Hossein Kashani

Apical peri-implantitis: possible predisposing factors, case reports, and surgical treatment suggestions.

BACKGROUND Apical peri-implantitis is often diagnosed by clinical findings such as pain, redness, tenderness, swelling, and sometimes the presence of a fistulous tract. There are few theories about how such a lesion occurs. Hence, the current clinical treatment protocols are scanty. PURPOSE The aim of this report was to evaluate and confer a more extended surgical protocol and to discuss possible predisposing factors for the development of retrograde peri-implantitis. MATERIALS AND METHODS Two patients were extensively evaluated with regard to clinical signs, implant treatment, postoperative complications, and surgical treatment. The surgical protocol comprised debridement, with the additional removal of the apical portion of the affected implant. Postoperative checkup included clinical examination and radiographs. The follow-up period ranged from 1 to 3 years following surgical debridement. The possible predisposing factors are also discussed in the article. RESULTS Both cases healed uneventfully with no further symptoms. Radiographs revealed complete bone fill into the resected area and continuous stable bone levels around the previously affected implants. CONCLUSIONS It is concluded that recommendations for treatment of apical peri-implantitis are still minimal. In the present study, a surgical approach with resection of the apical portion of the affected implants in combination with debridement is suggested. Our experience was that partially resected oral implants remain osseointegrated and also function well clinically with a follow-up period up to 3 years.

The effects of steroids in preventing facial oedema, pain, and neurosensory disturbances after bilateral sagittal split osteotomy: a randomized controlled trial

A randomized, prospective, controlled trial was conducted to determine the efficacy of single and repeated betamethasone doses on facial oedema, pain, and neurosensory disturbances after bilateral sagittal split osteotomy. Thirty-seven patients (mean age 23.62 years, range 17-62 years) with either mandibular prognathism or retrognathism were enrolled consecutively into the study and divided into three groups: control (n=12), repeated dose 4+8+4mg betamethasone (n=14), single dose 16mg betamethasone (n=11). The intake of diclofenac and paracetamol was assessed individually. Measurements of facial oedema, pain, and sensitivity in the lower lip/chin were obtained 1 day, 7 days, 2 months, and 6 months postoperatively. Furthermore, we investigated the possible influences of gender, age, total operating time, amount of bleeding, postoperative hospitalization, and advancement versus setback of the mandible. A significant difference (P=0.017) was observed in percentage change between the two test groups and the control group regarding facial oedema (1 day postoperatively). Less bleeding was associated with improved pain recovery over time (P=0.043). Patients who required higher postoperative dosages of analgesics due to pain had significantly delayed recovery of the inferior alveolar nerve at 6 months postoperatively (P<0.001). Betamethasone did not reduce neurosensory disturbances over time.

Sagittal split advancement osteotomy: Comparison of the tendency to relapse after two different methods of rigid fixation

Mandibular advancement was studied in 32 patients with mandibular retrognathia in whom the only intervention was in the mandible. Fifteen patients were treated with fixation by lag screws and 17 with monocortical miniplates. Lateral radiographs were taken preoperatively, postoperatively, 2 months postoperatively, and 1.5 years postoperatively, and mandibular movement analysed. All patients healed uneventfully. Cephalometric analysis of lateral radiographs showed no significant differences between the two groups in skeletal relapse during any of the control periods up to 18 months. Mandibular advancement for treatment of mandibular retrognathia using rigid fixation with either lag screws or miniplates was reproducable with only minor skeletal relapse.

A retrospective evaluation of iatrogenic dental root damage with predrilled vs drill‐free bone anchor screws for intermaxillary fixation

AIMS The aim of this study was to retrospectively evaluate iatrogenic dental root damage, caused by two different techniques that utilized bone anchor screws, for intermaxillary fixation (IMF) in orofacial trauma. MATERIALS AND METHODS The techniques used included either predrilled or drill-free bone anchor screws. A total of 123 patients who required IMF were evaluated (97 men and 26 women). Sixty-four patients were treated in the predrilled group, and 59 patients were treated in the drill-free group. The data were collected over an 8-year period and were analyzed using crosstabs and Fishers exact test. RESULTS Injuries to dental roots were found only in the predrilled group. Twenty-nine patients (45.3%) were injured at the time of surgery. One year after surgery, 10 patients (15.6%) had permanently injured dental roots. There was a significant difference in injury rates between the predrilled and drill-free groups 1 year after surgery (P < 0.001). CONCLUSION There is an increased potential risk of iatrogenic injury and permanent damage to the dental roots when a technique that involves predrilled holes for bone anchor screws is used.

Quality of life in patients undergoing orthognathic surgery – A two-centered Swedish study

AIM Surgical corrections of dentofacial deformities have both physical and psychological impact on quality of life (QoL). The objectives of the present study were to evaluate the impact of oral health related problems on QoL before and after a combination of orthodontic treatment and orthognathic surgery. Additionally, the study aimed to identify correlations between different dentofacial patterns and possible improvements due to treatment. MATERIAL AND METHODS In a prospective study, we evaluated fifty patients before start of treatment, 6 weeks and 6 months postoperatively. The questionnaires used were: OHIP-14 (Short Form Oral Health Impact Profile), a condition-specific QOL approach (Orthognathic Quality of Life Questionnaires; OQLQ) and a social-demographic questionnaire. RESULTS There was a statistically significant improvement in the OHIP domains from baseline to 6 months follow-up and for the OQLQ, the improvement was significant both at 6 weeks and 6 months in relation to the baseline data. CONCLUSION Significant improvement of quality of life over time is proved by both OHIP-14 and OQLQ in the present study. Socio-demographic and holistic considerations are important when evaluating treatment outcome after combined orthodontic and orthognatic surgery. However, longer follow-up would be beneficial.

One-year results of a clinical and radiological prospective multicenter study on NEOSS® dental implants.

BACKGROUND NEOSS® (Neoss Ltd., Harrogate, UK) dental implant system was introduced on the clinical arena in 2003. It is important that novel implant systems are systematically evaluated in a multicenter setting. PURPOSE The aim of this study was to follow a large number of consecutively treated patients, with NEOSS dental implant system, both clinically and radiographically. The current report constitutes the 1-year data of a planned 5-year study. MATERIALS AND METHODS The study included a total of 177 patients treated with 590 NEOSS implants at 13 clinics in Sweden. The material was composed of 72 males and 105 females treated for single, partial, and total edentulism. Clinical, radiographic, and subjective evaluations were performed. RESULTS Out of 590 implants, 13 early failures have been reported, corresponding to a 1-year cumulative survival rate (CSR) of 97.8%. Evaluation of function and esthetics at the 1-year visit resulted in 100% success for function and 98% success for the esthetic outcome. The mean marginal bone loss was 0.6 mm (SD 1.1) after 1 year in clinical function. No adverse effects of the NEOSS dental implants were reported, and complications were few and similar to those reported for implant treatment in general. CONCLUSION The CSR in the present study was 97.8%. No adverse effects of the NEOSS implants were reported, and complications during the study period were few and similar to those reported to for other well-documented implants system. Based on the present data, we conclude that NEOSS dental implant is a safe and predictable implant system. However, the high number of dropouts in the radiological evaluation must be considered when interpreting the data.

Effect of NaF-, SnF2-, and chlorhexidine-impregnated birch toothpicks on mutans streptococci and pH in approximal dental plaque

The antimicrobial effect of birch toothpicks impregnated with 4% NaF, 8% SnF2, or 2% chlorhexidine was studied both in vitro and in vivo. A non-impregnated toothpick served as a control. In vitro, suspensions of Streptococcus mutans were exposed to the various toothpicks for 20 min and then cultured on blood agar. The results of this susceptibility test revealed the following ranking order with respect to inhibition: chlorhexidine > SnF2 > NaF and non-impregnated; with significant differences in colony-forming units (CFU) between these three groups. In vivo, 12 individuals used the 4 types of toothpick 3 times a day for 5 days in a procedure with a crossover design. Saliva and approximal plaque samples were collected at baseline and on various occasions up to 23 days after the treatment. At the same time, plaque-pH was measured at approximal sites 10 min after rinsing with 10% sucrose. The results of these in vivo experiments revealed lower proportions of mutans streptococci after using all four types of toothpick, but the reduction was significant only after 2 days for the toothpicks impregnated with SnF2 and chlorhexidine (P< 0.05). On the sampling occasions 9 and 23 days after the treatment, the mutans streptococci were more or less back to baseline levels again. In saliva no significant differences in the number of mutans streptococci were found either within or between the four treatments. No significant differences were found regarding decline in the plaque-pH between the NaF-, SnF2-, chlorhexidine-, and non-impregnated toothpicks on any of the sampling occasions.

Incidence and risk factors predisposing plate removal following orthognathic surgery

OBJECTIVE The aim of this study was to investigate the incidence and reasons for titanium fixation plate removal following orthognathic surgery, identify risk factors predisposing removal, and explore if discomfort was reduced postoperatively. STUDY DESIGN Medical records of 404 consecutive cases were retrospectively reviewed. All patients received a questionnaire for follow-up, and 323 patients answered the questionnaire, thus forming the sample group. RESULTS Of all the responding patients, 15% had plates removed, and 92% of these patients experienced relief from discomfort after removal of the plates. Infection was the most common reason for plate removal (10%). Smoking (hazard ratio 2.74) and surgery performed in the mandible (hazard ratio 2.40) increased the need for plate removal. For each plate added in the mandible, the risk for removal increased by 34%. CONCLUSIONS Smoking, osteotomies, and additional numbers of plates in the mandible resulted in a higher incidence of plate removal. Most of the patients experienced relief from discomfort after plate removal.

Osteotomies in Orthognathic Surgery

Orthognathic surgery is mostly performed to correct developmental or acquired oral and maxillofacial skeletal deformities (OMSDs). During the past three decades, significant advances in surgical osteotomy techniques and instrumentation have been developed and carried out in orthognathic surgery. However, the basic surgical principles have more or less remained unchanged. At the same time, numerous surgical techniques have been developed and refined and used by surgeons in the field of oral and maxillofacial surgery. These techniques have treatment of the most complex dentofacial deformities with confidence. Additionally, it has been possible to predict the results of the treatment. Although the initial surgical techniques for correction of anterior mandibular open bite were reported as early as the late 1800s, widespread use of currently acceptable techniques began in the middle of the last century. Detailed surgical planning is essential for a successful outcome. The treatment involves an accurate treatment plan, correct type of instruments for a specific procedure, a thorough surgical routine, and adherence to the guidelines for each routine. Although similar orthognathic surgical techniques are used, there are multiple important differences related to each osteotomy. It is essential for the surgeon to understand these differen‐ ces in order to provide an effective and safe surgical care for the patient with facial anomalies. Choosing an optimal method of osteotomy depends on many factors, including the indication for treatment, the goal of therapy, patient profile, underlying medical conditions, and the magnitude of surgical movement. The major objective of this chapter is to provide practical guidelines and principles of osteotomies and commonly used techniques. These guidelines are based on a review of the current literature and the authors personal experience. The chapter focuses on the history of orthognathic surgery, anatomical considerations, indications for different osteoto‐ mies, and the surgical technique for each osteotomy. Techniques such as the Le Fort I, II, III osteotomies, segmental osteotomies of the maxilla, bilateral sagittal split osteotomy (BSSO), bilateral vertical osteotomy (BVO) genioplasty, segmental osteoto‐ my of the mandible, and the chin wing osteotomy are described.