Zhigui Ma

Is mandibular asymmetry more frequent and severe with unilateral disc displacement

PURPOSE To investigate the prevalence of mandibular asymmetry (MA) within the symptomatic unilateral anterior disc displacement (ADD) patients, and analyze the influence TMJ factors of the MA severity. METHODS Patients aged under 20 years old with symptomatic unilateral ADD and asymptomatic volunteers with normal disc-condyle relationship diagnosed by magnetic resonance imaging (MRI) were included in this study. Posteroanterior cephalometric radiographs were taken to measure MA. Condylar height, disc length and disc displacement were measured by MRI. The prevalence and severity of MA were compared between the ADD and the control groups. The correlation between the severity of MA with the amount of condylar height shortage, disc deformity and distance of disc displacement were also evaluated within the ADD group. RESULTS There were 165 cases in the unilateral ADD group, and 156 cases in the control group. One hundred and nineteen cases had MA which accounted 72.12% (119/165) in the ADD group; while in the control group, only 25.64% (40/156) exhibited MA. The mean horizontal menton deviation and condylar height shortage in the unilateral ADD group were significantly larger than that in the control group (5.62 mm vs. 4.19 mm; 3.14 mm vs. 1.32 mm, p < 0.01). The severity of MA was significantly correlated with the amount of disc displacement, disc deformity and condylar height shortage (correlation coefficient: 0.80, 0.70, and 0.82). CONCLUSION MA is much more common and severe in young unilateral ADD patients. The severity of MA is correlated with the height of condyle and the status of the disc.

An Orthodontic Technique for Minimally Invasive Extraction of Impacted Lower Third Molar

PURPOSE To present a novel orthodontic approach for minimally invasive extraction of impacted mandibular third molars (M3s) close to the inferior alveolar nerve (IAN). PATIENTS AND METHODS Eight patients (8 M3s) requiring extraction of M3s were included in this study; there were 2 cases of horizontal impaction, 4 of mesioangular impaction, and 2 of vertical impaction. Cone-beam computed tomogram showed that the roots of impacted M3s in 2 cases interrupted the cortices of the mandibular canal, and those in the other 6 cases were very close to the IAN. Orthodontic treatment was performed in this study. The crowns of 5 impacted teeth were surgically exposed before the application of the orthodontic device, whereas bonding was performed directly to the occlusal surface of the other 3 M3s, which had partially erupted. The opposing maxillary M3s were removed in 3 cases. One-step orthodontic extraction was applied to vertically impacted M3s and 2-step treatment was applied to horizontally or mesioangularly impacted M3s. Success was defined as the separation of the impacted tooth from the IAN as visualized on cone-beam computed tomogram. RESULTS After orthodontic treatment, all impacted M3s were extruded and separated from the IAN (mean, 6.6 months; range, 4 to 10 months), without any neurologic consequences. The average time of extraction was 5 minutes. In all 8 cases, new bone formation occurred distal to the adjacent second molar. CONCLUSION This orthodontic technique may be a minimally invasive approach for the extraction of impacted M3s adjacent to the IAN, with a decreased risk of paresthesias and with osteoperiodontal advantages.

Marsupialization Facilitates Eruption of Dentigerous Cyst-Associated Mandibular Premolars in Preadolescent Patients

PURPOSE The purpose of the present study was to investigate the eruption of dentigerous cyst (DC)-associated mandibular premolars after marsupialization in preadolescents. PATIENTS AND METHODS The present study was a retrospective cohort study of preadolescent patients with DCs who were treated as outpatients at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine. For our study, the data from these patients were collected, and the eruption of the premolar teeth, along with related factors, such as the interval to eruption, cusp depth, angulation, cyst size, and eruption space, were analyzed for the cyst group compared with the noncyst control group. RESULTS The mean age of the patients was 9.1 years. All teeth associated with DCs erupted successfully after marsupialization. The follow-up panoramic radiograph showed that the cysts had disappeared and had been replaced by regenerated bone. The initial panoramic radiograph showed the angulation of the teeth in the cyst group had a significantly larger inclination angle than did the teeth in the noncyst group (P < .05). However, no significant difference was found for cusp depth, root formation, or space measurement. The gender, age, cusp depth, angulation, and eruption space were not factors influencing the eruption of the DC-associated tooth for preadolescent patients in the present study. In addition, the cyst-associated teeth took less time to erupt than the teeth in the control group. CONCLUSIONS The results of the present study suggest that DC-associated mandibular premolars can erupt spontaneously after marsupialization in preadolescents.

Efficacy of the technique of piezoelectric corticotomy for orthodontic traction of impacted mandibular third molars

Our aim was to assess the efficacy of piezoelectric corticotomy for orthodontic traction of mandibular third molars close to the inferior alveolar nerve. Thirty patients with impacted third molars close to the nerve were included in the study, 15 of whom were treated with conventional orthodontic traction and 15 with piezoelectric corticotomy. We recorded duration of treatment including exposure and orthodontic traction, and time to the final extraction. Postoperative complications including trismus, swelling, and pain were also noted. Alveolar bone levels mesial and distal to the second molars were evaluated on cone-beam computed tomographic (CT) images. Students t test was used to assess the significance of differences between the groups. After orthodontic treatments all impacted third molars were successfully removed from the inferior alveolar nerve without neurological damage. The mean (SD) duration of surgical exposure in the piezoelectric corticotomy group was significantly longer than that in the conventional group (p=0.01). The mean (SD) duration of traction was 4 (2.3) months after piezoelectric corticotomy, much shorter than the 7.5 (1.3) months in the conventional group (p=0.03). There were no significant differences in postoperative complications between the groups. There was a significant increase in the distal alveolar height of second molars after treatment in both groups (p<0.01). We conclude that the use of piezoelectric corticotomy allows more efficient and faster traction of third molars with a close relation between the root and the inferior alveolar nerve, although it took longer than the traditional technique.

Changes in the temporomandibular joint space after functional treatment of disk displacement with reduction.

AbstractThis study aimed to evaluate the changes of temporomandibularjoint (TMJ) space in the treatment of disk displacement with reduction (DDWR) for class II cases. Forty-two adolescent patients with unilateral DDWR, who were successfully treated by functional appliance, were selected in this study. Magnetic resonance imaging scans were used before treatment (T1), at the start of treatment (T2), and after functional treatment (T3). Compared with the normal joint, the change of joint space index was calculated. The anterior, posterior, and superior joint spaces were analyzed on the largest sagittal plane among T1, T2, and T3. Student’s t-test was used for statistical analysis. The mean treatment period was 10 months (6–16 mo). Functional appliance was effective in eliminating pain and clicking. During the phase of T1, the value of the joint space index of DDWR was significantly higher than that of the control (P < 0.05). There was a significant decrease in the anterior space and an increase in the postsuperior space at T2 (P < 0.01), and then the contrary changes occurred at T3. However, there was a significant increase in the postsuperior space and no significant decrease in the anterior space when T1 and T3 were compared. This study indicates that the TMJ space is well distributed after disk repositioning with functional treatment of DDWR. It is also suggested that the adaptive remodeling in TMJ occurs via functional treatment.