Robert A. Strauss

Moving an Ankylosed Central Incisor Using Orthodontics, Surgery and Distraction Osteogenesis

When a dentist replants an avulsed tooth, the repair process sometimes results in the cementum of the root and the alveolar bone fusing together, with the replanted tooth becoming ankylosed. When this occurs, the usual process of tooth movement with bone deposition and bone resorption at the periodontium cannot function. If dental ankylosis occurs in the maxillary incisor of a growing child, the ankylosed tooth also cannot move vertically with the subsequent vertical growth of the alveolar process. This results in the ankylosed tooth leaving the plane of occlusion and often becoming esthetically objectionable. This report describes a 12-year-old female with a central incisor that was replanted 5 years earlier, became ankylosed, and left the occlusal plane following subsequent normal vertical growth of the alveolar process. When growth was judged near completion, the tooth was moved back to the occlusal plane using a combination of orthodontics, surgical block osteotomy, and distraction osteogenesis to reposition the tooth at the proper vertical position in the arch. This approach had the advantage of bringing both the incisal edge and the gingival margin of the clinical crown to the proper height in the arch relative to their antimeres. Previous treatment procedures for ankylosed teeth have often involved the extraction of the affected tooth. When this is done, a vertical defect in the alveolar process results that often requires additional bone surgery to reconstruct the vertical height of the alveolar process. If the tooth is then replaced, the replacement tooth must reach from the final occlusal plane to the deficient ridge. This results in an excessively long clinical crown with a gingival height that does not match the adjacent teeth.

The association of mucocutaneous lichen planus and chronic liver disease

A possible association between mucocutaneous lichen planus and chronic liver disease has been previously postulated in the medical literature. Despite the frequency with which lichen planus occurs in the oral cavity, little mention of such a relationship has been made in the dental literature. A case of lichen planus occurring in a patient with primary biliary cirrhosis and a review of the subject are therefore presented.

Telemedicine consultations in oral and maxillofacial surgery

PURPOSE The purpose of this study was to evaluate the efficiency of telemedicine consultation for preoperative assessment of patients. PATIENTS AND METHODS A retrospective study of 43 patients was done to evaluate the efficiency of telemedicine consultation in adequately assessing patients for dentoalveolar surgery with general anesthesia and nasotracheal intubation. Efficiency was defined as the ability to conduct surgery with general anesthesia at the immediately following clinic appointment without the need for further preoperative testing, evaluation, or consultation. Thirty-five of these patients were subsequently treated. RESULTS Ninety-five percent (33) of patients were able to undergo surgery with general anesthesia at the immediate appointment, and 100% of patients were assessed correctly, using telemedicine consultation. Two of the patients were assessed as American Society of Anesthesiologists Class III during telemedicine consultation and required further evaluation before surgery could be scheduled. No surgical procedure was canceled, and there were no anesthetic complications attributable to inadequate preoperative assessment of patients during telemedicine consultation. CONCLUSIONS This study confirms that telemedicine consultations are as reliable as those conducted by traditional methods. Because of the reorganization of health care and the ways it is financed, it may be more economical to move data from place to place than to move doctors from place to place. Telecommunication is an efficient and cost-effective mechanism to provide preoperative evaluation in situations in which patient transport is difficult or costly.

Diagnostic Imaging and Sleep Medicine

Obstructive sleep apnea syndrome (OSAS) is a relatively common disorder characterized by recurrent episodes of upper airway collapse and obstruction during sleep. It results in apneic events (or in the case of partial obstruction, hypopneic events) that lead to loud snoring, hypoxia, and arousals that interrupt the normal sleep cycle. Typically, these nocturnal arousals cause patients to complain of excessive daytime sleepiness, which may interfere with routine daily activities. More importantly, when moderate to severe, OSAS can lead to a wide variety of medical complications, some of which can result in severe consequences or even death.

Effect of a resorbable bone graft material on orthodontic tooth movement through surgical defects in the cat mandible

beta-Tricalcium phosphate ceramic, a resorbable synthetic bone material, was implanted into surgically created alveolar defects mesial to the mandibular first premolars of 12 adult male cats. Similar defects on the contralateral side were allowed to heal naturally. Six weeks later, nickel-titanium coiled springs were ligated between the mandibular canine and first premolar on both sides and activated to deliver 100 g of force. The distance between the canine and first premolar was measured with dial calipers at 0, 3, 6, and 9 weeks after appliance placement. Regression analysis of amount of tooth movement between the two teeth showed no significant difference between grafted and control sides. This suggests that placement of a resorbable synthetic bone material may have useful applications in situations where loss of alveolar width following extractions may compromise orthodontic tooth movement.

Augmentation of the anterior temporal fossa after temporalis muscle transfer

Pedicled transfer of the temporalis muscle has proven to be a reliable and versatile procedure in reconstructive craniomaxillofacial surgery. Excluding those complications related to the coronal incision, little specific attention has been given in the literature to the prevention or treatment of the esthetic defect that remains after muscle transfer. This article describes a case in which block porous high-density polyethylene was used to eliminate the residual defect of the anterior temporal fossa after transmaxillary pedicled transfer for closure of a large oral-antral communication. The implant provided an esthetically pleasing augmentation of the defect. A discussion and analysis of the implant materials available for reconstruction of this region is also presented.

Inferior alveolar nerve paresthesia secondary to orthodontic tooth movement: report of a case.

Temporary or permanent paresthesia of the areas innervated by the inferior alveolar nerve (IAN) can be caused by multiple conditions. These include neoplastic disease, infection, orthognathic surgery, endodontic treatment, and secondary to the removal of mandibular third molars. 1-4 Significant signs on plain films that indicate a tooth root may be in close proximity to the IAN include darkening of the tooth root, narrowing of the tooth root, interruption of the white lines, and diversion of the canal. 5 Temporary mental nerve paresthesia during fixed orthodontic treatment is rare and is usually caused by premolars being lingually inclined and then uprighted or excessive root lengths on second molars. 6-9 We present a case report of sensory disturbance occurring during the distalization of a third molar with an unknown buccal root extending into the IAN canal.

Serotonin Syndrome in the Oral and Maxillofacial Surgery Office: A Review of the Literature and Report of a Case

The treatment of patients on antipsychotic medications is a common, perhaps daily, practice for the oral and maxillofacial surgery (OMS) surgeon. However, the side effects and potential complications of treating patients on such medications are often overlooked preoperatively. Early recognition of such side effects, along with steps to prevent them, should be something every practitioner is cognizant of. Serotonin syndrome (SS) is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. The clinical diagnosis is often a triad of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities. The syndrome may result from ingestion of any drug that increases serotonergic neurotransmission. Therapeutic medication use, interactions between drugs, ingestion of 2 or more serotonin-increasing drugs, and intentional overdose may trigger the syndrome. Most of the cases reported present within 24 hours of ingestion of the offending drug(s), and symptoms typically resolved within 24 hours of discontinuation. 1,2 A review of the literature revealed several reports of SS related to drug overdosage or drug interaction, but no cases occurring in conjunction with OMS surgical treatment.

Comparison of morbidity of outpatient general anesthesia administered by the intravenous or inhalation route.

PURPOSE This study compares the morbidity between subjects receiving general anesthesia either by an intravenous or inhalation route for the extraction of impacted third molars in an outpatient setting. PATIENTS AND MATERIALS Forty ASA Class I subjects, 21 females and 19 males (age range, 17 to 43 years), who presented for the extraction of four impacted third molars, were studied. Subjects were alternately assigned to receive general anesthesia either by the intravenous route (group I) or the inhalation route via an endotracheal tube (group II). The parameters for comparison included psychomotor recovery, cardiovascular changes 20% above or below baseline, the frequency of nausea and vomiting perioperatively and at 48 hours, occurrence of laryngospasm and bronchospasm, the frequency of sore throat both perioperatively and at 48 hours, procedure time, and recovery time. The Trieger dot test was administered to patients at three different intervals to evaluate psychomotor recovery. All parameters were recorded for each subject and compared both within and between groups. RESULTS There was no statistical difference found between groups I and II with regard to psychomotor recovery, the frequency of nausea and vomiting, bronchospasm, laryngospasm, or median recovery time (P < .05). However, there was greater variability in both elevation and depression of blood pressure from baseline in the intubated subjects (P < .05). These deviations were both expected and easily managed. The probability of sore throat was greater in the intubated subjects (P < .05) than the nonintubated subjects. Procedure time, although a weak association, was nonetheless found to be significantly greater for the intubated group than for the intravenous group (P < .05). SUMMARY The results show greater cardiovascular variability, increased probability of sore throat, and slightly lengthened procedure time with the administration of general anesthesia by an inhalational route via an endotracheal intubation. However, there was no difference with regard to psychomotor recovery, recovery time, the probability of nausea and vomiting, or incidence of laryngospasm or bronchospasm.

Quantitation of rotational movements associated with surgical mandibular advancement.

Surgical mandibular advancement can be used to correct an anteroposterior and/or vertical malocclusion. The procedure of choice is often the bilateral sagittal split osteotomy (BSSO). By varying the amount of presurgical overbite correction, the rotational movement of the distal segment of the osteotomy can be controlled. Consequently, the malocclusion and the resultant vertical and anteroposterior facial form changes are predictably planned to produce both the desired occlusion as well as the optimal esthetic facial result. Opening rotation of the distal segment elongates the lower face height by varying amounts depending on the nature of the rotation. The amount and type of rotation can be determined and quantified by the technique presented in this paper, which is based on a geometric theorem used to determine the kinematic center of rotation of an object. This technique can shorten treatment time and produce more predictable results. The specific applications are: 1) treatment planning for individual patients, 2) uniform analyses of treatments and grouping of treatment types, and 3) development of more accurate computerized treatment planning programs.