Maxillary Tuberosity Research Articles

Correlations Between the Pterygomaxillary Junction and Appropriate Osteotome Placement Angles During Junction Separation in Le Fort I Osteotomy.

The authors evaluated pterygomaxillary junction angles across malocclusion patterns and identified the optimal technique for effective pterygomaxillary junction separation during Le Fort I osteotomy, focusing on appropriate osteotome angles and clinical applications. This retrospective study included 211 patients with malocclusion who had undergone Le Fort I osteotomy at Chang Gung Craniofacial Center between December 2015 and September 2023. The patients were stratified by sex and malocclusion class (class I, II, or III). Preoperative cone-beam computed tomography was performed to measure pterygomaxillary junction angles at 2 axial levels: the posterior nasal spine level and the lower border level corresponding to the maxillary tuberosity. Le Fort I osteotomy involving an angle oscillating saw, and a curved-tip Dautrey osteotome was performed, ensuring the precise placement of the osteotome and tilting of the osteotome handle during pterygomaxillary junction separation. The correlations between the pterygomaxillary junction and appropriate osteotome placement angles were investigated. Among the 211 patients, 5%, 15%, and 80% had class I, class II, and class III malocclusion, respectively. At the posterior nasal spine level, the average angles of the pterygomaxillary junction relative to the coronal plane were 16.76, 19.16, and 17.82 degrees in class I, class II, and class III groups, respectively; the corresponding angles at the lower border level were 27.29, 27.80, and 25.91 degrees. No significant between-class or between-sex differences were observed in pterygomaxillary junction angles; however, significant differences were noted between the 2 levels. Our surgical technique was both safe and effective for pterygomaxillary junction separation.

Modified Lateral Surgical Approach to the Pterygopalatine Fossa for Safe Preservation of the Peripheral Branch of the Marginal Mandibular Nerve

In cases where oral cancer spreads toward the maxillary tubercle, surgery may extend to the pterygopalatine fossa. There are 2 main extraoral approaches: anterior and lateral. Previously, we introduced a modified lateral approach with a mouth corner incision from the lower lip, that preserves the mental and marginal mandibular nerves. Now, we present a further modification that allows safer preservation of the peripheral branches of the marginal mandibular nerve around the mouth. The procedure has 2 key points. The first is to follow the course of the marginal mandibular nerve from the submandibular incision. The second is to begin the mouth corner incision from the upper lip. Deploying the cheek flap ensured the marginal mandibular nerve was contained within a preserved platysma band. The postoperative contours and unremarkable scar on the face were acceptable to the patient. Paralysis of the facial and mental nerves was almost nonexistent. In conclusion, this newly modified lateral approach is useful in fully exposing the pterygopalatine fossa while preserving the mental nerve and not only the main trunks of the marginal mandibular nerves but also the peripheral branches around the mouth.

Comparative Analysis of Adaptation of Conventional and Printable Complete Denture Bases to the Underlying Casts - An In Vitro Stereomicroscopic Study.

Properly adapted complete denture bases will have adequate retention to the underlying oral mucosa. With technological advancement, there are various techniques of fabrication of complete dentures. There are studies regarding the marginal adaptation of conventional and CAD-CAM denture bases, but there is not enough research comparing the marginal adaptation and polymerisation shrinkage of conventional and 3D printed complete denture bases. In vitro study using stereomicroscopy to determine the marginal discrepancy between the denture base and the cast. Twelve gypsum casts were taken and divided into conventional and 3D-printed groups. Conventional denture bases were fabricated by adapting wax of 2 mm thickness which was subsequently processed whereas 3D printed bases were designed and the standard tessellation language (STL) files were used to print the denture bases. Three points were marked at the mid-palatal line and on both maxillary tuberosities. Digital images were then captured at the marked regions and were used to measure the maximum gap between the cast and denture base at the marked regions. Data were analysed using an independent t-test and one-way ANOVA. Conventional dentures had a significantly lesser marginal discrepancy than 3D printed dentures (P = 0.000). The left maxillary tuberosity showed the highest marginal discrepancy, significantly different from mid-palatal and right tuberosity sites. Conventional dentures perform better than their counterparts in terms of adaptation. This accurate adaptation is vital for the retention of the complete denture.

Histological Analysis of Oral Tissue Grafting: A Focus on Donor Site Selection.

The science of dental tissue grafting is evolving, with an increased understanding of factors influencing graft behavior. Despite the widespread clinical use of soft tissue grafts, the histological characteristics of different gingival harvesting sites are still underexplored. This study aimed to fill this gap by analyzing 50 tissue samples harvested from 25 patients across three sites: the hard palate, maxillary tuberosity, and palatal rugae. Each sample underwent thorough histological and histomorphometric analysis. Conventional statistical analysis was performed using SPSS, while predictive modeling was conducted with RapidMiner Studio. The study identified significant histological differences among the graft sites, with notable variations in total graft height, epithelial height, and interdigitation perimeter. These findings underscore the importance of donor site selection in influencing graft success. Pair plots and principal component analysis (PCA) further highlighted the distinct histological features of each tissue type. The random forest classifier identified total graft height, epithelial height, and perimeter as the most influential factors in predicting graft site behavior. This study offers valuable insights into the histological characteristics of soft tissue grafts, potentially leading to more predictable clinical outcomes.

Do we consent to change? An evaluation of oral and maxillofacial outpatient department dentoalveolar consent forms

Obtaining informed consent before performing any dentoalveolar procedure is a professional, ethical, and legal obligation. Prior to this work, in this oral and maxillofacial department, no standardised consent process existed for dentoalveolar procedures. A targeted literature review established localised gold standards for dentoalveolar procedures, and retrospective data from 56 dentoalveolar consent forms over a four-week period assessed baseline compliance with these standards. Data analysis identified that risks of dry socket and trismus were documented in only 7% of cases, and maxillary tuberosity fracture was never documented. Thirty-three per cent of lower third molar cases did not include consent for inferior alveolar nerve injury. Findings were discussed in a departmental audit meeting, and a root cause analysis identified memory failure, repetition fatigue, and varying clinician knowledge and experience, as key drivers. The evidence base and localised gold standards were discussed. A standardised, bilingual, triple-copy dentoalveolar consent form was developed, including predefined indications, additional procedures, and risks, in a tick-box format. This form was presented to the Department of Patient Safety and Quality and gained local approval. Cases completed with the new form will now be evaluated against the localised gold standards, with a mixed-methods feedback survey investigating staff and patient opinions. Local processes for obtaining and documenting valid consent for dentoalveolar treatment were found to be inconsistent and frequently inadequate. Fifteen localised gold standards were set, and a new standardised consent form developed, which will be evaluated for effectiveness and acceptability.

Clinical Outcomes of Pterygoid and Maxillary Tuberosity Implants: A Systematic Review.

Background: This study aimed to assess the survival of implants placed in the maxillary tuberosity or in the pterygomaxillary region of the maxilla, based on a systematic review of the literature. Methods: An electronic search was undertaken in three databases. The cumulative survival rate (CSR) was calculated. The log-rank (Mantel-Cox) test was used to compare the survival distributions between some groups. Results: Thirty-eight studies were included, reporting 3446 implants (3053 pterygoid, 393 tuberosity) in 2245 patients, followed up for a mean ± SD of 61.0 ± 36.3 months (min-max, 1-144). A total of 208 pterygoid and 12 tuber implants failed, with a clear concentration of failures in the first year of follow-up and a 10-year CSR of 92.5% and 96.9%, respectively. The survival of pterygoid implants was lower than that of implants in the maxillary tuberosity (p = 0.006; log-rank test), and the survival of implants submitted to early/delayed loading was lower than that of immediately loaded implants (p < 0.001; log-rank test). Non-splinted implants presented higher failure rates. Few cases of intra- or postoperative complications were reported. Conclusions: Implants placed in the pterygoid process/maxillary tuberosity present a high 10-year CSR, although with lower survival for pterygoid in comparison to tuber implants. Pterygoid/tuber implants that are splinted with other implants may present higher survival rates than those that are not splinted.

Soft tissue inflammation around upper third molar cause limited mouth opening: common but overlooked.

The aim of this study was to explore inflammation of soft tissue around the upper third molar as a prevalent cause of limited mouth opening, identify the clinical and radiographic features, and summarize the therapeutic effectiveness of tooth extraction. A retrospective analysis of data from 264 patients with limited mouth opening over the last five years was performed. Among the 264 patients, 24 (9.1%) had inflammation of the soft tissue around the upper third molar, which was the second most common cause of limited mouth opening. Twenty-one of the twenty-four affected patients, with an average mouth opening of 19.1 ± 7.6mm, underwent upper third molar extraction. Gingival tenderness around the upper third molar or maxillary tuberosity mucosa was a characteristic clinical manifestation (p < 0.05). The characteristic features on maxillofacial CT included soft tissue swelling around the upper third molar and gap narrowing between the maxillary nodules and the mandibular ascending branch. Post extraction, the average mouth opening increased to 31.4 ± 4.9mm (p < 0.05), and follow-up CT demonstrated regression of the inflammatory soft tissue around the upper third molar. Inflammation of soft tissue around the upper third molar is a common cause of limited mouth opening. Symptoms of pain associated with the upper third molar and distinctive findings on enhanced maxillofacial CT scans are crucial for diagnosis. Upper third molar extraction yields favorable therapeutic outcomes. Inflammation of the soft tissue around the maxillary third molar commonly causes limited mouth opening, but this phenomenon has long been overlooked. Clarifying this etiology can reduce the number of misdiagnosed patients with restricted mouth opening and enable more efficient treatment for patients.

Newly revealed anatomy of the bucinator muscle: An anatomical and histological study

BackgroundCurrent anatomical knowledge of the origin of the bucinator muscle (BM), i.e., long thin attachments on the maxilla and mandible and the pterygomandibular raphe (PMR), is not supported by anatomical dissection of this muscle. The aim of this study was therefore to investigate the detailed morphology of the BM and associated structures and to discuss its function. MethodsThe anatomy of the BM and related structures was investigated in 15 cadaveric heads using a surgical microscope and histological analysis. ResultsThe inferior fibers of the BM originated from a small retromolar area (internal oblique line), which shared a common tendon with the deep tendon of the temporalis. The superior fibers of the BM originated from the maxillary tuberosity. The middle fibers originated the pterygoid hamulus. No PMR was identified in any of the specimens, but the border between the BM and superior pharyngeal constrictor muscle (SC) was clear because the muscle fibers followed different directions. Some horizontal fibers were continuous between the BM and SC. ConclusionsOur results suggest the need to revise established accounts of the origins of the bucinator (the maxillary tuberosity, conjoint tendon of the temporalis, and pterygoid hamulus without a pterygomandibular raphe. It also needs to be noted that some of its fibers merge directly with the SC.

Anatomical factors of the maxillary tuberosity that influence molar distalization.

To examine the areas of the maxillary tuberosity (MT) (coronal, apical, width, and height) with respect to the presence or absence of the third molar to establish possible anatomical limitations for molar distalization. A total of 277 tuberosities were evaluated through sagittal computed tomography (CT) images, divided for measurement into coronal (free of bone), apical (area of influence of the maxillary sinus), and tuberosity (bony area) zones, and stratified by the presence or absence of the third molar, sex, and two age subgroups. Mann-Whitney U test was used to compare the groups considering the third molar. The medians of the width and height of the tuberosity decreased significantly in the absence of the third molar (P < 0.001). The apical area also showed differences, with negative values in the absence of the third molar and positive values in the presence of the third molar (P < 0.001). However, no differences were observed for the coronal area (P > 0.05). In the absence of the third molar, the size of the MT, represented by its width and height, was smaller and negative values (decrease) were observed for the maxillary sinus. The sagittal CT provides useful information regarding the amount of bone tissue available for distalization and relationship of the second molar with respect to the maxillary sinus, which allows individualizing each case in relation to the amount and type of movement expected.

Digital technology-assisted extraction of impacted maxillary third molar located between the furcation of maxillary second molar by root dislocation: a case report.

Most of the maxillary impacted third molars are located in the maxillary tuberosity, where the vision and operation space are limited. This paper reports a case of surgical extraction of the left maxillary horizontal superhigh impacted third molar, which is located between the roots of the adjacent teeth and is closely related to the maxillary sinus. The digital simulation technology was used to reconstruct a three-dimensional visual image of the patient's maxilla, related teeth, and other adjacent anatomical structures to assist in finding the optimal surgical method accurately. Root dislocation before the crown not only protects the roots of the adjacent tooth, but also reduces the risk of maxillary sinus lining damage or perforation during operative procedures, improves the efficiency of the operation, and reduces surgical trauma, which conforms to the concept of minimally invasive surgery and provides a new idea and experience for the clinical extraction of such maxillary impacted third molars.

Management of the fractured maxillary tuberosity

Tuberosity fracture is a recognised complication of upper molar extractions. Failure to recognise the signs of a fractured tuberosity, and inadequate immediate management, can result in significant avoidable morbidity for patients. With an ageing population, and tooth retention into later life, such complications will become more commonplace. It is imperative that clinicians are competent at dealing with such complications, to ensure the best possible outcomes for their patients.

Treatment of Multiple RT1 Gingival Recessions Using a Coronally Advanced Flap Associated with L-PRF or Subgingival Connective Tissue Graft from Maxillary Tuberosity: A Randomized, Controlled Clinical Trial.

The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface.

Influence of the maxillary third molars and the surrounding cortical plate during maxillary tooth movement with TADS- A CBCT Study.

To determine the influence of the presence/absence of third molars and intact/loss of cortical plate of the maxillary tuberosity on the amount of distal movement of the maxillary first permanent molar during distal movement of the maxillary dentition with mini-implants. Thirty six maxillary tuberosity sites were evaluated in eighteen young adult patients. The distal movement of the entire maxillary dentition was performed with mini-implants with 200g of distalising force applied from the mini-implant placed in the maxillary posterior buccal region to attachments placed on the arch wire between the maxillary lateral incisor and canine bilaterally. The distal movement of the maxillary first permanent molars was measured on lateral cephalograms. The maxillary tuberosity sites with intact cortical plate due to congenitally missing third molars or atraumatic extraction of third molars (G1), partial loss of cortical plate due to surgical removal of third molars (G2), fully erupted third molars (G4), third molars located at (G3), and below the cementoenamel junction (G5) were evaluated with cone beam computed tomography. One way Anova and Fisher LSD test was done. The order of greater to lesser amount of distal movement of the maxillary first permanent molar depending on the integrity of maxillary of tuberosity was partial loss of cortical plate, third molars at the cementoenamel junction, third molars below the cementoenamel junction, intact cortical plate and fully erupted third molars. The integrity of the cortical plate and the relative position of the maxillary third molar to the second molar influence the amount of distal movement of the maxillary first permanent molar during distal movement of the maxillary teeth with TADS. The amount of distal movement of the maxillary dentition appears to depend on the presence or absence of the third molars and the condition of the cortical plate in the region of the maxillary tuberosity and thereby greatly influence the outcome of treatment.

Anatomical study on the posterior alveolar canal in maxillary tuberosity region using computed tomography

ObjectiveThis study aimed to identify the anatomical characteristics of the posterior alveolar canal (PAC) and related maxillary bone using computed tomography (CT). MethodsThe study included 40 Japanese cadavers (70 hemi-heads), comprising 23 males (41 hemi-heads) and 17 females (29 hemi-heads). Simple CT data of the maxillary bone region of the specimens were obtained and analyzed using a measurement software with reference to the Frankfurt horizontal (FH) plane to identify the PAC in the maxillary tuberosity region, alveolar crest (AC), and corner of the inferior crest of the zygomatic process (CICZP). The shortest distances between the PAC and the respective landmarks and the smallest width of the posterior wall of the maxillary sinus (WPWMS) at the PAC level were calculated and analyzed statistically. ResultsOf all specimens, the mean and SD of AC-PAC: 21.4 ± 3.32 mm, horizontal PAC-CICZP: 15.1 ± 2.89 mm, vertical PAC-CICZP: 5.70 ± 3.15 mm, WPWMS: 0.81 ± 0.31 mm, and the coefficients of variation ranged 15.5–55.3%. In the WPWMS, the mean value was statistically smaller in the female group (0.59 mm) than in the male group (0.96 mm) (p < 0.001). ConclusionsThe results showed certain tendencies in the distances between the PAC and the respective anatomical landmarks with large variations. The thickness of the posterior wall of the maxillary sinus was thinner in females than in males. However, it is < 1 mm in both sexes, and external forces caused by trauma or surgery may fracture the posterior wall of the maxillary sinus and damage the posterior superior alveolar artery regardless of sex.

The Accuracy of Intraoral Registration for Dynamic Surgical Navigation in the Edentulous Maxilla.

Despite the high clinical accuracy of dynamic navigation, inherent sources of error exist. The purpose of this study was to improve the accuracy of dynamic-navigated surgical procedures in the edentulous maxilla by identifying the optimal configuration of intraoral points that results in the lowest possible registration error for direct clinical implementation. Six different four-area configurations (left and right sides; n = 12) were tested by three operators against two negative controls (left and right sides) and one positive control (three-area and eight-area configurations, respectively) using a skull model. The two dynamic navigation systems (X-Guide and Navident) and the two registration methods (bone surface tracing and fiducial markers) produced four registration groups: XG tracing, ND tracing, XG fiducial, and ND fiducial. The accuracy of the registration was checked at the frontal process of the zygoma. Intra- and interoperator reliabilities were reported for each registration group. Multiple comparisons were conducted to find the best configuration with the minimum registration error. Ranking revealed one configuration in the tracing groups (Conf.3) and two configurations in the fiducial groups (Conf.3 and Conf.5) that had the best accuracy. When the inferior surfaces of the zygomatic buttress were excluded, fiducial registration produced better accuracy with both systems (P = .006 and < .0001). However, bilaterally tracing 1-cm areas at these surfaces resulted in similar registration accuracy to placing fiducial markers there (P = .430 and .237). Navident performed generally better (P = .049, .001, and .002), but the values had a wider margin of uncertainty. Changing the distribution of the four tracing areas or fiducial markers had a less pronounced effect with the X-Guide than with the Navident system. For surgery in the edentulous maxilla, four fiducial markers placed according to Conf.3 or Conf.5 resulted in the lowest registration error. Where implants are being placed bilaterally, an additional two sites may further reduce the error. For bilateral zygomatic implant placement, it is optimal to place two fiducial markers on the inferior surfaces of the maxillary tuberosities, two on their buccal surfaces, and another two on the anterior labial surface of the alveolar bone. Utilizing the inferior zygomatic buttress is recommended over the inferior maxillary tuberosities in other types of maxillary surgeries.

Congenital Tessier Type 7 Bilateral Maxillary Duplication: A Rare Craniofacial Deformity

It is uncommon for these rare congenital abnormalities to manifest as craniofacial clefts. The Tessier clefting scheme is one classification technique that is used for diagnosis. A maxillary duplication is an extra bone that is situated behind the maxillary tuberosity. The case of a six-year-old child with bilaterally supernumerary teeth who presented to the Department of Radiodiagnosis of our institute to assess and treat enlarged asymptomatic cheek swelling is presented. On the basis of the patient's medical history, physical examination, and radiological tests, the accessory maxillae were diagnosed. Later, there was a surgical reconstruction.

Alveolar Ridge Preservation Using the One-Piece Autologous Tuberosity Graft: A Clinical, Radiological, and Histological Pilot Study.

This prospective study investigated clinically and radiologically the effectiveness of the use of a combined hard and soft tissue graft retrieved from the maxillary tuberosity and designed for alveolar ridge preservation following tooth extraction. Seven patients scheduled for a single mono-rooted tooth extraction were included in the study. After atraumatic extraction, sockets were filled with a "one-piece" dual tissue graft harvested from the tuberosity using an adjusted trephine. CBCTs were performed before the extraction and 4 months after ridge preservation, to analyze the vertical and horizontal alterations of the ridge, using ITK-Snap software. Clinical measurements of both soft and hard tissues were also assessed during the extraction and implant placement. All sites healed uneventfully. After 4 months, the 3D super-imposition of both CBCTs showed a mean bone volume resorption of 65 ± 76.7 mm3 (10.2 ± 10%). The mean horizontal reduction at 2, 4, and 6 mm from the top of the crest was respectively 1.5 ± 1.3 mm, 0.47 ± 1.4 mm and 0.57 ± 0.7 mm, while the mean vertical loss was 0.026 mm ± 2 mm. The mean soft tissue horizontal gain was 1.73 ± 1.12 mm. The "one-piece" autologous tuberosity graft was proven to be a safe and effective alveolar ridge preservation technique and may represent a feasible, user-friendly, time saving, low-cost solution for minimizing dimensional loss following tooth extraction.

Volumetric and Linear Assessment of Maxillary Tuberosity Bone as A Donor Site for Alveolar Ridge Augmentation using CBCT A Cross Sectional Analytical Study

Volumetric and Linear Assessment of Maxillary Tuberosity Bone as A Donor Site for Alveolar Ridge Augmentation using CBCT A Cross Sectional Analytical Study

Single Vertical Incision at the Corner of the Maxillary Tuberosity for Impacted Upper Third Molar Removal: Technical Note

Single Vertical Incision at the Corner of the Maxillary Tuberosity for Impacted Upper Third Molar Removal: Technical Note

Analysis of risk factors affecting poor wound healing after primary cleft palate surgery.

To study the risk factors of poor wound healing after primary cleft palate surgery. In this study, 980 cases of congenital cleft palate treated by Sommerlad-Furlow in the Department of Cleft Lip and Palate Surgery of Sichuan University from 2017 to 2021 were continuously analyzed. Indicators included patient's age, gender, body weight, cleft palate type, width of the widest fistula, cleft palate index (width of the widest fistula/width at the posterior edge of the maxillary tubercle plane), preoperative white blood cell count, preoperative hemoglobin level, preoperative antibiotic use, doctor's seniority, use of relaxation incision, operation time, postoperative upper respiratory tract infection, and postoperative wound healing. The postoperative wound healing was divided into normal healing, delayed healing, and palatal fistula. Both delayed healing and palatal fistula were classified as poor healing. The factors that may affect the healing outcome of the palatal wound after primary cleft palate repair were analyzed using SPSS 26.0 software. A total of 825 patients (84.2%) had normal healing, 112 patients (11.4%) had delayed hea-ling, and 43 patients (4.4%) had palatal fistula. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time influenced the wound healing effect after cleft palate surgery (P<0.05). Doctors with low seniority, wide width of the widest fistula, large cleft palate index, and long operation time were the risk factors of poor wound healing. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time are related to the effect of healing effect after cleft palate surgery.