Objective: This study aimed to review the existing evidence regarding reconstruction of the alveolar cleft using recombinant human bone morphogenetic protein-2 (rhBMP-2) in terms of bone volume and bone height. Design: Systematic review and meta-analysis. Patients—Participants: A systematic search was done. Randomized and nonrandomized clinical trials, where rhBMP-2 was used in the reconstruction of human alveolar cleft were included. Interventions: Reconstruction of alveolar cleft with rhBMP-2. Main Outcome Measures: Average bone volume formation and average bone height formation in the alveolar cleft. Mean difference was calculated and pooled by meta-analysis. Results: Of 709 identified articles, 5 studies met the inclusion criteria. The average bone volume formation was higher in the rhBMP-2 group than in the control group (61.11% vs 59.12%). The average bone height formation was higher in the control group compared to the rhBMP-2 group (75.4% vs 61.5%). The risk of bias in the selected articles was high. The meta-analysis showed that rhBMP-2 treatment may benefit bone formation compared to iliac crest graft (low certainty evidence; mean difference: −208.76; 95% confidence interval: −253.59 to −163.93; −I2 = 0%). Conclusions: The results obtained in primary articles are promising but have a high risk of bias and have low quality of evidence; therefore, it is necessary to conduct controlled clinical trials with a greater number of patients to recommend the use of rhBMP-2 in the treatment of the alveolar cleft. PROSPERO registration number: CRD42018077741.
Background:Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery.Materials and Methods:A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña’s private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed.Results:Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14–58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later.Conclusions:The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.
The therapeutic algorithm proposed in the present work provides favorable functional and morphological results. Early and aggressive functional physiotherapy is essential to minimize the risk of reankylosis.
Contour augmentation and mandibular angle modification surgery is becoming increasingly. The aim of this research is to compare technique and outcomes in augmentations done with standard implants or PEEK-based patient specific implants (PSI) in mandibular angle. Data from surgical planning, operative and post-operative of 6 months follow-up were revised for 21 patients who were submitted to facial surgery using a stock implant obtained from companies currently on the market or 3D implants created with CAD/CAM technology using PEEK 3D printing. Surgical time, intra-operative and post-operative complications were compared, analyzing the advantages and disadvantage of each technique. Statistical analyses using t-test and chi-squared were performed considering P value< 0.05 for statistical differences. Twelve patients were operated on with stock implants and nine patients with PSI. The surgical time was 15 minutes less for the 3D implant surgeries (P = 0.021) and intraoperatively only the stock implants needed modifications with wear and adaptation methods; post-operative infections were observed in both groups with no significant differences (P > 0.05). The 3D implants had greater levels of facial symmetry than the stock implants, although they did not present significant differences.Considering the limitations of this study, mandibular angle implants with a PEEK-based 3D CAD/CAM are efficient, stable and have a low complication rate; the CAD/CAM strategy is useful in facial surgery and can be integrated as a standard for surgical planning in facial makeover surgery.
Summary:Craniofacial microsomia is a broad term that covers a variety of craniofacial malformation conditions that are caused by alterations in the derivatives of the first and second pharyngeal arches. In general terms, diverse therapeutic alternatives are proposed according to the growth stage and the severity of the alteration. When craniofacial growth has concluded, conventional orthognathic surgery (Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty) provides good alternatives for MI and MIIA type cases. Reconstruction of the mandibular ramus and temporomandibular joint before orthognathic surgery is the indicated treatment for cases MIIB and MIII. The goal of this article is to establish a surgical treatment algorithm for orthognathic surgery on patients with craniofacial microsomia, analyzing the points that allow the ideal treatment for each patient to be chosen.
The aim of this study was to characterize a commercial beta tricalcium phosphate (β-TCP) block allograft for use in maxillofacial reconstruction, evaluating its homogeneity, porosity and mineralization. Two commercial 5 x 5 x10 mm chronOS Vivify β-TCP blocks were used, which were evaluated by a STEM SU-3500 variable pressure scanning electron microscope (SEM-STEM) (Hitachi, Japan). For the semi-quantitative microanalysis of elements, the QUANTAX 100 energy dispersive x-ray spectrometer detector (EDX) (Bruker, Germany) was used. The homogeneity of the structural morphology, macropore and micropore size and component homogeneity were evaluated. The microscopic analysis showed micropores of 164.92 mm (± 35.032 mm) in diameter in the outer area and micropores in the inner area of 54.44 mm (± 17.676 mm). The formation of porosities and irregularities present in the block was heterogeneous between the outer and inner surfaces. The mineral content of the blocks presented homogeneity with the presence of carbon (2.02 %), oxygen (44.33 %), phosphate (16.62 %) and calcium (37.87 %). The β-TCP block can be used in bone reconstruction but the presence of reduced macropore and micropore sizes could limit efficiency in the substitution and bone regeneration phase. ALISTER, J. P.; URIBE, F.; VÁSQUEZ, B.; FARIÑA, R. & OLATE, S. Characterization of bone substitute β-TCP block for maxillofacial reconstruction. Int. J. Morphol., 37(1):82-86, 2019.
RESUMEN:La asimetría facial es una patología de compromiso funcional y estético que puede estar generado por hiperplasia condilar; el objetivo de esta investigación es determinar la influencia del tamaño condilar en la asimetría facial. Doce sujetos fueron estudiados mediante el análisis de tomografía computadorizada cone beam; todos los pacientes presentaron cintigrama óseo que determino la presencia de hiperplasia condilar activa; el análisis se realizo en un software del sistema de captura modelo Pax Zenith, marca Vatech (Korea 2011), utilizando 90 kV y 120 mA; se obtuvo mediciones de la distancia antero-posterior, superior-inferior y medio-lateral de la cabeza del cóndilo, relacionándose con la posición del cóndilo con la línea mediana facial y la posición de puntos faciales entre incisivos centrales superior e inferior así como con el mentón. Los resultados mostraron un promedio de desvío de mentón de 6,5 mm considerando un cóndilo hiperplásico con un tamaño de 2,7 mm mas que los cóndilos normales. El desvío de incisivo central inferior determinó que por cada 1 mm de desvío dentario existe 2,2 mm de desvío de mentón. El cóndilo hiperplásico fue de mayor tamaño y se posiciono casi 2 mm mas hacia lateral que los cóndilos no hiperplásicos. Es posible concluir que el cóndilo hiperplásico presenta clara influencia en la asimetría facial transversa y es posible estimar una relación de tamaño condilar con grado de asimetría facial. PALABRA CLAVE: Asimetría facial, Hiperplasia codilar, Deformidad facial INTRODUCCIÓNLa asimetría facial es una patología de origen variado y responde a diferentes condiciones como trauma, infecciones, malformaciones o deformidades (Pirttiniemi, 1994). Buena parte de las asimetrías faciales se vinculan a la patología condilar de crecimiento excesivo o a la reabsorción unilateral de un cóndilo mandibular lo que genera la disminución de la altura facial posterior unilateral, desvío de mentón y la consecuente asimetría facial (Nitzan et al., 2008 ).La hiperplasia condilar (HC) es causante de al menos el 50% de las asimetrías faciales (Saridin et al., 2009) de forma que su estudio es necesario para identificar elementos causantes de la asimetría mandibular y posteriormente la asimetría facial. La HC tiene una fisiopatología controversial y aun no existen datos concluyentes respecto de su evolución (Olate & de Moraes, 2012); aún así, se estima que es mas prevalente en mujeres de entre 15 y 24 años de edad (Raijmakers et al., 2012) aunque cualquier individuo puede ser comprometido en la enfermedad y a cualquier edad (Nitzan et al .).Existen limitados estudios morfológicos que relacionan las características morfológicas de cóndilos con HC activa y las características faciales; es claro que la asimetría resultante se relaciona con la gravedad de la HC (Obwegeser & Makek, 1986) pero aun no existen datos cuantificados al respecto. La clasificación de la morfología facial asociada a HC de Obwegeser & Makek ha sido utilizada consistentemente para identificar características de la enfermedad y se ha...
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