G. Millesi

TREATMENT RESULTS OF BISPHOSPHONATE-RELATED OSTEONECROSIS OF THE JAWS

Osteonecrosis of the jaws occurs after the administration of bisphosphonates. An unequivocal treatment strategy is yet to be devised. We assess the treatment of patients with bisphosphonate‐related osteonecrosis of the jaws (BRONJ).

Maxillomandibular advancement for treatment of obstructive sleep apnea syndrome: a systematic review.

PURPOSE To perform a systematic review of the published data concerning maxillomandibular advancement for the treatment of obstructive sleep apnea syndrome. MATERIALS AND METHODS A systematic literature search was performed in the PubMed database. Original articles in the English language were reviewed to obtain information about patient data, success rates, and outcome measures. RESULTS The systematic literature search yielded 1,113 citations, of which 101 articles met our inclusion criteria. After a review of the full text, 39 studies were included in the analysis. Most articles were classified as evidence level 4, and 5 met the inclusion criteria for level 2b. The only prospective randomized controlled study had been published in January 2010 and was assigned level 1b. CONCLUSIONS A recommendation grade of A to B was achieved with regard to the levels of evidence-based medicine. Our results have shown that maxillomandibular advancement is the most successful surgical therapy, and the postoperative polysomnography results are comparable to those under ventilation therapy.

Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws (BRONJs)

OBJECTIVES Bisphosphonates are associated with osteonecrosis of the jaw. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) may be treated conservatively or by surgery. PATIENTS AND METHODS 108 patients underwent surgery and 88 patients were followed for a mean period of 337 days. Age, gender, dental procedures, underlying disease, and the role of bisphosphonate treatment in the success of surgery were evaluated retrospectively. RESULTS Surgical treatment improved the stage distribution from 19% stage I, 56% stage II and 25% stage III to 59% intact mucosa, 19% stage I and 13% stage II and 8% stage III. The improvement in the stage of disease achieved by surgery was statistically significant. Further relevant parameters that favor a positive outcome of surgery were the event triggering the outbreak of BRONJ (p=0.05) and the underlying disease (p=0.05). BRONJ in the maxilla necessitated repeat surgery significantly earlier than did BRONJ in the mandible (p=0.03). CONCLUSION Effective surgery might improve the outcome of BRONJ, although prevention still is the most important aspect of this condition.

Facial aesthetics and the assignment of personality traits before and after orthognathic surgery

Processing and interpreting the face is generally very important because one is often required to make rapid decisions in life on the basis of meagre information. Ninety-two volunteers used a computer-assisted test battery to assess 40 profiles of patients (8 skeletal Class II and 8 skeletal Class III patients, each pre- and postoperatively, with 8 skeletal Class I photographs serving as controls). On a 7-point Likert scale the raters were asked to evaluate aesthetics and a few relevant personality traits (e.g. unintelligent, inhibited, aggressive, brutal). The photographs of the two patient groups were rated significantly less attractive and intelligent prior to surgery than the photographs of the control group. In respect of personality traits, the photographs of the skeletal Class III group differed more strongly from normal ones. In respect of aesthetics and intelligence, both patient groups benefited markedly from surgery. For some personality traits, significant interactions were found between the two groups on pre-post comparison. The method underlying the study is useful for evaluating the outcome of orthognathic surgery, but also indicates the strongly generalized and unconscious processes involved in the estimation of peoples personality traits, especially when these concern deviations from the socially normal condition.

Facial esthetics and the assignment of personality traits before and after orthognathic surgery rated on video clips

Typically, before and after surgical correction faces are assessed on still images by surgeons, orthodontists, the patients, and family members. We hypothesized that judgment of faces in motion and by naïve raters may closer reflect the impact on patients’ real life, and the treatment impact on e.g. career chances. Therefore we assessed faces from dysgnathic patients (Class II, III and Laterognathia) on video clips. Class I faces served as anchor and controls. Each patient’s face was assessed twice before and after treatment in changing sequence, by 155 naïve raters with similar age to the patients. The raters provided independent estimates on aesthetic trait pairs like ugly /beautiful, and personality trait pairs like dominant /flexible. Furthermore the perception of attractiveness, intelligence, health, the persons’ erotic aura, faithfulness, and five additional items were rated. We estimated the significance of the perceived treatment related differences and the respective effect size by general linear models for repeated measures. The obtained results were comparable to our previous rating on still images. There was an overall trend, that faces in video clips are rated along common stereotypes to a lesser extent than photographs. We observed significant class differences and treatment related changes of most aesthetic traits (e.g. beauty, attractiveness), these were comparable to intelligence, erotic aura and to some extend healthy appearance. While some personality traits (e.g. faithfulness) did not differ between the classes and between baseline and after treatment, we found that the intervention significantly and effectively altered the perception of the personality trait self-confidence. The effect size was highest in Class III patients, smallest in Class II patients, and in between for patients with Laterognathia. All dysgnathic patients benefitted from orthognathic surgery. We conclude that motion can mitigate marked stereotypes but does not entirely offset the mostly negative perception of dysgnathic faces.

Identification of ‘Point A’ as the prevalent source of error in cephalometric analysis of lateral radiographs

Deviations in measuring dentofacial components in a lateral X-ray represent a major hurdle in the subsequent treatment of dysgnathic patients. In a retrospective study, we investigated the most prevalent source of error in the following commonly used cephalometric measurements: the angles Sella-Nasion-Point A (SNA), Sella-Nasion-Point B (SNB) and Point A-Nasion-Point B (ANB); the Wits appraisal; the anteroposterior dysplasia indicator (APDI); and the overbite depth indicator (ODI). Preoperative lateral radiographic images of patients with dentofacial deformities were collected and the landmarks digitally traced by three independent raters. Cephalometric analysis was automatically performed based on 1116 tracings. Error analysis identified the x-coordinate of Point A as the prevalent source of error in all investigated measurements, except SNB, in which it is not incorporated. In SNB, the y-coordinate of Nasion predominated error variance. SNB showed lowest inter-rater variation. In addition, our observations confirmed previous studies showing that landmark identification variance follows characteristic error envelopes in the highest number of tracings analysed up to now. Variance orthogonal to defining planes was of relevance, while variance parallel to planes was not. Taking these findings into account, orthognathic surgeons as well as orthodontists would be able to perform cephalometry more accurately and accomplish better therapeutic results.