Implant osseointegration in circumferential bone defects treated with latex-derived proteins or autogenous bone in dog's mandible

Background: In sites with diminished bone volume, the osseointegration of dental implants can be compromised. Innovative biomaterials have been developed to aid successful osseointegration outcomes. Purpose: The aim of this study was to evaluate the osteogenic potential of angiogenic latex proteins for improved bone formation and osseointegration of dental implants. Materials and Methods: Ten dogs were submitted to bilateral circumferential defects (5.0×6.3mm) in the mandible. Dental implant (3.3×10.0mm, TiUnite MK3™, Nobel Biocare AB, Göteborg, Sweden) was installed in the center of the defects. The gap was filled either with coagulum (Cg), autogenous bone graft (BG), or latex angiogenic proteins pool (LPP). Five animals were sacrificed after 4 weeks and 12 weeks, respectively. Implant stability was evaluated using resonance frequency analysis (Osstell Mentor™, Osstell AB, Göteborg, Sweden), and bone formation was analyzed by histological and histometric analysis. Results: LPP showed bone regeneration similar to BG and Cg at 4 weeks and 12 weeks, respectively (p≥.05). Bone formation, osseointegration, and implant stability improved significantly from 4 to 12 weeks (p≤.05). Conclusion: Based on methodological limitations of this study, Cg alone delivers higher bone formation in the defect as compared with BG at 12 weeks; compared with Cg and BG, the treatment with LPP exhibits no advantage in terms of osteogenic potential in this experimental model, although overall osseointegration was not affected by the treatments employed in this study. © 2009 Wiley Periodicals, Inc.

Morphometric analysis of treatment effects of the Balters bionator in growing Class II patients

Objective: To investigate the effects of the standard (Class II) Balters bionator in growing patients with Class II malocclusion with mandibular retrusion by using morphometrics (thin-plate spline [TPS] analysis). Materials and Methods: Thirty-one Class II patients (17 male and 14 female) were treated with the Balters bionator (bionator group). Mean age at the start of treatment (T0) was 10.3 years, while it was 13 years at the end of treatment (T1). Mean treatment time was 2 years and 2 months. The control group consisted of 22 subjects (14 male and 8 female) with untreated Class II malocclusion. Mean age at T0 was 10.2 years, while it was 12.2 years at T1. The observation period lasted 2 years on average. TPS analysis evaluated statistical (permutation tests) differences in the craniofacial shape and size between the bionator and control groups. Results: Through TPS analysis (deformation grids) the bionator group showed significant shape changes in the mandible that could be described as a mandibular forward and downward displacement. The control group showed no statistically significant differences in the correction of Class II malocclusion. Conclusions: Bionator appliance is able to induce significant mandibular shape changes that lead to the correction of Class II dentoskeletal disharmony. © 2013 by The EH Angle Education and Research Foundation, Inc.

Effect of a hyperbolide mastication apparatus for the treatment of severe sleep bruxism in a child with cerebral palsy: Long-term follow-up

Purpose: Sleep bruxism is common among the various oromotor alterations found in individuals with cerebral palsy (CP). Few studies have investigated the use of the mastication device denominated hyperbola (HB) and none was found describing the use of such a device for the treatment of bruxism in children with CP. The aim of the present study was to evaluate the effect of the HB on electromyographic (EMG) activity in the jaw-closing muscles and the reduction in sleep bruxism in a child with CP using surface EMG analysis before and after nine months of treatment. Methods: A seven-year-old boy with severe spastic CP and sleep bruxism was enrolled in this study. The HB was chosen as the treatment option for sleep bruxism in this case because the child did not accept an occlusal splint. The HB has a hyperbolic shape and is made of soft, non-toxic, odorless, tasteless silicone. There are five different sizes of HB manufactured based on the diversity of tooth sizes. This device produces proprioceptive excitation in the dentoalveolar nerve, spindles and Golgi tendon organs. HB has been employed for the treatment of temporomandibular disorder, abnormal oro-dental development, abnormal occlusion, xerostomy, halitosis and bruxism. HB therapy was performed for 5 min six times a day over a nine-week period. Surface EMG of the mandible at rest and during maximum contraction was performed on the masseter and temporalis muscles bilaterally to evaluate electromyographic activity before and after nine months of HB usage. Results: HB usage led to a visible tendency toward the reorganization of mastication dynamics, achieving a marked balance in electromyographic activity of the jaw-closing muscles and improving the child's quality of life. Conclusion: Based on the findings of the present study, this noninvasive therapy may be useful for individuals with cerebral palsy due to its positive effects and low cost, which allows its use in the public health realm. Further clinical studies with a larger sample size are needed to validate these results and allow the development of a new treatment protocol for patients with spastic cerebral palsy. © 2013 Elsevier Ltd. All rights reserved.

Class II malocclusion treatment using high-pull headgear with a splint: a systematic review

Objective: To systematically review the scientific evidence pertaining to the effectiveness of high-pull headgear in growing Class II subjects. Methods: A literature survey was performed by electronic database search. The survey covered the period from January 1966 to December 2008 and used Medical Subject Headings (MeSH). Articles were initially selected based on their titles and abstracts; the full articles were then retrieved. The inclusion criteria included growing subjects between 8 to 15 years of age, Class II malocclusion treatment with high-pull headgear, and a control group with Class II malocclusion. References from selected articles were hand-searched for additional publications. Selected studies were evaluated methodologically. Results: Four articles were selected; none were randomized controlled trials. All of the articles clearly formulated their objectives and used appropriate measures. The studies showed that high-pull headgear treatment improves skeletal and dental relationship, distal displacement of the maxilla, vertical eruption control and upper molars distalization. One of the studies showed a slight clockwise rotation of the palatal plane; the others showed no significant treatment effect. The mandible was not affected by the treatment. Conclusion: While there is still a lack of strong evidence demonstrating the effects of high-pull headgear with a splint, other studies indicate that the AP relations improve due to distalization of the maxilla and upper molars, with little or no treatment effects in the mandible. Greater attention to the design should be given to improve the quality of such trials. © 2013 Dental Press Journal of Orthodontics.

Conservative Approach: Using Decompression Procedure for Management of a Large Unicystic Ameloblastoma of the Mandible

Ameloblastoma is a relatively uncommon benign odontogenic tumor, which is locally aggressive and has a high tendency to recur, despite its benign histopathologic features. This pathology can be classified into 4 groups: unicystic, solid or multicystic, peripheral, and malignant. There are 3 variants of unicystic ameloblastoma, as luminal, intraluminal, and mural. Therefore, in mural ameloblastoma, the fibrous wall of the cyst is infiltrated with tumor nodules, and for this reason it is considered the most aggressive variant of unicystic ameloblastomas. Various treatment techniques for ameloblastomas have been proposed, which include decompression, enucleation/curettage, sclerotizing solution, cryosurgery, marginal resection, and aggressive resection. Literature shows treatment of this lesion continues to be a subject of intense interest and some controversy. Thus, the authors aimed to describe a case of a mural unicystic ameloblastoma of follicular subtype in a 19-year-old subject who was successfully treated using conservative approaches, as decompression. The patient has been followed up for 3 years, and has remained clinically and radiographically disease-free.

Unilateral Condylar Hyperplasia: A Treatment Strategy

Condylar hyperplasia (CH) is a pathologic condition that causes overdevelopment of the condylar head and neck as well as the mandible. Slowly progressive unilateral enlargement of the head and the neck of the condyle causes crossbite malocclusion, facial asymmetry, and shifting of the midpoint of the chin to the unaffected side. The etiology and the pathogenesis of CH remain uncertain. The diagnosis is made by clinical and radiologic examinations and bone scintigraph. A difference in uptake of 10% or more between condyles is regarded as indicative of CH, and the affected condyles had a relative uptake of 55% or more. When the diagnosis of active CH is established, the treatment consists of removal of the growth center by a partial condylectomy. The authors present the case of a 46-year-old male patient with right active type II CH or hemimandibular hyperplasia who underwent a high condylectomy.

Maxillary molar intrusion with zygomatic anchorage in open bite treatment: lateral and oblique cephalometric evaluation

Purpose We aimed to use lateral and oblique radiographs to evaluate dental and skeletal changes arising from maxillary molar intrusion with zygomatic anchorage in open bite patients. Methods We conducted a pilot study including nine patients (six females and three males; mean age, 18.7±5.1 years) with skeletal open bite treated with titanium miniplates for posterior dentoalveolar intrusion. Lateral and oblique (right and left, 45°) radiographs were obtained before (T1) and 6 months after intrusion (T2). A paired t test was used for statistical evaluation. Results The maxillary posterior teeth were intruded 2.03± 0.87 mm (p<0.01) with 450×g of force, which resulted in counterclockwise rotation of the mandible (1.57°, p=0.02) and clockwise rotation of the occlusal plane (4.27±2.66°, p=0.01). Anterior facial height decreased by a mean of 1.79±1.51 mm (p<0.01). No significant change in the palatal plane or in anteroposterior molar movement was observed. Conclusion The oblique radiograph at 45° was useful for the assessment of molar intrusion and anteroposterior displacement. The treatment of anterior open bite with skeletal anchorage provided intrusion of molars and counterclockwise rotation of the mandible, resulting in open bite closure.

Treatment of Atrophic Mandibular Fractures with the Pencilboneplate: Report of 2 Cases

The incidence of fractures of the atrophic edentulous mandible is still low, even with the increasing life expectancy. The reduced blood supply of the sclerotic bone, the diminished contact area between bone fragments and the patient’s systemic condition makes the treatment of those fractures a challenge for any professional. Treatment of atrophic mandibular fractures by means of miniplate osteosynthesis has not been the preferred method of fixa- tion by many authors. Yet, many surgeons have applied this type of fixation for the atrophied jaw sections. This paper reports 2 cases of fractured atrophic mandibles treated with the pencilboneplate, a monocortical 2.0 mm titanium, 8 or 10-hole hardware with reinforcement on its middle portion, highlighting important considerations of its use. The pencilboneplate appears to be a valuable option for the treatment of atrophic mandibular fractures, espe- cially by an intra-oral approach, and warrants further bio- mechanical and clinical studies.

Implant-supported rehabilitation after treatment of atrophic mandibular fractures: report of two cases

Objective The objective of this article is to present options of rehabilitation with dental implants in two cases of severely atrophic mandibles (<10 mm) after rigid internal fixation of fractures. Patients and method Two patients who sustained fractures in severely atrophic mandibles with less than 10 mm of bone height were treated by open reduction and internal fixation through a transcervical access. Internal fixation was obtained with 2.4-mm locking reconstruction plates. The first patient presented satisfactory bone height at the area between the mental foramens and after 2 years, received flapless guided implants in the anterior mandible and an immediate protocol prosthesis. The second patient received a tent pole iliac crest autogenous graft after 2 years of fracture treatment and immediate implants. After 5 months, a protocol prosthesis was installed in the second patient. Results In both cases, the internal fixation followed AO principles for load-bearing osteosynthesis. Both prosthetic devices were Branemark protocol prosthesis. The mandibular reconstruction plates were not removed. Both patients are rehabilitated without complications and satisfied with esthetic and functional results. Conclusion With the current techniques of internal fixation, grafting, and guided implants, the treatment of atrophic mandible fractures can achieve very good results, which were previously not possible.

Pseudo-Class III treatment with reverse traction: case report

The pseudo-Class III can be defined as a functional reflex of an anterior positioning of the mandible, an acquired muscular position that simulates a mesiocclusion. The diagnosis and treatment plan of this condition must be based on a cephalometric evaluation that provides information about the relative contributions of the skeletal and dental components to the malocclusion. There is still great controversies about when is the best moment to start the Class III treatment. The purpose of this article is to describe a case report in which a Class III patient was successfully treated with reverse traction.

Chronic osteomyelitis of the maxilla and mandible: microbiological and clinical aspects

Osteomyelitis of the mandible and maxilla are common in developing countries and their treatment may be long-standing and difficult. Thus, the aim of this study was to discuss the main biological aspects of the chronic osteomyelitis of the jaws of especial interest for dental team. These infections are associated with a complex microbiota composed mainly by anaerobic bacteria, sometimes associated with microorganisms originated from the skin and digestive tract. These data suggest that chronic osteomyelitis of the mandible and maxilla should be treated as anaerobic infections in most cases. In addition, local surgical treatments are relevant in the therapy outcome, associated to the use of antimicrobial agents, and the failure to accomplish them is a major cause of treatment failure.