RESUMEN
PURPOSE: The aim was to define the indications for use of rapid prototyping models based on data of patients treated with this technique. PATIENTS AND METHODS: Since 1987 our department has been developing methods of rapid prototyping in surgery planning. During the study, first the statistical and reproducible anatomical precision of rapid prototyping models was determined on pig skull measurements depending on CT parameters and method of rapid prototyping. RESULTS: Measurements on stereolithography models and on selective laser sintered models confirmed an accuracy of +/-0.88 mm or 2.7% (maximum deviation: -3.0 mm to +3.2 mm) independently from CT parameters or method of rapid prototyping, respectively. With the same precision of models multilayer helical CT with a higher rate is the preferable method of data acquisition compared to conventional helical CT. From 1990 to 2002 in atotal of 122 patients, 127 rapid prototyping models were manufactured: in 112 patients stereolithography models, in 2 patients an additional stereolithography model, in 2 patients an additional selective laser sinter model, in 1 patient an additional milled model, and in 10 patients just a selective laser sinter model. CONCLUSION: Reconstructive surgery, distraction osteogenesis including midface distraction, and dental implantology are proven to be the major indications for rapid prototyping as confirmed in a review of the literature. Surgery planning on rapid prototyping models should only be used in individual cases due to radiation dose and high costs. Routine use of this technique only seems to be indicated in skull reconstruction and distraction osteogenesis.
Asunto(s)
Gráficos por Computador , Diseño Asistido por Computadora , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Modelos Anatómicos , Modelos Dentales , Rehabilitación Bucal , Cirugía Bucal , Tomografía Computarizada por Rayos X , Simulación por Computador , Implantación Dental , Humanos , Maloclusión/cirugía , Anomalías Maxilofaciales/cirugía , Traumatismos Maxilofaciales/cirugía , Osteogénesis por DistracciónRESUMEN
PURPOSE: The introduction of the four-splint technique in our hospital in 1997 made possible the reproducible centric condyle positioning in bimaxillary osteotomies, while taking the auto rotation of the mandible into consideration and avoiding steps in the mandibular osteotomy line. PATIENTS AND METHODS: From 1981 to 2002 a total of 622 patients underwent bimaxillary osteotomy surgery. During 1981-1997 a total of 395 patients (63.5%) underwent surgery without or only with centric condyle positioning in sagittal ramus osteotomy of the mandible. During 1997-2002 a total of 227 patients (36.5%) underwent surgery with continuous centric condyle positioning with the four-splint technique. RESULTS: In patients with preoperative functional disorders, surgery with continuous centric condyle positioning resulted in statistically significant (p<0.05) improvement compared to those who underwent surgery without continuous centric condyle positioning. CONCLUSION: The results confirm the indication for continuous centric condyle positioning in bimaxillary osteotomies.
Asunto(s)
Oclusión Dental Céntrica , Maloclusión/cirugía , Maxilar/cirugía , Ortodoncia Correctiva , Osteotomía Le Fort/métodos , Estudios de Seguimiento , Humanos , Modelos Dentales , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Cherubism is a rare fibro-osseous disorder that almost exclusively affects the maxilla and mandible. CASE REPORT: We report on three affected males in three generations in family A, and ten affected patients in family B. The youngest affected relative in family A also had craniosynostosis. His father and grandfather had cherubism and clubbed fingers. RESULTS AND DISCUSSION: Cherubism was mapped to region 4p16.3. Because of the associated craniosynostosis, we excluded the FGFR3 gene as a candidate gene for cherubism. The inheritance pattern is autosomal dominant with variable expression. The penetrance is 100% in males and 50-70% in females. We found incomplete penetrance in males, which does not conform with all publications.
Asunto(s)
Querubismo/genética , Proteínas Tirosina Quinasas , Adolescente , Adulto , Querubismo/diagnóstico , Niño , Preescolar , Aberraciones Cromosómicas , Cromosomas Humanos Par 4 , Terapia Combinada , Craneosinostosis/diagnóstico , Craneosinostosis/genética , Craneosinostosis/terapia , Femenino , Estudios de Seguimiento , Genes Dominantes , Predisposición Genética a la Enfermedad/genética , Humanos , Lactante , Masculino , Ortodoncia Correctiva , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Osteoartropatía Hipertrófica Secundaria/genética , Linaje , Receptor Tipo 3 de Factor de Crecimiento de Fibroblastos , Receptores de Factores de Crecimiento de Fibroblastos/genética , Anomalías Dentarias/diagnóstico , Anomalías Dentarias/genética , Anomalías Dentarias/terapiaRESUMEN
The study started in September 1999 and ended in April 2002. It is based on a questionnaire [www.phidias.org] assessing case-related questions due to the application of stereolithographic models. Each questionnaire contains over 50 items. These variables take into account diagnosis, indications and benefits of stereolithographic models with view on different steps of the surgical procedures: preoperative planning, intraoperative application and overall outcome after surgical intervervention. These questionnaires were completed by the surgeons who performed operation. Over the time course of our multicentric study (30 months), we evaluated 466 cases. The study population consists of n=231 male and n= 235 female patients. 54 surgeons from 9 European countries were involved. There are main groups of diagnosis that related to the use of a model. Most models were used in maxillofacial surgery. The operative planning may help to determine the resection line of tumor and optimize reconstructive procedures. Correction of large calvarian defects can be simulated and implants can be produced preoperatively. Overall in 58 % of all cases a time- saving effect was reported. The study strongly suggests, that medical modeling has utility in surgical specialities, especially in the craniofacial and maxillofacial area, however increasingly in the orthopedic field. Due to our results, medical modeling optimizes the preoperative surgical planning. Surgeons are enabeled to perform realistic and interactive simulations. The fabrication of implants, its design and fit on the model, allow to reduce operation time and in consequence risk and cost of operation. In addition, the understanging of volumetric data is improved, especially if medical models are combined with standart imaging modalities. Finally, surgeons are able to improve communication between their patientents and colleagues.
Asunto(s)
Simulación por Computador , Modelos Estadísticos , Procedimientos Quirúrgicos Operativos , Europa (Continente) , Femenino , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
Among Angle Class II patients scheduled for orthognathic surgery, those with short face syndrome with skeletal deep bite only make up a small portion. Nevertheless, it represents a complex challenge for the orthodontist as well as for the surgeon with respect to the individual treatment goals. The harmony of facial relations is impaired in these patients: The skeletal lower face and consequently the soft tissue profile show a deficit in height compared to the midface. Lengthening of the lower face with its respective effect on facial aesthetics can only be corrected by causal therapy, i.e., a combined approach with surgical enlargement of the gonion angle. In this study, a therapy concept specifically suited for the correction of Class II deformities with short face syndrome is presented. Consequences for the skeletal and dental situation with their benefit for extraoral appearance were tested in a clinical trial ( n=15, patients with class II deformities and short face syndrome). To evaluate skeletal and dental changes, cephalograms were taken prior to initiation of orthodontic treatment, 3 days after surgery but before initiation of postsurgery orthodontics, and 1 year after the end of treatment.
Asunto(s)
Cefalometría , Maloclusión Clase II de Angle/cirugía , Anomalías Maxilofaciales/cirugía , Mordida Abierta/cirugía , Ortodoncia Correctiva , Adulto , Estética Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Maloclusión Clase II de Angle/diagnóstico por imagen , Anomalías Maxilofaciales/diagnóstico por imagen , Mordida Abierta/diagnóstico por imagen , RadiografíaRESUMEN
The main aesthetic concern of patients with Angle class II deformities with skeletal deep bite--short face syndrome--is the short lower face. It is the orthodontist's task to correct this deformity insofar as possible. Depending on the extent, even orthodontists at the beginning of their training will recognize this. Since presurgical orthodontic treatment determines the kind and extent of the surgical procedure, the orthodontist has to plan the treatment in for individual case. It is the purpose of this article to demonstrate a concept of treatment for patients with class II deformities, skeletal deep bite, and a short lower face. Presurgical orthodontic treatment and the surgical procedure to correct the deformity are discussed. The treatment results show that it is necessary to leave or to create a certain curve of Speed, depending on the extent of the deformity, to achieve a satisfactory result in terms of to function, aesthetics, and stability. It can be concluded that it is only possible to reach the preset treatment goals with an exact diagnosis and the knowledge of the necessary preparation in combination with the surgical procedure.
Asunto(s)
Anomalías Craneofaciales/cirugía , Maloclusión Clase II de Angle/cirugía , Ortodoncia Correctiva , Adulto , Cefalometría , Terapia Combinada , Femenino , Humanos , Masculino , Avance MandibularRESUMEN
In today's society not only facial esthetics have become important, but also the information on ways to correct adult orthodontic problems is readily available. Subsequently, increasing number of adults seek orthodontic treatment merely to change their facial appearance. In general, these adult patients exhibit such a severe skeletal deformity that it is noticeable even by non-experts. The nature of these adult deformities is such that the only promising treatment is the combined orthodontic-surgical approach. A stable and functional occlusion with a physiologic position for the condyle is the common goal of orthodontic treatment. In patients with skeletal deformities, however, improvement of facial esthetics takes paramount importance. They judge the success of treatment by extraoral appearance. Accordingly, the clinician must assess both the dental and facial appearance, and then inform the patient of different treatment possibilities. In this scenario, patient's input into the decision making process is critical for a mutually satisfactory result. This clinical report describes a concept of systematic approach to treatment of Class II deformities with skeletal deep bite and short lower face (short-face syndrome). This approach emphasizes the soft tissue analysis.
RESUMEN
In 63 patients, 82 elevations of the maxillary sinus were performed. As augmentation, materials autografts from the iliac crest (combined with alveolar ridge augmentations in 16 sinus lifts) were transplanted in 39 cases and osteoinductive, allogeneic bone powder (AAA bone (autolyzed, antigen-extracted, allogeneic bone): n = 8, DFDBA (demineralized freeze-dried bone allograft) and/or Grafton (demineralized bone matrix gel): n = 35) were used in 43 cases. Some 4-6 months after implantation, osteoinductive, allogeneic (demineralized) bone implants showed radio-opaque areas as an equivalent of bone formation. Histological examinations revealed that osteoinductive implants were completely transformed into patients' own bone tissue. The average augmentation height after autograft transplantations was 14 (+/- 3) mm in comparison with 9 (+/- 3) mm after allograft implantations. Histologically as well as radiologically no differences of the bone quality could be determined between the two augmentation materials. Endoscopic controls showed, in both groups, nonirritated mucous membranes. On an average 2 endosseous implants (Bone Lock or ITI-screw implants) were inserted into the augmentated maxillary sinus floors in both groups. No osseointegration was achieved in 4 out of 67 dental implants when bone autografts were used and in 2 out of 74 dental implants of the allogeneic bone group. Patients with bone autografts suffered from postoperative complaints on an average of 19 (+/- 9) days (without consideration of 2 patients with postoperative complaints persisting for more than 90 days). The average postoperative complaints of recipients of allogeneic bone implants continued for 3 (+/- 5) days. The 13 patients who underwent an ambulant sinus lift procedure with allogeneic bone powder were already symptom-free several hours after the operation. Under critical consideration of all investigated parameters, osteoinductive bone implants are preferable to iliac bone autografts for maxillary sinus augmentations in those cases in which no additional alveolar ridge augmentation is required.
Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Enfermedades Maxilares/cirugía , Seno Maxilar/cirugía , Pérdida de Hueso Alveolar/diagnóstico por imagen , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/patología , Proceso Alveolar/cirugía , Atrofia , Femenino , Humanos , Masculino , Maxilar/diagnóstico por imagen , Maxilar/patología , Maxilar/cirugía , Enfermedades Maxilares/diagnóstico por imagen , Seno Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Trasplante Autólogo , Trasplante Homólogo , Resultado del TratamientoRESUMEN
AIM: To evaluate clinical outcome 24 months after guided tissue regeneration (GTR) therapy of deep periodontal pockets in patients poorly responding to conventional flap surgery, to compare its efficacy with conventional flap surgery, and to analyze the factors associated with the healing outcome. METHODS: Twenty defects underwent GTR with ePTFE membranes. Clinical measurements were recorded at the baseline and at 6, 12 and 24 months after the surgery. The 24-months outcomes were compared to those in the same 20 patients previously treated with conventional flap surgery (intra-subject control), and in matched control patients who underwent conventional treatment alone. RESULTS: After 24 months, GTR treatment significantly reduced the probing pocket depth (deltaPPD=2.7+/-1.2 mm, p<0.001) and increased probing attachment level (deltaPAL=2.31+/-1.5 mm, p<0.001) in comparison to the previous conventional treatment. No significant difference was observed before the 24-month measurement compare d to matched controls who responded well to the conventional treatment. However, 24 months after the surgery, dPAL obtained in the GTR group significantly exceeded that after conventional treatment. There was a significant association between 24-month dPAL and dPPD with the configuration and the intrabony depth of the defect, level of oral hygiene, and smoking status of the patient. CONCLUSION: The efficacy of GTR is at least equal to that of conventional flap surgery. It is desirable in patients poorly responding to flap surgery alone. The gain and maintenance of clinical attachment is associated with the level of oral hygiene, smoking status, and morphology and intrabony depth of the defect.
Asunto(s)
Regeneración Tisular Guiada Periodontal/métodos , Bolsa Periodontal/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Bolsa Periodontal/patología , Bolsa Periodontal/fisiopatología , Pronóstico , Valores de Referencia , Índice de Severidad de la Enfermedad , Colgajos Quirúrgicos , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
Autolyzed, antigen-extracted, allogeneic bone (AAA bone) is prepared from cortical bones of human organ donors. AAA bone possesses osteoinductive properties as it delivers BMPs from its bone matrix. Within a prospective study, 37 cranial defects were reconstructed using AAA bone implants over a period of more than 7 years. The patients were followed-up at standardized intervals. Roentgenographic assessments and bone scintigraphies revealed osseous integration and remodelling of the AAA bone implants. In one quarter of the cases re-entry was performed 10 to 18 months after the cranioplasty (removal of osteosynthesis material, recurrence of tumor). All nine AAA bone reconstructions showed bleeding surfaces and bony integrations. A bone biopsy was taken from the center of one of these AAA bone implants and this showed new bone formation originating from the surface of the implant. In one case an AAA bone implant was lost due to infection. This is noteworthy as in approximately one third of the cases the bone implants were in direct contact with the frontal sinus. The clinical results clearly emphasize the therapeutical benefit of AAA bone for cranioplasties. Large AAA bone chips from human skull bones facilitate the reconstruction of the skull's convexity, especially when sterolithography-based operation planning is performed.
Asunto(s)
Trasplante Óseo/fisiología , Anomalías Craneofaciales/cirugía , Craneotomía/métodos , Oseointegración/fisiología , Fracturas Craneales/cirugía , Neoplasias Craneales/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Proteínas Morfogenéticas Óseas/fisiología , Niño , Preescolar , Anomalías Craneofaciales/diagnóstico por imagen , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Fracturas Craneales/diagnóstico por imagen , Neoplasias Craneales/diagnóstico por imagen , Trasplante HomólogoRESUMEN
Autolyzed, antigen-extracted, allogeneic bone (AAA bone) is prepared from cortical bones of human organ donors. AAA bone possesses osteoinductive properties as it delivers BMPs from its bone matrix. Within a prospective study, 37 cranial defects were reconstructed using AAA bone implants over a period of more than 7 years. The patients were followed-up at standardized intervals. Roentgenographic assessments and bone scintigraphies revealed osseous integration and remodelling of the AAA bone implants. In one quarter of the cases re-entry was performed 10 to 18 months after the cranioplasty (removal of osteosynthesis material, recurrence of tumor). All nine AAA bone reconstructions showed bleeding surfaces and bony integrations. A bone biopsy was taken from the center of one of these AAA bone implants and this showed new bone formation originating from the surface of the implant. In one case an AAA bone implant was lost due to infection. This is noteworthy as in approximately one third of the cases the bone implants were in direct contact with the frontal sinus. The clinical results clearly emphasize the therapeutical benefit of AAA bone for cranioplasties. Large AAA bone chips from human skull bones facilitate the reconstruction of the skull's convexity, especially when sterolithography-based operation planning is performed.
RESUMEN
Stereolithography (STL) is a method of organ-model-production based on computed tomography scans which enables the representation of complex 3-dimensional anatomical structures. Surfaces and internal structures of organs can be produced by polymerization of UV-sensitive liquid resin using a laserbeam. In oral and maxillofacial surgery this technique is advantageous for reconstruction of severe skull defects because a more accurate preoperative planning is possible. Using recently developed software we are able to reconstruct unilateral bony defects by virtual mirror imaging of the contralateral side and production of a STL mirror model as well as the reconstruction of non-mirrorable defects by superposition. Advantages of STL are the representation of complex anatomical structures, high precision and accuracy, and the option to sterilize the models for intraoperative use. More accurate planning using this method improves postoperative results, decreases risks and shortens treatment time.
Asunto(s)
Craneotomía/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Modelos Anatómicos , Cráneo/cirugía , Tomografía Computarizada por Rayos X/métodos , Anciano , Huesos Faciales/diagnóstico por imagen , Huesos Faciales/cirugía , Femenino , Humanos , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Planificación de Atención al Paciente , Cráneo/diagnóstico por imagen , Técnicas Estereotáxicas , Cirugía Bucal/métodosRESUMEN
The hypothesis of reduction in lung cancer risk associated with the adoption of low-tar cigarettes was examined in a subset of subjects from a population-based, case-control study of incident primary lung cancer among New Jersey white men. Risk was related to time-weighted average tar levels of cigarettes smoked in 1973-1980. Unadjusted estimates of risk were significantly low for the lowest tar (less than 14 mg/cig) smokers [odds ratio = 0.53 (0.29,0.97)] compared with the highest (21.1-28 mg/cig). However, adjustment by age and total pack-years rendered the risk reduction insignificant. Of note was the finding that cases who smoked low-tar cigarettes compensated for reducing tar by increasing the number of cigarettes they smoked by almost half a pack per day from the years 1963-1972 to 1973-1980, while in the same period controls and high-tar cigarette smoking cases did not increase the numbers smoked.
Asunto(s)
Neoplasias Pulmonares/etiología , Fumar/efectos adversos , Breas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , New Jersey , Estudios Retrospectivos , Riesgo , Fumar/epidemiología , Breas/administración & dosificaciónRESUMEN
In a population-based case-control study of lung cancer among New Jersey men, usual adult consumption of many vegetables and fruits was included in the interview to assess the protective potential of carotenoids. With data from 900 controls the percentage of New Jersey white men who eat specific vegetables and fruits primarily in certain seasons, the relative importance of in-season and out-of-season consumption, and the median length of season were determined. Although first asking whether a food item was consumed all-year-round or primarily in certain seasons and then asking for the appropriate frequency of consumption facilitated the interview, obtaining out-of-season frequency of consumption and length of season was not necessary. Substituting 0 for reported out-of-season frequencies and 3 mo for reported season lengths reduced slightly the observed associations between diet and lung cancer risk but did not modify the overall pattern noted. Carotenoid intake in winter-fall was estimated to be about two-thirds that in summer-spring.