Pekka Laine

Oral findings in patients with active or inactive Crohn's disease

The frequency and type of oral mucosal lesions, dental infections, and salivary constituents were evaluated in 53 patients with Crohns disease, who were divided into inactive, mildly active, and severely active groups on the basis of clinical and endoscopic criteria. Buccal biopsies from nine patients with active disease showed morphologic changes that suggested Crohns disease-related lesions. Panoramic radiographs revealed more infectious foci in the teeth of patients with active Crohns disease than in patients with inactive disease. Salivary flow rate, buffering capacity, total protein, amylase, and IgA and IgG concentrations did not differ with respect to the activity of Crohns disease. The observed mucosal inflammation in patients with active Crohns disease, although high in frequency, was mild and did not need therapy, but the great number of dental infections in association with the activity of Crohns disease should be taken into account in the treatment of these patients.

Skeletal stability following mandibular advancement and rigid fixation with polylactide biodegradable screws

Skeletal stability during the first year after mandibular advancement surgery and fixation using biodegradable self-reinforced poly-l-lactide (SR-PLLA) screws, without postoperative intermaxillary fixation, was studied in 25 patients by means of cephalometric measurements. The magnitude of advancement was on average, 3.88 mm at pogonion (PG) (range 1.25-6.5 mm) and 4.57 mm at B-point (range 2.75-7.5 mm). After one year a mean relapse backwards of 0.59 mm at the PG (15%) and 0.78 mm at the B-point (17%) was observed. Nineteen patients (76%) and 17 patients (68%) were stable at PG and B-point, respectively. SR-PLLA screws are considered to be comparable to other forms of rigid internal fixation for fixation of bilateral splitting osteotomies after mandibular advancement, as far as skeletal stability is concerned.

Sagittal ramus osteotomies fixed with biodegradable screws: A preliminary report

Nine patients underwent bilateral sagittal split osteotomies of the mandible. The osteotomies were fixed using two self-reinforced poly-L-lactide screws. No maxillomandibular fixation was used postoperatively. The preliminary results with the shortest follow-up of 15 months show that primary healing was normal. No late-term clinical complications were encountered during the follow-up, the longest of which is now 23 months.

Sagittal split osteotomy fixed with biodegradable, self-reinforced poly-l-lactide screws: A pilot study in sheep

Self-reinforced poly-L-lactide (SR-PLLA) screws were used to fix bilateral mandibular sagittal split osteotomies (SSO) in six sheep. No intermaxillary fixation was used postoperatively. The follow-up time was 16 weeks, after which the sheep were killed. Both sides of the mandible were photographed and radiographed. The bending strength of the osteotomy was measured on the left side of the mandible. Histological and microradiographic studies were performed on the right side of the mandible. The results showed that the SR-PLLA screws were strong enough to fix the SSO rigidly. The bending force needed to break the bone was greater than that for the average unoperated mandible. The histological and microradiographic studies showed uneventful healing of the osteotomies in all six sheep. The results indicate that this method should be suitable for rigid fixation of SSO and fractures of the mandible in human beings.

Reconstruction of internal orbital wall fracture with iliac crest free bone graft: clinical, computed tomography, and magnetic resonance imaging follow-up study.

Background: The purpose of this study was to clinically and radiologically assess the outcome of internal orbital reconstruction with an iliac bone graft. Methods: Twenty-four consecutive patients with unilateral orbital wall fractures were enrolled in this prospective study. A medial cortical wall from the anterior ilium was used for reconstruction. At each follow-up visit, globe posture, diplopia, and eye movements were assessed. Coronal and sagittal computed tomography and magnetic resonance imaging were used to observe graft posture, bone defects, and intraorbital soft-tissue changes. Results: Most fractures (46 percent) were pure orbital floor fractures. The mean follow-up was 7.8 months. One patient with medial wall and floor fractures required reoperation because of insufficient bone graft. At the last follow-up, this was the only patient (4 percent) with both enophthalmos (2 mm) and hypophthalmos (3 mm). Five patients (21 percent) had hypophthalmos (>1 mm) at the end of the study. Resorption and remodeling were detected in all grafts, but no grafts were totally resorbed. Sagittal or coronal bone graft postures were assessed as good in 18 orbits (75 percent). Bone defects (>10 mm) at reconstructed areas were detected in 13 orbits (54 percent). Scar tissue was observed only in three reconstructed orbits (13 percent). Diplopia in central field of vision was registered in seven patients preoperatively but in none at the end of the study. Conclusions: The resorption rate was high, but most of it was advantageous remodeling. Overall outcome was good. Secondary operations led to poor outcomes. Thin computed tomography and magnetic resonance imaging sections (≤2 mm) are needed to evaluate accurately bone graft placement and posture and orbital volume.

Osteotomy site healing following mandibular sagittal split osteotomy and rigid fixation with polylactide biodegradable screws

Follow-up of 47 patients, treated using mandibular bilateral sagittal split osteotomy and self-reinforced poly-L-lactide acid (SR-PLLA) screws for rigid internal fixation, is presented. The focus was on clinical and radiological osteotomy healing. The average follow-up time was 2.1 years (range 0.5-5 years). Clinical recovery and radiological osteotomy healing during follow-up were uneventful. Osteolytic changes were seen around the SR-PLLA screws in 27% of cases. The majority of the screw canals remained as radiolucent shadows without bony filling.

Risk factors contributing to symptomatic miniplate removal: a retrospective study of 153 bilateral sagittal split osteotomy patients

Removal of miniplates is a controversial topic in oral and maxillofacial surgery. Originally, miniplates were designed to be removed on completion of bone healing. The introduction of low profile titanium miniplates has led to the routine removal of miniplates becoming comparatively rare in many parts of the world. Few studies have investigated the reasons for non-routine removal of miniplates and the factors that affect osteosynthesis after osteotomy in large numbers of patients. The aim of the present study was to investigate complications related to osteosynthesis after bilateral sagittal split osteotomy (BSSO) in a large number (n=153) of patients. In addition to the rates of removal, emphasis was placed on investigating the reasons and risk factors associated with symptomatic miniplate removal. The rate of plate removal per patient was 18.6%, the corresponding rate per plate being 18.2%. Reasons for plate removal included plate-related complications in 16 patients and subjective discomfort in 13 patients. Half of the plates were removed during the first postoperative year. Smoking was the only significant predictor for plate removal. Patients undergoing orthognathic surgery should be screened with regard to smoking and encouraged and assisted to cease smoking, at least perioperatively.

Oral infection as a reason for febrile episodes in lymphoma patients receiving cytostatic drugs.

56 patients receiving chemotherapy for non-Hodgkin lymphoma or Hodgkins disease with curative intent were monitored for up to one year after initiation of treatment. During chemotherapy (mean duration 5.2 months), 26 of the patients (46%) suffered from 38 febrile episodes. In only 16 instances was an extraoral cause for the septicaemia found. However, severe dental infection, reflected in an elevated radiological index for the jaws, was found more frequently in patients suffering febrile episodes than in those without (P = 0.02). Moderate to severe gingival inflammation was observed during 22 (58%) of episodes. During 71% of the episodes various pathological findings were also recorded in the oral mucosa. No source of infection other than an oral one was found in 42% of the patients. Our results emphasise the importance of oral foci as the possible infection source in patients receiving intensive chemotherapy.

Rigid reconstruction plates for immediate reconstruction following mandibular resection for malignant tumors

Thirty-four primary alloplastic reconstructions of segmental mandibular defects caused by surgery for oral malignancy were performed during a 6-year period. Eighty-eight percent of the tumors were classified as stage III or IV. One third of the patients died during follow-up, nine with their primary reconstruction plate in place. During the follow-up, 12 patients required plate removal because of complications; four of them were treated with another plate. Nineteen of 21 patients alive at the end of follow-up were free of disease. Ten had their primary plate in place, and four had had a secondary plate installed because of plate fracture or screw loosening. Three patients had their mandible permanently reconstructed with bone. The functional and esthetic results were considered excellent or fair in a majority of the cases. Because the 5-year survival rate for patients with advanced mandibular malignancies is 15% to 20%, extensive, definitive reconstructive procedures during primary surgery are usually not justified.

Gingival and dental status, salivary acidogenic bacteria, and yeast counts of patients with active or inactive Crohn's disease

To investigate dental, gingival, and salivary aspects during an exacerbation of Crohns disease, 53 patients with long-standing Crohns disease were clinically, endoscopically, and radiologically examined. The patients were divided in two groups: 32 patients had active disease and 21 patients had inactive disease. Oral examination of the patients did not reveal any statistically significant differences in gingival or dental indexes between the groups, but patients with active disease tended to have higher scores of gingivitis than patients with inactive disease despite the fact that the patients with active disease were younger than those in remission. No differences between the groups were observed in salivary flow rate or buffering capacity. Lactobacilli and yeast counts of saliva tended to be higher among patients with active disease than with inactive disease, but the difference between the groups was significant only for high mutans streptococci counts.