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At least 1,081 records · Page 60Linked to original sources
PubMed2000

Analysis of occlusal variables, dental attrition, and age for distinguishing healthy controls from female patients with intracapsular temporomandibular disorders.

STATEMENT OF PROBLEM: Confusion about the relationship of occlusion to temporomandibular disorders (TMD) persists. PURPOSE: This study attempted to identify occlusal and attrition factors plus age that would characterize asymptomatic normal female subjects. METHODS AND MATERIAL: A total of 124 female patients with intracapsular TMD were compared with 47 asymptomatic female controls for associations to 9 occlusal factors, 3 attrition severity measures, and age using classification tree, multiple stepwise logistic regression, and univariate analyses. Models were tested for accuracy (sensitivity and specificity) and total contribution to the variance. RESULTS: The classification tree model had 4 terminal nodes that used only anterior attrition and age. "Normals" were mainly characterized by low attrition levels, whereas patients had higher attrition and tended to be younger. The tree model was only moderately useful (sensitivity 63%, specificity 94%) in predicting normals. The logistic regression model incorporated unilateral posterior crossbite and mediotrusive attrition severity in addition to the 2 factors in the tree, but was slightly less accurate than the tree (sensitivity 51%, specificity 90%). When only occlusal factors were considered in the analysis, normals were additionally characterized by a lack of anterior open bite, smaller overjet, and smaller RCP-ICP slides. The log likelihood accounted for was similar for both the tree (pseudo R(2) = 29.38%; mean deviance = 0.95) and the multiple logistic regression (Cox Snell R(2) = 30.3%, mean deviance = 0.84) models. CONCLUSION: The occlusal and attrition factors studied were only moderately useful in differentiating normals from TMD patients.

Adolescent↗
PubMed2004

[Predictability of maxillary distraction with the trans-sinusoidal distractor].

INTRODUCTION: This work was conducted to evaluate a new maxillary distractor with an activating system introduced into the maxilary sinus. PATIENTS AND METHOD: Fourteen patients age 8 to 55 Years with severe maxillary and midfacial hypoplasia were treated in our center. A trans-sinusoidal maxillary distractor (TS-MD, developed by Dr. N. Nadjmi in cooperation with Martin, Tuttlingen, Germany) was placed intra-orally at each side of the maxilla. The distraction vector was predicted with devoted software (Medicim N.V Belgium), and was transferred to the patients using stereolithographic models and individual templates. A high Lefort I type osteotomy was performed. RESULTS: Forward maxillary movement at distractor level varied from 7 to 22 mm. Soft and hard tIssue formation resulted in complete healing across the distraction gaps. The maxillary movements and new bone formation in the sagittal, horizontal, and vertical planes could be predicted and achieved. Distractors were designed to allow clockwise rotation of the maxilla during the distraction phase allowing the correction of the anterior open-bite in all patients with this skeletal deformity. The distractors were almost completely submerged, and could be left in place as long as necessary to avoid relapse. DISCUSSION: The TS-MD distractor has the advantage of good tolerance since the most voluminous part is placed within the maxilary sinus. Implantation via an exclusively oral approach is a further advantage. The devise does not interfere with the patient's social life and does not require alveolodental fixation. The TS-MD distractor can also aleviate the need for bone grafting in cases with major advancement. Correct position of the vector is crucial but one-sided catch-up distraction is possible.

Adolescent↗
PubMed1997

The use of biodegradable fixation in sagittal split and vertical subsigmoid osteotomy of the mandible: a preliminary report.

OBJECTIVE: An absorbable pin made from poly-p-dioxanone (Orthosorb, Johnson and Johnson, UK) was used to internally fix osteotomies of the mandibular ramus. We present our initial series of 10 patients. DESIGN: Open study. SETTING: Regional unit, teaching hospital, UK. SUBJECTS AND INTERVENTIONS: 10 patients who required a bilateral sagittal split osteotomy (BSS, n = 3) or a vertical subsigmoid osteotomy (BVSS, n = 6), or both (n = 1). MAIN OUTCOME MEASURE: Jaw functioning and ability to open mouth. RESULTS: 9/10 followed up for 1 year, 1/10 lost to follow up at one month, 1/10 lost to follow up at one year. 7/9 reported the same degree of mouth opening as preoperatively, 2/9 slightly less. 3/10 developed slight anterior open bite problems; 1/10 required no treatment, 1/10 improved with selective grinding, and 1/10 was lost to follow up. No patient complained of discharge from the site of the implant or of any change in sensation of the lip. CONCLUSION: Small absorbable implants undoubtedly have a place in selected maxillofacial operations, but there are still some problems with their use, including complications during the learning curve.

Adolescent↗
PubMed1982

Simultaneous mobilization of the maxilla and mandible: surgical technique and results.

Simultaneous mobilization of the entire maxilla and mandible is a versatile procedure that can be used to correct multiple dentofacial deformities. The procedure is especially useful in correcting open bite deformities, as well as sagittal, vertical, and transverse dysplasias of the maxilla and mandible, and cases of asymmetry involving both the maxilla and mandible. Mock surgery performed on cephalometric tracings and study models provide a blueprint for the planned surgery. The use of an interim splint, constructed from sectioned models mounted on a semiadjustable articulator from a face bow transfer, is advocated to aid in accurate placement of the maxilla. The correct position of the maxilla is required to determine the ultimate position of the mandible; there is no room for error with this step if the procedure is to be accurate. Stabilization of the mobilized segments by direct osseous fixation, suspension wires, and maxillomandibular fixation is suggested. Maintenance of rigid maxillomandibular fixation for six weeks combined with an additional four weeks of guided mandibular function with skeletal elastics assures proper healing and position of segments.

Adult↗
PubMed1997

Diagnosis and management of condylar resorption.

PURPOSE: This article discusses the cause, appropriate diagnostic evaluation, and management of progressive condylar resorption. PATIENTS AND METHODS: This retrospective study evaluated 28 adult patients with bilateral progressive condylar resorption. Investigation included serial clinical examination, lateral cephalograms, tomograms, and a technetium isotope bone scan when indicated. Twenty-two patients were managed by either condylectomy and reconstruction with a costochondral graft (n = 5 patients) or orthognathic surgery (n = 18 patients). One patient initially had orthognathic surgery and subsequently underwent condylectomy and costochondral grafting, making a total of 23 procedures on 22 patients. Six patients received no surgical treatment. All patients were observed at least 2 years postoperatively. RESULTS: Of the 18 patients who underwent orthognathic surgery, four again demonstrated condylar resorption with recurrence of open bite and retrognathism. Four patients had a stable result, but currently have temporomandibular joint (TMJ) symptoms, whereas 10 patients had a stable result (no change in postoperative occlusion or jaw position) without TMJ symptoms. The five cases receiving condylectomy and costochondral grafting were stable and asymptomatic, with good mandibular function. Analysis of the 18 orthognathic surgery patients showed that relapse occurred in patients having bimaxillary surgery with mandibular advancements greater than 5 mm and with a preoperative posterior ramus height of less than 35 mm. CONCLUSION: The management of progressive condylar resorption remains controversial. Orthognathic surgery in this small sample was associated with a complication rate (relapse or TMJ dysfunction) of approximately 45% (8 of 18). In contrast, condylectomy and costochondral grafting appeared to produce stable and functional results. Further long-term outcome studies for patients with condylar resorption are needed to corroborate these results.

Adolescent↗
PubMed1998

The influence of neuropeptides, serotonin, and interleukin 1beta on temporomandibular joint pain and inflammation.

PURPOSE: This article describes the possible role of various peptides in producing pain and inflammation in the temporomandibular joint (TMJ). MATERIAL AND METHODS: Current research findings on the spectrophotometric quantification of TMJ synovial fluid for neuropeptide Y (NPY), serotonin (5HT), and interleukin-1beta (IL-1beta) are presented. FINDINGS: NPY was found in high levels in the synovial fluid of arthritic TMJs with resting pain, and serotonin (5-HT) was found in patients with pain perceived on mandibular movement. These pain-related mediators were also associated with restricted mandibular mobility. Interleukin-1beta (IL-1beta) was found to be strongly associated with hyperalgesia over the TMJ as well as resting pain. Anterior open bite as a clinical sign of joint destruction was found to be associated with high levels of NPY and IL-1beta in the synovial fluid. IL-1beta was also related to the radiographic signs of joint destruction. CONCLUSIONS: Interaction between the peripheral nervous system (sensory and sympathetic nerves) and the immune system is probably of importance for the modulation of pain and inflammation in the TMJ, but this subject has to be investigated further with experimental clinical studies.

Animals↗
PubMed2001

[Distraction osteogenesis with double internal devices combined with early frontal facial advancement for the correction of facial craniosynostosis. Report of clinical cases].

Frontofacial monobloc advancement is a surgical procedure which corrects at the same time both frontal and facial retrusions in faciocraniosynostosis. The high risk morbidity limited its use to major exorbitism or severe breathing impairment. We report the results of a preliminary experience in five children with a mean age of 3.8 years. All patients presented with a Crouzon or Pfeiffer syndrome. The procedure performed was a frontofacial monobloc osteotomy with peroperative mobilization. Two pairs of distractors (Martin-Medizin) were implanted. The upper pair of frontal distractors was located behind the supraorbital bar. The pair of temporo-zygomatic distractors (a modification of the MicroFrance prototypes) was implanted behind the zygomatic bone. In one patient a transfacial pin was connected to the anterior part the lower distractors, to avoid facial bipartition. Distraction was performed according to classical protocols with a 1 mm advancement per day, until sufficient advancement was obtained. The correction of exorbitism and facial retrusion was obtained in all cases. An open-bite was created by the advancement in two out of the five patients. Minor infection occurred in one patient. This combination of distractors with frontofacial advancement seemed to increase the efficacy and reduce the morbidity. This might lead to a one stage strategy for faciocraniosynostosis treatment, even if minor additive procedures will be necessary when children get older and that insufficient facial growth still reoccurs.

Child, Preschool↗
PubMed1979

Closed vertical subcondylar osteotomy (CVSO) of the mandible. A most versatile procedure.

The closed vertical subcondylar osteotomy (CVSO) of the mandible is accomplished with a wire saw. Through a systematic approach to anatomical landmark recognition and application of a very definite series of surgical maneuvers, the surgeon can achieve optimum results with little sequelae. Because the proximal segment resulting from this osteotomy is considerably larger than that produced in the closed subcondylar osteotomy, this procedure allows for a greater degree of movement (anterior, posterior and even rotational) of the distal segment. This added versatility permits the use of the CVSO in the treatment of aperthognathia, micrognathia, posterior open bite, and various combinations of these deformaties, as well as prognathia.

Humans↗
PubMed1977

Effect of tongue reduction on the orthodontic and surgical treatment of dysgnathia.

The results of reduction of tongue size in connection with orthodontic and surgical correction of prognathic anomalies of the jaws are presented. It is shown that reduction of the tongue size combined with orthodontic treatment arrests of tendency to prognathic growth when it is performed early. The results further indicate that the effect of prophylactic reduction of tongue size to check relapse following surgical correction of prognathism or open bite can only be confirmed in cases of genuine macroglossia. Since there was only one relapse in our cases without reduction of tongue size, the indication for preoperative prophylactic reduction of the tongue is limited. Personal results and experience have been compared with the findings published in the current literature.

Female↗
PubMed1977

Pulp changes after anterior mandibular subapical osteotomy in a primate model.

Subapical osteotomy of the anterior mandible was carried out on 10 adult Macaca Irus monkeys with and without open bite. Teeth were extracted at 8 weeks, 12 weeks, 24 weeks and 1 year after surgery and the pulps examined histologically. No normal pulps were found. Progressive fibrosis and calcification was noted in all teeth. Patent pulp blood vessels were found up to 24 weeks after surgery. Pulp damage to teeth distal to the osteotomy site was found in 50% of cases. Control teeth extracted from the opposing jaw at the same intervals were all found to have normal pulps.

Animals↗
PubMed1981

Experience with the sagittal osteotomy of the mandibular ramus: a 13-year review.

This report surveys the experience in 236 patients operated on by the author, of whom 155 provided records complete enough to provide information on all the elements of postoperative evaluation. Patients were evaluated at a minimum of 2 years after surgery. The patients had an average age of 23 years, and were predominantly female in a ratio of more than 4:1. No intraoperative or postoperative physiologically threatening problems as elsewhere described in the literature, such as profound blood loss, airway obstruction, or gross loss of bone substance, were encountered. An immediate postoperative paraesthesia incidence of almost 85% was observed, which diminished to 9% 1 year postoperatively. The prolonged paraesthesia were most common in patients over 40 years of age; similarly, healing was prolonged in patients over 40, prompting the author's recommendation that 8 weeks intermaxillary fixation rather than 6 be employed in these patients. The overall relapse rate was approximately 30%; this was clinically significant in approximately 12% of patients, and required reoperation in 4 patients. Relapse was most marked in apertognathic patients, demonstrating, in the author's opinion, that the sagittal ramus osteotomy should not be used, in general, in open-bite cases. The particulars of the technique and the author's views on regression are presented.

Adolescent↗
PubMed1985

Köle's osteotomy, a follow-up study.

A retrospective investigation into Köle's (1959) osteotomy for the correction of anterior open bite was performed. Changes in occlusion were seen in 32%. Bone graft incorporation was satisfactory. The vitality of the teeth adjacent to the osteotomy and the periodontal condition were satisfactory if a tooth at the osteotomy site was extracted. The sensibility of the lip was, in general, good.

Adolescent↗
PubMed1985

The TMJ dysfunction syndrome before and after sagittal split osteotomy of the rami.

280 patients with different types of mandibular deformities (prognathism, retrognathia, open bite, asymmetry) had been operated on by sagittal split osteotomy of the rami. The patients, routinely checked preoperatively, were found to present subjective or objective TMJ dysfunction symptoms with an incidence of 40.8%. After surgery the incidence of such symptoms in the same patients was 11.1%. The patients with no TMJ dysfunction symptoms preoperatively, presented such symptoms with an incidence of 3.7% postoperatively, a percentage very low in comparison with other statistics.

Adolescent↗
PubMed2000

Extraction of maxillary first bicuspids and mandibular lateral incisors, combined with orthognathic surgery to correct a severe class II skeletal malocclusion.

This is a case report of a 21-year-old female with a Class II Division 1 malocclusion. The maxillary arch was constricted with an associated anterior open bite. The lower facial height was excessive, and the mandibular plane angle was high. The treatment options were limited due to a previously extracted mandibular right lateral incisor. The patient was successfully treated by a surgical rapid palatal expansion procedure, extraction of the mandibular left lateral incisor, extraction of the maxillary first premolars at the time of a 3-piece Lefort 1 maxillary osteotomy procedure, and a bilateral sagittal split osteotomy advancement procedure.

Adult↗
PubMed2000

Dentoalveolar and skeletal changes associated with the pendulum appliance.

The purpose of the study was to examine the dentoalveolar and skeletal effects of the pendulum appliance in Class II patients at varying stages of dental development and with varying facial patterns (high, neutral, and low mandibular plane angles). Specifically, the amount and nature of the "distalization" of the maxillary first molars and the reciprocal effects on the anchoring maxillary first premolars and incisors were studied, as were skeletal changes in the sagittal and vertical dimensions of the face. Pretreatment and posttreatment cephalometric radiographs obtained from 13 practitioners were used to document the treatment of 101 patients (45 boys and 56 girls). The average maxillary first molar distalization was 5.7 mm, with a distal tipping of 10.6 degrees. The anchoring anterior teeth moved mesially, as indicated by the 1.8-mm anterior movement of the upper first premolars, with a mesial tipping of 1.5 degrees. The maxillary first molars intruded 0.7 mm, and the first premolars extruded 1.0 mm. Lower anterior facial height increased 2.2 mm; there was no significant difference in lower anterior facial height increase between patients of high, neutral, or low mandibular plane angles. In patients with erupted maxillary second molars, there was a slightly greater increase in lower anterior face height and in the mandibular plane angle and a slightly greater decrease in overbite in comparison to patients with unerupted second molars. Similar findings were observed in patients with second premolar anchorage versus those with second deciduous molar anchorage. The results of this study suggest that the pendulum appliance is effective in moving maxillary molars posteriorly during orthodontic treatment. For maximum maxillary first molar distalization with minimal increase in lower anterior facial height, this appliance is used most effectively in patients with deciduous maxillary second molars for anchorage and unerupted permanent maxillary second molars, although significant bite opening was not a concern in any patient in this study.

Activator Appliances↗
PubMed2000

The effects of a modified protraction headgear on maxilla.

Protraction headgears are commonly used in the treatment of Class III malocclusion characterized by maxillary retrognathism. The upward and forward rotation of the maxilla during protraction is a major unwanted side effect. The aim of this study was to eliminate the upward and forward rotation of maxilla while protracting. Seventeen patients with Class III malocclusion as a result of maxillary retrognathism were treated for 3 months; their average age was 12.81 years. A full coverage acrylic cap splint-type rapid maxillary expansion appliance was cemented and activated twice a day for 5 days. After sutural separation, a maxillary modified protraction headgear was worn and 750 g of force was applied. Wilcoxon signed rank test was carried out to evaluate 42 parameters measured on cephalometric radiographs. The maxilla was displaced anteriorly by downward and backward rotation. The mandible was displaced downward and backward due to anterior elongation of the maxilla. Extrusion and lingual tipping of the upper incisors and intrusion of upper molars and downward and backward rotation of functional occlusal plane were observed. The aim of our study was achieved, which was to avoid upward and forward rotation while protracting the maxilla. In conclusion, maxillary modified protraction headgear (MMPH) can be used effectively in Class III patients with retrognathic maxilla and anterior open bite tendency.

Adolescent↗