Strategies for removing a worn-out Bone Anchored Hearing Aid abutment screw

Abstract

First developed by Tjellström over 35 years ago, bone anchored hearing implants have been used effectively as a treatment for conductive or mixed hearing loss.¹ These devices have been implanted safely in adults and children with success rates of 90% or higher.² Nonetheless, bone anchored hearing implants present certain adverse effects most commonly related to soft tissue reaction, implant stability, failure to osseointegrate or due to trauma.

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Following Surgically Assisted Rapid Palatal Expansion, Do Tooth-Borne or Bone-Borne Appliances Provide More Skeletal Expansion and Dental Expansion?

Publication date: Available online 25 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adrien Hamedi-Sangsari, Zahra Chinipardaz, Lee Carrasco
PurposeThe aim of this study is to compare the outcome measures of skeletal and dental expansion with Bone-Borne (BB) versus Tooth-Borne (TB) appliances following SARPE. This study is being done to provide quantitative measurements that will help the oral surgeon and orthodontist in selecting the appliance with, on average, the greatest amount of skeletal expansion and the least amount of dental expansion.MethodsA computerized database search was performed using PubMed, EBSCO, Cochrane, Scopus, Web of Science, and Google Scholar on publications in reputable oral surgery and orthodontic journals. A systematic review and meta-analysis was then completed with the predictor variables of expansion appliance (TB versus BB) and outcome measure of expansion (in millimeters).ResultsA total of 487 articles were retrieved from the six databases. 5 articles were included, 4 with CBCT data and 1 with non-CBCT 3D cast data. There was a significant difference in the skeletal expansion (SMD = 0.92, 95% CI [0.54, 1.30], p = <0.001), in favor of BB appliances, when comparing BB and TB appliances. However, there was not a significant difference in the dental expansion (SMD = 0.05, 95% CI [-0.24, 0.34], p = 0.03).ConclusionThe literature points to the fact that in order to achieve more effective skeletal expansion and minimize dental expansion after SARPE, a Bone-Borne (BB) appliance should be favored.



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Preventive Effect of Phosphodiesterase Inhibitor Pentoxifylline against Medication-Related Osteonecrosis of the Jaw: An Animal Study

Publication date: Available online 26 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gül Merve Yalcin-Ulker, Alev Cumbul, Gonca Duygu-Capar, Ünal Uslu, Kemal Sencift
PurposeThe aim of this experimental study is to investigate the prophylactic effect of pentoxifylline (PTX) on medication- related osteonecrosis of the jaw (MRONJ).MethodsFemale Sprague-Dawley rats (n=33) received zoledronic acid (ZA) for 8 weeks to create osteonecrosis model. The left mandibular second molar teeth were extracted and the recovery period lasted 8 weeks before sacrification. PTX was intraperitoneally administered to prevent MRONJ. The specimens were histopathologically and histomorphometrically evaluated.ResultsHistomorphometrically, between control group and group ZA there was no statistically significant difference in total bone volume (p=0.999); but statistically significant difference in bone ratio in the extraction sockets (p<0.001). A comparison of the bone ratio of ZA group with ZA/PTX group (PTX administered after extraction) showed no statistically significant difference (p=0.69); but statistically significant difference with the ZA/PTX/PTX group (PTX administered before and after extraction) (p=0.008). Histopathologically, between control and ZA groups, there were statistically significant differences for inflammation (p=0.013), vascularization (p=0.022), hemorrhage (p=0.025) and regeneration (p=0.008). Between ZA and ZA/PTX groups, there were no statistically significant differences for inflammation (p=0.536), vascularization (p=0.642), hemorrhage (p=0.765) and regeneration (p=0.127). Between ZA and ZA/PTX/PTX groups, there were statistically significant difference for inflammation (p=0.017), vascularization (p=0.04), hemorrhage (p=0.044) and regeneration (p=0.04).ConclusionIn this experimental model for MRONJ, it might be concluded that although PTX, given after tooth extraction, improves new bone formation that positively affects bone healing, but it is not prophylactic. However, PTX, given before tooth extraction is prophylactic. In conclusion, PTX might affect healing in a positive way via optimizing inflammatory response.



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Comparison of Ozone and Photobiomodulation Therapies on Mental Nerve Injury in Rats

Publication date: Available online 26 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Türker Yücesoy, Nükhet Kütük, Dilek Günay Canpolat, Alper ALKAN
AimThis study compares photobiomodulation (PBM) and ozone therapy (OT) techniques on mental nerve injury by counting Schwann cell (SC) numbers, fasciculated nerve branches numbers and measuring the fascicule areas of the nerves.MethodsIn the present study, the effects of ozone and PBM therapies on mental nerve injury were evaluated. Mental nerves of 27 rats were partly suturated and allocated into three groups. Group 1 recevied no treatment, whereas OT and PBM therapies were administered in Group 2 and Group 3, respectively. Number of fascicules after nerve branching and Schwann cell counting before and after nerve injury have been evaluated histologically.ResultsA better healing pattern was observed in the treatment groups. The number of Schwann cells were significantly greater in OT and PBM groups then control groups.ConclusionsOral and maxillofacial surgeons must be familiar with the differential diagnosis, prevention, and management of neurosensory disturbances. This study provides insights into the management of neurosensory disturbances related to mental nerve injury by using OT and PBM. Our study clearly suggest that OT and PBM are promising novel methods in the treatment of mental nerve injury.



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Postural Preference and Musculoskeletal Complaints in Oral and Maxillofacial Surgeons

Publication date: Available online 26 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Corey A. Taylor, Robert A. Strauss, Alvin M. Best
PurposeOral and maxillofacial surgeons traditionally have suffered from musculoskeletal pain. The aim of this study is to determine the postural preferences of oral and maxillofacial surgeons and its effect on musculoskeletal pain.MethodsThe investigators designed and implemented a cross-sectional study. The association of demographic characteristics with postural preferences and use of loupes was first explored. Then, the relationship between demographic characteristics, postural preferences, and use of loupes with painful musculoskeletal complaints was analyzed. Contingency analysis was used to compare participant's responses and multiple logistic regression was used to identify the significant predictor variables.ResultsThe sample was composed of 153 oral and maxillofacial surgeons of which 32% indicated that they had ever had pain attributable to their practice which lasted more than two weeks. Practitioners reported neck and back pain as being most common. 84% of practitioners stood for both extractions and placement of implants. Those who stood did so for visibility. Practitioners who sat indicated they did so for orthopedic reason (p<0.001). 31% of practitioners indicated loupes use. Those who used loupes were more likely to report pain (P = 0.022).ConclusionThe majority of respondents stood and did not use loupes. Those who did use loupes were more likely to report pain. Those who stood did so for visibility; those who sat did so for orthopedic reasons. Almost a third of respondents reported pain lasting at least two weeks during practice.



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Periostitis ossificans arising in the mandibular bone of young patient: Report of an unusual case and review of the literature

Publication date: Available online 26 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Masakatsu Fukuda, Katsuyuki Inoue, Hideaki Sakashita
Periostitis ossificans is a specific type of chronic osteomyelitis, which forms new bone under the periosteum, resulting from a periosteal reaction to chronic inflammation or infections. Periostitis ossificans has conservatively been called Garrè's osteomyelitis before in our region. It commonly impacts the mandible of patients secondary to odontogenic infection. Therapeutic approach involves elimination of the infective origin and antibiotic administration. Here we report an unusual case of periostitis ossificans arising from the mandible of an 11-year-old male patient. The cause of infection was correlated with a lower right unerupted third molar, which had obviously no connection with the oral cavity. The histological diagnosis was chronic osteomyelitis with proliferative periostitis. The patient has been followed for 1 year, without any evidence of recurrences. Periostitis ossificans may be diagnostically problematic, and various conditions must be considered in the differential diagnosis.



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Autotransplantation of Third Molars with Platelet Rich Plasma for Immediate Replacement of Extracted Non-Restorable Teeth: A Case Series

Publication date: Available online 25 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jorge Gonzalez-Ocasio, Mark Stevens
PurposeThe aim of this study was to examine the use of platelet rich plasma (PRP) with autotransplantation of third molars as a successful technique to provide immediate tooth structure for space maintenance and masticatory function when premature loss of a permanent tooth occurs and other dental restorative options are not indicated.Materials and MethodsA case series of 10 young healthy individuals of 10 to 17 years of age with one or more immature third molars (one-third to two-thirds of root formation) used to replace extracted non-restorable teeth. Eleven third molars were transplanted, and adapted to sockets of the extracted teeth with the adjunct of PRP. The transplanted teeth were stabilized to the adjacent teeth using orthodontic wires and dental composite for one month. Patients were followed for a period of one year. Function, tooth vitality, root development, and periodontal health were recorded.ResultsAll ten patients had functioning asymptomatic transplanted teeth, with physiologic tooth mobility after splint removal at one month and over one year. All ten patients had positive tooth vitality (cold test) at three, six, and twelve months; all transplants showed positive root development (average growth of 2.01mm) confirmed and measured using periapical radiographs. No patients required root canal therapy (RCT) at any point in the study. Periodontal assessments were performed on the scheduled follow-up appointments with circumferential periodontal probings. Periodontal health was maintained as probings were less than four millimeters during a one-year period.ConclusionAutotransplantation of immature third molars with platelet rich plasma shows excellent results and should be considered a viable option for premature loss of permanent molars. PRP may also have other advantages, such as, promotion of root, and neurosensory development.



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