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This study aims to investigate overall career satisfaction rate amongst US-based oral and maxillofacial surgeons (OMSs) and to evaluate possible predictors of professional stress and quality of life.Members of the American Association of Oral and Maxillofacial Surgeons were invited to complete an online survey-based assessment. Descriptive statistics were computed; univariate analysis was performed to identify predictors for satisfaction.The overall response rate was 29%. Most of respondents were male (88.6%), aged45 years (71.7%), married (91.7%), and working at private and/or group-based practices (55.9%) for15 years (66.6%). Most surgeons 91.3% reported being satisfied with their career with 84.9% willing to choose a career in OMS again. No significant difference was noted in satisfaction rates between academic and non-academic surgeons. On univariate analysis, no demographic characteristic was predictive of satisfaction.Reportedly, 91.3% of US-based OMSs have a significant degree of career satisfaction, and a majority would choose the specialty as their profession again.

The purpose of this study was to evaluate the efficacy of multilevel phase I surgery for the treatment of moderate obstructive sleep apnea (OSA) in retrognathic patients with oropharyngeal and hypopharyngeal obstruction.This was a 10-year retrospective cohort study of patients treated by a single surgeon at the Boston University Medical Center. From 2000 to 2010, retrognathic patients with moderate OSA and verified palatal and tongue base obstruction were treated with multilevel phase I surgery that included uvulopalatopharyngoplasty, hyoid suspension, and genioglossus advancement. All patients were evaluated clinically and received polysomnographic studies at three time points: preoperatively (T1), between 6 and 12 months postoperatively (T2), and a minimum of 24 months postoperatively (T3).Twenty-five subjects composed the final study sample. At T2, 11 patients (44.0%) experienced a complete response, 13 (52.0%) experienced a partial response, and 1 (4.0%) experienced no response. Although phase I surgery was associated with significant changes in AHI (F(2,48) = 119.3; P .01) throughout the follow-up period, only one patient at T3 (4.0%) met the criteria for a complete response. The remaining patients were divided evenly between partial response (48.0%) and treatment failure (48.0%), of whom 4 (16.0%) patients had worsening of their obstruction. Thirteen of these patients subsequently elected to undergo maxillomandibular advancement, while 11 elected to continue using continuous positive airway pressure.Although phase I surgery was associated with AHI changes, this reduction was not sufficient to produce a long-term treatment response in over half of our patients. Treatment response was worse after 2 years than at 6 to 12 months. Patients with moderate OSA should understand that multilevel phase I surgery has a greater chance of failure than success and that transient improvements may not be durable.

Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care.

Inflammatory arthritis presents a unique destructive process to the temporomandibular joint. This article provides information on the proper diagnosis, treatment planning, and surgical management aimed to provide patients with improvement in pain, function, stability and facial aesthetics. Additionally, it aims to provide a detailed insight on the joint reconstruction options including alloplastic joint replacement, autogenous joint replacement, orthognathic surgery and distraction osteogenesis.

The objective of this project was to retrospectively evaluate changes in volume of different compartments of the upper airway in response to maxillary, mandibular, and bimaxillary advancement surgeries and to predict the extent of volumetric changes associated with these surgical movements. Pre- and post-surgical cone beam computed tomography scans of 36 patients were evaluated for changes in nasal cavity, nasopharyngeal, oropharyngeal, and hypopharyngeal compartments. The amount of movement for each surgery was measured from skeletal landmarks to reference planes and was correlated with volumetric changes. Maxillary advancement of 4.0±2.2mm increased the oropharyngeal volume significantly (41.40%), and mandibular advancement of 3.8±1.6mm also significantly increased the oropharyngeal volume (21.17%). Bimaxillary advancement of 5.1±1.3mm for the maxilla and 6.4±3.1mm for the mandible significantly increased nasopharyngeal (27.45%), oropharyngeal (66.39%), and hypopharyngeal (52.48%) volumes. Furthermore, for every millimeter anterior movement, oropharyngeal volume increased by 2319.2±771.8mm3. Bimaxillary advancement showed a greater increase than isolated maxillary and mandibular advancement in all pharyngeal compartments. Every millimeter of advancement in the bimaxillary group led to a significant increase in oropharyngeal volume, while every millimeter downward movement showed a significant increase in nasopharyngeal volume.

In the United States, 5–12% of adults have at least one symptom of temporomandibular joint (TMJ) disorders, including TMJ osteoarthritis (TMJ-OA). However, there is no chondroprotective agent that is approved for clinical application. We showed that LOXL2 is elevated in the regenerative response during fracture healing in mice and has a critical role in chondrogenic differentiation. Indeed, LOXL2 is an anabolic effector that attenuates pro-inflammatory signaling in OA cartilage of the TMJ and knee joint, induces chondroprotective and regenerative responses, and attenuates NF-kB signaling. The specific goal of the study was to evaluate if adenoviral delivery of LOXL2 is anabolic to human and mouse TMJ condylar cartilage in vivo and evaluate the protective and anabolic effect on cartilage-specific factors. We employed two different models to assess TMJ-OA. In one model, clinical TMJ-OA cartilage from 5 different samples in TMJ-OA cartilage plugs were implanted subcutaneously in nude mice. Adenovirus LOXL2 -treated implants showed higher mRNA levels of LOXL2, ACAN, and other anabolic genes compared to the adenovirus-Empty-treated implants. Further characterization by RNA-seq analysis showed LOXL2 promotes proteoglycan networks and extracellular matrix in human TMJ-OA cartilage implants in vivo. In order to evaluate if LOXL2-induced functional and sex-linked differences, both male and female four-month-old chondrodysplasia (Cho/+) mice, which develop progressive TMJ-OA due to a point mutation in the Col11a1 gene, were subjected to intraperitoneal injection with Adv-RFP-LOXL2 every 2 weeks for 12 weeks. The data showed that adenovirus delivery of LOXL2 upregulated LOXL2 and aggrecan (Acan), whereas MMP13 expression was slightly downregulated. The fold change expression of Acan and Runx2 induced by Adv-RFP-LOXL2 was higher in females compared to males. Interestingly, Adv-RFP-LOXL2 injection significantly increased Rankl expression in male but there was no change in females, whereas VegfB gene expression was increased in females, but not in males, as compared to those injected with Adv-RFP-Empty in respective groups. Our findings indicate that LOXL2 can induce specifically the expression of Acan and other anabolic genes in two preclinical models in vivo. Further, LOXL2 has beneficial functions in human TMJ-OA cartilage implants and promotes gender-specific anabolic responses in Cho/+ mice with progressive TMJ-OA, suggesting its merit for further study as an anabolic therapy for TMJ-OA.

Purpose To evaluate recent trends in Medicare reimbursement rates for common hospital-based oral-maxillofacial surgery procedures. Methods Physician Fee Schedule Look-Up Tool by the Centers for Medicare and Medicaid Services was searched for reimbursement rates for the 20 most performed oral-maxillofacial surgery procedures between 2003 and 2020. Total percent change, annual percent change, and compound annual growth rate (CAGR) were calculated using the adjusted reimbursement rates over the study period. Annual changes in reimbursement rates before and after 2016 were compared. Results After adjusting for inflation, average reimbursement rates for procedures decreased by 13.4%. Annual percent change and CAGR were −0.79 and −0.88%, respectively. Annual reimbursements decreased more between 2016 to 2020 (−1.83%,) than from 2003 to 2016 (−0.49%; P value = .003). Conclusion Inflation-adjusted Medicare reimbursement rates for oral-maxillofacial surgery procedures have decreased from 2003 to 2020. The rate of reimbursement decreases has accelerated in recent years.

We present a modified surgical technique which encompasses a combination of surgically-assisted accelerated orthodontics and guided bone regeneration for combined surgical and orthodontic management of dental crowding and maxillary transverse deficiency malocclusions with minimally invasive surgery, in a rapid manner, and without the use of general anesthesia.

Purpose To evaluate the effectiveness of a standard antibiotic regimen protocol in the management of maxillofacial trauma patients. Materials and methods The study sample included patients with at least one facial fracture and managed by either closed (CR/MMF) or open reduction (ORIF) by the Oral and Maxillofacial Surgery service. A standardized antibiotic administration protocol based on type of treatment performed and timing of surgical intervention was used in the management of all patients. The primary predictor variable was antibiotic usage. The primary outcome measured was postoperative surgical site infection. Bivariate analysis was performed to assess the association between antibiotic exposure and postoperative surgical site infection. A p value of less than or equal to .05 was deemed to be significant. Results The study sample comprised of 392 patients (102 midface and 290 mandible fractures). The mean age of the study group was 35 years and 89% of the patients were male. Postoperative infection was encountered in 18 patients (all with compound mandible fractures). The infection rates were 3.6% after CR/MMF and 8.7% after ORIF. No patient with midface fractures developed an infection. Chi-square test showed no statistically significant difference in postoperative infection rate in mandible fractures treated either by CR/MMF (p = 0.91) or ORIF (p = 0.94). Conclusions Use of this antibiotic administration protocol limits antibiotic usage and standardizes their administration in the management of maxillofacial trauma without increasing the rate of postoperative surgical site infections.

Purpose To evaluate clinical outcomes in patients with autoimmune or connective tissue (CT) disease undergoing temporomandibular joint (TMJ) reconstruction. Materials and Methods Patients were divided into 2 groups based on type of TMJ reconstruction. Patients in group 1 (n = 9) underwent autogenous reconstruction and had a diagnosis of rheumatoid arthritis (5), lupus arthritis (1), and psoriatic arthritis (3). Patients in group 2 (n = 2l) had alloplastic reconstruction with a patient-fitted total joint prosthesis (TMJ Concepts, Ventura, CA) and had a diagnosis of rheumatoid arthritis (15), lupus (3), and psoriatic arthritis (3). Standardized clinical and radiographic examinations were performed before surgery, immediately after surgery, and at longest follow-up after surgery (T3). Results Group l showed no meaningful improvement in maximal opening without pain, a decrease in lateral excursions, minimal decrease in TMJ pain, and a 32% relapse of chin projection at point B at T3. Average postsurgery follow-up time was 58 months. Postsurgical ankylosis was seen in 22% of patients. In contrast, group 2 showed a statistically meaningful decrease in subjective TMJ pain and lateral excursive movements and improvement in jaw function, diet, maximal incisal opening without pain, and only 5% showed a relapse at point B at T3. Average postsurgical follow-up in this group was 78 months. Conclusions Improved treatment outcomes were obtained with alloplastic TMJ total joint reconstruction compared with autogenous TMJ reconstruction in patients with autoimmune or CT disease.

Young females with retruded and hyperdivergent mandibles, class II openbite malocclusions, and steep occlusal planes with or without TMJ symptoms are at higher risk for Idiopathic Condylar Resorption (ICR). Such patients undergoing orthodontic and /or surgical treatment should be informed of possible relapse due to ICR. Orthognathic Surgery with Total joint replacement or Orthognathic surgery alone may both be acceptable options for management of the facial deformity and the malocclusion that ensues from ICR. Proper patient selection is key to achieving a successful outcome. Current trends and the evidence in the literature suggest that orthognathic surgery with alloplastic joint replacement may be the preferred approach.

PURPOSE Determine the incidence of blunt carotid injury (BCAI) in the blunt trauma induced isolated mandible fracture population and determine the utility of computed tomographic angiography (CTA) screening for BCAI in this population. METHODS A retrospective data review was performed on patients presenting to Boston Medical Center from January 2008 to January 2019 with a diagnosis of mandible fracture. Population selected utilizing ICD-9 and ICD-10 diagnosis codes for mandible fracture and BCAI. Excluded populations were pediatric (less than 18 years) and penetrating carotid injuries. RESULTS A total of 1,508 mandible fractures were identified, with 73% (n = 1,103) being isolated injuries. Five BCAIs were identified, and of these, 1 was associated with an isolated mandible fracture (incidence

PURPOSE We sought to obtain baseline statistics regarding the amount of opioid tablets prescribed by oral and maxillofacial surgeons (OMSs) in the New England area after office-based procedures and to identify factors that might be predictors of their prescription patterns. MATERIALS AND METHODS An anonymous online survey was e-mailed to practicing OMSs in the New England area. The survey explored the quantity of opioid medications prescribed for various procedures, how opioid precautions were given, practitioners' attitude toward opioid dependency, and whether certain surgeon- or patient-related factors influenced prescription behavior. Statistical analyses were used to categorize the OMSs according to their prescription patterns and to identify the most common factors affecting their decision to prescribe opioids. RESULTS Of 315 OMSs, 151 (43%) responded to the survey. Our analyses were of complete data obtained from 118 respondents. For procedures, such as extraction of 7 or more teeth, the placement of 4 or more implants, office-based sinus surgery, cortical block grafts, and removal of third molar teeth, respondents indicated they typically prescribed 8 to 12 opioid tablets. For all other procedures, they typically never or rarely prescribed opioid tablets. The respondents were grouped into low-, medium-, and high-quantity opioid prescribers. Regardless of their grouping status, the respondents showed general agreement regarding their roles in reducing opioid prescription-related issues. No group differences were found in terms of the demographic variables. Relative to the factors predicting increased prescribing habits, the results suggested that OMSs working either exclusively or primarily in academic settings tended to prescribe fewer opioid tablets than those working primarily in the private setting (β = -2.73; P

The aim of this study was to report on the opioid prescribing patterns of oral and maxillofacial surgery residents for routine office-based procedures.A survey was sent to current resident members of the American Association of Oral and Maxillofacial Surgeons (AAOMS). The survey asked questions related to the quantity and duration of opioids prescribed and if such factors as type of procedure, education, and prior opioid abuse by patients influenced prescription behavior.There was a positive relationship between the prescribing culture of residency and prescribing pattern (P value.001). Concerns about factors that promote addiction were negatively associated with prescribing patterns (P value.02). Prescribing culture and concerns about factors promoting addiction together explained 10% of the total variation. Residents receiving instruction on the risks of narcotic were less likely to prescribe opioids.Creating a culture in residency programs aimed at reducing factors that promote addiction may be the best method to reduce overprescription of opioids during training.

Purpose Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR. Patients and Methods A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse. Results Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range, 22 to 32 yr) and mean follow-up was 6.2 years (range, 5 to 12 yr). Mean mandibular advancement at the B point was 24.3 mm and mean change in occlusal plane was −10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions. Conclusions Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.

Recommended treatment for patients with osteochondromas of the mandibular condyle is to perform complete condylectomy with joint replacement. Low condylectomy with joint preservation has recently been proposed as a treatment option. This study compared the outcomes of these treatment options in patients with condylar osteochondromas.Patients were divided into 2 groups: patients who underwent complete condylectomy and joint replacement (group A, n = 13) and patients who underwent low condylectomy and joint preservation (group B, n = 8). To optimize occlusion, function, and esthetics, maxillary and mandibular orthognathic procedures were performed as necessary to re-establish vertical ramus height. Outcomes were measured clinically and radiographically.The 2 groups showed significant clinical improvement (P.05), with no tumor recurrence. Group A had increased operating room (OR) time and donor-site complications in those who received autogenous joint reconstruction compared with alloplastic joint replacement. Group B had a shorter OR duration with quicker postoperative recovery. Orthognathic procedures were stable in all cases.Complete and low condylectomies are viable options for the surgical management of osteochondromas of the mandibular condyle. If temporomandibular joint (TMJ) reconstruction is required, patient-fitted TMJ replacements provide similar clinical outcomes as autogenous reconstruction, but have the advantages of eliminating donor-site morbidity and decreasing operating time.

Purpose Retrospective analysis of the efficacy for two commonly used antibiotic regimens in the management of severe odontogenic infections. Patients and Methods Evaluation of records of patients admitted to the Oral and Maxillofacial Surgery service at Boston University Medical Center from 2009 to 2014 with severe infections of odontogenic origin (SOI). Patients were divided into two groups based on the administered intravenous antibiotic: 1) Group I: Clindamycin only and 2) Group II: Penicillin and Metronidazole. Variables evaluated included demographic characteristics, ASA status, and anatomic site of infection risk, length of hospital stay, antibiotic failure, and pharmaceutical treatment cost. Results 78 patients (46 males and 32 females) were included in the study. There were 57 patients in group I (average age 32.6 years) and 21 in Group II (average age 32.8 years). The average white cell count at time of admission count was higher in Group I (19.3) versus Group II (17.4). Antibiotic failure rate was 3.5% in Group I and 4.7% for group 2 patients. Conclusion Clindamycin alone and combination of Penicillin with Metronidazole are both effective pharmaceutical regimens for SOI. Clindamycin therapy resulted in shorter hospital stay and lower net treatment costs with a slightly higher success rate.

Purpose The purpose of this retrospective study was to document the prevalence of different complications and the mortality rate for outpatient procedures performed under anesthesia by oral and maxillofacial surgeons in the Commonwealth of Massachusetts. Materials and Methods A mailed questionnaire was filled out by active members of the Massachusetts Society of Oral & Maxillofacial Surgeons who practiced using the single–operator-anesthetist model. Morbidity and mortality information was acquired for calendar years 2015 and 2016. Results The findings of this study were consistent with those of previous publications on the same topic. No office deaths occurred, and the mortality rate was 0 of 431,680 patient visits. The prevalence of other anesthesia-related complications was low. Conclusions On the basis of the results of our study, we can conclude that the office-based team model used by oral and maxillofacial surgeons in Massachusetts for the delivery of outpatient anesthesia is safe with a low complication rate.

Purpose The purpose of this study was to determine the effect of individual characteristics, such as age, gender, and type of surgery, on postoperative pain intensity and opioid analgesic consumption after orthognathic surgery. Patients and Methods This prospective observational study was conducted at a single academic medical center during a 12-month period from 2015 to 2016. Thirty of 125 patients 18 to 65 years of age who had American Society of Anesthesiologists status I and II and were admitted to the hospital after orthognathic surgery were recruited. The main outcome variable was opioid analgesic consumption measured in morphine milligram equivalents (MME) during the patients' hospital stay. Secondary outcome variables were postoperative pain intensity measured using the numeric rating scale (0 to 10) and length of hospital stay. Data on age, gender, type of surgery, postoperative pain intensity, and opioid and nonopioid analgesic consumption for each 24-hour period during hospitalization were collected. The analgesic regimen consisted of oxycodone, hydromorphone, and acetaminophen. Differences in postoperative pain and opioid requirements between men and women, older and younger, and 1- and 2-jaw surgery were assessed using unpaired Student t test for statistical analysis. A P value less than .05 was considered statistically significant. Results Thirty patients (14 men, 16 women) with an average age of 26.3 years (18 to 50 yr) were admitted to the hospital for an average of 61 hours (24 to 170 hours) after orthognathic surgery. Twenty-three of 30 patients (77%) had bimaxillary surgery. The average postoperative pain score was 6.0 (2 to 8.5) on a scale of 0 to 10 and average opioid consumption was 106 MME (range, 0 to 407 MME). Women reported more postoperative pain (6.3 vs 5.3) and consumed more opioid analgesic than men (131 vs 78 MME). Patients younger than 25 years required 112 MME of opioid compared with 98 MME for those older than 25 years, although the 2 age groups reported similar pain scores. Patients who had 2-jaw surgery and mandibular (1-jaw) surgery reported more pain and required more opioid analgesics than those who had only maxillary surgery. Conclusion Based on these study results, there appears to be a trend for increased opioid analgesic requirement in women and younger patients during the immediate postoperative period after orthognathic surgery.

Purpose To evaluate 10-year patient data related to mandibular reconstruction with NVBG at a tertiary academic center. Patients and Methods Sixty patients with mandibular mandibular reconstruction were included. Patients were divided to continuity defect and non-continuity defect. Pathology lesion, immediate reconstruction, smoking habit, medical comorbidities, site and size of the defect, surgical approach, intraoperative perforation, cadaveric bone use, and maxilla-mandibular fixation use were analyzed as factors of influence on success. Success was defined as maintenance of more than 50% of graft for non-continuity defects (NCD) and bone continuity and stability for continuity defect (CD), and absence of infection on last follow up upon clinical and radiographic examination. Complications were classified as minor or major. Results The reconstruction was successful in 28 (87%) of CD patients and 23 (82.1%) of NCD patients. Analyses showed that the size of defect was significantly associated with failure. All 4 failed cases of CD had defects more than 9 cm. Four patients had major complications and 43 minor complication. Conclusions Nonvascularized iliac crest bone grafts are highly successful in mandibular continuity reconstruction for non-Cancer patients and should be considered as first choice for defects less than 9 cm. They are less predictable for defects larger than 9 cm but can be considered in these cases with osteoconductive cribs. Symphysis involvement may or may not be associated with lower success rate if our protocol is followed.

Purpose Although arthrocentesis of the temporomandibular joint (TMJ) has been shown to be an effective, minimally invasive surgical procedure, there is a paucity of literature that has examined its effectiveness under intravenous (IV) sedation compared with general anesthesia (GA) with a secure airway. Patients and Methods A retrospective analysis of patients with TMJ arthrocentesis was performed. Patients were divided into 2 groups based on type of anesthesia (sedation vs general) and location of surgery (office vs hospital). Visual analog scales were used to assess TMJ pain, headaches, jaw function, diet, and disability. Objective examinations were performed for maximum interincisal opening, lateral excursions, and TMJ sounds. Results Statistical improvements were seen for TMJ pain, headaches, dietary restrictions, jaw function, and disability. Patients reported an 80% satisfaction rate for surgery under IV sedation compared with a 95% satisfaction rate of patients who had surgery under GA. Conclusions Arthrocentesis is effective for treatment of TMJ pain and acute closed-lock conditions irrespective of Wilkes classification (grades I to III). Ninety-five percent of patients reported immediate resolution or decrease of pain within the first postoperative week. Although the procedure is effective when performed under IV sedation in an office setup, superior clinical outcomes were noticed when the procedure was performed with a secure airway under GA.

Adequate quality and quantity of soft tissue plays an integral part in the esthetic outcome of dental implants. Adequate band of attached tissue decreases the incidence of mucositis and improves hygiene around implants. This article discusses a variety of techniques for soft tissue augmentation. Soft tissue grafting can be achieved at various stages of implant therapy. Epithelial connective tissue grafts are commonly used to increase the band of attached tissue. Subepithelial connective tissue grafts are great for increasing soft tissue thickness and improving the gingival biotype.

One of the most well-known yet perhaps controversial conditions affecting temporomandibular dysfunction (TMD) and the signs and symptoms of facial pain and clinical outcomes after orthognathic surgery procedures is temporomandibular joint internal derangement. This article provides an overview of the mutual relationship between orthognathic surgery and TMD, with especial consideration to internal derangement. The existing literature is reviewed and analyzed and the pertinent findings are summarized. The objective is to guide oral and maxillofacial surgeons in their clinical decision making when contemplating orthognathic surgery in patients with preexisting TMD.

Background Lysyl oxidase like-2 (LOXL2) is a copper-dependent amine oxidase. Our previous studies showed that LOXL2 is elevated during mouse fracture healing. The goal of this study was to evaluate the potential of LOXL2 to act as an anabolic agent in cartilage affected by osteoarthritis (OA). Methods LOXL2 was visualized in tissues from human knee and hip joints and temporomandibular joints (TMJ) by immunofluorescence. The activity of LOXL2 in human articular and TMJ chondrocytes was assessed by cell-based assays, microarray analysis, and RT-qPCR, and LOXL2-mediated activation of NF-κB and extracellular signal-related kinase (ERK) signaling pathways was measured by western blotting. To examine LOXL2-induced effect in vivo, we implanted Matrigel-imbedded human chondrocytes into nude mice and exposed them to exogenous LOXL2 for 6 weeks. Finally, LOXL2-induced effects on collagen type 2 α1 (COL2A1) and phospho-SMAD2/3 were evaluated by immunofluorescence analysis. Results LOXL2 staining was detected in damaged regions of human TMJ, hip and knee joints affected by OA. Stimulation with transforming growth factor (TGF)-β1 upregulated LOXL2 expression, while pro-inflammatory cytokines IL-1β and TNF-α downregulated LOXL2, in human chondrocytes. Viral transduction of LOXL2 in OA chondrocytes increased the mRNA levels of chondroitin sulfate proteoglycan (CSPG4), aggrecan (ACAN), sex determining region Y-box containing gene 9 (SOX9), and COL2A1 but reduced the levels of extracellular matrix (ECM)-degrading enzymes matrix metalloproteinase (MMP)1, MMP3, and MMP13. Further, forced expression of LOXL2 promoted chondrogenic lineage-specific gene expression, increased the expression of COL2A1 in the presence of TNF-α, and inhibited chondrocyte apoptosis. LOXL2 expression also inhibited IL-1β-induced phospho-NF-κB/p65 and TGF-β1-induced ERK1/2 phosphorylation. Matrigel constructs of human chondrocytes from the knee joint and TMJ implanted in nude mice showed anabolic responses after LOXL2 transduction, including increased expression of SOX9, ACAN, and COL2A1. Finally, immunofluorescence staining revealed co-localization of LOXL2 with SOX9 in the nuclei of cells in the implants, decreased phospho-SMAD2/3, and increased COL2A1 staining. Conclusion Our results suggest that although LOXL2 is upregulated in cartilage affected by OA, this may be a protective response that promotes anabolism while inhibiting specific catabolic responses in the pathophysiology of OA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1388-8) contains supplementary material, which is available to authorized users.

PURPOSE: Despite socket preservation and/or immediate implant placement, resorption of the buccal plate after dental extraction continues to pose esthetic challenges to clinicians. Buccal plate preservation (BPP) is a technique that has been recently proposed with an aim to reduce the incidence of such resorption. This study was conducted to assess the long-term efficacy of BPP in maintaining the thickness of the buccal cortical plate after immediate implant insertion and provisionalization. MATERIALS AND METHODS: Ten consecutive patients were included in this study. Each patient underwent extraction of a non-restorable tooth, BPPPBPP, single immediate implant placement and immediate provisionalization. Cone beam CT scans were taken 3 months after surgery (T1) and 5 years after surgery (T2) to evaluate the effectiveness and longevity of the BPPPBPP technique in maintaining the augmented bone width. Two distinct measurements were taken for bone evaluation: (a) R1: 1 mm apical to the implant platform and (b) R2: 5 mm apical to the implant platform. The long axis of the implant was used as a fixed reference. Statistical test analysis was conducted using the SPSS software. Student’s t test was used to assess statistical significance, and a p value of

The complex anatomy and function of the temporomandibular joint (TMJ) and its close proximity to adjacent tissues may explain the wide spectrum of disorders involving this joint. It is often hard to identify the exact cause of TMJ pain or the factors that perpetuate the pain and dysfunction. In general, it is important to differentiate whether the symptomatology is the result of an extra-articular or intra-articular process as this can often aid in developing an appropriate differential diagnosis and treatment plan.

This was a double-blind randomized clinical trial to assess the effect of different pharmacological regimens on the level of prostaglandin E2 (PGE2) in urine and saliva, and to correlate the findings to the clinical course after removal of impacted lower third molars. Eighty patients were randomly divided into four groups: group 1 received placebo; group 2 received preoperative ibuprofen, which was continued for a week; group 3 received intraoperative dexamethasone; and group 4 received preoperative ibuprofen, which was continued for a week, in addition to intraoperative dexamethasone. Saliva and urine samples were taken at scheduled intervals. Patients receiving ibuprofen fared significantly better in most parameters. A single dose of dexamethasone alone had a potent but transient beneficial effect when compared to the results with ibuprofen, which showed significant improvement in both subjective and objective parameters. Use of a single dose of intravenous steroids perioperatively helped reduce untoward sequelae, although to a lesser degree and for a shorter duration than continuous ibuprofen. Combining ibuprofen with perioperative dexamethasone added some benefit in some of the measured parameters, but without a statistically significant advantage over using ibuprofen only.

Soft tissue chondromas are rare benign tumors that primarily arise in tubular bones of the limbs. Oral chondromas are extremely rare, with fewer than 30 cases reported in the literature. The most common site in the oral cavity is the tongue mucosa. Clinically, the lesion appears as a firm, slow-growing, and painless mass. Histologically, all chondromas show mature cartilage, interspersed with adipose or bony tissue. The vast majority seem to occur in younger individuals.

To assess the feasibility of the use of 3-dimensional (3-D) stereolithographic (SLA) technology in complex maxillofacial reconstructive surgery.3-D SLA technology was used in the treatment planning of complex maxillofacial procedures performed by the Department of Oral and Maxillofacial Surgery at Boston University. Specialized 3-D models were ordered and utilized for surgical treatment of a variety of indications including trauma surgery, temporomandibular joint surgery, orthognathic surgery, secondary correction of facial and skull deformities, and extensive jaw pathology. This technology was also used in one patient for jaw reconstruction using novel bone and tissue engineering techniques.The use of 3-D models in Oral and Maxillofacial Surgery significantly improved predictability of clinical outcomes when compared to similar treatments without its use. Total operating time was reduced which had the benefit of decreasing the duration of general anesthesia and reducing wound exposure time. They allowed for assessment of extensive traumatic and pathologic defects in three-dimensions prior to surgical reconstruction. The models were also useful in the design and fabrication of custom prostheses, sizing of bone grafts and allowed for manufacturing of scaffolds for bone regeneration.3-D SLA models can be very effectively used in oral and maxillofacial surgery for multiple indications and diverse clinical scenarios. Successful incorporation of this technology for jaw bone regeneration using tissue engineering techniques offers exciting new prospects for the future.

Alveolar ridge resorption occurs after tooth extraction and has the potential to either complicate implant placement or impair the final esthetic result. Techniques to preserve natural bone and soft tissue contours are of great interest to clinicians and patients because even subtle postextraction buccal plate resorption may have significant clinical effects, particularly in the esthetic zone. Buccal plate augmentation (BPA) is a novel approach for ridge preservation aiming to avoid recession of the facial wall of the socket without interfering with the natural healing mechanism of the extraction socket. It consists of placement of bone graft material over an intact buccal plate, underneath the soft tissues in a surgically created pouch with an aim to maintain or augment the soft tissue esthetics of the region.