Maxillary Impaction Research Articles

当科における上顎正中埋伏過剰歯の臨床的検討

当科における上顎正中埋伏過剰歯の臨床的検討

The Influence of Three Root Canal Irrigation Methods on PostThe Influence of Three Root Canal Irrigation Methods on PostOperative Pain “Randomized Clinical Trial”

Introduction: Facial soft tissue changes in relation to hard tissue movements after orthognathic surgery cases is always of concern to patients , surgical and orthodontics teams. The aim of the present study was to assess facial soft tissue changes and stability using 3D facial laser scanner after orthognathic surgery Le Forte I maxillary impaction in excessive gingival display patients. Methods: The subjects consisted of 12 patients with skeletal vertical maxillary excess (VME) causing an aesthetic concern to the patients in the form of “Gummy smile”, who underwent LeFort I osteotomy with maxillary impaction, Three-dimensional images of the patients were acquired with a 3D laser scanner preoperatively and postoperatively. The changes in facial soft tissue were detected using a colour coded map for analysis. Results: Significant change was recorded in the upper lip, alar base, nasolabial fold and nasal tip areas, without specification of this change in direction. Conclusions: The 3D images captured using the laser scanner in this study can be a useful tool for communication with both patients and professionals but cannot be relied upon solely for accurate analysis of the facial soft tissue changes. The colour coded map analysis cannot be relied upon solely as a method of analysis as it lacks an important aspect of the change which is the direction.

Complications on maxilar impaction: A systematic review and meta-analysis

ObjectivesMaxillary impactions are seen as an orthognathic surgical movement that increases the number of complications. The aim of this paper is to research literature on this topic, with special attention to avoiding of complications. MethodsA systematic review was carried out according to the PRISMA guidelines. The PROSPERO registration has been performed. A risk of bias assessment was carried out with RevMan and graphics were created. A total of 20 articles were included in this systematic review. ResultsSome interesting and conclusive facts about maxillary impactions. Relapses are not common due to the higher bone contact. Bleeding is a common complication due to the location of palatal artery. Aesthetic and functional complications can arise, especially in the nasal region. Bimaxillary orthognathic surgeries has a higher incidence of complications. ConclusionsToday it is not possible to confirm that maxillary impactions alone are responsible for a higher incidence of complications due to the complexity of the three-dimensional movements. Some surgical steps could be safer and cause fewer complications.

Association Between Maxillary Impacted Canine Position and Root Resorption of the Adjacent Incisors: A CT Study

Resorption of permanent maxillary incisors is a common complication of ectopically positioned maxillary canines and when they occur they may drastically increasing both the cost and complexity of the orthodontic treatment, thus early diagnosis and corrective measures are imperative. This study aimed to investigate the association between the maxillary impacted canines labio-palatal and mesio-distal positions and the associated root resorption of adjacent maxillary incisors. Materials and Methods: The sample included 46 patients with an age ranged between 12 and 30 years referred to the CT scan image to detect unilaterally or bilaterally impacted maxillary canines. The mesio-distal position of the canine cusp tip, the labio-palatal position of the impacted canines, contact and root resorption of permanent incisors were evaluated with CT scan image. The association between the impacted canines position and root resorption of permanent incisors were analyzed using Chi square test.Results: Labially and mid-alveolus impacted canines were more common in sectors I and IV, while palatally impacted canines were most frequent in Sector IV. Lateral incisors were more often affected than central incisors by root resorption. Root resorption of permanent incisors showed a high significant association with sector location [p ≤ 0.001] and was observed in sectors III and IV.Conclusions: When canine impactions are suspected in sectors III or IV, CT scan must be considered to disclose suspected incisor resorption.

Three-dimensional analysis of condylar remodeling and skeletal relapse following LeFort-I osteotomy: A one-year follow-up bicenter study

The aim of the study was to quantify the postoperative condylar remodeling after Le Fort I surgery.Patients treated with a Le Fort I osteotomy were investigated. CBCT scans were acquired preoperatively, one week and one year postoperatively. A preoperative 3D cephalometric analysis was performed on the preoperative CBCT. Surgical movements were quantified using a voxel-registration based method (OrthoGnaticAnalyser). After rendering of the condyles from the CBCT, a volumetric analysis was performed. The correlation between the surgical movement of the maxilla and the postoperative condylar volume changes was determined with analysis of variance. ResultsA total of 45 subjects were included in this study. 47 of 90 condyles (52%) showed a mean volume reduction of 93 mm3 (4.9 volume-%) postoperatively. The maxilla was impacted in 12 patients (2.44 ± 2.49 mm) and extruded in 33 patients (1.78 ± 1.29 mm). The maxillary impaction group showed a volume reduction of 50 ± 122 mm3 and the extrusion group showed a mean volume gain of 21 ± 139 mm3 (p = 0.028). ConclusionClinicians should be aware of potential condylar remodeling following solitary Le Fort I osteotomies, particularly in female patients with maxillary impaction.

Anterior implant placement in the presence of maxillary impacted teeth: Case reports

Anterior implant placement in the presence of maxillary impacted teeth: Case reports

Short-Term Stability After Segmental Le Fort I Maxillary Impaction Surgery With Mandibular Autorotation in Seven High-Angle Class II Patients: A Case Series.

To retrospectively evaluate skeletal stability after Le Fort I maxillary impaction surgery and mandibular autorotation without bilateral sagittal split osteotomy (BSSO) in high-angle class II patients. Seven female high-angle class II patients who underwent maxillary impaction surgery and mandibular autorotation without bilateral sagittal split osteotomy were included in this study. Surgical changes and relapse were measured on lateral cephalograms taken preoperatively and at 1 month, 6 months and 1 year postoperatively. The horizontal movement of the maxilla at point A was 5.8 ± 3.3 mm backward, and the upward movement at the posterior nasal spine was 3.3 ± 1.4 mm. The mean horizontal change at point A during the 1-year follow-up period was 0.1 ± 0.2 mm, and the vertical change at posterior nasal spine was 0.2 ± 1.3 mm, which were not statistically significant. The horizontal surgical change at point B was 4.0 ± 1.8 mm forward and the vertical surgical change at point B was 4.7 ± 1.8 mm upward. Postoperative relapse was 10.9% and 13.7% in the horizontal and vertical directions, respectively. Le Fort I maxillary impaction surgery with mandibular autorotation may be 1 of the suitable procedures for high-angle class II patients.

Evaluation the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings of the second molar teeth with CBCT scans.

To evaluate the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings on the distal surface of the second molar teeth with cone beam computerized tomography (CBCT) scans. All CBCT images of 189 impacted maxillary teeth belonging to 121 patients were examined by an observer. After determining the position and impaction level of the impacted maxillary third molar teeth, presence of caries, resorption and marginal bone loss in the distal of the second molar tooth were evaluated.IBM SPSS Statistics 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) was used for statistical analyses and calculations. Data were analysed using the Chi-square test and Fisher's exact test. A statistically significant difference was found in terms of the impaction level of the impacted maxillary third molar tooth and the presence of caries in the distal surface of the second molar tooth, in terms of the impaction level of the impacted third molar tooth and the presence of marginal bone loss in the distal surface of the second molar tooth. A similar difference was found in terms of the impaction level of the impacted third molar tooth and the presence of root resorption in the distal surface of the second molar tooth. These data on the natural history of impacted maxillary third molars may contribute to both more accurate estimates of the risk of complications associated with these teeth and determination of the prophylactic approach to asymptomatic impacted third molars.

A Unique Bone Osteotome Technique for Extraction of Palatally Inclinated Maxillary Impacted Tooth: A Technical Note

Background: There have been reported about impacted tooth[1,2,3], but a very few literature about extraction technique using bone osteotomy. Bone osteotome is routinely used in various oral surgeries. We describe a technique of a unique bone osteotome technique for extraction of palatally inclinated maxillary impacted tooth. Methods: We occasionally encounter the patient with tooth crown of impacted tooth inclinated from the buccal site toward the palatal site. When the use of an elevator and forceps is difficult due to the palatal tilted and interference of neighboring teeth, tooth extraction is a challenge.Using this osteotome from the buccal site causes the canine to easily rise out of the socket in the palatal direction. Results and Conclusion: This bone osteotome technique for extraction of palatally inclinated maxillary impacted tooth was very useful and convenient.This is because the impacted canine can be removed with a bone osteotome, a minimally invasive surgical instrument. No appreciable disadvantages are noted with this bone osteotomy. Keywords: Unerupted Tooth; Impacted Canine; Supernumerary Teeth

Orthodontic management of skeletal class II malocclusion with horizontally impacted maxillary canine: A case report

Management of skeletal class II relation in growing patient require careful evaluation of growth status, proper diagnosis and treatment plan to address the patient’s need. Twin block is the appliance of choice among functional appliance to correct the skeletal class II malocclusion due to it’s acceptability by the patient and simplified design. Maxillary canine impaction is the second most prevalent impaction after the third molars. Treatment of maxillary canine impaction is usually a challenge to orthodontic approach as the defect lies in the esthetic region of the jaw.
 This case report describes the orthodontic management of a 9 years male patient having skeletal Class II malocclusion with horizontally impacted maxillary canine. Some modifications in the treatment mechanics are deemed essential to address the patient’s need for achieving the optimal esthetic and to improve the occlusion.
 Twin block is beneficial for the treatment of skeletal malocclusion in a growing patient to achieve the maximum benefit. The orientation of impacted teeth may change from horizontal to favorable one, hence it should be considered a viable treatment alternative. In such case, early diagnosis and interception at the right time along with radiographic follow-ups are necessary to achieve successful results.
 Keywords: Canine Impaction, Class II malocclusion, Growth modification, Twin block appliance

Correlation between cephalometric nasal changes and patients’ perception after orthognathic surgery

The purpose of this study was to evaluate the correlation between cephalometric measurements and patients' perception of nasal changes in those with Class III malocclusion who had undergone orthognathic surgery. Eighty-five patients (36 men and 49 women) who received maxillary advancement with (group 1) or without (group 2) maxillary impaction were included in this study. Lateral cephalometric radiographs taken before and at the end of the treatment were analyzed. The patients were given an esthetic evaluation form and asked to evaluate their own noses on the Likert scale (subjective perception), while at the same time, they were asked to evaluate profile silhouettes without knowing that it was their own profile (objective perception). The changes and correlations between the cephalometric measurements and the scores obtained from the esthetic perception questionnaire were evaluated statistically. Postoperative nasal tip inclination and rotation, nasofacial angle, and sagittal position of pronasale had increased significantly (P<0.05), whereas nasal tip protrusion, nasofrontal angle, and vertical position of pronasale had decreased (P<0.05). The change in the nasolabial angle and vertical position of pronasale was statistically different between the 2 surgical groups (P<0.05). In the end, a significant increase was observed in the patients' objective nasal esthetic scores (P<0.05). Soft tissues are affected by the vertical and sagittal surgical movements of the maxilla. There was a moderate correlation between patients' perception of nasal changes and cephalometric measurements. The subjective evaluation of the nose was similar among patients after surgery, but in the objective assessment, patients found their noses more esthetic.

Analysis of Gull in Flight Appearance and Related Parameters Following Le Fort I Osteotomy.

The present study aimed to investigate how "Gull in Flight" appearance and alar-columellar relationship change following maxillary surgery. Thirty-three patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in this retrospective study. Measurements which were angle of columella triangle, alar-rim angle, columella lobular angle, and distance of points forming "Gull in Flight" appearance were evaluated on pre and postoperative frontal and lateral photos of patients. Data was submitted to statistical analysis and significance level was determined as 0.05. Following Le Fort I surgery, distance of points forming "Gull in Flight" appearance with respect to canthus was decreased significantly (P < 0.05). Positions of these points to each other were not changed (P > 0.05). Every 1 mm maxillary impaction led to 0.58 mm reduction in y3 (the distance from the point that illustrates Gull's body) (P = 0.032). There was a decrease in angle of columella triangle, alar-rim angle and increase in columella lobular angle. However, these changes were not found significant (P > 0.05). Angle of columella triangle was increased 2.51 degree for every 1 mm maxillary advancement (P = 0.028). In conclusion, maxillary surgery had an impact on nasal region from frontal view. However, "Gull in Flight" appearance which is one of the aesthetic parameters in nose was not changed following maxillary surgery.

Comparison of scleral show alterations following Le Fort I osteotomy with either maxillary impaction or lengthening

This study aimed at evaluating changes in scleral show following Le Fort I osteotomy with either impaction or lengthening of the mid face. Patients who underwent Le Fort I osteotomy were included. The patients were divided according to the direction of the movement: group 1 underwent maxillary advancement and impaction, while group 2 underwent maxillary advancement and lengthening. Standardized preoperative and 6-month postoperative photos were superimposed using Microsoft PowerPoint. The inferior visible scleral area was assessed with landmarks and measured separately using ImageJ software. Marked scleral surface area was determined using pixel count. A total of 36 consecutive patients were included. The mean maxillary advancement in the patients was 4.16 ± 2.14 mm. The mean impaction in group 1 (n= 21) was 1.06 ± 1.49 mm, while the mean vertical lengthening in group 2 (n = 15) was 1.54 ± 1.65 mm. The difference in improvement in the inferior scleral show between the groups was not statistically significant. Preoperative (180 ± 118.2 mm) and postoperative (147.75 ± 92.2 mm) scleral show significantly improved (p = 0.012) in both groups. Scleral show can be overlooked for movements under 6 mm while planning for maxillary orthognathic movement, as it improves regardless of the desired movement.

Management of skeletal class III malocclusion by surgery-first approach: A case report

The purpose of Dentofacial Deformity Treatment is to achieve the proper aesthetic and function- al occlusion results. Conventional orthognathic surgery involves a long-term orthodontic phase before surgery for about 18 months, in which patients’ facial appearance worsens and their mo- tivation decreases. In the SFA (surgery first approach) method, the surgery is performed before orthodontics and orthodontic therapy is performed to improve dental occlusion and final settle- ment. Two main advantages of this method are the reduction of the therapy period and the initial improvement in the patient’s facial appearance. The SFA has certain benefits, especially in Class 3 malocclusion. In this case report, a 19-year-old girl with a relatively severe Class 3 malocclu- sion with skeletal discrepancy due to a mandibular prognathism and maxillary retrognathism, and asymmetrical face with chin deviation to left is presented with a unilateral posterior cross bite which was effectively treated using the SFA protocol. The SFA therapy was performed by removing orthodontics before surgery, followed by maxillary advancement surgery, and posterior maxillary impaction and postoperative orthodontic sets to dental alignment and settling the occlusion. De- spite the overall reduction in the orthodontic therapy period to less than 9 months, good results and functional occlusion were obtained.

Temporomandibular joint stability after two types of maxillary impaction surgery in patients with skeletal class II open bite due to condylar deformations: a preliminary study

ABSTRACT Purpose: The aim of this study was to evaluate the effect of two types of mandibular autorotation concept (MAC) surgery using maxillary impaction combined with a straight locking miniplate (SLM) technique on the condyles of patients with skeletal Class II open bite. Materials and methods: Fourteen female patients with skeletal Class II mandibular retrusion with open bite were included in this study. The patients were divided into two groups based on the type of MAC surgery performed: a group of subjects who underwent maxillary impaction only (MAC-1 group) and a group of subjects who underwent maxillary impaction combined with mandibular osteotomy (MAC-2 group). A 3D-printing CAD/CAM wafer was fabricated. The SLM technique was performed to stabilize the vertical maxillomandibular relationship during surgery. A computed tomographic image was obtained preoperatively as well as on the third post-surgical day and 1 year post-surgically to evaluate the relapse by assessing changes in cephalometric measurements, condylar volume, and condylar surface area. Results: Neither the MAC-1 group nor the MAC-2 group showed significant changes in their condylar surface area that could have led to skeletal relapse. The condylar volume was significantly decreased in the MAC-2 group, but the affected location did not contribute to the relapse of the mandibular position. Conclusion: Our findings suggest that MAC surgery with the SLM technique in patients with skeletal Class II retrognathia did not result in post-surgical relapse or further deformation and resorption of the condyle; rather, it yielded promising functional and morphological stability.

Nasal airway function after Le Fort I osteotomy with maxillary impaction: A prospective study using the Nasal Obstruction Symptom Evaluation scale.

BackgroundThis study evaluated changes in nasal airway function following Le Fort I osteotomy with maxillary impaction according to the Nasal Obstruction Symptom Evaluation (NOSE) scale.MethodsThis cohort study included 13 patients who underwent Le Fort I osteotomy with maxillary impaction. Nasal airway function was evaluated based on the NOSE scale preoperatively and at 3 months postoperatively. The change in the NOSE score was calculated as the preoperative score minus the postoperative score. If the normality assumptions for changes in the NOSE score were not met, a nonparametric test (the Wilcoxon signed-rank test) was used. Differences in NOSE score changes according to patient characteristics and surgical factors were evaluated using the Kruskal-Wallis test and the Mann-Whitney test.ResultsPatients ranged in age from 18 to 29 years (mean±standard deviation [SD], 23.00±3.87 years). Three were men and 10 were women. Eleven patients (84%) had an acquired dentofacial deformity with skeletal class III malocclusion. The preoperative NOSE scores ranged from 40 to 90 (mean±SD, 68.92±16.68), and the postoperative NOSE scores ranged from 25 to 80 (53.84±18.83). The cohort as a whole showed significant improvement in nasal airway function following maxillary impaction (P=0.028). Eleven patients (84%) had either improved (n=8) or unchanged (n=3) postoperative NOSE scores. However, nasal airway function deteriorated in two patients. Patient characteristics and surgical factors were not correlated with preoperative or postoperative NOSE scores.ConclusionsNasal airway function as evaluated using the NOSE scale improved after maxillary impaction.

EXTRACTION OF ECTOPIC MAXILLAR THIRD MOLARS AFTER CONE BEAM COMPUTED TOMOGRAPHY SURGICAL PLANNING: A CASE REPORT

Intraoperative imaging is increasingly used by surgeons and has become an integral part of many surgical procedures. Ectopically impacted third molars in the upper jaw, become a common developmental abnormality. Surgical planning of a case with bilaterally impacted maxillary teeth by using cone beam computed tomography is presented. The 3D model provide valuable information for improved diagnosis and treatment plan and ultimately results in more successful treatment, as in the present case. The surgeon, knowing the precise location of the tooth and shape of roots in all projections would reduce the invasiveness of surgery. This report describes a case of impacted upper wisdom teeth without any associated pathologic condition. Keywords:&nbsp;Third Molar; Ectopic Molar, Maxillary Sinus; Headache; Cone Beam Computed Tomography

Prevalence of Impacted Third Molars in AZ-Zulfi Region of Saudi Arabia: A Cross-sectional Study

Background and Aim: This study aims to evaluate the prevalence of the impacted third molars and their associated pathologies in the population of Az Zulfi, Saudi Arabia. Methods: This study was conducted in the clinics of the College of Dentistry, Majmaah University, Saudi Arabia. A total of 1695 orthopantomograms (OPG) from December 2018 and December 2019 were evaluated using the third molar characteristics evaluation form (TMCEF). Results: Minimum of one impacted third molar had been found in 240 OPG among 1695 studied. Among the gender, males (15.6%) showed more impacted teeth prevalence than females (3.1%). The incidence of mandibular molar impaction (23%) is more when compared to that of the maxilla (14.3%). The mandible shows more prevalence of mesioangular impaction (50.44%) and in the maxilla, it is vertical impaction (49.39%). Depending upon the space available between the second molar distal surface and the mandibular anterior ramus, Class II (51.09%) pattern is found to be more common than the other two Classes. Depending on the level of impaction Position B (45.95%) and Position C (59.83%) were found to be more common in the lower and upper jaw, respectively. More than 66% of maxillary impactions had close approximation to the maxillary sinus floor on both sides. Among the impacted teeth 187 had some associated pathology and dental caries were the most frequent one among all the other pathology reported. Conclusions: The most common impacted tooth in Az Zulfi, Kingdom of Saudi Arabia is mesioangular and position B in the mandible and vertical and position C in the maxilla.

Complete Management of Maxillary Impacted and Dilacerated Central Incisor

Complete Management of Maxillary Impacted and Dilacerated Central Incisor

Autorotation of the Mandible as Sequelae to Maxillary Intrusion: A Systematic Review.

Background:Autorotation of the mandible is a normally anticipated phenomenon following a surgical superior repositioning of the maxilla in clinical situations where patients have an excessive gummy smile. Prediction of the surgical treatment outcome following a presurgical orthodontic treatment is a critical element in the surgical treatment planning.Materials and Methods:The relevant articles were selected by hand search and electronic media (Google Scholar, PubMed, Science Direct, Medline, Embase, and Cochrane) from 1982 to 2020. All the relevant articles were properly screened, and findings were extracted from the articles.Results:It was observed that, following maxillary intrusion, mandible would eventually autorotate to take a new occlusion. Mandibular autorotation as a result of maxillary intrusion would lead to minimal shortening of the lower lip in the vertical plane. It was observed that the amount of mandibular autorotation correlates with the extent of maxillary impaction. Studies have shown that there is a passive soft-tissue response which may be attributed to the fact that no muscular detachment had been affected in the lower lip and soft-tissue chin region during the maxillary surgery.Conclusion:It is observed that there is a definite influence on the mandibular and chin positions as a result of maxillary intrusion and autorotation of the mandible. Every 1 mm of maxillary superior impaction, the chin moved 0.6 mm vertically and 0.2 mm horizontally. There is an appreciable shortening of the lower lip length.