As maloclusões de ordem esquelética são alterações do crescimento das bases ósseas mandibulares e maxilares que acarretam em mal posicionamento dentário e conseqüentemente, perda ou restrição da função mastigatória. Em muitos casos, grande desconforto pode ser causado pelo contato dente a dente ou dente a tecidos moles. Atualmente, na Medicina Veterinária, estes traumatismos vêm sendo tratados de forma paliativa pela ausência de protocolo cirúrgico estabelecido. Na odontologia humana, a cirurgia ortognática é o recurso mais indicado pelos cirurgiões-dentistas para se corrigir as maloclusões esqueléticas severas, trazendo benefícios estéticos e funcionais aos seus pacientes. Com o mesmo intuito, este trabalho analisou a viabilidade da realização da técnica intra-oral de osteotomia sagital mandibular em cães em amostra de 20 cadáveres portadores de maloclusão esquelética. Após a osteotomia e reposicionamento da mandíbula, as extremidades ósseas foram fixadas com mini-placas e parafusos de titânio, com 1,5mm de diâmetro. A análise estatística mostrou que houve diferença significativa da oclusão final dos cadáveres testados (Teste de Wilcoxon, p < 0,05) onde, em 95% dos casos, houve a correta fratura em bizel e, em 100% dos casos, houve a preservação do feixe alveolar inferior durante a osteotomia e a fixação. Independente do método de fixação, esta apresentou-se estável em 100% dos casos. Concluiu-se, portanto, que a técnica intra-oral de osteotomia sagital da mandíbula em cães é viável, porém ressalta-se a importância em realizar planejamento ortodôntico-cirúrgico prévio para adequado ajuste oclusal durante o ato cirúrgico in vivo. / Skeletal malocclusions are growth modifications of the bone of mandible and maxilla that can cause mal positioning of teeth and consequently, loosing or reduction of masticatory function. In most cases, some discomfort can be caused because there is trauma to the teeth or between teeth and soft tissues. Nowadays, in Veterinary Medicine, these traumas have been treated palliativelly because there is not any surgical procedure established to be applied on animals so far. In human dentistry, the orthognathic surgery has been the most indicated treatment by dentists to correct severe skeletal malocclusions, offering esthetic and function benefits to the patients. With the same objective, this research evaluated the viability of the intra-oral mandible sagital split osteotomy in 20 cadavers of dogs with skeletal malocclusion. After sagital osteotomy and repositioning of the mandible, the bone fractures were fixed with titanium mini-plates and screws, with 1.5mm of diameter. The statistic analysis showed a significant difference on occlusion of the treated cadavers (Wilcoxon test, p<0,05); 95% of the cases had a correct sagital split osteotomy (bizel osteotomy), all animals had the lower alveolar vessels and nerve preservation during osteotomy and fixation. Regardless of the fixation method used, 100% of the cases had stable fixation of the fragments. In conclusion, it is viable to accomplish the intra-oral mandible sagital osteotomy in dogs. However, it is important to do a previous orthodontic-surgical planning to acquire a satisfactory oclusal arrangement during the surgery in vivo.

Orientador: José Ricardo de Albergaria Barbosa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-18T23:46:45Z (GMT). No. of bitstreams: 1 Oliveira_MarceloViniciusde_D.pdf: 1959101 bytes, checksum: 50a4cad57e9f79f74fc52cba91fd5fc7 (MD5) Previous issue date: 2011 / Resumo: A osteotomia sagital do ramo mandibular (OSRM) como descrito por Obwegeser e Dal-Pont é atualmente um procedimento comum e de sucesso na cirurgia oral e maxilo-facial no tratamento de certas discrepâncias mandibulares. Em cirurgia ortognática, entre muitas diferentes propostas de osteotomia para correções de deformidades dento-faciais na mandíbula, é evidente que a osteotomia sagital da mandíbula (OSRM) é a mais utilizada pelos cirurgiões buco-maxilo-faciais. Este fato, devido a várias razões, principalmente a estabilidade alcançada pelo contato osso grande entre os segmentos, sem a necessidade de enxerto ósseo, função mandibular precoce; estabilidade no tratamento em longo prazo e fixação fácil. Diferentes métodos para fixação interna foram utilizados para permitir a mobilização precoce e funções após a OSRM. A introdução dispositivos de fixação interna, como miniplacas e parafusos diminui substancialmente a duração do bloqueio maxilo-mandibular ou mesmo o elimina completamente. A espessura da cortical óssea mandibular tem demonstrado ser um dos muitos fatores que levam a falha de afrouxamento de parafuso e, conseqüentemente, o poder de fixação do parafuso. Mensurações da morfologia mandibular utilizando métodos convencionais têm sido relatadas na literatura. Até o momento, apenas um estudo foi publicado em que analisa a espessura do osso cortical no ramo mandibular relacionando-a com fixação interna na osteotomia sagital do ramo mandibular. O objetivo deste estudo foi quantificar a espessura do osso cortical do ramo mandibular para determinar as condições relacionadas com a osteotomia sagital do ramo e colocação de parafusos. A amostra foi composta por 44 pacientes de pacientes, com idades variando de 46 a 52 (idade média de 49 anos). Tomografias computadorizada Cone-Beam foram realizadas fazendo três cortes; na área de terceiro molar (seção A), posterior 5mm (seção B) e 5 milímetros posterior a este último (seção C). Foram realizadas as medidas das corticais em nível superior e inferior relacionada com o canal mandibular além das medições relacionadas com a largura total da mandíbula. Coeficiente de correlação intra classe com p <0,05 foi usado. O resultado mostrou que as corticais vestibular e lingual não apresentaram diferenças estatísticas e seu menor valor foi 1,5 milímetros para cada um. Corticais ósseas superior e inferior não apresentaram diferenças e a largura total da mandíbula foi entre 15,9 milímetros a 8,5 milímetros na região anterior, entre os 17,4 milímetros a 12,8 milímetros na área intermediária e 18mm de 8,8 milímetros na região posterior. A distância superiormente ao canal mandibular apresentou um desvio padrão mínimo com uma média de 8,5 milímetros na região anterior, 10,6 milímetros para a região intermediária e 12,5 milímetros na região posterior. Em conclusão, a espessura cortical do ramo mandibular é particularmente forte e oferece um bom ancoradouro para SSRO osteossíntese com parafusos de fixação independente do tipo de disposição / Abstract: The sagittal split ramus osteotomy (SSRO) as described by Obwegeser and Dai­Pont is now a standard, common and successful procedure in oral and maxillofacial surgery for the treatment for certain mandibular discrepancies. In orthognathic surgery, among many different designs proposed osteotomy for correction of dental­facial deformities in the jaw, it is clear that the sagittal osteotomy of the mandibular (OSRM) is the most commonly used by surgeons maxillofacial. This fact due to several reasons, mainly the stability achieved by the large bone contact between the segments, without the need for bone grafts, early jaw function; stability in long-term treatment and easy fixation. Different methods for internal fixation have been used to allow early mobilization and functions after the common use of the SSRO. The introduction of modern devices for internal fixation such as miniplates or lag screws substantially shortens the duration of intermaxillary fixation (IMF) or even obviates it completely. Cortical bone thickness has been shown to be one of many factors affecting screw pullout strength and, consequently, the holding power of the screw. Measurement of mandibular ramus morphology using conventional methods has been reported in the literature28, but surgeons have found that further investigatio of the anatomical relationship is needed. To date, only one study have been publi hed in which the thickness of cortical bone at the mandibular ramus relates to stable internal fixation of SSRO. The objective of this study was to quantify the cortical bone thickness of the mandibular ramus to determine conditions related to sagittal split ramus osteotomy and placement of screws. The patient sample comprised 44 patients, ages ranging. from 46 to 52 (mean age, 49 years). The cone beam computed tomography were periormed and realized three cuts in third molar area (section A), 5 mm posterior (section B) and 5mm posterior to the latter (section C). Was executed measurement in cortical areas of superior and inferior level related to mandibular canal and measurement related to total width of mandible. Intra class Correlation Coefficient with p<0.05 was used. The result showed that buccal and lingual cortical zone was not present sta1istical differences and his minor value was 1.5mm for each one. Superior and inferior cortical bone was not present differences and the total width of mandible was between 15.9mm to 8.5mm in the anterior area, between 17.4mm to 12.8mm in the meddle area and 18mm to 8.8 mm in the posterior area. The distance superiorly to mandible canal presented a minimal standard deviation with a mean of 8.5mm in the anterior region, 10.6 mm for meddle region and 12.5mm in the posterior region. In conclusion, the cortical thickness of the mandibular ramus is particularly strong and offers a good anchorage for SSRO using osteosynthesis screws independently of disposition fixation type / Doutorado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Doutor em Clínica Odontológica

Orientador: Darcy Flavio Nouer / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T00:08:27Z (GMT). No. of bitstreams: 1 Viotti_AdrianadeOliveira_M.pdf: 2563925 bytes, checksum: 4df9549d622411867272692474ab8ed9 (MD5) Previous issue date: 2004 / Resumo: As variações morfológicas e o tamanho mandibular contribuem para a maioria dos desvios oclusais, maloclusões, e displasias dos maxilares. O tratamento ortodôntico é um procedimento de gerenciamento de espaços, e o estudo do processo de crescimento da região retromolar é essencial ao diagnóstico e planejamento do tratamento ortodôntico, com a finalidade de ajustar os dentes às dimensões ósseas de suporte. A avaliação do espaço disponível para se obter as posições dentárias corretas e conseguir a oclusão desejada é um dos passos do diagnóstico diferencial. Este trabalho apresenta uma metodologia para avaliar o ¿espaço útil ortodôntico¿ por meio do aumento dos incrementos de crescimento da região retromolar baseado somente em estruturas ósseas: área anterior, representada pela cortical vestibular do mento e na área posterior, a borda anterior do ramo ascendente mandibular. No presente estudo transversal foram mensuradas 240 lerradiografias da cabeça em norma lateral, distribuídas igualmente para os gêneros femininos e masculinos nas faixas etárias dos 7 aos 18 anos de idade. As análises dos dados estatísticos mostraram que o espaço retromolar teve um aumento de 0,9mm/ano no gênero feminino e 0,8mm/ano no gênero masculinono período estudado. Especificamente na avaliação das faixas etárias estudadas, os seguintes crescimentos foram observados: no gênero feminino de 7 a 10 anos: 5,2 mm, de 11 a 14 anos: 3,6mm e de 15 a 18 anos: 2,4mm. Já no gênero masculino, observou-se, de 7 a 10 anos: 3,6mm, de 11 a 14 anos: 2,8mm e dos 15 aos 18 anos: 3,2mm. Na correlação da medida equivalente à base mandibular (B ¿ X) e parte da altura do ramo (Y ¿ Z) constatou-se uma equivalência no crescimento dos segmentos. No tocante a metodologia proposta e a preconizada por Merrifield observou-se na correlação de Pearson um índice de 0,726 / Abstract: The morphologic variations and the mandible size contribute for most deviations occlusions, malocclusion and diseases of the maxillaries. The orthodontic treatment is a spaces management procedure, and the growth process study of the region retromolar is essential to the diagnosis and planning of the orthodontic treatment, with the purpose of adjusting the teeth to the bony dimensions of support. The evaluations of the available space to if obtain the dental positions and to get the wished occlusion is one of the diagnosis differential. This study show us a methodology of the evaluated the ¿utile orthodontic area ¿based in the growing increments of the retromolar region based only in bone structure: anterior area, the vestibular sinfisys cortical, and in the posterior area the anterior board of the mandible branch. In this study was measured 240 cephalometrics radiographies divided for the female and male sex in the age zones from 7 to 18 years. The results show us that the retromolar space had an increase of 0,9 mm/year in the female sex and 0,8 mm/year in male sex in the study period. Specifically in the evaluation of age zones was study, we observed the following growing increments in female sex 7 to 10 years: 5,2 mm/year, 11 to 14 year: 3,6 mm/year, 15 to 18 year: 2,4 mm/year. In the male sex observed in 7 to 10 year: 3,6 mm/year, 11 to 14 year: 2,8 mm/year and 15 to 18 year: 3,2 mm/year. In the correlation equivalent of mandible base (B ¿ X) and part of the mandible branch¿s high (Y ¿ Z), observed a growing synchrony of the segments. In the propose methodology and in Merrifield¿s propose observed the Pearson correlation an indices of 0,726 / Mestrado / Ortodontia / Mestre em Ortodontia

Orientador: Glaucia Maria Bovi Ambrosano / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T03:10:26Z (GMT). No. of bitstreams: 1 Guedes_FabioRibeiro_M.pdf: 16708948 bytes, checksum: 136372754eec5ecaf8e3293298f9b330 (MD5) Previous issue date: 2005 / Resumo: Foi identificado o fator de magnificação de tomógrafos convencionais e comparado a mangnificação fornecida pelos fabricantes, e a confiabilidade de medidas lineares das imagens tomográficas corrigidas, quando comparadas às mensurações reais nos segmentos ósseos. Foram utilizadas 16 mandíbulas humanas maceradas edêntulas, e selecionada região correspondente aos incisivos, caninos, pré-molares e molares bilateralmente. Em cada região foram fixados sobre a crista óssea e na região vestibular, um fio ortodôntico com 5,0 milímetros de comprimento, que foi utilizado como guia radiográfico. Os equipamentos utilizados neste trabalho foram os tomógrafos convencionais Quint Sectograph, Orthopantomograph OP100, X Mind TOME, e computadorizados Somatom Esprit com reconstrução multiplanar e Toshiba X vision EX com software Denta Scan. As mandíbulas foram posicionadas nos tomógrafos convencionas conforme as especificações dos fabricantes e obtidas as imagens. Para os tomógrafos computadorizados as mandíbulas foram posicionadas com suas bases perpendiculares ao solo e obtidas as imagens axiais ara posterior reconstrução oblíquo-sagital das regiões. Após obtidas as imagens, foram mensuradas a altura e espessura óssea de cada região, corrigindo-se as medidas com base a ampliação do guia radiográfico e em seguida com o fator de magnificação dado pelo fabricante. As mandíbulas foram seccionadas exatamente nas regiões selecionadas, e realizadas as medidas da altura e espessura óssea, obtendo-se os valores reais por região. As magnificações calculadas, por meio do guia radiográfico dos tomógrafos convencionais, foram comparados pelo teste t, com os fornecidos pelos fabricantes, observando-se diferenças significativas para os três tomógrafos convencionais. A altura e espessura óssea corrigidas pela ampliação do guia radiográfico apresentaram diferenças estatisticamente significativas (p<0,05) pelo teste de Dunnett para as medidas do tomógrafo computadorizado Somatom Esprit quando comparadas com as dimensões reais. A medida da altura óssea corrigida com o fator de magnificação fornecido pelo fabricante demonstrou diferenças para os tomógrafos (p<0,05) com exceção do tomógrafo computadorizado Toshiba X vision EX, e para espessura óssea observou-se diferenças para o tomógrafo Quint Sectograph e Somatom Esprit quando comparados com as dimensões reais (p<0,05). Concluiu-se que as diferenças de magnificação calculadas, comparadas com as fornecidas pelos fabricantes não possuem significância clínica. As mensurações da altura e espessura ósseas foram precisas com exceção das realizadas no tomógrafo computadorizado com reconstrução multiplanar Somatom Sprit / Abstract: The magnification factors of conventional tomography was identified and compared them to the factors provided by the manufacturers, and the reliability of linear measurements achieved on corrected tomographic images, when compared to the real measurements on the bone segments. Sixteen dry edentulous human mandibles were used, and the area corresponding to the incisors, canines, premolars and molars were selected bilaterally. A 5.0-mm long orthodontic wire was fixated on the bone crest and buccal region of each area, to be used as a radiographic guide. The equipments used in this study were the conventional tomography Quint Sectograph, Orthopantomograph OP100, X Mind TOME, and the computerized tomography Somatom Esprit with multiplanar reconstruction and Toshiba X Vision EX with the Denta Scan software. The mandibles were positioned on the conventional scanners following the manufacturers¿ instructions, and the images were obtained. As to the computerized scanners, the mandibles were positioned with their bases perpendicular to the ground, and axial images were achieved for later oblique-sagittal reconstruction of the regions. After achievement of the images, the bone height and thickness of each region were measured, with correction of measurements based on the magnification of the radiographic guide and then according to the magnification factor supplied by the manufacturer. The mandibles were sectioned at the selected areas and bone height and thickness were directly measured, for achievement of the real values for each region. The magnification factors calculated by utilization of the radiographic guide for the conventional tomography were compared to those provided by the manufacturers by the t test, which revealed significant differences for the three conventional scanners. The bone height and thickness with correction according to magnification of the radiographic guide presented statistically significant differences (p<0.05) according to the Dunnett test for the measurements achieved on the computerized tomography Somatom Esprit compared to the real dimensions. The bone height corrected according to the magnification factor provided by the manufacturer demonstrated differences for the scanners (p<0.05), except for the computerized tomography Toshiba X vision EX, with differences in bone thickness for the Quint Sectograph and Somatom Esprit tomography compared to the real dimensions (p<0.05). It was concluded that differences between the magnification factors calculated compared to those provided by the manufacturers do not have any clinical implication; also, measurements of bone height and thickness were reliable, except for those achieved on the computerized tomography with multiplanar reconstruction Somatom Sprit / Mestrado / Radiologia Odontologica / Mestre em Radiologia Odontológica

Magister Chirurgiae Dentium - MChD / Aim: The aim of the study was to investigate whether a correlation exists between the intra- operative position of the Inferior Alveolar Nerve (IAN) and the nerve position as noted on a pre-operative Cone Beam Computer Tomography (CBCT) scan in patients requiring Bilateral Sagittal Split Osteotomy (BSSO) of the mandible. Introduction: The BSSO of the mandible is of fundamental importance in the correction of dental facial deformities. The main post-operative complication of a BSSO of the mandible is Neurosensory Impairment (NSI). To avoid possible NSI it is important to have as much pre- operative information as possible. In this regard, pre-operative CBCT scans can provide the surgeon with an important assessment of the mandibular canal. This information on the buccolingual, superior and inferior position of the canal, especially in the region of the planned osteotomy, could help the surgical team to avoid IAN injury. Materials and Methods: This study correlates the pre-operative position of the IAN as indicated on a CBCT scan with the intra-operative IAN position in patients requiring BSSO of the mandible. Ten standardised cases were included in a prospective case series where twenty mandibular sides were assessed. Results: The variables assessed in this study were location of the nerve, age, sex, type of movement and side of mandible operated on. It was found that only the distance between the Inferior Alveolar Canal (IAC) and the lower border of the mandible are predictive of whether the IAN will be attached to - or free from - the proximal segment of the mandible. Conclusion: From the study it can be concluded that a CBCT scan is a useful and reliable modality in the pre-operative evaluation of patients undergoing BSSO especially with regard to the assessment and mapping of the mandibular canal.

Orientador: Marcelo Silva Monnazzi / Resumo: As reconstruções maxilofaciais, cada vez mais utilizadas para o reparo das deficiências dos tecidos ósseos na face ou nos maxilares, são cirurgias demasiadamente importantes. Elas não devolvem apenas a função local, mas também, em muitos casos, restabelecem a autoestima do paciente, e assim, melhoram sua qualidade de vida. Para as grandes reconstruções ósseas, a quantidade de tecido ósseo necessário como substrato para a realização do enxerto, muitas vezes é um fator limitante. Este estudo observacional foi planejado, para avaliar a anatomia e a quantidade óssea do processo coronóide da mandíbula, do mento e da crista ilíaca anterior. Quinhentas e dez mandíbulas secas foram analisadas e medidas em pontos pré-determinados, por meio de um paquímetro digital. Após as medidas, foi estabelecida a média da espessura e das medidas lineares do processo coronóide; a media de espessura de pontos do mento e a média de espessura de pontos da crista ilíaca anterior, bem como uma estimativa de volume para este último. Observou-se que a crista ilíaca anterior apresentou uma estimativa média de volume ósseo de 21.347,19 mm3 e 21.125,56 mm3 para o lado esquerdo e direito, respectivamente. O processo coronóide apresentou menor espessura (2,11 mm) e tamanho linear (5,77 mm) em sua porção mais superior e maior espessura (3,63 mm) e tamanho linear (14,51 mm) na sua base, em média. No mento, foi observada maior média de espessura na linha média (12,90 mm), além disso, essa espessura foi 1,57 mm ma... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Maxillofacial reconstructions, used for the repair of boneless areas of the face or jaw, are extremely important surgeries. They restore the local function and in many cases, also restore the patient's self-esteem, and thus, improve their quality of life. For extensive maxillary reconstructions, the amount of bone tissue required as a substrate for grafting is often a limiting factor. This observational study was designed to evaluate the anatomy and the amount of bone found in the coronoid process, chin and anterior iliac crest. Five hundred and ten dry mandibles were analyzed and measured at predetermined points by a digital calypter. After the measurements, the mean thickness and linear measurements of the coronoid process were established; the mean thickness of points of the chin and the mean thickness of points of the anterior iliac crest, as well as an estimate of volume of the iliac crest. It was observed that the anterior iliac crest had an average bone volume estimate of 21,347.19 mm3 and 21.125,56 mm3 for the left and right sides, respectively. The coronoid process had a smaller thickness (2.11 mm) and linear (5.77 mm) in its uppermost portion and greater thickness (3.63 mm) and linear (14.51 mm) in its base, on average. At the chin, a greater mean thickness was observed in the midline (12.90 mm), in addition, this thickness was 1.57 mm greater in males. The anterior iliac crest provides a large amount of bone volume, compared to intra-oral areas. The knowledge of th... (Complete abstract click electronic access below) / Mestre

Much research has been done to understand the complex process of facial growth and development for decades. Recently, the form and function of the human mandibular symphysis has been of interest. The human symphysis theoretically experiences three types of strains during function, which may influence symphyseal shape and development. These forces are influenced by the size and position of the mandible relative to the muscles that act upon it. The purpose of this study is to determine whether an increase in mandibular length through surgery leads to increased skeletal indicators of resistance to wishboning forces. We retrospectively collected a sample of 47 subjects who had undergone mandibular advancement surgery and compared their pre- and post-surgical radiographs to examine for any changes. The results of our analysis did not provide any evidence to suggest increased wishboning resistance as a result of surgical lengthening. Perhaps there were truly not changes in the symphysis, or that we were unable to detect them due to limitations of using two-dimensional images on an adult population with a relatively short follow-up. Further research is needed to understand the role of function in the form of the human mandibular symphysis.

Magister Chirurgiae Dentium (MChD) / Introduction: Defects in the mandible and maxilla have various etiological factors. These include trauma, inflammatory diseases or pathology such as benign and malignant tumours. Patients that are exposed to these factors are often left with compromised function and aesthetics which could have a deleterious effects on the patients’ quality of life if not adequately restored with reconstructive surgery (Goh et al. 2008). Reconstruction should aim to allow rehabilitation of normal stomatognathic function, facial contour and aesthetics, obliteration of dead space left after ablation, and the need to examine the area for recurrence (Kim and Ghali 2011). The fibula free flap has become the gold standard for maxillofacial reconstruction. This flap offers various advantages that makes it suitable, especially for reconstructing defects of the mandible (Anne-Gaelle et al. 2011). The success of rehabilitation of these patients should however also take into consideration the patient’s ability to use a dental prosthesis (conventional or implant retained) post-operatively. This remains challenging (Kramer and Dempf 2005). The effective placement of a dental prosthesis relies on the basic principles of retention, stability and support. With the altered anatomy caused by the graft, placement of dental implants is used to enhance retention and stability. Quality of life (QoL) is a measure of a patient’s satisfaction with their current situation in regards to function and other factors compared to a perceived or expected ideal. The subjective component linked to quality of life means that it could vary from one locality to another, and therefore gathering data that will establish a baseline for these patients that have undergone tumour ablative surgeries. This could be invaluable to healthcare practitioners that operate in this specific field.

Magister Chirurgiae Dentium (MChD) / Introduction: A common complication of poorly managed mandible fractures is infection. There is a consensus amongst clinicians in treating infected mandible fractures in an immediate setting. The approach includes drainage of the purulent discharge, debridement of the fracture, removal of teeth in the fracture line and immediate fixation. Fixation can be load bearing or load sharing in nature. Although clinicians advocate for the use of a reconstruction load bearing plate, a double miniplate fixation could be an alternative. Aim: The aim is to assess the outcomes of double miniplate osteosynthesis in the immediate management of infected mandible fractures Material and method: A prospective cohort study was conducted. The sample size was 20 (n =20). Infections were treated with an incision and drainage and the fractures fixated with a double miniplate fixation system. Pain scores, fracture union, fracture stability and surgical times were measured. Follow–up visits included one week, six weeks and three months respectively. Results: Mandibular angle fractures were most commonly infected. The most common cause of infection were teeth in the line of fracture. The buccal fascial space was the most commonly involved fascial space in regard to spread of infection. Nineteen of the twenty cases attained fracture stability. However, complications commonly encountered were persistent infection and wound dehiscence. Conclusion: Although a limited number of clinical cases were treated, the results correspond with the current literature when an immediate miniplate fixation protocol is used in infected mandible fractures. However, complications encountered in the study included the persistence of infection and wound dehiscence.

OBJECTIVES: Cephalometric analysis is a tool used in orthodontics for craniofacial growth assessment. Magnitude and direction of mandibular growth pose challenges that may impede successful orthodontic treatment. Accurate growth prediction enables the practitioner to improve diagnostics and orthodontic treatment planning. Deep learning provides a novel method due to its ability to analyze massive quantities of data. We compared the growth prediction capabilities of a novel deep learning algorithm with an industry-standard method. METHODS: Using OrthoDx™, 17 mandibular landmarks were plotted on selected serial cephalograms of 101 growing subjects, obtained from the Forsyth Moorrees Twin Study. The Deep Learning Algorithm (DLA) was trained for a 2-year prediction with 81 subjects. X/Y coordinates of initial and final landmark positions were inputted into a multilayer perceptron that was trained to improve its growth prediction accuracy over several iterations. These parameters were then used on 20 test subjects and compared to the ground truth landmark locations to compute the accuracy. The 20 subjects’ growth was also predicted using Ricketts’s growth prediction (RGP) in Dolphin Imaging™ 11.9 and compared to the ground truth. Mean Absolute Error (MAE) of Ricketts and DLA were then compared to each other, and human landmark detection error used as a clinical reference mean (CRM). RESULTS: The 2-year mandibular growth prediction MAE was 4.21mm for DLA and 3.28mm for RGP. DLA’s error for skeletal landmarks was 2.11x larger than CRM, while RGP was 1.78x larger. For dental landmarks, DLA was 2.79x, and Ricketts was 1.73x larger than CRM. CONCLUSIONS: DLA is currently not on par with RGP for a 2-year growth prediction. However, an increase in data volume and increased training may improve DLA’s prediction accuracy. Regardless, significant future improvements to all growth prediction methods would more accurately assess growth from lateral cephalograms and improve orthodontic diagnoses and treatment plans.