Risk factors for post-orthognathic condylar resorption: a review.
ABSTRACT To evaluate the current evidence identifying risk factors for post-orthognathic mandibular condylar resorption.
Studies published between January 1980 and August 2006 related to post-orthognathic condylar resorption were identified by searching the following databases: PubMed, Medline, EMBASE, PsycInfo, DARE, CENTRAL, and the Cochrane database of systematic reviews. The following keywords were used to identify relevant publications: condylar resorption, progressive condylar resorption, condylar atrophy, dysfunctional remodeling, and condylysis. A hand search of these papers was also carried out to identify additional articles.
A number of methodological flaws are present within the current literature, including the comparison of nonmatched patient groups and poor imaging techniques, which makes evaluation difficult. Significant risk factors identified for condylar resorption include being female with mandibular retrognathia associated with an increased mandibular plane angle, the presence of pretreatment condylar atrophy, and undergoing posterior condylar displacement and upward and forward rotation of the mandible at the time of surgery.
Better-controlled studies are required to fully understand the link between condylar resorption and orthognathic surgery. A number of risk factors have been identified within this article. It is important for orthodontists to consider these, particularly when consulting patients for treatment and identifying patients who may require closer postsurgical follow-up.
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ABSTRACT: Objective: In order to understand the conflicting information on temporomandibular joint (TMJ) pathophysiologic responses after mandibular advancement surgery, an overview of the literature was proposed with a focus on certain risk factors. Methods: A literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases in the period from January 1980 through March 2013. Various combinations of keywords related to TMJ changes [disc displacement, arthralgia, condylar resorption (CR)] and aspects of surgical intervention (fixation technique, amount of advancement) were used. A hand search of these papers was also carried out to identify additional articles. Results: A total of 148 articles were considered for this overview and, although methodological troubles were common, this review identified relevant findings which the practitioner can take into consideration during treatment planning: 1- Surgery was unable to influence TMJ with preexisting displaced disc and crepitus; 2- Clicking and arthralgia were not predictable after surgery, although there was greater likelihood of improvement rather than deterioration; 3- The amount of mandibular advancement and counterclockwise rotation, and the rigidity of the fixation technique seemed to influence TMJ position and health; 4- The risk of CR increased, especially in identified high-risk cases. Conclusions: Young adult females with mandibular retrognathism and increased mandibular plane angle are susceptible to painful TMJ, and are subject to less improvement after surgery and prone to CR. Furthermore, thorough evidenced-based studies are required to understand the response of the TMJ after mandibular advancement surgery.Journal of applied oral science: revista FOB 02/2014; 22(1):2-14. DOI:10.1590/1678-775720130056 · 0.80 Impact Factor
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ABSTRACT: This case report describes the interdisciplinary treatment of a 19-year-old Brazilian man with a Class I malocclusion, a hyperdivergent profile, an anterior open bite, and signs of temporomandibular joint internal derangement. The treatment plan included evaluation with a temporomandibular joint specialist and a rheumatologist, orthodontic appliances, and maxillomandibular surgical advancement with counterclockwise rotation. Cone-beam computed tomography images were taken before and after surgery at different times and superimposed at the cranial base to assess the changes after orthognathic surgery and to monitor quantitatively the internal derangement of the temporomandibular joints and surgical relapse. Our protocol can improve the orthodontist's understanding of surgical instability, demonstrate the clinical value of cone-beam computed tomography analysis beyond the multiplanar reconstruction, and guide patient management for the best outcome possible. Copyright © 2014 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.American Journal of Orthodontics and Dentofacial Orthopedics 11/2014; 146(5):641-54. DOI:10.1016/j.ajodo.2013.11.026 · 1.44 Impact Factor
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ABSTRACT: Objective: Patients with Class II skeletal malocclusion and high occlusal plane angle are more susceptible to TMJ osteoarthritis. The objectives of this study were to evaluate condylar positional changes and remodeling after bimaxillary surgical advancement and to assess the outcomes of articular disc repositioning, using longitudinal 3D volume voxel-wise superimpositions one year following surgery. Method: Twenty-seven patients treated with maxillo-mandibular advancement had CBCTs taken before surgery (T1), immediately following surgery (T2) and at one-year follow-up (T3). Ten patients had no TMJ abnormality and received maxillo-mandibular advancement only (MMA). Seventeen patients had diagnosis of articular disc displacement before surgery and received maxillo-mandibular advancement with TMJ disc repositioning simultaneously (MMA_disc_rep). Result: Presurgery and postsurgery 3D virtual models were registered on the surface of the cranial base. The location, direction and magnitude of changes in the condyles between superimposed models was displayed and quantified by graphical overlay and 3D color-coded surface distance maps. Immediately after surgery, all MMA patients had condylar displacements >1.5mm in either posterior, superior or medio-lateral direction, while MMA_disc_rep patients presented more marked anterior, inferior and medio-lateral condylar displacements. At 1-year post-surgery, patients in the MMA group showed >1.5mm bone resorption of the condylar superior surface in 15% of the cases, anterior (25%), posterior (10%), medial (25%) and/or lateral poles (25%). MMA_disc_rep patients had >1.5mm condylar bone resorption at superior (29.4%), anterior (8.8%), posterior (20.6%), medial (23.5%) and/or lateral (38.2%) surfaces and bone apposition at superior (26.4%), anterior (23.4%), posterior (29.4%), medial (5.9%) and/or lateral (38.2%) surfaces. Conclusion: Post-surgical adaptations tended to compensate displacements with surgery in both groups. One year after surgery, mild condylar resorptive changes (post-surgical condylar adaptations) were observed in both groups, although articular disc repositioning facilitated bone overgrow in localized condylar regions.IADR/AADR/CADR General Session and Exhibition 2013; 03/2013