Reticular mandibular gingival ridges

This paper reports five cases of a heretofore unreported condition of the gingiva named reticular mandibular gingival ridges. Occurring in middle-aged males, macroscopically, they are bilateral ridges on the mandibular attached gingivae resembling rugae and having a reticular pattern that may be mistaken for lichen planus. Microscopically, they are formed of fibrous tissue with vessels that have a minimal perivascular infiltrate; the epithelium has extension of rete ridges. Of unknown etiology, the condition does not appear to change, is innocuous and does not require treatment.     

Periodontal status of mandibular incisors following excessive proclination. A study in adults with surgically treated mandibular prognathism

The present study was undertaken to examine whether excessive proclination of mandibular incisors results in gingival retraction. In patients with surgically treated mandibular prognathism, 29 with more than 10 degrees proclination of mandibular incisors and 33 with minimal change in incisor inclination during presurgical orthodontic phase were selected. A total of 21 and 19 patients, respectively, could meet for a clinical follow-up examination including Visible Plaque Index, Gingival Bleeding Index, probing pocket depth, and length of supracrestal connective tissue attachment. Study models and intraoral color slides were also made. The mean postoperative times at this examination were 7.8 (SD 2.5) and 8.1 (SD 2.8) years, respectively. Clinical crown height was measured on the study models taken before and after appliance therapy, at the 3-year postoperative control (check) and at the follow-up examination. The number of teeth with recession was determined from the color slides taken at the same intervals; the thickness of the symphysis was measured on the cephalograms taken before treatment. The results demonstrated significantly more increase in clinical crown height and significantly more teeth developing recession both during appliance therapy and during the period from removal of appliance to the 3-year postoperative control in the patients with excessive proclination than in the patients with minimal change in incisor inclination. The correlation coefficient between width of symphysis and increase in clinical crown height in patients with excessive proclination was statistically significant. Only minimal changes were observed from 3 years postoperatively to the follow-up examination. No differences in clinical measurements were observed between the groups and bone dehiscences were not found.     

Non-surgical management of non-condylar mandibular fractures

Unlike fractures of the remaining facial skeleton, fractures of the non-condylar part of the mandible are invariably treated surgically, with the potential risk of further iatrogenic injury. There is, however, a substantial evidence gap pertaining to the potential non-surgical management of such injuries. The aim of this study was to determine the outcomes of mandibular fractures treated with non-surgical management. All patients with mandibular fractures who were referred to a large regional major trauma service over a one-year period (1 January–31 December 2021) were identified. Those treated with surgery or who sustained fractures of the condylar portion of the mandible were excluded. Of all the patients referred to our unit with mandibular fractures, 34/155 (22%) underwent non-surgical management. In all cases plain radiographs demonstrated minimal displacement. Thirty-two (94%) fractures were unilateral, of which 24 (70%) involved the angle. Two of 34 patients subsequently required open reduction and internal fixation due to pain that did not improve over time, one of whom declined. A minimally extruded tooth in the fracture line, which altered the occlusion in one additional patient, required minimal reduction of the enamel. The remaining patients healed without complication six weeks after injury. Non- surgical management requires careful case selection and regular follow up, so is of value to only a small proportion of patients. Twenty-two per cent of all mandibular fractures were managed non-surgically at our unit in one year, with a 97% success rate, demonstrating the potential utility of this strategy in carefully selected cases.     

Implant treatment of posterior mandibular sextants

In mandibular posterior sextants an insufficient bone quality or volume may contraindicate implant placement. Crestal bone resorption, supra-eruption of teeth, and minimal bone coronal to the mandibular canal are the principal reasons for not placing dental implants. The available prosthetic space is also a major factor in determining surgical and prosthetic treatment. Various surgical approaches are used to create adequate bone volume in the posterior mandible, thereby allowing the possibility for implant placement. The therapeutic choice is made depending upon residual bone volume and available prosthetic space. The risks and disadvantages of the various techniques must be seriously evaluated and explained to the patient.     

The vascularized fibula graft in mandibular reconstruction

The use of a vascularized graft from the fibula for mandibular reconstruction is presented. The great strength, pliability, and long vascular pedicle that characterize such grafts make them particularly suitable for this type of repair. The results in six cases were highly satisfactory. Masticatory function was well restored, without alteration of the facial contour, and with minimal sequelae at the donor site.     

Role of muscle function in mandibular prosthetics

The various effects of muscle function on mandibular prosthetics have been categorized and discussed. For obvious reasons, specifics such as muscle origins and insertions have not been included. This has been done most capably in the past. Many obvious and superficial facts have been presented to examine the depth and pervasiveness of muscle function in mandibular prosthodontic service. A similar case can be made for the maxillary denture, but to a lesser degree. The dictum of Martone calls attention to the fact that biologically inert prostheses are constructed for patients who are in state of minimal functional activity. When customary day-to-day activity resumes, those prostheses must serve harmoniously with the oral environment into which they are thrust.     

Mucogingival changes resulting from mandibular incisor tooth movement.

This study involved a cephalometric analysis of 1,150 fully treated orthodontic cases evaluated by Kodachrome slides, plaster casts, and cephalometric films to determine changes in the width of keratinized gingiva relative to lower incisor tooth movement and to ascertain the incidence of mucogingival problems in orthodontic patients. It was apparent that in a small percentage of cases visible mucogingival changes occurred and could be statistically correlated with the magnitude and direction of tooth movement. In this group of patients 1.3 percent (sixteen) showed a decrease in the width of keratinized gingiva with either minimal movement or some labial movement of the mandibular incisors; 0.69 percent (eight) had an increase in keratinized gingival width concomitant with significant lingual positioning of the lower incisors. The salient point to be made is that with an initial minimal or inadequate width of keratinized gingiva (0 to 2 mm.), mandibular incisor tooth movement over a period of treatment could significantly affect the final quality of gingival health in the critical mandibular anterior region.     

Postoperative physiotherapy device for mandibular hypomobility.

The most difficult problem in the treatment of ankylosis of the temporomandibular joint is to maintain the immediate jaw mobility gained by surgery over a long period of time. This article describes a spring-loaded device for physiotherapy which provides an active opening force from the mandibular splint, distributed against a splint on the maxillary teeth and hard palate. Because the force is continuous and broadly distributed, patients have been able to exercise with minimal discomfort, and they have been able to maintain their initial postoperative mobility.     

Intraoral reconstruction of mandibular defects after tumor resection

The intraoral reconstruction of mandibular defects resulting from tumor resection with autogeneic iliac bone is described. Large pieces of pelvis can be harvested and split sagittally for lengthening or altering the direction and shape of the body or angle of the reconstructed mandible. A graft taken from the iliac tubercle region can be used for satisfactory reshaping of the chin area. Delays in reconstruction, if necessary, should be of short duration, and a fabricated Kirschner wire splint with fixation screws, or a Kirschner wire and acrylic condyle may serve to counteract scar retraction prior to grafting. Esthetic and functional results have been good, and postoperative complications have been minimal.     

Trifid mandibular condyle: A case report

A few cases of bifid, but no case of trifid mandibular condyle, have been reported in the literature. This article presents the first reported case of trifid mandibular condyle in a living subject with a history of previous trauma to the temporomandibular joint (TMJ). Additionally, the patient's other condyle was bifid. The patient had no complaint related to the functions of TMJ except for minimal weakness following chewing. The etiology and the prognosis of bifid and trifid condyle are discussed briefly. We considered computed tomography essential to rule out early stages of TMJ pathology in similar cases that resemble trifid mandibular condyle on conventional radiographs.     

The mandibular rest position and electromyography—a review

The objective of clinical methods for the establishment of the rest position of the mandible is to establish a position at which masticatory muscle activity is minimal. Several methods are in clinical use but these methods may not elicit a position which is coincident with the lowest level of muscle activity as determined electromyographically.     

Correction of mandibular dentoalveolar retrusion by anterior segmental advancement.

Mandibular anterior segmental advancement offers an alternative mode of management for certain patients with Class II dentoalveolar malocclusion. The procedure is ideally indicted in paradoxical occlusal situations wherein Class II malocclusion is associated with a prognathic profile or when total body advancement would produce an unacceptable occlusion or profile. Arch expansion and augmentation genioplasty may be achieved by tailoring the surgical approach. Complications were minimal in the cases presented. Since arch lengthening results, the potential food table is increased, necessitating either fixed or removeable prosthetic care.     

Introduction of the "Rotterdam mandibular distractor" and a biomechanical skull analysis of mandibular midline distraction

The Rotterdam mandibular distractor (RMD) is a slim, rigid, boneborne distractor for use in midline distraction of the mandible. We did a biomechanical study to compare the RMD with the Trans Mandibular Distractor-flex (TMD-flex). This included an anatomical biomechanical study that was conducted on 9 dentate human cadaveric heads using both the RMD and the TMD-flex. In the vertical plane less tipping was measured in the RMD group than in the TMD-flex group. Significantly less skeletal tipping was found in the horizontal plane in the RMD group (P=0.021). There was minimal difference in the intercondylar distance between the groups. As the amount of lateral displacement of the condyle was similar in both groups and there was less rotational movement in the RMD group, the TMD-flex would be expected to increase stress on the temporomandibular joint. As a result of the increased parallel widening in the vertical plane, more basal bone is being created and less relapse is expected using the RMD. The study design involves an in vitro anatomical model and conclusions must be drawn with care. At present clinical studies are under way and results will follow.     

Bilateral fusion in primary mandibular teeth: a report of two cases

The rare anomaly of fusion in primary dentition has very little documentation in Indian population. Two rare cases of bilateral fusion between primary mandibular lateral incisors and canines and primary mandibular central incisors and lateral incisors have been presented in this report. A minimal intervention approach, preventive procedures, and a long-term follow-up have been discussed.     

The mandibular orthopedic bone staple in the treatment of the atrophic mandible

Postoperative clinical findings of the mandibular orthopedic bone staple have been essentially positive, from both the dentist's and the patient's viewpoint. The mandibular bone staple is a technically feasible procedure with a minimal morbidity, an acceptable operating time, excellent stability, good retention, minimal physiological insult, and a high degree of patient acceptance. Postoperative alveolar ridge height seems to be stabilized by the technique. It should be considered in the rehabilitation of the atrophic, edentulous mandible, especially for those patients with significant systemic diseases who might not be suitable candidates for more extensive procedures such as mandibular bone graft augmentation or visor osteotomy. In addition, another attractive advantage of this technique for the nutritionally deficient patient, is that within 4 weeks of the initiation of treatment the patient can function successfully with a mandibular denture. This can be compared with a minimum 4- to 6-month waiting period described for the patient who had either mandibular bone graft augmentation or visor osteotomy.     

Transoral plating of mandibular angle fractures: a technique

A technique has been presented for transcutaneous management of angle fractures with employment of two plates: one at the tension band, the second at the compression zone of the mandible. Our preliminary experience with this procedure has been favorable. When a comparison is made of an intraoral approach to an extraoral one, there are three advantages. First, the cutaneous scar is minimal when compared with a transcutaneous one. Second, visualization of the occlusion is maintained throughout the procedure. Third, injury to branches of the facial nerve and other anatomic structures is reduced.     

Immediate reconstruction of a large mandibular defect of locally invasive benign lesions (a new method)

Locally invasive benign tumor and large lesions such as ameloblastoma, giant cell granuloma, odontogenic keratocyst, and odontogenic myxoma are a benign, invasive, lesions of the jaws that predominantly affects the mandible. Despite the benign nature of these lesions, there is a high rate of local recurrence after curettage, which usually requires resection. The traditional surgical approach for resection of these lesions, via either mandibulotomy or mandibulectomy is extraoral approach which is associated with significant functional and esthetic sequelae. A case series is presented here in which less invasive and intraoral approach. An intraoral approach provides wide and fast access to the mandible. This approach represents a less invasive alternative that provides access to the mandible for curative resection of benign tumors with minimal postoperative sequelae. At 5 years follow-up, there were minimal functional and esthetic defects.We explored the use of the less invasive and more esthetic incision as an approach to resection and reconstruction of the mandible. It is our belief that these concerns have been best addressed by the minimally invasive procedure used in this report. This approach resulted in a minimal esthetic and functional defect even though a massive mandibular resection was performed.     

Stability of mandibular incisors following excessive proclination: a study in adults with surgically treated mandibular prognathism

The purpose of this study was to determine if mandibular incisors could be proclined markedly without increasing the potential for relapse of crowding. Patients with surgically treated mandibular prognathism were selected. In 29 patients the mandibular incisors were proclined more than 10 degrees during the presurgical orthodontic phase. The remaining 33 patients had only minimal change in incisor inclination. A long-term follow-up examination was performed 10.0 (SD 2.3) and 11.1 (SD 3.1) years postoperatively in 26 and 24 patients, respectively. Study casts were measured before and after treatment, three years after surgery, and long-term. Cephalograms were evaluated before and after treatment, immediately before and after surgery, and three years after surgery. Prior to therapy the patients treated with presurgical proclination had less dental arch length and more retroclined and crowded mandibular incisors than the patients in the other group. No differences in parameters were observed at later intervals. Dental arch length and intercanine width decreased and incisor irregularity increased in both groups during the follow-up periods. No intergroup differences in changes were observed. Indications for proclination of mandibular incisors are discussed.     

The vascularized fibular flap for mandibular reconstruction.

Vascularized fibular bone grafts have advantages over other bone grafts in the restoration of the contour and function of defective mandibles. The fibular graft can be tailored to fit even major mandibular defects; in combination with preformed temporomandibular joint prostheses total mandibular reconstruction can be performed in a single procedure. The fibular transplant is considered ideal for the insertion of implants to support dental suprastructures to obtain maximal oral rehabilitation. We have used fibular grafts in eight cases for primary or secondary reconstruction of a variety of mandibular defects resulting from cancer, chronic osteomyelitis or gunshot injuries. The results have been most encouraging with respect to function and cosmetic appearance. There have been no transplant failures and minimal donor site complications.     

Radiological features of mandibular primordial cysts. (Keratocysts).

Primordial cysts (keratocysts) have been shown to have a greater tendency to recurrence than other jaw cysts. Some radiological features may assist in establishing the diagnosis. Thirteen mandibular primordial cysts have been studied radiologically in detail. Characteristic features are extension along the medulla with minimal expansion except in young children. Margins are generally sharply demaracated and either smooth or scalloped. Cortical resorption occurs before expansion. The cysts may displace adjacent teeth, particularly when unerupted, but generally do not produce root resorption. They may displace the neurovascular bundle. Antero-posterior dimensions in this series ranged from 28 to 77 mm, with a mean of 50 mm.