Richard F. Scott

Major maxillomandibular malrelations and temporomandibular joint pain-dysfunction

A retrospective questionnaire survey of 102 patients who underwent orthognathic surgery for maxillomandibular disharmonies assessed the incidence of TMJ pain-dysfunction in both pretreatment and posttreatment phases. While retrospective questionnaire studies have obvious limitations, the following conclusions deserve consideration. The incidence of TMJ pain-dysfunction symptoms found in this patient population appears to be higher than the incidence of those symptoms reported in previous epidemiologic studies of general populations which involved subjective symptoms alone. Maxillomandibular disharmonies may be an important etiologic factor in the development of TMJ pain-dysfunction. Surgical correction of the disharmony in a significant percent of patients with maxillomandibular disharmonies and concomitant TMJ pain-dysfunction may alleviate or improve the TMJ pain-dysfunction symptoms. There is a possibility that patients may develop TMJ pain-dysfunction symptoms after orthognathic surgery.

Evaluation of anterior maxillary alveolar ridge resorption when opposed by the transmandibular implant

Fifteen edentulous patients with complaints regarding denture comfort and/or function were treated with the transmandibular implant. All patients were restored with conventional maxillary dentures opposed by implant-supported removable prostheses. Two to 4 years after surgery, these patients were evaluated for vertical and horizontal maxillary bone loss with a radiographic analysis developed by the authors. With this technique, attention was focused on vertical alveolar ridge resorption in the anterior maxilla. Although the sample size was small, the findings from this study indicate that vertical bone loss in the anterior maxilla does occur when a maxillary denture is opposed by an implant-supported overdenture. Comparison of these results with a previous study that evaluated anterior maxillary resorption when a complete maxillary denture opposed natural mandibular anterior teeth and a distal extension removable partial denture demonstrated no statistically significant difference.

Persistent cemento-ossifying fibroma of the mandible: Report of a case and review of literature

This case report describes an unusual recurrence of a cemento-ossifying fibroma and illustrates the diagnostic difficulties that may be encountered when treating fibro-osseous lesions.

The transmandibular implant: A 2-year prospective study**

Thirteen consecutive patients with complaints of dysfunction and pain associated with a mandibular denture were treated with the transmandibular implant. The implant was placed from a submental approach with an atraumatic surgical technique. No load was placed on the implant for 12 weeks. Patients were evaluated for pain, paresthesia, healing of the submental wound, soft tissue response, radiographic change, and mobility of the implant for a period of 2 years. Patient satisfaction was recorded at the 1- and 2-year examinations. The results demonstrate the reliability and reparability of the transmandibular implant system.

A study of the utility of measuring mandibular mobility by means of the interincisal dimension

The purpose of this investigation was to determine the reliability of using the interincisal dimension as a measure of mandibular range of motion. Thirty patients who underwent mandibular advancement and 15 patients who underwent mandibular setback were included in this study. Preoperatively, a lateral cephalogram in centric relation and a second cephalogram with the mandible at maximum voluntary gape were obtained. Immediately following surgery, another centric relation cephalogram was obtained. A composite tracing of the two preoperative tracings was made to show how the mandible changed in position from the closed-mouth to the open-mouth radiographs. The proximal segment (ramus) of the postoperative cephalogram was then superimposed on the open-mouth mandibular ramus, and the distal segment of the postoperative mandible was drawn. This composite produced a tracing of what the postoperative maximal gape cephalogram would be if the same amount of condylar rotation and translation as in the preoperative tracing had occurred. The preoperative interincisal dimension was recorded on the composite tracings (factoring in any overbite or openbite) as was the would-be postoperative interincisal dimension. These measures were compared using the paired t test and Pearsons correlations to determine if there were any significant differences between them. The results showed that the interincisal dimension is a fairly reliable measure of mandibular mobility even when the length of the mandible is altered with surgery.

A double-blind comparison of nalbuphine and meperidine hydrochloride as intravenous analgesics in combination with diazepam for oral surgery outpatients.

This study compared the analgesic efficacy, sedative, and amnesic properties, and side effects of nalbuphine versus meperidine as intravenous premedicants in combination with intravenous diazepam for the treatment of outpatients undergoing the removal of impacted third molars with alveolar nerve block anesthesia. Forty patients were evaluated in this double-blind crossover study. Nalbuphine was shown to have analgesic, sedative, and amnesic properties similar to meperidine. Nalbuphine, when compared to meperidine, produced significantly lower intraoperative systolic and diastolic blood pressures. Because of this cardiovascular stability, nalbuphine should be considered over meperidine for use in the cardiovascularly compromised patient undergoing oral surgery.

Consequences of inadequate bone healing before implant surgery.

T he research, development, and subsequent success of the dental implant has allowed dentistry to offer patients a new, high level of care unattainable with more conventional therapy.lp2 Unfortunately, the rush to provide care may compromise the outcome of the treatment. The following clinical report illustrates the need for adequate consideration of bone healing and implant site preparation before implant placement.