Biomedical subjects

T J Hoppenreijs

Publications and source records attributed to T J Hoppenreijs.

16 recordsLinked to original sources

PubMed2001

[Stability of orthodontic-maxillofacial surgical treatment of anterior open bite deformities]].

A sample of 267 patients with maxillary hyperplasia, a Class I or Class II occlusion and anterior open bite, collected from three different institutions, was analysed regarding stability after Le Fort I intrusion osteotomies or bimaxillary osteotomies. Skeletal and dento-alveolar stability of the maxilla, postional changes of the mandible and of incisors were evaluated on cephalometric radiographs. The stability of maxillary arch dimensions after correction of the open bite is measured on dental casts. Patients with anterior open bite, treated with a Le Fort I osteotomy in one-piece or in multi-segments, with or without bilateral sagittal split osteotomy exhibited good skeletal stability of the maxilla. Rigid internal fixation showed better maxillary and mandibular stability than intraosseous wire fixation. Considerable relapse of transverse dimensions, however, was measured after orthodontic and surgical expansion. The mean overbite at the 69 months follow-up was 1.24 mm and lacking of overlap between opposing incisors was present in 19%.

Adolescent↗

PubMed1999

Long-term evaluation of patients with progressive condylar resorption following orthognathic surgery.

The aim of this retrospective study was to evaluate the long-term treatment results of 26 patients who developed progressive condylar resorption (PCR) following a bilateral sagittal split advancement osteotomy (n= 19) or a bimaxillary osteotomy (n=7). PCR was diagnosed clinically and from a comparison of pre- and postoperative cephalometric and orthopantomographic radiographs. The preoperative condylar configuration and resorption pattern were assessed distinguishing between 'deep bite' and 'open bite'. Patients with 'deep bites' tended to have more resorption on the superior site of the condyle, while 'anterior open bites' often had resorption on the superior and anterior sites of the condyle. The patients were divided into 2 groups, one receiving non-surgical treatment that included splints, orthodontics with or without extractions and restorative dentistry. The second group underwent repeated surgery to treat skeletal relapse. Thirteen patients who underwent non-surgical treatment after orthognathic surgery had satisfactory results from orthodontic dental compensation, although only 3/13 had Class I occlusion. Another 13 patients had unacceptable occlusal and/or esthetic results and, therefore, underwent a second surgery. Following surgery, 7 patients had satisfactory occlusal and esthetic results and were skeletally stable. Four patients had 40-80% relapse, but with a stable occlusion. Two patients had 120% and 100% relapse, respectively, and needed a third surgical intervention. The first patient had a stable occlusal and esthetic result with approximately 30% relapse at pogonion, but the second patient still had an unstable malocclusion with again 100% relapse. It appeared that, without surgical intervention after PCR, further resorption ceased after approximately two years. Second surgery appeared to produce variable results, but, in this series, the majority had significant improvement.

Adolescent↗

PubMed1999

Psychologic implications of surgical-orthodontic treatment in patients with anterior open bite.

Two hundred eighty-two patients who received surgical-orthodontic treatment to correct anterior open bite were retrospectively evaluated by interview and questionnaires to determine the motivation and expectations before treatment, experience during treatment, psychosocial impact, functional and esthetic results, and satisfaction. All patients underwent a Le Fort I osteotomy, and 126 patients also received a bilateral sagittal split advancement osteotomy. The mean follow-up was 6 years. The most important reasons for treatment, as cited by the patients, were biting and chewing problems (28%), dissatisfaction with facial appearance (26%), and symptoms of temporomandibular joint (TMJ) dysfunction (21%). Patients with anterior open bite had a critical attitude toward facial appearance; therefore, esthetic aspects should be taken seriously. The expectations on chewing ability, phonetics, nasal passage, and facial appearance were met by the treatment; however, expectations on TMJ function, interincisal relationship, and biting ability were not completely fulfilled. There was a subjective improvement of TMJ sounds in 27% and a worsening in 14% of the patients. Dysesthesia of the infraorbital nerve was noticed in 4% of patients and of the mental or inferior alveolar nerve in 23% of the patients. Chewing and biting abilities improved in 53% and 73%, respectively. Facial appearance, self-confidence, and social interaction had improved. Patients had expected more information before and psychologic support after treatment. Despite the relapse of open bite in 20% of the patients, 75% were satisfied with the dental and 85% with the facial appearance.

Adolescent↗

PubMed1998

Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite. A clinical and radiological study.

A sample of 259 patients with vertical maxillary hyperplasia, mandibular hypoplasia and anterior vertical open bite, collected from three different institutions, was analysed regarding temporomandibular joint (TMJ) sounds, condylar remodelling, and condylar resorption. All patients underwent Le Fort I osteotomies, and bilateral sagittal split advancement osteotomies were performed in 117 patients. Intraosseous wire fixation was used in 149 and rigid internal fixation in 110 patients. Cephalometric and orthopantomographic radiographs were available before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). The number of patients with TMJ sounds decreased from 38% to 31%. At the latest follow up 23.6% of the patients showed condylar remodelling, 7.7% unilateral condylar resorption and 7.7% bilateral condylar resorption. Condylar contours, as assessed on orthopantomographic radiographs, were classified as five different types. Condyles with preexisting radiological signs of osteoarthrosis or having a posterior inclination were at high risk for progressive resorption. Female patients with severe anterior open bite, high mandibular plane angle and a low posterior-to-anterior facial height ratio, who underwent a bimaxillary osteotomy, were prone to condylar resorption. Bone loss was predominantly found at the anterior site of the condyle. The incidence of condylar resorption was significantly higher after bimaxillary osteotomies (23%) than after only Le Fort I intrusion osteotomies (9%). Avoidance of intermaxillary fixation by using rigid internal fixation tended to reduce condylar changes, in particular in patients who underwent only a Le Fort I osteotomy. Rigid internal fixation in bimaxillary osteotomies resulted in condylar remodelling in 30% and progressive condylar resorption in 19% of the patients. Condylar changes were not significantly different after using either miniplate osteosynthesis or positional screws in bilateral sagittal split osteotomy procedures.

Adolescent↗

PubMed1998

Open bite deformity in amelogenesis imperfecta. Part 1: An analysis of contributory factors and implications for treatment.

Anterior open bite (AOB) is often seen in patients with amelogenesis imperfecta (AI). The skeletal and dental components were analysed in 15 patients with AI and AOB. Measurements on cephalometric radiographs and dental models were compared with those of 130 patients with AOB but without enamel anomalies. Skeletal components in the AI and non-AI group were comparable. The AI group showed omega-shaped dental arches and a reversed mandibular curve of Spee. Orthodontic treatment options are limited because of the conical form of the teeth, tight contacts in the posterior regions and the condition of enamel resulting in difficulties in bonding brackets. Fixation problems encountered during surgery are discussed. A multidisciplinary treatment is outlined consisting of a multi-segment Le Fort I osteotomy followed by prosthetic rehabilitation to stabilize occlusion for at least one year postoperatively.

Adolescent↗

PubMed1998

Open bite deformity in amelogenesis imperfecta. Part 2: Le Fort I osteotomies and treatment results.

Functional conditions, skeletal and dento-alveolar stability and condylar changes in 15 patients with mandibular hypoplasia, anterior open bite (AOB) and amelogenesis imperfecta (AI), who had undergone a Le Fort I osteotomy, were analysed after a mean follow-up of 5 years. Two patients underwent a one-piece Le Fort I intrusion osteotomy and 13 patients a multi-segment Le Fort I osteotomy. In three of these patients, an additional bilateral sagittal split osteotomy was performed. Thirteen patients underwent a genioplasty. Surgery was followed by prosthetic rehabilitation in 10 patients. Skeletal and dento-alveolar stability were analysed on lateral cephalometric radiographs and condylar changes on orthopantomographic radiographs. Transverse stability of the dental arches was analysed on dental casts. The treatment results in this group were compared with patients with similar skeletal features but without amelogenesis imperfecta. The harmony of the long faces was restored and a reasonable vertical stability of the maxilla was achieved, however, a slight open bite and tongue interposition was still present. The transverse stability of dental arches (60%) was disappointing. Rigid internal fixation produced better transverse stability. Progressive condylar resorption was seen in two patients (13%). Less occlusal stability could be achieved in patients with AI, but resulted neither in less skeletal stability nor in more susceptibility to morphological condylar changes.

Adolescent↗

PubMed1998

Stability of transverse maxillary dental arch dimensions following orthodontic-surgical correction of anterior open bites.

A sample of 130 patients with vertical maxillary hyperplasia; mandibular hypoplasia with a high mandibular plane angle; narrow, tapered maxillary dental arch form; and anterior vertical open bite were collected from three different institutions to evaluate the stability of transverse maxillary arch dimensions after correction of the open bite. Surgical treatment consisted of Le Fort I or bimaxillary osteotomies. Intermolar, interpremolar, and anterior arch widths were measured three-dimensionally on dental casts using a Reflex microscope, and transverse stability after orthodontic or surgical maxillary expansion was analyzed. Orthodontic expansion followed by a one-piece Le Fort I intrusion osteotomy was performed in 77 patients, and surgical maxillary expansion by a multisegment Le Fort I intrusion osteotomy was performed in 53 patients. The increase of transverse arch width and the relapse after orthodontic or surgical expansion were not significantly different. The transverse arch width in these two groups did not relapse in 20% of the patients after a mean follow-up of 69 months. An additional bilateral sagittal split osteotomy had no detectable effect on stability. Patients who underwent a multisegment Le Fort I osteotomy stabilized with rigid internal fixation showed better transverse stability than those with intraosseous wire fixation and maxillomandibular fixation. Maxillary intermolar and interpremolar arch width relapses were not correlated with tongue interposition or loss of interdigitation. The relapse of these arch widths showed significant correlations with clockwise rotation of the mandible but not with changes of overbite or overjet.

Adolescent↗

PubMed1997

Skeletal and dento-alveolar stability of Le Fort I intrusion osteotomies and bimaxillary osteotomies in anterior open bite deformities. A retrospective three-centre study.

A sample of 267 patients with maxillary hyperplasia, a Class I or Class II/I occlusion and anterior vertical open bites, collected from three different institutions, was analysed regarding stability after surgical corrections. Skeletal and dento-alveolar stability of the maxilla, and positional changes of the mandible and of the incisors were evaluated. All patients underwent Le Fort I intrusion osteotomies and in 92 patients segmentation of the maxillae was performed. An additional bilateral sagittal split advancement osteotomy was performed in 123 patients. Intraosseous wire fixation was used in 153 patients and rigid internal fixation in 114 patients. Cephalometric radiographs were collected before orthodontic treatment, before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). It can be concluded that patients with anterior open bites, treated with a Le Fort I osteotomy in one-piece or in multi-segments, with or without bilateral sagittal split osteotomy, exhibited good skeletal stability of the maxilla. Rigid internal fixation produced the best maxillary and mandibular stability. The mean overbite at the longest follow up was 1.24 mm and a lack of overlap between opposing incisors was present in 19%. The overbite did not differ significantly between the different treatment procedures, probably due to compensatory movements of the mandibular and maxillary incisors.

Adolescent↗

PubMed1997

[Surgical correction of the intermaxillary relation for placement of implants].

The loss of teeth is associated with alveolar bone resorption. Severe resorption of the maxillary alveolar process may cause persistent instability and loss of retention of the upper denture. Large intermaxillary discrepancies may complicate the treatment with implants to retain maxillary overdentures. Reconstructive surgical treatment methods that create sufficient bone volume for the placement of implants and at the same time normalize intermaxillary relationships, provide the basis for adequate oral rehabilitation.

Alveolar Bone Loss↗

PubMed1996

Simultaneous placement of endosteal implants and mandibular onlay grafting for treatment of the atrophic mandible. A preliminary report.

A method of placing two endosteal implants with simultaneous bone grafting to the anterior mandible is described. This technique is simple to use, has minimal morbidity, and has produced good preliminary results. Retrospectively, 18 patients with a total of 36 implants were reviewed. An implant success rate of 91.6% was seen at a mean follow-up time of 17 months after loading with an implant-supported, soft-tissue-borne overdenture.

Adult↗

PubMed1996

Perioperative morbidity in maxillofacial orthopaedic surgery: a retrospective study.

The data of 2049 patients, who underwent maxillofacial orthopaedic surgery, were retrospectively analysed for major intra- and immediate postoperative complications. Immediate life-threatening complications were very rare. They can in most cases be avoided by good anaesthetic and surgical techniques and adequate postoperative care. The most frequently encountered problem in maxillary surgery is excessive blood loss, whilst a compromised airway due to swelling is the most frequent complication in mandibular surgery. Good co-operation between anaesthetist and surgeon is essential to prevent major intraoperative and immediate postoperative problems.

Adolescent↗

PubMed1996

Occlusal and functional conditions after surgical correction of anterior open bite deformities.

The dental occlusion and alterations in orofacial muscles were studied in 267 patients whose severe anterior open bite had been treated with a Le Fort 1 intrusion osteotomy with or without an advancement sagittal split osteotomy about 6 years ago. Only 17% of those patients showed anterior contact, and 20% had no vertical overlap of mandibular and maxillary central incisors at all. Tongue position, activity of masticatory muscles, lip competence, lip-incisor relationship, and breathing mode were assessed. Statistically significant correlations were found between tongue positions and occlusion in both the anterior and the posterior regions. In addition, the activity of the masticatory muscles, habitual mouth posture, and interlabial distance were each significantly correlated to overbite, open bite, and overjet. The interlabial distance was also significantly correlated with both breathing mode and mentalis muscle activity. The activity of the masticatory muscles was negatively correlated with tongue position.

Adaptation, Physiological↗

PubMed1992

The chin as a donor site in early secondary osteoplasty: a retrospective clinical and radiological evaluation.

26 unilateral cleft palate patients received an autogenous bicortical chin bone graft for early reconstruction of the alveolar process. In the evaluation of the donor site, 4% of the anterior teeth showed a negative pulpal sensibility, less than 1% a peri-apical granuloma and 12% pulp canal obliteration. The tooth buds of the canines showed developmental disturbances in 6%. Exposure of unerupted canines should be avoided, and a 5 mm safety margin is advised. Based on its architecture, topographic accessibility, minimal post-operative morbidity and absence of visible scars, the chin can be considered to be a very useful donor site in bone grafting procedures.

Alveolar Process↗

PubMed1992

[Anterior open bite].

In almost 50% of the Dutch population, the mandibular incisors do not contact the maxillary ones. An open bite is usually based on an interposition of the tongue and can be combined with other functional disturbances as digit sucking. A large open bite with an excessive facial deformity can be treated adequately, after facial growth is completed, by a combined orthodontic-surgical approach, in which a good cooperation between the orthodontist and the oral surgeon is essential. The correction of the facial deformity is of a permanent nature. That does not always apply to the open bite due to interposition of the tongue. Often it is not possible to arrive at complete contact by orthodontic or surgical means. The improvement realized can fade away partly in the years following.

Fingersucking↗

PubMed1990

Sensibility and cutaneous reinnervation of pectoralis major myocutaneous island flaps. A preliminary clinical report.

The cutaneous sensibility of 13 pectoralis major cutaneous island flaps has been investigated retrospectively. Although in raising the pectoralis major myocutaneous island flap sensory denervation of the skin is produced, after a mean follow-up period of 29 months (range 5 to 71 months), 68% of the cutaneous portion of the flap revealed sensibility to touch, suggesting a reinnervation from the surrounding intact oral mucosa or skin. The rate of reinnervation was found to be related to the sensibility present in the surrounding tissue.

Adult↗

PubMed1990

Primary palatorraphy in the adult cleft palate patient. Surgical, prosthetic and logopaedic aspects.

The treatment of 8 adults with untreated cleft palates is retrospectively discussed. A palatorraphy, consisting of a palatoplasty with pedicled palatal mucoperiosteal flaps and an intravelar veloplasty, is performed. A rib graft between the nasal and oral layer and a partial vestibuloplasty are used in a few patients to create a more favourable anatomical situation for the prosthetic appliance. The palatorraphy contributes to improved speech intelligibility however, combined with a pharyngeal flap as performed in 5 patients, an even better result can be achieved. According to the results, a surgical procedure in the adult still seems to be worthwhile.

Adult↗