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Unusually severe limitation of the jaw attributable to fibrodysplasia ossificans progressiva: a case report with cone-beam computed tomography findings

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary connective tissue disease characterized by the progressive ectopic ossification of ligaments, tendons, and facial and skeletal muscles throughout life. Symptoms begin in childhood as localized soft tissue swellings. Immobility and articular dysfunction appear with involvement of the spine and proximal extremities. The temporomandibular joint (TMJ) is a critical component involved in the maxillofacial region, resulting in severe limitation of masticatory function, although TMJ involvement is rare. We report a case of FOP presenting as severely limited TMJ movements owing to ectopic calcification of the left coronoid process. In addition to the clinical examination, panoramic radiography and cone-beam computed tomography images were obtained. The case is presented and the clinical and imaging findings, differential diagnosis, and treatment modalities are discussed.

Biomechanical Evaluation of Different Fixation Methods for Mandibular Anterior Segmental Osteotomy Using Finite Element Analysis, Part One: Superior Repositioning Surgery.

AbstractThe aim of the current study was to comparatively evaluate the mechanical behavior of 3 different fixation methods following various amounts of superior repositioning of mandibular anterior segment. In this study, 3 different rigid fixation configurations comprising double right L, double left L, or double I miniplates with monocortical screws were compared under vertical, horizontal, and oblique load conditions by means of finite element analysis. A three-dimensional finite element model of a fully dentate mandible was generated. A 3 and 5 mm superior repositioning of mandibular anterior segmental osteotomy were simulated. Three different finite element models corresponding to different fixation configurations were created for each superior repositioning. The von Mises stress values on fixation appliances and principal maximum stresses (Pmax) on bony structures were predicted by finite element analysis. The results have demonstrated that double right L configuration provides better stability with less stress fields in comparison with other fixation configurations used in this study.

Biomechanical Evaluation of Different Fixation Methods for Mandibular Anterior Segmental Osteotomy Using Finite Element Analysis, Part Two: Superior Repositioning Surgery With Bone Allograft.

AbstractIn this study, the biomechanical behavior of different fixation methods used to fix the mandibular anterior segment following various amounts of superior repositioning was evaluated by using Finite Element Analysis (FEA). The three-dimensional finite element models representing 3 and 5 mm superior repositioning were generated. The gap in between segments was assumed to be filled by block bone allograft and resignated to be in perfect contact with the mandible and segmented bone. Six different finite element models with 2 distinct mobilization rate including 3 different fixation configurations, double right L (DRL), double left L (DLL), or double I (DI) miniplates with monocortical screws, correspondingly were created. A comparative evaluation has been made under vertical, horizontal and oblique loads. The von Mises and principal maximum stress (Pmax) values were calculated by finite element solver programme. The first part of our ongoing Finite Element Analysis research has been adressed to the mechanical behavior of the same fixation configurations in nongrafted models. In comparison with the findings of the first part of the study, it was concluded that bone graft offers superior mechanical stability without any limitation of mobilization and less stress on the fixative appliances as well as in the bone.

Does the angulation of the mandibular third molar influence the fragility of the mandibular angle after trauma to the mandibular body? A three-dimensional finite-element study

Abstract The relationship between mandibular third molar (M3) angulation and mandibular angle fragility is not well established. The aim of this study was to evaluate the impact of M3 angulation on the mandibular angle fragility when submitted to a trauma to the mandibular body region. A three-dimensional (3D) mandibular model without M3 (Model 0) was obtained by means of finite-element analysis (FEA). Four models were generated from the initial model, representing distoangular (Model D), horizontal (Model H), mesioangular (Model M) and vertical (Model V) angulations. A blunt trauma with a magnitude of 2000 N was applied perpendicularly to the sagittal plane in the mandibular body. Maximum principal stress (Pmax) (tensile stress) values were calculated in the bone. The lowest Pmax stress values were noted in Model 0. When the M3 was present extra stress fields were found around marginal bone of second molar and M3. Comparative analysis of the models with M3 revealed that the highest level of stress was found in Model V, whereas Model D showed the lowest stress values. The angulation of M3 affects the stress levels in the mandibular angle and has an impact on mandibular fragility. The mandibular angle becomes more fragile in case of vertical impaction when submitted to a trauma to the mandibular body region.

Coronal Split Corpus Osteotomy of the Mandible: A Modified Visor Osteotomy Technique for Bone Volume Enhancement.

Abstract The bony augmentation of severely atrophied mandible is generally required for the purposes of prosthetic rehabilitations. The treatment strategies have been well defined in the literature ranging from osteotomy techniques to distraction osteogenesis. Visor osteotomy is the milestone of the reconstructive surgery for the atrophied mandible which has received some modifications. In the present study, the authors describe a new modification of visor osteotomy in which a complete coronal split osteotomy down to the inferior border at the mental region has been performed. The main advantage of this modification is to preserve the lingual cortex from the inferior border of the mandible up to the alveolar region without disturbance of the suprahyoid muscle attachments. The procedure is thought to be a “highly sensitive” one and undesired fractures may occur during splitting of the bony segments.

Bir diş hekimliği fakültesi ağız, diş ve çene cerrahisi kliniğine başvuran hastaların dental kaygı düzeylerinin değerlendirilmesi

AMAC: Bu calismanin amaci, Agiz, Dis ve Cene Cerrahisi klinigine basvuran hastalarin dental kaygi duzeylerini belirlemek ve dental kayginin iliskili olabilecegi dusunulen faktorlerle olan baglantisini degerlendirmektir. GEREC VE YONTEM: Gazi Universitesi Dis Hekimligi Fakultesi Agiz, Dis ve Cene Cerrahisi Klinigine 1 Şubat 2013- 1 Ocak 2014 tarihleri arasinda basvuran hastalara (n=1165) dental kaygi duzeyinin degerlendirilmesi amaciyla Modifiye Dental Anksiyete Skalasi (MDAS) ve dental kayginin baglantili olabilecegi dusunulen faktorlere iliskin sorulari iceren anketler uygulandi. MDAS skor degeri ≥19 olan katilimcilar yuksek dental kaygi duzeyine sahip olarak degerlendirildi. Katilimcilarin demografik ozelliklerini de iceren veriler istatistik programina aktarilarak deskriptif yontemler ile sonuclar degerlendirildi. BULGULAR: Calismaya katilan hastalarin %14.1’inde yuksek dental kaygi saptandi. Dental kaygi, cinsiyet, daha once gecirilmis travmatik deneyim varligi ve dis hekimine gitme sikligi ile iliskili bulundu (p 0.05). SONUC: Bu calismanin sonuclari agiz cerrahisi islemleri oncesi dental kayginin gunumuzde dis hekimligi alanindaki teknik, farmakolojik ve cerrahi gelismelere ragmen dikkate deger olcude varligini surdurdugunu gostermektedir. Agiz cerrahisi uygulamalarinda anksiyete tanimlayici/giderici yontemlerin uygulanmasi hasta rahatinin artirilmasi ve cerrahi kosullarin iyi hale getirilmesi acisindan onem tasimaktadir.

Dental treatment of a patient with central sleep apnea and phobic anxiety under sedation: report of a case and clinical considerations

Central sleep apnea (CSA) results from a reduction in lack of output from the central respiratory generator in the brainstem, manifesting as apneas and hypopneas without discernible efforts. CSA can lead to hypercarbia, arrhythmias, pulmonary hypertension, and heart failure. Indeed, the patient may develop a disturbed breathing during sedation procedures. We report a patient who was diagnosed with CSA and had been on continuous positive airway pressure (CPAP) therapy for 5 years. He was referred for multiple tooth extractions under sedation owing to severe gag reflex and phobic anxiety disorder. The treatment was completed uneventfully under N(2)O and sevoflurane inhalation accompanied by midazolam and ketamine induction. The role of sedative, analgesic, and anesthetic agents as a precipitating factor for CSA is of particular concern. The combined administration of midazolam, ketamine, sevoflurane, and N(2)O/O(2) is a useful and safe option for patients requiring sedation.