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The factors that influence postoperative stability of the dental implants in posterior edentulous maxilla.

Yun Ho KIM ; Na Rae CHOI ; Yong Deok KIM

Maxillofacial Plastic and Reconstructive Surgery.2017;39(1):2-. doi:10.1186/s40902-016-0100-2

BACKGROUND: All clinicians are aware of the difficulty of installing a dental implant in posterior maxilla because of proximate position of maxillary sinus, insufficient bone width, and lower bone density. This study is to examine which factors will make the implantation in the posterior maxilla more difficult, and which factors will affect the postoperative implant stability in this region. METHODS: Five hundred seventy-three fixtures on the maxilla posterior were included for this study from all the patients who underwent an installation of the dental implant fixture from January 2010 to December 2014 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital (Yangsan, Korea). The postoperative implant stability quotient (ISQ) value, fixture diameter and length, presence of either bone graft or sinus lift, and graft material were included in the reviewed factors. The width and height of the bone bed was assessed via preoperative cone beam CT image analysis. The postoperative ISQ value was taken just before loading by using the OsstellTM mentor® (Integration Diagnostics AB, Gothenburg, Sweden). The t test and ANOVA methods were used in the statistical analysis of the data. RESULTS: Mean ISQ of all the included data was 79.22. Higher initial bone height, larger fixture diameter, and longer fixture length were factors that influence the implant stability on the posterior edentulous maxilla. On the other hand, the initial bone width, bone graft and sinus elevation procedure, graft material, and approach method for sinus elevation showed no significant impact associated with the implant stability on the posterior edentulous maxilla. CONCLUSIONS: It is recommended to install the fixtures accurately in a larger diameter and longer length by performing bone graft and sinus elevation.
Bone Density ; Busan ; Cone-Beam Computed Tomography ; Dental Implants* ; Hand ; Humans ; Maxilla* ; Maxillary Sinus ; Methods ; Surgery, Oral ; Survival Rate ; Transplants

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Woo Sung CHOI ; Jae Il LEE ; Hyun Joong YOON ; Chang Ki MIN ; Sang Hwa LEE

Maxillofacial Plastic and Reconstructive Surgery.2017;39(1):1-. doi:10.1186/s40902-016-0099-4

BACKGROUND: Multiple myeloma (MM) is characterized by a neoplastic proliferation of plasma cells primarily in the bone marrow. Bisphosphonates (BP) are used as supportive therapy in the management of MM. This study aimed to analyze the incidence, risk factors, and clinical outcomes of medication-related necrosis of the jaw (MRONJ) in MM patients. METHODS: One hundred thirty MM patients who had previous dental evaluations were retrospectively reviewed. Based on several findings, we applied the staging and treatment strategies on MRONJ. We analyzed gender, age, type of BP, incidence, and local etiological factors and assessed the relationship between these factors and the clinical findings at the first oral examination. RESULTS: MRONJ was found in nine male patients (6.9%). The mean patient age was 62.2 years. The median BP administration time was 19 months. Seven patients were treated with a combination of IV zoledronate and pamidronate, and two patients received single-agent therapy. The lesions were predominantly located in the mandible (n = 8), and the most common predisposing dental factor was a history of prior extraction (n = 6). Half of the MRONJ were related to diseases found on the initial dental screen. Patients with MRONJ were treated with infection control and antibiotic therapy. When comparing between the MRONJ stage and each factor (sign, location, etiologic factor, BP type, treatment, and outcome), there were no significant differences between stages, except for between the stage and sign (with or without purulence). CONCLUSIONS: For prevention of MRONJ, we recommend routine dental examinations and treatment prior to starting BP therapy.
Bone Marrow ; Diagnosis, Oral ; Diphosphonates ; Humans ; Incidence ; Infection Control ; Jaw* ; Male ; Mandible ; Multiple Myeloma* ; Necrosis ; Osteonecrosis* ; Plasma Cells ; Retrospective Studies* ; Risk Factors

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Extensive Adenomatoid Odontogenic Tumor of the Maxilla: A Case Report of Conservative Surgical Excision and Orthodontic Alignment of Impacted Canine.

Jee Won MOON

Maxillofacial Plastic and Reconstructive Surgery.2014;36(4):173-177.

The present report describe the surgical therapy, clinical course, orthodontic treatment and morphological characteristics of an adenomatoid odontogenic tumor in the maxilla of an 11-year-old patient. The cystic tumor filled the maxillary sinus and involved a tooth. Marsupialization was accompanied by partial enucleation and applied traction to the affected tooth by a fixed orthodontic appliance. Healing was uneventful and no local recurrence was observed during a 1-year period of follow-up control.
Child ; Follow-Up Studies ; Humans ; Maxilla* ; Maxillary Sinus ; Odontogenic Tumors* ; Orthodontic Appliances ; Recurrence ; Tooth ; Tooth, Impacted ; Traction

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Trismus Due to Bilateral Coronoid Hyperplasia.

Moon Gi CHOI ; Dong Hyuck KIM ; Eun Jung KI ; Hae Myung CHEON

Maxillofacial Plastic and Reconstructive Surgery.2014;36(4):168-172.

Bilateral coronoid hyperplasia causes painless progressive trismus, resulting from coronoid process impingement on the posterior aspect of the zygomatic bone. The etiology of coronoid hyperplasia is unclear, with various theories proposed. An endocrine stimulus, increased temporalis activity, trauma, genetic inheritance and familial occurrence have all been proposed, but no substantive evidence exists to support any of these hypotheses. Multiplanar reformatting of axial scans and 3-dimensional reconstruction permit precise reproduction of the shape and size of the coronoid and malar structures, and relationships of all structures of the temporal and infratemporal fossae. This case shows remarkably increased mouth opening by coronoidectomy in a patient who complained of trismus due to hyperplasia of coronoid process.
Humans ; Hyperplasia* ; Mandible ; Mouth ; Reproduction ; Trismus* ; Wills

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Considerations and Protocols in Virtual Surgical Planning of Reconstructive Surgery for More Accurate and Esthetic Neomandible with Deep Circumflex Iliac Artery Free Flap.

Nam Kyoo KIM ; Hyun Young KIM ; Hyung Jun KIM ; In Ho CHA ; Woong NAM

Maxillofacial Plastic and Reconstructive Surgery.2014;36(4):161-167.

PURPOSE: The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results. METHODS: Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes. RESULTS: This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour. CONCLUSION: Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap.
Bone and Bones ; Classification ; Free Tissue Flaps* ; Humans ; Iliac Artery* ; Logic ; Mandible ; Mandibular Reconstruction ; Osteotomy ; Rehabilitation ; Temporomandibular Joint ; Tissue Transplantation ; Transplants

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Anchor Plate Efficiency in Postoperative Orthodontic Treatment Following Orthognathic Surgery via Minimal Presurgical Orthodontic Treatment.

Tae Min JEONG ; Yoon Ho KIM ; Seung Il SONG

Maxillofacial Plastic and Reconstructive Surgery.2014;36(4):154-160.

PURPOSE: The efficiency of an anchor plate placed during orthognathic surgery via minimal presurgical orthodontic treatment was evaluated by analyzing the mandibular relapse rate and dental changes. METHODS: The subjects included nine patients with Class III malocclusion who had bilateral sagittal split osteotomy at the Division of Oral and Maxillofacial Surgery, Department of Dentistry in Ajou University Hospital, after minimal presurgical orthodontic treatment. During orthognathic surgery, anchor plates were placed at both maxillary buttresses. The anchor plates were used to move maxillary teeth backward and for maximum anchorage of Class III elastics to minimize mandibular relapse during the postoperative orthodontic treatment. The lateral cephalometric X-ray was taken preoperatively (T0), postoperatively (T1), and one year after the surgery (T2). Seven measurements (distance from Pogonion to line Nasion-Nasion perpendicular [Pog-N Per.], angle of line B point-Nasion and Nasion-Sella [SNB], angle of line maxilla 1 root-maxilla 1 crown and Nasion-Sella [U1 to SN], distance from maxilla 1 crown to line A point-Nasion [U1 to NA], overbite, overjet, and interincisal angle) were taken. Measurements at T0 to T1 and T1 to T2 were compared and differences tested by standard statistical methods. RESULTS: The mean skeletal change was posterior movement by 13.87+/-4.95 mm based on pogonion from T0 to T1, and anterior movement by 1.54+/-2.18 mm from T1 to T2, showing relapse of about 10.2%. There were significant changes from T0 to T1 for both Pog-N Per. and SNB (P<0.05). However, there were no statistically significant changes from T1 to T2 for both Pog-N Per. and SNB. U1 to NA that represents the anterior-posterior changes of maxillary incisor did not differ from T0 to T1, yet there was a significant change from T1 to T2 (P<0.05). CONCLUSION: This study found that the anchor plate minimizes mandibular relapse and moves the maxillary teeth backward during the postoperative orthodontic treatment. Thus, we conclude that the anchor plate is clinically very useful.
Bone Plates ; Crowns ; Dentistry ; Humans ; Incisor ; Malocclusion ; Maxilla ; Orthognathic Surgery* ; Osteotomy ; Overbite ; Recurrence ; Surgery, Oral ; Tooth

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The Efficacy of the Graft Materials after Sinus Elevation: Retrospective Comparative Study Using Panoramic Radiography.

Tae Min JEONG ; Jeong Keun LEE

Maxillofacial Plastic and Reconstructive Surgery.2014;36(4):146-153.

PURPOSE: This study compares and evaluates the efficacy of graft materials after maxillary sinus bone grafts with autogenous tooth bone graft material (AutoBT), demineralized freeze-dried bone allograft (DFDBA) and deproteinized bovine bone mineral (DBBM). METHODS: The study involved 30 sinuses in 26 patients who visited the Division of Oral and Maxillofacial Surgery, Department of Dentistry in Ajou University Hospital and received either AutoBT, DFDBA or DBBM with sinus elevation using the lateral window technique. Sinus graft height was measured before, immediately after, and six months after bone graft with panoramic radiography and the height changes of the sinus floor was compared according to the graft materials. RESULTS: After six months, the decrease ratio of graft heights were 13.57% for AutoBT group, 14.30% for DFDBA group, and 11.92% for DBBM group. There was no statistically significant difference. CONCLUSION: The new maxillary sinus floor formed by the upper border of bone graft material, can repneumatize after the maxillary sinus elevation. Thus, long-term stability of sinus graft height represents an important factor for implant success. We found that the three graft materials for sinus elevation do not differ significantly and all three graft materials showed excellent resistance to maxillary sinus repneumatization. However, due to the special circumstances of the maxillary sinus and small sample, the actual difference between the three graft materials may not have been detectable. Therefore further study needs to be conducted for more reliable study results.
Allografts ; Bone Substitutes ; Dentistry ; Humans ; Maxillary Sinus ; Radiography, Panoramic* ; Retrospective Studies* ; Sinus Floor Augmentation ; Surgery, Oral ; Tooth ; Transplants*

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Facial Bone Fracture Patients Visiting Pusan National University Hospital in Busan and Yangsan: Trends and Risks.

Hyo Geon KIM ; Yong Hyun SON ; In Kyo CHUNG

Maxillofacial Plastic and Reconstructive Surgery.2014;36(4):140-145.

PURPOSE: This study examined patients with facial bone fracture visiting Pusan National University Dental Hospital to understand the trends, and to enhance appropriate care and treatment for patients with facial bone fracture. METHODS: We investigated 531 patients presenting with facial bone fracture in Yangsan and 802 patients in Busan from January 2010 to December 2013. We divided the patients by year, month, gender, age, site, and cause to compare with historic data and other studies. RESULTS: The gender ratio was 3.58:1 in Yangsan and 4.31:1 in Busan. Patients aged in their 20s had the highest number of facial bone fractures in both Yangsan and Busan. The most frequent fracture site was the mandible, and the most frequent cause was slip down in both Yangsan and Busan. CONCLUSION: The investigation and comparison of patients with facial bone fracture who visited Pusan National University Hospital located at Yangsan and Busan from 2010 to 2013 found a difference in the total number of patients at each hospital, but the trends were not significantly different.
Busan ; Facial Bones* ; Fractures, Bone ; Gyeongsangnam-do ; Humans ; Mandible ; Maxilla ; Zygoma

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Comparison of Costochondral Graft and Customized Total Joint Reconstruction for Treatments of Temporomandibular Joint Replacement.

Woo Young LEE ; Young Wook PARK ; Seong Gon KIM

Maxillofacial Plastic and Reconstructive Surgery.2014;36(4):135-139.

PURPOSE: We review published research on temporomandibular joint (TMJ) total replacement that compares costochondral graft and customized total joint reconstruction (especially TMJ concepts), focusing on effectiveness. METHODS: We searched PubMed databases, including prospective, retrospective, case-control or longitudinal studies and significant statistical analysis. In data analysis, we divided outcomes into 'Acceptable' or 'Non-acceptable'. RESULTS: There were seven articles found dealing with costochondral graft and 180 patients. The majority of patients had satisfactory treatment outcomes (n=109, 61%). There were six articles including 275 patients using the alloplastic material TMJ concepts. Almost all patients had satisfactory treatment outcomes (n=261, 95%). CONCLUSION: Comparing customized total joint reconstruction with costochondral graft, use of TMJ concepts resulted in increased quality of life and fewer complications. In conclusion, we judged that alloplastic material such as TMJ concepts is more effective device in total joint replacement than costochondral graft.
Autografts ; Case-Control Studies ; Humans ; Joint Prosthesis ; Joints* ; Longitudinal Studies ; Quality of Life ; Statistics as Topic ; Temporomandibular Joint Disorders ; Temporomandibular Joint* ; Transplants*

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Successful and rapid response of speech bulb reduction program combined with speech therapy in velopharyngeal dysfunction: a case report.

Yu Jeong SHIN ; Seung O KO

Maxillofacial Plastic and Reconstructive Surgery.2015;37(7):22-. doi:10.1186/s40902-015-0022-4

Velopharyngeal dysfunction in cleft palate patients following the primary palate repair may result in nasal air emission, hypernasality, articulation disorder and poor intelligibility of speech. Among conservative treatment methods, speech aid prosthesis combined with speech therapy is widely used method. However because of its long time of treatment more than a year and low predictability, some clinicians prefer a surgical intervention. Thus, the purpose of this report was to increase an attention on the effectiveness of speech aid prosthesis by introducing a case that was successfully treated. In this clinical report, speech bulb reduction program with intensive speech therapy was applied for a patient with velopharyngeal dysfunction and it was rapidly treated by 5months which was unusually short period for speech aid therapy. Furthermore, advantages of pre-operative speech aid therapy were discussed.
Articulation Disorders ; Cleft Palate ; Humans ; Methods ; Palate ; Prostheses and Implants ; Speech Therapy* ; Velopharyngeal Insufficiency

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