Background:
The three commonly employed sequences of distraction osteogenesis (DO) in the management of temporomandibular joint (TMJ) ankylosis with dentofacial deformities include post-arthroplastic distraction osteogenesis (PAD), simultaneous arthroplastic distraction osteogenesis (SAD), and pre-arthroplastic distraction osteogenesis (PrAD).
Objective:
The aim of this systematic review is to compare the effectiveness of various sequences of DO in the management of TMJ ankylosis with micrognathia/and obstructive sleep apnea syndrome (OSAS).
Data Sources:
A comprehensive online and manual search of English language literature with no date restrictions was done on March 2020.
Eligibility Criteria:
Inclusion criteria were case series and prospective and retrospective studies involving adult/paediatric human subjects with unilateral/bilateral TMJ ankylosis and micrognathia/OSAS treated with DO.
Study Appraisal and Synthesis Methods:
Of 73 studies identified, only 10 were included in the qualitative synthesis. The outcomes assessed were as follows: maximum mouth opening (MMO), posterior airway space (PAS), polysomnography variables, reankylosis, mandibular length, and chin and mandible position.
Results:
All the included studies showed high risk of bias. MMO and mandibular length increased, chin and mandibular position improved by the end of treatment in all the three sequences, and polysomnography variables and PAS significantly improved in PrAD compared to PAD and improved in SAD compared to baseline. Reankylosis was significantly less in PrAD.
Conclusion:
More well-designed studies comparing the three sequences of DO should be carried out to arrive at a consensus.
The most common reason for mandibular third molar impaction is due to reduced space between the distal part of the second mandibular molar and the anterior border of the ascending ramus of the lower jaw. The tooth that is impacted is commonly asymptomatic, or sometimes present with various pathological conditions causing pain and swelling as well as pus discharge. In our current study, we have assessed the patterns of Mandibular third molar impactions using the Orthopantomogram (OPG’s). OPG’s of 150 patients (91 female and 59 male) who were between 18-25 years of age and had impacted mandibular third molars was assessed for gender, the region having the highest frequency of impaction and the fashion of impaction of the mandibular third molars. The study shows Bilateral impaction was more commonly seen in 26.66% of the study population and case of unilateral impactions the most frequent site is particularly in left side 23.33% and in right 19.33% unilateral impactions. The mesioangular pattern of impaction was more common in both male and female and was followed by distoangular, vertical and horizontal patterns.The study showed that there was no gender bias in the presence of impacted mandibular third molars and that the mesioangular pattern of impaction was more common.
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