disability, and psychological disability domains (P < 0.05). Patients with CLP presented with less myofascial pain (OR, 0.28; 95% CI, 0.11-0.71] and other articular conditions (OR 0.24; 95% CI 0.06-0.90]. More patients with CLP reported no chronic pain (P = 0.012). The QOL of patients with CLP with no depression or with no nonspecific physical symptoms including pain (NSPSIP) was better than that of patients without CLP. The OHRQOL of patients with CLP without TMDs or no psychological factors was better than that of patients without CLP.

CONCLUSIONS

Patients with skeletal Class III malocclusion who require orthognathic surgery with CLP have better OHRQOL and present with fewer TMDs than those patients without CLP.

Individuals requiring orthognathic surgery have more depression and pain than controls

The objective of this study was to evaluate if individuals with dentofacial deformities (DFD) who require orthognathic surgery are affected more by depression and pain. A case-control study was performed with 195 individuals. In the DFD group, 145 individuals with Class II and III malocclusion requiring orthognathic surgery were selected. The control group was composed of 50 individuals with no DFD. All patients were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data were analyzed with a significance level of 0.05. The DFD group more often presented severe depression (p = 0.020) and chronic pain (p = 0.017). They also presented higher prevalence of Nonspecific Physical Symptoms Including Pain (P = 0.002) and Nonspecific Physical Symptoms Excluding Pain (p = 0.002). Concerning TMD symptoms, the DFD group had more myofascial (p = 0.002) and articular pain (p = 0.041). Therefore, the results of this study suggest that depression and pain are more common in individuals with DFD requiring orthognathic surgery compared with individuals without DFD.

Orthognathic surgery in class II patients: a longitudinal study on quality of life, TMD, and psychological aspects

OBJECTIVES

To evaluate, longitudinally, the impacts of orthognathic surgery in patients with skeletal class II malocclusion on oral health-related quality of life (OHRQoL), temporomandibular disorders (TMD) and psychological symptoms.

MATERIALS AND METHODS

Forty-three patients with skeletal class II malocclusion who were submitted to orthognathic surgery were evaluated during their preoperative and postoperative periods. They answered the short version of the Oral Health Impact Profile (OHIP-14) and were also diagnosed according to Axes I and II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The evolution of OHRQoL and TMD before and after surgery was verified, and the relationships among these variables were found through statistical analysis using Wilcoxon, McNemar, chi-square, and Mann-Whitney tests, with a 5% significance level.

RESULTS

The median of the overall OHIP-14 score and five domains decreased after orthognathic surgery (p < 0.05), the functional limitation domain increased (p = 0.014), and the physical disability domain did not show an association (p = 0.133). There were improvements in articular pain (p = 0.016), chronic pain (p = 0.019), and nonspecific physical symptoms excluding pain (p = 0.013). In addition, an association was found between poorer OHRQoL (overall scale and domains) and the Axis II variables of the RDC/TMD (p < 0.05).

CONCLUSION

Orthognathic surgery improved perceived OHRQoL, articular pain, and chronic pain. The conditions of Axis II of the RDC/TMD interfered with OHRQoL postoperatively.

CLINICAL RELEVANCE

Although orthognathic surgery improves QoL and some TMD conditions in skeletal class II patients, poorer postoperative outcomes are observed when psychological conditions are present.

Association between facial measurements and polymorphisms in human epidermal growth factor and transforming growth factor β1

The aim of the study was to evaluate the association between genetic polymorphisms in human epidermal growth factor (EGF) (rs4444903) and transforming growth factor β1 - (TGF-β1) (rs1800470) with facial measurements in patients with dentofacial deformities. A total of 144 adult patients with dentofacial deformities were included. Facial linear and angular measurements were traced in lateral cephalometric radiographs used Dolphin 2D software. Cells from oral mucosa were collected for DNA to be extracted. The polymorphisms were genotyped using real-time polymerase chain reaction (PCR). Probabilites of less than 0.05 were accepted as significant. The rs4444903 heterozygous patients had a decrease in the mandibular length (p=0.043) and the length of the mandibular base (p=0.008), and homozygous A patients also had a reduction in the length of the mandibular base (p=0.013) compared with homozygous G patients. Patients AG had an increase in measurement of the anterior facial height (p=0.032) and in ANS-Me distance (p=0.022) when compared with homozygous A. To the rs1800470, heterozygous patients had an increase in the length of the mandibular base (p=0.043) when compared with homozygous A. Heterozygous AG patients had an increase in angular measurements in TGF-β1 polymorphism for the upper gonial angle, when compared with the homozygous AA (p=0.032). Genetic polymorphisms in EGF and TGF-β1 are associated with facial measurements in a Brazilian population of patients with dentofacial deformities.

Benign Cementoblastoma Associated with an Impacted Third Molar inside Maxillary Sinus

INTRODUCTION

Cementoblastoma is a rare and benign odontogenic mesenchymal tumor, often characterized by the formation of cementum-like tissue produced by neoplastic cementoblasts attached to or around the roots of a tooth.

CASE REPORT

22-year-old male patient was referred to the Federal University of Paraná after occasional finding on a routine panoramic radiograph. Clinical examination suggested no alterations. Medical and family history presented no alterations as well. Computed tomographic (CT) showed the presence of a radiopaque area associated with the roots of the impacted third molar measuring 15 mm × 10 mm inside the left maxillary sinus. The treatment plan suggested was to surgically remove it under general anesthesia. An intraoral approach was conducted, using the Newmann incision from the superior left first molar to the retromolar area with anterior and posterior relaxant incisions. Using a Caldwell-Luc access next to the maxillary tuberosity region, the maxillary sinus was exposed and the calcified mass attached to the roots of the tooth was reached. Pathological mass removed was sent for histopathological investigation. Examination revealed dense, mineralized, cementum-like material and vascular soft tissue areas that consisted of cementoblasts. One-year follow-up shows no recurrence and absence of symptoms.