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Bioengineering (Basel, Switzerland) Mar 2024Mandibular fractures are very common in maxillofacial trauma surgery. While previous studies have focused on possible risk factors related to post-operative...
Mandibular fractures are very common in maxillofacial trauma surgery. While previous studies have focused on possible risk factors related to post-operative complications, none have tried to identify pre-existing conditions that may increase the risk of mandibular fractures. We hypothesized, through clinical observation, that anatomical conditions involving poor dental contacts, such as malocclusions, may increase the risk of mandibular fractures. This work was subdivided into two parts. In the first part, Digital Imaging and Communications in Medicine (DICOM) data of four healthy patients characterized by different dentoskeletal occlusions (class I, class II, class III, and anterior open bite) have been used to develop four finite element models (FEMs) that accurately reproduce human bone structure. A vertical and lateral impact have been simulated at increasing speed on each model, analyzing the force distribution within the mandibular bone. Both vertical and lateral impact showed higher level of stress at the impact point and in the condylar area in models characterized by malocclusion. Specifically, the class III and the open bite models, at the same speed of impact, had higher values for a longer period, reaching critical stress levels that are correlated with mandibular fracture, while normal occlusion seems to be a protective condition. In the second part of this study, the engineering results were validated through the comparison with a sample of patients previously treated for mandibular fracture. Data from 223 mandibular fractures, due to low-energy injuries, were retrospectively collected to evaluate a possible correlation between pre-existing malocclusion and fracture patterns, considering grade of displacement, numbers of foci, and associated CFI score. Patients were classified, according to their occlusion, into Class I, Class II, Class III, and anterior open bite or poor occlusal contact (POC). Class I patients showed lower frequencies of fracture than class II, III, and open bite or POC patients. Class I was associated with displaced fractures in 16.1% of cases, class II in 47.1%, class III in 48.8% and open bite/POC in 65.2% of cases (-value < 0.0001). In class I patients we observed a single non-displaced fracture in 51.6% of cases, compared to 12.9% of Class II, 19.5% of Class III and 22.7% of the open bite/POC group. Our analysis shows that class I appears to better dissipate forces applied on the mandible in low-energy injuries. A higher number of dental contacts showed a lower rate of multifocal and displaced fractures, mitigating the effect of direct forces onto the bone. The correlation between clinical data and virtual simulation on FEM models seems to point out that virtual simulation successfully predicts fracture patterns and risk of association with different type of occlusion. Better knowledge of biomechanics and force dissipation on the human body may lead to the development of more effective safety devices, and help select patients to plan medical, orthodontic/dental, and/or surgical intervention to prevent injuries.
PubMed: 38534548
DOI: 10.3390/bioengineering11030274 -
Orthodontics & Craniofacial Research Mar 2024To describe the clinical and radiographic oro-dental characteristics of patients with pycnodysostosis (PDO).
OBJECTIVES
To describe the clinical and radiographic oro-dental characteristics of patients with pycnodysostosis (PDO).
MATERIALS & METHODS
A short interview and clinical examination of seven patients with PDO were performed as well as assessment of the temporomandibular joints and masticatory muscles using the diagnostic criteria for temporomandibular disorders, DC-TMD form. A full set of records were taken including photos and intraoral scan. Finally, existing cone beam computed tomography (CBCT) images and radiographs were also studied.
RESULTS
All patients presented with bimaxillary micrognathia, five had a convex profile, and two had a straight profile. In addition, posterior open bite, Angle Class III molar relation with accompanying anterior crossbite and a grooved median palate were common findings. No patient showed symptoms of temporomandibular disorder (TMD) apart from some clicking. Finally, the main radiographic findings were the obtuse mandibular angle, the frontal bossing, the elongation of the coronoid/condylar process and the presence of hypercementosis with obliterated pulp chambers.
CONCLUSION
The examined patients with PDO were characterized by dental crowding, malocclusion (anterior crossbite, posterior open bite), hypercementosis, obliterated pulp chambers and deviations in mandibular morphology. In conclusion, patients with PDO have a specific need for dental and orthodontic monitoring with focus on crowding and posterior open bite. The patients will benefit from a long-term orthodontic plan including extractions.
PubMed: 38532649
DOI: 10.1111/ocr.12782 -
Journal of Orthodontic Science 2024Anterior open bite (AOB) malocclusion is one of the highly challenging malocclusions. Cephalometric radiographs have been used for the diagnosis of occlusal anomalies in...
BACKGROUND
Anterior open bite (AOB) malocclusion is one of the highly challenging malocclusions. Cephalometric radiographs have been used for the diagnosis of occlusal anomalies in the vertical and anteroposterior directions. This study aims to compare skeletal and dental features in open and non-open bite subjects to identify factors that help predict and categorize open bites in a Nigerian population.
MATERIALS AND METHODS
Pretreatment cephalometric radiographs of 82 patients were recruited into this study. This study comprised 41 AOB patients and 41 (Class 1 malocclusion) patients (control group). The radiographs were obtained from the orthodontic unit, Department of Child Dental Health of the Lagos University Teaching Hospital, Idi-Araba Lagos. Cephalometric tracing and analysis of the obtained radiographs were used to identify and compare the skeletal and dental differences between the two groups.
RESULTS
The mean age of the participants was 20.47 ± 8.05 years. The patients consisted of 26 (31.7%) males and 56 (68.3%) females. There was a significant difference in the open bite depth indicator (ODI) of the open bite ( value < 0.001). There was a statistically significant increase in the vertical skeletal parameters - lower facial height (LFH), total facial height (TFH), posterior facial height (PFH), Frankfort-mandibular plane angle (FMA), mandibular-maxillary angle (MMA), and gonial angle in the AOB group compared to the control group. The vertical height of the dentoalveolar segments measured was all significantly increased in the open bite group compared to the control group.
CONCLUSION
The results suggest that the skeletal and dental vertical parameters, including ODI of the open bite subjects, varied compared with the non-open bite subjects in the Nigerian population studied and could be used to predict AOB tendency.
PubMed: 38516112
DOI: 10.4103/jos.jos_56_23 -
Plastic and Reconstructive Surgery.... Mar 2024Because the auricle plays an important role in facial aesthetics, all earlobe operations must seek to limit postoperative ear deformity. This report describes the...
Because the auricle plays an important role in facial aesthetics, all earlobe operations must seek to limit postoperative ear deformity. This report describes the single-stage posterior-auricle bilobed cartilage-skin flap technique for reconstructing the earlobe. A 31-year-old man incurred a left earlobe deficiency due to a human bite. Earlobe reconstruction was conducted 102 days later. A bilobed flap was designed on the posterior-auricular skin. Both flaps were pedicled in the caudal posterior-auricular area. The first incision raised the upper lobe, which consisted of posterior-auricle skin and conchal cartilage. The skin was sutured to the auricle base so that it formed the anterior earlobe. The cartilage was then cut to separate and processed to the natural curve. The second incision elevated the second flap from the caudal posterior-auricular area. This was sutured to the first flap so that it formed the posterior earlobe. The donor sites were closed with simple sutures. The reconstructed earlobe had no obvious contracture after surgery. Most donor-site scarring was hidden behind the auricle. At 9 months postoperative, the patient was satisfied with the result. Our technique allows us to harvest cartilage from the same operative field, perform a single-stage reconstruction, and recreate a relatively large earlobe with good size and shape. The posterior auricle bilobed cartilage-skin flap technique is useful for earlobe reconstruction.
PubMed: 38510329
DOI: 10.1097/GOX.0000000000005693 -
Cureus Feb 2024In this case report, we discuss a 32-year-old diabetic male patient who presented with right foot pain three days following a spider bite. The foot progressively became...
In this case report, we discuss a 32-year-old diabetic male patient who presented with right foot pain three days following a spider bite. The foot progressively became swollen, preventing the patient from bearing weight on it. After admission to the emergency department, the examination showed discoloration of the dorsum of the proximal phalanx of the first toe with an open wound and pus. The patient received fluid resuscitation along with a course of metronidazole and levofloxacin. Subsequently, the patient was referred to an orthopedic and podiatric team where he underwent a complete foot fasciotomy. The procedure was successful, and the patient recovered well. This case showcases a rare manifestation of necrotizing fasciitis (NF) and highlights the importance of future research regarding NF and its association with diabetes mellitus.
PubMed: 38481912
DOI: 10.7759/cureus.54062 -
Journal of Neuroscience Research Mar 2024Finasteride is used in female-pattern hair loss, hirsutism, and polycystic ovarian syndrome. It inhibits 5α-reductase, which is an important enzyme in the biosynthesis...
Finasteride is used in female-pattern hair loss, hirsutism, and polycystic ovarian syndrome. It inhibits 5α-reductase, which is an important enzyme in the biosynthesis of neurosteroids. The effects of finasteride treatment on mental health in female patients as well as the effects of repeated/chronic finasteride administration in female rodents are still unknown. Accordingly, in our study, we administered finasteride (10, 30, or 100 mg/Kg, s.c.) for 6 days in female rats and evaluated behavior, plasma steroid levels, and synaptic plasticity. Depression-like behavior was evaluated using forced swim test (FST) and splash test. Anxiety-like behavior was evaluated using novelty-suppressed feeding task (NSFT), elevated plus maze (EPM), open field test (OFT), and light-dark test (LDT). Plasma steroid levels were assessed using ELISA and synaptic plasticity by field potential recordings. We observed that finasteride decreased total immobility duration in FST, indicating antidepressant-like effect and decreased the latency to first bite in NSFT, showing anxiolytic-like effect. We also found a significant increase in plasma estradiol and a significant decrease in plasma corticosterone level. Furthermore, field potential recordings showed that finasteride increased hippocampal long-term potentiation. These results indicate that repeated finasteride administration in female rats may have antidepressant- and anxiolytic-like effect, which might be mediated by enhanced estradiol levels or decreased corticosterone levels. Further studies are required to validate the molecular mechanisms underlying the effects of finasteride in female rats. Understanding the mechanisms will help us in developing novel neurosteroid-based therapeutics in the treatment of neuropsychiatric disorders in women.
Topics: Humans; Rats; Female; Animals; Finasteride; Anti-Anxiety Agents; Corticosterone; Depression; Steroids; Estradiol; Antidepressive Agents; Neuronal Plasticity
PubMed: 38468573
DOI: 10.1002/jnr.25306 -
Scientific Reports Mar 2024This single-center trial aimed to longitudinally compare the oral health-related quality of life (OHRQOL), adaptation and discomfort during anterior open bite (AOB)... (Randomized Controlled Trial)
Randomized Controlled Trial
This single-center trial aimed to longitudinally compare the oral health-related quality of life (OHRQOL), adaptation and discomfort during anterior open bite (AOB) treatment with lingual spurs and build-ups (SBU) versus spurs only (S) approaches. Children (7-11 years) with AOB were randomly allocated into two treatment groups (SBU or S). The Child Perception Questionnaire (CPQ) was applied 1 and 12 months after installation of the appliances. Questionnaires evaluating functional adaptation and discomfort during the first month of treatment were also applied. A visual analog scale (VAS) was used in these questionnaires. Generalized mixed models were used for analyzing OHRQOL and discomfort data. Generalized linear models were used to assess adaptation outcomes (α = 0.05). The SBU group included 24 patients (7 males and 17 females; mean age 8.2 years) and the S group included 25 patients (11 males and 14 females; mean age 8.3 years). Regardless of the treatment type, overall OHRQOL scores at 12 months were 0.69 times those recorded at 1 month after the appliances installation (i.e., ~ 31% reduction; exp (β) = 0.69; 95% CI: 0.55, 0.88). A significant interaction between treatment and time was detected for the 'functional limitations' domain. For this domain, a significant improvement from the first to the twelfth month was observed in the S group (P < 0.001). Patients in both treatment groups showed similar and easy adaptation to the appliances. Independent of the type of treatment, tongue-related discomfort decreased over time. One week and one month after the appliance's delivery, the discomfort scores were 0.19 (i.e., ~ 81% reduction; exp (β) = 0.19; 95% CI: 0.13, 0.28; P < 0.001) and 0.02 (i.e., ~ 98% reduction; exp (β) = 0.02; 95% CI: 0.01, 0.07; P < 0.001) times, respectively, those issued immediately after the installation of the appliances. Regardless of treatment type; overall OHRQOL improved from the first to the twelfth month of AOB treatment. The functional limitations score decreased in the S group. Children showed easy adaptation, and their discomfort decreased 1 week after the installation of the appliances.Trial registration: Clinicaltrials.gov; NCT03702881, date of registration: October 11, 2018.
Topics: Male; Child; Female; Humans; Open Bite; Quality of Life; Tongue; Surveys and Questionnaires
PubMed: 38459254
DOI: 10.1038/s41598-024-56363-0 -
Oral Surgery, Oral Medicine, Oral... Apr 2024Evaluate which factors compromise patients' quality of life who have undergone orthognathic surgery in the pre and postoperative period of 2 years.
PURPOSE
Evaluate which factors compromise patients' quality of life who have undergone orthognathic surgery in the pre and postoperative period of 2 years.
STUDY DESIGN
In this longitudinal prospective study, 46 adult patients undergoing orthognathic surgery were evaluated. The primary outcome variable was quality of life, assessed using the overall score of the orthognathic quality of life questionnaire (OQLQ) in the pre and 2-year postoperative periods. The predictor variables were axis I (temporomandibular dysfunction) and axis II (psychosocial) RDC/TMD diagnoses, assessed preoperatively and 2 years postoperatively; profile, asymmetry, and open bite preoperatively; and orthodontic treatment active 2 years postoperatively. The covariables were age and sex. The OQLQ score was compared preoperatively and postoperatively using the Wilcoxon test and with the other variables using the Mann-Whitney and Kruskall-Wallis tests.
RESULTS
Preoperatively, higher OQLQ scores were associated with myofascial pain (P = .012) and severe depression (P = .030). Two years after surgery, there was an improvement in overall OQLQ (P < .001), myofascial pain (P = .012) and chronic pain (P = .001). However, higher OQLQ scores were associated with individuals who had myofascial pain (P = .012), active orthodontic treatment (P = .007), and other nonspecific physical symptoms including pain (NSPSIP) (P = .049).
CONCLUSION
Quality of life was affected preoperatively by myofascial pain and depression, and although it improved significantly 2 years after surgery, it continued to be affected by myofascial pain, NSPSIP, and active orthodontic treatment.
Topics: Adult; Humans; Orthognathic Surgery; Quality of Life; Orthognathic Surgical Procedures; Prospective Studies; Pain; Surveys and Questionnaires
PubMed: 38458845
DOI: 10.1016/j.oooo.2023.12.002 -
Cureus Feb 2024An anterior open bite is a form of vertical discrepancy that presents as a lack of contact between maxillary and mandibular segments. The treatment modalities usually...
Evaluation of Dimensional Changes in Maxillary and Frontal Sinus in Adult Patients With Anterior Open Bite and Normal Overbite: A Retrospective Cone Beam Computed Tomography (CBCT) Study.
INTRODUCTION
An anterior open bite is a form of vertical discrepancy that presents as a lack of contact between maxillary and mandibular segments. The treatment modalities usually involve either intrusion of posterior teeth or extrusion of anterior or a combination of both. The anatomical relationship between the apex of the maxillary molar roots to the inferior wall of the maxillary sinus floor is crucial in planning posterior intrusion. The paranasal sinuses influence the growth of the facial structures that eventually get altered in various malocclusions. Studies have proven that the height of the sinus gets modified in anterior open bite owing to pneumatization. This study aims to evaluate the distance from the root apex of maxillary first molars (mesiobuccal, distobuccal, and palatal roots) to the maxillary sinus floor to evaluate the significance of the vertical pneumatization of the sinus on planning for true intrusion in anterior open bite and to assess the correlation between frontal and maxillary sinuses in an anterior open bite.
METHODS
This retrospective study evaluated 30 pre-treatment cone beam computed tomographies (CBCTs) of patients out of which 15 were with anterior open bite and 15 with ideal overbite. Linear measurements were carried out using care stream software in CBCTs.
RESULTS
There was a significant correlation between the distance of the palatal root and the distobuccal root of the maxillary first molar to the maxillary sinus floor bilaterally in the anterior open bite (p<0.04). A significant moderate positive correlation of the maxillary and frontal sinus height in anterior open bite (p<0.006). A significant moderate negative correlation between the distance from the palatal root to the maxillary sinus floor and maxillary sinus height in anterior open bite (p<0.001).
CONCLUSION
Vertical pneumatisation of the maxillary sinus has caused a significant negative correlation between the apex of the palatal root of the maxillary first molar tooth and the maxillary sinus floor in the anterior open bite. The palatal root being the closest to the sinus floor, and the distobuccal root being second nearest. There is a significant correlation between the height of the sinuses in the anterior open bite.
PubMed: 38455800
DOI: 10.7759/cureus.53710 -
The British Journal of Oral &... Apr 2024Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open...
Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients. Arthroscopy provides the best diagnostic aid should there be a failure to improve and should enable the surgeon to appropriately plan open surgery. Historically, surgical intervention was based on a 'one size fits all' philosophy with the surgeon carrying out a procedure which they are used to doing regardless of the pathology. Prior to arthroscopy this carried an '80% chance of getting 80% better' regardless of approach. Prior arthroscopy reduced success rates to 50%-60% and a better success rate is needed. Basing surgical intervention on the pathology encountered is a sensible approach to joint management, with the surgeon performing surgery on the articular surfaces or disc as indicated. Having used this approach over the last 15 years the author has achieved success rates of 80% in the longer term and this philosophy, rationale, and technique will be discussed along with analysis of more recent publications in the field.
Topics: Humans; Arthrocentesis; Arthroplasty, Replacement; Arthroscopy; Temporomandibular Joint Disorders
PubMed: 38453560
DOI: 10.1016/j.bjoms.2024.01.006