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PubMed2004

Radiologic measurements of the mandible: a comparison between CT-reformatted and conventional tomographic images.

This study was carried out to compare the accuracy of determination of the mandibular contour and the position of the mandibular canal in cadaver mandibles by the multiplanar reconstruction method (MPR-CT), which has recently come to be used widely for preoperative examinations, with those by tomographic techniques and to evaluate the usefulness of MPR-CT. Using three imaging systems, i.e. Quantum CT scanner, Scanora, and OP-100, a total of 6 sites were scanned in the molar regions of 3 cadaver mandibles. The images obtained were measured twice each by 4 radiologists. The anatomic structures measured were the height and thickness of the mandible, distance from the alveolar crest to the mandibular canal, and distance from the buccal cortical bone to the mandibular canal. After scanning, the scanned areas of the mandibles were sliced at a thickness of 2 mm, and soft X-ray images of these slices were obtained. The values of the above 4 anatomic structures obtained by measurements in the soft X-ray radiograms using digital-display calipers were regarded as true values. When compared with the true values, the errors in the distance from the alveolar crest to the mandibular canal were within 1 mm (+/- 1 mm) in 93.7% of the measurements by Direct-CT, 89.6% of the measurements by MPR-CT, 87.5% of the measurements by Scanora, and 47.9% of the measurements by OP-100, and the accuracy of the 4 methods ranked in the order of Direct-CT, MPR-CT, Scanora, and OP-100. A similar tendency was observed in the measurements of other anatomic structures, and statistically significant differences were observed among the methods. Thus, MPR-CT allows more accurate measurements than by the other 2 tomographic techniques,and to be useful as a preoperative examination for implant surgery.

Aged↗
PubMed2007

Immediate loading of dental implants placed in severely resorbed edentulous mandibles reconstructed with autogenous calvarial grafts.

OBJECTIVE: The aim of this prospective study was to present the clinical outcome of immediately loaded dental implants placed in edentulous, severely atrophied mandibles, after reconstruction with autogenous multilayered calvarial grafts. MATERIALS AND METHODS: Six patients, two males and four females, aged 40-67 years (mean: 56 years) presenting with severely atrophied edentulous mandibles (Cawood and Howell class VI), were reconstructed with multilayered calvarial bone grafts placed in the intraforaminal area of the mandible. Five to 8 months afterwards, 23 dental implants were placed in the reconstructed areas (three to four implants per patient) and immediately loaded with implant-supported overdentures. Patients were followed with clinical and radiographic controls annually. RESULTS: Recovery after the reconstruction was uneventful in all patients. All 23 implants were osseointegrated 1-3 years after the start of immediate loading. The survival and success rates of implants were 100% and 95.7%, respectively. CONCLUSION: Results from this study showed that immediate loading of dental implants placed in severely atrophied edentulous mandibles reconstructed with calvarial bone grafts is a predictable procedure, which permits a successful dental rehabilitation with a shortening of treatment times.

Adult↗
PubMed1985

Blood flow in maxilla and mandible of normal and atherosclerotic rhesus monkeys.

Atherosclerotic vascular disease affects many individuals, particularly in an elderly population. This study examined alterations in the vasculature and blood flow in the maxilla and mandible in rhesus monkeys fed an atherogenic (high fat) diet. No significant difference was found in blood flow between different regions of the bone (anterior mandible, posterior mandible and maxilla) in animals on either a normal or a high fat diet but overall blood flow in the monkeys on the atherogenic diet was significantly lower (p less than 0.001) than in the control group. Histologic examination of tissue from the animals fed an atherogenic diet revealed minimal changes within the intrabony vasculature and measurements of these vessels showed no significant difference in the percentage of tissue occupied by vessel lumina or in average wall thickness between the groups of animals. On the other hand, tissue from the tongue exhibited gross atherosclerotic vascular lesions and examination of the carotid arteries revealed not only intimal plaques but extensive calcification. It thus appears that the decreased flow measured in the maxilla and mandible may be related to the severely involved afferent vessels rather than to functional changes in the local vasculature.

Animals↗
PubMed1997

Hypothetical mortality risk associated with spiral tomography of the maxilla and mandible prior to endosseous implant treatment.

Radiation dose delivered from the SCANORA radiography unit during the cross-sectional mode for dentotangential projections was determined. With regard to oral implantology, patient situations of an edentulous maxilla and mandible as well as a single tooth gap in regions 16 and 46 were simulated. Radiation doses were measured between 0.2 and 22.5 mGy to organs and tissues in the head and neck region when the complete maxilla or mandible was examined. When examining a single tooth gap, only 8% to 40% of that radiation dose was generally observed. Based on these results, the mortality risk was estimated according to a calculation model recommended by the Committee on the Biological Effects of Ionizing Radiations. The mortality risk ranged from 31.4 x 10(-6) for 20-year-old men to 4.8 x 10(-6) for 65-year-old women when cross-sectional imaging of the complete maxilla was performed. The values decreased by 70% when a single tooth gap in the molar region of the maxilla was radiographed. The figures for the mortality risk for examinations of the complete mandible were similar to those for the complete maxilla, but the mortality risk decreased by 80% if only a single tooth gap in the molar region of the mandible was examined. Calculations according to the International Commission on Radiological Protection carried out for comparison did not reveal the decrease of the mortality risk with age and resulted in a higher risk value in comparison to the group of 35-year old individuals in calculations according to the Committee on the Biological Effects of Ionizing Radiations.

Adult↗
PubMed2005

Rehabilitation of edentulous mandibles by means of turned Brånemark System implants after one-stage surgery: a 1-year retrospective study of 152 patients.

BACKGROUND: Rehabilitation of the edentulous mandible with oral implants is today predominantly executed with one-stage surgery and early or immediate loading. It is generally claimed that the outcome is similar to that of the classic two-stage technique. PURPOSE: The aim of the present investigation was to retrospectively evaluate the 1-year results of one-stage surgery and early loading performed in edentulous mandibles in a large group of patients. The outcome was compared with that of a study, from the same clinic (control), that used the two-stage surgical technique in edentulous mandibles and whose data were well controlled. MATERIALS AND METHODS: The study included 152 individuals with 750 turned Brånemark System implants of various designs placed in edentulous mandibles by means of one-stage surgery. The prosthetic procedure was commenced at a mean of 13 days after the surgical intervention. Intraoral apical radiography was performed at the time of prosthesis placement and at the 1-year annual checkup. Comparison of failure rates between the test and the control groups was made by means of the chi-square test. RESULTS: A total of 18 implants in 12 patients in the study group were found to be mobile up to and including the first annual checkup, equivalent to a 1-year implant cumulative survival rate (CSR) of 97.5%. The corresponding CSR for the control group was 99.7%. Differences between the two groups in regard to implant survival reached significant levels when analyzed with the chi-square test (p < .05). No such significant difference was seen on the patient level (p > .05). Because of implant failures one prosthesis in the study group was remade. The mean marginal bone resorption during the first year of function was 0.4 mm in both groups. CONCLUSIONS: The present investigation showed a high but (compared with the classic two-stage technique) somewhat lower CSR after 1 year for the one-stage technique. More prosthetic adjustments due to implant failures were observed in the study group, and the results emphasize the need for large study samples in order to statistically verify small differences between various treatment techniques.

Adult↗
PubMed1984

Mandible movements during increasingly rapid articulations of single syllables: preliminary observations.

A previous study of mandible movements in normal speech [W.L. Nelson, J. Acoust. Soc. Am. Suppl. 1 68, S32 (1980)] suggested that the speech motor control process resulted in a relationship between movement time, distance, and peak velocity which implied (1) some adaptation to the physical effort required for the movement, and (2) that the force limit effective during speech was considerably below that which the mandibular muscles are capable of producing. In the present study, mandible movements were measured during maximally rapid opening and closing tasks, and during increasingly rapid repetitions of a spoken syllable and a nonspeech "syllable." The results indicate that (1) peak acceleration levels for the repeated mandible movements were less than half of those for the maximally rapid single mandible movements, and (2) a rather different mode of control is used for the repeated speech movements as compared to the nonspeech movements.

Humans↗
PubMed1995

Advancement of the mandible improves velopharyngeal airway patency.

The velopharynx is the most common site of obstruction in patients with obstructive sleep apnea (OSA). Advancement of the mandible effectively reverses the pharyngeal obstruction. Accordingly, we hypothesized that mandibular advancement increases cross-sectional area of several segments of the upper airway, including the velopharynx and the oropharynx. We examined the pressure-area properties of the pharyngeal airway in 13 patients with OSA. Under general anesthesia and total muscle paralysis, the pharynx was visualized with an endoscope connected to a video-recording system. During an experimentally induced apnea, we manipulated the nasal pressure from 20 cmH2O to the point of total closure at the velopharynx. The procedure was repeated after maximal forward displacement of the mandible. Measurements of the cross-sectional area at different levels of nasal pressure allowed construction of a static pressure-area relationship of the "passive pharynx," where active neuromuscular factors are suppressed. In 12 of 13 patients with OSA, advancement of the mandible stabilized the airway by reducing the closing pressure and increasing the area at any airway pressure. Thus the maneuver shifted the static pressure-area curve of the velopharynx and the oropharynx upward in these patients. We conclude that anterior movement of the mandible widens the retropalatal airway as well as that at the base of the tongue in the passive pharynx of OSA patients.

Adult↗
PubMed1996

Effects of masticatory muscle function on bone mass in the mandible of the growing rat.

The effect of altered masticatory muscle function on bone mass at different sites in the rat mandible was studied using aluminium as a reference substance in computer-assisted image analysis. Forty-two growing male rats were divided into three groups, of which one group was killed at the beginning of the experiment to provide baseline values. Of the remaining two, one received a hard diet (control group) and the other a soft diet. After 28 days the rats were killed and the mandibles were excised. Lateral radiographs were taken of the mandible halves together with an aluminium stepwedge and then analysed by an image analysis system. Radiographic bone mass was measured in the transverse plane as "aluminium-equivalent thickness' in millimetres. Standardized areas were chosen to investigate regions with different functional demands. Significant differences were found between the groups in the alveolar bone of the molars and the incisor, as well as in the condylar costa and the condylar process. Significant differences were also found in some areas related to muscle insertion, such as the anterior lower border of the ramus, whereas no statistically significant differences could be found in others, such as the posterior lower border of the angular process. In conclusion, altered masticatory function influences the amount of bone mass in certain parts of mandible, where changes in applied bending forces have possibly altered the bone strain.

Animals↗
PubMed1991

Biometric analysis of the mandibles of Papio anubis and Cercopithecus aethiops.

Six biometric measurements were recorded from dry mandibles of 53 Papio anubis and 84 Cercopithecus aethiops: intercondylar width, intercoronoid width, intermolar width (IMW), mesiodistal width of the condyles, height of the occlusal table and anteroposterior length of the chewing surface from P4 to M3 (CL). The mean values and correlation matrices of these variables show that, despite the difference in size, the overall shape of the mandible in male and female is similar within species. The principal component analysis shows that in P. anubis the six variables contribute almost equally to the first component (75% of total variance), suggesting that the large mandible may be force related because of the greater mechanical forces required for chewing certain foods. In C. aethiops, the contribution of IMW and CL is less in the first component (52.7% of total variance), suggesting that the biochemical forces of mastication are more complex to adapt the mandible to a shorter muzzle and a particular diet.

Animals↗
PubMed1993

Mandible enclosure of upper airway and weight in obstructive sleep apnea.

Although anatomic lesions and obesity can produce obstructive sleep apnea (OSA), most subjects with OSA have no recognizable anatomic lesion. We hypothesized that the occurrence of OSA is related to the size of the region enclosed by the mandible and the degree of obesity. We studied 30 subjects with a range of OSA and obesity with magnetic resonance imaging (MRI). MRI was performed with T-1 weighted sequences. Nocturnal polysomnography was performed in all subjects. Univariate regression analysis indicated there was a significant correlation between the number of apneas and hypopneas per hour of sleep (AH/h) and (1) the area enclosed by the mandible ramus (AMR1) (r = 0.48, p < 0.01) and (2) the distance from the teeth to the posterior mandible ramus (r = 0.39, p < 0.05). Stepwise multiple regression analysis indicated that weight, AMR1, and height explained 69% of the variance of AH/h (r2 = 0.69). We conclude that the occurrence of OSA in these subjects is related to the size of the region enclosed by the mandible as well as to their weight.

Adult↗
PubMed1997

Intermittent parathyroid hormone administration stimulates bone formation in the mandibles of aged ovariectomized rats.

Intermittent administration of parathyroid hormone (PTH) is known to stimulate bone formation in many skeletal sites and is being investigated as a possible therapeutic agent for the treatment of osteopenic conditions, including post-menopausal osteoporosis. The purpose of this study was to determine the ability of PTH to stimulate bone formation in the mandibles of aged ovariectomized (Ovx) rats, and the results are compared with a site in the appendicular skeleton (humerus). The Ovx rat is a useful model of estrogen deficiency, replicating many aspects of post-menopausal osteoporosis. Female rats were ovariectomized or sham-operated, and one year later a group of the ovariectomized rats was treated with the 1-34 fragment of human PTH daily, five days a week for 10 weeks. During the experiment, the animals were given fluorochrome bone markers for histomorphometry. More than one year after ovariectomy or sham surgery, there were few differences in the histomorphometric indices of bone formation in the humerus or mandible. PTH treatment had no effect on dentin formation, measured in the mandibular incisor; however, most indices of bone formation-including the double-labeled surface, mineralizing surface, mineral appositional rate, new bone area, and surface-referent bone formation rates-were substantially greater in the PTH-treated group compared with both the Ovx and the Sham controls measured at the periosteal and endocortical surfaces of the humerus and the periosteal and cancellous bone surfaces of the mandible. In addition, bone formation at the alveolar crest, particularly on the buccal side, was greater in the PTH-treated group. The results from this study demonstrate that systemic intermittent PTH treatment stimulates bone formation in the mandibles in aged, estrogen-deficient animals.

Aging↗
PubMed2002

Quantitative trait loci on chromosomes 10 and 11 influencing mandible size of SMXA RI mouse strains.

Predicting the mandible size before the termination of growth of the maxillofacial bones is essential in pedodontics as well as for the predictions needed for genetic analysis. Here, Quantitative Trait Locus (QTL) analysis was used to detect the chromosomal regions responsible for the mandible length between the menton and gonion in an SMXA recombinant inbred strain of mice. Around the region 60 cM from the centromere in chromosome 10, the logarithm of the odds score showed a higher than suggestive level. Around the regions 13 cM and 16 cM in chromosome 11, two significant QTLs were detected. Analysis of genotypes from loci corresponding to those QTLs revealed a large mandible when the region between the markers Hba and D11Mit163 and D10Mit70 and D10Mit136 indicated the genotype from the A/J and SM/J alleles, respectively. These results suggest that the major gene(s) responsible for mandible length are located in these regions.

Animals↗
PubMed1989

Giant fibrous dysplasia of the mandible: surgical management.

Giant fibrous dysplasia of the mandible (GFDM) represents a far advanced lesion which may be monostotic, polyostotic, a component of craniofacial fibrous dysplasia, a component of Albright's syndrome, or associated with other endocrinopathies. The current philosophy is to consider fibrous dysplasia of the mandible (FDM) as one of a group of lesions classified as fibro-osseous lesions of the jaws. The natural course and manifestations in the mandible result in GFDM if they are unabated by curative therapy or if stabilization or regression does not occur. A rational therapeutic approach depends upon the extent of the disease at the time of diagnosis. The earlier in the disease process that the diagnosis is made, the more likely that a curative surgical procedure may be undertaken. Complete resection of the diseased mandible should be performed when feasible. A lesser surgical procedure has no curative potential and is performed only as a palliative, cosmetic delaying procedure.

Adolescent↗
PubMed1994

An osteometrical study of the cranium and mandible of Ryukyu wild pig in Iriomote island.

We measured crania and mandibles of Ryuku wild pigs from Iriomote Island. Sex and age were determined by observation of lower teeth. From the present data, the growth pattern was established for some items. For several parts of the cranium and mandible, the relative growth coefficient was compared. The results obtained here are summarized as follows: (1) Although sexual dimorphism was already shown in the younger group, a significant difference in profile length and length from the angle was not seen in the adult group. (2) As the animal grew, the proportion of length to width became larger in the skull. (3) The visceral cranium grew more rapidly in length than the cerebral cranium. On the other hand, growth of the cerebral cranium contributed to width in cranial development. (4) The body of the mandible was shown to grow more rapidly in length than the ramus of the mandible. (5) The growth pattern of some items was related to that of their associated muscles. These basic data are expected to be compared with data from other population of the same subspecies and Japanese wild pig. The comparisons will contribute to the establishment of origin and phylogeny of this animal.

Age Factors↗
PubMed2004

Integration and modularity of quantitative trait locus effects on geometric shape in the mouse mandible.

The mouse mandible has long served as a model system for complex morphological structures. Here we use new methodology based on geometric morphometrics to test the hypothesis that the mandible consists of two main modules, the alveolar region and the ascending ramus, and that this modularity is reflected in the effects of quantitative trait loci (QTL). The shape of each mandible was analyzed by the positions of 16 morphological landmarks and these data were analyzed using Procrustes analysis. Interval mapping in the F(2) generation from intercrosses of the LG/J and SM/J strains revealed 33 QTL affecting mandible shape. The QTL effects corresponded to a variety of shape changes, but ordination or a parametric bootstrap test of clustering did not reveal any distinct groups of QTL that would affect primarily one module or the other. The correlations of landmark positions between the two modules tended to be lower than the correlations between arbitrary subsets of landmarks, indicating that the modules were relatively independent of each other and confirming the hypothesized location of the boundary between them. While these results are in agreement with the hypothesis of modularity, they also underscore that modularity is a question of the relative degrees to which QTL contribute to different traits, rather than a question of discrete sets of QTL contributing to discrete sets of traits.

Animals↗
PubMed2003

Early functional loading at 5 days for Brånemark implants placed into edentulous mandibles: a prospective, open-ended, longitudinal study.

BACKGROUND: Traditionally, implants placed in the mandible heal for 3 to 4 months before they are loaded. In maxillae, healing time usually takes 5 to 6 months. The purpose of this study was to evaluate placement of 4 to 6 implants in edentulous mandibles. The implants were placed between mental foramina for support of non-metal, reinforced, fixed, implant-supported provisional prostheses. A unique method was used to convert existing dentures into fixed, implant-supported appliances. The implants were functionally loaded early (5 days). METHODS: Twenty patients with edentulous mandibles or with 2 to 3 remaining mandibular teeth were enrolled in this open-ended, prospective study. Existing dentures without porcelain teeth were modified for use as a surgical guide. These dentures were used as temporary fixed prostheses. Patients were to have metal-reinforced appliances fabricated by the referring dentists after 3 to 4 months of healing. After implant installation, prosthetic abutments were fixed to the implants and tightened to 20 Ncm without counter torque. Bone quality and quantity as well as implant size and position were entered into a computer database. Impression copings were attached to the abutments, and the modified denture was used for a pick-up impression. After the impression was made, implant replicas were fitted to the impression copings and casts were poured. Gold cylinders were processed into the tissue side of the denture. Laboratory screws were used to attach the denture with gold cylinders to abutment replicas. The dentures were processed, polished, and inserted 5 days after implant surgery. Radiographs were taken to verify proper fit of the gold cylinders to the prosthetic abutments (baseline). Radiographs were taken at each follow-up visit and were used to measure changes in crestal bone levels. RESULTS: Twenty patients received 92 machined-surface commercially pure titanium implants in fully edentulous mandibles. Of the total number of implants placed, two were lost between 0 to 1 year and one between 1 to 2 years. Twenty patients with a total of 90 implants were followed between 0 to 1 year. Fourteen patients have been followed between 1 to 2 years, 7 between 2 to 3 years, and 2 between 3 to 4 years. One patient died after 9 months of loading (4 implants loaded, 2 sleeper implants); another died between 1 to 2 years. A total of 6 implants remained buried (sleepers). At 2 years, the cumulative success rate is 96.3%. Survival of the implant bridges is 100.00%. The mean crestal bone level at 5 days for 11 patients was 2.1 mm (SD 0.526, SE mean 0.159) (measurements were not available for the deceased patient), while the mean level at an average of 15 months was 1.96 mm (SD 0.585, SE mean 0.176). Differences between the measurements taken at 5 days with those taken at an average of 15 months were not significant (P < 0.683). CONCLUSIONS: Results of this study indicate that 4 to 5 implants can be placed and loaded within 5 days of implant insertion with high success (96.3%). Success rates for the interim and final prosthesis are 100%. A simple, possibly cost-effective method of using non-metal reinforced dentures as interim fixed, provisional dentures has been described. Impressions and registrations for making the prosthesis can be made at the time of implant installation, and this method is accurate enough to make provisional restorations. The modified denture can function as an interim fixed, implant-supported prosthesis for up to 30 months. Results of x-ray measurements indicate stable crestal bone levels for up to an average of 15 months.

Aged↗
PubMed2002

Overview of the radiology, histology, and bone morphogenetic protein expression during distraction osteogenesis of the mandible.

INTRODUCTION: Distraction osteogenesis (DO) is a form of in vivo tissue engineering during which an osteotomy and controlled distraction are used to lengthen bone. The molecular signals that govern distraction-induced bone formation have not been fully elucidated. Specifically, the role of bone morphogenetic proteins (BMPs) in DO of the mandible remains unclear. OBJECTIVE: To characterize the radiologic and histologic evolution of newly formed bone during DO of the mandible and to relate these changes to the expression of BMPs. METHODS: Fourteen skeletally mature male rabbits were used. A distractor device was surgically applied to one side of the mandible following osteotomy. After 1 week (latency period), distraction was started at a rate of 0.25 mm every 12 hours for 3 weeks (distraction period) and was followed by a 3-week consolidation period. Two animals were sacrificed each week after surgery (weeks 1 to 7). The mandible was resected and the new bone assessed by radiography and histology. The expression of BMPs was also analyzed using immunohistochemistry. RESULTS: There was radiographic and histologic evidence of bone formation during the distraction period. By week 6, there was mature woven bone within the distraction zone. Bone morphogenetic proteins 2 and 4 were strongly expressed in osteoblasts during distraction and in chondrocytes during consolidation. The expression of BMP-7 was relatively minor. CONCLUSION: The temporal and spatial pattern of BMP expression suggests that these proteins are important mediators of mandibular DO. Understanding the expression of BMPs may facilitate the use of recombinant proteins to enhance the rate and quality of bone generation during craniofacial DO.

Animals↗
PubMed2005

Effect of recombinant human bone morphogenetic protein 7 on bone density during distraction osteogenesis of the rabbit mandible.

OBJECTIVES: To examine whether the quality of bone generation in distraction osteogenesis of the rabbit mandible is enhanced by administering recombinant human bone morphogenetic protein 7 (rhBMP-7) to the lengthened site at the end of the distraction phase. STUDY DESIGN: Prospective randomized study of 24 rabbits undergoing distraction osteogenesis of the mandible, followed by injection of rhBMP-7 or a lactate buffer. SETTINGS: McGill University animal care facility. METHODS: Twenty-four white New Zealand rabbits underwent unilateral mandibular osteotomy and application of an Orthofix uniplanar M-100 fixator (Orthofix Inc., Verona, Italy) to the mandible. Mandibular distraction was carried out for 3 weeks. The animals were divided into three groups: group 1 (eight rabbits), control group: distraction, no injection; group 2 (eight rabbits), study group: distaction + injection of 200 microg of rhBMP7-lactate buffer; group 2 (eight rabbits), comparison group: distraction + injection of lactate buffer. All rabbits were sacrificed 7 weeks after surgery. The mandibles underwent radiology and bone densitometry analysis. MAIN OUTCOME MEASURES: Radiology assessment of bone generation within distracted segments and objective analysis of bone mineral density. RESULTS: Radiology confirmed the presence of bone generate within distraction sites. Densitometry showed a difference in bone mineral density among the three groups (p < .05). CONCLUSION: Local injection of a single dose of 200 microg of rhBMP-7 did enhance bone density when compared with the control group, although not in a statistically significant way when analyzed by an x-ray bone densitometer. This study serves as a starting point for future studies in bone tissue engineering by guiding the strategic administration of rhBMPs and the use of new state-of-the-art technologies, such as micro CT scanning, to analyze in a more detailed way, the effects of rhBMP administration.

Absorptiometry, Photon↗