Publications by authors named "Vitomir S Konstantinović"

24 Publications

  • Page 1 of 1

Surgical Management of Mandibular Angle Fractures: Does the Extraction of the Third Molar Lead to a Change in the Fixation Pattern? A European Multicenter Survey.

J Oral Maxillofac Surg 2021 02 17;79(2):404-411. Epub 2020 Sep 17.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria.

Purpose: The authors conducted a retrospective, multicenter study to investigate the differences in the fixation patterns, in terms of number and thickness of plates, between patients in whom a third molar (3M) was maintained or removed in the line of mandibular angle fractures.

Materials And Methods: The study was conducted in 6 European level I and II maxillofacial trauma centers. Data were collected on patients ≥ 16 years of age who underwent open reduction internal fixation (ORIF) for mandibular angle fractures (MAF) from 2008 to 2018, in whom a 3M in the fracture line was present and who had a follow-up duration of 6 months. The study population was divided into 2 groups: patients treated with ORIF in whom the 3M was maintained (group 1) and those treated with ORIF in whom the 3M was extracted (group 2) during treatment. The 2 groups were compared for differences in the internal fixation pattern, specifically in terms of the number and thickness of the plates.

Results: A total of 749 patients with 774 MAF were collected. A total of 1,050 plates were placed: 849 were ≤ 1.4 mm thick (80.9%) and 201 plates ≥ 1.5 mm thick (19.1%). 548 patients were treated with ORIF and 3M maintained (group 1), and 201 treated with ORIF and 3M extracted (group 2). Statistically significant differences were seen in the number of ≤1.4 mm plates between the 2 groups for single undisplaced/displaced MAF(P value ≤ 0.5) and for undisplaced/displaced angle + parasymphysis/body fractures (P-value ≤ 0.5).

Conclusions: Analyses of data collected from 6 European maxillofacial centers indicated that the majority of surgeons of our sample perceived the MAF as being more unstable when removing the 3M during ORIF leading them to perform a rigid fixation in the angular region.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2020.09.022DOI Listing
February 2021

Management of maxillofacial trauma in the elderly: A European multicenter study.

Dent Traumatol 2020 Jun 9;36(3):241-246. Epub 2020 Jan 9.

Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia.

Background/aims: Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017.

Results: A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association (P < .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age (P < .000005).

Conclusions: Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/edt.12536DOI Listing
June 2020

Surgical management of unilateral body fractures of the edentulous atrophic mandible.

Oral Maxillofac Surg 2020 Mar 17;24(1):65-71. Epub 2019 Dec 17.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

Introduction: Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery.

Methods: This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications.

Results: A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases.

Conclusions: Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10006-019-00824-8DOI Listing
March 2020

The epidemiology of edentulous atrophic mandibular fractures in Europe.

J Craniomaxillofac Surg 2019 Dec 29;47(12):1929-1934. Epub 2019 Nov 29.

Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.

Introduction: The objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented.

Methods: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay.

Results: A total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study population was 75 years. Statistically significant associations were found between Luhr classes I - II and condylar fractures on one hand (p < .0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p < .05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries.

Conclusions: The management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2019.11.021DOI Listing
December 2019

Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Sep 13;128(3):199-204. Epub 2018 Dec 13.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objectives: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures.

Study Design: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1.

Results: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures.

Conclusions: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oooo.2018.12.009DOI Listing
September 2019

The "European Mandibular Angle" research project: the analysis of complications after unilateral angle fractures.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Jul 28;128(1):14-17. Epub 2019 Feb 28.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objective: The aim of this study was to analyze the complications and outcomes of surgical treatment of angle fractures managed at departments of maxillofacial surgery in several European countries.

Study Design: Patients hospitalized with unilateral isolated angle fractures between 2013 and 2017 were included. The following data were recorded: gender and age of patients, fracture etiology, presence of the third molar, maxillomandibular fixation, osteosynthesis technique, and complications.

Results: In total, 489 patients were included in the study. The Champy technique was found to be the most frequently chosen osteosynthesis technique. Sixty complications were observed, at a rate of 12.3%. Complications were associated with the absence of third molars (P < .05). Instead, the Champy technique was associated with fewer complications (P < .05), in comparison with the other adopted techniques.

Conclusions: The management of angle fractures still represents a challenging task with a significant complication rate. The Champy technique still seems to be a valid option for the treatment of such injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oooo.2019.02.027DOI Listing
July 2019

The "European zygomatic fracture" research project: The epidemiological results from a multicenter European collaboration.

J Craniomaxillofac Surg 2019 Apr 30;47(4):616-621. Epub 2019 Jan 30.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

Purpose: Fractures of the zygomaticomaxillary complex (ZMC) are common injuries that may lead to loss of an aesthetically pleasing appearance and functional impairment. The aim of this study was to analyze the demographics, causes, characteristics, and outcomes of zygomatic fractures managed at several European departments of oral and maxillofacial surgery.

Materials And Methods: This study is based on a multicenter systematic database that allowed the recording of all patients with ZMC fractures between 1 January 2013 and 31 December 2017. The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications.

Results: A total of 1406 patients (1172 males, 234 females) were included in the study. Statistically significant correlations were found between assault-related ZMC fractures and the A3 class (p < .0000005) and between Infraorbital Nerve (ION) anesthesia and B class (p < .00000005).

Conclusion: The most frequent cause of ZMC fractures was assault, followed by falls. The most frequently involved decade of age was between 20 and 29 years. The decision and type of surgical treatment of ZMC fractures depends on several issues that need to be considered on a case by case basis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2019.01.026DOI Listing
April 2019

The "European Mandibular Angle" Research Project: The Epidemiologic Results From a Multicenter European Collaboration.

J Oral Maxillofac Surg 2019 Apr 27;77(4):791.e1-791.e7. Epub 2018 Dec 27.

Full Professor, Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

Purpose: The aim of this study was to analyze the demographic variables and causes and characteristics of mandibular angle fractures managed at several European departments of maxillofacial surgery.

Materials And Methods: This study was based on a multicenter systematic database that allowed the recording of data from all patients with mandibular angle fractures between January 1, 2013, and December 31, 2017. The following data were recorded: gender, age, etiology, side of angle fracture, associated mandibular fractures, presence of third molar, intermaxillary fixation, and osteosynthesis.

Results: The study included 1,162 patients (1,045 male and 117 female patients). A significant association was found between the presence of a third molar and the diagnosis of an isolated angle fracture (P < .0000005). Furthermore, assaults were associated with the presence of voluptuary habits (P < .00005), a younger mean age (P < .00000005), male gender (P < .00000005), and left-sided angle fractures (P < .00000005).

Conclusions: Assaults and falls actually represent the most frequent causes of angle fractures. The presence of a third molar may let the force completely disperse during the determination of the angle fracture, finding a point of weakness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2018.12.013DOI Listing
April 2019

Assessment of Stability of Craniofacial Implants by Resonant Frequency Analysis.

J Craniofac Surg 2016 Mar;27(2):e185-9

*School of Dentistry, Clinic for Maxillofacial Surgery †School of Dentistry, Clinic for Prosthodontics, University of Belgrade, Belgrade, Serbia ‡Private Dental Practice, Montenegro.

Implant stability is a principal precondition for the success of implant therapy. Extraoral implants (EO) are mainly used for anchoring of maxillofacial epithesis. However, assessment of implant stability is mostly based on principles derived from oral implants. The aim of this study was to investigate clinical stability of EO craniofacial disk implants (single, double, and triple) by resonance frequency analysis at different stages of the bone's healing. Twenty patients with orbital (11), nasal (5), and auricular (4) defects with 50 EO implants placed for epithesis anchorage were included. Implant stability was measured 3 times; after implant placement, at 3 months and at least after 6 months. A significant increase in implant stability values was noted between all of the measurements, except for triple-disk implants between third and sixth months, and screw implants between 0 and third months. Disk implants showed lower implant stability quotient (ISQ) values compared with screw implants. Triple-disk implants showed better stability compared with single and double-disk implants. Based on resonance frequency analysis values, disk implants could be safely loaded when their ISQ values are 38 (single disks), 47 (double disks), and 48 (triple disks). According to resonance frequency analysis, disk implant stability increased over time, which showed good osseointegration and increasing mineralization. Although EO screw implants showed higher ISQ values than disk implants, disk-type implants can be safely loaded even if lower values of stability are measured.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000002443DOI Listing
March 2016

High frequency of p16 and p14 promoter hypermethylation and marked telomere instability in salivary gland tumors.

Arch Oral Biol 2015 Nov 22;60(11):1662-6. Epub 2015 Aug 22.

Institute of Human Genetics, School of Dental Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia. Electronic address:

Objectives: to investigate p16(INK4a) and p14(ARF) tumor suppressor gene methylation status, determine telomere length and assess the importance of these epigenetic and genetic parameters in the development of pleomorphic adenoma and carcinoma ex pleomorphic adenoma of the parotid salivary glands.

Materials And Methods: Genomic DNA from paraffin-embedded samples of 50 pleomorphic adenomas and 10 carcinomas ex pleomorphic adenoma was subjected to methylation specific polymerase chain reaction for hypermethylation analyses and real time polymerase chain reaction for the relative telomere length calculations.

Results: Promoter hypermethylation of the two genes was a very frequent event in both neoplasms - between 60% and 90% of samples were hypermethylated - but without significant difference between the groups. The mean relative telomere length in the pleomorphic adenoma group was significantly increased in comparison to the control group (P=0.00), and significantly decreased in comparison to the carcinoma group (P=0.05). Telomeres were also longer in myxoid and cellular histological subtypes of adenomas than in the classic type (P=0.044 and P=0.018, respectively). Longer telomeres were more frequent in tumors with hypermethylated p14(ARF) alleles (P=0.013).

Conclusion: Promoter hypermethylations seems to be an important mechanism of p16(INK4a) and p14(ARF) inactivation in parotid gland tumors. Telomeric lengthening appears to be involved in the pathogenesis of both benign and malignant tumors of the parotid glands.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.archoralbio.2015.08.011DOI Listing
November 2015

Application of Computer-Aided Designing and Rapid Prototyping Technologies in Reconstruction of Blowout Fractures of the Orbital Floor.

J Craniofac Surg 2015 Jul;26(5):1558-63

*Faculty of Medicine, Department of Dentistry, Clinic of Maxillofacial Surgery, University of Priština, Priština †School of Dentistry, Clinic of Maxillofacial Surgery, University of Belgrade, Belgrade ‡Faculty of Technical Sciences, University of Novi Sad, Novi Sad, Serbia.

Introduction: Traumatology of the maxillofacial region represents a wide range of different types of facial skeletal injuries and encompasses numerous treatment methods. Application of computer-aided design (CAD) in combination with rapid prototyping (RP) technologies and three-dimensional computed tomography techniques facilitates surgical therapy planning for efficient treatment.

Objective: The purpose of this study is to determine the efficiency of individually designed implants of poly-DL-lactide (PDLLA) in the reconstruction of blowout fractures of the orbital floor.

Methods: In the course of a surgical treatment, individually designed implants manufactured by CAD/RP technologies were used. Preoperative analysis and postoperative monitoring were conducted to evaluate the successfulness of orbital floor reconstruction using customized PDLLA implants, based on: presence of diplopia, paresthesia of infraorbital nerve, and presence of enophthalmos.

Results: In 6 of the 10 patients, diplopia completely disappeared immediately after surgical procedure. Diplopia gradually disappeared after 1 month in 3 patients, whereas in 1, it remained even after 6 months. In 7 patients, paresthesia disappeared within a month after surgery and in 3 patients within 2 months. Postoperative average Orbital volume (OV) of the injured side (13.333 ± 3.177) was significantly reduced in comparison with preoperative OV (15.847 ± 3.361) after reconstruction of the orbital floor with customized PDLLA implant (P < 0.001). Thus, average OV of corrected orbit was not different compared with the OV of the uninjured orbit (P = 0.981).

Conclusions: Reconstruction of blowout fractures of the orbital floor by an individually designed PDLLA implant combined with virtual preoperative modeling allows easier preoperative preparation and yields satisfactory functional and esthetic outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000001883DOI Listing
July 2015

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 May 24;119(5):499-504. Epub 2014 Dec 24.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year.

Study Design: The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years.

Results: The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures.

Conclusions: Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oooo.2014.12.012DOI Listing
May 2015

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 Apr 11;119(4):385-91. Epub 2014 Dec 11.

Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia.

Objective: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study.

Study Design: Demographic and injury data were recorded for each patient who was a victim of an assault.

Results: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures.

Conclusions: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oooo.2014.12.004DOI Listing
April 2015

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study.

J Craniomaxillofac Surg 2015 Jan 22;43(1):62-70. Epub 2014 Oct 22.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2014.10.011DOI Listing
January 2015

Possibilities of reconstruction and implant-prosthetic rehabilitation following mandible resection.

Vojnosanit Pregl 2013 Jan;70(1):80-5

Clinic of Maxillofacial Surgery, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia.

Introduction: Mandible reconstruction is still very challenging for surgeons. Mandible defects could be the consequence of ablative surgery for malignancies, huge jaw cysts, infection and trauma. Segmental resection of the mandible may compromise orofacial function and often lead to patients psychological disorders. Despite very frequent use of microvascular flaps, autogenous bone grafts are still very reliable technique for mandible reconstruction. Comprehensive therapy means not only mandible reconstruction, but prosthodontic rehabilitation supported by dental implants, which can significantly improve patients quality of life. The aim of this paper was to evaluate possible techniques of mandible reconstruction and to present a patient who had been submitted to mandible resection and reconstruction with autogenous iliac bone graft and prosthodontic rehabilitation with fixed denture anchoraged by disc-shaped implants in early loading protocol.

Case Report: Mandible reconstruction was performed simultaneously with resection. Autogenous iliac bone graft was taken, reshaped and placed in two parts, to the required optimal contour of the mandible. After graft consolidation, decision was made for prosthodontics rehabilitation with fixed dentures supported by implants. In addition to the standard preoperative procedures, planning was done based on a biomodel gained by rapid prototyping after CT scan. It offered a real 3D planning to obtain a proper shape, dimension and the position of implants.

Conclusion: If bone dimensions of a reconstructed mandible are insufficient, like in the presented case, the use of basal osseointegrated implants may be a method of choice. Avoiding bone augmentation procedures, as well as early loading protocol for this type of implants, shorten the total rehabilitation time, which is very convenient for patients. Fixed denture supported by dental implants is the best solution for comprehensive rehabilitation after mandible resection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/vsp1301080kDOI Listing
January 2013

Endoscope-assisted transoral reduction and internal fixation versus closed treatment of mandibular condylar process fractures--a prospective double-center study.

J Oral Maxillofac Surg 2012 Feb 12;70(2):384-95. Epub 2011 Jun 12.

Department for Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.

Purpose: The aim of this international AO-study was to compare the functional outcome after open versus closed treatment of mandibular condylar neck fractures.

Patients And Methods: A prospective comparative study with two follow-ups (FU) at 8-12 weeks and 1 year was undertaken in two clinics, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from clinic 1 (ENDO group) received endoscope-assisted transoral open reduction and internal fixation, whereas patients from clinic 2 (CONS group) were treated conservatively without surgery. Patients with unilateral condylar neck fractures showing one or more of the following conditions were included: displacement of the condyle with an inclination >30° and/or severe functional impairment such as malocclusion or open bite, with or without dislocation of the condylar fragment; severe pain upon palpation or movement, and/or vertical shortening of the ascending ramus. High or intracapsular condylar neck fractures were excluded.

Results: 75 patients (44 CONS and 31 ENDO patients) with condylar neck fractures were included in this study. The Asymmetric Helkimo Dysfunction Score (A-HDS) was slightly lower in the CONS group than in the ENDO group at the 8-12-week FU, corresponding to better function on the short-term. At the 1-year FU, however, there were slightly better values in the ENDO group. For the Clinical Dysfunction Index (Di) and the Anamnestic Dysfunction Index (Ai), CONS patients had a better outcome than ENDO patients at the 8-12 week FU, ie, a higher proportion of ENDO patients had severe symptoms due to the operative trauma. Yet these symptoms improved by one year, finishing with a significant higher proportion of symptom-free patients in the ENDO group. In addition, these patients had better values for the Index for Occlusion and Articulation Disturbance (Oi) at both FU examinations, ie, the proportion of patients without any occlusal disturbances was significantly higher in the ENDO group. On average, the duration of postoperative maxillo-mandibular fixation (MMF) was 3 times longer for the CONS group than for the ENDO group (33 vs. 11 days).

Conclusion: Both treatment options may yield acceptable results for displaced condylar neck fractures. Especially in patients with severe malocclusion directly after trauma, however, endoscope-assisted transoral open reduction and fixation seems to be the appropriate treatment for prevention of occlusal disturbances during FU.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2011.02.035DOI Listing
February 2012

Oral squamous cell carcinoma detection by salivary biomarkers in a Serbian population.

Oral Oncol 2011 Jan 24;47(1):51-5. Epub 2010 Nov 24.

School of Dentistry and Dental Research Institute, University of California - Los Angeles, 10833 Le Conte Avenue, 73-029 CHS, Los Angeles, CA 90095, USA.

Early detection of oral squamous cell cancer (OSCC) is the key to improve the low 5-year survival rate. Using proteomic and genomic technologies we have previously discovered and validated salivary OSCC markers in American patients. The question arises whether these biomarkers are discriminatory in cohorts of different ethnic background. Six transcriptome (DUSP1, IL8, IL1B, OAZ1, SAT1, and S100P) and three proteome (IL1B, IL8, and M2BP) biomarkers were tested on 18 early and 17 late stage OSCC patients and 51 healthy controls with quantitative PCR and ELISA. Four transcriptome (IL8, IL1B, SAT1, and S100P) and all proteome biomarkers were significantly elevated (p<0.05) in OSCC patients. The combination of markers yielded an AUC of 0.86, 0.85 and 0.88 for OSCC total, T1-T2, and T3-T4, respectively. The sensitivity/specificity for OSCC total was 0.89/0.78, for T1-T2 0.67/0.96, and for T3-T4 0.82/0.84. In conclusion, seven of the nine salivary biomarkers (three proteins and four mRNAs) were validated and performed strongest in late stage cancer. Patient-based salivary diagnostics is a highly promising approach for OSCC detection. This study shows that previously discovered and validated salivary OSCC biomarkers are discriminatory and reproducible in a different ethnic cohort. These findings support the feasibility to implement multi-center, multi-ethnicity clinical trials towards the pivotal validation of salivary biomarkers for OSCC detection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oraloncology.2010.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3032819PMC
January 2011

Epidemiological, clinical, and forensic aspects of chainsaw, circular saw, and grinding saw injuries in the maxillofacial region.

J Craniofac Surg 2010 Jul;21(4):1029-32

Clinic of Maxillofacial Surgery, University of Belgrade, Belgrade, Serbia.

The aim of this article was the epidemiological, clinical, and forensic evaluation of the chainsaw, circular saw, and grinding saw maxillofacial injuries. A retrospective analysis of the medical records at the Clinic of Maxillofacial Surgery, School of Dentistry, University of Belgrade, was performed. A total of 133 patients were treated during a period of 19 years (1989-2008). Grinding saw injuries were more frequent (62%) in comparison to chainsaw and circular saw injuries that were present in 23% and 15% of patients, respectively. All injured individuals were men, and most of them were aged 31 to 40 years. Accident by self injuring was the only mechanism of all the analyzed injuries. There were no suicide or homicide attempts. Isolated injuries of the facial soft tissues, which were mainly lacerations, were present in most patients. Less frequently, soft tissues injuries were compounded with bone fractures of the face and teeth injuries. Surgical debridement, revision, and suturing were performed in all patients where only soft tissues were injured. Patients with compound injuries of the soft tissues, facial bones, and teeth were treated according to the common surgical protocol for the type of the injuries. Most often, these injuries were accidental without fatalities. The number of these injuries increased in the recent years owing to the "do-it-yourselfers" for home hobbies. To avoid these types of injuries, users should be carefully instructed, and attention should be paid to the use of accurately guarded saws and appropriate safety equipment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0b013e3181e432bdDOI Listing
July 2010

Nasal epithesis retained by basal (disk) implants.

J Craniofac Surg 2010 Jan;21(1):33-6

Clinic of Maxillofacial Surgery, daggerSchool of Dentistry, University of Belgrade, Serbia.

Aim: To report the case of a patient who underwent facial reconstruction with nasal epithesis anchored on basal (disk) implants after ablation of midface squamous cell carcinoma.

Methods: Ablative surgery of the midface region and insertion of 3 basal implants into the glabellar area of the frontal bone, the upper part of the right side of the alveolar crest, and the lateral side of the maxillary bone, which forms the left lateral wall of the nose, respectively, was performed. Implants were placed at the time of the primary surgical attempt.

Results: After an unloaded osseointegration phase of 3 months, all implants appeared well integrated according to radiologic criteria and clinical stability. At the end of the osseointegration process, the final epithesis was delivered. Epithesis was anchored to the bars that were fabricated to provide retention and better stability, whereas the implant on the left side was used individually only to improve stability. At the control examinations after 1, 3, 6, 12, and 18 months, respectively, there were no signs of recurrence of the tumor or any complications related to the implants.

Conclusions: Disk implants that were applied to our patient present an excellent alternative, particularly in cases with minimal available bone, resulting in reduced complications in elderly oncologic patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0b013e3181c3626cDOI Listing
January 2010

[Contemporary implantology--challenges, possibilities, limits].

Srp Arh Celok Lek 2008 May;136 Suppl 2:123-8

The loss of teeth, which is a frequent occurrence, is followed by functional, aesthetic and psychological problems. Dentistry has very important role to enable adequate rehabilitation as soon as possible. Removable dentures or fixed bridges on dental implants are most modern and best mode of rehabilitation for the patient. The advantages of implant anchored tooth restorations compared with classical procedures are multiple. Among others, there is prevention of bone resorption, correction of the stability and retention of the restorations, elimination of the preparation of adjacent teeth, as well as the improvement of the patient's psychological status. In order to achieve successful implantation, the following principles have to be taken into consideration: indications and contraindications; biocompatibility; osseointegration; the protocol of implant loading and the assessment of implant success. One of the biggest challenges is implantology under unfavourable anatomical conditions, as well as the implantation on irradiated tissue. However, these conditions are not absolute contraindications for implantation. The adequate choice of adequate implantological system enables successful implantation under different conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2298/sarh08s2123kDOI Listing
May 2008

The therapeutic use of botulinum toxin in cervical and maxillofacial conditions: an evidence-based review.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007 Aug 7;104(2):e1-11. Epub 2007 Jun 7.

Gommiswald Dental Clinic, Gommiswald, Switzerland.

Introduction: The role of botulinum toxin as a therapeutic agent for several conditions is expanding. We sought to determine if botulinum toxin is safe and effective in treating patients with cervical dystonia and maxillofacial conditions. Our purpose was to establish a safety and efficacy profile to determine whether or not this treatment may be used prophylactically in patients undergoing dental implant therapy.

Methods: We performed a systematic search of the literature to identify randomized clinical trials evaluating patients treated with botulinum toxin as an adjunct to dental implant therapy, maxillofacial conditions including temporomandibular disorders (TMD), and cervical dystonia.

Results: Four randomized controlled trials (RCTs) met our search criteria in the area of cervical dystonia and chronic facial pain. No RCTs were identified evaluating dental implant therapy. Patients with cervical dystonia exhibited significant improvements in baseline functional, pain, and global assessments compared to placebo. Adverse events were mild and transient with numbers needed to harm (NNH) ranging from 12 to 17. Patients with chronic facial pain improved significantly from baseline in terms of pain compared to placebo. Rates of adverse events were less than 1%.

Conclusion: Botulinum toxin appears relatively safe and effective in treating cervical dystonia and chronic facial pain associated with masticatory hyperactivity. No literature exists evaluating its use in dental implantology. Randomized clinical trials are warranted to determine its safety and efficacy in dental implantology and other maxillofacial conditions such as bruxism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tripleo.2007.02.004DOI Listing
August 2007

Occlusion splint therapy in patients with craniomandibular disorders (CMD).

J Craniofac Surg 2006 May;17(3):572-8

Clinic of Maxillofacial Surgery, Faculty of Dentistry, University of Belgrade, Serbia and Montenegro.

The etiology of craniomandibular disorders (CMD) is multi-factorial and the treatment should be selected with recognition of the different factors. The aim of the study was to investigate the influence of occlusion splint therapy (Michigan splint), physical exercises and transcutaneous nerve stimulation (TENS) on CMD symptomatology. At the Clinic of Maxillofacial Surgery in Belgrade, in the period from May, 2001-December, 2003, 168 patients were examined by the CMD working group. This group, comprised of different specialties (maxillofacial surgeon, prosthodontist, orthodontist, neurologist, psychiatrist and physiatrician), enabled multidisciplinary treatment of CMD patients according to the guidelines given by American Academy for Craniomandibular Dysfunctions. In all, a total of 30 patients with prevalent muscular tensions among other CMD symptoms were included in this study. The examination form according to Fricton and Shiffman for Craniomandibular Index (CMI) was used in order to evaluate the function of Craniomandibular system before and after therapy.A statistically significant difference (t = 8,735; P < 0,001) between the average values for CMI of patients before (0,2297 +/- 0,0827) and after therapy (0,1002 +/- 0,0479) was observed. Performed treatment resulted in complete response (pain relief and absence of CMD symptoms and signs) in over than 80% of patients and could be considered as a method of choice in reversible occlusal therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/00001665-200605000-00033DOI Listing
May 2006

Evaluation of maxillofacial weapon injuries: 15-year experience in Belgrade.

J Craniofac Surg 2004 Jul;15(4):543-6

Institute of Forensic Medicine and Clinic of Maxillofacial Surgery, Faculty of Stomatology, University of Belgrade, Belgrade, Serbia.

The aim of this research was to evaluate maxillofacial weapon-related injuries from the epidemiological, clinical, and forensic points of view. Analysis of medical records of 183 patients treated for weapon-related injuries in Belgrade maxillofacial surgery clinics in the period 1988 through 2002 has been carried out. Most treated patients were male, 21 to 50 years of age, and injured during the war in the territory of the former Yugoslavia. Injuries involving the mandible were the most frequent (40%); firearm (85%) and perforating (70%) wounds occurred more frequently than explosive (25%) and penetrating (30%) wounds; in certain cases, medical records were incomplete and thus useless for forensic court expertise and evidence. A rapid increase in maxillofacial weapon-related injuries was recorded in the period from 1991 to 1995 as a result of war injuries; high-velocity projectiles caused most of the injuries. It is necessary to keep adequate medical records for successful forensic and court expertise and evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/00001665-200407000-00003DOI Listing
July 2004