RESUMEN
The aim of this study was to monitor changes in chondroitin sulphate (CS; WF6 epitope) levels in peri-miniscrew implant crevicular fluid (PMICF) during orthodontic loading. Ten patients (seven males and three females; aged 22.0 +/- 3.4 years), who required orthodontic treatment with extraction of all four premolar teeth, participated in the study. Twenty miniscrew implants (used as orthodontic anchorage) were placed, two in each patient, buccally and bilaterally in the alveolar bone between the roots of the maxillary posterior teeth. Sentalloy closed-coil springs (50 g) were used to load the miniscrew implants and to move the maxillary canines distally. During the unloaded period, PMICF samples were collected on days 1, 3, 5, and 7 after miniscrew implant placement and on days 14, 21, 28, and 35 during the loaded period. Clinical mobility assessments of the miniscrew implants were recorded at each visit. The competitive enzyme-linked immunosorbent assay with monoclonal antibody WF6 was used to detect CS (WF6 epitope) levels in the PMICF samples. The differences between the CS (WF6 epitope) levels during the unloaded and loaded periods were determined by a Mann-Whitney U-test. During the loaded period, two miniscrew implants were considered to have failed. The CS (WF6 epitope) levels during the unloaded period ranged from 0.00 to 758.03 ng/ml and those during the loaded period from 0.00 to 1025.11 ng/ml. Medians of CS (WF6 epitope) levels, around 'immobile' miniscrew implants, between the unloaded and loaded periods were not significantly different (P = 0.07). CS (WF6 epitope) levels in PMICF can be detected and may be used as biomarkers for assessing alveolar bone remodelling around miniscrew implants during orthodontic loading.
Asunto(s)
Proceso Alveolar/metabolismo , Remodelación Ósea/fisiología , Sulfatos de Condroitina/metabolismo , Líquido del Surco Gingival/metabolismo , Métodos de Anclaje en Ortodoncia/instrumentación , Técnicas de Movimiento Dental/métodos , Adulto , Biomarcadores/metabolismo , Tornillos Óseos , Epítopos , Femenino , Humanos , Masculino , Estadísticas no Paramétricas , Técnicas de Movimiento Dental/instrumentación , Adulto JovenRESUMEN
PURPOSE: The external traction hooks of the intraoral splint used in the rigid external distraction (RED) system for maxillary distraction osteogenesis interfere with the surgical procedures. The purpose of this study is to introduce an innovative splint fixation method for maxillary distraction osteogenesis with Locking Attachments and evaluate their advantages, such as reduction of operating time compared with the traditional intraoral splint method. PATIENTS AND METHODS: Retrospective comparison of operative times of maxillary Le Fort I osteotomy procedures was carried out with the traditional protocol using the intraoral splint cemented to the maxillary dentition (n = 14), and a removable intraoral splint that is inserted postsurgically (n = 14). Operative procedure times were compared and analyzed statistically using the data extracted from the surgical records. RESULTS: There were no complications inserting the removable splint postsurgically, including pain, discomfort, or time-consuming procedure. Stable and secure splint fixation was obtained before the distraction procedure and the desired treatment goals were obtained in all patients. The total operative procedure times were significantly reduced in the Locking Attachments group by 24% to 41% (approximately 65 minutes) compared with earlier operations involving the conventional splints (P < .05). CONCLUSIONS: Maxillary distraction osteogenesis with the Locking Attachments is a highly effective fixation approach to manage severe hypoplastic maxilla, eliminating lip constraints resulting from scarring and allowing for easier, more deliberate and careful dissection. The use of the Locking Attachments is reliable in craniofacial surgery and has proved to be advantageous in the reduction of the operating time and surgical risks.
Asunto(s)
Fijadores Externos , Maxilar/cirugía , Micrognatismo/cirugía , Osteogénesis por Distracción/instrumentación , Osteotomía Le Fort/instrumentación , Adolescente , Adulto , Niño , Labio Leporino/complicaciones , Labio Leporino/rehabilitación , Fisura del Paladar/complicaciones , Fisura del Paladar/rehabilitación , Humanos , Maxilar/anomalías , Micrognatismo/etiología , Estudios Retrospectivos , Férulas (Fijadores) , Factores de TiempoRESUMEN
The simultaneous use of cleft reduction and maxillary advancement by distraction osteogenesis has not been applied routinely because of the difficulty in three-dimensional control and stabilization of the transported segments. This report describes a new approach of simultaneous bilateral alveolar cleft reduction and maxillary advancement by distraction osteogenesis combined with autogenous bone grafting. A custom-made Twin-Track device was used to allow bilateral alveolar cleft closure combined with simultaneous maxillary advancement, using distraction osteogenesis and a rigid external distraction system in a bilateral cleft lip and palate patient. After a maxillary Le Fort I osteotomy, autogenous iliac bone graft was placed in the cleft spaces before suturing. A latency period of six days was observed before activation. The rate of activation was one mm/d for the maxillary advancement and 0.5 mm/d for the segmental transport. Accordingly, the concave facial appearance was improved with acceptable occlusion, and complete bilateral cleft closure was attained. No adjustments were necessary to the vector of the transported segments during the activation and no complications were observed. The proposed Twin-Track device, based on the concept of track-guided bone transport, permitted three-dimensional control over the distraction processes allowing simultaneous cleft closure, maxillary distraction, and autogenous bone grafting. The combined simultaneous approach is extremely advantageous in correcting severe deformities, reducing the number of surgical interventions and, consequently, the total treatment time.
Asunto(s)
Trasplante Óseo/métodos , Fisura del Paladar/cirugía , Maxilar/cirugía , Osteogénesis por Distracción/métodos , Osteotomía Le Fort/métodos , Adulto , Terapia Combinada/métodos , Humanos , Ilion/trasplante , Masculino , Maxilar/anomalías , Aparatos Ortodóncicos , Osteogénesis por Distracción/instrumentaciónRESUMEN
Mechanisms of disc displacement in temporomandibular joint (TMJ) internal derangement (ID) in mandibular asymmetry have not been clearly defined. This study examines the degree and direction of disc displacement and their relationship with vertical asymmetry in terms of both clinical and biomechanical aspects. A retrospective study of disc displacement was performed in 31 mandibular asymmetry patients using MR imaging. The degree and direction of disc displacements on the shifted side and contralateral side TMJ were investigated with the degree of vertical asymmetry. Furthermore, three-dimensional finite element models of entire mandible include TMJ and maxillary teeth in occlusion were created to simulate displacement of the articular disc during clenching condition. The direction of displacement on the shifted side and contralateral side were significantly different. Articular disc has tendencies to displace more on the shifted side even in mild degree of vertical asymmetry. The degree of displacement was correlated with the amount of asymmetry. The MR results were consistent with the tendencies of disc displacement predicted from the finite element models. We suggest that disturbance in the direction of stress distribution through asymmetry of the mandible is one of the mechanisms related to disc displacement.