Manuel Somoza-Martín

Blood Loss in Orthognathic Surgery: A Systematic Review

PURPOSE Intraoperative blood loss during orthognathic surgery is frequently abundant and sometimes requires blood transfusion. The aim of the present study was to conduct a systematic review of the published data regarding intraoperative blood loss during orthognathic surgical interventions, including Le Fort I osteotomy, mandibular ramus osteotomy, and both combined, to determine the range of information available to help surgeons better prepare themselves, their patients, and the auxiliary support needed for this type of surgery and the transfusion requirements. MATERIALS AND METHODS Selected reports from the PubMed and Cochrane Library databases for studies conducted from 1978 to 2008 were evaluated to determine whether they included information on the volume of bleeding during surgery and the factors that might have influenced the amount of bleeding. Of the 90 reports examined and evaluated, 7 were included in the critical analysis conducted as a part of the present systematic review. RESULTS Referring to the reports used for statistical analysis of the volume of blood loss, the mean intraoperative bleeding volume was 436.11 mL, the mean of the standard deviations was ±207.89 mL, and mean surgery duration was 196.9 minutes. CONCLUSIONS Our results have shown that the intraoperative bleeding observed in patients during Le Fort I or mandibular ramus osteotomies or both combined was less than the limits set for blood transfusion. However, bleeding was occasionally heavier, and surgeons should be prepared for heavier bleeding by reserving blood at a blood bank or by preparing an autotransfusion.

Alveolar distraction before insertion of dental implants in the posterior mandible

We investigated the efficacy of alveolar distraction for reducing crown height:implant length ratio in the posterior mandible. Ten alveolar distractions were done in seven patients. The pre-distraction ratio of required crown height to bone height available for implantation was in all cases > or =1. Two implants were placed in each distracted area (total 20 implants). Before distraction, the mean (SD) predicted crown height was 12.8 (2.1) mm; mean bone height available for implantation was 7.8 (1.5) mm. After distraction and insertion of implants, mean crown height was 8.1 (1.9) mm, and mean implant length was 11.3 (1.9) mm. Before distraction, the mean required crown height:available bone height ratio was 1.7 (0.3); after distraction and insertion of implants, the mean crown:implant ratio was 0.7 (0.2) (P<0.0005). Alveolar distraction is effective for increasing the height of the alveolar ridge in the posterior mandibular region, and should be considered when the height of the predicted crown that is required is greater than or equal to the maximum height of bone available for implantation.

Ultrasonic osteotomy in oral surgery and implantology

Over the past decade, coinciding with the appearance of a number of new ultrasonic surgical devices, there has been a marked increase in interest in the use of ultrasound in oral surgery and implantology. This paper reviews the published literature on ultrasonic osteotomy in this context, summarizes its advantages and disadvantages, and suggests when it may and may not be the technique of choice.

Peri-Implant Bone Resorption Around Implants Placed in Alveolar Bone Subjected to Distraction Osteogenesis

PURPOSE This study was conducted to evaluate bone resorption around implants placed in alveolar bone previously subjected to distraction osteogenesis (DO). PATIENTS AND METHODS The study included 9 patients who had undergone alveolar DO with subsequent placement of 37 implants. None of the implants was lost. Vertical peri-implant bone deficit was measured on the distal and mesial surfaces from panoramic radiographs obtained at implant loading and again 1 year later. Resorption over the year of loading was calculated as the increase in vertical bone deficit. RESULTS Mean peri-implant bone resorption over the first year after loading was 0.60 mm mesially and 0.68 mm distally. In both cases, the resorption (ie, the difference between the mean bone deficit at loading and 1 year later) was statistically significant (P < .05). CONCLUSION Vertical bone resorption around implants placed in distracted alveolar bone is similar to that seen around implants placed in nondistracted bone.