Titanium Mini Research Articles

Comparison of the biomechanical behavior between commercial and 3D-printed patient-specific Ti6Al4V L-Shaped titanium plates following le fort i osteotomy using finite element analysis: A technical Note

ObjectiveTo evaluate and compare the biomechanical behavior of three-dimensionally (3D) printed patient-specific Ti6Al4V with commercially made titanium mini plates following Lefort-I osteotomy using finite element analysis. MethodsLe Fort I osteotomy was virtually simulated with a 5 mm maxillary advancement and mediolateral rotation in the coronal plane, resulting in a 3 mm gap on the left side's posterior. Two fixation methods were modeled using software to compare 3D-printed Ti6Al4V and commercial titanium mini plates, both featuring a 4-hole l-shape with thicknesses of 0.5 mm and 0.7 mm at the strategic piriform rim and zygomaticomaxillary buttress locations. Using ANSYS R19.2, finite element models were developed to assess the fixation plates and maxilla's stress, strain, and displacement responses under occlusal forces of 125, 250, and 500 N/mm². ResultsThis comparative analysis revealed slight variation in stress, strain, and displacement between the two models under varying loading conditions. Stress analysis indicated maximum stress concentrations at the vertical change in the left posterior area between maxillary segments, with the Ti6Al4V model exhibiting slightly higher stress values (187 MPa, 375 MPa, and 750 MPa) compared to the commercial titanium model (175 MPa, 351 MPa, and 702 MPa). Strain analysis showed that the commercial titanium model recorded higher strain values at the bending area of the l-shaped miniplate. Moreover, displacement analysis revealed a maximum of 3 mm in the left posterior maxilla, with the Ti6Al4V model demonstrating slightly lower displacement values under equivalent forces. ConclusionThe maximum stress, strain, and segment displacement of both fixation models were predominantly concentrated in the area of the gap between the maxillary segments. Notably, both fixation models exhibited remarkably close values, which can be attributed to the similar design of the fixation plates.

Radiofrequency-Induced Heating of Amalgam Restorations and Dental Implants during 1.5T Magnetic Resonance Imaging.

Objectives: This study aimed to evaluate radiofrequency-induced heating of different amalgam restorations and dental implants during 1.5T magnetic resonance imaging (MRI). Materials and Methods: Standardized class I cavities (5 mm long, 3 mm wide, and 3 mm deep) were prepared on the occlusal surface of 45 extracted human third molars. The samples were restored by three different types of amalgam including Cinalux amalgam (non-gamma-2, spherical), GS-80 (non-gamma-2, admix), and GK-110 amalgam (non-gamma-2, admix in silver). As a separate intervention group (G4), five titanium mini drive-lock implants with 2mm diameter and 10mm length were also selected and mounted to the base of the Eppendorf tube with 3mm of the implants extending above the mounting putty. The box containing the specimens was placed parallel to the long axis of the standard head and neck coil of the MRI device (64MHz radio-frequency energy with 25kW amplifier, 1.5T). Temperature fluctuations of the metallic materials in each group were monitored during MRI scans using a calibrated thermometer. One-way ANOVA was used to compare temperature changes among the amalgam groups (P<0.05). Results: Temperature elevations ranged from 0.21°C to 0.70°C in amalgam restorations and from 0.35 to 0.47°C in dental implants. The temperature changes among the three amalgam agents were not statistically significant. Conclusion: According to our findings, the radiofrequency-induced heating of amalgam restorations and dental implants during MRI examination can be considered within acceptable ranges. Therefore, amalgam restorations and dental implants can be categorized as "MR safe" in terms of radiofrequency-induced heating during 1.5 T MRI.

Comprehensive functional outcome analysis and importance of bone remodelling on personalized cranioplasty treatment using Poly(methyl methacrylate) bone flaps.

Cranioplasty involves the surgical reconstruction of cranial defects arising as a result of various factors, including decompressive craniectomy, cranial malformations, and brain injury due to road traffic accidents. Most of the modern decompressive craniectomies (DC) warrant a future cranioplasty surgery within 6-36months. The conventional process of capturing the defect impression and polymethyl methacrylate (PMMA) flap fabrication results in a misfit or misalignment at the site of implantation. Equally, the intra-operative graft preparation is arduous and can result in a longer surgical time, which may compromise the functional and aesthetic outcomes. As part of a multicentric pilot clinical study, we recently conducted a cohort study on ten human subjects during 2019-2022, following the human ethics committee approvals from the participating institutes. In the current study, an important aspect of measuring the extent of bone remodelling during the time gap between decompressive craniectomy and cranioplasty was successfully evaluated. The sterilised PMMA bone flaps were implanted at the defect area during the cranioplasty surgery using titanium mini plates and screws. The mean surgery time was 90 ± 20min, comparable to the other clinical studies on cranioplasty. No signs of intra-operative and post-operative complications, such as cerebrospinal fluid leakage, hematoma, or local and systemic infection, were clinically recorded. Importantly, aesthetic outcomes were excellent for all the patients, except in a few clinical cases, wherein the PMMA bone flap was to be carefully customized due to the remodelling of the native skull bone. The extent of physiological remodelling was evaluated by superimposing the pre-operative and post-operative CT scan data after converting the defect morphology into a 3D model. This study further establishes the safety and efficacy of a technologically better approach to fabricate patient-specific acrylic bone flaps with improved surgical outcomes. More importantly, the study outcome further demonstrates the strategy to address bone remodelling during the patient-specific implant design.

Comparison of Neurosensory Recovery of the Inferior Alveolar Nerve After Open and Closed Reduction for Mandibular Fractures: A Prospective Study.

Traumatic mandibular fractures are the most common fractures of the facial region and are associated with loss of neurosensation in the inferior alveolar nerve (IAN). The present study aimed to compare IAN recovery after traumatic mandibular fractures between the open and closed reduction methods. The study included 90 patients with traumatic mandibular fractures of the body, angle, and symphysis, divided into two groups of 45 patients: group 1 was treated with closed reduction and fixation with rich arch-bar fixation under local anesthesia, and group 2 was treated with open reductionand rigid internal fixation with 2-mm titanium mini plates and monocortical screws (6 mm), and the plate was fixed to the fractured bony fragments. All patients underwent neurosensory testing using the Zuniga and Essick algorithm at baseline (preoperative), one week after surgery (postoperative), at three months, and at six months of follow-up. No statistically significant differences were observed in IAN recovery between the groups. The most common site of fracture was the body (44% in group 1 and 56% in group 2). The maximum recovery was observed in the younger age group (25-30 years). At baseline, functional nerve recovery was observed in 40 cases (88%) in group 1 and 38 cases (84%) in group 2, and the difference was not statistically significant. Levels A and B tests were affected by surgical management and improved after three months.The total recovery in group 1 ranged from 60% to 80%, and that in group 2 ranged from 56% to 72%. Based on the findings of the current study, both methods are recommended for surgical management of traumatic mandibular fractures with IAN recovery in 60-80% of cases six months postoperatively.

Comparative study of CAD/CAM reconstruction and miniplates for patient-specific fixation in LCL-type mandibular reconstruction.

Miniplates offer superior clinical handling and facilitate postoperative removal after mandibular reconstruction but unfavorable load distribution under high stress has been shown. This study aimed to compare the clinical outcome of patient-specific 3D-printed (PS-3D) titanium miniplate with reconstruction plate fixation in three-segmental LCL-type reconstructions for the first time. Patients undergoing three-segmental LCL-type mandibular reconstruction after malignant tumor resection between April 2017 and July 2023 were analyzed in a retrospective single-center study. Inclusion criteria were primary reconstruction using a fibula free flap and PS-3D titanium mini- or reconstruction plate fixation. Complication rates were recorded and analyzed within 6 months after surgery using the N - 1 Chi2- and unequal variance t-test. 38 patients (10 females, 28 males; mean age 61.4 ± 7.6 years) met the inclusion criteria. In 14 patients (36.8%) miniplates were used in the anterior region. Rates of fixation failure, plate exposure, incomplete osseous union, wound infection, soft tissue, and overall complications did not differ significantly between the two plate systems. Complication rates did not differ significantly between PS-3D mini- and reconstruction plates in three-segmental LCL-type mandibular reconstructions. Given their advantages in clinical handling and postoperative removal, PS-3D miniplates can be a viable alternative also in larger mandibular reconstructions.

Increasing the depth of vestibular sulcus using a disposable IV infusion set tube in apically positioned flap surgery: A technical note

AbstractAimIn this technical note, it was aimed to provide an appropriate retention, better stability and function for our patient's denture by the technique applied newly.Materials and MethodsThe authors offer a new and effective method using a part of disposable IV infusion set tube and single mini titanium screw stabilizing of apically positioned flap in order to secure vestibule sulcus depth gained.Results and ConclusionOne‐year follow‐up of our patient showed that our technique provided a consistent and predictable increase in attached gingival width and could be used successfully in the treatment of insufficient vestibular depth cases.

Replantation of lamina spinous process ligament complex and miniature titanium plate shaping internal fixation in the treatment of tumors in the spinal canal

ObjectivePurpose This study aims to explore the clinical efficacy of laminospinous process ligament complex reimplantation combined with mini-titanium plate fixation in the treatment of thoracolumbar intraspinal tumors.MethodsA retrospective analysis was performed on 43 cases of intraspinal tumors treated with thoracolumbar intraspinal tumor resection from August 2018 to March 2021, and 27 cases underwent laminospinous process ligament complex reimplantation combined with micro titanium plate shaping. Fixation (laminar replantation group), and 16 patients underwent laminectomy combined with pedicle screw internal fixation (laminectomy group). The operation time, blood loss, drainage tube removal time, cerebrospinal fluid leakage, spinal instability, and the incidence of secondary spinal stenosis were compared between the two groups. The pain VAS score, ODI score, and modified Macnab at the last follow-up were compared between the two groups. And the laminar fusion rate of the laminoplasty group was measured.ResultsBoth groups successfully completed the surgery and obtained complete follow-up. The incidence of cerebrospinal fluid leakage and secondary spinal canal stenosis in the laminectomy group was lower than that in the laminectomy group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the incidence of spinal instability between the two groups (P > 0.05). The operation time and intraoperative blood loss in the laminectomy group were less than those in the laminectomy group, and the drainage tube removal time was earlier than that in the laminectomy group. The difference was statistically significant (P < 0.05). At the final follow-up, there was no statistically significant difference in the pain VAS score, ODI score, and modified Macnab between the two groups (P > 0.05), but they were all significantly improved compared with preoperative ones. Fusion evaluation was conducted on the laminoplasty group. Two years after surgery, the fusion rate was 97.56% (40/41).ConclusionsThe application of laminospinous process ligament complex reimplantation combined with mini titanium plate fixation during thoracolumbar intraspinal tumor resection can effectively reconstruct the spinal canal and posterior column structure, reduce the incidence of cerebrospinal fluid leakage and secondary spinal stenosis. The laminar fusion rate is high.

Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients.

Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type IIB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50° ° (range 20°-70°), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficial, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.

Impact of C3 laminectomy on cervical sagittal alignment in cervical laminoplasty: a prospective, randomized controlled trial comparing clinical and radiological outcomes between C3 laminectomy with C4–C6 laminoplasty and C3–C6 laminoplasty

Background ContextC3 laminectomy in cervical laminoplasty is a modified laminoplasty technique that can preserve the semispinalis cervicis muscle attached to the C2 spinous process. Several previous studies have shown that this technique can lead to better outcomes of postoperative axial neck pain and C2–C3 range of motion (ROM) than conventional cervical laminoplasty. However, there is still a lack of understanding of total and proportional postoperative cervical sagittal alignment outcomes. PurposeTo assess the effects of C3 laminectomy in cervical laminoplasty on postoperative cervical alignment and clinical outcomes. DesignA single-center, patient-blinded, randomized controlled trial. Patient SampleWe included consecutive 126 patients diagnosed with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) who were scheduled for cervical laminoplasty from March 2017 to January 2020. Outcome MeasuresThe primary outcome measures were C2–C7 Cobb angle (CA) and neck disability index (NDI). Secondary outcomes measures included other clinical outcomes and radiographic parameters including segmental Cobb angle and presence of C2–C3 interlaminar fusion. MethodsPatients were randomly allocated to either the C3 laminectomy with C4–C6 laminoplasty group (LN group) or the C3–C6 laminoplasty group (LP group) at a 1:1 ratio. Laminoplasty was performed using a unilateral open-door technique and stabilized with titanium mini plates. A linear mixed model analysis was employed to examine the longitudinal data from postoperative 1-year through 3-year. Additional analysis between three types of cervical sagittal alignment morphology was done. ResultsAmong 122 patients who were randomly allocated to one of two groups (LN group, n=61; LP group, n=61), modified intent-to-treat analysis was done for 109 patients (LN group, n=51, LP group, n=58) who had available at least a year of postoperative data. Postoperative C2–C7 CA was not significantly different between the two groups. However, NDI was significantly different between the two groups (12.8±1.0 in the LN group vs 8.6±1.0 in LP group, p=.005), which exceeded the minimum clinically important difference (MCID). The postoperative C2–C3 CA was significantly greater in the LN group (7.1±0.5° in LN group vs 3.2±0.5° in LP group, p<.001) while C4–C7 CA was significantly smaller in the LN group (3.9±0.8° in LN group vs 7.7±0.7° in LP group, p<.001) with greater cSVA in the LN group (31.6±1.4 mm in LN group vs 25.5±1.3 mm in LP group at postoperative 3-year, p=.002). Postoperative Euro-Quality of Life-5 Dimension (EQ-5D), numerical rating scores for neck pain (NRS-N) were significantly better in the LP group than in the LN group (all p<.05) and only EQ-5D surpassed the MCID. The C2-C3 fusion rate was significantly different between the LN group (9.8%) and the LP group (44.8%) (p<.001). The LN group showed a higher prevalence of a specific cervical alignment morphology characterized by a sigmoid shape with proximal lordosis and distal kyphosis (S curve). This S curve demonstrated significantly unfavorable outcomes across multiple outcome variables. ConclusionThe impact of C3 laminectomy in cervical laminoplasty on postoperative kyphosis among patients with CSM or OPLL did not significantly differ from that of C3–C6 laminoplasty. However, C3 laminectomy in cervical laminoplasty might result in an unfavorable clinical outcome with an unbalanced cervical sagittal alignment characterized by a sigmoid shape with proximal lordosis and distal kyphosis.

Evaluation of Titanium Mini Plates for Repair of Mandibular Fractures in Clinical Cases of Dogs

Evaluation of Titanium Mini Plates for Repair of Mandibular Fractures in Clinical Cases of Dogs

Regeneration of periodontal ligament fibers around mini dental implants and their attachment to the bone in an animal model: A radiographic and histological study.

Tissue-engineered periodontal ligament (PDL) around a dental implant by using PDL stem cells (PDLSCs) may be useful in periodontal regeneration and can reduce or eliminate certain shortcomings of dental implants. PDLSCs were isolated from extracted human PDL cells and cultured in a bioreactor. They were identified using markers CD45, CD73, CD90, CD105, and CD146. After the formation of multiple cellular layers, they were then attached on titanium mini dental implants and placed in rabbit tibia. The rabbits were sacrificed after 9 months, and the implants were analyzed histologically and radiographically by Cone beam computed tomography (CBCT). Isolated PDLSCs obtained from human premolars showed a colony-forming ability on the 7th day and 14th day. Immunocytochemistry revealed that cells had taken up the adequate positive stains for primary antibodies CD73, CD90, CD105, and CD146 and negative staining for CD45. The histological sections obtained from sacrificed rabbits, when viewed under the light microscope, clearly showed the presence of PDL around dental implants. CBCT examination showed that the implant was well within the bone and did not migrate. The site appeared to be normal without any lytic changes in the bone. It can safely be postulated from the present study that tissue engineering of PDL can be achieved around dental implants using PDLSCs. Important inter-tissue interactions like the formation of a functional PDL around the implantation site, and induction of bone formation in the vicinity of the implants may be possible. Future research in humans is required for further research.

Initial clinical experiences of the muscle-preserving double door cervical laminoplasty with adjustable mini plates.

Shirashi's double door laminoplasty method was a popular decompression procedure for cervical myelopathy. In this paper, we introduced a modified double door laminoplasty based on Shirashi's method with preliminary results. This study retrospectively analyzed 22 patients who underwent modified double door laminoplasty. During procedure, a single segment of the unilateral lamina was separated from the cervical semispinalis muscle and the multifidus muscle space for the preparation of lamina groove. A self-developed mini titanium plate was used to fix the inner side of the spinous process to complete the fixation after open-door process. The VAS, JOA scores and QoL scale were recorded for pain assessment, neurological and functional recovery. The overall curvature and range of motion of C2-C7 were measured with x-ray images. Changes in sagittal diameter of spinal canal were measured by CT scans. MRI was used to measure the cross-sectional area of cervical paravertebral muscles. All 22 patients successfully recovered with this procedure. The mean operation time, blood loss and follow-up durations were 117 ± 25 min, 149 ± 32 ml and 16.1 ± 3.6 months respectively. The preoperative, 3-month postoperative and 12-month postoperative JOA scores were 9.35 ± 3.25, 13.74 ± 4.86 and 15.73 ± 5.19 respectively. with improvement rates of 57.4% and 83.4%. Mean VAS scores before, 3 months after and 12 months after surgery were 1.81 ± 0.79, 2.82 ± 1.56 and 2.18 ± 1.34 respectively. The C2-7 lordotic angle and overall range of motion shows no statistical difference preoperatively and 12 post-surgery. The average sagittal diameter of the cervical spinal canal was enlarged from 9.15 ± 1.55 mm to 14.25 ± 1.46 mm. The average area of cervical paravertebral volume measured preoperatively and 3 months post operation was 84% of pre-operative value respectively. This value was improved to 93% of the preoperative value at 12 months post-surgery. This paper introduced initial experience on a modified posterior cervical double-door laminoplasty that was based on Shirashi's method, featuring creating bilateral laminar grooves on both sides and fixing central gap with self-developed mini plates. This procedure prevented obvious axial symptoms and improved patients' quality of life, which provided a baseline for further research with larger cohorts.

Evaluation of Stress Distribution of Maxillary Anterior Segment during en Masse Retraction Using Posterior Mini Screw: A Finite Element Study

The current study aimed to perceive and estimate the distribution of stress generated by the forces on the maxillary anterior teeth during orthodontic retraction using the bilateral mini screw implant. Finite element models were generated from the three-dimensional (3D) reconstruction of the maxillary arch via cone–beam computed tomography (CBCT). These models imitate the retraction of maxillary anterior teeth with the mini screw placed as the skeletal anchorage. The titanium mini screw of 1.3 mm × 8 mm dimension was placed at a height of 9 mm between the first molar and second premolar on both sides of the maxilla. A nickel titanium (NiTi) coil spring of 9 mm length was attached from the mini screw implant to the power arm which generated a force of 250 gm/side. Two different power arms were placed between the lateral incisor and canine at a height of 4 mm (group 1) and 8 mm (group 2), respectively. There were no significant differences observed when the stress values were compared to the left side and the right side in group 1 with a power arm of 4 mm. In group 2, the stresses around the lateral incisors were found to be on the higher side when compared with the central incisors and canines. The length of the power arm shows no significant difference in stress distribution pattern on the left and right sides except for stresses moving from the canine region to the lateral incisor region with the increase in power arm height.

Electron-microscopic study on structural changes of mini-implants following fixed orthodontic treatment

In today's society, patients who turn to the orthodontist want final results in the shortest possible time, with maximum emphasis on smile aesthetics, dental alignment and facial harmony. In this regard, some procedures have emerged to accelerate the movement of teeth through the alveolar bone, thus shortening the duration of active treatment: corticotomy, application of mini-implants, etc. Of these methods, bone anchorage on mini-implants is increasingly popular among adult patients, as it is a versatile technique that ensures a stable, bony anchorage and more predictable final results. Compared to implantology in prosthodontics, which has a long history, mini- orthodontic implants emerged later in medical practice. In 1998, Shapiro and Kokich described for the first time the possibility of using dental implants for anchorage in orthodontic therapy. Odman J et al. (Upsala University, Sweden) applied implants to patients with partial edentulousness. The results were favorable, leading the authors to recommend the technique for adult partial edentulousness. Kanomi (1997) showed that a 1.2 mm diameter titanium mini- implant provides anchorage for the intrusion of the lower front teeth. After 4 months, the mandibular incisors were intruded by 6 mm without root resorption. Birte Melsen et al. (1998) introduced the use of zygomatic ligatures as anchorage in patients with partial edentulousness. To this they attached nickel-titanium springs for intrusion and retraction of maxillary incisors. Hugo de Clerk (2008) used 4 mini-implants (Bollard type) inserted into the infra-zygomatic crest in patients with Angle class III anomalies. He used 2 mini-implants with hooks in the chin area, and patients wore Class III 150 grams elastics on each side. This direct anchorage also has orthopedic effects, with clinicians achieving upper jaw advancement and correction of mandibular prognathism.

First complex maxillofacial reconstruction with free flaps in the Gaza Strip, occupied Palestinian territory: case series from an area under conflict

BackgroundLarge mandibular and maxillary defects are repaired by maxillofacial reconstructive microsurgery (MRM) using free flaps, which is challenging to perform in austere settings owing to its demanding nature in terms of time, equipment, and trained personnel. Humanitarian missions refrain from performing MRM procedures in the host country and instead transfer patients to their home country to perform surgery. We report on the first nine MRM procedures in Gaza. MethodsA French medical mission performed the surgical operations at Al Shifa Hospital, Gaza, occupied Palestinian territory. Fibula free flap, radial forearm free flap, scapular free flap, and thoracodorsal perforator free flap were performed. We recorded the patients’ demographics, diagnoses, and immediate postoperative and follow-up status. We also report the special considerations required to perform the surgery in Gaza's austere and resource-poor environment. FindingsNine patients (five female, four male; mean age 22 years) underwent ablative head and neck surgery from January, 2017, to March, 2019. Before arrival, the missions closely coordinated with local surgeons, who assisted in performing the surgeries and followed the patients postoperatively. Essential surgical equipment needed for the surgery (such as loupes, microvascular sutures, and titanium plates) were donated by the foreign missions. Patients were followed up by local surgeons for a period ranging from 5 to 12 months. No complications occurred at the donor or recipient sites. There was no extrusion of hardware or breakage of the titanium mini plates or reconstructive plates. Patients remained in the intensive care unit postoperatively for at least 48 h. Owing to financial restraints, removable prostheses were used. Rehabilitation was provided by a local dental team despite the lack of professional dental rehabilitation services. Patients had stable bony union and acceptable facial contour. Patients regained satisfactory masticatory function, resumed their normal diets after 6 months without weight loss, and maintained intelligible speech. InterpretationMRM can be successfully performed in conflict settings such as Gaza. Although the study population was small, the study suggests that further investigation into the conditions and elements needed to perform complex surgeries in conflict settings is warranted. Selection of health-care professionals in the surgical and postoperative care teams, effective coordination with local doctors, availability of essential equipment, and postoperative follow-up protocols could all be carefully considered to optimise the results of surgery. In addition, starting rehabilitation as soon as possible following surgery may restore and improve functional and aesthetic outcomes. FundingThe Palestine Children's Relief Fund (PCRF).

Combined Implant Prosthetic Rehabilitation and Orthognatic Treatment of a Patient With a Teeth Loss and Class III skeletal Malocclusion

Objective: The objective of the study is to assess treatment success of teeth loss patients with class III skeletal malocclusion through a multidisciplinary approach, including orthognathic surgery and implant prosthetic rehabilitation. Materials and Methods: The present retrospective study aimed at investigating the 5-year clinical treatments outcomes 16 patients with class III malocclusion and teeth loss. Clinical, laboratory, radiological methods were used in the examination of patients. Surgical stage included sagittal bilateral osteotomy of the lower jaw and reposition it back, Le Fort I osteotomy, 7-8 months after the orthognathic surgery 132 implants were inserted. After 2 to 4 months of submerged healing period patients had received implant-fixed prostheses. Results: No serious intraoperative or immediate postoperative complications were noted. At the control examination after 6 months after surgery, an X-ray examination we did not observe any clinical or radiological signs of inflammation in the area of osteotomy sites and titanium mini plates. Success rate of implants 5 years after was 96.2%. Conclusion:After orthognathic surgery and dental implant prosthetic rehabilitation, the masticatory function, esthetics of the facial profile and occlusion was improved. Patients expressed satisfaction with the result of treatment and improved quality of life.

Assessment of the Success of Oral Rehabilitation of Patients with with Teeth Loss and Class III Skeletal Malocclusion

Abstract Objective: The objective of the study is to assess treatment success of teeth loss patients with class III skeletal malocclusion through a multidisciplinary approach, including orthognathic surgery and implant prosthetic rehabilitation. Materials and methods: The present retrospective study aimed at investigating the 5-year clinical treatments outcomes 16 patients with class III malocclusion and teeth loss. Clinical, laboratory, radiological methods were used in the examination of patients. Surgical stage included sagittal bilateral osteotomy of the lower jaw and reposition it back. Le Fort I osteotomy, 7-8 months after the orthognathic surgery 132 implants were inserted. After 2 to 4 months of submerged healing period patients had received implant-fixed prostheses. Results: No serious intraoperative or immediate postoperative complications were noted. At the control examination after 6 months after surgery, an X-ray examination we did not observe any clinical or radiological signs of inflammation in the area of osteotomy sites and titanium mini plates. Success rate of implants 5 years after was 96.2%. Conclusion: After orthognathic surgery and dental implant prosthetic rehabilitation, the masticatory function, esthetics of the facial profile and occlusion was improved. Patients expressed satisfaction with the result of treatment and improved quality of life.

Long-Term Functional Results of Intra- and Extra-Articular Hand Fractures Treatment With Titanium Miniature Plates and Screws With Minimum Follow-Up of 24 Months

IntroductionThe purpose of this study was to evaluate the long-term outcome of an extended range of hand fractures treated with titanium, low profile plates, and screws.Materials and methodsThis retrospective study included adult patients with at least one phalangeal and/or metacarpal fracture, treated with mini titanium plates and screws, between 2004-2016, in a single trauma center, that were followed-up for at least 24 months and with complete, intact medical records.Results90 patients (79 men and 11 women) with 114 hand (46 phalangeal, 68 metacarpal) fractures fulfilled the inclusion criteria. Thirty-two fractures were open (28.07%), 27 were intra-articular (23.68%), and 12 were both open and intra-articular fractures. The mean age of the patients was 36.02 years (range 17-75). Mean follow-up was 95.3 months (range 24 to 138). Open fractures had a reduced mean grip strength and total active motion. No difference was observed between intra-articular and extra-articular fractures (for grip strength and total active motion). Predictors of the final outcome included the severity of the initial injury (open vs closed) and not the anatomic location (intra- or extra-articular, metacarpal, or phalangeal) of the fracture.ConclusionsLow-profile plates and screws can successfully be used to establish union and restore the alignment of the fractured bone while achieving a satisfactory clinical outcome, even in cases of open or intra-articular fractures.

Biomechanical Impact of a Zygoma Complex Fracture Using Human Cadaver.

Zygomaticomaxillary complex fractures are common in midface trauma, with treatment often involving repair using titanium mini plates. However, the need for plate fixation along the zygomaticomaxillary suture on the infraorbital rim remains controversial. This study utilized a previously reported bite force simulator to investigate craniofacial strain patterns following zygomaticomaxillary complex fracture repairs with and without plating of the infraorbital rim. Osteotomies were made to 6 fresh-frozen cadaveric heads to simulate 2 types of zygomatic complex fractures: a dipod fracture with osteotomies at the zygomaticofrontal and zygomaticomaxillary sutures, and a tripod fracture with an additional osteotomies at the zygomaticotemporal suture. Repairs with and without the use of a titanium mini plate across the infraorbital rim were compared in both dipod and tripod fractures. Physiologically proportional masticatory loads were applied using the bite force simulator by actuating intrinsic muscle lines of action. The outcome metric was facial bone strains measured using uniaxial strain gauges. Mixed-effects linear models did not find a significant main effect on the overall strain pattern with the use of an infraorbital rim plate in both dipod (P = 0.198) and tripod (P = 0.117) fracture repairs. However, statistically significant differences were found locally at the zygomatic buttress (P = 0.019) and the zygomatic arch (P = 0.027) on the fractured side in dipod fractures. This is the first known study that successfully utilized a mechanical simulator to reproduce physiological intrinsic masticatory loads in a fracture fixation study. This new technology opens avenues for future biomechanical investigations on maxillofacial fracture repairs and other surgical treatments.

Surgical Management of Frontal Bone Fractures.

Frontal bone fractures show a low frequency of occurrence of about 5% to 15% of all maxillofacial fractures occurring due to high-velocity injuries such as in the case of road traffic accidents, sporting events, assaults. Successful surgical management revolves around the concept of minimizing cosmetic deformity, maintaining normal sinus function, avoidance of short and long-term complications. In this article, the authors report a case series of 24 cases of frontal bone fracture treated with various treatment modalities. A total of 24 cases of frontal bone fracture admitted to our facility were treated accordingly and the subsequent follow up data were collected and compiled to be included in this study. In our study, 83.33% cases showed isolated anterior table fractures, 8.3% cases with combined anterior and posterior table fractures. 40% cases managed conservatively, 41.6% with titanium mini plates, 12.5% cases with titanium mesh and 4% with cranialisation with fat obliteration. Our treatment decisions were based upon the extent and severity of the injuries which aided in tailoring the treatment modality. Thereby, curbing the long-term complications which could be foreseen and hence, a better functional outcome was achieved.