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PubMed1998

Changes in overbite and face height from 5 to 45 years of age in normal subjects.

The purpose of this study was to evaluate changes in overbite over a 40-year span, and to relate these changes to those occurring in vertical skeletal facial relationships. Lateral cephalograms of 20 males and 15 females from the Iowa Facial Growth Study were evaluated at ages 5, 10, 15, 25, and 45 years. Correlation coefficients were computed to determine the relationship between overbite and various skeletal parameters. Analysis of variance and Duncan's multiple-range test were used to compare various periods of growth. Statistical significance was predetermined at the 0.05 level of confidence. No significant correlations were found between the absolute values of overbite and the vertical skeletal parameters in either males or females. Incremental changes in overbite during four growth periods were compared with changes in various vertical parameters and only a few significant correlations were found. In males, the change in overbite was significantly correlated with changes in N-Ans'/N-Me and MP:SN during the 10-to-15 year growth period. In females, the change in overbite was significantly correlated with changes in N-Ans'/N-Me% during the 5-to-10-year period and also with change in Ar'-Go/S-Go% during the 15-to-25-year period. In general, changes in overbite with age are difficult to predict from the initial overbite in the deciduous or mixed dentitions. On the other hand, evaluation of individual curves shows that males who initially had the least amount of overbite maintained that trend during the later stages of development. Although overbite changes were significantly associated with changes in some vertical parameters, the associations were not of clinical significance for predictive purposes, and overbite changes are probably dependent on concurrent changes in the growth of the alveolar processes.

Adolescent↗
PubMed2005

Masticatory demands induce region-specific changes in mandibular bone density in growing rats.

This study investigates the structural adaptation of the mandibular bone when subjected to different masticatory functional and mechanical demands during growth. The effect of two experimental factors, the insertion of a bite block and the alteration of food consistency, on the bone mineral density (BMD) of the mandible was investigated in growing rats. Fifty-two male albino rats were divided into two equal groups, fed with either the standard hard diet or soft diet, at the age of four weeks. After two weeks, half the animals in both groups had their upper molars fitted with an upper posterior bite block. The remaining animals served as a control. Region-specific BMD of the mandible was subsequently measured using dual-energy X-ray absorptiometry (DXA). Soft diet and the consequent reduction of the forces applied to the mandible during mastication resulted in the reduction of BMD in all regions under study. The insertion of the bite-opening appliance (bite block) and the resulting stretching of the soft tissues led to the application of a continuous light force on the lower molars, which was associated with a significant increase of the BMD in the part of the alveolar process just below the root apices. These results raise the question of whether orthodontic treatment with similar appliances may have some, previously unsuspected, short- or long-term effects on the mandibular bone during growth and whether their effects depend on the individual soft-tissue characteristics.

Absorptiometry, Photon↗
PubMed2003

Simultaneous or staged installation with guided bone augmentation of transmucosal titanium implants. A 3-year prospective cohort study.

A prospective cohort study of 45 nonsmoking consecutively admitted patients was studied for the treatment outcomes following jaw bone augmentation in conjunction with installment of oral implants. Twenty-eight patients were treated for both bone augmentation and implant treatment simultaneously, while 17 patients were treated with a staged approach with the bone augmentation being performed 6-8 months prior to implant installation. Three months following this, prosthetic reconstructions were incorporated. One year thereafter, baseline data and 3 years after reconstruction, follow-up data were obtained. Moderately low mean scores for the bleeding on probing percentage were found at baseline (24%) and after 3 years of function (17%), while the corresponding values at the implant sites were 40.6% and 52.4%, respectively. However, the modified gingival index (mGI) = 2 was found in only 4.8%, and 6.9% at the baseline and 3-year examinations. Peri-implant Probing depth (PPD) and level of attachment mean values did not vary between baseline and follow-up examinations. Only a small proportion of 1.8% yielded PPD = 6.0 mm after 3 years of function. Radiographic bone level measurements showed that 18.2% of the implants lost 0.5 mm during the observation period. Seventy percent of the sites were considered completely stable. It was concluded that predictable treatment outcomes resulted for oral implant installation combined with or staged after jawbone augmentation. Only 6.5% of the sites had lost 1.5% crestal bone with the staged approach while 14% of the sites had lost 1.5 mm, when the implants were placed simultaneously. This suggests that the staged approach may have a lower risk for greater amounts of crestal bone loss as the simultaneous approach. In general, crestal bone loss encountered in the present study corresponded very well with that reported following placement of the same implant system into nonaugmented bone.

Alveolar Bone Loss↗
PubMed2000

Radiation induced sarcomas of the head and neck following radiotherapy for nasopharyngeal carcinoma.

AIM: To report the radiological findings of radiation induced sarcomas (RIS) in the head and neck following radiotherapy for nasopharyngeal carcinoma. MATERIALS AND METHODS: The clinical notes and radiological studies (MR n = 3, CT n = 4) of four patients were reviewed retrospectively. RESULTS: RIS developed 5 to 10 years following radiotherapy. Two patients had tumours arising from the alveolar process of the maxilla, one from the nasal cavity, and one patient had a tumour at two sites, involving the external auditory canal and the uvula. Three of the four patients had large tumours at diagnosis with a 3.5-6 cm predominately homogeneous soft tissue mass, complete destruction of bone and extensive local invasion. One was small and localized to the nasal turbinate. Radiation osteitis was identified in two of the four (50%) patients. CONCLUSION: The site of RIS following radiotherapy for NPC is variable but is invariably within the high dose zone of the radiotherapy. These sarcomas tend to present late with a large soft tissue mass. Radiation osteitis is not a constant feature. As surgery provides the only chance of cure, imaging has an important role in the pre-operative mapping of the extent of tumour. et al.

Adult↗
PubMed2001

Measurement of the maxilla and zygoma as an aid in installing zygomatic implants.

PURPOSE: This study used maxillary and zygomatic measurements to obtain information for installing zygomatic implants. PATIENTS AND METHODS: Angular and linear distances between the maxilla and the zygoma were measured in 12 cadavers (n = 22 sides) classified into short and tall groups by height (140 to 159 cm and 160 to 180 cm, respectively). RESULTS: Based on mean and standard deviation values, the installation angle of zygomatic implants was between 43.8 degrees and 50.6 degrees. The distance between the crest of the maxillary alveolar process near the palate and the jugale (Ju) point of the zygoma was between 44.3 and 54.3 mm. The minimum distance between the most lateral corner of the maxillary sinus and the Ju point was 6.41 mm, and the minimum anteroposterior length of the zygoma was 5.68 mm in the shorter group. CONCLUSIONS: When the installation angle of zygomatic implants is 43.8 degrees or less, perforation of the maxilla and the zygoma or the infratemporal fossa must be avoided. When the angle is 50.6 degrees or more, perforation of the orbital floor must be avoided. Special attention is needed to ensure osseointegration in shorter patients, because the distance between the most lateral corner of the antrum supporting the zygomatic implant and the Ju point is 10 mm or less. The apex of the implant is 3.75 mm in diameter, and the thickness of the zygoma must be 5.75 mm or more. The threads of the implant must not be exposed from the zygoma in shorter patients.

Body Height↗
PubMed2002

The transgingival approach for placement of distraction implants.

PURPOSE: Since 1997, distraction implants have been clinically used for alveolar ridge distraction and, later, for prosthetic treatment. While 63 patients have been treated by the authors by alveolar ridge distraction with distraction implants with an open approach, the aim of this study was to demonstrate a minimally invasive technique of distractor placement via a transgingival approach. PATIENTS AND METHODS: Twelve patients were treated with a modified surgical incision using distraction implants. A tissue punch was used to remove transgingival mucosa, and a segmental osteotomy was performed using a vestibular incision. The distracted segment was pedicled at the lingual and crestal mucoperiosteum. Distraction was carried out for 0.5 mm per day, divided into 2 to 4 turns per day. A distraction of 5 to 7 mm was performed. At the end of distraction, the distraction insert was changed into a definitive stable implant insert. Prosthetic treatment was performed 4 months after the distraction period with fixed superstructures. The follow-up was performed with the aid of dental radiographs, evaluation of peri-implant probing depths, and Periotest values (Siemans, Bensheim, Germany). RESULTS: The outcome of this technique showed minimal scarring of the gingiva with good aesthetic results, the clinical and radiologic findings were satisfying, and the Periotest values were negative at every examination. The rate of complications was low. CONCLUSION: Minimal scarring and good aesthetic and functional outcome resulted in patients with alveolar ridge distraction performed with a transgingival approach.

Alveolar Bone Loss↗
PubMed1999

Muscular reconstruction to improve the deterioration of facial appearance and speech caused by mandibular atrophy: technique and case reports.

One of the consequences of severe mandibular atrophy is the loss of attachment of the facial muscles that originate from the alveolar process and basal bone. Another is a loss of vestibular depth and reduction in the width of the attached gingiva. The result is reduced ability to chew, a changed and aged appearance, difficulties with pronunciation, and a reduced range of expressions. The traditional goal of treatment has been to improve the ability to chew. We describe a technique by which all these functions can be improved by a combination of insertion of implants and functional reconstruction of the facial muscles and position of the lips. When the muscles are repositioned, the buccal vestibule is deepened, and the incidence of gingival hyperplasia and infrabony pockets along the posts is eliminated. This treatment, which also rejuvenates the face and improves the ability to speak, should help to overcome the loss of self-confidence and self-esteem of these patients by improving their quality of life.

Atrophy↗
PubMed2000

Surgical and orthodontic rapid palatal expansion in adults using Glassman's technique: retrospective study.

In 1984, Glassman et al. described a conservative surgical method of separation of the midpalatal suture in which an osteotomy is done only at the lateral and anterior wall of the maxilla. Between 1991 and 1997, we have operated on 21 patients with maxillary transverse discrepancies using the method that they described. This gave good results in 20 patients. The other, who was operated on at the age of 38 years, developed a fracture of the alveolar process of the maxilla on one side because of ossification of the midpalatal suture. The surgically assisted rapid palatal expansion described by Glassman et al. is suitable for patients up to the age of 30. Older patients require additional surgical separation of the midpalatal suture.

Adolescent↗
PubMed2001

Complete bony fusion of the mandible to the zygomatic complex and maxillary tuberosity: case report and review.

Congenital craniofacial disorders represent approximately 20% of all birth defects. One of these disorders is syngnathia, of which only 24 cases have been reported since 1936. Twenty cases involved fusion of the alveolar processes of the maxilla and mandible. Only four are similar to the presented case, which includes bony fusion of the ascending ramus of the mandible to the zygomatic complex and the posterior part of the maxilla. This case report will present details from the 23rd week of gestation to 8 months of age when the infant underwent the first attempt to free the syngnathia. The literature is discussed and a causative mechanism and new classification are proposed.

Adult↗
PubMed2001

Alveolar ridge augmentation by distraction osteogenesis.

Distraction osteogenesis is an alternative method for reconstructing atrophic alveolar bone. Fourteen patients underwent vertical alveolar distraction by the LEAD SYSTEM-Endosseous Alveolar Distraction System (Stryker Leibinger, Kalamazoo, MI). An alveolar segmental osteotomy was carried out and the vertical distraction device was mounted. In patients with an extensive alveolar defect, two distraction devices were placed in order to better control the vector of elongation in both bone edges. The distraction was started on the fourth postoperative day at a rate of 0.8 mm/day for 10-16 days, followed by a consolidation period of 60 days. Vertical distraction osteogenesis (VDO) was completed successfully in all patients with segment lengths in the range of 8 to 13 mm and with an average of 10.3 mm. Subsequently, the devices were removed and 23 threaded titanium dental implants were placed for osteointegration. Earlier mineralization in the vertically distracted area was seen radiographically during the consolidation period. In a follow up of 6-20 months after the distraction, 22 implants were successfully osteointegrated while one implant failed due to improper distracted segment stability. As a result of alveolar distraction, a segment of mature bone was transported vertically in order to lengthen the crest for better implant anchorage, either for aesthetic purposes or for functional prosthetic requirements. The main advantages of VDO are: (1) augmentation of alveolar bone height with new bone formation and simultaneous expansion of the soft tissues; (2) no bone harvesting is necessary; (3) the technique has a lower morbidity rate compared with conventional techniques; (4) it makes the insertion of longer dental implants feasible.

Adolescent↗
PubMed2000

Autotransplantation of premolars to replace maxillary incisors: a comparison with natural incisors.

The published literature contains no comprehensive studies that compare the outcome of premolar autotransplantation to the maxillary anterior region with natural incisors in the same patients. This article describes the gingival and periodontal conditions around premolars transplanted to the maxillary incisor region, subsequent to restoration. Forty-five premolars autotransplanted to the maxillary incisor region in 40 adolescent patients were evaluated after a mean observation period of 4.0 years. Mean age at surgery was 11.0 years. Established clinical criteria were used to assess tooth mobility, plaque and gingival indexes, probing pocket depth, and percussion. Recession and hyperplasia of interproximal gingival papillae were assessed according to a recently proposed index. Standardized radiography was used to evaluate presence of pathosis, pulp obliteration, root length, and crown-root ratios. Clinical variables for transplants did not differ from those of the natural incisors, except for increased mobility and more plaque in a few transplanted premolars. The interproximal gingival papillae adjacent to all transplanted teeth were normal or slightly hyperplastic. Radiographically, all transplants showed varying degrees of pulp obliteration, but no signs of pathosis. Crown-root ratios were similar for natural and transplanted teeth as were distances from cementoenamel junction to marginal bone. The overall status of the transplanted premolars and surrounding tissues indicated that this treatment modality may be recommended when maxillary incisors are missing in adolescents. In addition, tooth transplantation represents an inherent potential for bone induction and reestablishment of a normal alveolar process.

Adolescent↗
PubMed2002

A retrospective study of selected oral and maxillofacial fractures in a group of Jordanian children.

Objective. The purpose of this study was to review the etiology, incidence, and treatment of selected oral and maxillofacial fractures in children in Jordan. Study Design. This retrospective review of patient records and radiographs was conducted during the 5-year period between 1996 and 2001. Age, gender, etiology, anatomic site, and treatment methods were reviewed. Results. During the 5-year period, 227 patients with 274 maxillofacial fractures were treated. The age range was from 1 to 15 years (mean age, 11.2 years). Of the patients, 70% were male, with the peak incidence rate occurring in the 10-year-old to 12-year-old age group. The mandible was the most frequent bone of fracture, with 169 cases (74.5%), followed by the alveolar process in 28 cases (12.3%), the maxilla in 27 cases (11.9%), and the zygomatic complex in 3 cases (1.3%). Of the fractures, 52% were from accidental falls, 20% from road traffic accidents, 17% from assaults, 8% from sport injuries, and 3% from other causes, such as horse kick. Most patients (82.3%) were treated with closed reduction (45.2% with eyelet wiring and 54.8% with arch bars and intermaxillary fixation). Only 17.7% of patients were treated with open reduction and fixation. All maxillary fractures were treated with orbital and circumzygomatic suspension with interdental wiring and intermaxillary fixation. The 3 cases of zygomatic complex fractures were kept under observation without the necessity of surgical intervention. Conclusion. Accidental falls were found to be the leading cause of maxillofacial fractures in our environment, and males were 3 times more affected than females.

Accidental Falls↗
PubMed1998

Treatment of oroantral communications after tooth extraction. Is drainage into the nose necessary or not?

Seventy-six patients with oroantral communications after tooth extraction and chronic maxillary sinusitis were treated as follows: bacterial cultures were taken in all of them and maxillary sinuses were irrigated with an antibiotic from the cephalosporin group. Then, in 36 patients, drainage using the Caldwell Luc procedure was performed, including a naso-antral window. In all patients operations were completed by closing oroantral communications with flaps of the mucosa of the alveolar process close to the fistula. Antibiotics according to antibiogram were administered to all patients at least 10 days after surgery. Retrospective comparison between the results obtained in the first group and those in the second group 1, 3 and 6 months after operation was based on objective findings (condition of the oroantral communication, maxillary sinusitis), side effects (pain, numbness of the operated area, headache) and control radiographs (clear maxillary sinus or with mucosal thickening). The study suggests that transnasal drainage is not required in maxillary sinus surgery and in the closure of oroantral communications. Equally good results are achieved by treating with antibiotics and without drainage of the maxillary sinus into the nose.

Cephalosporins↗
PubMedDate not supplied

Rabbit as an animal model of paranasal sinus mycoses.

Paranasal sinus mycoses are endemic in rural populations of northern India. To study host-parasite interactions, we developed an animal model of paranasal sinus mycoses. After failure in small animals such as mice and rats, we used New Zealand white rabbits weighing 2.5-3 kg. Inoculum sizes consisted of 0.75-1.0 x 10(8), 0.75-1.0 x 10(7), 0.75-1.0 x 10(6) conidia of a clinical isolate of Aspergillus flavus. The inoculum was injected at a spot 0.5 cm in front of the alveolar process of the maxilla and 0.5 cm below the maxillary process of frontal bone and vertically to a depth of 0.5 cm across the bone directly into the nasal sinus. Paranasal sinus mycoses proven by culture and histopathology developed in 67% of animals injected with 0.75-1.0 x 10(8) conidia and 17% of animals with 0.75 x 10(7) conidia. No lesions were found in the group injected with 0.75-1.0 x 10(6) conidia. Precipitating antibody against culture filtrate antigen was found in rabbits with paranasal sinus mycoses. Therefore, rabbits can be used as an animal model to study paranasal sinus mycoses.

Animals↗
PubMed1997

Chest cancer refers pain to face and jaw: a case review.

The dentist's sphere of treatment is generally limited by state law to the teeth, alveolar process, gums, cheeks, jaws or oral cavity and associated structures. However today, an appreciation of the total person is necessary. Pain referred from the chest to the face and jaw is presented to the new student when first assuming responsibility for treatment of the clinic patient. With contemporary dental practice expanded to orofacial pain and the temporomandibular joint area, general medical knowledge is essential. Without hesitancy, when the situation is not distinct, referral for medical consultation may be the best part of patient care.

Carcinoma, Neuroendocrine↗
PubMed2005

Experimental-induced periodontitis is exacerbated in spontaneously hypertensive rats.

Studies show that systemic diseases such as diabetes, hyperthyroidism, osteoporosis, and dyslipidemia may influence periodontal inflammation. However, few studies relate the influence of arterial hypertension on periodontitis. The present study was undertaken to assess the severity of the experimental ligature-induced periodontitis in an experimental model of genetic arterial hypertension. The experimental periodontitis model was induced in 6 spontaneously hypertensive rats (SHR) and 6 Wistar normotensive rats (NT) by cotton ligature, which was placed subgingivaly around the neck of the first left inferior molar tooth. In the same animal, the first right molar tooth was sham-ligated and used as a control. After 7 days, the mean arterial pressure (MAP) and heart rate (HR) were recorded in conscious animals. As expected, MAP was significantly higher in SHR (151 +/- 6 mmHg) than in NT (105 +/- 3 mmHg), without significant differences in HR. The histopathologic examination of the periodontal structure showed alveolar integrity and lack of neutrophils and osteoclasts in the control side of both SHR and NT. In contrast, examination of the ligated side in all animals showed collagen degradation in the alveolar process from a moderate (50%) to severe (50%) level in SHR and mild in NT (100%). These data show that experimental periodontitis, characterized by the spreading of the inflammatory process from the gingiva deep into periodontium tissues, is greatly exacerbated in SHR.

Animals↗
PubMed2001

Conservative closure of antro-oral communication stimulated with laser light.

OBJECTIVE: To evaluate application of laser biostimulation in the treatment of antro-oral communications. BACKGROUND DATA: Sixty-one patients between the ages of 14 and 58 were subjected to biostimulation with laser light. Therapy was performed with a CTL 1106 biostimulative laser of 30 mW power with a tip-emitting light of 830-nm wavelength. METHODS: Three cycles of laser irradiation were performed in a continuous mode. During one cycle, 3.5 min of extraoral irradiation of 4J with the contact "sweeping" method or the "woodpecker technique" was made through the facial skin to the suborbital region, 3.5 min of intraoral irradiation of 4J with the contact "point" method to the region of maxillary sinus floor, and 3.5 min of intraoral one of 4J with the contact "point" method to the alveolar process at the site of the antro-oral communication. The above cycle of irradiation was repeated for 4 days. RESULTS: After 4 days of laser therapy, a complete closure of antro-oral communication occurred. CONCLUSION: Laser therapy can be recommended as an effective method of treatment in this type of complication following tooth extraction.

Adolescent↗
PubMed1993

Ectopic eruption of the maxillary first permanent molars in children with cleft lip and/or palate.

The purpose of this study was to analyse the prevalence of ectopic eruption of maxillary first permanent molars in children with cleft lip and palate, and evaluate the influence of both local and genetic factors. Radiographs from 225 children, 125 girls and 100 boys, were studied. The prevalence in cleft children was found to be more than four times higher than in non-cleft children (4.3 per cent). In children with cleft lip or cleft lip and alveolar process the prevalence was 15.4 per cent and in children with cleft palate only it was 28.8 per cent. A notable finding is that the ectopically erupting molar was not related to the cleft side. In children with surgically corrected cleft lip in combination with cleft palate or with cleft palate only, the surgery may have influenced the prevalence to some extent, but the main explanation for the increased prevalence of ectopic eruption in cleft children is a genetic aetiology.

Chi-Square Distribution↗