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Disease Markers 2022To analyze the relationship between the position of embedded mesiodens in maxilla and surgical approach in children and thus provide reference materials for surgical...
OBJECTIVE
To analyze the relationship between the position of embedded mesiodens in maxilla and surgical approach in children and thus provide reference materials for surgical design.
METHODS
According to the preoperative cone-beam computed tomography (CBCT) examination, the location and surgical approach characteristics of 625 children aged 4-16 years old who presented with embedded mesiodens in maxilla and were diagnosed in our department from January 2016 to December 2021 were statistically analyzed.
RESULTS
There were 877 embedded mesiodens in 625 children. The selected cases were classified according to the axial angle relationship between mesiodens and adjacent normal teeth or tooth germs, including 84 cases of acute angle type (including the same direction) (13.4%), 66 cases of vertical type (10.6%), 114 cases of obtuse angle type (18.2%), 271 cases of inverted type (43.4%), and 90 cases of mixed type (14.4%). The palatal gingival margin approach was the most selected surgical approach for the cases of acute angle (including synclastic), obtuse angle, and inverted type, and the palatal gingival margin approach and the combined labial-palatal approach were the most selected surgical approach for the cases of vertical and mixed type.
CONCLUSION
Palatal gingival margin approach was the most common surgical approach for various types of embedded mesiodens in maxilla in children. Surgeons should classify the case of mesiodens according to the preoperative imaging examination and design the surgical approach reasonably.
Topics: Adolescent; Child; Child, Preschool; Cone-Beam Computed Tomography; Humans; Maxilla; Tooth, Supernumerary
PubMed: 35557873
DOI: 10.1155/2022/6517024 -
Clinical Oral Implants Research Apr 2023To retrospectively assess clinical and radiographic outcomes of immediately loaded full-arch fixed prostheses supported by axial and tilted implants up to 15 years of...
PURPOSE
To retrospectively assess clinical and radiographic outcomes of immediately loaded full-arch fixed prostheses supported by axial and tilted implants up to 15 years of function.
MATERIALS AND METHODS
Patients with one completely edentulous arch received an immediate full-arch fixed prosthesis supported by two anterior axial and two posterior tilted implants. Definitive prosthesis consisting of a CAD-CAM titanium framework and acrylic teeth was delivered 6 months later. Patients were regularly followed to assess clinical parameters and marginal bone level (MBL) change. Multilevel regression analysis was performed to investigate factors affecting implant failure and MBL.
RESULTS
Six hundred ninety-two implants were placed in 72 maxillae and 101 mandibles. Seven maxillary implants (5 axial and 2 tilted) in 6 patients and 12 mandibular implants (6 axial and 6 tilted) in 5 patients failed. 15-year cumulative implant survival was 97.51% and 96.91% in maxilla and mandible, respectively (p = .64). After 10 years, the difference in MBL between axial and tilted implants was not significant in the maxilla (p = .47, 65 patients), while it was in the mandible (p < .001, 80 patients). Significant higher bone loss was reported in the mandible at both 5- and 10-year follow-up (p < .001 and p = .004, respectively). Mixed-effect multilevel linear regression evidenced a correlation between arch and bone loss at 5- and 10-year follow-up, while no correlation was found with age, gender, smoking, diabetes, and history of periodontal disease.
CONCLUSION
This long-term study suggests that the present technique can be considered a viable treatment modality for the immediate rehabilitation of both maxilla and mandible.
Topics: Humans; Dental Implants; Retrospective Studies; Follow-Up Studies; Dental Prosthesis Design; Jaw, Edentulous; Dental Prosthesis, Implant-Supported; Immediate Dental Implant Loading; Maxilla; Treatment Outcome
PubMed: 36760035
DOI: 10.1111/clr.14047 -
Scientific Reports Nov 2017In this paper we use Bayesian networks to determine and visualise the interactions among various Class III malocclusion maxillofacial features during growth and...
In this paper we use Bayesian networks to determine and visualise the interactions among various Class III malocclusion maxillofacial features during growth and treatment. We start from a sample of 143 patients characterised through a series of a maximum of 21 different craniofacial features. We estimate a network model from these data and we test its consistency by verifying some commonly accepted hypotheses on the evolution of these disharmonies by means of Bayesian statistics. We show that untreated subjects develop different Class III craniofacial growth patterns as compared to patients submitted to orthodontic treatment with rapid maxillary expansion and facemask therapy. Among treated patients the CoA segment (the maxillary length) and the ANB angle (the antero-posterior relation of the maxilla to the mandible) seem to be the skeletal subspaces that receive the main effect of the treatment.
Topics: Adolescent; Adult; Bayes Theorem; Child; Female; Humans; Male; Malocclusion; Mandible; Maxilla; Models, Biological
PubMed: 29127377
DOI: 10.1038/s41598-017-15293-w -
PloS One 2020Implant-retained custom-milled framework enhances the stability of palatal obturator prostheses. Therefore, to evaluate the mechanical response of implant-retained...
Implant-retained custom-milled framework enhances the stability of palatal obturator prostheses. Therefore, to evaluate the mechanical response of implant-retained obturator prostheses with bar-clip attachment and milled bars, in three different materials under two load incidences were simulated. A maxilla model which Type IIb maxillary defect received five external hexagon implants (4.1 x 10 mm). An implant-supported palatal obturator prosthesis was simulated in three different materials: polyetheretherketone (PEEK), titanium (Ti:90%, Al:6%, V:4%) and Co-Cr (Co:60.6%, Cr:31.5%, Mo:6%) alloys. The model was imported into the analysis software and divided into a mesh composed of nodes and tetrahedral elements. Each material was assumed isotropic, elastic and homogeneous and all contacts were considered ideal. The bone was fixed and the load was applied in two different regions for each material: at the palatal face (cingulum area) of the central incisors (100 N magnitude at 45°); and at the occlusal surface of the first left molar (150 N magnitude normal to the surface). The microstrain and von-Mises stress were selected as criteria for analysis. The posterior load showed a higher strain concentration in the posterior peri-implant tissue, near the load application side for cortical and cancellous bone, regardless the simulated material. The anterior load showed a lower strain concentration with reduced magnitude and more implants involving in the load dissipation. The stress peak was calculated during posterior loading, which 77.7 MPa in the prosthetic screws and 2,686 με microstrain in the cortical bone. For bone tissue and bar, the material stiffness was inversely proportional to the calculated microstrain and stress. However, for the prosthetic screws and implants the PEEK showed higher stress concentration than the other materials. PEEK showed a promising behavior for the bone tissue and for the integrity of the bar and bar-clip attachments. However, the stress concentration in the prosthetic screws may represent an increase in failure risk. The use of Co-Cr alloy can reduce the stress in the prosthetic screw; however, it increases the bone strain; while the Titanium showed an intermediate behavior.
Topics: Benzophenones; Biomechanical Phenomena; Chromium Alloys; Dental Materials; Humans; Ketones; Materials Testing; Maxilla; Models, Anatomic; Palatal Obturators; Polyethylene Glycols; Polymers; Stress, Mechanical; Titanium
PubMed: 33125441
DOI: 10.1371/journal.pone.0241589 -
Clinical Oral Investigations Mar 2016In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis... (Review)
Review
OBJECTIVE
In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition.
MATERIALS AND METHODS
A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract.
RESULTS
Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting.
CONCLUSIONS
An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting.
CLINICAL RELEVANCE
The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.
Topics: Adolescent; Bone Transplantation; Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Maxilla; Orthodontics
PubMed: 26374747
DOI: 10.1007/s00784-015-1589-y -
BMJ Case Reports Sep 2020A 52-year male patient reported with loosening of right upper jaw. He has no pain or discharge, or any acute symptoms and systemic disease. Intraoral examination reveals...
A 52-year male patient reported with loosening of right upper jaw. He has no pain or discharge, or any acute symptoms and systemic disease. Intraoral examination reveals necrosed maxillary bone. He also has no sickle cell disease, hepatitis, HIV or tuberculosis. 3D CT scan reveals destruction of maxilla, maxillary sinus, lateral nasal wall, superior and inferior orbital wall, zygoma and frontal bone(outer table). The clinical diagnosis of osteomyelitis was made. Under general anaesthesia, sequestrectomy was done with the help of Weber-Ferguson incision with infraorbital extension for maxilla, maxillary sinus, zygomatic bone, lateral nasal wall and infraorbital and medial wall of orbit. Frontal sinus region sequestrectomy was done via bicoronal flap. The patient was completely diseased free after 4 years follow-up.
Topics: Frontal Sinus; Humans; Male; Maxilla; Middle Aged; Osteomyelitis; Tomography, X-Ray Computed; Zygoma
PubMed: 32928834
DOI: 10.1136/bcr-2020-236163 -
Orthodontics & Craniofacial Research Dec 2021This study aimed to quantify the 3D asymmetry of the maxilla in patients with unilateral cleft lip and palate (UCP) and investigate the defect factors responsible for...
OBJECTIVE
This study aimed to quantify the 3D asymmetry of the maxilla in patients with unilateral cleft lip and palate (UCP) and investigate the defect factors responsible for the variability of the maxilla on the cleft side using a deep-learning-based CBCT image segmentation protocol.
SETTING AND SAMPLE POPULATION
Cone beam computed tomography (CBCT) images of 60 patients with UCP were acquired. The samples in this study consisted of 39 males and 21 females, with a mean age of 11.52 years (SD = 3.27 years; range of 8-18 years).
MATERIALS AND METHODS
The deep-learning-based protocol was used to segment the maxilla and defect initially, followed by manual refinement. Paired t-tests were performed to characterize the maxillary asymmetry. A multiple linear regression was carried out to investigate the relationship between the defect parameters and those of the cleft side of the maxilla.
RESULTS
The cleft side of the maxilla demonstrated a significant decrease in maxillary volume and length as well as alveolar length, anterior width, posterior width, anterior height and posterior height. A significant increase in maxillary anterior width was demonstrated on the cleft side of the maxilla. There was a close relationship between the defect parameters and those of the cleft side of the maxilla.
CONCLUSIONS
Based on the 3D volumetric segmentations, significant hypoplasia of the maxilla on the cleft side existed in the pyriform aperture and alveolar crest area near the defect. The defect structures appeared to contribute to the variability of the maxilla on the cleft side.
Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Deep Learning; Female; Humans; Male; Maxilla; Spiral Cone-Beam Computed Tomography
PubMed: 33711187
DOI: 10.1111/ocr.12482 -
BioMed Research International 2014This systematic review was aimed at assessing the feasibility by means of survival rate, histologic analysis, and causes of failure of allogeneic block grafts for... (Review)
Review
PURPOSE
This systematic review was aimed at assessing the feasibility by means of survival rate, histologic analysis, and causes of failure of allogeneic block grafts for augmenting the atrophic maxilla.
MATERIAL AND METHODS
A literature search was conducted by one reviewer in several databases. Articles were included in this systematic review if they were human clinical trials in which outcomes of allogeneic bone block grafts were studied by means of survival rate. In addition other factors were extracted in order to assess their influence upon graft failure.
RESULTS
Fifteen articles fulfilled the inclusion criteria and subsequently were analyzed in this systematic review. A total of 361 block grafts could be followed 4 to 9 months after the surgery, of which 9 (2.4%) failed within 1 month to 2 months after the surgery. Additionally, a weighed mean 4.79 mm (95% CI: 4.51-5.08) horizontal bone gain was computed from 119 grafted sites in 5 studies. Regarding implant cumulative survival rate, the weighed mean was 96.9% (95% CI: 92.8-98.7%), computed from 228 implants over a mean follow-up period of 23.9 months. Histologic analysis showed that allogeneic block grafts behave differently in the early stages of healing when compared to autogenous block grafts.
CONCLUSION
Atrophied maxillary reconstruction with allogeneic bone block grafts represents a reliable option as shown by low block graft failure rate, minimal resorption, and high implant survival rate.
Topics: Atrophy; Bone Resorption; Bone Transplantation; Dental Implants; Humans; Maxilla; Osteogenesis; Survival Rate
PubMed: 25535616
DOI: 10.1155/2014/814578 -
Clinical Oral Investigations Jun 2021The aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP))...
Multivariate analysis of the influence of peri-implant clinical parameters and local factors on radiographic bone loss in the posterior maxilla: a retrospective study on 277 dental implants.
OBJECTIVES
The aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants.
MATERIALS AND METHODS
Two hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss.
RESULTS
Among the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively) CONCLUSIONS: ISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study.
CLINICAL RELEVANCE
Patients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss.
Topics: Alveolar Bone Loss; Dental Implants; Dental Prosthesis, Implant-Supported; Humans; Maxilla; Multivariate Analysis; Peri-Implantitis; Retrospective Studies
PubMed: 33155065
DOI: 10.1007/s00784-020-03666-x -
Clinical Oral Investigations Feb 2021Currently, empirical clinical findings on the blood supply of the maxillary vestibule are not backed up with sufficient literature. The purpose of this study was to...
OBJECTIVES
Currently, empirical clinical findings on the blood supply of the maxillary vestibule are not backed up with sufficient literature. The purpose of this study was to investigate the mucosal and periosteal vascular supply in the maxillary vestibule macroscopically and radiographically to improve surgical strategies and flap designs.
MATERIALS AND METHODS
Thirty head corpses were selected (9 dentate, 11 partially edentulous, 10 edentulous). Twenty-six corpses were injected by red latex milk and embalmed with Thiel solution. Four cadavers were prepared for corrosion casting. Arterial path and anastomoses in the maxillary vestibule of dentate, partially edentulous and edentulous ridges, were analyzed macroscopically and by computed tomography (CT).
RESULTS
Transverse periosteomucosal anastomoses were detected in the posterior and esthetic zones of the maxillary vestibule. The buccal branches penetrated the interdental septum toward the palate. In the esthetic zone, superior labial artery (SLA) supplied the mucosa and the infraorbital artery (IOA) supplied the periosteum. Corrosion casting showed anastomoses between IOA and nasal septal branches. CT analysis revealed ipsilateral and contralateral anastomoses between SLA and IOA. In dentate ridges, mucosal star-shaped terminal branches were detected.
CONCLUSIONS
The macroscopic and radiographic vascular survey analysis revealed the anatomical background behind several clinically documented phenomena related to oral and periodontal surgeries.
CLINICAL RELEVANCE
This study permits clinicians to design less invasive flaps when releasing incisions in the maxillary vestibule during periodontal and implant surgeries. Our observations strongly point to the significance of an undamaged periosteum to prevent compromised flap revascularization and wound healing disturbances.
Topics: Dental Implants; Esthetics, Dental; Gingiva; Maxilla; Surgical Flaps
PubMed: 32638127
DOI: 10.1007/s00784-020-03419-w