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ABSTRACT: The aim of the present study was to retrospectively review the treatment outcome of low subcondylar temporomandibular joint fractures. The retrospective analysis was performed on all patients treated for low subcondylar fractures (below the sigmoid notch) between 2006 and 2011. Patients were divided into two groups: the closed reduction group (maxillomandibular fixation, MMF) and the open reduction group (anteroparotid transmasseteric (APTM) approach). Out of 129 condylar fractures, a total of 37 patients met the inclusion criterion of a fracture below the sigmoid notch (low subcondylar). Ten patients (seven males and three females) were treated using the APTM approach, and 27 patients were treated conservatively by MMF. In the open reduction group, two patients (20%) had limited mouth opening that resolved following physiotherapy; the closed reduction group had a similar percentage (18.5%) of mouth opening limitation (below 35mm). No facial nerve damage was noted. Adult patients suffering from low subcondylar fractures can be treated by open reduction and internal fixation using the APTM approach, which was found to be a safe and reproducible procedure with no facial nerve damage; however this is a surgical procedure with a shallow learning curve.
International Journal of Oral and Maxillofacial Surgery 04/2013; · 1.51 Impact Factor
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ABSTRACT: Squamous cell carcinoma developed around dental implants has seldom been described. It simulates peri-implantitis. The authors present two cases and a literature review.
A 70 year-old woman presented with an exophytic tumor developed around dental implants placed in the anterior part of the mandible. Panoramic X-rays showed major osteolysis, especially around the distal abutment implants. A 72 year-old patient, smoker, presented with chronic lichen planus; he was carrying two implants supporting an overdenture with ball-attachments, placed 15 years before. He presented with an ulcerated symphyseal tumor, bone loss around implant in position 43. The implant had been spontaneously pushed out. In both cases the diagnosis was squamous cell carcinoma.
Few cases of squamous cell carcinoma developed around dental implants have been reported. They initially mimic peri-implantitis. The carcinogenic role of the implant has never been established. Another hypothesis is the migration of malignant cells, originating from a mucosal tumor, through the sulcus. Risk factors for squamous cell carcinoma (smoking or alcohol consumption, precancerous lesions) are an indication for a permanent follow-up. Biopsies will prove the diagnosis.
Revue de Stomatologie et de Chirurgie Maxillo-faciale 12/2007; 108(5):458-60. · 0.25 Impact Factor
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ABSTRACT: The incidence of lipoma in the parotid gland is very low, and lipomas in the deep lobe of the parotid are extremely rare and seldom considered in the differential diagnosis of deep lobe parotid gland tumours. A deep lobe parotid gland lipoma is presented and discussed.
Annales de Chirurgie Plastique Esthétique 07/2006; 51(3):239-42. · 0.41 Impact Factor
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ABSTRACT: Several conflicting findings have been published in previous literature regarding the effects of impacted third molar extraction on the periodontal health of the adjacent second molar; some authors have shown improvement of periodontal health distal to the adjacent second molar, whilst others have demonstrated loss of attachment and reduction of alveolar bone height. The purpose of this controlled clinical and radiographic study is to evaluate the long-term changes in periodontal health and alveolar bone height distal to the adjacent second molar following extraction of an impacted third molar. This split-mouth design study included 25 patients who underwent extraction of one mandibular impacted third molar (test), whereas the opposite tooth remained intact (control). Pre-operative and current-state panoramic radiographs were than scanned, and alveolar bone height was digitally measured on the distal aspect of the second molar on the test and control sides. Current-state clinical measurements were performed on both sides, and consisted of plaque index, gingival index, periodontal pocket depth, gingival margin position and clinical attachment level. Student's t-test for paired observations was used in order to examine the statistical significance of the differences in clinical parameters between the test and control sides and the differences in alveolar bone height pre- and post-operatively on both sides. Extraction of an impacted third molar resulted in a significant gain of alveolar bone height on the distal aspect of the adjacent second molar on the test side, whereas slight bone loss was noted on the control side. Even though the difference in plaque index between the test and control sides approached statistical significance following extraction, all clinical parameters seem to be unchanged. Further follow-up on clinical and radiological parameters is required for a more profound understanding of the long-term effects of third molar extraction on the periodontal health of the adjacent second molar.
International Journal of Oral and Maxillofacial Surgery 11/2005; 34(7):756-60. · 1.51 Impact Factor
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ABSTRACT: Cleft lip and palate patients often present maxillary retrusion and class III malocclusion after cleft repair. Maxillary distraction is a technique that can provide simultaneous skeletal advancement and expansion of soft tissue. Twelve patients with cleft maxillary deficiency due to cleft lip and palate were treated by Le Fort I osteotomy and two intraoral distraction devices that were activated after 4 days of latency period, 1mm per day on both sides. Long-term clinical and cephalometric evaluation of one and two years demonstrate stable results concerning the skeletal, dental and soft tissue relations. In this paper we discuss the advantages of distraction osteogenesis as a method for treatment of maxillary deficiency in cleft patients in terms of stability and relapse. The indications for maxillary distraction: (1) Moderate and severe retrusion that needs large advancement as in cleft lip and palate patients. (2) Forward and downward lengthening of the maxilla with no need for intermediate bone graft. (3) Growing patients. In conclusion, maxillary distraction in moderate or severe retrusion, as in cleft patients offers marked maxillary advancement with long-term stability.
International Journal of Oral and Maxillofacial Surgery 08/2005; 34(5):473-9. · 1.51 Impact Factor
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ABSTRACT: The purpose of this study was to present the method of mandibular distraction osteogenesis in order to improve airway to respiratory distressed patients due to significant mandibular deficiency, and to present the quantitative volumetric evaluation of mandible and upper airway using three-dimensional-CT (3D-CT) before and after distraction. This study involved 12 patients aged 12 months to seven years with various complaints of Obstructive Sleep Apnea (OSA) such as noisy breathing during sleep, waking episodes, pauses in respiration and daytime somnolence. Some of them were considered tracheostomy candidates. All the patients underwent bilateral mandibular distraction under general anesthesia. 3D-CT of face and neck was performed before and after distraction and a quantitative volumetric evaluation of mandibular volume and airway volume was performed. The results reveal successful mandibular advancement with increase of mandibular volume by an average of 28.24% and increase of upper airway volume with a mean of 71.92%. Moreover, there were improved apnea index and oxygen saturation and elimination of OSA symptoms. In conclusion, the results demonstrate that following distraction osteogenesis of hypoplastic mandible the volume of the mandible and upper airway increases, eliminating symptoms of OSA and preventing tracheostomy.
International Journal of Oral and Maxillofacial Surgery 02/2005; 34(1):9-18. · 1.51 Impact Factor
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ABSTRACT: Orbital abscesses are common infectious diseases. The etiology of orbital abscesses may vary from common sinusitis in most of the cases, to cocaine sniffing. As a result of the proximity to the brain, orbital abscesses may complicate to life threatening situations. The infectious process spreads to the orbit in several ways: hematogenous, via anatomic spaces in the maxillofacial region, direct invasion. The treatment philosophy combines surgical and Antibiotic therapy to resolve the acute phase of the disease, followed by elimination of the source. The purpose of this paper is to report a case of pre septal orbital cellulitis, that was treated surgically combined with endodontic therapy. To describe the different subtypes of orbital abscesses, differential diagnosis, imaging and treatment options.
Refuʾat ha-peh ṿeha-shinayim (1993) 08/2004; 21(3):60-4, 95.
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ABSTRACT: Replacing missing teeth with osseointegrated dental implants is a predictable technique as evidanced by overall 5-years survival rate that range between 93% to 97%. Few studies, however have adressed the history and frequency of inflammatory complication associated with dental implant. Inflammatory complications are the main cause of failure of dental implants. In this review we classified the inflammatory complications to acute and chronic and to those limited to the hard tissue, to the soft tissue or both. The incidence of the complications is discussed with an emphasis on their risk factors.
Refuʾat ha-peh ṿeha-shinayim (1993) 05/2004; 21(2):55-62, 98.
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ABSTRACT: Replacing missing teeth with osseointegrated dental implants is a predictable technique as evidenced by the overall five-year implant survival rates ranging 93% to 97%. Few studies, however, address systematically the frequency or natural history of complications related to the use of dental implants. Reported complication rates range so widely, i.e. 1%-40%, as to be rendered clinically meaningless. Differences in reported rates may be attributable to differing definitions of complications. Even less has been written about risk factors for developing surgical complications related to the use of dental implants. Knowledge regarding the type and frequency of complications that can occur with implants is an important aspect of treatment planning, surgeon-patient communication, informed consent and post-treatment care. The purposes of this chapter are to: 1) summarize the reported types and frequencies of implant-associated complications, 2) identify risk factors for developing complications associated with the use of dental implants, and 3) to suggest strategies to avoid complications.
Refuʾat ha-peh ṿeha-shinayim (1993) 08/2003; 20(3):20-6, 99.
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ABSTRACT: Immediate loading of dental implants aims to shorten treatment time. Stability at implant insertion is critical to success. The aim of this prospective study is to compare primary implant stability, measured by insertion torque (IT) with resonance frequency analysis (RFA) expressed as ISQ. Patients requiring implant therapy were treated by teeth extractions, placement of 1-9 MIS implants, bone augmentation as needed and fixed provisional restorations. We measured IT and ISQ for non-submerged loaded (NSL), non-submerged non loaded (NSNL) and submerged (S) implants. 14 patients, aged 34-79 years, were recruited. 53 implants were inserted (38 maxillary & 15 mandibular). 30 implants, 18 in fresh extraction sites, were immediately loaded. ISQ was 63.3 +/- 2.8 (S.E.), 67.2 +/- 3.5 (S.E.) and 58.8 +/- 2.7 for the NSL, NSNL and S groups, respectively (p = 0.0459). IT was 40.4 +/- 1.8 Ncm, 46 +/- 4.0 and 35.3 +/- 2.1 (p = 0.0646). ISQ and IT were not statistically different between extraction vs. non-extraction and augmented vs. non-augmented sites. We found a significant difference in IT between maxillary & mandibular sites, and a significant correlation between ISQ & IT and between ISQ & implant diameter. These data suggest that ISQ is correlated to IT and is influenced mainly by implant diameter and not by implant length, location or bone level. Finally, a case including immediate implants, bone augmentation and immediate provisional restoration is presented.
Refuʾat ha-peh ṿeha-shinayim (1993) 07/2003; 20(3):80-8, 104.
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ABSTRACT: An integral component of apicoectomy procedure is the placement of a root end filling material. In this 20 years literature review we identified at least 19 different materials that have been used as root end filling materials. Unfortunately, the ideal material for this purpose is yet to be found. Amalgam is the most frequently used material in apicoectomy procedure and can lead to satisfying results in many cases. IRM, super EBA and MTA are more suitable materials, and give better results in apicoectomy procedures than Amalgam. IRM and super EBA are both ZOE cements. Super EBA is less cytotoxic than IRM, suggesting that the decreased eugenol in Super EBA allows it to be less irritating. MTA gives better results when tested for leakage and biocompatibility than IRM and Super EBA, and has the ability of induction of hard tissue. A possible disadvantage that prevents MTA from being acceptable as "the ideal root-end filling material" is a long setting time that may lead to dislodgment or deformation from root end preparation. Yet, in most cases MTA serves as the best choice for a root end filling material.
Refuʾat ha-peh ṿeha-shinayim (1993) 05/2003; 20(2):49-54, 80.
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ABSTRACT: Eagle syndrome is an aggregate of symptoms that includes recurrent throat pain, foreign body sensation, dysphagia, and/or facial pain as a direct result of an elongated styloid process or calcified stylohyoid ligament. The etiology is poorly understood and several theories have been proposed. The pathophysiological mechanism of symptoms is debated as well. Diagnosis is made both radiographically and by physical examination. Treatment of Eagle syndrome is either surgical or non surgical. A case report of temporomandibular joint pain that has been finally diagnosed as Eagle syndrome is presented and discussed.
Refuʾat ha-peh ṿeha-shinayim (1993) 02/2003; 20(1):44-5, 80.
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ABSTRACT: Invasive and malignant tumors of the oral soft tissues adjacent to the mandible are often treated with partial resection of the osseous structure adjacent to the lesion (marginal mandibulectomy). Autogenous bone graft and composite bone grafts are being used to fill the osseous defects with various degrees of success. The aim of the present study was to explore the utilization of membrane barriers and the principle of guided bone regeneration to negotiate these defects.
Following the removal of P1, P2, and P3, experimental bilateral marginal mandibulectomy defects were created in 4 adult dogs. The bone segments (measuring 25 mm x 15 mm) were then removed. Each side was then randomly selected for either experimental (titanium-reinforced expanded polytetrafluoroethylene membrane, [ePTFE-TR]) or control (repositioning flaps) treatment. Postoperatively, the animals were put on soft diet, antibiotics, and analgesics. Sutures were removed under light sedation after 4 weeks, and the area was left to heal and mature for 4 to 6 months (mean 5.3 months). The animals were then sacrificed, and block sections of the mandible were obtained for macroscopic and histological evaluation.
The size of the residual defect (the vertical distance between the most apical depression in the ridge and the horizontal line connecting the free gingival margins of the proximal teeth) in the experimental sites (6.10 +/- 1.00 mm) was much smaller compared to the controls (10.65 +/- 0.82 mm), which was statistically significant (P = 0.0127). Histomorphometric measurements of new bone formation (NBF) revealed a similar pattern: for the experimental sites, NBF was 8.08 +/- 0.85 mm compared to 4.99 +/- 0.61 mm in the controls. These differences were also statistically significant (P = 0.0257).
A regenerative approach to large mandibular osseous defects has been described. If this new treatment modality is further substantiated in other independent studies, it might prove a useful tool in restoring the lost osseous structure associated with marginal mandibulectomy procedures.
Journal of Periodontology 01/2003; 73(12):1451-6. · 2.60 Impact Factor
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ABSTRACT: Dental implants are a functional and esthetic solution to partial and total edentulism. The initial success rate of this treatment modality is 90-95%. But, that treatment modality is not free of complications. One of the rare complications yet, with severe clinical results is fracture of dental implants. The current literature review presents the various causative factors that may lead to implant fracture. Implant failures may be sorted into groups by the timing of their appearance, or by the origin of failure. Fractures belong to the group of late complications, caused by a biomechanical overload. Overload may be caused by inappropriate seat of the superstructure, in-line arrangement of the implants, leverage, heavy occlusal forces (bruxing, clenching), location of the implant and the size of the implant or metal fatigue. Good clinical examinations and correct treatment plans may reduce the risk of implant fracture.
Refuʾat ha-peh ṿeha-shinayim (1993) 11/2002; 19(4):19-24, 68.
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ABSTRACT: Saliva plays an important role in maintaining the oral and the dental health, by lubricating the mucosae and protecting the teeth from caries attack. Furthermore, saliva participates in the taste sensation and recognition processes and is a central component in the first stage of the food digestion. Saliva collection, either in the pure or in the whole form, is a relatively easy procedure. Since the collection is non invasive, it is not harmful to the patient and has no complications. The paper discusses the use of saliva in the diagnosis of oral and systemic diseases and in monitoring the levels of molecules like hormones and medicines. The experience accumulated in our department in that field is also presented.
Refuʾat ha-peh ṿeha-shinayim (1993) 08/2002; 19(3):51-6, 90.
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ABSTRACT: Alveolar bone is particularly sensitive to increased levels of parathyroid hormone (PTH) from either primary or secondary hyperparathyroidism (HPT). The purpose of this study was to examine the effect of secondary HPT on the periodontium of patients on hemodialysis.
The experimental group consisted of 35 patients with secondary HPT, with chronic renal failure treated by hemodialysis (E group). A control group (C group) was formed from 35 healthy age- and gender-matched subjects attending the maxillofacial outpatient clinic for a variety of reasons. Blood samples were taken from the E group, and the biologically active intact parathormone molecule, PTH(1-84), was assayed using two-site immunoradiometric assay (IRMA). The time of onset and the duration since diagnosis of HPT was also recorded. In addition, for a subgroup of 25 matched pairs of patients, a clinical periodontal examination was performed, and the Ramfjord index teeth were recorded for: Plaque index (PI); Gingival index (GI); Probing depth (PD); and Clinical attachment level (CAL). A standardized panoramic X-ray was taken from all patients and computer-based linear measurements were used to assess alveolar bone loss (BL). Unpaired Student's t-test served to compare the two groups. Pearson's correlation coefficient test was used to study the association between PI, PTH level, disease duration and BL.
Demographically, both groups were similar with no statistical difference. PI was also similar in the C and E group (2.03 +/- 0.13 and 1.76 +/- 0.17, respectively). GI, however, was slightly greater in the C group (1.28 +/- 0.09) compared to the E group (0.97 +/- 0.01). PD in the E group (2.92 +/- 0.14 mm) was almost identical to that of the C group (2.90 +/- 0.12 mm). Likewise, CAL in the E group (4.43 +/- 0.29 mm) did not differ from CAL in the C group (4.03 +/- 0.25 mm). Mean BL was also similar in the E and C groups (3.60 +/- 0.23 mm and 3.85 +/- 0.24 mm, respectively). PI showed a positive, significant correlation with BL (r = 0.457, P = 0.0008).
From this study it can be concluded that secondary HPT does not have an appreciable effect on periodontal indices and radiographic bone height.
Journal Of Clinical Periodontology 07/2002; 29(6):479-83. · 3.00 Impact Factor
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ABSTRACT: Le Fort I osteotomy fails in many cases to completely separate the pterygomaxillary junction and often results in fractures of the pterygoid bone and the tuberosity, which subsequently can cause complications. The objectives of this study were to describe the specifically developed Laster 'shark-fin' osteotome and to compare its use to other methods of pterygomaxillary dysjunction. Pterygomaxillary dysjunction was performed in 10 adult patients requiring Le Fort I osteotomy. In one randomly chosen side of the maxilla, the Obwegeser osteotome was used, while the Laster 'shark-fin' osteotome was used on the opposite side. A postoperative computerized tomography of the separation at the pterygomaxillary junctions revealed that in all sites treated with the Laster 'shark-fin' osteotome, a complete or almost complete separation was obtained, whereas the use of the Obwegeser osteotome resulted in five sites with fractures of the maxillary tuberosity and three with high-level fractures of the pterygoid plates (P<0.001). Comparing these findings with the literature, we concluded that the Laster 'shark-fin' osteotome is preferable for separating the pterygomaxillary junction in Le Fort I osteotomy.
International Journal of Oral and Maxillofacial Surgery 02/2002; 31(1):100-3. · 1.51 Impact Factor
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ABSTRACT: Distraction osteogenesis is an alternative method for reconstructing atrophic alveolar bone. Fourteen patients underwent vertical alveolar distraction by the LEAD SYSTEM-Endosseous Alveolar Distraction System (Stryker Leibinger, Kalamazoo, MI). An alveolar segmental osteotomy was carried out and the vertical distraction device was mounted. In patients with an extensive alveolar defect, two distraction devices were placed in order to better control the vector of elongation in both bone edges. The distraction was started on the fourth postoperative day at a rate of 0.8 mm/day for 10-16 days, followed by a consolidation period of 60 days. Vertical distraction osteogenesis (VDO) was completed successfully in all patients with segment lengths in the range of 8 to 13 mm and with an average of 10.3 mm. Subsequently, the devices were removed and 23 threaded titanium dental implants were placed for osteointegration. Earlier mineralization in the vertically distracted area was seen radiographically during the consolidation period. In a follow up of 6-20 months after the distraction, 22 implants were successfully osteointegrated while one implant failed due to improper distracted segment stability. As a result of alveolar distraction, a segment of mature bone was transported vertically in order to lengthen the crest for better implant anchorage, either for aesthetic purposes or for functional prosthetic requirements. The main advantages of VDO are: (1) augmentation of alveolar bone height with new bone formation and simultaneous expansion of the soft tissues; (2) no bone harvesting is necessary; (3) the technique has a lower morbidity rate compared with conventional techniques; (4) it makes the insertion of longer dental implants feasible.
International Journal of Oral and Maxillofacial Surgery 01/2002; 30(6):510-7. · 1.51 Impact Factor
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ABSTRACT: Numerous complications following impacted third molar extractions have been described previously. Among these are swelling, infection, subdermal hematomas, nerve injuries, injuries to adjacent teeth and mandibular fractures. The parapharyngeal space is a funnel-shaped space with its base located at the base of the skull and its apex near the hyoid bone. It is bounded medially by the superior constrictor muscle and the tonsillar fossa and laterally by the medial pterygoid muscle, the mandibular ramus, the deep lobe of the parotid gland and the posterior belly of the digastric muscle. The junction of the buccinator and superior constrictor muscles at the pterygomandibular raphe forms the anterior border. The posterior border is formed by the vertebral column and the prevertebral muscles. Infratemporal and peritonsillar space infections following third molar extractions are relatively rare because of anatomical barriers that exist in that area, but complications of such infections are considered to be highly severe and sometimes even life threatening. These complications include septic thrombophlebitis of the internal jugular vein, septic aneurysms of the internal carotid artery and mediastinitis. This article presents a parapharyngeal and peritonsillar space abscess resulting from a third molar extraction. Several articles reviewed in this paper revealed similar signs and symptoms in parapharyngeal abscesses. The main radiological finding was soft tissue swelling in the prevertebral area. Cultures have demonstrated Klebsiella pneumoniae as the dominant microorganism in these infections. Early identification and correct diagnosis of parapharyngeal and peritonsillar abscesses are necessary to avoid life-threatening complications that may accompany such infections. Airway control should receive top priority in treatment, followed by extensive surgical drainage and administration of high dose organism-specific antibiotics as well as removal of the source of infection.
Refuʾat ha-peh ṿeha-shinayim (1993) 11/2001; 18(3-4):35-9, 109-10.
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ABSTRACT: Cyclosporin A (CsA) is widely used to prevent liver transplantation failure. CsA-induced gingival overgrowth is a common side effect. However, the effect of cirrhotic liver disease, liver transplantation, and immunosuppressive therapy on the periodontium is yet unclear. The aim of the present cross-sectional study was to examine the effect of liver cirrhosis, transplantation, and immunosuppressive therapy on the periodontium.
The experimental group (LC) consisted of 13 liver cirrhosis patients. A second experimental group (PT) included 24 patients, post-liver transplantation, receiving immunosuppressive therapy. Seventeen healthy subjects formed a control group. The Ramfjord index teeth were recorded for plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and gingival overgrowth (GO).
Mean PI and mean GI for the LC, PT, and C groups were not statistically different (P >0.05). Mean PD for the LC (3.32+/-0.24 mm) and PT group (3.41+/-0.13 mm) was significantly higher (P = 0.0001, ANOVA) compared to the C group (2.45+/-0.16 mm). Likewise, CAL for the LC (4.89+/-0.47 mm) and PT group (4.68+/-0.47 mm) was significantly higher (P = 0.001, ANOVA) than the C group (2.78+/-0.23 mm). Patients in the PT group exhibited the greatest mean GO scores (0.88+/-0.09) compared to the LC group (0.37+/-0.07) and the C group (0.09+/-0.02). All 3 groups were significantly different from each other (P = 0.0001) despite great variability within the groups. GO in the CsA-treated patients (1.1+/-0.09) was significantly higher (P = 0.0001) than in those treated with tacrolimus (0.57+/-0.1).
Liver cirrhosis patients demonstrated greater pocketing and attachment loss compared to healthy matched controls. These same differences were observed in patients post-transplantation. Gingival overgrowth occurred as a result of the immunosuppressive therapy with CsA, while to a lesser degree with tacrolimus. Replacement of CsA by tacrolimus in patients manifesting gingival overgrowth might be recommended whenever possible to overcome this problem.
Journal of Periodontology 09/2001; 72(9):1236-40. · 2.60 Impact Factor
