- Email: [email protected]
Use of the Ultrasound-activated Pinned (SonicWeld Rx®) Resorbable Anchor as an Alternative to the Mitek Mini Anchor in Temporomandibular Joint Disc-repositioning Surgery: Report of a Technique and Preliminary Findings
OOOOE Volume 106, Number 4 Material and Methods: A survey constructed from five definitions of centric relation (CR) as provided from the glossary of prosthodontic terms was sent to the chairmen of every oral and maxillofacial surgery and orthodontic program in the U.S. Only full time faculty from each program were asked to respond to the survey. The different responses were analyzed statistically by chi square analysis. Results: Seventy-three responses were obtained from the oral and maxillofacial surgeons and 64 from the orthodontists. There were 69 different programs represented in this survey. Orthodontists and surgeons had a significantly different response regarding the definition of centric relation (chi-square⫽ 28, df⫽ 4, p-value⬍ 0.0001). There was no difference between the two groups on the need for mounting models in centric relation for use in orthognathic surgery (chi-square⫽ 1, p-value⬎ 0.6). Regarding the definition of centric occlusion, there was a significant difference between orthodontists and surgeons (chi-square⫽ 9.9, df⫽ 1, p-value⫽ 0.0070). The fourth and fifth questions had to do with CR/CO slide and the direction of movement. There was a significant difference between the two groups regarding mandibular movement (chisquare⫽ 28, df⫽ 2, p-value⬍ 0.0001). Surgeons were nearly unanimous in their opinion that the mandible would move anteriorly (88%), whereas there was more discordance among orthodontists. Within the orthodontic group, 50% indicated anterior movement and 47% indicated that either an anterior or posterior movement could occur. The surgeons were asked one additional question which the orthodontists were not. Forty-nine percent of the surgeons indicated that during a BSSO the proximal segment should be seated vertically and posteriorly prior to rigid fixation. Conclusion: The results of this study show there is a statistical lack of consistency amongst practitioners regarding an absolute definition of centric relation as it relates to orthognathic surgery. The inconsistency exists between specialties and within practitioners in each specialty.
USE OF THE ULTRASOUND-ACTIVATED PINNED (SONICWELD RX®) RESORBABLE ANCHOR AS AN ALTERNATIVE TO THE MITEK MINI ANCHOR IN TEMPOROMANDIBULAR JOINT DISC-REPOSITIONING SURGERY: REPORT OF A TECHNIQUE AND PRELIMINARY FINDINGS Authors: James Andrew Wendelken, DDS and Steven M. Sullivan, DDS Presented by: James Andrew Wendelken Purpose: This study examines the clinical and subjective outcomes of patients after placement of resorbable SonicWeld Rx® (KLS Martin, Tuttlingen, Germany) anchors into the posterior aspect of the mandibular condyle to reposition the temporomandibular joint disc. Materials and Methods: Forty-four patients (36 female / 8 male) who presented with internal temporomandibular joint derangements including either anterior disc displacement with reduction or anterior disc displacement without reduction of unilateral or bilateral joints underwent surgery, each meeting the AAOMS ParPath indications for this type of surgery. Patients were taken to surgery during which SonicWeld Rx® anchors with a 3-0 braided polyester suture (Ethilon [Ethicon Inc., Piscataway, NJ]) were welded into small osteotomies created in the posterior condyle either unilaterally or bilaterally using the associated ultrasound-activated wand. These anchors, made of poly (D,L-lactide) acid (PDLLA), were used to fixate the discs inti-
Abstracts 507 mately with the head of the condyle using the Ethilon suture in a vertical mattress fashion. PDLLA is an amorphous polymer that retains its mechanical properties over 10 weeks then absorbs until 72 weeks post-implantation. In contrast, the Mitek mini anchor (Mitek Inc., Norwood, MA) is non-resorbable. Each patient was followed closely after surgery and asked to present subjective findings. Post-operative evaluations were completed by all patients in whom their overall experience including changes in facial pain and headaches, pain within the temporomandibular joint, and improvements in jaw functioning, diet, and/or disability were evaluated. Results: Only two out of 44 patients (5%) had a secondary procedure performed (one a Hyalgan® [sodium hyaluronate; Sanofi Aventis, Bridgewater, NJ] injection and the other bilateral intraoral vertical mandibular ramus osteotomies) due to recurrent disc displacement. Forty-two out of 44 (95%) patients reported subjective findings that were positive, displaying overall decreased facial, headache, and temporomandibular joint pain, absence of joint noise as well as improvements in jaw function and diet. Of the 44 patients in the study, there were 81 joints total in which SonicWeld Rx® anchors were placed. Conclusion: Surgical placement of SonicWeld Rx® anchors is an effective alternative for disc-repositioning in patients with temporomandibular internal joint derangements and overall patient satisfaction was high. This method of disc stabilization, when compared to Mitek anchor disc stabilization, had similar post-operative outcomes. This study is the first known study for use of SonicWeld Rx® anchors in this capacity and is preliminary in nature due to the time that these anchors have been available for use.
5 YEAR RETROSPECTIVE EVALUATION OF HELMETED VS. NON HELMETED MOTORCYCLE CRASHES AND FACIAL INJURIES SUSTAINED AT A LEVEL 1 TRAUMA CENTER Authors: B. Evans DMD, S. Kaltman DMD, MD, M.W. Parra MD, I. Puente MD, P. Taber Presented by: Brock Evans DMD Objective: On July 1, 2000 Florida became the 30th state to amend its mandatory helmet law. Much attention has been focused on the effects on death rates and head trauma since this helmet law change. Although head trauma remains the number one reason for motorcycle crash related deaths, the survivors of motorcycle crashes also suffer from multiple other injuries to the head and neck region requiring increased hospital care and costs. The purpose for this review of trauma data is to compare helmeted motorcyclists vs. non helmeted motorcyclists involved in crashes and compare the number and types facial and head injuries involved between the two groups. Methods: A retrospective analysis was performed from the trauma data registry at Broward General Medical Center in Ft. Lauderdale, Florida from dates June 2000 to December 2005. The data compares helmeted vs. non helmeted motorcyclists involved in crashes and the facial and head injuries sustained. No IRB approval was required to obtain trauma data for review and correlation. Results: 631 patients were involved in motorcycle crashes between the dates June 2000 to December 2005 and were taken to BGMC. 336 patients were helmeted (H), while 295 where non helmeted (NH). The average age for H group was 30.74 while NH group was 37.5; the age range for patients was from 4.5-74.7 years
USE OF THE ULTRASOUND-ACTIVATED PINNED (SONICWELD RX®) RESORBABLE ANCHOR AS AN ALTERNATIVE TO THE MITEK MINI ANCHOR IN TEMPOROMANDIBULAR JOINT DISC-REPOSITIONING SURGERY: REPORT OF A TECHNIQUE AND PRELIMINARY FINDINGS Authors: James Andrew Wendelken, DDS and Steven M. Sullivan, DDS Presented by: James Andrew Wendelken Purpose: This study examines the clinical and subjective outcomes of patients after placement of resorbable SonicWeld Rx® (KLS Martin, Tuttlingen, Germany) anchors into the posterior aspect of the mandibular condyle to reposition the temporomandibular joint disc. Materials and Methods: Forty-four patients (36 female / 8 male) who presented with internal temporomandibular joint derangements including either anterior disc displacement with reduction or anterior disc displacement without reduction of unilateral or bilateral joints underwent surgery, each meeting the AAOMS ParPath indications for this type of surgery. Patients were taken to surgery during which SonicWeld Rx® anchors with a 3-0 braided polyester suture (Ethilon [Ethicon Inc., Piscataway, NJ]) were welded into small osteotomies created in the posterior condyle either unilaterally or bilaterally using the associated ultrasound-activated wand. These anchors, made of poly (D,L-lactide) acid (PDLLA), were used to fixate the discs inti-
Abstracts 507 mately with the head of the condyle using the Ethilon suture in a vertical mattress fashion. PDLLA is an amorphous polymer that retains its mechanical properties over 10 weeks then absorbs until 72 weeks post-implantation. In contrast, the Mitek mini anchor (Mitek Inc., Norwood, MA) is non-resorbable. Each patient was followed closely after surgery and asked to present subjective findings. Post-operative evaluations were completed by all patients in whom their overall experience including changes in facial pain and headaches, pain within the temporomandibular joint, and improvements in jaw functioning, diet, and/or disability were evaluated. Results: Only two out of 44 patients (5%) had a secondary procedure performed (one a Hyalgan® [sodium hyaluronate; Sanofi Aventis, Bridgewater, NJ] injection and the other bilateral intraoral vertical mandibular ramus osteotomies) due to recurrent disc displacement. Forty-two out of 44 (95%) patients reported subjective findings that were positive, displaying overall decreased facial, headache, and temporomandibular joint pain, absence of joint noise as well as improvements in jaw function and diet. Of the 44 patients in the study, there were 81 joints total in which SonicWeld Rx® anchors were placed. Conclusion: Surgical placement of SonicWeld Rx® anchors is an effective alternative for disc-repositioning in patients with temporomandibular internal joint derangements and overall patient satisfaction was high. This method of disc stabilization, when compared to Mitek anchor disc stabilization, had similar post-operative outcomes. This study is the first known study for use of SonicWeld Rx® anchors in this capacity and is preliminary in nature due to the time that these anchors have been available for use.
5 YEAR RETROSPECTIVE EVALUATION OF HELMETED VS. NON HELMETED MOTORCYCLE CRASHES AND FACIAL INJURIES SUSTAINED AT A LEVEL 1 TRAUMA CENTER Authors: B. Evans DMD, S. Kaltman DMD, MD, M.W. Parra MD, I. Puente MD, P. Taber Presented by: Brock Evans DMD Objective: On July 1, 2000 Florida became the 30th state to amend its mandatory helmet law. Much attention has been focused on the effects on death rates and head trauma since this helmet law change. Although head trauma remains the number one reason for motorcycle crash related deaths, the survivors of motorcycle crashes also suffer from multiple other injuries to the head and neck region requiring increased hospital care and costs. The purpose for this review of trauma data is to compare helmeted motorcyclists vs. non helmeted motorcyclists involved in crashes and compare the number and types facial and head injuries involved between the two groups. Methods: A retrospective analysis was performed from the trauma data registry at Broward General Medical Center in Ft. Lauderdale, Florida from dates June 2000 to December 2005. The data compares helmeted vs. non helmeted motorcyclists involved in crashes and the facial and head injuries sustained. No IRB approval was required to obtain trauma data for review and correlation. Results: 631 patients were involved in motorcycle crashes between the dates June 2000 to December 2005 and were taken to BGMC. 336 patients were helmeted (H), while 295 where non helmeted (NH). The average age for H group was 30.74 while NH group was 37.5; the age range for patients was from 4.5-74.7 years