Oral Maxillofac Research Articles

Zygomatic Implants Are a Reliable Treatment Option for Patients With Atrophic Maxilla

Survival and Complications of Zygomatic Implants: An Updated Systematic Review. Chrcanovic BR, Albrektsson T, Wennerberg A. J Oral Maxillofac Surg 2016;74(10):1949-64. Self-funding TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.

Abstract: A Microplate Fixation for Treatment of Comminuted Mandibular Fractures

INTRODUCTION: Strong rigid fixation with miniplates and large plates has been widely used in comminuted mandibular fractures. However, normal bite forces are not generated for months after mandibular fracture1. Therefore, absolute rigidity of the bone segments is not necessary during the bone healing period2, 3. The purpose of this article is to evaluate availability of microplate fixation for comminuted mandibular fractures. METHODS: Fourteen patients with comminuted mandibular fractures were treated by microplate fixation. Accurate reduction of the all bony segments and multiple fixation were performed at each fracture site with 1.2(1.0)-mm microplates with or without wire. At the lower border, no fracture gap of the inner and outer cortices along the inferior margin was confirmed after fixation. At the upper border, interdental wiring was applied to approximate the fracture edges of the inner and outer cortex as external fixation. In edentulous cases, microplate fixation was done at the upper margin. At the middle of the outer cortex, multiple microplate fixation was done at the outer cortex, pushing on the mandibular angles to tightly approximate the fracture edges of the inner cortex. When premature occlusal contact was observed by a thin-paper bite test after fixation, intermaxillary fixation was applied and maintained for 1 week postoperatively, and followed by active mouth opening exercise. The patients without IMF were allowed immediate mouth opening and provided a liquid diet for the first three or four days after the operation. All patients took a soft diet for the 6 weeks after the operation. RESULTS: Comminuted mandibular fractures were located in the symphysis (6), the symphysis and the body (2), the body (4), the angle (1) and the symphysis, the body, the ramus and the subcondyle (1). During the follow-up period from 3 to 16 months, all fractures showed excellent bone healing without major complications requiring further treatment. Minor malocclusion with good functional occlusion was observed in two patients, who required no additional treatment. CONCLUSION: We could achieve complete bone healing and premorbid occlusion using microplates. The microplates are strong enough to keep comminuted mandibular fractures reduced. Their small size and malleability allow multiple fixation of comminuted bony segments in accurate-anatomical position, less periosteal stripping and self-occlusal adjustment. Therefore, microplate fixation may be one of good options for reconstruction of comminuted mandibular fractures. Reference Citations: 1. Gerlach KL, Schwarz A. Bite forces in patients after treatment of mandibular angle fractures with miniplate osteosynthesis according to Champy. Int J Oral Maxillofac Surg. 2002;31:345-348 2. Ellis 3rd E. Treatment methods for fractures of the mandibular angle. Int J Oral Maxillofac Surg. 1999;28(4):243–252. 3. Ellis 3rd E. Selection of internal fixation devices in mandibular fractures: How much fixation is enough? Semin Plast Surg. 2002;16(3):229–241.

Insufficient evidence about the comparative effectiveness of 3 horizontal ridge augmentation techniques

Deeb GR, Tran D, Carrico CK, Block E, Laskin DM, Deeb JG. How effective is the tent screw pole technique compared to other forms of horizontal ridge augmentation [published online ahead of print June 13, 2017]? J Oral Maxillofac Surg. http://dx.doi.org/10.1016/j.joms.2017.05.037.

Customised instrument to retract alveolar subperiosteal flap during the placement of dental implants: new technique

Retraction of subperiosteal flaps on the buccolingual aspect of the alveolar ridge is important for the proper insertion of dental implants. The width and height of alveolar bone should be felt clearly to prevent misdirection of the implant or penetration of bony walls. 1 Vadepally A.K. Sinha R. Use of Thudichum nasal speculum for retraction during insertion of dental implants. Br J Oral Maxillofac Surg. 2017; 55: 554-555 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Recently the Thudichum nasal speculum was described for retraction during the procedure, 1 Vadepally A.K. Sinha R. Use of Thudichum nasal speculum for retraction during insertion of dental implants. Br J Oral Maxillofac Surg. 2017; 55: 554-555 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar and here we describe a self-retaining instrument that we designed to retract the alveolar subperiosteal flap.

How Effective Is the Tent Screw Pole Technique Compared to Other Forms of Horizontal Ridge Augmentation?

The tent screw pole technique is one of the methods available for practitioners to perform horizontal ridge augmentation to facilitate dental implant placement. The purpose of this study was to evaluate the efficacy of the tent screw pole technique for horizontal ridge augmentation and to compare the results with those of the tunnel technique and open ridge augmentation. In this retrospective cohort study, 35 patients underwent horizontal ridge augmentation with the tent screw pole technique, a 1:1 ratio of mineralized freeze-dried bone allograft and particulate bovine hydroxyapatite, and a resorbable collagen membrane. The incidence of early wound dehiscence and membrane exposure, the number of courses of antibiotics and postoperative visits required for their management, and the number of sites that subsequently had successful implant placement were recorded. These parameters were compared with those in 21 patients who had undergone horizontal ridge augmentation by the tunnel technique and 31 patients who had been treated using an open procedure and a resorbable polytetrafluoroethylene (PTFE) membrane in the authors' previous study (J Oral Maxillofac Surg 74:1752, 2016). Implant placement rate was similar for all 3 methods (71 to 97%). However, there were significant differences among the 3 surgical techniques for membrane exposure and wound dehiscence (P=.0033), graft loss (P=.0256), courses of antibiotics (P=.0017), and postoperative visits (P=.0043). The PTFE method consistently had the highest rate of complications, whereas the tent screw and tunnel techniques were comparable. All 3 techniques allowed a high rate of implant placement; however, the PTFE technique was consistently associated with increased postoperative complications compared with the other 2 methods. The tent screw technique might be more favorable than the tunnel technique in cases in which the bony deficiency is flat.

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Platelet-rich fibrin might not provide a benefit in healing and complications after third-molar extraction

Al-Hamed FS, Tawfik MA, Abdelfadil E, Al-Saleh MA. Efficacy of platelet-rich fibrin after mandibular third molar extraction: a systematic review and meta-analysis [published online ahead of print February 1, 2017]. J Oral Maxillofac Surg. http://dx.doi.org/10.1016/j.joms.2017.01.022.

Secondary sinus lift: a viable option to increase contact of bone to implant

The secondary sinus lift is a new treatment for patients with osseointegrated implants and insufficient height of the alveolar remnant. This can be caused by the loss of a graft after the initial procedure, or when the sinus has not been augmented in the first instance. 1 Pérez-Martinez S. Martorell-Calatayud L. Peñarrocha-Oltra D. et al. Indirect sinus lift without bone graft material: systematic review and meta-analysis. J Clin Exp Dent. 2015; 7: e316-e319 Crossref PubMed Scopus (19) Google Scholar , 2 Bassi A.P. Pioto R. Faverani L.P. et al. Maxillary sinus lift without grafting, and simultaneous implant placement: a prospective clinical study with a 51-month follow-up. Int J Oral Maxillofac Surg. 2015; 44: 902-907 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar Our protocol is simple. It means that the original implants do not need to be removed, and it aims to increase their stability and longevity (Fig. 1).

Advanced Stage of Medication‐Related Osteonecrosis of the Jaw Associated With Oral Bisphosphonates: Report of Three Cases

Introduction: Bisphosphonates (BPs) are prescribed for treating diseases exhibiting high bone turnover rates. Medication‐related osteonecrosis of the jaw (MRONJ) is a major adverse effect of BPs. Cases of MRONJ associated with oral BPs for treatment of osteoporosis are much less common compared with intravenous BPs. Most reports of oral BP–associated MRONJ are either stage 1 or stage 2 as classified by the 2014 American Academy of Oral and Maxillofacial Surgeons position paper (Ruggiero et al., J Oral Maxillofac Surg 2014;72:1938‐1956). There are ≈24 reported cases of oral BP–induced stage 3 MRONJ presenting as an area of exposed necrotic bone with pain and infection along with a pathologic fracture, an extraoral fistula, oroantral communication, or osteolysis extending to the inferior border of the mandible or sinus floor.Case Series: Three cases of stage 3 MRONJ associated with oral BPs are presented. All three patients had a long history of use of alendronate for over 10 years. Diagnosis of stage 3 MRONJ was made based on clinical, radiographic, and histopathologic findings. Patients were managed with a course of antibiotics and removal of the necrotic bone.Conclusions: Development of stage 3 MRONJ associated with oral BPs is relatively rare. However, there is an increased risk of advanced MRONJ associated with oral BPs in the presence of longer duration of therapy, dentoalveolar surgery, denture trauma, inflammatory oral diseases, and presence of comorbid factors. Therefore, it is recommended that clinicians educate patients about the advanced adverse effects of oral BPs.

Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients.

Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary "Alternatives to CPAP program" (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients.

Disk displacement, eccentric condylar position, osteoarthrosis - misnomers for variations of normality? Results and interpretations from an MRI study in two age cohorts.

BackgroundClinical decision-making and prognostic statements in individuals with manifest or suspected temporomandibular disorders (TMDs) may involve assessment of (a) the position of articular disc relative to the mandibular condyle, (b) the location of the condyle relative to the temporal joint surfaces, and (c) the depth of the glenoid fossa of the temporomandibular joints (TMJs). The aim of this study was twofold: (1) Determination of the prevalence of these variables in two representative population-based birth cohorts. (2) Reinterpretation of the clinical significance of the findings.MethodsFrom existing magnetic resonance imaging (MRI) scans of the TMJs that had been taken in 2005 and 2006 from 72 subjects born between 1930 and 1932 and between 1950 and 1952, respectively, the condylar position at closed jaw was calculated as percentage displacement of the condyle from absolute centricity. By using the criteria introduced by Orsini et al. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:489-97, 1998), a textbook-like disc position at closed jaw was distinguished from an anterior location. TMJ morphology of the temporal joint surfaces was assessed at open jaw by measuring the depth of the glenoid fossa, using the method proposed by Muto et al. (J Oral Maxillofac Surg 52:1269-72, 1994).Frequency distributions were recorded for the condylar and disc positions at closed jaw.Student’s t-test with independent samples was used as test of significance to detect differences of condylar positions between the age cohorts (1930 vs. 1950) and the sexes. The significance levels were set at 5%. First, the results from the measurement of the age cohorts were compared without differentiation of sexes, i.e., age cohort 1930–1932 versus age cohort 1950–1952. Subsequently, the age cohorts were compared by sex, i.e., men in cohort 1930–1932 versus men in cohort 1950–1952, and women in cohort 1930–1932 women men in cohort 1950–1952.ResultsIn both cohorts, condylar position was characterized by great variability. About 50% of the condyles were located centrically, while the other half was either in an anterior or in a posterior position. In both female cohorts, a posterior position predominated, whereas a centric position prevailed among men. Around 75% of the discs were positioned textbook-like, while the remaining forth was located anteriorly. Age had no statistically significant influence on condylar or on disc position. Conversely, comparison between the age groups revealed a statistically significant decrease of the depth of the glenoid fossa in both older cohorts. This age-dependent changes may be interpreted as flattening of the temporal joint surfaces.ConclusionsWe call for a re-interpretation of imaging findings because they may insinuate pathology which usually is not present. Instead, anterior or posterior positions of the mandibular condyle as well as an anterior location of the articular disc should be construed as a variation of normalcy. Likewise, flattening of articular surfaces of the TMJs may be considered as normal adaptive responses to increased loading, rather than pathological degenerative changes.Trial registrationNot applicable.

A technique for minimizing subgingival residual cement by using rubber dam for cement-retained implant crowns

Excellent esthetics and a passive fit are facilitated by using cement-retained prostheses. However, eliminating residual cement is difficult in the subgingival area. Residual cement may cause periimplantitis, gingival swelling, pain, bleeding on probing, and other complications.1Pauletto N. Lahiffe B.J. Walton J.N. Complications associated with excess cement around crowns on osseointegrated implants: a clinical report.Int J Oral Maxillofac Implants. 1999; 14: 865-868PubMed Google Scholar Generally, the margin of an anterior implant crown is placed in the subgingival area for esthetic reasons. Because removing residual cement in subgingival areas is difficult, techniques using abutment replicas or Teflon tape have been introduced to minimize the problem.2Galván G. Kois J.C. Chaiyabutr Y. Kois D. Cemented implant restoration: a technique for minimizing adverse biologic consequences.J Prosthet Dent. 2015; 114: 482-485Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 3Wadhwani C. Piñeyro A. Technique for controlling the cement for an implant crown.J Prosthet Dent. 2009; 102: 57-58Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar, 4Hess T.A. A technique to eliminate subgingival cement adhesion to implant abutments by using polytetrafluoroethylene tape.J Prosthet Dent. 2014; 112: 365-368Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar The presented technique uses rubber dam to allow only the minimal amount of residual cement to flow into the subgingival area when cement-retained prostheses with subgingival margins are delivered. The procedure does not require any additional laboratory steps. Moreover, it enables the isolation of a prosthesis before the cementation procedure. Since the cement does not flow into the subgingival area, less bleeding may occur when the residual cement is removed, thus causing less discomfort. Furthermore, rubber dam protects the gingiva from direct contact with the cement, thus decreasing chemical irritation. 1.Cut a sheet of rubber dam (Blossom; Mexpo Intl Inc) into a size approximating the mesiodistal width of the edentulous area and make a hole in the center with a dental explorer (EXDTU17/236; Hu-Friedy Mfg Co).2.Push the implant abutment (Myplant; RaphaBio Co) through the hole of the rubber dam and place it below the margin of the abutment (Fig. 1A ).3.Connect the customized abutment with rubber dam to the implant fixture and tighten to 30 Ncm. Adjust the occlusal contact of the restoration. After 10 minutes, retighten and seal the hole.5Siamos G. Winkler S. Boberick K.G. Relationship between implant preload and screw loosening on implant-supported prostheses.J Oral Implantol. 2002; 28: 67-73Crossref PubMed Scopus (169) Google Scholar Make sure not to cover the proximal contacts with the rubber dam (Fig. 1B).4.Apply a small amount of cement (RelyX Unicem; 3M ESPE) along the margin of the crown6Wadhwani C. Goodwin S. Cementing an implant crown: a novel measurement system using computational fluid dynamics approach.Clin Implant Dent Relat Res. 2014; 18: 97-106Crossref PubMed Scopus (13) Google Scholar and place the crown over the abutment. Light polymerize for an initial 1 or 2 seconds according to the manufacturer’s instructions (Fig. 2A ).Figure 2A, Place crown over abutment and light polymerize for 1 to 2 seconds. B, Remove residual cement.View Large Image Figure ViewerDownload Hi-res image Download (PPT)5.Remove the initially polymerized cement and carefully cut the rubber dam with scissors and remove it (Fig. 2B). After complete polymerization, ensure no cement remains.

Abstract: Adipose Derived Stem Cells Improve Union Rates and Biomechanical Strength Following Fracture in the Irradiated Murine Mandible

INTRODUCTION: Pathologic fractures and associated non-unions arising in irradiated bone are complex management dilemmas for the reconstructive surgeon. These complications are commonly managed with debridement of necrotic bone and vascularized free tissue transfers. Unfortunately, free tissue transfers remain complex and invasive procedures which are fraught with additional risk and morbidity1-4. This study examines a novel treatment paradigm for the management of non-unions and pathologic fractures utilizing implanted adipose derived stem cells (ASCs). Herein, we hypothesize that ASCs will mitigate the detrimental effects of radiation induced injury to the murine mandible and improve clinical union rates and metrics of biomechanical strength. METHODS: Isogenic Lewis rats (n=36) were divided into 3 groups. Control fracture (n=5), radiated fracture (n=15), radiated fracture + ASCs (n=16). The radiated groups received fractionated, 35Gy (human dose equivalent of 70Gy) radiation over 5 days, two weeks prior to mandibular osteotomy. The radiated fracture + ASCs group received implantation of the ASCs at the time of surgery on a Surgifoam scaffold. Following a 40-day healing period, mandibles were assessed for bony-union and mechanically tested to failure. ANOVA was used for comparison of continuous variables (p<0.05) and Chi Square for categorical variables χ2< 0.05. RESULTS:Bony Union: A statistically significant increase in bony union rates was seen in the radiated fracture + ASCs group (94%) vs radiated fracture alone (20%) χ2=0.00003. Clinical union rates in the radiated fracture + ASCs group (94%) approximated that of the control fracture group (100%) χ2=0.57. Biomechanical Testing: Significant improvements were found between radiated fracture + ASCs group and radiated fracture group in the metrics of Yield (61.46 N vs 23.5 N, p=0.003), Energy (56.12 Nmm vs 9.97 Nmm p=0.001), and Ultimate Load (73.47 N vs 33.72 N, p=0.002). Additionally, metrics of Yield and Ultimate Load were not statistically different between the radiated fracture + ASCs group and control fracture whereas Energy was significantly improved with ASC treatment (56.12 Nmm vs 9.91 Nmm p=0.001) CONCLUSION: Our data demonstrate the in-vivo efficacy of adipose derived stems cells (ASCs) and their ability to improve clinical union rates and biomechanical properties in the irradiated murine mandible. We support the continued investigation of this novel treatment paradigm and its further translational development for the management of pathologic fractures and associated non-unions after radiotherapy. 1. Urken ML, Buchbinder D, Costantino PD, et al. Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg 1998; 124:46–55. 2. Peled M, El-Naaj IA, Lipin Y, Ardekian L. The use of free fibular flap for functional mandibular reconstruction. J Oral Maxillofac Surg 2005; 63:220–224. 3. Ross DA, Hundal JS, Son YH, et al. Microsurgical free flap reconstruction outcomes in head and neck cancer patients after surgical extirpation and intraoperative brachytherapy. Laryngoscope 2004; 114:1170–1176. 4. Shaari CM, Buchbinder D, Constantio PD, Lawson W, Biller HF, Urken ML. Complications of microvascular head and neck surgery in the elderly. Arch Otolaryngol Head Neck Surg 1998; 124:407–411.

Abstract: The Change of Posterior Pharyngeal Space after Counter Clock-wise Rotational Orthognathic Surgery Based on Cephalometry

INTRODUCTION: Maxillomandibular advancement (MMA) is an orthognathic surgical procedure that has been used to manage OSA in individuals who are noncompliant with CPAP therapy.1 MMA is a site-specific procedure, performed for the purpose of creating an enlarged posterior airway space at multiple anatomic levels, including the nasopharynx, oropharynx, and hypopharynx.2 MMA has been shown to significantly improve OSA, with reported short term success rates ranging from 75% to 100%.3–5 This prospective investigation describes the functional and aesthetic outcomes after the counter clock wise rotational orthognathic surgery in skeletal class II patients with the obstructive sleep apnea based on pre and postoperative polysomnography and cephalometry. MATERIALS AND METHODS: This retrospective study investigated the surgical outcome of 12 patients who suffered from obstructive sleep apnea following the counter clock wise rotational orthognathic surgery in terms of functional and aesthetic outcomes. The patients included in this study were skeletal class II patients who underwent orthognathic surgery between March, 2013 and December, 2014 at the Seoul Asan Medical Center, University Medical Center for tertiary care. The pharyngeal airway assessment was done through polysomnography and cephalometric posterior airway analysis using PRL–PSP, PRL–PTO and PRL–E distances. RESULTS: The follow-up period ranged from 10 to 36 months (average, 20.5 months). The average age of the patients was 28.5 years, with 9 male and 11 female patients. Compared to preoperative results (mean preop distance of PRL–PSP: 19.97, PRL–PTO: 18.68, PRL–E: 16.2), PRL–PSP, PRL–PTO and PRL–E distances were increased statistically significant in immediate postoperative cephalometry. (p<0.005) (mean immediate postop distance of PRL–PSP: 23.1, PRL–PTO: 22.9, PRL–E: 18.6). The results were maintained 6 months after the surgery(mean distant postop distance of PRL–PSP: 22.2, PRL–PTO: 22.5, PRL–E: 18.0). There was no significant change in PRL–PSP, PRL–PTO and PRL–E distances.(p>0.05). CONCLUSION: The change of the posterior pharyngeal space in counter clock-wise rotational orthognathic surgery without maxilla advancement for the correction of obstructive sleep apnea is presented. Our findings indicate that this approach can lengthen the posterior pharyngeal space effectively. With considered application, this novel approach could be an alternative to standard approaches in the correction of obstructive sleep apnea using orthognathic surgery. DISCLOSURES/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Fernández-Ferrer L, Montiel-Company JM, Pinho T, Almerich-Silla JM, Bellot-Arcís C. Effects of mandibular setback surgery on upper airway dimensions and their influence on obstructive sleep apnoea - a systematic review. J Craniomaxillofac Surg. 2015;43:248–53. 2. Demetriades N, Chang DJ, Laskarides C, Papageorge M. Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders. J Oral Maxillofac Surg. 2010;68:2431–6. 3. Gonçalves JR, Gomes LC, Vianna AP, Rodrigues DB, Gonçalves DA, Wolford LM. Airway space changes after maxillomandibular counterclockwise rotation and mandibular advancement with TMJ Concepts® total joint prostheses: three-dimensional assessment. Int J Oral Maxillofac Surg. 2013;42:1014–22. 4. Hatab NA, Konstantinović VS, Mudrak JK. Pharyngeal airway changes after mono- and bimaxillary surgery in skeletal class III patients: Cone-beam computed tomography evaluation. J Craniomaxillofac Surg. 2015;43:491–6. 5. Jakobsone G, Stenvik A, Espeland L. The effect of maxillary advancement and impaction on the upper airway after bimaxillary surgery to correct Class III malocclusion. Am J Orthod Dentofacial Orthop. 2011;139:e369-76.

Abstract: Can a Surgery-First Orthognathic Approach Reduce the Total Treatment Time?

INTRODUCTION: A traditional orthognathic approach requires presurgical orthodontic treatment for an average of approximately 17 months,1 followed by surgery and postsurgical orthodontic treatment for approximately 6–12 months. Therefore, the total treatment time for the conventional orthognathic approach takes approximately 18–36 months.2–4 Because traditional orthognathic surgery requires 2–3 years to complete, it is a rarely adopted procedure. Therefore, shortening the total treatment time would be extremely beneficial for patients. Although presurgical orthodontic treatment has been approved as an inevitable process for stable orthognathic correction before surgery, recent advances in the application of mini-screws and presurgical simulational orthodontic management skills on a dental model show that it is possible to perform a surgery-first orthognathic approach without presurgical orthodontic treatment.5 MATERIALS AND METHODS: We assessed 45 consecutive Asian patients with skeletal class III dentofacial deformities with surgery-first orthognathic surgery compared to 52 patients with conventional two-jaw orthognathic surgery. Using cephalometric landmark data for the patients with a surgery-first approach, we analyzed postoperative changes in vertical and horizontal facial, denture, and soft tissue patterns. Assuming that tooth extraction is a factor that affects the total treatment time, both groups were divided into two subgroups. RESULTS: The treatment duration of the surgery-first group was significantly less than that of the orthodontics-first group. Overall, the analysis revealed that the total treatment time period in the surgery-first orthognathic approach averaged 14.6 months compared to 22.0 months of treatment in an orthodontic-first orthognathic approach. Among the surgery-first cases without tooth extraction, the average treatment interval was only 13.6 months versus 24.8 months for the six that required tooth extraction (p < 0.001). In contrast, the average treatment period of traditional orthodontics-first cases without tooth extraction was roughly comparable to the nine cases that required tooth extraction (21.7 months vs. 21.6 months, respectively). The difference between immediate postoperative and preoperative, postoperative and immediate postoperative cephalometric data revealed factors that have correlation with total treatment duration. CONCLUSION: Surgery-first orthognathic surgery can dramatically shorten the total treatment time with no major complications. By analyzing the cephalometric landmark data we identified several possible factors that have an effect on the total treatment time. DISCLOSURES/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Luther F, Morris DO, Hart C: Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study. Br J Oral Maxillofac Surg 41:401–406, 2003. 2. Van Sickels JE, Loftus MJ, Weiss WW, Jr: Orthognathic surgery: a team approach. Bull Phila Cty Dent Soc. 45:8–9, 1979. 3. Slavnic S, Marcusson A: Duration of orthodontic treatment in conjunction with orthognathic surgery. Swed Dent J. 34:159–166, 2010. 4. Dowling PA, Espeland L, Krogstad O, Stenvik A, Kelly A: Duration of orthodontic treatment involving orthognathic surgery. Int J Adult Orthodon Orthognath Surg. 14:146–152, 1999. 5. Choi JW, Lee JY, Yang SJ, Koh KS: The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal class III dentofacial deformity. Ann Plast Surg. 74:333–341, 2015.

Prevalence of Substance Abuse Among Oral and Maxillofacial Surgery Residents From 2006 to 2015

Substance abuse in oral and maxillofacial surgery (OMS) training programs is an important and under-represented topic in the literature. This study's purpose was to assess the prevalence of substance abuse in OMS training programs in the United States during a 10-year period and to determine the substances most abused by OMS residents. A cross-sectional survey study was conducted by sending an online questionnaire to program directors and chairpersons of all OMS graduate training programs accredited by the Commission on Dental Accreditation. The content- and validity-tested survey asked respondents to report on substance abuse cases at their program from 2006 to 2015. Auxiliary questions asked opinions on substance abuse. To analyze the data, percentages were calculated, including the estimated prevalence of abuse; results were presented as bar charts. Forty-six of the 101 OMS training programs (45.5%) responded. Sixteen of the responding 46 programs (34.8%) reported at least 1 suspected or encountered incident of substance abuse. The 2 most abused substances were alcohol and narcotics. During the decade studied, the prevalence of resident substance abuse was estimated to be 1.2%. The estimated prevalence of resident substance abuse has gone unchanged since Rosenberg's initial study in 1986 (J Oral Maxillofac Surg 44:458, 1986). With the introduction of new drugs and despite more stringent protocols, substance abuse continues to be a germane issue for OMS requiring ongoing attention clinically and in the literature.

Recognising human factors and minimising error

Brennan PA et al (2016) Good people who try their best can have problems: recognition of human factors and how to minimise error. Br J Oral Maxillofac Surg 54: 3–7. doi:10.1016/j.bjoms.2015.09.023

Retention of Asymptomatic Third Molars May be Unwise

What is the risk of future extraction of asymptomatic third molars? A systematic review. Bouloux GF, Busaidy KF, Beirne OR, Chuang S-K, Dodson TB. J Oral Maxillofac Surg 2015;73(5):806-11. No external funding source is identified although all 5 authors appear to be on the American Association of Oral and Maxillofacial Surgery 3rd Molar Task Force Systematic review.

Third Molars May Remain Free of Periodontal Pathology Among Well-educated Young Adults With Good Oral Health Practices

Monitoring for periodontal inflammatory disease in the third molar region. Golden BA, Baldwin C, Sherwood C, Abdelbaky O, Phillips C, Offenbacher S, White RP, Jr.J Oral Maxillofac Surg 2015;73(4):595-9. Ventä Irja, DDS, PhD PURPOSE/QUESTION: Third molars were followed up at 2-year intervals to assess changes of periodontal status in initially asymptomatic third molars with no clinical evidence of periodontal pathology. This work was funded by the Oral & Maxillofacial Surgery Foundation, the American Association of Oral and Maxillofacial Surgeons, and the Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill. Prospective cohort study Level 2: Limited-quality, patient-oriented evidence Not applicable.

Pattern of maxillofacial fractures among population in Assam, India

Background: Surveys of facial injuries have shown that etiology varies from country to country and even within the same country depending on the prevailing socioeconomic, cultural and environmental factors. 1 Olasoji H.O. Tahir A. Arotiba G.T. Changing picture of facial fractures in northern Nigeria. Br J Oral Maxillofac Surg. 2002; 40: 140-143 Abstract Full Text PDF PubMed Scopus (67) Google Scholar