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Poster 209: Application of Alveolar Distraction Osteogenesis for Orthodontic Treatment of Severe Ankylosed Tooth
Scientific Poster Session mini plates. Inter maxillary fixation continued for a week after operation. Results: One year after operation, his occlusion is stable and sensory disturbance of lower lip is not recognized. Conclusion: We consider this method should be a candidate for patients with mandibular prognathism, who have normal occlusion in the molar region, although decompression of the neurovascular bundle is necessary to minimize damage to this structure. References Kallela I, Tulamo RM, Hietanen J, et al: Fixation of mandibular body osteotomies using biodegradable amorphous self-reinforced (70L: 30DL) polylactide or metal lag screws: an experimental study in sheep. J Cranio-Maxillofac Surg, 27:124-133 1999 Kikuta T, Miyako H and Fukuda J: Changes of front face after sagittal split ramus osteotomy and mandibular body ostectomy for mandibular asymmetric patients with ramus distortion. Int J Oral Maxillofac Surg 26, Supplement 1:141 1997 Susami T, Shigeta H, Itoh D, et al: The application and Problems of the mandibular body osteotomy. Jpn J Jaw Deform 2:8-18 1992
POSTER 207 Mandibular Angle Contour Surgery Jin-Gew Lee, DDS, PhD, Korea (Lee YO; Jung IW) Statement of the Problem: Angular prominence of the mandible is an esthetic problem for some Asian women. Reduction of a prominent angle of the mandible is often requested to improve body image. We approach the reduction of the angle of the mandible differently depending on the lower facial contours. A prominent mandibular genial angle is reduced by angle resection. Oscillating saws are used to reshape the prominent mandibular angle into a smooth and round curve at the angle. A curved rasp, in a reciprocating saw hand piece, is helpful for smoothing the irregular bony cut surface. A square face with wide mandibular angles is reduced by a capital ostectomy of the outer cortex of the mandibular angle and posterior body. A horizontal bony incision is made from the external oblique ridge to the posterior border of the mandible. Then a reciprocating saw is used to osteotomize the external cortex of the lower third of the ramus and the lower two thirds of the posterior body of the mandible. An additional reduction procedure is added in patients with masseteric hyperplasia. Condylar fracture, bleeding from the facial artery, asymmetry, hypoesthesia of the lower lip, and unnatural appearance are the possible complications associated with mandible reduction surgery. Experienced oral and maxillofacial surgeons with advanced knowledge of the anatomy, physiology and pathology with the appropriate surgical skills should be able to avoid these complications. 43.e116
References Kim CH, Lee JH, Cho JY, Kim KW: Skeletal stability after simultaneous mandibular angle resection and sagittal split ramus osteotomy for correction of mandible prognathism. J Oral Maxillofac Surg 65(2): 192-7, 2007 Satoh K: Mandibular contouring surgery by angular contouring combined with genioplasty in Orientals. Past Reconstr Surg 101:461, 1998
POSTER 208 Spectral Characteristics of Resonance Disorders in the Submucosal Type of Cleft Palate Patients Jong-Seok Lee, DDS, Korea (Kim YB; Baek JA; Shin HK) Statement of the Problem: The submucosal type of cleft palate is subdivision of cleft palate. Because this is usually detected late, the treatment (the operation or the speech therapy) for the submucosal type of cleft palate patients is usually administered late. In this study, we wanted to find the objective characteristics of the submucosal type of cleft palate patients, compared with the normal and the complete cleft palate patients. The experimental groups were 10 submucosal type of cleft palate patients who underwent operation in our hospital, 10 complete cleft palate patients and 10 normal patients as a control group. The sentence patterns used in this study were 5 simple vowels. Using a computerized speech lab program, we evaluated the formant, bandwidth etc. We analyzed the spectral characteristics of the speech signals of the 3 groups, before and after the operation. In most cases, the formant scores were higher in the experimental groups (complete cleft palate group and the submucosal type of cleft palate group) than the controls. There were small differences when speaking /a/, /i/ and /e/ between the experimental groups and the control groups, and there were large differences when speaking /o/ and /u/. After surgery, the formant scores were decreased in the experimental groups (the complete cleft palate and submucosal type of cleft palate groups). For the bandwidth scores, there were no differences between the experimental groups and the controls.
POSTER 209 Application of Alveolar Distraction Osteogenesis for Orthodontic Treatment of Severe Ankylosed Tooth Akiyoshi Nishiyama, DDS, Okayama University Hospital, Department of Oral and Maxillofacial Surgery and Biopathological Science, 2-5-1, Shikata-cho, Okayama, 700-8525, Japan (Kishimoto K; Domae S; Yoshida S; Sasaki A) AAOMS • 2007
Scientific Poster Session Statement of the Problem: Tooth ankylosis, that is caused by trauma or inflammation, leads to eruption disturbance and malposition of the tooth when it occurred during a process of jaw growth or tooth eruption. In such a case, it is so difficult to move the ankylosed tooth in orthodontic treatment that it may be easier to move the surrounding alveolar bone together with the tooth. In this presentation, we report a case of successful treatment for severe ankylosed tooth using alveolar distraction osteogenesis. Materials and Methods: An 11-year-old girl was referred to our hospital complaining of infraversion of her left maxillary central incisor. She has an experience of undertaking extraction of a mesiodens and receiving the orthodontic treatment of the submerged tooth. We diagnosed the cause of the unsuccessful treatment as tooth ankylosis and growth disturbance of the surrounding alveolar bone because of the traumatic injury at the time of the mesiodens extraction. We selected alveolar distraction osteogenesis for orthodontic treatment of the severe ankylosed tooth because we considered that the method was more reliable than that of tooth luxation or alveolar splitting. Method of Data Analysis: First, we started the leveling of the adjacent teeth to an original position. Then, the osteotomy of alveolar bone around the tooth was performed under general anesthesia, and the distraction device (TRACK 1.0mm. KLS Martin. Germany) was applied. After a latency period of 5 days, the distraction device was activated at a rate of 0.6 mm per day and totally 5.1 mm. Results: Although the tooth tipped to palatal side slightly, it was possible to guide into proper position by occlusion. After consolidation period of 4 months, the distraction device was removed under local anesthesia. The extended part showed satisfactory bone formation. Conclusion: This clinical case describes a promising and unique application of alveolar distraction osteogenesis for orthodontic treatment of severe ankylosed tooth. References Nocini PF, De Santis D, Ferrari F, et al.: A customized distraction device for alveolar ridge augmentation and alignment of ankylosed teeth. Kofod T, Wurtz V, Melsen B:Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop. 127:72, 2005
POSTER 210 Removal of an OKC at the Ramus of the Mandible via a Sagittal Splitting Technique Jin-Hyuk Yim, DDS, Korea (Yim JH; Ryu DM; Kim YG; Lee BS; Oh JH; Jee YJ; Kwon YD; Yu YJ) AAOMS • 2007
Statement of the Problem: Odontogenic keratocyst (OKC) is an epithelial developmental cyst, first described by Phillipsen in 1956. The frequency of OKC has been reported to vary from 3 to 11 percent of all odontogenic cysts. The most characteristic clinical feature of OKC is the high frequency of recurrence. The mechanism of recurrence is thought to be related to residues of cyst epithelium and the intrinsic growth potential following excision. Since the lining of the OKC is thin and friable, removal of the cyst in one piece may sometimes be difficult. Complete removal of the cyst lining without leaving behind remnants attached to the soft tissue or bone is necessary to avoid recurrence. Therapeutic approaches vary in different studies from marsupialization and enucleation, which may be combined with adjuvant therapy such as cryotherapy or Carnoy’s solution, to marginal or radical resection. The recurrence rate varies from approximately 20 to 62 percent. An OKC at the angle-ramus region of the mandible has a higher tendency to recur, because of the difficulty in accessing and removing the OKC from the ramus. However, good surgical access can be obtained by sagittal splitting of the mandible, using this approach the cyst can be removed completely. We present an illustrative case of a small, lobulated OKC that involved the ramus of the mandible, and review the contemporary literature.
POSTER 211 Utility of the Mandibular Channel Retractor With Wings for Mandibular Sagittal Split Ramus Osteotomy Hiroaki Yoshida, DDS, DMSc, Japan (Yoshida H; Sako J; Nakagawa A; Yamada K; Morita S) Statement of the Problem: Sagittal split ramus osteotomy of the mandibule (SSRO) is probably the most popular procedure currently used to correct mandibular deformities. The basic operative technique of osteotomy was originally introduced by Schuchardt, extended by Trauner and Obwegeser and further modified by Dal Pont, Hunsuck and Epker.1,2 It is proved to be a secure technique with stable results and very few serious complications. In SSRO, the insertion of the conventional channeled retractors is the most difficult procedure and sometimes causes excessive bleeding due to soft tissue injury.3 We evaluated the utility of the newly developed Mandibular Channel Retractor with Wings (produced by Formedic Corpration. Tokyo) for safe SSRO of the mandibule. Materials and Methods: In general, after the initial sagittal incision from the anterior ramus along the oblique line of the extra buccal to the first and second molar, the medial soft tissues of the ascending ramus 43.e117
POSTER 207 Mandibular Angle Contour Surgery Jin-Gew Lee, DDS, PhD, Korea (Lee YO; Jung IW) Statement of the Problem: Angular prominence of the mandible is an esthetic problem for some Asian women. Reduction of a prominent angle of the mandible is often requested to improve body image. We approach the reduction of the angle of the mandible differently depending on the lower facial contours. A prominent mandibular genial angle is reduced by angle resection. Oscillating saws are used to reshape the prominent mandibular angle into a smooth and round curve at the angle. A curved rasp, in a reciprocating saw hand piece, is helpful for smoothing the irregular bony cut surface. A square face with wide mandibular angles is reduced by a capital ostectomy of the outer cortex of the mandibular angle and posterior body. A horizontal bony incision is made from the external oblique ridge to the posterior border of the mandible. Then a reciprocating saw is used to osteotomize the external cortex of the lower third of the ramus and the lower two thirds of the posterior body of the mandible. An additional reduction procedure is added in patients with masseteric hyperplasia. Condylar fracture, bleeding from the facial artery, asymmetry, hypoesthesia of the lower lip, and unnatural appearance are the possible complications associated with mandible reduction surgery. Experienced oral and maxillofacial surgeons with advanced knowledge of the anatomy, physiology and pathology with the appropriate surgical skills should be able to avoid these complications. 43.e116
References Kim CH, Lee JH, Cho JY, Kim KW: Skeletal stability after simultaneous mandibular angle resection and sagittal split ramus osteotomy for correction of mandible prognathism. J Oral Maxillofac Surg 65(2): 192-7, 2007 Satoh K: Mandibular contouring surgery by angular contouring combined with genioplasty in Orientals. Past Reconstr Surg 101:461, 1998
POSTER 208 Spectral Characteristics of Resonance Disorders in the Submucosal Type of Cleft Palate Patients Jong-Seok Lee, DDS, Korea (Kim YB; Baek JA; Shin HK) Statement of the Problem: The submucosal type of cleft palate is subdivision of cleft palate. Because this is usually detected late, the treatment (the operation or the speech therapy) for the submucosal type of cleft palate patients is usually administered late. In this study, we wanted to find the objective characteristics of the submucosal type of cleft palate patients, compared with the normal and the complete cleft palate patients. The experimental groups were 10 submucosal type of cleft palate patients who underwent operation in our hospital, 10 complete cleft palate patients and 10 normal patients as a control group. The sentence patterns used in this study were 5 simple vowels. Using a computerized speech lab program, we evaluated the formant, bandwidth etc. We analyzed the spectral characteristics of the speech signals of the 3 groups, before and after the operation. In most cases, the formant scores were higher in the experimental groups (complete cleft palate group and the submucosal type of cleft palate group) than the controls. There were small differences when speaking /a/, /i/ and /e/ between the experimental groups and the control groups, and there were large differences when speaking /o/ and /u/. After surgery, the formant scores were decreased in the experimental groups (the complete cleft palate and submucosal type of cleft palate groups). For the bandwidth scores, there were no differences between the experimental groups and the controls.
POSTER 209 Application of Alveolar Distraction Osteogenesis for Orthodontic Treatment of Severe Ankylosed Tooth Akiyoshi Nishiyama, DDS, Okayama University Hospital, Department of Oral and Maxillofacial Surgery and Biopathological Science, 2-5-1, Shikata-cho, Okayama, 700-8525, Japan (Kishimoto K; Domae S; Yoshida S; Sasaki A) AAOMS • 2007
Scientific Poster Session Statement of the Problem: Tooth ankylosis, that is caused by trauma or inflammation, leads to eruption disturbance and malposition of the tooth when it occurred during a process of jaw growth or tooth eruption. In such a case, it is so difficult to move the ankylosed tooth in orthodontic treatment that it may be easier to move the surrounding alveolar bone together with the tooth. In this presentation, we report a case of successful treatment for severe ankylosed tooth using alveolar distraction osteogenesis. Materials and Methods: An 11-year-old girl was referred to our hospital complaining of infraversion of her left maxillary central incisor. She has an experience of undertaking extraction of a mesiodens and receiving the orthodontic treatment of the submerged tooth. We diagnosed the cause of the unsuccessful treatment as tooth ankylosis and growth disturbance of the surrounding alveolar bone because of the traumatic injury at the time of the mesiodens extraction. We selected alveolar distraction osteogenesis for orthodontic treatment of the severe ankylosed tooth because we considered that the method was more reliable than that of tooth luxation or alveolar splitting. Method of Data Analysis: First, we started the leveling of the adjacent teeth to an original position. Then, the osteotomy of alveolar bone around the tooth was performed under general anesthesia, and the distraction device (TRACK 1.0mm. KLS Martin. Germany) was applied. After a latency period of 5 days, the distraction device was activated at a rate of 0.6 mm per day and totally 5.1 mm. Results: Although the tooth tipped to palatal side slightly, it was possible to guide into proper position by occlusion. After consolidation period of 4 months, the distraction device was removed under local anesthesia. The extended part showed satisfactory bone formation. Conclusion: This clinical case describes a promising and unique application of alveolar distraction osteogenesis for orthodontic treatment of severe ankylosed tooth. References Nocini PF, De Santis D, Ferrari F, et al.: A customized distraction device for alveolar ridge augmentation and alignment of ankylosed teeth. Kofod T, Wurtz V, Melsen B:Treatment of an ankylosed central incisor by single tooth dento-osseous osteotomy and a simple distraction device. Am J Orthod Dentofacial Orthop. 127:72, 2005
POSTER 210 Removal of an OKC at the Ramus of the Mandible via a Sagittal Splitting Technique Jin-Hyuk Yim, DDS, Korea (Yim JH; Ryu DM; Kim YG; Lee BS; Oh JH; Jee YJ; Kwon YD; Yu YJ) AAOMS • 2007
Statement of the Problem: Odontogenic keratocyst (OKC) is an epithelial developmental cyst, first described by Phillipsen in 1956. The frequency of OKC has been reported to vary from 3 to 11 percent of all odontogenic cysts. The most characteristic clinical feature of OKC is the high frequency of recurrence. The mechanism of recurrence is thought to be related to residues of cyst epithelium and the intrinsic growth potential following excision. Since the lining of the OKC is thin and friable, removal of the cyst in one piece may sometimes be difficult. Complete removal of the cyst lining without leaving behind remnants attached to the soft tissue or bone is necessary to avoid recurrence. Therapeutic approaches vary in different studies from marsupialization and enucleation, which may be combined with adjuvant therapy such as cryotherapy or Carnoy’s solution, to marginal or radical resection. The recurrence rate varies from approximately 20 to 62 percent. An OKC at the angle-ramus region of the mandible has a higher tendency to recur, because of the difficulty in accessing and removing the OKC from the ramus. However, good surgical access can be obtained by sagittal splitting of the mandible, using this approach the cyst can be removed completely. We present an illustrative case of a small, lobulated OKC that involved the ramus of the mandible, and review the contemporary literature.
POSTER 211 Utility of the Mandibular Channel Retractor With Wings for Mandibular Sagittal Split Ramus Osteotomy Hiroaki Yoshida, DDS, DMSc, Japan (Yoshida H; Sako J; Nakagawa A; Yamada K; Morita S) Statement of the Problem: Sagittal split ramus osteotomy of the mandibule (SSRO) is probably the most popular procedure currently used to correct mandibular deformities. The basic operative technique of osteotomy was originally introduced by Schuchardt, extended by Trauner and Obwegeser and further modified by Dal Pont, Hunsuck and Epker.1,2 It is proved to be a secure technique with stable results and very few serious complications. In SSRO, the insertion of the conventional channeled retractors is the most difficult procedure and sometimes causes excessive bleeding due to soft tissue injury.3 We evaluated the utility of the newly developed Mandibular Channel Retractor with Wings (produced by Formedic Corpration. Tokyo) for safe SSRO of the mandibule. Materials and Methods: In general, after the initial sagittal incision from the anterior ramus along the oblique line of the extra buccal to the first and second molar, the medial soft tissues of the ascending ramus 43.e117