Jun-Young Paeng

Morphologic Evaluation and Classification of Facial Asymmetry Using 3-Dimensional Computed Tomography

PURPOSE A systematic classification is needed for the diagnosis and surgical treatment of facial asymmetry. The purposes of this study were to analyze the skeletal structures of patients with facial asymmetry and to objectively classify these patients into groups according to these structural characteristics. PATIENTS AND METHODS Patients with facial asymmetry and recent computed tomographic images from 2005 through 2009 were included in this study, which was approved by the institutional review board. Linear measurements, angles, and reference planes on 3-dimensional computed tomograms were obtained, including maxillary (upper midline deviation, maxilla canting, and arch form discrepancy) and mandibular (menton deviation, gonion to midsagittal plane, ramus height, and frontal ramus inclination) measurements. All measurements were analyzed using paired t tests with Bonferroni correction followed by K-means cluster analysis using SPSS 13.0 to determine an objective classification of facial asymmetry in the enrolled patients. Kruskal-Wallis test was performed to verify differences among clustered groups. P < .05 was considered statistically significant. RESULTS Forty-three patients (18 male, 25 female) were included in the study. They were classified into 4 groups based on cluster analysis. Their mean age was 24.3 ± 4.4 years. Group 1 included subjects (44% of patients) with asymmetry caused by a shift or lateralization of the mandibular body. Group 2 included subjects (39%) with a significant difference between the left and right ramus height with menton deviation to the short side. Group 3 included subjects (12%) with atypical asymmetry, including deviation of the menton to the short side, prominence of the angle/gonion on the larger side, and reverse maxillary canting. Group 4 included subjects (5%) with severe maxillary canting, ramus height differences, and menton deviation to the short side. CONCLUSION In this study, patients with asymmetry were classified into 4 statistically distinct groups according to their anatomic features. This diagnostic classification method will assist in treatment planning for patients with facial asymmetry and may be used to explore the etiology of these variants of facial asymmetry.

Comparative study of skeletal stability between bicortical resorbable and titanium screw fixation after sagittal split ramus osteotomy for mandibular prognathism

INTRODUCTION Resorbable screw fixation for orthognathic surgery is widely used in oral and maxillofacial surgery and has several advantages. However, surgeons are concerned about using resorbable screws in orthognathic surgery because of possible postoperative complications such as relapse, screw fracture, and infection. The purpose of this study was to evaluate the skeletal stability of bicortical resorbable screw fixation after sagittal split ramus osteotomies for mandibular prognathism. MATERIALS AND METHODS This study included 25 patients who underwent mandibular setback surgery fixed with resorbable screws after sagittal split osteotomy at the Department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital. Five resorbable screws (Inion CPS(®), Inion Ltd., Finland) were applied bicortically at each osteotomy site via a transbuccal approach. No rigid intermaxillary fixation was applied on the first postoperative day. Passive mouth opening exercises were allowed, using two light, rubber elastics for guidance. The control group was 25 patients fixed with four titanium screws. The follow-up period was 12-22 months (mean 17.8 months). Postoperative skeletal changes on lateral cephalometric radiographs were analyzed and compared between the two groups preoperatively, immediately postoperatively, and 6 months postoperatively. RESULTS The average setback was 6.9 mm and no major intraoperative complications occurred. One patient experienced infection immediately after surgery that was controlled uneventfully. The data did not demonstrate any significant difference in postoperative skeletal stability between the two groups. Differences between the immediate postoperative state and 6 months after surgery were not significant. In earlier cases, especially for patients with severe mandibular prognathism, immediate postoperative elastic traction was needed for stable occlusal guidance. CONCLUSIONS The results of this study indicate that bicortical resorbable screws offer a clinically stable outcome for the fixation of mandibular sagittal split osteotomies in mandibular prognathism. However the resorbable screws showed less stable results vertically than the titanium screws.

Trifocal distraction-compression osteosynthesis in conjunction with passive self-ligating brackets for the reconstruction of a large bony defect and multiple missing teeth

Reconstruction of a maxillary dentoalveolar defect and closure of a wide oronasal fistula in a patient with a traumatic injury are challenging for both orthodontists and surgeons. A conventional bone graft is used to fill the alveolar bone defect, to restore continuity between bony segments, and to provide bony support for tooth eruption adjacent to the defect or for orthodontic tooth movement into the bony defect. However, if the defect is too large to allow for a conventional bone graft, transport distraction osteogenesis can be used for reconstruction of the alveolar bone and implant placement. However, there is usually a discrepancy in the movement rates between the bony segment and the teeth. Passive self-ligating brackets can minimize friction between the bracket and the archwire; therefore, the rate of tooth movement can be balanced with that of the bony segment. By using orthodontic miniscrew and elastomeric traction, the regenerated bony segments can be bent to form a curved arch in the alveolar bone. In the treatment reported here, trifocal distraction-compression osteosynthesis with orthodontic miniscrews and passive self-ligating brackets helped establish bone continuity in a bony defect area, created anterior curvature of the alveolar bone, and provided good-quality regenerated bone for implant placement.

Segregation analysis of mandibular prognathism in Korean orthognathic surgery patients and their families

OBJECTIVE To investigate the existence of genetic influences on the incidence of mandibular prognathism (MP) in Korean Class III patients. MATERIALS AND METHODS The probands consisted of 100 Class III patients with MP (51 men and 49 women; mean age, 22.1 ± 5.2 years; SNA, 81.2° ± 3.2°; SNB, 84.1° ± 3.9°) who underwent orthognathic surgery. Using three-generation pedigree charts, questionnaires, and clinical examinations, general information and information regarding MP for a total of 3777 relatives of the probands (1911 men and 1866 women) was ascertained. Familial correlations of MP between possible pairs in the pedigree were estimated. Heritability (h(2)) of MP under various models was estimated. Segregation analysis was conducted under the assumption of the nonpolygenic multivariate logistic model and finite polygenic mixed model. One-, two-, and three-susceptibility-type models were evaluated. RESULTS Among 3777 relatives, 199 (97 men and 102 women) were affected with MP (5.3%). Correlation coefficients of MP incidence in full siblings and in parent-offspring were .2003 and .2036, respectively (all P < .001). The h(2) of MP was estimated as 21.5% after adjusting for sex and founder effects. Two- and three-susceptibility-type models showed that the general model fit better than the other models. MP incidence did not have a major gene transmission model and was influenced by numerous minor effect genes and their additive effects. CONCLUSION These results suggest that the inherited susceptibility to MP in Korean Class III patients might be due to the summation of minor effects from a variety of different genes and/or influence of environmental factors, rather than Mendelian transmission of major genes.

The Effects of Defect Type and Depth, and Measurement Direction on the Implant Stability Quotient Value.

The purpose of this study was to evaluate the effect of defect type and depth as well as measurement direction on implant stability in an ex vivo peri-implant bovine rib bone model. Six kinds of defects (3-wall 2.5 mm, 3-wall 5 mm, 1-wall 2.5 mm, 1-wall 5 mm, circumferential 2.5 mm, circumferential 5 mm), and control (no defect) were prepared in 14 bovine rib bones. A total of 84 defects and 14 controls were created. The same type and size of implants (4 × 10 mm) were placed in each group. The thickness of cortical bone and the insertion torque were measured for each defect, and the implant stability quotient (ISQ) value was measured 3 times from 4 different directions. The thickness of cortical bone ranged from 2.71-3.18 mm. Insertion torque decreased as the defect size increased. As the defect size for the same defect depth increased, the ISQ value decreased (P < .001). There were significant differences between the ISQ values obtained with different measurement directions only between the control and 3-wall 5 mm defect (P < .0001). The ISQ value opposite to the defect direction was higher than that in the defect direction in all 3 directions of the 3-wall and 1-wall 5 mm defects. ISQ values were influenced by defect type and depth. Loss of cortical bone reduced the stability of implants and reduced the ISQ value. Measurement direction also influenced ISQ values.

Orthodontic treatment of an ankylosed maxillary central incisor through single-tooth osteotomy by using interdental space regained from microimplant anchorage

This case report describes the treatment of a boy, aged 13.6 years, whose ankylosed maxillary left central incisor had been avulsed and replanted 2.5 years earlier. Ankylosis of the tooth and adjacent alveolar process led to the development of infraocclusion, migration of adjacent teeth, midline deviation, and a vertical alveolar bone defect. Initially, distal tooth movement in the maxillary arch was performed with microimplant anchorage to gain space for repositioning the ankylosed tooth. Then a single-tooth osteotomy was performed in 1 surgical stage to allow for inferior repositioning of the tooth and bone. The ankylosed tooth was successfully leveled in the maxillary arch with a harmonic gingival margin. The total treatment period was 18 months, and the results were acceptable at 14 months after debonding.

Anatomical and Functional Recovery of Intracapsular Fractures of the Mandibular Condyle: Analysis of 124 Cases after Closed Treatment.

Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases.

Schwannoma With Cystic Changes in the Pterygomandibular Space.

AbstractSchwannomas are tumors that arise from Schwann cells. Although schwannomas can occur almost anywhere in the body where nerve cells are present, they rarely occur in the head and neck region, including the oral and maxillofacial region. Cystic changes in schwannomas are extremely rare. This report is on a case of schwannoma with cystic changes that occurred in the pterygomandibular space.A 46-year-old woman presented with a complaint of limited mouth opening and pain on the left side of the mandible for 3 months. On panoramic radiography, radiolucency was seen on the left mandibular ramus. On enhanced computed tomography, a 4 × 3 cm cystic mass was found along the inner side of the left mandibular ramus area. Magnetic resonance imaging showed a multiseptated, well-demarcated cystic lesion on the inner side of the mandibular ramus on the left side. Under general anesthesia, the tumor was excised. The final diagnosis was schwannoma with cystic changes. Lower lip hypoesthesia occurred postoperatively. At the 1-year postoperative follow-up, maximum mouth opening was increased to 44 mm, and lip hypoesthesia was improved.

In vitro Antibacterial Effect of Orthodontic Adhesives Mixed with Silver Nanoparticles

Purpose: To examine the antibacterial effectiveness of silver nanoparticles (SNP) mixed with commercial orthodontic adhesives. Materials and Methods: SNP was prepared by dissolving silver perchlorate in an organic solvent and reducing it with ultraviolet radiation. SNP was then mixed with four commercial orthodontic adhesives (Light Bond, Blugloo, Transbond XT, and Fuji Ortho LC) (0.05 wt %), which were then formed into disc-shape specimens (8.0 ㎜×3.0 ㎜). Commercial orthodontic adhesives containing no SNP were used as the control groups. Specimens of the four experimental and four control groups were incubated with streptococcus mutans and the medium turbidity was assessed at 3, 6, 9, 12, and 24 hours after incubation. The agar diffusion test was also performed to examine the growth inhibition zone of these groups. The data were statistically analyzed using a Wilcoxon rank sum test and t-test with a Bonferroni’s correction (P＜0.05). Result: The SNP containing groups had a superior antibacterial effect compared to the control groups. In the agar diffusion test, the control groups without SNP did not produce an inhibition zone, whereas the SNP containing groups showed inhibition zone of 10~13 ㎜. Conclusion: The incorporation of SNP into orthodontic adhesives can inhibit cariogenic bacterial growth.

Canalicular Adenoma of the Parotid Gland: A Rare Case Report and Review of the Literature

Canalicular adenoma is an uncommon, benign salivary gland tumor. It has a significant predilection for occurrence in the minor salivary glands, with most cases occurring in the upper lip, followed by the buccal mucosa and palate. Rarely, canalicular adenoma can involve the major salivary glands, such as the parotid gland. Only a small number of cases of canalicular adenoma of the parotid gland have been reported in the literature. We report a rare case of canalicular adenoma on the left parotid gland of an 81-year-old man, and present a review of the literature.