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ABSTRACT: Transgingival fixation screws are used for intermaxillary fixation in different situations. The aim of this study was to evaluate the risk of root trauma and tooth loss using pre-drilled transgingival fixation screws.
521 patients with mean age 26.9 (SD 9.9) years who had orthognathic surgery or trauma to the maxilla or mandible were selected for the study. Postoperative orthopantomographs (OPT) taken before and after screw removal were examined. The location of the screws and dental-root "hits" were recorded.
1663 screws were inserted either to the maxilla or to the mandible. 285 teeth (17.1%) showed radiologically proven contact between the dental roots and the screws or the dental roots were hit by the screw (screw inserted with more than the screws radius into the root). In three cases (0.2%) teeth were lost due to apical or periradicular inflammation, four teeth (0.2%) had to be root filled and five teeth (0.3%) were persistent painful at the follow-up examination before miniplate removal 10.3 (SD 8.1) months post-surgery.
Dental problems occurred in 0.7% at the screw insertions sites. The use of transgingival fixation screws showed a low risk of tooth loss. Root defects healed without any incident. However surgeons must be aware of possible consequences to provide a safe treatment.
Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 11/2011; 40(7):e214-7. · 1.25 Impact Factor
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ABSTRACT: Mandibular distraction osteogenesis is used in the treatment of patients with syndromic and nonsyndromic class II mandibular hypoplasia. The three-dimensional distraction of the mandible is extremely complex. Past experience with mandibular distraction has demonstrated the indispensability of solid presurgical planning to achieve predictable results. We report a method for a virtual three-dimensional planning of the bilateral mandibular distraction with intraoperative transfer by stereolithographic guides. Five patients (mean age, 22.8 years) with bilateral mandibular hypoplasia were examined with preoperative and postoperative computed tomographic scans. The direction and dimension of the distraction were planned on the three-dimensional computed tomographic scans. Tooth- and bone-borne stereolithographic guides for transferring the planning were then applied intraoperatively. It was feasible to transfer and perform the surgery as planned by the use of the stereolithographic drilling and cutting guides. The mean distraction width was 11.33 (SD, 8.32) mm. The mean difference of the distraction width between the planning and the achieved final mandibular position was 1.80 (SD, 0.43) mm. The intercondyle distance decreased by 3.28 (SD, 1.01) mm. A parallel distraction within the planned vectors was achieved. Mandibular distraction osteogenesis in the treatment of severe mandibular hypoplasia needs careful presurgical planning. Parallel distraction and fast placement of the distractors are provided by the planning. The method provides a useful tool for both planning and intraoperative transfer of the virtually preplanned distraction vectors.
The Journal of craniofacial surgery 11/2011; 22(6):2031-5. · 0.81 Impact Factor
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ABSTRACT: Different devices are available to aid surgically-assisted maxillary expansion. In this study we have evaluated the changes to the anchoring teeth, the hard palate, and the lower nasal passage made by tooth-borne distraction devices. Thirty-one patients (mean (SD) age 28 (2) years) with deficiencies in the transverse width of the maxilla were examined by computed tomography and cone beam scans before and after operation. The data were analysed with the help of Wilcoxon's signed rank test and Spearman's r correlation. The mean (SD) distraction width was 6.5 (2.3) mm. All anchorage teeth were tilted (p<0.01). The axes changed by a mean (SD) of 4.8 (0.9)° in the first premolar and 3.1 (0.8)° in the first molar. The nasal isthmus increased by a mean (SD) of 2.5 (0.3) mm. The hard palate adjacent to the anchoring teeth increased anteriorly by a mean (SD) of 2.8 (0.4) mm and posteriorly by 2.7 (0.4) mm. The hard palate was lowered by 1.2 (0.8) mm. There was a significant correlation in the distraction width, with changes in the intercoronal and interapical distances of the anchoring premolars (p<0.05) and with the interapical distance of the anchoring molars (p<0.01). There was also a correlation between the distraction width and the overall gain in width of the lower nasal passage (p<0.05). The results suggested that surgically-assisted maxillary expansion with tooth-borne devices has significant effects on the anchoring teeth, the nasal floor, and the hard palate. Both tilting of the teeth and an evenly distributed movement of the segments were seen.
British Journal of Oral and Maxillofacial Surgery 07/2011; 49(5):381-5. · 1.95 Impact Factor
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ABSTRACT: Different devices to perform a mandibular symphyseal distraction osteogenesis (MSDO) are available. This study evaluates how tooth borne distraction devices change to the teeth, the mandible and the condyles.
19 patients (mean age 27.1) with anterior width deficiencies of the mandible were examined with routine pre- and postoperative CT-scans 1 month before and 4 months after a mean distraction width of 5.68 mm (SD 0.88). The anchorage teeth of the tooth borne device were examined concerning displacement of their axes as well as the movement of the condyles and the mandibular symphysis. The data were evaluated using Wilcoxon signed rank test and Spearman rho correlation.
Significant tilting of the anchorage teeth was observed (p<0.01). The axes changed by 3.32° (SD 1.57) in the first premolar and by 2.63° (SD 1.75) in the first molar. A total of 2.67 mm (SD 1.17) of bone was formed on the symphysis. A significant correlation was found between distraction width and intercoronal distance changes of the anchorage teeth (p<0.01). No significant change of the intercondylar distance was found pre- and postoperatively in the Wilcoxon test.
MSDO with tooth borne devices has strong effects on the anchorage teeth. No severe effects on the condyles were observed. The postoperative width gain is a result of newly generated bone in the symphysis and tooth tilting. Nevertheless stable postoperative bite corrections are achievable.
Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 04/2011; 39(3):177-81. · 1.25 Impact Factor
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ABSTRACT: Surgically assisted rapid maxillary expansions (SARME) are commonly used to widen the maxilla. This study evaluates long term stability of surgically assisted rapid palatal expansion without performing osteotomy of the pterygoid plates and its effects on nasal airway volume.
13 patients (mean age 31, 23+/-6, 11) with a maxillary transverse deficit of at least 5mm were examined 1 month before and on average 63 months after a mean palatal distraction of 8.29+/-1.68mm by acoustic rhinometry. Profiles of the nasal airway volumes were collected. A cast model analysis was performed. The data were evaluated using Wilcoxon signed rank test.
A V-shaped movement of the segments was observed. The gain for total nasal volume was 23.25%. Findings indicate a significant enhancement of nasal volume in all patients (P<0.01) as result of the maxillary expansion. No relapse occurred in the study group.
SARME provides a long term stable orthodontic bite correction and permanently enhances the nasal airways. A transverse shift of the segments can be achieved over the whole bony palate even when no osteotomy of the pterygo-maxillary suture is performed.
Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 08/2009; 38(3):175-8. · 1.25 Impact Factor
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ABSTRACT: To analyze the number and type of complications during mandibular midline distraction.
The records of 100 consecutive patients who underwent mandibular midline distraction were evaluated, and complications which occurred up to 2 weeks after surgery were recorded.
Fourteen patients had complications during the distraction period. In four cases the screw of the appliance rotated back between the activations. In three cases the osteotomy had to be repeated because the symphysis did not open; two cases developed scar strictures, in another two a lower incisor fractured. One case developed an abscess, one a mandibular swelling, and one a large gingival recession.
Complications during or shortly after mandibular midline distraction surgery are relatively rare and mostly mild or transient. Only 3% of the patients presented irreversible damage. Thus, mandibular midline distraction appears to be a relatively safe method of expanding the mandible.
The Angle Orthodontist 02/2008; 78(1):20-4. · 1.21 Impact Factor
