Journal of the Korean Association of Oral and Maxillofacial Surgeons
- P-ISSN : 2234-7550
- E-ISSN : 2234-5930
- Publisher : The Korean Association of Oral and Maxillofacial Surgeons
- CCL :
11papers in this issue.
This systematic review and meta-analysis evaluates the contributory factors and failure rates in anastomosis during microvascular fibula flap reconstruction in maxillomandibular regions. A comprehensive search strategy was employed across databases including MEDLINE, Web of Science, EMBASE, Scopus, Cochraneʼs CENTRAL, as well as grey literature sources, and manual searches of noteworthy journals, covering studies from inception up to April 2023. The inclusion criteria targeted retrospective or prospective cohort and clinical studies that investigated functional and dental rehabilitation outcomes in human subjects undergoing maxillofacial reconstruction using microvascular fibula flaps. Exclusion criteria encompassed case-control studies, alternative reconstruction method research, and animal-based investigations. The studyʼs findings revealed a cumulative vascular failure rate of 6%. Subsequent analysis delineated the primary causes of this failure, attributing 3% to venous thrombosis, 1% to arterial thrombosis, and less than 1% to blood vessel compression due to hematoma. However, notable heterogeneity across the studies indicates substantial variability in vascular failure rates reported. These results of our review and meta-analysis underscore the intricate factors impacting anastomosis success, such as anastomosis technique, recipient vessel quality, the choice between couplers.
Objectives: To evaluate the factors that influence the survival of dental implants and marginal bone loss (MBL) in patients taking osteoporosis or osteopenia medication. Materials and Methods: This study included patients who underwent dental implant treatment after taking medication for osteoporosis or osteopenia. Electronic medical records were used to collect data of patient age, sex, age at osteoporosis or osteopenia diagnosis, types of medications, age at medication initiation, duration of medication before implant surgery, whether the medication was paused before surgery, paused duration of medication, implant survival status, and MBL before and after prosthetic treatment. Firth’s logistic regression was used to analyze the relationships between each variable and implant survival as well as between MBL before and after prosthetic treatment. Results: Of the 267 patients, 111 with 209 implants were included in the study. The mean observation period was 57.9 months. The survival rate was 92.8% at the patient level and 96.2% at the implant level. No significant associations were found between implant survival and any of the variables examined. MBL before prosthetic treatment was significantly associated with use of receptor activator of nuclear factor-κB ligand (RANKL) inhibitors (P=0.032) and bone formation stimulators (P=0.022). Comparing the concurrent and single use of bisphosphonates and RANKL inhibitors, only the use of RANKL inhibitors alone was significantly associated with MBL before prosthetic treatment (P=0.039). MBL after prosthetic treatment was significantly associated with injection method among the routes of drug administration (P=0.011). Conclusion: The implant survival rate in patients undergoing medical treatment for osteoporosis or osteopenia was comparable to the general implant survival rate. MBL before prosthetic treatment was associated with type of anti-osteoporotic medication, whereas MBL after prosthetic treatment was correlated with drug administration route. Further studies with larger sample sizes are required.
Objectives: To investigate the causal factors of proximal contact loss (PCL) between an implant prosthesis and the adjacent natural teeth using cast model analysis. Materials and Methods: Patients who underwent restoration using dental implants in the posterior region were analyzed. To identify factors associated with PCL incidence, cast model analyses were conducted based on sex, implant site, jaw position, Angle’s classification, anterior overbite, preexisting interproximal gap between consecutive (mesial side) natural teeth adjacent to the implant, generalized gap of the full arch, and mandibular anterior crowding. Chi-square, multivariate logistic regression, and multivariate generalized estimating equation (GEE) analyses were used to evaluate the impact of each factor. The incidence of PCL over time was analyzed using Kaplan–Meier analysis. Results: Of 653 implants, 293 implants were selected from 240 patients. Ninety implant sites (30.7%) showed PCL between the implant prostheses and the adjacent teeth. The analysis of PCL incidence revealed a gradual increase over time, with half of PCL cases occurring by 19.2 months. The chisquare test revealed significant associations between a pre-existing interproximal gap between adjacent natural teeth and a generalized overall gap in the corresponding arch and PCL (P=0.002 and P=0.027). The logistic regression (P=0.007, odds ratio [OR]: 2.684) and GEE (P=0.003, OR: 3.255) showed significant correlations between PCL and a pre-existing interproximal gap between adjacent natural teeth. Conclusion: The occurrence of PCL between implant prostheses and adjacent teeth is influenced by the pre-existing interproximal gap between consecutive natural teeth adjacent to the implant. This factor should be carefully monitored.
Objectives: Clinical situations that make it challenging to differentiate odontogenic cysts from non-odontogenic cysts and benign tumors of the jaw include cases with cystic conditions accompanied by secondary infection, impacted teeth, cortical thinning and expansion, or external root resorption. This study aimed to identify risk factors for complications in patients undergoing cyst enucleation of the jaw, propose a clinical model, and determine the necessary indications for preoperative root canal of adjacent teeth. Materials and Methods: A review of surgical, pathological, and radiological reports, as well as medical records, was conducted. Pathological diagnosis, lesion size, history of preoperative endodontic treatment of the adjacent tooth, operator details, surgical procedures, age, gender, and complications (with severity) were analyzed. Results: This study involved 77 patients (55 men, 22 women) and found 10 complications. Procedure type (cyst enucleation only, apicoectomy and bone graft, or bone graft only) and lesion size were significant risk factors. Preoperative root canal therapy and men gender also tended to positively correlate with complications, while age was not a factor. Conclusion: Within the limitations of our study, additional procedures contributed to lower risk of complications with the exception of bone graft. A large cyst size was also associated with a higher risk of complications. It is important to consider the possibility of a second procedure and take thorough precautions to prevent infection when performing bone grafts. Patients should be informed of these risks in advance, scheduled for regular follow-up, and provided additional treatment when necessary.
Objectives: Although many publications compare suture materials in vivo and in vitro , only some studies have compared suture techniques, and those studies only compare dehiscence rates, not wound healing. This study compares wound healing with interrupted and locked continuous sutures in edentulous ridges. Materials and Methods: This study was designed as a prospective, split-mouth clinical study, with crestal surgical wounds divided into two halves up to the midline and sutured using interrupted and locked continuous techniques. Patients who required maxillar full-arch alveoloplasty were included in the study. Three expert observers evaluated the wounds via an Early Wound Healing Score (EHS) on days 3 and 7. These scores, suture time, suture removal difficulty, and suture removal pain were compared between groups. Results: Our study included 34 patients, among whom suture removal difficulty, pain, and day 3 EHS were not significantly different. Suture time and day 7 EHS significantly differed between interrupted and locked continuous suturing techniques. The locked continuous suture also required less suturing time and showed better healing scores on day 7. Conclusion: Our findings suggest that the locked continuous suture technique can lead to significant time savings and better wound healing in the context of edentulous full arch procedures.
Objectives: This study evaluates the efficacy of a new temporomandibular joint (TMJ) capsule suspension technique for stabilizing the TMJ after free fibular flap reconstruction of the mandibular condyle. Patients and Methods: Patients undergoing the TMJ capsule suspension technique during free fibular flap reconstruction after mandibulectomy with condylectomy (study group; n=9) were compared with a control group (n=9). Mandibular movement trajectory and surface electromyographic signals of bilateral masseters were recorded. The neocondyle–disc relationship was examined with magnetic resonance imaging (MRI) at 6 months after surgery. Results: Maximal mouth opening and bilateral marginal movement distances were comparable between the two groups (P>0.05). The asymmetry index of the condyle path length was significantly higher in controls (P=0.02). Bilateral mouth opening trajectories were symmetric in 7 patients and deviated to the affected side in 2 patients in the study group; they deviated to the affected side in all controls. The mean electromyographic values of the masseter on the affected side in resting, maximum bite, and chewing states were comparable between the two groups (P=0.13, P=0.65, and P=0.82, respectively). On MRI at 6 months, the thicknesses of the anterior, medial, and posterior bands and TMJ disc length were similar on the affected and normal sides in the study group (P=0.57, P=0.13, P=0.48, and P=0.87, respectively). Conclusion: The proposed TMJ capsule suspension technique could improve postoperative TMJ structure and function after fibular free flap reconstruction following mandibulectomy with condylectomy.
Insufficient treatment of mandibular fractures can result in malocclusion, often necessitating revision surgery. Therefore, appropriate surgical treatment by oral and maxillofacial surgeons with adequate consideration of the occlusion is crucial. Moreover, in patients with bone defects between the fractured ends, bone grafting may be required. A 48-year-old man was referred to our department with malocclusion after initial surgery for mandibular fracture performed by plastic surgeons at another hospital. We performed revision surgery with bone grafting for a bone defect, and favorable postoperative occlusion and bone healing were achieved. Occlusal reconstruction is paramount, and bone grafting may be required if the procedure creates a bone defect. The skills and technique of oral and maxillofacial surgeons are critical, although collaboration with plastic surgeons may be necessary.
Xanthomas are benign lesions characterized by the aggregation of lipid-laden histiocytes and foamy cells within tissues. Intraosseous xanthomas (IOXs), especially those in the jaw bone, are rare, with only around 50 cases documented. This case report describes an IOX located at an osteotomy site in the mandible during sagittal split ramus osteotomy (SSRO). Preoperative radiographs revealed a heterogenic radiolucent-radiopaque lesion in the right ramus. After meticulous curettage of the lesion, proximal and distal segments were fixed in the semi-rigid plates and screws. At the one-year followup, radiographs showed excellent bony union between proximal and distal segments, with no significant interval change. IOXs rarely occur in the jaw. However, their predilection for the posterior mandible suggests that such lesions can be encountered during orthognathic surgery. This report demonstrates the feasibility of performing SSRO directly through the lesion with concurrent curettage without compromising surgical outcomes. This case will contribute to the limited literature on IOX of the jaw bone and its treatment via SSRO as a feasible surgical option in concomitant orthognathic surgery.