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Saghafi H, Benington P, Ju X, Ayoub A. The surgery-first approach for orthognathic correction of maxillary deficiency-is it stable? Three-dimensional assessment of CBCT scans and digital dental models. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00055-9. [PMID: 38448352 DOI: 10.1016/j.ijom.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
The aim of this study was to determine the skeletal stability of Le Fort I maxillary advancement following the surgery-first approach, by three-dimensional (3D) assessment of cone beam computed tomography (CBCT) scans and digital dental models. CBCT scans of 25 class III patients obtained 1 week preoperatively (T0) and 1 week (T1) and 6 months (T2) postoperatively were superimposed to measure surgical movements (T0-T1) and skeletal relapse (T1-T2). The distorted dentition of the CBCT scans at T1 was replaced with 3D images of the dental models to assess the postoperative occlusion. Surgical movements of the maxilla (mean ± standard deviation values) were 6.79 ± 2.30 mm advancement, 1.28 ± 1.09 mm vertically, and 0.71 ± 0.79 mm mediolaterally. Horizontal rotation (yaw) was 1.56° ± 1.21°, vertical rotation (pitch) 1.86° ± 1.88°, and tilting (roll) 1.63° ± 1.54°. At T2, the posterior relapse was 0.72 ± 0.43 mm (P = 0.001) and relapse in pitch was 1.56° ± 1.42° (P = 0.007). There was no correlation between the size of the surgical movements and the amount of relapse. A weak correlation was noted between the number of teeth in occlusal contact immediately following surgery and relapse of maxillary roll (r = - 0.434, P = 0.030). The stability of maxillary advancement with the surgery-first approach was satisfactory and was not correlated with the quality of the immediate postoperative occlusion.
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Affiliation(s)
- H Saghafi
- Glasgow University Dental Hospital and School, Glasgow, UK
| | - P Benington
- Glasgow University Dental Hospital and School, Glasgow, UK
| | - X Ju
- Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Hospital, Glasgow, UK
| | - A Ayoub
- Glasgow University Dental Hospital and School, Glasgow, UK.
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Ueki K, Moroi A, Takayama A, Yoshizawa K. Assessment of temporomandibular joint disc position and skeletal stability after bimaxillary surgery. Oral Maxillofac Surg 2024; 28:137-148. [PMID: 37280442 DOI: 10.1007/s10006-023-01161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE This study aimed to assess the correlation between temporomandibular joint (TMJ) disc position and skeletal stability and identify the cephalometric measurements associated with relapse after bimaxillary surgery. METHODS The participants were 62 women with jaw deformities (124 joints) who underwent bimaxillary surgery. The TMJ disc position was classified into four types (anterior disc displacement (ADD), anterior, fully covered, and posterior) using magnetic resonance imaging, and cephalometric analysis was performed preoperatively and 1 week and 1 year postoperatively. The differences between pre- and 1-week postoperative values (T1) and 1-week and 1-year postoperative value (T2) were calculated for all cephalometric measurements. Moreover, the relationship between skeletal stability using cephalometric measurements, skeletal class, and TMJ disc position was analyzed. RESULTS The participants included 28 patients in class II and 34 in class III. There was a significant difference in T2 in SNB between class II mandibular advancement cases and class III mandibular setback cases (P = 0.0001). In T2, in ramus inclination, there was a significant difference between the ADD and posterior types (P = 0.0371). Stepwise regression analysis revealed that T2 was significantly correlated with T1 for all measurements. However, the TMJ classification was not applied to all measurements. CONCLUSION This study suggested that TMJ disc position, including ADD, could not affect skeletal stability, including the maxilla and distal segment after bimaxillary osteotomy, and short-term relapse could be related to the movement amount or angle change by surgery for all measurements.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3893, Japan.
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3893, Japan
| | - Akihiro Takayama
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3893, Japan
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3893, Japan
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Grillo R, Borba AM, da Silva YS, Brozoski MA, Miloro M, Naclério-Homem MDG. Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:101-112. [PMID: 38155010 DOI: 10.1016/j.oooo.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery. STUDY DESIGN We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression. RESULTS Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence. CONCLUSIONS An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Alexandre Meireles Borba
- Research Program in Integrated Dental Sciences Department, Faculty of Dentistry of the University of Cuiabá, Cuiabá-MT, Brazil
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
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Shafaee H, Jahanbin A, Ghorbani M, Samadi A, Bardideh E. Electromyographic Evaluation of Masticatory Muscle Activity in Individuals with and without Cleft Lip/Palate: A Systematic Review and Meta-analysis. Cleft Palate Craniofac J 2023:10556656231201235. [PMID: 38037351 DOI: 10.1177/10556656231201235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE This study aims to systematically review and meta-analyze the electromyographic activity of masticatory muscles in cleft palate and non-cleft patients, and identify influencing factors. DESIGN Systematic Review and Meta-analysis. PATIENTS AND EXPOSURES Patients with cleft lip/ palate. COMPARISON Patients without CL/P. MAIN OUTCOME MEASURES Electrical activity of masseter and temporalis muscles at rest and during peak activation. RESULTS After a comprehensive search in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to December 2022, without language or date restrictions. Eligible trials were selected based on the PECO question and assessed for bias using Cochrane's ROBINS-E tool. Eight clinical trials with 474 participants were included in the review. Then relevant data was extracted from included studies using customized forms. A random-effects meta-analysis was performed to combine the results of the studies, meta-analyses showed that CL/P patients have elevated electrical activity in the masseter (P = .01) and temporalis (P = <.01) muscles at rest compared to non-cleft control patients. During maximum bite force, cleft patients exhibited a statistically significant decrease in electrical activity in both the masseter (P = .03) and temporalis (P = <.01) muscles. CONCLUSIONS According to our meta-analysis, cleft patients exhibited increased resting muscle activity but decreased activity during maximum bite force, indicating reduced efficiency of masticatory muscles compared to non-cleft patients. These differences can be attributed to anatomical variations, compensatory mechanisms, and previous treatments.
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Affiliation(s)
- Hooman Shafaee
- Orthodontics Department, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arezoo Jahanbin
- Orthodontics Department, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Ghorbani
- Undergraduate Student of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asma Samadi
- Undergraduate Student of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Erfan Bardideh
- Orthodontics Department, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Passalboni C, Taverne M, Lopez R, Rotenberg M, Lauwers F, Prevost A. Characterization of labiomandibular movements induced after isolated LeFort I osteotomy in the surgical management of class III malocclusion. PLoS One 2023; 18:e0292391. [PMID: 37812623 PMCID: PMC10561870 DOI: 10.1371/journal.pone.0292391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Maxillary surgery alone can be proposed for the surgical management of class III malocclusion, but anticipating outcomes for the labiomental muscle complex is challenging due to the mandibular autorotation phenomenon. The objective of this study was to quantify the mandibular and labiomental movements induced by maxillary osteotomy alone in the management of class III malocclusion according to different clinical and surgical variables. METHODS The post-operative changes in mandibular and labiomental shapes were studied by geometric morphometry from the pre- and post-operative lateral cephalometric radiograph of 25 patients. The explanatory variables tested were maxillary advancement, maxillary rotation, and divergence. RESULTS Soft tissues repositioning are different from postoperative mandibular repositioning after maxillary osteotomy. Neuromuscular adjustments of mandible depend on divergence and the maxillary rotation. Labiomental response only depends on divergence. CONCLUSION The surgical procedure does not have the same bone-related and musculocutaneous effects on patients with the same class III malocclusion. It is therefore essential for surgeons to understand the effects of their procedure on musculocutaneous tissues in order to best anticipate post-operative outcomes.
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Affiliation(s)
- Chris Passalboni
- Plastic and Maxillo-facial Surgery Department, Toulouse University Hospital Center, Toulouse, France
| | - Maxime Taverne
- Craniofacial Growth and Form Laboratory, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Lopez
- Plastic and Maxillo-facial Surgery Department, Toulouse University Hospital Center, Toulouse, France
| | - Maxime Rotenberg
- Dental Faculty, Department of Orthodontics, Toulouse University Hospital Center, Toulouse, France
| | - Frédéric Lauwers
- Plastic and Maxillo-facial Surgery Department, Toulouse University Hospital Center, Toulouse, France
| | - Alice Prevost
- Plastic and Maxillo-facial Surgery Department, Toulouse University Hospital Center, Toulouse, France
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Byun SH, Park SY, Yi SM, Park IY, On SW, Jeong CK, Kim JC, Yang BE. Clinical Stability of Bespoke Snowman Plates for Fixation following Sagittal Split Ramus Osteotomy of the Mandible. Bioengineering (Basel) 2023; 10:914. [PMID: 37627799 PMCID: PMC10452001 DOI: 10.3390/bioengineering10080914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Maxillofacial skeletal surgery often involves the use of patient-specific implants. However, errors in obtaining patient data and designing and manufacturing patient-specific plates and guides can occur even with accurate virtual surgery. To address these errors, bespoke Snowman plates were designed to allow movement of the mandible. This study aimed to compare the stability of bespoke four-hole miniplates with that of a bespoke Snowman plate for bilateral sagittal split ramus osteotomy (SSRO), and to present a method to investigate joint cavity changes, as well as superimpose virtual and actual surgical images of the mandible. This retrospective study included 22 patients who met the inclusion criteria and underwent orthognathic surgery at a university hospital between 2015 and 2018. Two groups were formed on the basis of the plates used: a control group with four-hole bespoke plates and a study group with bespoke Snowman plates. Stability was assessed by measuring the condyle-fossa space and superimposing three-dimensional virtual surgery images on postoperative cone-beam computed tomography (CBCT) scans. No significant differences were observed in the condyle-fossa space preoperatively and 1 year postoperatively between the control and study groups. Superimposing virtual surgery and CBCT scans revealed minimal differences in the landmark points, with no variation between groups or timepoints. The use of bespoke Snowman plates for stabilizing the mandible following SSRO exhibited clinical stability and reliability similar to those with bespoke four-hole plates. Additionally, a novel method was introduced to evaluate skeletal stability by separately analyzing the condyle-fossa gap changes and assessing the mandibular position.
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Affiliation(s)
- Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Min Yi
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - In-Young Park
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
- Department of Orthodontics, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea
| | - Sung-Woon On
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Chun-Ki Jeong
- Department of Dental Science & Technology, Shingu College, Seongnam 13174, Republic of Korea;
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Mir Dental Hospital, Daegu 41940, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; (S.-H.B.); (S.-Y.P.); (S.-M.Y.); (J.-C.K.)
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; (I.-Y.P.); (S.-W.O.)
- Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
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Valls-Ontañón A, Triginer-Roig S, Trujillo I, Brabyn PJ, Giralt-Hernando M, Hernández-Alfaro F. Three-dimensional evaluation of postoperative stability: a comparative study between surgery-first and surgery-late protocols. Int J Oral Maxillofac Surg 2023; 52:353-360. [PMID: 35871880 DOI: 10.1016/j.ijom.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/04/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
The main objective of this study was to compare the stability of the surgery-first and surgery-late approaches according to the standardized centre protocols, by three-dimensional evaluation after 1 year of follow-up. A retrospective study was designed that included a test group (surgery-first protocol) and a control group (surgery-late protocol), with a follow-up period of at least 1 year (average 14 months; range 12-24 months). Stability was evaluated using linear and angular measurements by superimposing cone beam computed tomography images obtained at specific points in time: preoperatively, 1 month after surgery, and at the end of the orthodontic treatment. A total of 56 patients with a mean age of 32.2 ± 11.1 years were included in the study. After surgery there were significant changes in all of the measurements in at least one dimension in both groups (except for the transverse maxillary dimension), which remained stable at the end of the treatment, with no statistically significant differences between the two groups. At the 1-year follow-up, both groups presented a SNA angle relapse; this relapse was more significant in the surgery-late group (P = 0.031) and was present only in Class III patients (P = 0.013). In conclusion, an equivalent three-dimensional stability between surgery-first and surgery-late protocols was demonstrated after 1 year of follow-up when eligibility criteria were strictly adhered to.
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Affiliation(s)
- A Valls-Ontañón
- Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
| | - S Triginer-Roig
- Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain
| | - I Trujillo
- Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain
| | - P J Brabyn
- Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain
| | - M Giralt-Hernando
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - F Hernández-Alfaro
- Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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Xue Z, Ye G, Qiu T, Liu X, Wang X, Li Z. An objective, quantitative, dynamic assessment of facial movement symmetry changes after orthognathic surgery. Int J Oral Maxillofac Surg 2023; 52:272-281. [PMID: 35753942 DOI: 10.1016/j.ijom.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study was to generate a quantitative dynamic assessment of facial movement symmetry changes after orthognathic surgery. Twenty-five patients diagnosed with skeletal class III malocclusion with facial asymmetry who underwent bimaxillary surgery were recruited. The patients were asked to perform a maximum smile that was recorded using a three-dimensional facial motion capture system preoperatively (T0), 6 months postoperatively (T1), and 12 months postoperatively (T2). Eleven facial landmarks were selected to analyse the cumulative distance and average speed during smiling. The absolute differences for the paired landmarks between the sides were analysed to reflect the symmetry changes. The results showed that the asymmetry index of the cheilions at T2 was significantly lower than that at T0 (P = 0.004), as was the index of the mid-lateral lower lips (P = 0.006). The mean difference in cheilions was 2.13 ± 1.41 mm at T0, 1.33 ± 1.09 mm at T1, and 1.00 ± 0.98 mm at T2. The facial total mobility at T1 was significantly lower than that at T0 (P < 0.001), while the total mobility at T2 was significantly higher than that at T1 (P = 0.012). The orthognathic surgical correction of facial asymmetry was able to improve the associated asymmetry of facial movements.
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Affiliation(s)
- Z Xue
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - G Ye
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - T Qiu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Z Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Park CH, Jeon JB, Oh S, Oh HK, Lee KM, Cho JH, Hwang HS, Oh MH. Comparison of short-term condylar positional changes in mandibular prognathism after surgery-first approach: Symmetric setback versus asymmetric setback. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e940-e947. [PMID: 35817318 DOI: 10.1016/j.jormas.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
The aim of this study was to compare how the displacement of the mandibular condyle changed after symmetric or asymmetric mandibular setback surgery using the surgery-first approach (SFA). Patients who underwent mandibular setback surgery using the SFA were selected and divided into a symmetry group (n = 18) with differences of less than 2 mm between the right and left setback, and an asymmetry group (n = 18) with a difference of greater than 2 mm. Cone-beam computed tomography (CBCT)-generated cephalograms were obtained after three-dimensional superimposition of CBCT images taken before surgery (T0), within one week after surgery (T1), and seven months after surgery (T2). The condylar positions were measured. Condylar positional changes according to time were compared between the two groups and correlation analysis was performed. There were significant positional changes in mandibular condyles over time in both groups. However, most of these changes returned to their initial state. In the asymmetry group, there was a greater internal rotation of the mandibular condyle on the lesser setback side. The correlation analysis results revealed that only the setback difference was associated with rotational displacement of the condyle on the lesser setback side at two time points (T1-T0, T2-T0). In the SFA, significant condylar displacement occurred immediately after both symmetric and asymmetric mandibular setback surgery, and the right/left difference in mandibular setback showed a significant positive correlation with rotational displacement. Although more significant rotational displacement of the mandibular condyle was observed after asymmetric mandibular setback surgery, the amount was not large enough to be clinically significant.
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Affiliation(s)
- Chae-Hee Park
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Jun-Bo Jeon
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Seungwon Oh
- Department of mathematics & Statistics, Chonnam National University, Gwangju, Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Kyung-Min Lee
- Department of Orthodontics, School of Dentistry, Dental 4D Research Institute, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Jin-Hyoung Cho
- Department of Orthodontics, School of Dentistry, Dental 4D Research Institute, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Hyeon-Shik Hwang
- Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju; Korean Adult Orthodontic Research Institute, Seoul, Korea
| | - Min-Hee Oh
- Department of Orthodontics, School of Dentistry, Dental 4D Research Institute, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.
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Imampai S, Patchanee S, Klaisiri A, Chaiprakit N. Evaluation of Skeletal Changes after Mandibular Setback Surgery Using the NM-Low Z Plasty Technique in Skeletal Class III Patients. Eur J Dent 2022. [PMID: 35785823 DOI: 10.1055/s-0042-1749364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Bilateral sagittal split osteotomy (BSSO) is a standard mandibular setback procedure for skeletal class III patients. Our center has been using NM-Low Z plasty, a BSSO modification, since 2016. The study's objective was to evaluate skeletal changes in 38 skeletal class III patients following mandibular setback surgery using NM-Low Z plasty. With Dolphin Imaging software, three lateral cephalograms were traced and digitized: T0, T1, and T2. The distance between the B-point and the SN7 perpendicular line defined immediate changes after surgery (T1-T0) and stability after surgery (T2-T1). The reliability test included 6 cephalograms retraced after 2-week interval. At point B, the principal result was horizontal movement forward. STATISTICAL ANALYSIS The analysis used paired t-tests. RESULTS The mean mandibular setback was 9.78 mm, and the mean skeletal relapse was 2.61 mm, or 26.69%. Statistical analysis showed postoperative differences (p < 0.05). Vertical measurement in B-SN7 reduced immediately and postoperatively. CONCLUSION Postoperatively, the mandible relapsed significantly forward and upward. Rotational relapse is a concern with NM-Low Z plasty in hypo-/: normodivergent patients.
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Affiliation(s)
- Sarunpong Imampai
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Bangkok, Thailand
| | - Siripatra Patchanee
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Bangkok, Thailand.,Thammasat University Research Unit in Mineralized Tissue Reconstruction, Thammasat University, Bangkok, Thailand
| | - Awiruth Klaisiri
- Division of Restorative Dentistry, Faculty of Dentistry, Thammasat University, Bangkok, Thailand.,Thammasat University Research Unit in Restorative and Esthetic Dentistry, Thammasat University, Bangkok, Thailand
| | - Narissaporn Chaiprakit
- Thammasat University Research Unit in Mineralized Tissue Reconstruction, Thammasat University, Bangkok, Thailand.,Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thammasat University, Bangkok, Thailand
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Elkaseh A, Shayeb MA, Kuduruthullah S, Elsubeihi ES. Cephalometrics of Libyan adults. Asian J Surg 2021; 45:1089-1094. [PMID: 34627686 DOI: 10.1016/j.asjsur.2021.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/14/2021] [Accepted: 08/13/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Cephalometric radiography enables a physician to identify specific areas of craniofacial disproportionality and decide on a treatment plan. Cephalometric analysis is a method for localizeing malocclusion with the facial skeleton and soft tissue structures. This study reports the results from the cephalometric analysis of Libyan adults, as a surrogate for the population of North Africa. METHODS Lateral cephalometric radiographs were taken of 100 non-growing Libyan adults: 74 males and 26 females, aged 17-45 years. All subjects had no previous orthodontic treatment. The mean values and standard deviations of 92 parameters were determined. RESULTS The hard tissue cephalometric analysis revealed lower variability in the length of vertical distances compared to those extending more horizontally. In adult Libyans, linear and angular midface measurements (hard tissue and soft tissue) exhibit less variability compared to other measurements taken. Libyans exhibit some of the structural deviations from Bolton's means that were previously found in Americans of African descent. Namely, they are characterized by the greater development of the maxillomandibular complex and by the presence of dentoalveolar protrusion, which must be taken into account when treating patients of this ethnic group. CONCLUSION The current study once again confirmed the need to develop cephalometric norms for different ethnic groups, the Arab population in North Africa in particular.
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Affiliation(s)
- Abed Elkaseh
- Surgical Science Department, Ajman University, Ajman, United Arab Emirates
| | - Maher Al Shayeb
- Surgical Science Department, Ajman University, Ajman, United Arab Emirates; Center of Medical and Bioallied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.
| | - Syed Kuduruthullah
- Basic Medical Science Department, Ajman University, Ajman, United Arab Emirates; Center of Medical and Bioallied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Emad S Elsubeihi
- Restorative Dentistry Department, Ajman University, Ajman, United Arab Emirates
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Sinha SP, Duong TDH, Duy TDT, Ko EWC, Chen YR, Huang CS. Penetration of inferior alveolar nerve canal increased by bicortical fixation after bilateral sagittal split osteotomy in mandibular prognathism. Int J Oral Maxillofac Surg 2021; 51:200-205. [PMID: 33985866 DOI: 10.1016/j.ijom.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/10/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this three-dimensional cone beam computed tomography (CBCT) study was to identify the difference between monocortical fixation (MCF) and bicortical fixation (BCF) in mandibular canal penetration after bilateral sagittal split osteotomy (BSSO) to correct mandibular prognathism, where interosseous fixation was done by BCF or MCF. CBCT was performed 1 week postoperatively and Dolphin 3D software was used to assess direct penetration of the mandibular canal by either type of screw. The primary outcome variable was the presence or absence of mandibular canal penetration and was categorized as a binary coded variable. The BCF and MCF groups were compared by χ2 test, and the odds ratio for canal penetration was estimated. Multiple logistic regression was performed to identify factors related to canal penetration. A total of 118 patients were included. The MCF group had only 6% canal penetrations (3/50 patients) and the BCF group had 58.8% canal penetrations (40/68 patients). The regression model showed that BCF was the only factor causing mandibular canal penetration, with an adjusted odds ratio of 52.5. Awareness of the increased risk of canal penetration with BCF and potential nerve injury might influence case selection.
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Affiliation(s)
- S P Sinha
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - T D H Duong
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Maxillofacial Surgery and Odonto-stomatology, National Children's Hospital, Hanoi, Viet Nam
| | - T-D T Duy
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Orthodontics, Ho Chi Minh City Dental Hospital, Ho Chi Minh City, Viet Nam
| | - E W-C Ko
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-R Chen
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - C S Huang
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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13
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Wang M, Zhang B, Li L, Zhai M, Wang Z, Wei F. Vertical stability of different orthognathic treatments for correcting skeletal anterior open bite: a systematic review and meta-analysis. Eur J Orthod 2021; 44:1-10. [PMID: 33822036 DOI: 10.1093/ejo/cjab011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several orthognathic procedures have been applied to correct skeletal anterior open bites (SAOB). Which method is most stable has been debated and no consensus has been reached and there is no conclusive evidence for clinicians to use. OBJECTIVE To analyse whether maxillary, mandibular, or bimaxillary surgery provides a better stability. MATERIALS AND METHODS A systematic search was conducted up to December 2020 using PubMed, EMBASE, Medline, Scopus, Web of Science, Cochrane CENTRAL, and Google Scholar. We made direct comparisons among the controlled trials and also made indirect comparisons via subgroup analysis on the aspects of occlusional, skeletal, and dento-alveolar stability to assess the overall stability of each method. RESULTS Finally 16 cohort studies were identified. At the occlusional level, pooled change in overbite was 0.21 mm in maxillary surgery, 0.37 mm in bimaxillary surgery, and -0.32 mm in mandibular surgery. At the skeletal level, pooled sella-nasion-Point A angle (SNA) was -0.12 degrees in bimaxillary surgery, -0.37 degrees in maxillary surgery and -0.20 degrees in mandibular surgery. The sella-nasion to palatal plane angle (SNPP) relapsed to a statistically significant degree in all samples received single maxillary surgery. Relapse of the sella-nasion-Point B angle (SNB) was 0.47 degrees in mandibular setback, -1.8 degrees in mandibular advancement, and -0.48 degrees in maxillary surgery. The Sella-Nasion to mandibular plane angle (SNMP) relapsed more in procedures involving bilateral sagittal split osteotomy than in other procedures. As for dento-alveolar changes, intrusion of molars and extrusion of incisors took place in most patients. CONCLUSIONS Bimaxillary surgery produced the most beneficial post-operative increase in overbite, maxillary surgery led to a lesser but still positive overbite change, and mandibular surgery correlated with some extent of relapse. Skeletally, bimaxillary surgery was more stable than maxillary surgery at both SNA and SNPP; SNB was more stable in mandibular setback than advancement; and SNMP was unstable in both mandibular and bimaxillary surgeries versus maxillary surgery with comparable surgical changes. Dento-alveolar compensation helped maintain a positive overbite. REGISTRATION NUMBER CRD42020198088.
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Affiliation(s)
- Mengqiao Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Bowen Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Lan Li
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Mingrui Zhai
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Zhengyan Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Fulan Wei
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
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Barone M, De Stefani A, Baciliero U, Bruno G, Gracco A. The Accuracy of Jaws Repositioning in Bimaxillary Orthognathic Surgery with Traditional Surgical Planning Compared to Digital Surgical Planning in Skeletal Class III Patients: A Retrospective Observational Study. J Clin Med 2020; 9:jcm9061840. [PMID: 32545621 PMCID: PMC7355953 DOI: 10.3390/jcm9061840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Technological progress has led to the transition to digital methods to perform surgical planning and to obtain surgical splints with CAD/CAM technologies. The present study aimed to compare the accuracy of jaw repositioning in bimaxillary orthognathic surgery using traditional and digital surgical planning in skeletal class III patients. Methods: This study included 60 skeletal class III patients divided into two groups based on the method used to perform surgical planning: traditional (T, n = 30) and digital (D, n = 30). For each patient, a 2D presurgical Visual Treatment Objective (VTO) was prepared and the outcome of the surgery was compared with that planned by using determined cephalometric measurements (ANB, SNA, SNB, Ar-Go-Me, S-Ar-Go). Statistical analysis showed that the measurements planned and those obtained after surgery were equivalent in Group D. For Group T, the analysis showed equivalence only for one of the considered measurements (ANB). By comparing the results of the two groups, Group D presented a lower level of error than Group T. Conclusions: Digital surgical planning performed significantly better in terms of accuracy of jaw repositioning than the traditional protocol.
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Affiliation(s)
- Martina Barone
- Department of Neuroscience, School of Dentistry, University of Padua, 35100 Padua, Italy; (M.B.); (G.B.); (A.G.)
| | - Alberto De Stefani
- Department of Neuroscience, School of Dentistry, University of Padua, 35100 Padua, Italy; (M.B.); (G.B.); (A.G.)
- Correspondence: ; Tel.: +39-33-4334-5850
| | - Ugo Baciliero
- Maxillofacial Surgery Complex Unit of San Bortolo Hospital of Vicenza (Italy), 36100 Vicenza, Italy;
| | - Giovanni Bruno
- Department of Neuroscience, School of Dentistry, University of Padua, 35100 Padua, Italy; (M.B.); (G.B.); (A.G.)
| | - Antonio Gracco
- Department of Neuroscience, School of Dentistry, University of Padua, 35100 Padua, Italy; (M.B.); (G.B.); (A.G.)
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