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At least 19 recordsLinked to original sources

The triumph and tragedy of James Baxler Bean, MD, DDS (1834-1870).

In 1863, James Baxter Bean, a Southern physician and dentist, invented the interdental splint. This device was used to treat hundreds of Confederate soldiers who had received gun shot-related facial and jaw injuries during the Civil War. Made of vulcanized India-rubber, the splint provided a dramatic breakthrough in the treatment of maxillofacial wounds. In an Atlanta, Georgia hospital, Dr. Bean utilized his invention by establishing the first ward devoted exclusively to the treatment of jaw fractures. He also invented an apparatus that manufactured and administered nitrous oxide. Additionally, Bean's groundwork in casting aluminum as a denture base material led to Taggart's later invention (in 1907) of the casting machine. After the Civil War, Dr. Bean became a highly successful dentist, practicing in Baltimore, Maryland. In the fall of 1870, at age 36, Bean, representing the Smithsonian Institution in Washington, D.C., traveled to Europe to gather geological specimens. A short time after arriving, Bean decided to climb Mont Blanc with ten other men. The entire group perished in a raging 8-day snow storm on the mountain peak. This tragedy, a compelling drama, is legendary in the annals of mountaineering history. After Dr. Bean's passing, his wife lost her sanity and subsequently died. Later, the death of the couple's only child, Chapin, sadly ended the family line. Although his life was cut short, Bean's contributions to dentistry have been significant and far-reaching.

Anesthesia, Dental↗

Simple intermaxillary fixation for maxillomandibular osteosynthesis.

A simple intermaxillary fixation technique for the maxillomandibular osteosynthesis is devised using miniscrews and surgical wires. Using this technique, we have treated 13 cases of maxillomandibular fractures and osteotomies. Sufficient intermaxillary fixation was provided at surgery, and satisfactory results were obtained in all patients. This technique is quite simple and easy to use and requires no special instruments. Positive occlusion during surgery is obtained for the osteosynthesis, providing a very useful auxiliary technique for rigid internal fixation. The details of this technique are described.

Bone Screws↗

The functional long-term results after bilateral sagittal split osteotomy (BSSO) with and without a condylar positioning device.

PURPOSE: The goal of this retrospective study was to examine whether utilization of condylar positioning devices in bilateral sagittal split osteotomy leads to long-term benefits for temporomandibular joint function as compared with the manual positioning technique. PATIENTS AND METHODS: The joint function of 49 patients (98 joints) who underwent bilateral sagittal split osteotomy or bimaxillary osteotomy at the University Hospital of Aachen between 1993 and 2003 was analyzed by recording joint movements with axiography supported by clinical examination of the temporomandibular joint. In 10 patients out of 28 with mandibular advancement and in 10 out of 21 with mandibular setback the Luhr positioning device was used intraoperatively to reproduce the condylar position. The joints of the remaining patients were positioned manually. The received data were statistically evaluated by using unrelated t test at P = .05. RESULTS: In mandibular advancement the manually positioned group showed significantly less signs of temporomandibular disorders, while there were slight advantages in axiographically measured joint track lengths for the patients who were operated with positioning devices. After mandibular setback surgery clinical analysis as well as axiography presented comparable results in both groups. CONCLUSION: The use of a positioning device did not provide a better functional outcome long term in either mandibular advancement or setback surgery. With the manual positioning technique, an at least equally good temporomandibular joint function was attained.

Bone Plates↗

Mandibulomaxillary fixation with bone anchors and quick-release ligatures.

Mandibulomaxillary fixation (MMF) is an essential technique for accurate treatment of maxillary and mandibular fractures. Traditional techniques of obtaining MMF (circumdental wires and load-distributing arch bars with or without plastic splints) often work poorly in children and adults with partial or absent dentition, require significant operative time, are at risk for glove puncture, and are painful to patients at time of removal. We have developed two new techniques for the rapid establishment of MMF in all ages and all types of dentition with or without splints. These techniques use four bone anchors--two placed in the pyriform rim of the maxilla and two in the mandibular symphysis. "Microlugs" are anchors constructed from Luhr Witallium mesh and are fixated to bone with 0.8-mm microscrews in primary- and mixed-dentition patients. Mitek MiniGII bone anchors are placed for treatment of secondary-dentition patients. Central skeletal MMF is achieved by linking each maxillary bone anchor to each mandibular bone anchor with suture ligatures and heavy orthodontic elastics. In this study, 112 patients (age range, 15 months-75 years) with maxillary and mandibular fractures underwent central skeletal MMF with one of the two new techniques described. Central skeletal MMF was maintained intraoperatively and for up to 6 weeks postoperatively, according to pathological anatomy. Our techniques succeeded with primary, mixed, and secondary dentition, and with splints and dentures, resulting in functional bone healing in 110 of 112 patients. Malocclusion occurred in 2 patients (1.8%), constituting treatment failure. Microlug central skeletal MMF required 15 to 20 minutes to place, and Mitek anchor central skeletal MMF required 7 to 12 minutes to place. There were no glove punctures noted during the course of treatment. Patient satisfaction has been clearly superior with these two techniques, since MMF amy be released in the office with minimal discomfort, even without topical anesthesia.

Adolescent↗

Mandibular fracture reduction without intraoperative intermaxillary fixation: a technique using two modified reduction forceps.

This case report demonstrates a technique that is useful for precompressing mandibular fractures and obtaining anatomical reduction of the fracture edges without the use of peroperative intermaxillary fixation (IMF) in a mandibular fracture by using two modified reduction forceps. The first forcep is positioned at the inferior mandibular border and the other in the neutral zone where it is an ideal location to place a fixation plate in mandibular fractures. This technique is indicated for the anatomic reduction in mandibular fractures of the partial dentate patient.

Bone Plates↗

Indications for treatment of subcondylar mandibular fractures.

BACKGROUND AND OBJECTIVES: The purpose of this study was to establish a reliable criteria for implementation of either an open surgical or a closed conservative treatment of subcondylar fractures, based on clinical data and analytical mathematical model. METHODS AND MATERIALS: A total of 512 subcondylar fractures were treated during a 3-year period. Of these, 256 were fractures characterized by either displacement or dislocation of the proximal (condylar) segment. Patients were treated with open reduction and internal fixation (ORIF) or closed reduction (CR) techniques. Patients were evaluated pre- and postoperatively by clinical examination, 3-dimensional axiography, radiographic imaging, and ultrasonography. A mathematical model was developed for estimating the loss of vertical ramus height. RESULTS AND/OR CONCLUSIONS: When the displacements were less than 37 degrees from the sagittal axis of the ascending ramus, the ensuing loss of vertical height was negligible when fractures were treated by conservative techniques. When the displacements exceeded 37 degrees, the fractures resulted in a significant decrease of vertical ramus height. Based on these data, 37 degrees appears to be the point for decision of whether to use closed or open treatment.

Adolescent↗

Comparison between the rigidity of bicortical screws and a miniplate for fixation of a mandibular setback after a simulated bilateral sagittal split osteotomy.

PURPOSE: This investigation compared the biomechanical stability of three bicortical screws with that of a single four-hole miniplate after 5-mm mandibular setback after a bilateral sagittal split osteotomy (BSSO) in cadaver mandibles. MATERIALS AND METHODS: Thirty human cadaver hemimandibles underwent BSSO followed by two different rigid fixation techniques. All specimens had no third molar, bony pathology, or evidence of mandibular fracture, and there was no history of renal disease or hyperparathyroidism. The specimens were randomly divided into two groups. In group I, three bicortical screws were placed at the superior border, and in group II, one four-hole miniplate was secured on the external oblique ridge with four monocortical screws. The bony height of the mandible was recorded. Maximum resistance load (MRL), the greatest load recorded just before a sudden decrease in load level (bone or fixation failure), was recorded when the mandibles were tested in a compression machine. Multiple regression analysis was used to evaluate the differences in bone height and the MRL between groups I and II. RESULTS: The mean bone height in groups I and II were 28.64 +/- 2.50 mm and 28.72 +/- 4.08 mm, respectively. The mean MRL in group I (20.49 +/- 7.22 kg) was greater than in group II (17.41 +/- 7.81 kg). The multiple regression analysis showed no significant difference in the bone height and the MRL between group I and group II (beta = 2.3492, P = .4114). CONCLUSION: There was no statistically significant difference in stability provided the two techniques.

Adult↗

Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible.

The study was performed to evaluate and compare the results of open and closed treatments of diacapitular fractures of the mandible. Following open reduction and internal fixation (ORIF) 14 patients with 15 displaced condylar fractures, which had caused a shortening of the mandibular ramus, were examined clinically (Helkimo index), radiologically (Orthopantomogram, Clementschitsch [reversed Towne's] view, Submentovertex view) and axiographically (CARDIAX). These findings were compared to a group of 29 patients with 34 similar condylar fractures which had been treated using closed techniques. Following ORIF patients showed better radiological results with regard to the mandibular ramus height, resorption and pathological changes to the condyle, compared to the patient group after closed functional treatment. In both groups some signs of dysfunction persisted, although there were slightly better results in the ORIF group. In 30% of the closed treatment group, lateral deviation during mouth opening, crepitus and occlusal disturbances were noted. No cases of occlusal disturbance were observed in the ORIF group. The axiographic examinations revealed a significant limitation of movement of the fractured condyle in both groups. However, after open treatment, the temporomandibular joint displayed significantly less irregularities in the condylar paths. In cases of complex reconstruction of the mandibular condyle, ORIF appears to improve the function of fractured condyles, when combined with a postoperative therapeutic exercise regime.

Adolescent↗

[Implant prosthesis rehabilitation after maxillofacial injuries--case report].

The dental and oral rehabilitation of patients with severe trauma that involves the oral cavity is demanding and challenging. Recently, advanced surgical techniques and innovations in oral implantology led to more sophisticated treatment modalities that may better fulfill the patients needs in special situations. Young people rather often suffer from accidents--at school and during leisure activities--in a period of their life that has a great impact on their physical, mental and personal development. Thus, the wish for a quick functional and esthetical rehabilitation contrasts with the complex clinical situation and the compromised oral conditions. All persons involved in the rehabilitation process--including the patient--must seek for the best solution that takes into account treatment time, invasivity of procedures and patients morbidity. Further, it is also observed that insurances very much stress the reduction of cost and the simplicity of treatment. This will also influence the treatment planning and the sequence of the procedures as shown by the following case.

Accidental Falls↗

Assessment of patients treated for intracapsular fractures of the mandibular condyle by closed techniques.

PURPOSE: The goals to study different lines of intracapsular fractures of the mandibular condyle and to evaluate their influence on the prognosis after closed treatment. PATIENTS AND METHODS: Clinical, radiologic, and axiographic follow-up of 40 patients with 50 intracapsular fractures of the mandibular condyle was carried out after closed treatment. The examinations were performed an average of 22 weeks after treatment. Three types of intracapsular fractures were distinguished: type A, or fractures through the medial condylar pole; type B, or fractures through the lateral condylar pole with loss of vertical height of mandibular ramus, and type M, multiple fragments, comminuted fractures. RESULTS: Moderate to serious dysfunction was observed in 33% of the cases. Radiologic examination of fracture types B and M revealed a reduction in the height of the mandibular ramus of up to 13% compared with the contralateral side. These 2 fracture types also resulted in the most prominent deformations of the condylar head. Axiography revealed irregular excursions and a limitation of condylar movement in comminuted fractures of up to 74% compared with the nonfractured side. CONCLUSION: Lesions to the osseodiscoligamentous complex of the temporomandibular joint caused by intracapsular fractures of the mandibular condyle can be severe. The poor functional and radiologic results encountered in the fracture types B and M showed the limitations of closed functional treatment.

Adolescent↗

Proximal segment positioning in bilateral sagittal split osteotomy: intraoperative controlled positioning by a positioning splint.

PURPOSE: Most techniques of proximal segment positioning hinder intraoperative condyle displacement. However, merely maintaining condylar position cannot optimize the preoperative condyle-disc-fossa relationship. This study attempts to optimize condylar position in the osteotomy patient. PATIENTS AND METHODS: A study group of 23 bimaxillary operated patients had intraoperative joint positioning by positioning splint and plates (9 Angle Class II, 14 Class III). After assessing the habitual and appraising the optimized condyle position on preoperative sonograms and magnetic resonance images, positioning splints were constructed as acrylic occlusal wafers in a semi-individual articulator. Set in occlusion before adaptation of positioning plates, they were intended to move the condyles into the calculated position. Eighteen bimaxillary operated control patients had conventional plate positioning according to the habitual occlusion (9 Angle Class II, 9 Class III). Clinical follow-up, axiography, or sonography was maintained for 24 months. Preoperative lateral cephalograms were scrutinized for horizontal and vertical joint spaces and compared with the immediate postoperative radiography. RESULTS: Postoperative Class II study group patients had less dorsal and more vertical joint space and Class III patients more dorsal and vertical space compared with the controls. The study group exhibited significantly less postoperative dysfunction compared with the control group (2-way analysis of variance: P <.021, F = 9.2, alpha =.05 significance level), disc dislocation prevalence was lower (P <.07, F = 9.2), postoperative changes in condylar translation were smaller (P <.014, F = 4.9), and 8% skeletal relapses versus 22% in the controls were seen. CONCLUSIONS: A proximal segment-positioning splint effectively positioned the condyle in the desired direction, but with considerable relapse, significantly reduced postoperative dysfunction, disc dislocations, changes to the condylar translation, and incidence of skeletal relapse at 24-month follow-up.

Adolescent↗

Bilateral sagittal split osteotomy for correction of mandibular prognathism: long-term results.

PURPOSE: To identify the long-term maxillomandibular changes after surgical correction of mandibular prognathism using bilateral sagittal split osteotomy (BSSO). PATIENTS AND METHODS: Twenty patients who underwent BSSO to setback the mandible and had cephalometric radiographs taken preoperatively and postoperatively at 6 weeks, 1 year, and long-term follow-up (mean, 28 months). The cephalograms were traced and measured to determine the operative and postoperative changes. Correlation analyses were performed to see the relationship between the magnitude of setback and the amount of long-term postsurgical change at B point and pogonion. RESULTS: The mean surgical setback was 8.2 mm at B point and 8.8 mm at pogonion. The mean long-term horizontal relapse was 2.3 mm (28.0%) at B point and 3.0 mm (34.1%) at pogonion. Out of 20 patients, 12 (60.0%) relapsed horizontally greater than 2 mm at B point and 13 (65.0%) at pogonion. The mean vertical surgical changes showed downward displacement of B point (2.3 mm) and pogonion (2.0 mm). The mean long-term vertical relapse was 1.6 mm (69.6%) at B point and 1.7 mm (85.0%) at pogonion. CONCLUSION: There was no correlation between the magnitude of setback and the amount of relapse at B point and pogonion. However, there was significant correlation between the magnitude of vertical, downward surgical displacement and the amount of vertical relapse at B point and pogonion. The majority of the maxillofacial changes occurred within 1 year postoperatively.

Adolescent↗

Condylar motion after open and closed treatment of mandibular condylar fractures.

PURPOSE: A comparative study was performed to evaluate the function of the temporomandibular system after open and closed treatment of condylar fractures. MATERIALS AND METHODS: A total of 37 temporomandibular joints were examined that had undergone either open treatment (n = 24) or closed treatment with maxillomandibular fixation (n = 13) for condylar fracture. The joints were investigated clinically and on the basis of radiographs. In addition, the movements of the condyles of the temporomandibular system were recorded in 3 dimensions with a computed electronic jaw tracking system (stereognathograph). RESULTS: The clinical investigation revealed no severe functional abnormality in either of the 2 groups. The mean of the recorded condyle paths was, however, consistently lower in the temporomandibular joints with closed treatment than in those with open treatment, although the difference was only significant for movements without tooth contact (Mann-Whitney U test, P < .05). CONCLUSIONS: In summary, open as well as closed treatment gave clinically acceptable functional results. However, condylar mobility was markedly greater after open treatment than after closed treatment.

Adult↗

A review and update of new methods for immobilization of the mandible.

In 1948, Dr Kurt H Thoma, a leading authority of the day, published a paper on new methods for immobilization of the mandible in the first issue of this Journal. He reviewed the state of the art for management of patients with fractures of the mandible. By reviewing the paper now we can see how difficult to treat some of the injuries he saw were. This paper assesses his patient management in light of today's knowledge and experience. It discusses changes in therapy that have occurred during this over fifty-year time span. Although many things have changed since then, what has not changed is our desire to provide the best care for our patients using currently available scientific knowledge and clinical evidence.

Absorbable Implants↗

Using composite bonding in oral and maxillofacial surgical office practice.

OBJECTIVE: Composite bonding plays a significant role in all phases of dental practice from orthodontics to restorative dentistry and even endodontics, yet, at the present time has had limited use by the oral and maxillofacial surgeon. The purpose of this article is 3-fold: to recommend a material for bonding and the method of application for composites; to describe the requirements of the orthodontist when referring a patient for the uncovering of teeth because this is usually the surgeon's primary, if not only, experience with bonding; and to describe situations that may present in the office that will benefit with the use of composite bonding. PATIENTS AND METHODS: Patients with various problems requiring the stabilization of teeth are presented and in a number of cases the effectiveness of the wired bar and the bonded bar is compared. These cases include the management of dentoalveolar fractures, avulsed or displaced teeth, its application to porcelain restorations without ill effects, and other situations that may arise in the office where fixation and stabilization of teeth is mandatory for success. RESULTS: Composite bonding provides the most effective method of stabilizing and immobilizing teeth with successful results in almost all cases. On the other hand, the wired arch bar and other wire combinations, which at the present time is the primary, if not the only treatment for these cases, are second to it from all aspects. CONCLUSION: The successful results with composite bonding along with its case of placement without pain or bleeding or psychological stress on the patient or operator warrants consideration by the oral and maxillofacial surgeon for greater utilization of this material in his office.

Composite Resins↗

Etiology and incidence of maxillofacial fractures in the north of Jordan.

OBJECTIVE: The objective of this investigation was to determine the causes and incidence of maxillofacial fractures in the country of Jordan. DESIGN: A retrospective review of patient records and radiographs for the 5-year period from 1992 to 1997 was conducted. Data regarding age, gender, cause of fracture, anatomic site, and treatment modalities were reviewed. RESULTS: During the 5-year period, 563 patients with 756 maxillofacial fractures were treated. The age range was 5 to 73 years (mean, 28.8 years). Of the 563 patients, 75.3% were male, with the peak incidence occurring in the age group 20 to 29 years. The bone of fracture was most frequently the mandible (seen in 419 cases, or 74.4% of the total), followed by the maxilla (76 cases; 13.5%), the zygomatic arch (60 cases; 10.7%), and the alveolar process (8 cases; 1.4%). Of the fractures, 55.2% were due to traffic accidents, 19.7% to accidental falls, and 16.9% to assaults. Most patients (82.3%) were treated by closed reduction surgery (45.2% with eyelet wiring; 54.8% with arch bars and intermaxillary fixation). Only 17.7% of patients were treated by open reduction surgery. All maxillary fractures were treated by orbital and circumzygomatic suspension with interdental wiring and intermaxillary fixation. Of the zygomatic complex fractures, 26 cases were treated with Gillies' temporal approach, 20 with percutaneous hook elevation, and 14 with observation alone. CONCLUSION: The findings support the view that both the causes and the incidence of maxillofacial fractures vary from one country to another.

Accidental Falls↗