Steven M. Sullivan

The use of fibrin adhesive in sinus lift procedures

Sinus lift bone grafting has expanded the use of dental implants in reconstructions of the atrophic maxilla. Potential problems include sinus membrane tear, which can lead to graft infection and early failure. Attempts at managing sinus membrane perforations are often limited by difficulty of access, as well as by the friability of the soft tissue lining the sinus. Various techniques have been proposed for managing such membrane tears. The use of fibrin adhesive, however, may present a potential solution in such situations. This article reports our experience with the use of fibrin adhesive in sinus lift procedures, as well as on its autologous preparation.

Postsurgical volumetric airway changes in 2-jaw orthognathic surgery patients

INTRODUCTION Findings from early cephalometric studies on airway changes after 2-jaw orthognathic surgery have been challenged because the previous anteroposterior interpretation of airway changes can now be evaluated in 3 dimensions. The aims of this study were to use cone-beam computed tomography to quantify the nasopharynx, oropharynx, and total airway volume changes associated with skeletal movements of the maxilla and mandible in a sample of patients undergoing 2-jaw orthognathic surgery for correction of skeletal malocclusion. METHODS Skeletal movements and airway volumes of 71 postpubertal patients (31 male, 40 female; mean age, 18.8 years) were measured. They were divided into 2 groups based on ANB angle, overjet, and occlusion (Class II: ANB, >2°; overjet, >1 mm; total, 35 subjects; and Class III: ANB, <1°; overjet, <1 mm; total, 36 subjects). Presurgical and postsurgical measurements were collected for horizontal, vertical, and transverse movements of the maxilla and the mandible, along with changes in the nasopharynx, oropharynx, and total airways. Associations between the directional movements of skeletal structures and the regional changes in airway volume were quantified. Changes in the most constricted area were also noted. RESULTS Horizontal movements of D-point were significantly associated with increases in both total airway (403.6 ± 138.6 mm(3); P <0.01) and oropharynx (383.9 ± 127.9 mm(3); P <0.01) volumes. Vertical movements of the posterior nasal spine were significantly associated with decreases in total airway volume (-459.2 ± 219.9 mm(3); P = 0.04) and oropharynx volume (-639.7 ± 195.3 mm(3); P <0.01), increases in nasopharynx (187.2 ± 47.1 mm(3); P <0.01) volume, and decreases in the most constricted area (-10.63 ± 3.69 mm(2); P <0.01). In the Class III patients only, the vertical movement of D-point was significantly associated with decreases in both total airway (-724.0 ± 284.4 mm(3); P = 0.02) and oropharynx (-648.2 ± 270.4 mm(3); P = 0.02) volumes. A similar negative association was observed for the most constricted area for the vertical movement of D-point (-15.45 ± 4.91 mm(2); P <0.01). CONCLUSIONS Optimal control of airway volume is through management of the mandible in the horizontal direction and the vertical movement of the posterior maxilla for all patients. The surgeon and the orthodontist should optimally plan these movements to control gains or losses in airway volume as a result of orthognathic surgery.

Heat generation by superpulsed CO2 lasers on plasma-sprayed titanium implants: An in vitro study ☆ ☆☆

OBJECTIVE The purpose of this study was to record the generation of heat in selected titanium implants while exposing them to a superpulsed CO(2) laser mode. These results can be compared with previous studies in which continuous and pulsed CO(2) laser modes were used. STUDY DESIGN Titanium implants with cover screws were used in this study. The length of exposure time ranged from 2 to 15 seconds, and the wattage ranged from 3 to 15 W. A thermocoupler with a module recorder was used to record temperature changes at the implant-cover screw interface with the implant in a 37 degrees C water bath. Temperature changes were documented during the exposure phase, as well as after termination of the exposure. Statistical analysis consisted of analysis of variance (P <.05) for statistically significant differences among the exposure time-wattage pairs. RESULTS Temperature increases were directly related to wattage and exposure time. All temperatures returned to baseline within 1 minute. CONCLUSION Superpulsed CO(2) lasers generate significantly less heat with the 15-second, 15-W trial as compared with continuous and pulsed laser modes. Peak temperature increases with similar exposure and wattage times are comparable to those of the pulsed-laser mode.

The development and use of a computerized database for the evaluation of facial fractures incorporating aspects of the AAOMS parameters of care

PURPOSE This article discusses the development and use of a computerized database to evaluate facial fracture patients. Examples of epidemiologic and treatment outcome analyses that can be performed are also discussed. MATERIALS AND METHODS FileMaker Pro 2.1 and 3.0 (Claris Corporation, Santa Clara, CA) for the Macintosh (Apple Computer, Inc, Cupertino, CA) was used for the development of the database. The database contained information on the facial fracture patients treated at The University of Oklahoma Health Sciences Center by the Oral and Maxillofacial Surgery service between January 1, 1994 and December 31, 1996. Eight evaluation forms were used: general information, and mandibular, maxillary, zygomatic, nasal, naso-orbital-ethmoid, orbital, and frontal sinus fractures. Indications for therapy and postoperative complications from the AAOMS Parameters of Care, Section on Trauma Surgery, were also included. RESULTS This database allowed collection of a vast amount of data on 265 patients. Some of the analyses done on patients with mandibular fractures are described. CONCLUSION This computerized database provides a quick and systematic method of obtaining and retrieving information on facial fracture patients. Numerous epidemiologic and treatment outcome analyses can be performed. Overall complication rates based on the AAOMS Parameters of Care are higher than previously published rates because of the longer list of complications being evaluated.

Successful Hereditary Angioedema Prophylaxis With C1 Inhibitor in Orthognathic Surgery

Hereditary angioedema (HAE) is characterized by sudden attacks of nonpitting edema typically involving the extremities, genitalia, trunk, gastrointestinal tract, face, or larynx. Although attacks often occur withut a trigger, trauma, including surgical procedures, re responsible for 54% of attacks. Dental procedures n particular are high risk for airway obstruction in his disease. Postprocedure swelling may be immeiate or latent for up to 30 hours. Many patients with HAE are denied routine dental care because of the potential for laryngeal swelling after these procedures. Nevertheless, the dental literature provides examples of well-planned tooth extractions in patients with HAE who were given prophylactic treatment with an appropriate medication before the procedure. We report successful prophylaxis using C1 inhibitor (INH) in a 16-year-old female patient with HAE undergoing orthognathic surgery. To our knowledge, this is the first reported case of maxillofacial surgery in a patient with HAE who was given prophylactic treatment with C1 INH.

Why segment the maxilla between laterals and canines

Introduction: Maxillary surgery on a bone segment enables movement in the sagittal and vertical planes. When performed on multiple segments, it further provides movement in the transverse plane. Typical sites for interdental osteotomies are between laterals and canines, premolars and canines, or between incisors. Additionally, osteotomies can be bilateral, unilateral or asymmetric. The ability to control intercanine width, buccolingual angulation of incisors, and correct Bolton discrepancy are some of the advantages of maxillary segmentation between laterals and canines. Objective: This article describes important features to be considered in making a clinical decision to segment the maxilla between laterals and canines when treating a dentoskeletal deformity. It further discusses the history of this surgical approach, the indications for its clinical use, the technique used to implement it, as well as its advantages, disadvantages, complications and stability. It is therefore hoped that this paper will contribute to disseminate information on this topic, which will inform the decision-making process of those professionals who wish to make use of this procedure in their clinical practice. Conclusions: Segmental maxillary osteotomy between laterals and canines is a versatile technique with several indications. Furthermore, it offers a host of advantages compared with single-piece osteotomy, or between canines and premolars.