Journal of Clinical Medicine

Research

11 pages, 2602 KiB

Open AccessArticle

The Skeletal Stability of Combined Surgery First Approach and Clear Aligners in Skeletal Class III Malocclusion Correction: A Randomized Controlled Trial

by Meng Li, Shunyao Shen, Jingyang Huang, Yiming Wang, Jiahao Bao, Bo Wang and Hongbo Yu

J. Clin. Med. 2024, 13(3), 872; https://doi.org/10.3390/jcm13030872 - 2 Feb 2024

Cited by 1 | Viewed by 1235

Abstract

The surgery first approach (SFA) and clear aligners technique can address traditional treatment defects, such as prolonged waiting times for surgery and a less desirable facial appearance due to wire aligners. However, the curative effect of the combination remains uncertain. The randomized controlled [...] Read more.

The surgery first approach (SFA) and clear aligners technique can address traditional treatment defects, such as prolonged waiting times for surgery and a less desirable facial appearance due to wire aligners. However, the curative effect of the combination remains uncertain. The randomized controlled study aimed to evaluate the skeletal stability of the SFA compared to the conventional orthodontic first approach (OFA), both of which were applied with clear aligners. A total of 74 participants were randomly allocated to two groups: the SFA group (experimental) and the OFA group (control). The skeletal deviation was calculated using reconstruction models from computed tomography scans taken immediately and 6 months after surgery. The largest median deviations were detected in the y-axis of the mandible for both two groups, separately 1.36 mm in the experimental group and 1.19 mm in the control group. Apart from the maxillary yaw dimension (p = 0.005), there were no significant differences between the two groups in terms of linear and angular deviation. The experimental group had an overall treatment time of 18.05 ± 2.53 months, while the control group took 22.83 ± 3.60 months (p < 0.05). Therefore, the combined surgery-first and clear aligners treatment can achieve comparable skeletal stability to the conventional approach, while also saving significant time. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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12 pages, 3864 KiB

Open AccessArticle

Integrating Virtual Surgical Planning and 3D-Printed Tools with Iliac Bone Grafts for Orbital and Zygomatic Reconstruction in Hemifacial Microsomia Patients

by Zhiyang Zhao, Jiahao Bao, Guofang Shen, Ming Cai and Hongbo Yu

J. Clin. Med. 2023, 12(24), 7538; https://doi.org/10.3390/jcm12247538 - 6 Dec 2023

Cited by 1 | Viewed by 1267

Abstract

Hemifacial Microsomia (HFM) is the second most common congenital craniofacial malformation syndrome, and the complexity of HFM makes its treatment challenging. The present study aimed to introduce a new approach of utilization of virtual surgical planning (VSP) and 3D-printed surgical adjuncts for maxillofacial [...] Read more.

Hemifacial Microsomia (HFM) is the second most common congenital craniofacial malformation syndrome, and the complexity of HFM makes its treatment challenging. The present study aimed to introduce a new approach of utilization of virtual surgical planning (VSP) and 3D-printed surgical adjuncts for maxillofacial reconstruction. Five HFM patients were included in this study. All participants were provided with a full VSP, including the design of osteotomy lines, the design and fabrication of 3D-printed cutting guides, fixation plates, and titanium mesh for implantation. With the assistance of 3D-printed cutting guides and fixation plates, the orbital deformities were corrected, and a 3D-printed titanium mesh combined with iliac cancellous bone graft was applied to reconstruct the zygomatic arch. The surgical accuracy, effectiveness, and bone absorption rate were evaluated. All patients completed the entirely digital treatment process without experiencing severe complications. The surgical adjuncts were effective in aligning the movement of the bone segments with the surgical plan, resulting in mean 3D deviations (1.0681 ± 0.15 mm) and maximum 3D deviations (3.1127 ± 0.44 mm). The image fusion results showed that the patients’ postoperative position of the maxilla, zygoma, and orbital rim was consistent with the virtual surgical plan, with only a slight increase in the area of bone grafting. The postoperative measurements showed significant improvement in the asymmetry indices of Er (AI of Er: from 17.91 ± 3.732 to 5.427 ± 1.389 mm, p = 0.0001) and FZ (AI of FZ: from 7.581 ± 1.435 to 4.070 ± 1.028 mm, p = 0.0009) points. In addition, the observed bone resorption rate at the 6-month follow-up across the five patients was 45.24% ± 3.13%. In conclusion, the application of VSP and 3D-printed surgical adjuncts demonstrates significant value in enhancing the precision and effectiveness of surgical treatments for HFM. A 3D-printed titanium mesh combined with iliac cancellous bone graft can be considered an ideal alternative for the reconstruction of the zygomatic arch. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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17 pages, 294 KiB

Open AccessArticle

A Comparative Study of Condylar Bone Pathology in Patients with and without Temporomandibular Joint Disorders Using Orthopantomography

by Mohamed Jaber, Alaa Khalid, Amena Gamal, Raghad Faisal, Asok Mathew and Mohamed Ingafou

J. Clin. Med. 2023, 12(18), 5802; https://doi.org/10.3390/jcm12185802 - 6 Sep 2023

Cited by 1 | Viewed by 1357

Abstract

This study aimed to compare condylar bony pathology in patients with and without temporomandibular joint disorder (TMD) using orthopantomography at Ajman University dental clinics between 2017 and 2021. Patient data from the Ajman University archives were collected after obtaining ethical approval. OPG (orthopantomogram) [...] Read more.

This study aimed to compare condylar bony pathology in patients with and without temporomandibular joint disorder (TMD) using orthopantomography at Ajman University dental clinics between 2017 and 2021. Patient data from the Ajman University archives were collected after obtaining ethical approval. OPG (orthopantomogram) views were evaluated for potential TMJ pathology. Three independent observers underwent calibration and image analysis, with their agreement level calculated using Kappa statistics (score 0.781). Condylar changes were coded from 0 to 6. Statistical tests such as the Mann–Whitney Test, Kruskal–Wallis test, Spearman’s correlation, and logistic regression analysis were used to analyze the data. The inter-examiner reliability for OPG was 0.903, and intra-examiner reliability was 0.908. The most common condylar bony changes observed in OPG views were flattening and osteophyte. Female participants had a higher prevalence of all bony changes. Temporomandibular Disorder (TMD) can manifest with symptomatic and detectable bony changes in OPG views. The prevalence of temporomandibular disorder appeared similar between genders, but differences were observed regarding the number of teeth lost, with unilateral tooth loss being more common. Interestingly, bruxism did not seem to significantly impact of temporomandibular disorder patients. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

12 pages, 273 KiB

Open AccessArticle

Patterns of Mandibular Fractures through Human Aggression: A 10-Year Cross-Sectional Cohort Retrospective Study

by Mircea Rivis, Raluca Iulia Juncar, Abel Emanuel Moca, Rahela Tabita Moca, Mihai Juncar and Paul Andrei Țenț

J. Clin. Med. 2023, 12(12), 4103; https://doi.org/10.3390/jcm12124103 - 17 Jun 2023

Cited by 2 | Viewed by 1078

Abstract

The World Health Organization considers the victims of interpersonal violence to be a medical priority. In order to provide services at the highest level, we aimed to evaluate the patterns of maxillofacial fractures caused by interpersonal violence, in order to treat, counsel and [...] Read more.

The World Health Organization considers the victims of interpersonal violence to be a medical priority. In order to provide services at the highest level, we aimed to evaluate the patterns of maxillofacial fractures caused by interpersonal violence, in order to treat, counsel and guide these patients. This retrospective study was conducted in 478 patients with mandibular fractures caused by interpersonal violence over 10 years in a university clinic. The most affected were male patients (95.19%), 20–29 years of age (46.86%), under the influence of alcohol (83.26%) and without education (43.9%). The majority of mandibular fractures were displaced (89.3%) and intraorally open (64.0%). The most frequent location was the mandibular angle (34.84%). The most frequent soft tissue lesions were hematomas (45.04%) and abrasions (34.71%), being associated frequently with closed (p = 0.945/p = 0.237), displaced (p = 0.001/p = 0.002), single angle fractures (p = 0.081/p = 0.222). Educating the population and fighting alcohol consumption would decrease the occurrence of mandibular fractures through aggression. Clinical diagnosis should be made, keeping in mind that the severity of associated soft tissue lesions is directly proportional to the pattern and number of underlying fracture lines. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

14 pages, 5553 KiB

Open AccessArticle

Intraoral Condylectomy with 3D-Printed Cutting Guide versus with Surgical Navigation: An Accuracy and Effectiveness Comparison

by Jiawen Si, Chenglong Zhang, Ming Tian, Tengfei Jiang, Lei Zhang, Hongbo Yu, Jun Shi and Xudong Wang

J. Clin. Med. 2023, 12(11), 3816; https://doi.org/10.3390/jcm12113816 - 2 Jun 2023

Cited by 3 | Viewed by 1820

Abstract

This study compares the accuracy and effectiveness of our novel 3D-printed titanium cutting guides with intraoperative surgical navigation for performing intraoral condylectomy in patients with mandibular condylar osteochondroma (OC). A total of 21 patients with mandibular condylar OC underwent intraoral condylectomy with either [...] Read more.

This study compares the accuracy and effectiveness of our novel 3D-printed titanium cutting guides with intraoperative surgical navigation for performing intraoral condylectomy in patients with mandibular condylar osteochondroma (OC). A total of 21 patients with mandibular condylar OC underwent intraoral condylectomy with either 3D-printed cutting guides (cutting guide group) or with surgical navigation (navigation group). The condylectomy accuracy in the cutting guide group and navigation group was determined by analyzing the three-dimensional (3D) discrepancies between the postoperative computed tomography (CT) images and the preoperative virtual surgical plan (VSP). Moreover, the improvement of the mandibular symmetry in both groups was determined by evaluating the chin deviation, chin rotation and mandibular asymmetry index (AI). The superimposition of the condylar osteotomy area showed that the postoperative results were very close to the VSP in both groups. The mean 3D deviation and maximum 3D deviation between the planned condylectomy and the actual result were 1.20 ± 0.60 mm and 2.36 ± 0.51 mm in the cutting guide group, and 1.33 ± 0.76 mm and 4.27 ± 1.99 mm in the navigation group. Moreover, the facial symmetry was greatly improved in both groups, indicated by significantly decreased chin deviation, chin rotation and AI. In conclusion, our results show that both 3D-printed cutting-guide-assisted and surgical-navigation-assisted methods of intraoral condylectomy have high accuracy and efficiency, while using a cutting guide can generate a relatively higher surgical accuracy. Moreover, our cutting guides exhibit user-friendly features and simplicity, which represents a promising prospect in everyday clinical practice. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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9 pages, 259 KiB

Open AccessArticle

Depression in Chinese Patients with Cleft Lip and/or Palate: A Preliminary Study

by Weiyao Xia, Renjie Yang, Yuan Zong, Yichun Yang, Zhuojun Xie, Ting Chi, Bing Shi, Caixia Gong and Hanyao Huang

J. Clin. Med. 2023, 12(4), 1366; https://doi.org/10.3390/jcm12041366 - 8 Feb 2023

Viewed by 1354

Abstract

(1) Objectives: To investigate the difference in prevalence of depression between patients with CL/P (cleft lip and/or palate) and analyze the possible demographic factors that affect the prevalence of depression in Chinese patients with CL/P. (2) Methods: Patients with CL (cleft lip only), [...] Read more.

(1) Objectives: To investigate the difference in prevalence of depression between patients with CL/P (cleft lip and/or palate) and analyze the possible demographic factors that affect the prevalence of depression in Chinese patients with CL/P. (2) Methods: Patients with CL (cleft lip only), CP (cleft palate), and CLP (cleft lip and palate) were included in the study group. Non-CL/P individuals were included in the control group. The Patient Health Questionnaire (PHQ-9) was used to screen the depression of Chinese patients with CL/P. The different proportions of different depression groups between the CL/P group and the control groups were tested by the Fisher–Freeman–Halton test and Bonferroni correction. The scores between the study groups and the control group were analyzed by one-way ANOVA. In the study groups, demographic and clinical data of the patients, including diagnosis (CL, CP, CLP), gender, age, the only child or not, and region were collected to analyze whether they were the possible factors affecting depression through one-way independent-samples t-test. Pearson correlation analysis was used to analyze the correlation between monthly family income and depression. (3) Results: 111 and 80 valid questionnaires were collected from the study and control groups, respectively. The mean PHQ-9 score of the study group (5.459 ± 6.082) was relatively higher than the control group (4.362 ± 3.384), and the difference in proportions of depression groups was statistically significant between the CL/P group and the control group (p = 0.01), especially in the mild depression (p < 0.05) and moderately severe depression groups (p < 0.05). Statistically significant differences in PHQ-9 scores were observed between the individuals of different genders (p = 0.036) and ages (p = 0.007) in patients with CL/P, the individuals who were the only child or not in patients with CL (p = 0.007), and the individuals of different ages in patients with CP (p = 0.016). (4) Conclusions: The prevalence of depression in Chinese patients with CL/P was different compared with those without CL/P, while gender, age, the only child or not, and region played significant roles in affecting depression psychology. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

15 pages, 6503 KiB

Open AccessArticle

Evaluation of the Properties of 3D-Printed Ti Alloy Plates: In Vivo and In Vitro Comparative Experimental Study

by Qi Wang, Wael Telha, Yange Wu, Bassam Abotaleb, Nan Jiang and Songsong Zhu

J. Clin. Med. 2023, 12(2), 444; https://doi.org/10.3390/jcm12020444 - 5 Jan 2023

Cited by 10 | Viewed by 2216

Abstract

Titanium (Ti)-based implants play a significant role in rigid internal fixation in maxillofacial surgery. No study has reported that three-dimensional-printed Ti alloy plates (3D-Ti plates) have comprehensively excellent properties similar to standard plates (Matrix-MANDIBLE, SYNTHES, Switzerland) (Synthes-Ti plates). In this work, we manufactured [...] Read more.

Titanium (Ti)-based implants play a significant role in rigid internal fixation in maxillofacial surgery. No study has reported that three-dimensional-printed Ti alloy plates (3D-Ti plates) have comprehensively excellent properties similar to standard plates (Matrix-MANDIBLE, SYNTHES, Switzerland) (Synthes-Ti plates). In this work, we manufactured 3D-Ti plates by selective laser melting with Ti6Al4V powder. The surface morphology, mechanical properties, and bone–plate contact rate of the 3D-Ti plates and the Synthes-Ti plates were characterized and compared via electron microscopy, atomic force microscopy, Vickers hardness test, three-point bending test, and software calculation. Human bone marrow stromal cells (HBMSCs) were cultured on the plates to test their biocompatibility. Importantly, the 3D-Ti plates were placed into a mandibular fracture model to assess the effect of medical application for 4 and 24 weeks. The 3D-Ti plates were demonstrated to have similar biocompatibility and stability for rigid internal fixation with the Synthes-Ti plates, lower roughness (106.44 ± 78.35 nm), better mechanical strength (370.78 ± 1.25 HV10), and a higher bone–plate contact rate (96.9%). These promising results indicate the feasibility of using 3D-Ti plates for irregular shapes and complex anatomical structures in a clinical context. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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9 pages, 12280 KiB

Open AccessArticle

3D Printing Technique Assisted Autologous Costal Cartilage Augmentation Rhinoplasty for Patients with Radix Augmentation Needs and Nasal Deformity after Cleft Lip Repair

by Haidong Li, Jingyi Wang and Tao Song

J. Clin. Med. 2022, 11(24), 7439; https://doi.org/10.3390/jcm11247439 - 15 Dec 2022

Cited by 4 | Viewed by 2491

Abstract

Objective: to better reconstruct the nasal shape after cleft lip repair with 3D printing assisted autologous costal cartilage augmentation rhinoplasty, especially for patients with radix augmentation needs. Method: 20 patients with nasal deformity secondary to cleft lip repair and radix augmentation needs had [...] Read more.

Objective: to better reconstruct the nasal shape after cleft lip repair with 3D printing assisted autologous costal cartilage augmentation rhinoplasty, especially for patients with radix augmentation needs. Method: 20 patients with nasal deformity secondary to cleft lip repair and radix augmentation needs had received surgical treatment from July 2016 to November 2021. A total of 10 cases were treated with autologous costal cartilage augmentation rhinoplasty for nasal deformity after cleft lip repair, and 10 cases were treated with the help of 3D printing. According to the characteristics of nasal deformity, autologous costal cartilage was carved and implanted into the nose back. Results: 3D printing assisted autologous costal cartilage augmentation in the treatment of nasal deformity after cleft lip repair, the incision healed well, and there were no complications in the thoracic cartilage donor area. The shape of the nose is satisfactory, the height and shape of the nose tip and the size of both nostrils are mostly symmetrical, the nasal columella is elongated, the original nose tip is flat, the collapse of the nose wing is satisfactory, and the nose lip angle is close to normal. Conclusions: 3D printing assisted autologous costal cartilage augmentation is an ideal treatment for nasal deformity after cleft lip repair. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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10 pages, 701 KiB

Open AccessArticle

Extraoral Root-End Resection May Promote Pulpal Revascularization in Autotransplanted Mature Teeth—A Retrospective Study

by Petra Rugani, Barbara Kirnbauer, Irene Mischak, Kurt Ebeleseder and Norbert Jakse

J. Clin. Med. 2022, 11(23), 7199; https://doi.org/10.3390/jcm11237199 - 3 Dec 2022

Cited by 4 | Viewed by 1737

Abstract

Tooth germ autotransplantation of open apices of the teeth exhibits high pulpal healing rates, whereas that of mature permanent teeth normally causes irreversible pulpal necrosis. Extraoral root-end resection (EORER) during transplantation may promote pulpal revascularization (PRV) in transplanted mature teeth and reduce endodontic [...] Read more.

Tooth germ autotransplantation of open apices of the teeth exhibits high pulpal healing rates, whereas that of mature permanent teeth normally causes irreversible pulpal necrosis. Extraoral root-end resection (EORER) during transplantation may promote pulpal revascularization (PRV) in transplanted mature teeth and reduce endodontic treatment requirement. This study compared the primary outcomes of survival rates, PRV, and root resorption and determined relevant confounders in autotransplanted mature and immature teeth. The medical charts of consecutive patients who underwent tooth autotransplantation between January 2017 and March 2021 were evaluated. Teeth with a documented follow-up of at least 1 year were included. During the study period, 59 teeth were transplanted in 44 patients. Overall, 2 teeth were excluded owing to missing data; 57 teeth were analyzed, including 25 mature teeth additionally treated with EORER. After a mean follow-up of 21.2 ± 16.1 months, no significant differences in primary outcomes were detected. Fifty-five teeth remained in situ (96.5%), and radiological signs of root resorption were detected in 9/57 teeth (15.8%). PRV was positive in 54/57 teeth (94.7%). Surgical duration and PRV failure were significantly associated with high incidences of root resorption. Mature teeth autotransplantation with EORER yielded similar results to immature teeth autotransplantation and is a feasible treatment option. Long surgery and failed revascularization increased root resorption rates. More factors should be evaluated in larger trials with longer observation periods. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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11 pages, 958 KiB

Open AccessArticle

How the Loss of Second Molars Corresponds with the Presence of Adjacent Third Molars in Chinese Adults: A Retrospective Study

by Li-Juan Sun, Yang Yang, Zhi-Bang Li, Yi Tian, Hong-Lei Qu, Ying An, Bei-Min Tian and Fa-Ming Chen

J. Clin. Med. 2022, 11(23), 7194; https://doi.org/10.3390/jcm11237194 - 3 Dec 2022

Cited by 6 | Viewed by 1369

Abstract

Third molars (M3s) can increase the pathological risks of neighboring second molars (M2s). However, whether the M3 presence affects M2 loss remains unknown. This retrospective study aimed to reveal the reasons for M2 loss and how M2 loss relates to neighboring M3s. The [...] Read more.

Third molars (M3s) can increase the pathological risks of neighboring second molars (M2s). However, whether the M3 presence affects M2 loss remains unknown. This retrospective study aimed to reveal the reasons for M2 loss and how M2 loss relates to neighboring M3s. The medical records and radiographic images of patients with removed M2(s) were reviewed to analyze why the teeth were extracted and if those reasons were related to adjacent M3s. Ultimately, 800 patients with 908 removed M2s were included. In the included quadrants, 526 quadrants with M3s were termed the M3 (+) group, and the other 382 quadrants without M3s were termed the M3 (−) group. The average age of patients in the M3 (+) group was 52.4 ± 14.8 years and that of the M3 (−) group was 56.7 ± 14.9 years, and the difference between the two groups was statistically significant (p < 0.001). Of the 908 M2s, 433 (47.7%) were removed due to caries and sequelae and 300 (33.0%) were removed due to periodontal diseases. Meanwhile, 14.4% of the M2s with adjacent M3s were removed due to distal caries and periodontitis, which were closely related to the neighboring M3s; this percentage was much lower when M3 were absent (1.8%). Additionally, 42.2% of M3s were removed simultaneously with neighboring M2s. The presence of M3s, regardless of impaction status, was associated with an earlier loss of their neighboring M2s. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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10 pages, 2595 KiB

Open AccessArticle

BSSRO Improves Mandibular Morphology Mainly through Correction of Body Length and Volume in Patients with Asymmetric Mandibular Prognathism

by Yanfei Liu and Yunfeng Li

J. Clin. Med. 2022, 11(23), 7131; https://doi.org/10.3390/jcm11237131 - 30 Nov 2022

Cited by 2 | Viewed by 1773

Abstract

Purpose: The purpose of this study is to analyze the change and stability of mandibular morphology in patients with asymmetric mandibular prognathism after bilateral sagittal split ramus osteotomy (BSSRO). Methods: We retrospectively analyzed fifty patients with asymmetric mandibular prognathism from the West China [...] Read more.

Purpose: The purpose of this study is to analyze the change and stability of mandibular morphology in patients with asymmetric mandibular prognathism after bilateral sagittal split ramus osteotomy (BSSRO). Methods: We retrospectively analyzed fifty patients with asymmetric mandibular prognathism from the West China Hospital of Stomatology, Sichuan University, between January 2018 to March 2021. The spiral CT data before surgery, within two weeks after surgery, and at more than six months after surgery of each patient were collected. According to the deflection direction of the chin, the bilateral mandibles were defined as the long side and the short side. The morphological data of the bilateral condyle, the mandibular ramus, and the mandibular body were analyzed to determine the effect and stability of BSSRO on asymmetric mandibular prognathism. Results: It was found that the long-side mandible had greater condylar volume and diameter, mandibular ramus height and volume, and mandibular body length and volume (p < 0.05) before surgery. After surgery, the volume of the mandibular ramus increased, while the length and volume of the mandibular body decreased (p < 0.05) at the long side of the mandible; the morphological changes of the mandibular ramus and body at the short side of the mandible were not statistically significant (p > 0.05). When comparing the long and short sides of the mandible, the long side still had greater height and volume of the mandibular ramus (p < 0.01). The volume difference of the mandibular body from the two sides was corrected (p > 0.05), and the length difference of the mandibular body from the two sides was overcorrected (p < 0.05). At more than six months after surgery, the volume of the mandibular ramus and body increased, while their height decreased at the long side of the mandible (p < 0.05). For the other side, or the short side, the volume of the ramus and body increased, too. However, their height decreased (p < 0.01). Conclusion: The results of this study suggested good effect and stability of BSSRO on asymmetric mandibular prognathism, except for the correction of ramus height and volume. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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10 pages, 2719 KiB

Open AccessArticle

The Feasibility of Robot-Assisted Chin Osteotomy on Skull Models: Comparison with Surgical Guides Technique

by Jinyang Wu, Wenyu Hui, Jianhua Huang, Nan Luan, Yanping Lin, Yong Zhang and Shilei Zhang

J. Clin. Med. 2022, 11(22), 6807; https://doi.org/10.3390/jcm11226807 - 17 Nov 2022

Cited by 2 | Viewed by 1710

Abstract

Surgical robotic technology is characterized by its high accuracy, good stability, and repeatability. The accuracy of mandibular osteotomy is important in tumor resection, function reconstruction, and abnormality correction. This study is designed to compare the operative accuracy between robot-assisted osteotomy and surgical guide [...] Read more.

Surgical robotic technology is characterized by its high accuracy, good stability, and repeatability. The accuracy of mandibular osteotomy is important in tumor resection, function reconstruction, and abnormality correction. This study is designed to compare the operative accuracy between robot-assisted osteotomy and surgical guide technique in the skull model trials which simulated the genioplasty. In an experimental group, robot-assisted chin osteotomy was automatically performed in 12 models of 12 patients according to the preoperative virtual surgical planning (VSP). In a control group, with the assistance of a surgical guide, a surgeon performed the chin osteotomy in another 12 models of the same patients. All the mandibular osteotomies were successfully completed, and then the distance error and direction error of the osteotomy plane were measured and analyzed. The overall distance errors of the osteotomy plane were 1.57 ± 0.26 mm in the experimental group and 1.55 ± 0.23 mm in the control group, and the direction errors were 7.99 ± 1.10° in the experimental group and 8.61 ± 1.05° in the control group. The Bland–Altman analysis results revealed that the distance error of 91.7% (11/12) and the direction error of 100% (12/12) of the osteotomy plane were within the 95% limits of agreement, suggesting the consistency of differences in the osteotomy planes between the two groups. Robot-assisted chin osteotomy is a feasible auxiliary technology and achieves the accuracy level of surgical guide-assisted manual operation. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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10 pages, 1021 KiB

Open AccessArticle

OCCS Classification and Treatment Algorithm for Comminuted Mandibular Fractures Based on 109 Patients and 11 Years Experiences: A Retrospective Study

by Xiaofeng Xu, Fangxing Zhu, Chengshuai Yang, Bing Xu, Zhaoqi Yuan, Wenbin Zhang and Jun Shi

J. Clin. Med. 2022, 11(21), 6301; https://doi.org/10.3390/jcm11216301 - 26 Oct 2022

Cited by 2 | Viewed by 2352

Abstract

Comminuted mandibular fractures (CMFs) pose significant challenges to surgeons for their serious complications and poor outcomes. We aimed at proposing a classification with treatment algorithm of each category for CMFs. Patients with CMFs were retrospectively reviewed and classified into five categories: Type I: [...] Read more.

Comminuted mandibular fractures (CMFs) pose significant challenges to surgeons for their serious complications and poor outcomes. We aimed at proposing a classification with treatment algorithm of each category for CMFs. Patients with CMFs were retrospectively reviewed and classified into five categories: Type I: relatively good occlusion, no or slightly displaced fragments, no continuity destruction or bone defect; Type II: relatively good occlusion, damaged morphology, low comminution degree but intact continuity without bone defect; Type III: damaged morphology and higher comminution degree with intact continuity and relatively good occlusion; Type IV: high comminution, impaired continuity and poor occlusion without segmental bone defect; Type V: segmental bone defect. Conservative treatment, open reduction and internal fixation or microvascular osteocutaneous free flap transplantation was performed, accordingly. Demographics, perioperative data, complications and reasons for reoperations were recorded. The chi-square test was used for statistical analysis. In total, 109 patients were included in the study. After surgery, in the following group, 5 manifested infections, 1 manifested bone non-union, and 2 experienced reoperations, while in the unfollowing group, 10 manifested infections, 5 manifested bone non-union and 8 experienced reoperations. The OCCS classification and algorithm for CMFs achieve better outcomes and with lower complication rate. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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11 pages, 2217 KiB

Open AccessArticle

Risk Factors for Maxillary Sinus Pathology after Surgery for Midfacial Fracture: A Multivariate Analysis

by Linli Jiang, Mengsong Wu, Hui Li, Jiayu Liang, Jinlong Chen and Lei Liu

J. Clin. Med. 2022, 11(21), 6299; https://doi.org/10.3390/jcm11216299 - 26 Oct 2022

Cited by 5 | Viewed by 3511

Abstract

This study aimed to determine the incidence of maxillary sinus pathology in patients with a midfacial fracture who underwent osteosynthesis surgery and evaluate the associated risk factors. We conducted a retrospective case-control analysis of patients with midfacial fractures involving a maxillary sinus wall [...] Read more.

This study aimed to determine the incidence of maxillary sinus pathology in patients with a midfacial fracture who underwent osteosynthesis surgery and evaluate the associated risk factors. We conducted a retrospective case-control analysis of patients with midfacial fractures involving a maxillary sinus wall who were treated with open reduction and internal fixation (ORIF) between January 2015 and December 2020. Fracture reduction, the number of screws implanted in the maxillary sinus, and the number of screws penetrating the maxillary sinus, etc., were examined as potential risk factors. Maxillary sinus pathology on postoperative CT was considered the primary outcome for case-control analysis. Binary logistic regression was used to identify variables associated with postoperative maxillary sinus pathology. Thereafter, propensity score matching (PSM) was used to extract confounding factors. A total of 262 patients (totaling 372 maxillary sinuses) were included for analysis. PSM yielded 178, 246, and 70 matched sinuses, respectively, depending on the potential risk factors. Postoperative maxillary sinus pathology was visualized in 218 of the 372 maxillary sinuses (58.60%). The risk factors for postoperative maxillary sinus pathology included the number of screws penetrating the maxillary sinus (odds ratio (OR), 1.124; p = 0.007), an imperfect maxillary sinus wall fracture reduction (OR, 2.901; p = 0.021), and the number of sinus walls involved (OR, 1.383; p = 0.011). After PSM, postoperative maxillary sinus pathology was still more prevalent in sinuses with multiple maxillary sinus wall fractures (64.04% vs. 48.31%, p = 0.034), sinuses with more screws penetrating the maxillary sinus (64.23% vs. 50.41%, p = 0.028), and sinuses with an imperfect reduction (80% vs. 51.43%, p = 0.012). In conclusion, maxillary sinus pathology is common after the ORIF of midfacial fractures. Patients with a fracture of multiple maxillary sinus walls require a close follow-up. Screw penetration of the maxillary sinus should be avoided to prevent maxillary sinus pathology after a midfacial fracture ORIF. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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Review

Jump to: Research, Other

21 pages, 4240 KiB

Open AccessReview

Management of Tooth Extraction in Patients Taking Antiresorptive Drugs: An Evidence Mapping Review and Meta-Analysis

by Chang Liu, Yu-Tao Xiong, Tao Zhu, Wei Liu, Wei Tang and Wei Zeng

J. Clin. Med. 2023, 12(1), 239; https://doi.org/10.3390/jcm12010239 - 28 Dec 2022

Cited by 6 | Viewed by 4067

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a well-known severe adverse reaction of antiresorptive, antiangiogenic or targeted therapies, and usually occurs after tooth extraction. This review is aimed at determining the efficacy of any intervention of tooth extraction to reduce the risk [...] Read more.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a well-known severe adverse reaction of antiresorptive, antiangiogenic or targeted therapies, and usually occurs after tooth extraction. This review is aimed at determining the efficacy of any intervention of tooth extraction to reduce the risk of MRONJ in patients taking antiresorptive drugs, and present the distribution of evidence in these clinical questions. Methods: Primary studies and reviews were searched from nine databases (Medline, EMBase, Cochrane Library, Scopus, WOSCC, Inspec, KCI-KJD, SciELO and GIM) and two registers (ICTRP and ClinicalTrials.gov) to 30 November 2022. The risk of bias was assessed with the ROBIS tool in reviews, and the RoB 2 tool and ROBINS-I tool in primary studies. Data were extracted and then a meta-analysis was undertaken between primary studies where appropriate. Results: Fifteen primary studies and five reviews were included in this evidence mapping. One review was at low risk of bias, and one randomized controlled trial was at moderate risk, while the other eighteen studies were at high, serious or critical risk. Results of syntheses: (1) there was no significant risk difference found between drug holiday and drug continuation except for a subgroup in which drug continuation was supported in the reduced incidence proportion of MRONJ for over a 3-month follow-up; (2) the efficacy of the application of autologous platelet concentrates in tooth extraction was uncertain; (3) there was no significant difference found between different surgical techniques in any subgroup analysis; and (4) the risk difference with antibacterial prophylaxis versus control was −0.57, 95% CI −0.85 to −0.29. Conclusions: There is limited evidence to demonstrate that a drug holiday is unnecessary (and may in fact be potentially harmful) in dental practice. Primary closure and antibacterial prophylaxis are recommended despite limited evidences. All evidence have been graded as either of a low or very low quality, and thus further high-quality randomized controlled trials are needed to answer this clinical question. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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12 pages, 1819 KiB

Open AccessSystematic Review

Sagittal and Vertical Changes of the Maxilla after Surgically Assisted Rapid Palatal Expansion: A Systematic Review and Meta-Analysis

by Jia-Hong Lin, Steven Wang, Usama Al Abdullah, Anh D. Le, Chun-Hsi Chung and Chenshuang Li

J. Clin. Med. 2023, 12(10), 3488; https://doi.org/10.3390/jcm12103488 - 16 May 2023

Cited by 2 | Viewed by 1726

Abstract

Surgically assisted rapid palatal expansion (SARPE) is often performed to correct the transverse deficiency in the maxilla for skeletally mature patients. However, there is little consensus on the sagittal and vertical displacement of the maxilla after SARPE. This systematic review aims to analyze [...] Read more.

Surgically assisted rapid palatal expansion (SARPE) is often performed to correct the transverse deficiency in the maxilla for skeletally mature patients. However, there is little consensus on the sagittal and vertical displacement of the maxilla after SARPE. This systematic review aims to analyze the position changes of the maxilla in the sagittal and vertical dimensions after the completion of SARPE. Registered with PROSPERO (registration number: CRD42022312103), this study complied with the 2020 PRISMA guideline and was conducted on 21 January 2023. Original studies were screened from MEDLINE (PubMed), Elsevier (SCOPUS), and Cochrane, and supplemented by hand-searching. Cephalometric changes of skeletal vertical and sagittal measurements were the focus. A fixed-effects model was applied in R for meta-analysis. After applying inclusion and exclusion criteria, seven articles were included in the final review. Four studies had a high risk of bias, and the other three had a medium risk of bias. Meta-analysis revealed that the SNA angle increased by 0.50° ± 0.08° (95% confidence interval, 0.33° to 0.66°), and the SN–PP angle increased by 0.60° ± 0.09° (95% confidence interval, 0.41° to 0.79°) after SARPE. In summary, the maxilla displayed statistically significant forward and clockwise downward movement after SARPE. However, the amounts were small and might not be clinically significant. Due to the high risk of bias of included studies, our results must be taken cautiously. Future studies are needed to discern the effects of direction and angulation of the osteotomies of SARPE on the displacement of the maxilla. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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Open AccessCase Report

Minimally Invasive Harvesting Technique for Costal Cartilage Graft: Donor Site, Morbidity and Aesthetic Outcomes

by Umberto Committeri, Antonio Arena, Emanuele Carraturo, Simona Barone, Giovanni Salzano, Domenico Mariniello, Giacomo De Riu, Luigi Angelo Vaira, Francesco Giovacchini, Luigi Califano and Pasquale Piombino

J. Clin. Med. 2023, 12(10), 3424; https://doi.org/10.3390/jcm12103424 - 12 May 2023

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Abstract

Cartilage grafts are well-known as being reliable in reconstructive surgery for craniofacial pathologies. The aim of this study is to describe a new technique which requires an incision smaller than 1.5 cm but is still effective for harvesting cartilage graft. Thirty-six patients who [...] Read more.

Cartilage grafts are well-known as being reliable in reconstructive surgery for craniofacial pathologies. The aim of this study is to describe a new technique which requires an incision smaller than 1.5 cm but is still effective for harvesting cartilage graft. Thirty-six patients who underwent costal cartilage harvesting for septorhinoplasty have been included in this study, admitted from January 2018 to December 2021. Out of 36 patients, 34 have not reported any major complications, and two cases were followed up for pneumothorax. There were no infections and no chest wall deformities. All patients reported minimal pain at the donor site. The Vancouver Scar Scale was used to evaluate the entity of the postoperative scarring phenomena. This scale total ranges from 0 (representing normal skin) to a maximum score of 13 (representing worst scar imaginable). The results were 1.53 SD ± 0.64 (on average) 1 week after the surgical procedure and 1.28 SD ± 0.45 (on average) at the 6 months follow-up. This minimally invasive method provided a valid and effective surgical technique for cartilage graft. Despite the limitations of the case series, it seems that this procedure might be comparable to other and well-established traditional procedures and could be even preferred when the minimal invasiveness is mandatory. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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12 pages, 1707 KiB

Open AccessCase Report

Maxillary Antral Pseudocyst Drift after Osteotome Sinus Floor Elevation with Simultaneous Implant Placement: A Case Report and Literature Review

by Peihan Wang, Nan Huang, Jiayin Ren, Ping Gong, Jie Long and Bo Huang

J. Clin. Med. 2023, 12(3), 920; https://doi.org/10.3390/jcm12030920 - 24 Jan 2023

Cited by 1 | Viewed by 1881

Abstract

This report describes maxillary antral pseudocyst drift after maxillary sinus floor augmentation through osteotome sinus floor elevation with simultaneous implant placement. 3D Slicer was used to measure the pseudocyst and maxilla for the placement of the implants; follow-up visits were scheduled at 6, [...] Read more.

This report describes maxillary antral pseudocyst drift after maxillary sinus floor augmentation through osteotome sinus floor elevation with simultaneous implant placement. 3D Slicer was used to measure the pseudocyst and maxilla for the placement of the implants; follow-up visits were scheduled at 6, 12, and 22 months. No adverse effects were observed during or after surgery, and all implants exhibited osseointegration without mobility. At 6 months after surgery, the pseudocyst had moved posterolaterally from the preoperative position near the anterior medial maxillary sinus, then returned to its original position at 12 months. However, it had remigrated to the posterolateral position at 22 months. The preoperative volume of the pseudocyst was 3.795 mm³; it was 2.370, 3.439, and 2.930 mm³ at 6, 12, and 22 months after surgery, respectively. The changes in pseudocyst drift and volume did not have a substantial negative influence on the implants, presumably because of cystic attachment and the recurrence of multiple pseudocysts at different locations. The risks associated with changes in a pseudocyst can be avoided, if an appropriate treatment plan is selected. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Clinical Practice and Future Trends)

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