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Journal of Otolaryngology - Head & Neck... Jul 2023Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient's...
INTRODUCTION
Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient's life. We have approached the reconstruction of mandibular defects that include the condyle with simultaneous reconstruction with a vascularized free fibular flap (FFF) using Surgical Design and Simulation (SDS) and alloplastic TMJ prosthesis. The objective of this study is to report the functional and quality of life (QOL) outcomes in a cohort of patients that had undergone our reconstructive protocol.
METHODS
This was a prospective case series of adult patients that underwent mandibular reconstruction with FFF and alloplastic TMJ prosthesis at the our center. Pre-operative and post-operative maximum inter-incisal opening (MIO) measurements were collected, and patients completed a QOL questionnaire (EORTC QLQ-H&N35) during those perioperative visits.
RESULTS
Six patients were included in the study. The median patient age was 53 years. Heat map analysis of the QOL questionnaire revealed that patients reported a positive clinically significant change in the domains of pain, teeth, mouth opening, dry mouth, sticky saliva, and senses (relative change of 2.0, 3.3, 3.3, 2.0, 2.0, and 1.0 respectively). There were no negative clinically significant changes. There was a median perioperative MIO increase of 15.0 mm, and this was statistically significant (p = 0.027).
CONCLUSIONS
This study highlights the complexities involved in mandibular reconstruction with involvement of the TMJ. Based on our findings, patients can obtain an acceptable QOL and good function following simultaneous reconstruction with FFF employing SDS and an alloplastic TMJ prosthesis.
Topics: Adult; Humans; Middle Aged; Mandibular Reconstruction; Free Tissue Flaps; Quality of Life; Joint Prosthesis; Temporomandibular Joint; Treatment Outcome
PubMed: 37400904
DOI: 10.1186/s40463-023-00639-4 -
Cureus Sep 2023Restoration of hemimandibulectomy defects following tumour extirpation to restore oral function is a herculean task for practitioners. Prosthetic treatment alternatives... (Review)
Review
Restoration of hemimandibulectomy defects following tumour extirpation to restore oral function is a herculean task for practitioners. Prosthetic treatment alternatives available for rehabilitation of acquired hemimandibulectomy defects according to mandibular reconstruction type and extent (Cantor-Curtis classification) are unclear. This systematic review aims to assess the spectrum of prosthodontic rehabilitation approaches with regard to reconstruction type and extent of mandibular surgical defects. The databases incorporated for literature search were Google Scholar and Medline (PubMed). Relevant search terms for hemimandibulectomy and reconstruction with prosthetic rehabilitation were used. Two reviewers independently assessed the articles using eligibility criteria; published case reports and case series in the English language and depicting prosthodontic treatment modality of patients greater than 15 years were included. A total of 202 records were identified from the database search of which 19 duplicates were removed. The remaining articles were assessed for eligibility, and 55 articles (comprising 58 cases) were finally included in the study. This review revealed various prosthetic alternatives ranging from guide flange, twin occlusion, palatal ramp, conventional to hybrid partial and complete dentures to implant-supported prosthesis including a few innovative prosthetic approaches. This systematic review provides a plethora of prosthodontic rehabilitation approaches according to the extent of hemimandibular surgical defect and type of reconstruction. This will facilitate practitioners and prosthodontists in sequential treatment planning and management of hemimandibulectomy cases in their routine practice.
PubMed: 37799255
DOI: 10.7759/cureus.44647 -
Nigerian Journal of Clinical Practice Sep 2023Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients.... (Review)
Review
Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Young Adult; Anodontia; Dental Implants; Dental Prosthesis, Implant-Supported; Immediate Dental Implant Loading; Tooth Loss
PubMed: 37794532
DOI: 10.4103/njcp.njcp_884_22 -
Frontiers in Bioengineering and... 2023Mandibular flexure, characterized by unique biomechanical behaviors such as elastic bending and torsion under functional loading, has emerged as a crucial factor in oral... (Review)
Review
Mandibular flexure, characterized by unique biomechanical behaviors such as elastic bending and torsion under functional loading, has emerged as a crucial factor in oral clinical diagnosis and treatment. This paper presents a comprehensive review of the current research status on mandibular flexure, drawing insights from relevant studies retrieved from the PubMed database (www.ncbi.nlm.nih.gov/pubmed), including research conclusions, literature reviews, case reports, and authoritative reference books. This paper thoroughly explores the physiological mechanisms underlying mandibular flexure, discussing different concurrent deformation types and the essential factors influencing this process. Moreover, it explores the profound implications of mandibular flexure on clinical aspects such as bone absorption around dental implants, the precision of prosthesis fabrication, and the selection and design of superstructure materials. Based on the empirical findings, this review provides crucial clinical recommendations. Specifically, it is recommended to exert precise control over the patients mouth opening during impression-taking. Those with a high elastic modulus or bone-tissue-like properties should be prioritized when selecting superstructure materials. Moreover, this review underscores the significance of customizing framework design to accommodate individual variations in facial morphology and occlusal habits. Future research endeavors in this field have the potential to advance clinical diagnosis and treatment approaches, providing opportunities for improvement.
PubMed: 37744259
DOI: 10.3389/fbioe.2023.1238181 -
International Journal of Dentistry 2023To compare the BioHPP (biocompatible high-performance polymer) as a substructure for the hybrid prosthesis versus the BioHPP bar supporting and retaining implant...
AIM
To compare the BioHPP (biocompatible high-performance polymer) as a substructure for the hybrid prosthesis versus the BioHPP bar supporting and retaining implant overdenture by radiographic evaluation to identify bone height alteration around the implants and to evaluate satisfaction based on visual analoge scale questionnaire.
MATERIALS AND METHODS
Ill-fitting mandibular dentures were chosen for 14 fully edentulous male patients with adequate dental hygiene, enough interarch space, and free of systemic diseases and parafunctional habits. Patients who received new dentures (CDs) were randomly allocated into each group using computer software, and four interforaminal implants were inserted in parallel using a surgical guide. Three months after osseointegration, the patients received either CAD-CAM BioHPP framework hybrid prosthesis (Group I) or BioHPP bar supported and retained overdenture (Group II). Using digital preapical radiography, the bone loss is evaluated 6, 12, and 18 months after insertion. The subjective patient evaluation was done using a questionnaire based on the VAS includes five points for chewing, comfort, esthetics, speech, oral hygiene, and general satisfaction.
RESULTS
The overall marginal bone loss (MBL) revealed that Group I (hybrid prosthesis) was more than Group II (bar overdenture) at all intervals in the anterior and posterior implants' mesial and distal surfaces. The patient satisfaction survey results showed that, after 18 months, the difference was statistically not significant between them all ( > 0.05) except for the comfort (for the overdenture group, 4.43 ± 0.53 while the fixed hybrid was 5.00 ± 0.00).
CONCLUSION
BioHPP framework material is an alternative material for implant rehabilitation of edentulous mandible with minimal MBL in BioHPP bar overdenture compared to BioHPP hybrid prosthesis.
PubMed: 37426766
DOI: 10.1155/2023/4108679 -
BMC Research Notes Sep 2023This retrospective study aims to evaluate the mandibular flexure on a long-span rigid fixed prosthesis supported by natural teeth.
PURPOSE
This retrospective study aims to evaluate the mandibular flexure on a long-span rigid fixed prosthesis supported by natural teeth.
MATERIALS AND METHODS
Nine patients (five males and four females) were included in this study who had long-span rigid mandibular fixed prostheses for long-term (10-15 years) that have led to radiographic changes around the supporting teeth. The mandibular flexure was measured digitally after adhering reference markers to the prostheses. Intraoral scans were obtained at the minimum and maximum mouth openings before and after splitting the preexisting prostheses. The distances between the markers were measured, and mandibular flexure was calculated.
RESULTS
This study showed a significant deviation (narrowing) of the mandible before and after splitting the rigid fixed prostheses (P value < 0.05).
CONCLUSION
Digital analysis of the data collected from the patients in this retrospective study indicated that deviations occur during mandibular flexure.
CLINICAL RELEVANCE
Splitting the full arch prosthesis could prevent the negative consequences of mandibular flexure on restorations. Trial registration The study was registered on clinicaltrials.gov with registration number NCT05617274 (15/11/2022).
Topics: Female; Male; Humans; Retrospective Studies; Mandible; Patients
PubMed: 37697386
DOI: 10.1186/s13104-023-06486-w -
Journal of Clinical Medicine Jun 2023The aim of this study was to assess intra-arch mandibular dimensional changes that may occur during mouth opening using cone beam-computed tomography (CBCT). Fifteen...
The aim of this study was to assess intra-arch mandibular dimensional changes that may occur during mouth opening using cone beam-computed tomography (CBCT). Fifteen patients in need of any type of treatment whose execution considered a pre- and post-CBCT assessment consented and were enrolled. CBCTs were taken with the following settings: 90 kV, 8 mA, field of view (FOV) 140 by 100 mm (height and diameter), Voxel size 0.25 mm (high resolution). The pre-CBCT was executed in the maximum mandibular opening (MO), while the post-CBCT was in the maximum intercuspation (MI). A thermoplastic stent with radiopaque fiducial markers (steel ball bearings) was fabricated for each patient. Measurements were made using radiographic markers between contralateral canines and contralateral first molars and between ipsilateral canines and first molars on both sides. Paired -tests were performed to evaluate the difference between open and closed positions on these four measurements. In the MO position were registered a significative tightening of the mandible at the canine (-0.49 mm, SD 0.54 mm; < 0.001) and molar points (-0.81 mm, SD 0.63 mm; < 0.001) and a significative shortening of the mandible on the right (-0.84 mm, SD 0.80 mm; < 0.001) and left sides (-0.87 mm, SD 0.49 mm; < 0.001). Within the study limitations, mandibular flexure determined a significant shortening and tightening between maximum intercuspation to maximum opening positions. Mandibular dimensional changes should be considered in light of other patient factors in the treatment planning of implant positioning and long-span complete arch implant-supported fixed prostheses in order to avoid technical complications.
PubMed: 37373841
DOI: 10.3390/jcm12124149 -
Quantitative Imaging in Medicine and... Jul 2023To analyze and compare the trajectory of condylar motion during mouth opening in normal volunteers and patients after total joint replacement (TJR) of the...
BACKGROUND
To analyze and compare the trajectory of condylar motion during mouth opening in normal volunteers and patients after total joint replacement (TJR) of the temporomandibular joint (TMJ).
METHODS
Condylar movement during mouth opening was recorded by dynamic magnetic resonance imaging (MRI) for volunteers with normal TMJs and dynamic computed tomography (CT) for patients after TMJ TJR. Trajectories of the points selected every 5 mm from the superior point of the condyle (P) along its axis to the mandibular angle (P) were recorded. The arc length and curvature radius of average trajectories for each point were calculated and compared between the normal joints and TJRs, especially P which is the corresponding point of the prosthesis apex without lateral pterygoid muscle (LPM) attachment at the normal joint with LPM attachment. The location of the point with the most similar trajectory was identified in the normal joints and compared with the condylar prosthesis.
RESULTS
A total of 9 volunteers with 18 normal TMJs, and 5 patients with 6 prostheses were included in this study. For normal TMJs, the average condylar trajectories during mouth opening were a concave upward curve. Meanwhile, the trajectories of contralateral normal joints in patients with unilateral TJR and all condylar prostheses were significantly decreased. The arc length and curvature radius of average trajectories gradually decreased from P. In the normal joints, P had the most similar trajectories with the average arc lengths and a curvature radius of 13.0/4.2 mm. In P, the average arc lengths and curvature radius of the normal cases, natural TMJ of the unilateral replacement patients, prosthetic TMJ of the unilateral replacement patients, and prosthetic TMJ of the bilateral replacement patient, were 15.6/6.6 mm, 13.1/4.9 mm, 4.7/4.4 mm, and 6.4/5.8 mm, respectively.
CONCLUSIONS
P in the normal joint exhibited the most similar trajectory among individuals. The trajectory difference between the prosthesis apex without LPM attachment and the corresponding point at the normal joint with LPM attachment provides a reference for fossa prosthesis functional surface design.
PubMed: 37456288
DOI: 10.21037/qims-22-1239