• Title/Summary/Keyword: Mandibular surgery

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Success rates of the first inferior alveolar nerve block administered by dental practitioners

  • Kriangcherdsak, Yutthasak;Raucharernporn, Somchart;Chaiyasamut, Teeranut;Wongsirichat, Natthamet
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.16 no.2
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    • pp.111-116
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    • 2016
  • Background: Inferior alveolar nerve block (IANB) of the mandible is commonly used in the oral cavity as an anesthetic technique for dental procedures. This study evaluated the success rate of the first IANB administered by dental practitioners. Methods: Volunteer dental practitioners at Mahidol University who had never performed an INAB carried out 106 INAB procedures. The practitioners were divided into 12 groups with their advisors by randomized control trials. We recorded the success rate via pain visual analog scale (VAS) scores. Results: A large percentage of the dental practitioners (85.26%) used the standard method to locate the anatomical landmarks, injecting the local anesthetic at the correct position, with the barrel of the syringe parallel to the occlusal plane of the mandibular teeth. Further, 68.42% of the dental practitioners injected the local anesthetic on the right side by using the left index finger for retraction. The onset time was approximately 0-5 mins for nearly half of the dental practitioners (47.37% for subjective onset and 43.16% for objective onset), while the duration of the IANB was approximately 240-300 minutes (36.84%) after the initiation of numbness. Moreover, the VAS pain scores were $2.5{\pm}1.85$ and $2.1{\pm}1.8$ while injecting and delivering local anesthesia, respectively. Conclusions: The only recorded factor that affected the success of the local anesthetic was the administering practitioner. This reinforces the notion that local anesthesia administration is a technique-sensitive procedure.

REAPPRAISAL OF SOFT TISSUE PREDICTION IN ORTHOGNATHIC SURGERY FOR MANDIBULAR PROGNATHISM (외과적 악교절수술에 있어서 측모연조직예측의 재평가에 대한 연구)

  • Chung, Moo-Hyeok;Nam, Il-Woo
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.13 no.1
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    • pp.37-43
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    • 1991
  • Cephalometric prediction tracing is the preoperative double checking procedure which can predict bony and soft tissue change. Soft tissue profile prediction is routinely performed according to the known ratios of the soft to hard tissue movement which can vary considerably in each individual. Besides interindividual variation of the ratios of the soft to hard tissue change, actual results of the postoperative soft tissue profile can reflect other important modifying factors if it is compared with prediction tracing used. The purpose of this study is to compare soft tissue prediction tracing used with postoperative tracing and to find intervening modifying factor via serial tracing. Review of 30 prediction tracing showed that the most important factor contributing to prodiction tracing inaccuracy was the skeletal and dental relapse. And, some factors which may be responsible for prediction tracing inaccuracy were discussed.

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THE INFLUENCE OF THE INITIAL STABILITY AFTER DENTAL IMPLANT INSTALLATION ON THE OSSEOINTEGRATION (임프란트 식립시 초기 안정성이 골유착에 미치는 영향)

  • Lee, Young-Hoon;Kim, Yeo-Gab;Choi, Byung-Jun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.30 no.6
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    • pp.518-528
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    • 2008
  • Purpose: The long-term experience of using osseointegrated implants for prosthetic rehabilitation of the edentulous patients shows that high success rates can be predictably achieved. Primary implant stability has been identified to be a prerequisite to achieve osseointegration. In this study, we set up the amount of removed bone so that it differed on implant installation site for each group. The influence of each initial stability on secondary stability and osseointegration was compared with time lapse using resonance frequency analysis and histomorphometric analysis. Materials and methods: A total 27 US $II^{(R)}$ (Osstem, Korea) implants were placed in the mandibular edentulous area of 3 beagle dogs. The implant site was prepared by the conventional technique with drills, and three experimental groups were divided into under-drilling group, normal-drilling group and over-drilling group. The Implant Stability Quotient (ISQ) was measured at intervals of immediately, 4, 8, 12 weeks after placement using $Osstell^{(R)}$ mentor RFA. After the animals were sacrificed, histomorphometric evaluation was executed for measuring BIC and BD. Results: 1) The under-drilled group showed most high ISQ value for whole experiment period. 2) Bone-to-implant-contact(BIC) showed the tendency to be increased gradually as the experiment period passed except the 8 weeks of the normal group. 3) The under-drilled group showed most high bone density(BD) level for whole experiment period, and it was expressed the aspect to be increased gradually according to an experiment period passage in the average of all group. 4) Resonance frequency analysis and histomorphometric analysis are presumed by generally proportional. Conclusions: As this research result, it seems that there are some correlation between resonance frequency analysis and histomorphometric analysis. As are accomplished osseointegration stably so that more superior at the region which the overpressure comes to add, it will be applicable method in clinical field.

Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy Studies on Processed Tooth Graft Material by Vacuum-ultrasonic Acceleration

  • Lee, Eun-Young;Kim, Eun-Suk;Kim, Kyung-Won
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.36 no.3
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    • pp.103-110
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    • 2014
  • Purpose: The current gold standard for clinical jawbone formation involves autogenous bone as a graft material. In addition, demineralized dentin can be an effective graft material. Although demineralized dentin readily induces heterotopic bone formation, conventional decalcification takes three to five days, so, immediate bone grafting after extraction is impossible. This study evaluated the effect of vacuum ultrasonic power on the demineralization and processing of autogenous tooth material and documented the clinical results of rapidly processed autogenous demineralized dentin (ADD) in an alveolar defects patient. Methods: The method involves the demineralization of extracted teeth with detached soft tissues and pulp in 0.6 N HCl for 90 minutes using a heat controlled vacuum-ultrasonic accelerator. The characteristics of processed teeth were evaluated by scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS). Bone grafting using ADD was performed for narrow ridges augmentation in the mandibular area. Results: The new processing method was completed within two hours regardless of form (powder or block). EDS and SEM uniformly demineralized autotooth biomaterial. After six months, bone remodeling was observed in augmented sites and histological examination showed that ADD particles were well united with new bone. No unusual complications were encountered. Conclusion: This study demonstrates the possibility of preparing autogenous tooth graft materials within two hours, allowing immediate one-day grafting after extraction.

Overall and disease-specific survival outcomes following primary surgery for oral squamous cell carcinoma: analysis of consecutive 67 patients

  • Sim, Yookyeong Carolyn;Hwang, Jong-Hyun;Ahn, Kang-Min
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.45 no.2
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    • pp.83-90
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    • 2019
  • Objectives: This study evaluated the predictive factors for survival of patients with oral squamous cell carcinoma (OSCC) and investigated the overall and disease-specific survival (DSS) outcomes. Materials and Methods: A total of 67 consecutive patients who underwent surgery for OSCC from January 2006 to November 2014 were included in this study. Patients were classified according to age, sex, pTNM stages, primary sites, smoking and alcohol drinking habits, depth of invasion, perineural and lymphovascular invasion, cell differentiation and postoperative radiotherapy. Kaplan-Meier methods were used to estimate the survival categorized by patient groups. Cox regression methods were used to investigate the main independent predictors of survival. Results: Nineteen patients died of OSCC during follow-up periods. Another five patients died of other diseases including lung adenocarcinoma (n=1), cerebral infarction (n=1), general weakness (n=2), and pneumonia (n=1). The tongue (n=16) was the most common site for primary origin, followed by buccal mucosa (n=15), mandibular gingiva (n=15), maxillary gingiva (n=9), floor of mouth (n=9), retromolar trigone (n=2), and palate (n=1). Eleven patients had pTNM stage I disease, followed by stage II (n=22) and stage IV (n=34). No patients had pTNM stage III disease in this study. The overall survival of all patients was 64.2% and the DSS was 71.6%. DSS of patients with stage I and II disease was 100%. Stepwise Cox regression showed the two predictors for DSS were pTNM stage (P<0.0001, odds ratio=19.633) and presence of metastatic lymph nodes (P=0.0004, odds ratio=0.1039). Conclusion: OSCC has been associated with poor prognosis; however, there were improved survival outcomes compared with past studies. Advanced-stage disease and presence of metastatic lymph nodes were associated with poorer survival compared with early-stage OSCC and absence of neck node metastasis. Stage I and II OSCC were associated with excellent survival results in this study.

Sagittal split ramus osteotomy, intraoral vertical ramus osteotomy, and lateral corticectomy for asymmetric mandibular prognathism

  • Lee, Joo Young;Han, Se Jin
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.47 no.4
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    • pp.249-256
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    • 2021
  • Objectives: The purpose of this study was to evaluate the postoperative anteroposterior stability and improvements in facial asymmetry after performing LeFort I osteotomy in the maxilla, sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) in the mandible, and lateral corticectomy on the IVRO side. Materials and Methods: From July 2009 to October 2018, a retrospective analysis was performed on 11 subjects. Lateral cephalometric radiograph was performed preoperatively (T0), postoperatively (T1), and at 12 months of follow-up (T2), and the B point distance was measured. Posteroanterior cephalometric radiograph was performed preoperatively (S0) and at 12 months of follow-up (S1) and was used to measure five indicators (Ag angle, M-Ag, Co-Ag, Co-Me, and Ag-Me) of facial asymmetry. Results: The B point distances for T0 and T1 were significantly different (P=0.007), whereas those for T1 and T2 were not significantly different (P=0.1). In addition, there was a significant difference between the B point distances of T2 and T0 (P=0.026). Comparison of the facial asymmetry indicators before and after surgery showed a significant difference for all indicators between S0 and S1: the P-values of Ag angle, M-Ag, Co-Ag, Co-Me, and Ag-Me were 0.003, 0.003, 0.008, 0.006, and 0.004, respectively. The Z value was based on negative ranks. Conclusion: There was no significant difference in the B point distances from postoperation to the 12-month follow-up. However, there were significant differences in all five indicators related to facial asymmetry before and after surgery. The values for the five indicators of facial asymmetry all increased postoperatively.

Comparison of vital sign stability and cost effectiveness between midazolam and dexmedetomidine during third molar extraction under intravenous sedation

  • Jun-Yeop, Kim;Su-Yun, Park;Yoon-Sic, Han;Ho, Lee
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.48 no.6
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    • pp.348-355
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    • 2022
  • Objectives: To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and Methods: This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pressure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer's assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. Results: The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had similar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). Conclusion: DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.

Effects of a modified surgical protocol on the positional accuracy of dental implants placed using fully guided implant surgery in the partially edentulous posterior ridge with distal extension: a dentiform model study

  • Young Woo Song;Seung Ha Yoo;Ui-Won Jung
    • The Journal of Advanced Prosthodontics
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    • v.16 no.1
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    • pp.1-11
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    • 2024
  • PURPOSE. The present experiment aimed to evaluate the placement accuracy of fully guided implant surgery using a mucosa-supported surgical guide when the protocol of osteotomy and installation was modified (MP) compared to when the protocol was sequentially and conventionally carried out (CP). MATERIALS AND METHODS. For 24 mandibular dentiform models, 12 dentists (6 experts and 6 beginners) performed fully guided implant placements two times at the right first and second molar sites using a mucosa-supported surgical guide, once by the CP (CP group) and at the other time by the MP (MP group). The presurgical and postsurgical stereolithographic images were superimposed, and the deviations between the virtually planned and actually placed implant positions and the procedure time were compared statistically (P < .05). RESULTS. The accuracies were similar in the CP and MP groups. In the CP group, the mean platform and apex deviations at the second molar site for the beginners were +0.75 mm and +1.14 mm, respectively, which were significantly larger than those for the experts (P < .05). In the MP group, only the mean vertical deviation at the second molar site for the beginners (+0.53 mm) was significantly larger than that for the experts (P < .05). The procedure time was significantly longer for the MP group (+94.0 sec) than for the CP group (P < .05). CONCLUSION. In fully guided implant surgery using a mucosa-supported guide, the MP may improve the placement accuracy when compared to the CP, especially at sites farther from the most-posterior natural tooth.

MANDIBULAR DISTRACTION OSTEOGENESIS WITH COMPRESSION FORCE - BONE DENSITY, HISTOLOGICAL FINDINGS AND TMJ RESPONSE (압축력을 병용한 하악골 신장술)

  • Hwang, Young-Seob;Heo, June;Kim, Uk-Kyu;Park, Seong-Jin;Hwang, Dae-Seok;Kim, Yong-Deok;Chung, In-Kyo;Kim, Kyu-Cheon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.28 no.6
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    • pp.531-548
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    • 2006
  • The purpose of this study was to investigate the biomechanical, histologic findings of distracted regenerate and TMJ response in modified distraction osteogenesis (DO) technique combined with compression force as biomechanical stimulation method which has been suggested in 2002, and developed thereafter by authors. This study was performed with two experiments. First experiment was designed to explore the optimal ratio of compression force versus distraction force for the new DO technique. Second experiment was planned to evaluate the reaction of TMJ tissue, especially condyle, disc after application of the DO technique with compression force. Total 52 New Zealand adult male-rabbits with 3.0kg body weight were used for the study. For the first study, 30 adult male-rabbits underwent osteotomy at one side of mandibular body and a external distraction device was applied on each rabbit with same manner. In the control group of 10 rabbits, final 8 mm of distraction with 1 mm rate per day was done with conventional DO technique after 5 latency days. For the experimental group of 20 rabbits, a compression force with 1 mm rate per day was added to the distracted mandible on 3-latency day after over-distraction (over-lengthening). As the amount of the rate of compression versus distraction, experimental subgroup I (10 rabbits) was set up as 2 mm compression versus 10 mm distraction (1/5) and experimental subgroup II (10 rabbits) was set up as 3 mm compression versus 11 mm distraction (about 1/3). All 30 rabbits were set up to obtain final 8 mm distraction and sacrificed on postoperative 55 day to analysis on biomechanical, and histologic findings of the bone regenerates. For second study, 22 adult male-rabbits were used to evaluate TMJ response after the DO method application with compression force. In the control group, 10 rabbits was used to be performed with conventional DO method, on the other hand, in a experimental group of 10 rabbits, 10 mm distraction with 2 mm compression (1/5 ratio) was done. The remaining 2 rabbits served as the normal control group. Histomorphologic examinations on both condyle, histological studies on condyle, disc were done at 1, 2, 3, 4, 7 weeks after distraction force application. The results were as follows: 1. On the bone density findings, the experimental group II (force ratio - 1/3) showed higher bone density than the other experimental group (force ratio - 1/5) and control group (control group - $0,2906\;g/cm^2$, experimental group I - $0.2961\;g/cm^2$, experimental group II - $0.3328\;g/cm^2$). 2. In the histologic findings, more rapid bone maturation like as wide lamellar bone site, more trabeculae formation was observed in two experimental groups compared to the conventional DO control group. 3. In morphologic findings of condyle, there were no differences of size and architecture in the condyle in the control and experimental groups. 4. In histologic findings of condyles, there were thicker fiberous and proliferative layers in experimental group than those of control group until 2 weeks after distraction with compression force. But, no differences were seen between two groups on 3, 4, 7 weeks after compression. 5. In histologic findings of disc, more collagen contents in extracellular matrix, more regular fiber bundles, and less elastin fibers were seen in experimental group than control group until 2 weeks after distraction with compression. But, no differences were seen between two groups on 3, 4, 7 weeks after distraction with compression. From this study, we could identify that the new distraction osteogenesis technique with compression stimulation might improve the quality of bone regeneration. The no remarkable differences on TMJ response between control and experimental groups were seen and TMJ tissues were recovered similarly to normal TMJ condition after 3 weeks.

SUBANTRAL AUGMENTATION WITH AUTOGENOUS BONE GRAFT FOR SIMULTANEOUS IMPLANT INSTALLATION (상악동저 점막 거상술을 이용한 인공치아 임프란트 동시 식립술 후 예후에 관한 임상적 연구)

  • Kim, Myung-Jin;Kim, Tae-Young;Hwang, Kyung-Gyun;Yu, Sang-Jin;Myoung, Hoon;Kim, Soo-Kyung;Kim, Jong-Won;Kim, Kyoo-Sik
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.26 no.6
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    • pp.644-651
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    • 2000
  • In cases of severe alveolar bony resorption in the edentulous posterior maxillae, implant placement is limited anatomically due to maxillary sinus. If the ridge is atrophic, the various bone grafting methods are required for the ridge augmentation. But the result of the onlay grafting procedure is not always promising. On the posterior maxilla, maxillary sinus mucosa lifting and bone grafting into the sinus floor, subantral augmentation(SA) technique are recommended. Various SA procedures have been developed for implant installation. We perfer to simultaneous block bone graft and implant installation through the residual alveolar ridge into the grafted block bone to fix the grafted bone and to gain the primary stability of the installed fixture. When a sagittal skeletal discrepancy in present due to the severe alveolar bony resorption of the maxilla, the advancement of the maxilla by Le Fort I osteotomy simultaneously with installation of implant fixtures combined with sinus lifting and interpositional bone graft procedure can be indicated. We applied various SA techniques for implant installtion to the 46 edentulous posterior maxillae, and total 154 implants were installed at our department from 1992 to 1999. Various SA techniques were classified in detail and the indications of each techniques were discussed. The changes of residual bony height following SA procedure were studied. The results were as follows. 1. The SA procedure combined with bone graft and simultaneous fixture installation were performed in 41 cases, 126 fixtures were installed and 5 fixtures were removed out of them. Le Fort I osteotomy procedure combined with sinus lifting and interpositional bone graft simultaneous with fixture installation were performed in 5 cases. Total 28 fixtures were installed and 2 fixtures were removed so far. 2. Autogenous block bone graft into sinus floor were performed in 35 cases, autogenous particulated marrow cancellous bone(PMCB) graft in 9 cases, and demineralized human bone powder in 2 cases. The donor site for bone graft were anterior iliac bone in 39 cases, posterior iliac bone in 3 cases and mandibular symphysis in 1 case and mandibular ramus in 1 case. 3. In 9 cases with which SA procedure had been performed with the block bone graft, the change of pre- and postoperative residual bony height were measured using MPR(multiplanar reformatted)-CT. The mean residual bony height was 8.0mm preoperatively, 20.2mm at 6 months following up operation and we gained average 12.2mm alveolar bony height. So, we can recommend this one-stage subantral augmentation and fixture installation technique as a time conserving, safe and useful method for compromised posterior edentulous maxilla.

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