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Objectives To systematically assess the current literature on soft tissue response associated with osseous movement following orthognathic surgery in patients with facial asymmetry. Methods Six electronic databases (PubMed, EMBASE (via Ovid), Medline (via Ovid), Cochrane Library, Scopus, and Web of Science) were searched for studies evaluating hard and soft tissue response 3-dimensionally after orthognathic surgery and gray literature using MeSH terms and keywords. The methodological quality and level of evidence of the included studies were analyzed using EPHPP and GRADE, respectively. Results The primary search yielded 125 articles, and 10 articles that satisfied the predefined inclusion criteria were finally included. All the included articles evaluated soft tissue response, whereas six of them additionally investigated the magnitude of the soft tissue response. Soft tissues move with hard tissues horizontally and anteroposteriorly; however, soft tissue movement is less than hard tissue movement. In addition, soft tissue movement is more pronounced in the lower facial central region. Six articles were judged as having “strong” methodological quality, and the evidence was found to be of “low” quality for the soft tissue response and magnitude of the response. Conclusion Despite a low level of evidence, the present review substantiates a favorable 3dimensional soft tissue response following osseous surgery. The soft tissue response is more pronounced horizontally, antero-posteriorly and in the lower central facial region. Nevertheless, well-designed prospective studies with a higher level of evidence are needed.

The present study aimed to evaluate the morphological characteristics of the sphenoid sinus (SS), and the impact of potential influencing factors on the morphometric features using CBCT imaging. CBCT scans of 148 patients, aged between 15 and 85 (32.88 ± 15.33) years were retrospectively evaluated. DICOM files from the CBCT scans were imported into semi-automatic software and the SS of each patient was assessed for the morphological characteristics including configuration, symmetry, extension, shape, septation, volume, and maximum diameter. Furthermore, potential influencing factors such as age, gender, side, and sinus condition were analysed. A significant association was observed between sinus extension and age. Septation was also found to be significantly associated with age, gender and sinus condition. Besides, sinus volume was significantly associated with gender and sinus condition. No significant influence of shape and side on the morphometric features was noticed. The average volume and diameter of the SS were 6576.92 ± 3748.12 mm3 and 30.48 ± 9.28 mm, respectively. In conclusion, the present findings indicate that age, gender and sinus condition have a significant impact on the morphometric characteristics of the SS. Mature sinuses exhibit a post-sellar extension pattern until middle age. In addition, males, and sinuses with healthy sinus condition have larger volumes compared to females and pathological sinuses. ispartof: ANATOMICAL SCIENCE INTERNATIONAL vol:96 issue:4 pages:544-555 ispartof: location:Japan status: published

Objective The present study aimed to determine the site and severity of maxillomandibular asymmetry before and after orthognathic surgery in asymmetric patients. Materials and methods Presurgery and postsurgery cone beam computed tomography (CBCT) data of 21 facial asymmetry patients (7 males and 14 females, mean age: 23.0 ± 3.36 years) with soft tissue chin deviation ≥ 3 mm who had undergone bimaxillary surgery were evaluated. Seven midline and twenty bilateral hard tissue landmarks were identified for the evaluation of facial asymmetry and outcomes were assessed against age- and gender-matched control subjects. Results In the asymmetry group, bilateral landmarks exhibited significant deviation in the mandible and midface regions. Before surgery, asymmetry was more severe at the mandibular midline and sites close to it, in the asymmetry group. Bimaxillary surgery proved to be highly effective, with a significant correction of the menton to a clinically normal value (2.90 mm, p p = 0.001) in the R-L direction. Moreover, significant asymmetry persisted at the sigmoid notch (p = 0.001) in the S-I direction. Conclusions Mandibular midline landmarks and chin peripheral regions contribute significantly to overall facial asymmetry characteristics. Despite significant correction after bimaxillary surgery, asymmetry persisted at several sites, thereby requiring secondary correction. Comprehensive 3D presurgical planning is central for asymmetry correction in a single surgery. Clinical relevance The present study specifies the location of residual asymmetry sites and advocates the correction of those sites during initial surgery.

Background.Matrix metalloproteinases (MMPs) are considered to play an important role during tissue remodeling and extracellular matrix degradation. And functional polymorphisms in MMPs genes have been reported to be associated with the increased risk of periodontitis. Recently, many studies have investigated the association between MMPs polymorphisms and periodontitis risk. However, the results remain inconclusive. In order to quantify the influence of MMPs polymorphisms on the susceptibility to periodontitis, we performed a meta-analysis and systematic review.Results.Overall, this comprehensive meta-analysis included a total of 17 related studies, including 2399 cases and 2002 healthy control subjects. Our results revealed that although studies of the association betweenMMP-8−799 C/T variant and the susceptibility to periodontitis have not yielded consistent results,MMP-1(−1607 1G/2G, −519 A/G, and −422 A/T),MMP-2(−1575 G/A, −1306 C/T, −790 T/G, and −735 C/T),MMP-3(−1171 5A/6A),MMP-8(−381 A/G and +17 C/G),MMP-9(−1562 C/T and +279 R/Q), andMMP-12(−357 Asn/Ser), as well asMMP-13(−77 A/G, 11A/12A) SNPs are not related to periodontitis risk.Conclusions.No association of these common MMPs variants with the susceptibility to periodontitis was found; however, further larger-scale and multiethnic genetic studies on this topic are expected to be conducted to validate our results.

Dental implants have to be placed with the long axis in different angulations due to the change in bone morphology. The objective of this study was to investigate the different bone remodeling response induced by the tilted dental implants and to assess whether it could lead to bone loss and implant failure. In this study, bone remodeling due to palato-labially inclined dental implants placed in the anterior maxillary incisor region was simulated. CT-based finite element models of a maxillary bone with dental implants were created herein. Five dental implants were placed at [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text], respectively. The remodeling progression was recorded and compared. Model [Formula: see text] (palatal side) shows the highest bone density values, but the inclined implant at [Formula: see text] (labial side) leads to significant bone loss. From a biomechanical perspective, it is speculated that a palatally inclined implant is more likely to enhance the bone density in the maxillary anterior region, but labial inclination of implant could jeopardize its stability.

Background Although many studies have focused on the association of the MMP-9 promoter −1562 C/T polymorphism with the susceptibility and/or severity of chronic periodontitis (CP), results have been inconsistent. Therefore, a meta-analysis of all eligible studies was performed to derive a more precise estimation of the association between this polymorphism and CP risk. Methods All relevant studies were identified through a database search in PubMed, Medline, and Web of Science. All the full-text studies with appropriate analytical design, published in English, which evaluated the association of MMP-9 promoter −1562C/T polymorphism with CP risk using validated genotyping methods, and with non-duplicated data were selected for this study. A fixed-effect model was used to calculate pooled ORs in the absence of heterogeneity across included trials (P > 0.1 and I2

Purpose Surgically assisted mandibular arch expansion has proved to be an effective treatment modality in alleviating constriction and crowding issues. However, only mandibular symphyseal distraction osteogenesis has been in favor for the purpose of mandibular arch expansion. In addition, no relevant study has compared the biomechanical response of different osteotomy designs on mandibular expansion. The present study evaluated the effect of different osteotomy approaches and modes of loading on the expansion of the adult mandible using biomechanics. Materials and Methods To address the research purpose, 9 finite element (FE) models, including 2 novel osteotomy designs, were simulated. Stress, strain, and displacement of crown, root, and bone were calculated and compared under different osteotomy approaches and loading conditions. Results The biomechanical response envisaged by the FE models in terms of displacement on the X axis was consistent from the anterior to posterior teeth with parasymphyseal step osteotomy and a hybrid mode of force application. In addition, the amount of displacement predicted by parasymphyseal step osteotomy with the hybrid mode was greater compared with that of the other models. Conclusions The results of our study suggest parasymphyseal step osteotomy with the hybrid mode is a viable treatment option for true bony expansion in the adult mandible.

Introduction Surgically assisted mandibular arch expansion is an effective treatment modality for alleviating constriction and crowding. However, only mandibular symphyseal osteotomy is recommended for mandibular arch expansion. No relevant studies have compared the biomechanical responses of different corticotomy designs on mandibular expansion. Therefore, the aim of this study was to evaluate the effect of different corticotomy approaches and modes of loading on the expansion of adult mandibles using biomechanics. Methods Nine finite element models including 2 novel corticotomy designs were simulated. Stress, strain, and displacement of crown, root, and bone were calculated and compared under different corticotomy approaches and loading conditions. Results The biomechanical response seen in the finite element models in terms of displacement on the x-axis was consistent from anterior to posterior teeth with parasymphyseal step corticotomy and tooth-borne force application. In addition, the amount of displacement predicted by parasymphyseal step corticotomy in the tooth-borne mode was greater compared with other models. Conclusions These results suggest that parasymphyseal step corticotomy with tooth-borne force application is a viable treatment option for true bony expansion in an adult mandible.

Background The purpose of this study was to identify potential concealed variables associated with the difficulty of lower third molar (M3) extractions. Material and Methods To address the research purpose, we implemented a prospective study and enrolled a sample of subjects presenting for M3 removal. Predictor variables were categorized into Group-I and Group-II, based on predetermined criteria. The primary outcome variable was the difficulty of extraction, measured as extraction time. Appropriate univariate and multivariate statistics were computed using ordinal logistic regression. Results The sample comprised of 1235 subjects with a mean age of 29.49 +/- 8.92 years in Group-I and 26.20 +/- 11.55 years in Group-II subjects. The mean operating time per M3 extraction was 21.24 +/- 12.80 and 20.24 +/- 12.50 minutes for Group-I and Group-II subjects respectively. Three linear parameters including B-M2 height (distance between imaginary point B on the inferior border of mandibular body, and M2), lingual cortical thickness, bone density and one angular parameter including Rc-Cs angle (angle between ramus curvature and curve of spee), in addition to patient’s age, profile type, facial type, cant of occlusal plane, and decreased overbite, were found to be statistically associated (P < or = 0.05) with extraction difficulty under regression models. Conclusions In conclusion, our study indicates that the difficulty of lower M3 extractions is possibly governed by morphological and biomechanical factors with substantial influence of myofunctional factors. Practical Implications: Preoperative evaluation of dynamic concealed factors may not only help in envisaging the difficulty and planning of surgical approach but might also help in better time management in clinical practice. Key words:Third molar, impacted, extraction, mandibular, facial type.

To modify the conventional straight elevator with a unique and innovative design in respect to approach and accessibility during extraction for patients with abrasions around corners of the mouth and with thick buccal mucosa, without causing overstretching of angles of the mouth.The shank of the straight elevator in the shape of a 'U' was modified, giving it a shape similar to 'P' in the English alphabet hence it is named the P Elevator. The P elevator utilises a 'U' shaped bend in the shank of the conventional straight elevator making space for the buccal soft tissues and the angle of the mouth, to accommodate properly in the 'U' shank. The application of this elevator in the successful removal of third molars is described.Two hundred patients underwent extraction of third molars with the P elevator including 166 patients with disimpaction of all third molars, 23 patients with abrasion around the angle of the mouth, and 11 patients with thick buccal mucosa. Satisfactory results were obtained in all the cases with no postoperative complications.The P elevator permits prudent, meticulous, innovative and proficient extraction of third molars in patients with thick buccal mucosa and abrasions around the angle of the mouth, without overstretching the corners of the mouth. We introduce novel applications of the P elevator in third molar extraction that provide substantial advantages over a conventional straight elevator.

Introduction: the aim of this paper is to describe a case of rehabilitation of trauma induced mandibular defect, reconstructed by distraction osteogenesis, and followed by the precise placement of implants aided with digital planning software. case report: In the following case report, a 56-year-old male patient with mandibular segmental defect, was treated with distraction osteogenesis followed by the