A review of biomechanical studies for mandibular angle fracture internal fixation

Mandible fractures correspond to 19-40% of all facial fractures. Among all mandible fractures, 12-30% are fractures of the mandibular angle. These fractures are mainly caused by sports activities, interpersonal violence and car accidents. The presence of the third molar and the thin transverse bone area seem to be responsible for the frequent involvement of the mandibular angle in facial fractures. Before the advent of antibiotics, a high frequency of infection was always associated after an open reduction in mandibular angle fractures. Wired osteosynthesis and maxillomandibular fixation (MMF) were traditional methods for fixing mandibular angle fractures. The limitation of both methods has influenced the development of new approaches for the treatment of mandibular angle fractures. Currently, osteosynthesis of mandibular angle fractures with plates and screws has become an effective treatment option. Several forms are described in the literature as: fixation of bone segments with a miniplate on the upper edge of the mandible, fixation with two miniplates, lag screw or by a single rigid plate on the lower edge of the mandible. The purpose of this study was to summarize the main characteristics of biomechanical studies such as the type of mandible source used, the plating techniques employed, the plate material, and the loading protocols used to evaluate the stability of the fixation methods. The Medline (PubMed) database was searched combining relevant terms and pertinent articles in English were included. Articles had to meet the following inclusion criteria: be in vitro biomechanical studies evaluating fixation methods for mandibular angle fractures. A total of 27 articles fulfilled the inclusion criteria. Synthetic mandibles (n=12), animal mandibles (n=9), and human cadaveric mandibles (n=5) were used as the sample source to perform the biomechanical analysis. One article used both synthetic and human cadaveric mandibles. Also, a variety of fixation techniques was described such as mini-plates, lag-screws, reconstruction plates, and three-dimensional plates. The materials of the bone plates used were: stainless steel, commercially pure titanium, titanium alloy or bioresorbable. However, there was inconsistency in reporting the materials and not all studies clearly stated the material of the bone plates. For the biomechanical analysis, there was a high variation among all studies regarding the loading protocols used. The same side of fixation, the anterior part of the mandible (central incisors) or the contralateral side were reported as the dentate regions in which the force was applied. For more than 2 decades, in vitro biomechanical studies have been used to help researchers and clinicians in the field of Oral and Maxillofacial Surgery to properly evaluate and compare the different devices and techniques available for the treatment of mandibular angle fractures. Also, biomechanical studies are important to answer questions on fatigue performance and fracture strength on the gross level.

Prevalence of maxillary sinus alterations after zygomatic surgery. A comparative study between intra-sinus and ZAGA approaches

Zygomatic implant (ZI) is an option of the edentulism. Complications associated with ZI are maxillary sinusitis and soft tissue recession. The Zygoma Anatomy-Guided Approach (ZAGA), reduce the complications of the Original zygomatic intra-sinus Surgical technique (OI-ST). Study Aims: 1) report and compare the prevalence of sinus complications between ZAGA and OI-ST. 2) propose therapeutic guidelines for sinus. Material and Methods: ZAGA has been proposed to reduce the complications of the OI-ST. Results: Statistically significant increase of the "Modified Lund Mackay" (MLM) score (was noted in CT of patients after ZI surgery in comparison with the pre-surgical Lund-Mackay (LM) score (t=5, 0, p<.0005). Our study indicates that patients who underwent the ZI surgery according to the OI-ST. (M = 2.93, SD = 3.65) demonstrated a significantly higher ML-M score (t = 2.99, p < .003) compared to the patients operated with the ZAGA Concept (M = 1.52, SD = 2.36). Conclusions: ZI procedures can lead to sinus alterations. Significant differences have been found between two different approaches.

Reattachment of Crown in Anterior Fractured Tooth-A Case Report

In dentistry, traumatic injuries are most common in the anterior teeth due to its anatomic position. The various treatment modalities have been used depending on the extent of injury on teeth and supporting structures. Esthetic concerns are the most important challenges in modern dental practice. Adhesive dentistry is an excellent approach regarding esthetics, especially for fractured anterior teeth. This case report describes the successful treatment of reattachment procedure in a 17-year-old male patient presented with a fractured maxillary left central incisor.

A Cross-Sectional Study on the Oral Health of the Infants and Toddlers at the National Guard, Jeddah, Saudi Arabia

Background: The high prevalence of dental caries among preschool children had been reported in literature. However, studies on dental caries and related problems among infants and toddlers in Saudi Arabia are lacking. Aim: This study assessed the oral health status of the infants and toddlers in the Iskan Primary Health Care (PHC) Center for the National Guard in Jeddah, Saudi Arabia. Settings and Design: The assessment included 151 children between the ages of 5 to 36 months during 2015 to 2016. Materials and Methods: The caregivers were provided with a structured questionnaire. Oral examinations on the children were based on the WHO’s assessment form and criteria. Statistical Analysis: Frequency, mean, standard deviation, and regression analysis were used for the risk assessment of the caries. Results: Dental caries was reported in 9% of the children in the Center, and 95.5% of them were categorized as severe early childhood caries (S-ECC). More than half of the children were bottle-fed. About 70% of the caregivers never cleaned their children’s mouth. The caries among the children was highly associated with bottle-feeding during their sleep. Conclusions: Nocturnal bottle-feeding, failure to clean the children’s mouths, and the use of cleaning materials other than toothpaste were identified as the risk factors that promoted the development of caries among the children. With these findings, we recommend that the mothers and the medical professionals should be trained on necessary oral health practices. Early preventive dental health services within the National Guard health services should be initiated.

Key Points on Short Term Medical Mission International organization on Orofacial cleft

Background: Children suffering from congenital facial malformations in underdeveloped countries are the main objective of the STMMIs with the aim of easing their lives. Clarós Foundation (CF) has carried out 115 missions worldwide with the aim, among others, of treating patients with this type of orofacial cleft malformation. We think that the experience we have acquired in this field can be transmitted to new NGOs institutions that want or wish to continue in this line. The optimization of the use of means and human resources, both from the NGO and the local health workers, will make it possible to achieve greater outcomes and results when applied in the development of Short Term Medical Mission International (STMMIs) missions. Material and Methods: We present the experience CF has acquired throughout the various STMMIs it has accomplished, during a period of 7 days each, specifying the details of its organization, patient selection, preparation of the surgery and its performance, in a well- organized manner to be fast, effective and safe in its results. During each of the 115 missions, the medical team has treated patients with this congenital pathology, in different proportions that go from 90% of the total cases to only 10% of the patients attended. The surgical techniques applied are those used in our medical center in Barcelona, which we may say, are the state-of-the-art surgical techniques used by the most advancedcenters. Results: A total of 1725 patientsunderwent surgery throughout 115 STMMIs, averageduration of 7 days each,115 STMMIs by 15 cases average. During this time 925 patients were operated for cleft lip and 800 patients for cleft palate. Male patients accounted for 58% and female for 42%. According to the age of the patients we found that the majority of cases were operated on babies 68.35% (1.179 neonatal period); 20.2% on children (300 cases) and (19.76%) adolescents (233 cases); and 1.10% adults in the 20-67 age range (13 cases). Of the total number of operated patients(1.725), there have been few immediate and late postoperative complications, but we estimate them at 11%. Conclusion: International cooperation between experienced NGOs and local medical teams turn out to be much more effective, less expensive and with better clinical results than those obtained without this collaboration. This organizational model can be very useful in order to know the details that these missions entail and apply them in your own activities.

An Evaluation of Factors Involved in Perception of Smile Attractiveness of Static and Dynamic Smile

According to Jackson, the three main objectives of orthodontic treatment are Functional efficiency, Structural balance and aesthetic harmony which is called as Jackson's triad. These prime objectives in orthodontic treatment are directed towards improvement in function, improvement in aesthetics and the maintenance of these improvements

Central Giant Cell Granuloma

Central giant cell granuloma (central giant cell granuloma) is an uncommon benign bony lesion that occurs in the mandible and maxilla and accounts for approximately 7% of all benign tumours of the jaws [1]. The World Health Organization (WHO) has defined central giant cell granuloma as an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of haemorrhage, aggregations of multinucleated giant cells and occasional trabeculae of woven bone [2]. Central giant cell granuloma occurs predominantly in children or young adults, with approximately 75%of cases presenting before 30 years of age although presentation can occur at any age [3]. Females are affected more frequently than males, with a ratio of 2:1

Evaluation and correlation of depth cure and degree of conversion of bulk-fill posterior restorative composite resins

Background: The problem of composite resin filling is the longer time consumed for incremental application. Bulk-fill composite resins were introduced to the market as substitutes for dental amalgam for restoration of posterior teeth. Objectives: The aim of this study was to evaluate the curing depth and degree of conversion of two bulk-fill composite resins. Materials and methods: . Specimens of specific dimensions were prepared from Glacier and SureFil (universal shade, A2), they classified as bulk-fill composite resins. Depth of cure, degree of conversion at different thicknesses for each material (2,3,4,5 and 6 mm) for each thickness separately. The curing depth was determined by the scrapping method (ISO 4049, 2000). The degree of conversion was measured by the Buker FTIR Spectroscopy. Results: The results indicated that, Glacier composite resin has greater curing depth than that of SureFil composite resin. Glacier composite resin was cured above 6 mm thickness, while SureFil composite resin was cured above 5 mm. In general, the degree of conversion was different at the different thicknesses of the materials. SureFil composite resin showed highest degree of conversion at 3 mm followed by 2 mm thickness, while the lowest degree of conversion was noted at 6 mm thickness. Glacier composite resin has the highest degree of conversion at 3 mm followed by 2 mm thickness, while the lowest degree of conversion was noted at 6 mm thickness. SureFil showed positive correlation between the depth of cure and the degree of conversion. Glacier composite resin showed no significant correlation between the depth of cure and degree of conversion. Conclusions: The studied bulk-fill composite resins, cured up to 5mm to 6mm thicknesses. 2 and 3mm thicknesses adequately polymerized than 4 mm, 5 mm and 6 mm thicknesses. The degree of conversion of 2 mm and 3 mm thicknesses was greater than that of the other thicknesses. There was positive correlation between the degree of conversion and curing depth of SureFil composite resin. On the other hand, Glacier composite resin showed no significant correlation between the depth of cure and degree of conversion.

The Survival Of All Ceramic Crowns With A Zirconia Core (Lava™)

Background: Few studies have assessed the survival of restorations and particularly zirconia based crowns in the restoration of the severely worn dentition. This study aimed to determine survival and factors associated with failure in anterior teeth worn through to dentine restored with Lava™ crowns. Methods: A convenience sample of 30 participants (27 male, 3 female) had 161 Lava™ crowns placed by one specialist clinician in a hospital setting. Follow-up was over a median 72 month period. Results: Of the 161 Lava™ crowns only 25 failed (15.5%) in 15 individuals up to 84 months for the longest case. Major failures were total debond (N=7) or minor delamination chips within the veneer ceramic layer (N=18). The mean time to first failure was 25.23 months. The Kaplan Meier survival plot estimated the Mean Survival Time for the crowns to be 74 months (95%CI 70.4, 77.3). Failures by subject were not associated with an increase in Occlusal Vertical Dimension using a Dahl approach but were associated with an edge-to-edge incisal relation (p<0.05), attrition (p<0.05) and bruxism (p<0.005). Conclusion: The Kaplan Meier survival plot estimated the Mean Survival Time for the crowns to be 74 months. The high loads in bruxism result in increased risk of fracture or debond. Clinical relevance: A protective bi-laminar splint is thus advisable. Nonetheless, application of zirconia based crowns in a difficult clinical situation such as bruxism can be a successful treatment modality.

Accelerated Orthodontics: A Review

Nowadays, there is an increased tendency for researches to focus on accelerating methods for tooth movement due to the greater demand for adults for a shorter orthodontic treatment duration. Unfortunately, long orthodontic treatment time has many disadvantages like higher predisposition to caries, gingival recession, and root resorption. This increases the demand to increase tooth movement with the least possible disadvantages. Several modalities have been reported for accelerating the tooth movement. Thus, accelerating orthodontic tooth movement and the resulting shortening of the treatment time would be quite beneficial.