Johan P. Reyneke

Comparison of titanium and resorbable copolymer fixation after Le Fort I maxillary impaction

INTRODUCTION Advances in skeletal stabilization techniques have led to the use of titanium devices for rigid fixation. Their advantages include strength and skeletal stability, but they also have disadvantages. The purpose of this study was to investigate the stability of a resorbable copolymer as a potential alternative to titanium for fixation of Le Fort I maxillary impaction. METHODS Fifty consecutive patients underwent maxillary impaction with nonsegmental monopiece Le Fort I osteotomy. Twenty-five patients were treated with titanium fixation; 25 patients were treated with resorbable copolymer fixation (82% poly-L-lactic acid: 18% polyglycolic acid). Lateral cephalograms were obtained 1 week preoperatively, 1 week postoperatively, and a minimum of 8 months postoperatively. Linear and angular measurements were recorded digitally to evaluate 2-dimensional skeletal changes. RESULTS Statistical analysis showed no significant radiographic differences (P <0.05) in long-term stability in or between the 2 groups. No clinical or radiographic evidence of wound healing problems was noted. CONCLUSIONS These results support the use of resorbable copolymer fixation for Le Fort I impaction as a viable alternative to titanium fixation.

Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars: its effect on the sagittal split ramus osteotomy

The authors undertook a prospective study to evaluate the influence that the anatomical dimensions of the ramus of the mandible and the presence of lower third molar teeth may have on the sagittal split ramus osteotomy. The anatomical dimensions measured included the width of the anterior mandibular ramus, the height of the corpus posterior to the second mandibular molar and the antero-posterior anatomical position of the lingual. The influence that these dimensions of the mandible may have on the successful splitting of the mandibular ramus was investigated. The effect that the presence of wisdom teeth had on the difficulty of the procedure was also investigated. This study found that, unlike the presence of third molars, there was no single anatomical measurement that contributed to the level of difficulty of the sagittal split osteotomy. For descriptive purposes the authors proposes a classification of the four typical patterns of unfavourable splits.

Treatment of maxillary deficiency by a Le Fort I downsliding technique

The treatment of patients with vertical maxillary deficiency by a Le Fort I downsliding technique where the maxilla is moved forward and downward on a planned angulated osteotomy cut, is discussed and the results in nine patients who were treated using this method are reported.

Medial pterygoid muscle and stylomandibular ligament: the effects on postoperative stability

The postoperative skeletal stability following surgical advancement of the mandible can be influenced by several factors. The effect of the medial pterygoid muscle and the stylomandibular ligament on the stability of results following surgical advancement has possibly been underestimated. In this retrospective study, the long-term postoperative skeletal stability following surgical advancement of the mandible in two groups of patients was studied and compared. In one group the medial pterygoid muscle and the stylomandibular ligament were stripped from the medial side of the angle of the mandible during the bilateral sagittal split osteotomy (BSSO) procedure while for the other group of patients these muscles and ligaments were left attached. The long term skeletal stability of the two groups was compared and the group that had the muscles and the ligaments stripped proved to be more stable than the other group.

The Bilateral Sagittal Split Mandibular Ramus Osteotomy

Sound technical craft requires a consistent surgical routine. Knowledge of the tips and traps associated with each surgical step makes surgical efforts occur smoothly. Correct positioning of the mandibular condyle in the glenoid fossa is mandatory for successful treatment outcome. The application of an established step-by-step operating technique prevents intraoperative uncertainty and often postoperative complications.

Rotation of the maxillomandibular complex (alteration of the occlusal plane): indications, treatment planning, and treatment outcomes

Mercuri LG, Wolford LM, Sanders B, et al: Custom CAD/CAM Total temporomandibular Joint Reconstruction System: Preliminary multicenter report. J Oral Maxillofac Surg 53:106, 1995 Mercuri LG: The TMJ Concepts Patient Fitted Total Temporomandibular Joint Reconstruction Prosthesis. Oral Maxillofac Surg Clin North Am 12:73, 2000 Mercuri LG, Wolford LM, Sanders B, et al: Long-term follow-up of the CAD/CAM total temporomandibular joint reconstruction system. J Oral Maxillofac Surg 60:1440, 2002