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PubMed2002

Aesthetic and functional outcomes using osseous or soft-tissue free flaps.

The authors compared functional and aesthetic outcomes following reconstruction of the posterior mandible (i.e., unilateral defects distal to the mental foramen) with free flaps containing vascularized bone (VBFs) or only soft-tissue (STFs). Fifty-eight reconstructions of the posterior mandible were performed with STFs (n=32) or VBFs (n=26) and were available for review. All patients (n=58) completed a functional outcome questionnaire containing questions about diet, oral competence, pain, trismus, speech, cosmesis, social reintegration, and return to work. Computer-assisted image analysis was performed comparing facial proportions of patients with STFs (n=10), VBFs (n=11), or unoperated controls (n=10). VBFs yielded statistically significantly superior functional scores compared to STFs in 5/12 categories. Normal scores were found for diet in 31 percent (10/32) vs. 21 percent (3/26) ( p=0.006); oral competence in 56 percent (18/32) vs. 35 percent (9/26) ( p=0.05); and speech in 47 percent (15/32) vs. 30 percent (7/26) ( p=0.026). VBF patients returned to public dining (72 percent, 23/32) more frequently than STF patients (35 percent, 9/26), ( p=0.003). VBFs yielded superior results for midline symmetry with a mean mandible deviation of 3.3+/-2.3 mm vs. 5.8+/-3.6 mm (STFs), and 1.2+/-0.7 mm (controls, p=0.001). An objective method for the evaluation of aesthetic and functional outcomes in posterior mandible reconstruction was developed. This method demonstrated that posterior mandible reconstruction with VBFs is associated with superior results in speech, diet, and midline symmetry. However, rigorous analyses of oropharyngeal soft-tissue defects and the radiation therapy protocols utilized, were not performed in this study. Without these additional analyses, one cannot definitively conclude that VBFs are superior to STFs.

Adult↗
PubMed1993

[Temporary sagittal mandibulotomy as an approach to the pterygopalatine fossa, the parapharyngeal space and the oropharynx].

Standard procedures for temporary mandibulotomy are medial or the lateral osteotomy. Median mandibulotomy is associated with destruction of anatomical structures in the floor of the mouth and with lateral osteotomy no preservation of the nervus alveolaris inferior is possible. Therefore, a modification of mandibulotomy is described with wide-field exposure, minimal functional defects and reduction of osteotomy-related complications. The first osteotomy is carried out vertically before the foramen mentale on the buccal compacta of the mandible. A second vertical osteotomy is placed on the lingual compacta posterior to the musculus myohyoideus. Horizontal osteotomies on the alveolar ridge and the basal ridge of the mandible are connected with the vertical osteotomies. Using a chisel, the lingual and the buccal part of the mandible are split sagittally with preservation of the nervus alveolaris inferior located in the buccal fragment of the mandible. The two parts of the mandible are divided to provide access to the oropharynx. Surgical approach to the fossa pterygopalatina and the parapharyngeal space is reached with dissection of the mucosa along the ascending mandible, subluxation in the mandibular joint and reflection of the mandible cranially and posteriorly. The wide access offers a lot of advantages especially in combination with a microvascular flap reconstruction. Fixation of the mandible is carried out with two titanium miniplates at the anterior vertical osteotomy. The wide areas of the split bone marrow, resulting from sagittal splitting, achieved an exact adaptation of the mandibular parts and an easy and sure fixation via miniplates. Therefore, post-operative radiation therapy can be started two weeks after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Plates↗
PubMed2000

Case-control study on self-reported osteoporotic fractures and mandibular cortical bone.

OBJECTIVES: The purpose of this case-control study was to determine whether the radiographic appearance of the mandibular cortical bone in patients who were elderly and noninstitutionalized was related to a self-reported history of osteoporotic fractures. STUDY DESIGN: Patients who had a billing statement at the School of Dentistry dated between 1993 and 1996, who were older than 60, and who had a panoramic radiograph were invited to be interviewed regarding fracture history (circumstances and year of fracture) and risk factors for osteoporosis. Cases (n = 93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n = 394) were individuals reporting traumatic fractures (n = 105) or no fractures (n = 289). Blinded to case-control status, we evaluated the mandibular cortex on a panoramic radiograph and classified them as normal (even and sharp endosteal margin), moderately eroded (evidence of lacunar resorption or endosteal cortical residues), or severely eroded (unequivocal porosity). In addition, cortical thickness was measured below the mental foramen. RESULTS: After adjustment for potentially confounding factors, the odds ratio for an osteoporotic fracture associated with moderately eroded and severely eroded mandibular cortices was 2.0 (95% CI, 1.2 to 3.3) and 8.0 (95% CI, 2.0 to 28.9), respectively. After adjusting for all potentially confounding factors, we found that the cortex was 0.54 mm (or 12%) thinner in subjects with an osteoporotic fracture compared with controls (95% CI, 0.25 to 0.84 mm). CONCLUSIONS: Subjects with a self-reported history of osteoporotic fractures tend to have increased resorption and thinning of the mandibular lower cortex.

Aged↗
PubMed2003

Implant prosthodontic management of partially edentulous patients missing posterior teeth: the Toronto experience.

STATEMENT OF THE PROBLEM: The clinical success of implant-supported fixed partial dentures has been documented. However, few studies have reported long-term results or any association between implant outcomes and host determinants. PURPOSE: This study reports on implant and prosthesis outcomes in a group of partially edentulous patients treated with Brånemark implants in the posterior zones. It also examines factors described in the medical history that may influence implant survival. MATERIAL AND METHODS: The charts of patients treated with implants from 1983 and followed prospectively through December 2001 at the University of Toronto were reviewed. One hundred thirty partially edentulous patients treated with implant-supported restorations in the posterior zones (area distal to mental foramen) were selected. Implant and prosthesis treatment outcomes were recorded and analyzed through the Kaplan-Meier and Cox regression methods (P<.05). RESULTS: A total of 130 patients received 432 Brånemark dental implants in 174 posterior edentulous spans. The mean age of the patients at the time of insertion of the implants was 50.97 +/- 13.27 years. At 15 years, the overall implant and prosthesis survival rates were 91.6% and 89%, respectively. At 5 years, the survival rate of the wide-platform 5-mm-diameter implants was 76.3%. Implant diameter (P=.0001) and a history of a chronic medical condition (P=.01) were correlated with implant survival outcomes. CONCLUSIONS: High success of implant-supported prostheses in the posterior zones of both the maxilla and mandible. It corroborated other studies that have shown higher failure rates for wide-platform implants, emphasizing the need for proper establishment of clinical trials prior to marketing of new implant designs.

Adolescent↗
PubMed2003

An early modern human from the Peştera cu Oase, Romania.

The 2002 discovery of a robust modern human mandible in the Peştera cu Oase, southwestern Romania, provides evidence of early modern humans in the lower Danubian Corridor. Directly accelerator mass spectrometry radiocarbon (14C)-dated to 34,000-36,000 14C years B.P., the Oase 1 mandible is the oldest definite early modern human specimen in Europe and provides perspectives on the emergence and evolution of early modern humans in the northwestern Old World. The moderately long Oase 1 mandible exhibits a prominent tuber symphyseos and overall proportions that place it close to earlier Upper Paleolithic European specimens. Its symmetrical mandibular incisure, medially placed condyle, small superior medial pterygoid tubercle, mesial mental foramen, and narrow corpus place it closer to early modern humans among Late Pleistocene humans. However, its cross-sectional symphyseal orientation is intermediate between late archaic and early modern humans, the ramus is exceptionally wide, and the molars become progressively larger distally with exceptionally large third molars. The molar crowns lack derived Neandertal features but are otherwise morphologically undiagnostic. However, it has unilateral mandibular foramen lingular bridging, an apparently derived Neandertal feature. It therefore presents a mosaic of archaic, early modern human and possibly Neandertal morphological features, emphasizing both the complex population dynamics of modern human dispersal into Europe and the subsequent morphological evolution of European early modern humans.

Anthropology↗
PubMed1993

A new osteotomy for genioplasty--stepped osteotomy: preliminary report.

A new osteotomy for genioplasty, stepped osteotomy, is described. This osteotomy is a combination of horizontal and sagittal osteotomy of the mandibular symphysis. It consists of horizontal osteotomy at a distance of 3 to 4 mm below the apexes of the anterior teeth, connecting at right angles with the conventional horizontal osteotomy below the mental foramen, making a step-fashioned osteotomy of the chin. This procedure is particularly advantageous in simultaneous elongation and advancement genioplasty because the central portion between the apexes of the anterior teeth and the conventional horizontal osteotomy line is available as augmentation and the bony contact of the osteotomized mandible can be retained in elongating the chin. The characteristics of this procedure are described and typical patients are shown.

Adolescent↗
PubMed2005

The pediatric mandible: I. A primer on growth and development.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe embryonic and fetal mandibular development. 2. Summarize the aggregate changes in mandibular form from birth to puberty. 3. Describe the eruption and maturation of the deciduous and permanent mandibular dentition. BACKGROUND: In this, the first of two articles addressing the surgical management of pediatric mandibular fractures, the authors provide a detailed discussion of mandibular development and anatomy during the fetal period, infancy, and childhood. METHODS: A review of the pertinent literature was performed. The changing structure of the developing mandible is discussed, with particular attention to surgically relevant anatomical structures. RESULTS: Throughout development, key anatomical structures with relevance to surgical therapy change markedly in position. The mandible undergoes significant change in its bony structure and the composition of its surrounding soft tissues. The mandible's bony structure becomes more robust, with an increasingly acute gonial angle and enlargement of the ramus and body. Furthermore, the mandible provides the bony structure from which tooth buds erupt as the deciduous and permanent dentition--a process that generates significant growth of the alveolar process. As a consequence, the distance between the developing dentition and the inferior mandibular border increases. While the canal of the inferior alveolar nerve undergoes significant superior displacement, the mental foramen becomes positioned more posteriorly over time. In addition, the ligamentous and muscular attachments that surround the temporomandibular joint become increasingly robust. Throughout childhood and adolescence, the blood supply of the mandibular body changes little, with the buccal periosteal plexus and inferior dental artery making significant contributions. CONCLUSIONS: Mandibular growth provides the basis for normal occlusal relations and the generation of increasingly large masticatory force. Although the exact mechanisms of bone remodeling during mandibular development remain unclear, the process likely receives contributions from primary growth centers and the response to local alterations in biomechanical force produced by surrounding soft-tissue structures. A working knowledge of the changing mandibular anatomy is a prerequisite for effective clinical management of traumatic injury.

Bone Remodeling↗
PubMed1977

The relationship between the metacarpal index and the rate of mandibular ridge resorption.

This study tried to determine whether a relationship exists between the degree of alveolar resorption of the edentulous mandible and the degree of osteoporosis, as expressed by the metacarpal index. Eighty patients were examined. Each had a radiograph of the left hand to show the second metacarpal, and a standard pan-oral radiograph. A morphological measurement of the metacarpal bone, which is a good indication of the mineral content of the skeleton, was made on each hand radiograph. Alveolar resorption was estimated on the pan-oral radiograph by taking the original height of the alveolar process as being three times the distance from the inferior border of the madible to the inferior edge of the mental foramen. The regression analysis revealed no relationship between osteoporosis, as measured by the metacarpal index, and the amount of alveolar bone resorption.

Adult↗
PubMed1994

Location of implants in the interforaminal region of the mandible and the consequences for the design of the superstructure.

The location and the number of implants to support an overdenture is of major importance for the superstructure design. Sometimes, jaw bone anatomy or posteriorly placed implants enforce the use of an angular bar to achieve a position above the alveolar ridge. Loads on such a bar may introduce a moment on the implants which can result in high bone stresses and eventually the loss of the implants. This study on stress distribution in the bone around the implants in an edentulous mandible was performed using a three-dimensional finite element model. One model with two implants placed just anteriorly of the mental foramen and connected with an anteriorly placed bar, following the curvature of the alveolar ridge, was compared with two other designs. First with a similar model but now without a bar and secondly with a model with four implants connected with straight bars. It is concluded that loading a bar, which is placed anteriorly of the interconnecting line between two implants, causes extremely large compressive and tensile stress concentrations in the bone around the implants. Therefore, in those cases, it is advised not to connect the implants or, in case a bar-clip attachment is preferred, to place additional implants in the frontal region.

Bite Force↗
PubMed2005

Neurosensory disturbances following bone harvesting in the symphysis: a prospective clinical study.

OBJECTIVE: To analyse the occurrence and resolution of neurosensory disturbances following bone harvesting from the symphysis. MATERIAL AND METHODS: In 30 patients, skin sensitivity of the chin/lower lip area and pulp sensitivity of all mandibular anterior teeth were assessed preoperatively, at the time of suture removal, at 6 and 12 months postoperatively. In addition, bone defect dimensions of the donor site were measured intraoperatively, and distances from defect margins to adjacent anatomical structures, such as root apices, mental foramen and inferior border of mandible, were assessed postoperatively on a panoramic radiograph. RESULTS: Pulp sensitivity changes were found in 18.6% of adjacent teeth at the time of suture removal. At the 6-month follow-up, 8.1% of teeth, and at the 12-month re-examination, 0.6% of teeth presented with altered sensitivity. This decrease over time of the number of affected teeth per patients with sensitivity changes was significant (P=2.35e-007). Lower lip hypaesthesia was only observed in one patient postoperatively, with complete resolution at the 6-month follow-up. Radiographic measurements of distances between donor defect and adjacent anatomical structures only reached significant difference for one parameter in patients with sensitivity changes compared with patients without sensitivity changes. CONCLUSIONS: Patients must be informed about possible transient and long-term sensitivity changes of adjacent teeth and soft tissues following bone harvesting from the chin. However, by correctly placing mucoperiosteal incisions and bone cuts, the risk of sensitivity changes can be minimized.

Adolescent↗
PubMed1990

Root exposure in the primary dentition studied in human skulls.

The aims of the present study were to examine, on the primary dentition of 75 human dried skulls, the distance from the cemento-enamel junction (CEJ) to the alveolar bone crest, and to evaluate its relation to developmental age, bone morphology and attrition. The measurements from the CEJ to the alveolar crest were longer for the maxillary teeth, the second molars showed the shortest measurements, while the cuspids showed the longest. Significant positive partial correlations were found between age and the distance from the CEJ to the alveolar crest when controlling for attrition (r = 0.64), and between age and attrition when controlling for the distance from the CEJ to the alveolar bone crest (r = 0.54). The partial correlation between migration and attrition when controlling for age proved to be not significant (r = 0.13). Significant correlations were found between age and the distances from the mental foramen to: the alveolar crest (r = 0.90), and to the lower border of the mandible (r = 0.97). These findings suggest that root exposure takes place in the primary dentition, as the result of continuous eruption at a faster rate than formation of alveolar bone, presumably to compensate for facial growth.

Age Factors↗
PubMed1980

Pattern of age related bone loss in mandibles.

A study was carried out to analyze the pattern of the age related bone loss in the mandibular cortex and to establish normal values and the observed range of morphometric variables on microradiograms of bone sections taken from a well defined site anterior to and below the mental foramen. Specimens were obtained from 100 Danish subjects with no known systemic bone disease or severe mandibular atrophy. Microradiograms of 100-micron-thin undemineralized vertical ground cross-sections were produced. An electric point-counting system was used for the determination of 1) percentage bone mass, 2) mean cortical width (MCW), and 3) the percentage of Haversian canals with resorption surfaces. The analysis showed that cortical porosity and the percentage of Haversian canals showing resorption are unrelated to sex and increased after the age of 50. MCW and absolute bone mass (MCW x % bone mass) are greater in males than in females and show a parallel age related decrease after the age of 50. Furthermore, the age related increase in cortical thinning and porosity is dependent on the individual as well as on age. Marked individual variation confined the use of these parameters to group analysis.

Adult↗
PubMed1985

Dual-photon absorptiometry of mandibles: in vitro test of a new method.

A new method for non-invasive in vivo measurement of changes in bone mineral content (BMC) of mandibles, comprising two-dimensional dual-photon absorptiometry (GT45), has been developed and tested in vitro on mandibular specimens. The analysis showed that: 1) in vitro precision and accuracy of the methods are high, 2) effect of fat and soft tissue on photon attenuation is slight when scanning jaws and forearm bones, 3) BMC in units (U/cm2) in standard area, comprising mandibular base and body in left molar region, is representative for BMC in total mandibular base and body, 4) cortical bone constitutes the main part of measured BMC in mandibles, and 5) BMC of molar region is highly correlated to cortical bone mass in mm3/mm2 subperiosteal surface of standard locality anterior to and below mental foramen, measured by histomorphometry. GT45 seems suitable for in vivo estimation of BMC changes in edentulous jaws and in mandibular base and body of dentate mandibles in longitudinal and cross-sectional studies. The radiation dose is negligible.

Adipose Tissue↗
PubMed1993

Cortical bone mineral density in the mandible and osteoporosis status in postmenopausal women.

Mineral density of the cortical bone of the mandible was determined by single-energy QCT (quantitative computed tomography) for 77 menopausal women. Bone mineral densities (BMD) were measured in the buccal and lingual layers of the cortex, distally from the foramen mentale, on both sides of the mandible. All the women were edentulous in that region, and the alveolar processes were far resorbed. These results were compared with the BMD values of the femoral neck, lumbar spine, and trabecular portion of the mandible between the detected layers of cortex. The BMD of the buccal cortex correlated remarkably well with all values, except those of the trabecular portion. Of the women tested, the correlations were lowest in the least osteoporotic group. The values for the lingual cortex did not correlate with other variables as well as did those for the buccal cortex, but in the most osteoporotic part of the sample the lingual cortex values correlated significantly with the BMD of the trabecular portion. The BMD values for the buccal cortex were significantly higher than those for the lingual cortex.

Absorptiometry, Photon↗
PubMed2001

Fixed mandibular restorations on three early-loaded regular platform Brånemark implants.

BACKGROUND: Originally, the Brånemark System was used as a two-stage surgical procedure. Comparable clinical results have made one-stage and early-loading concepts possible alternatives in the edentulous mandible. From the patient's point of view, the financial aspect of implant treatment is important. In an attempt to decrease financial burden, the reduction of surgical interventions and reduction of the number of implants could be considered. PURPOSE: This prospective multicenter study evaluated (1) the 1- and 3-year success rates of implants loaded within 1 month after one-stage surgery with a fixed 10- to 12-unit bridge on three regular platform Brånemark System implants in the mandible, (2) the outcome of the prosthetic treatment, and (3) the opinion of patients regarding the treatment procedure. MATERIALS AND METHODS: Of 20 patients, 19 received five implants in the mandible, of which three were functionally loaded with the one-stage technique (group 1). The loaded implants were inserted in a tripodal position, one implant in the symphysis and two located anterior of the mental foramen in the bicuspid area. Two additional implants were inserted for safety reasons but were not intended to be included in the restoration. These two additional implants served as either an unloaded one-stage control implant (group 2) or an unloaded control implant installed with the submerged technique (group 3). Immediately after surgery, the implants were loaded with a relined denture. The patients received a 10- to 12-unit prosthetic reconstruction an average 31 days (range, 4-53 d) after surgery. Implant stability was clinically checked at 3, 12, and 36 months. Radiographs were taken at corresponding follow-up visits to calculate bone-to-implant level and marginal bone resorption. RESULTS: Six of 60 functionally loaded implants (10%) and 3 of 20 prostheses (15%) failed within the first year. The cumulative implant failure rate in group 1, both after 1 and after 3 years, was 9.5%. No implant failure occurred in the control groups 2 and 3. The average marginal bone level measured at 1 and 3 years was 1.6 mm (SD = 0.8 mm) and 2.1 mm (SD = 0.2 mm), respectively, for group 1; 1.5 mm (SD = 1.3 mm) and 2.4 mm (SD = 0.6 mm), respectively, for group 2; 0.8 mm (SD = 1.4 mm) and 0.7 mm (SD = 0.9 mm), respectively, for group 3. CONCLUSIONS: The results of treatment using three regular platform Brånemark System implants supporting a fixed mandibular arch reconstruction were less favorable than the outcome that can be expected with a standard four- to six-implant with one-stage surgery.

Adult↗
PubMed1994

Muscle strength and mineral densities in the mandible.

Bone mineral density (BMD) in the femoral neck and lumbar spine was measured for 355 postmenopausal 48- to 56-year-old women and the BMD in five different regions in the mandible for 77. All 355 women were also classified according to the size of the masseter muscle. Both skeletal measures and the BMD of the buccal cortex distally from the foramen mentale were compared with the size of the masseter muscle. This study indicates that functional stress, caused by the masseter muscle, is involved in maintaining bone mineral density in edentulous regions of the mandible. Those individuals who are physically active or are bruxists may lose less mineral, after extractions of teeth, from those regions of the jaw bones where the muscles are attached.

Absorptiometry, Photon↗
PubMed1976

Direction of the mental canal in human mandibles.

The direction of the mental canal was calculated in the horizontal and vertical planes with a view to aiding anaesthetic techniques. Based on our data, it is advisable to give the following approximate inclinations to the needle when penetrating the mental canal in anaesthetic procedures: 55 degrees postero-anteriorly in relation to a horizontal plane and 40 degrees latero-medially in relation to a horizontal line tangent to the body of the mandible at the level of the mental foramen.

Adult↗
PubMedDate not supplied

New method for comparing the activity of local anesthetics used in dentistry.

A method using conscious rats was designed to determine, measure, and compare the local anesthetic property of agents used in dentistry. The technique involves a local anesthetic blockade of the mental and incisive nerves at the mental foramen and electrical stimulation proximal to the anesthetized region. This pharmacodynamic method is simple to perform and appropriate for the assessment of local anesthetics as used in clinical dentistry.

Anesthesia, Dental↗