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Purpose: The study goal was to evaluate the incidence of patients older than 40 years who required third molar removal., Patients and Methods: Two prospective 5-year studies were compared over a 10-year period of 1992 to 1997 and 1997 to 2002. The study was initiated to evaluate how the large increase in the older population with longer life expectancies is reflected in the third molar population., Results: In 1997, 10.5% of patients requiring third molar surgery were 40 years or older. In 2002, 17.3% of patients were 40 years or older., Conclusions: It is well known that patients 40 years and older have increased risk in removal of third molars. It is concluded that 1 patient in 5 in the high-risk category is in a very high risk category. The risk to patients and to the profession can be dramatically reduced by considering early removal of abnormal third molars.

Management of asymptomatic malposed third molars is a controversial topic. As a result, many malposed or mildly pathologic third molars are not removed. Historical pro and con arguments regarding removal centered around cost and the aspects of the surgical removal itself. Current epidemiology and medical advances address issues not considered before. There is a large growth of the aging population (over 40 years). More and more of these elderly patients are requiring third molar removal. Over a five-year period, 1997-2002, the incidence almost doubled to 17.9 percent. This age category is known to be high risk for third molar surgery. An equally or higher risk is the rapidly growing number of patients seeking third molar surgery who are moderately severely medically compromised. This paper reviews how this lack of consensus results in delayed removal of malposed third molars in this population. Preventive dental concepts, removing compromised third molars earlier, would eliminate the high risk to this aging population.

Advances in tissue engineering provide an increased level of understanding of the mechanical and chemical stimuli that regulate tissue responses. Oral tissue engineering can be applied to recreate missing osseous or dental structures or correct orofacial deformities, changing the patient's smile, midfacial height, and the soft tissue drape. Biomechanical principles can also be applied to tissue engineering to enhance the bone/tooth or bone/implant functionality and long-term stability. Advancements are also being achieved in the area of biomimetics that will allow the creation of new biologic replacements for missing oral structures. The opportunity for bioengineering to charter the course of tooth regeneration is an exciting prospect and will improve the quality of life for patients for decades to come.

Background: This study quantifies the changes in bone height of the posterior area of the edentulous mandible when the load of complete dentures is borne entirely by anteriorly placed osseointegrated implants., Methods: Thirty-three patients, of whom there were radiographs from the beginning of implant loading and from a follow-up visit at least three years later (a mean of 6.6 years later), were included in the study. Working with panoramic radiographs, the authors took height measurements in the premolar area (15 millimeters distal to the most distal implants). A valid correction factor was available because implants of known length were proximal to the area being evaluated., Results: The authors calculated descriptive statistics using means, standard deviations, medians and proportions as appropriate. A P-value of less than .05 was considered significant. Of the 33 subjects, most showed increases in bone height--29 (87.9 percent) on the right side and 28 (84.9 percent) on the left side. The mean change in all subjects was +1.0 mm (range -0.8 to +3.3 mm). A comparison of mandibular height at implant placement vs. follow-up showed a statistically significant increase bilaterally (P < .001)., Conclusions: This study demonstrates that dentures for edentulous mandibles that are borne totally by implants in the anterior area conserve or enhance the bone of the posterior portion of the mandible. An important future study should test the effect of implant-assisted restorations for the edentulous mandible that load the posterior ridge (a bar clasp, for example)., Clinical Implications: One of the considerations in planning treatment for the edentulous mandible should be the preserving effect of totally implant-borne restorations vs. the continued resorption of the body of the mandible with conventional dentures.

The purpose of this study was to evaluate the accuracy of two video imaging systems, Prescription Portrait and Orthognathic Treatment Planner, in predicting the soft tissue profiles of 39 patients who underwent mandibular advancement surgery. Presurgical cephalograms and profile photographs were entered into a computer. Computerized cephalometric line and video image predictions were generated and compared with the actual postsurgical results. The results indicate that both programs were equally accurate clinically in their line drawing and video image predictions. In the line drawings, clinically acceptable accuracy was shown in approximately 80% of the upper lip and chin predictions and in less than 50% of the lower lip predictions. The video images produced by both programs received fair to good ratings from a panel of professional and lay judges. Orthodontists and surgeons rated all aspects of the images similarly, while lay people were most critical of the chin and submental areas and least critical in their overall evaluation.

The purpose of this retrospective study was to investigate the accuracy of two video imaging systems, Orthognathic Treatment Planner (OTP) and Prescription Portrait (Portrait), in predicting soft tissue profile changes after maxillary impaction surgery. Computer-generated line drawing predictions were compared with actual postsurgical profiles. Neither program was very accurate with vertical measures and lower lip contour. Portrait was more accurate at pronasale, inferior labial sulcus, and pogonion in the y-axis direction (P < 0.05). Video image predictions produced from the presurgical photographs were rated by orthodontists, surgeons, and lay people, who compared the predictions with the actual postsurgical photographs using a visual analog scale. Portrait's prediction images were scored higher than OTP's for five of eight areas. Orthodontists were most critical of the lips and the overall appearance. Lay people were most critical of the chin and submental areas.

This study evaluates the first 51 consecutive cases treated for limitation of mandibular movement due to closed lock. Eighty joints (22 unilateral, 29 bilateral) were treated with arthroscopic surgery. The mean follow-up was 29.4 weeks, with a range of 6 to 77 weeks. These results showed an immediate improvement after arthroscopy followed by a more gradual improvement during the next 6 months, with a plateau in improvement thereafter. All cases, unilateral and bilateral, generally reached the same level of opening.

A two-year follow-up was made of twenty-one impacted, mesially inclined mandibular molars which were surgically uprighted and splinted with autogenous bone grafts. There were two instances of follicular cysts in the adjacent impacted third molars and two instances of supereruption of uprighted teeth. With these exceptions, all uprightings were successful according to the criteria of continued root growth, normality of pulp chambers, normal periodontium, and normal contiguous structures.

This first of two articles describes a modified distolingual splitting technique for removal of impaction of various classes. The second article evaluates the efficacy of the technique by reporting and comparing the incidence of postoperative sequelae with earlier research findings. In this technique, the lingual soft tissue is not separated from the bone. In addition, the fragmented lingual bone attached to the periosteum is not removed. The procedure is best performed with the patient under sedation or general anesthesia.

The two cases presented here illustrate advantageous uses of orthopedic-type craniomandibular headgear. Both cases demonstrate the use of headgear for postoperative cephalad movement of the maxilla. In Case 1 the use of headgear accomplished 6 mm. of anterior maxillary cephalad movement and 3.5 mm. of posterior maxillary cephalad movement. In Case 2 the use of postoperative headgear accomplished 8 mm. of anterior maxillary cephaled movement and 6.25 mm. of posterior maxillary cephalad movement. Table I indicates the duration of intermaxillary immobilization and the ensuing time that the cranial traction appliance was used. Fig. 10 illustrates the profile changes for Cases 1 and 2.

Nineteen patients who had autologous rib grafts for mandibular augmentation were monitored for six to 13 years to evaluate the rate of resorption as a function of time. Data were collected from panoramic radiographs that were corrected for distortion. The findings indicated that rapid resorption occurs during the first two years after grafting and decreases markedly thereafter. Although some prolonged benefits resulted from the procedure, it was concluded that it is not an ideal solution to the problem of ridge augmentation.

This modification of the LeFort I osteotomy places the horizontal bony cut higher and into the dense cortical bone of the maxillozygomatic complex. It gives greater stability and also provides a more solid bony base for intraosseous wiring of the mobilized segment. This usually eliminates the need for dento-osseous or maxillomandibular fixation, and the segments appear to solidify more quickly. Over the last year, we have used this technique in 23 cases (four maxillary advancements, seven one-piece maxillary intrusions, and 12 segmental maxillary intrusions) with very favorable results. This modification has given us greater control and stability, especially in combined maxillary and mandibular osteotomies.