The most cited articles published since 2010, extracted from Scopus
Volume 39, Issue 4, June 2011, Pages 272-277
Sven Otto | Mario Hakim Abu-Id | Stefano Fedele | Patrick H H Warnke | Stephan Thomas Becker | Andreas Kolk | Thomas Mücke | Gerson Mast | Robert Köhnke | Elias Volkmer | Florian Haasters | Olivier Lieger | Tateyuki Iizuka | Stephen R. Porter | G. Campisi | Giuseppe Colella | Oliver Ploder | Andreas Neff | Jörg Wiltfang | Michael Ehrenfeld | Thomas Kreusch | Klaus Dietrich Wolff | Stephen Richard Stürzenbaum | Matthias Schieker | Christoph Pautke
Introduction: Bisphosphonates (BPs) are powerful drugs that inhibit bone metabolism. Adverse side effects are rare but potentially severe such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, research has primarily focused on the development and progression of BRONJ in cancer patients with bone metastasis, who have received high dosages of BPs intravenously. However, a potential dilemma may arise from a far larger cohort, namely the millions of osteoporosis patients on long-term oral BP therapy. Patients and methods: This current study assessed 470 cases of BRONJ diagnosed between 2004 and 2008 at eleven different European clinical centres and has resulted in the identification of a considerable cohort of osteoporosis patients suffering from BRONJ. Each patient was clinically examined and a detailed medical history was raised. Results: In total, 37/470 cases (7.8%) were associated with oral BP therapy due to osteoporosis. The majority (57%) of affected individuals did not have any risk factors for BRONJ as defined by the American Association of Oral and Maxillofacial Surgery. The average duration of BP intake of patients without risk factors was longer and the respective patients were older compared to patients with risk factors, but no statistical significant difference was found. In 78% of patients the duration of oral BP therapy exceeded 3 years prior to BRONJ diagnosis. Discussion: The results from this study suggest that the relative frequency of osteoporosis patients on oral BPs suffering from BRONJ is higher than previously reported. There is an urgent need to substantiate epidemiological characteristics of BRONJ in large cohorts of individuals. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 40, Issue 8, December 2012, Pages 706-718
Andreas Kolk | Jörg Handschel | Wolf R. Drescher | Daniel Rothamel | Frank Rudolf Kloss | Marco Bleßmann | Max Heiland | Klaus Dietrich Wolff | Ralf E H Smeets
An autologous bone graft is still the ideal material for the repair of craniofacial defects, but its availability is limited and harvesting can be associated with complications. Bone replacement materials as an alternative have a long history of success. With increasing technological advances the spectrum of grafting materials has broadened to allografts, xenografts, and synthetic materials, providing material specific advantages. A large number of bone-graft substitutes are available including allograft bone preparations such as demineralized bone matrix and calcium-based materials. More and more replacement materials consist of one or more components: an osteoconductive matrix, which supports the ingrowth of new bone; and osteoinductive proteins, which sustain mitogenesis of undifferentiated cells; and osteogenic cells (osteoblasts or osteoblast precursors), which are capable of forming bone in the proper environment. All substitutes can either replace autologous bone or expand an existing amount of autologous bone graft. Because an understanding of the properties of each material enables individual treatment concepts this review presents an overview of the principles of bone replacement, the types of graft materials available, and considers future perspectives. Bone substitutes are undergoing a change from a simple replacement material to an individually created composite biomaterial with osteoinductive properties to enable enhanced defect bridging. © 2011 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 5, July 2010, Pages 358-364
Poramate Pitak-Arnnop | André Chaine | Nicoleta Oprean | Kittipong Dhanuthai | Jacques Charles Bertrand | Chloé Bertolus
Background: The treatment of odontogenic keratocyst (OKC) of the jaws remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for OKC. Methods: We collected data of all OKC patients treated in the Department of Maxillofacial Surgery, Pitié-Salpêtrière University Hospital from 1995 to 2004. Basal cell naevus syndrome (Gorlin's syndrome) patients were excluded. Recurrence data was analysed in relation to radiographic features, type of microscopic diagnosis, presence of cortical perforation, and site of involvement. Results: One hundred and twenty cysts in 109 patients were examined. OKCs were more frequent in the third and the fourth decades of life (range: 11-79 years, mean: 40 years) and in men (n = 71). Most of the lesions were unilocular radiolucencies in the tooth-bearing area and in the posterior part of the mandible. Histologically, 80 lesions showed parakeratosis. Most of the patients underwent uneventful enucleation. Postoperatively, infection occurred in 4 patients, and there was no jaw fracture. Recurrence was found in 28 cysts (26%), of which 7 cysts (6%) had multiple recurrences. There was no significant association between recurrences and radiographic features, histological type, cortical perforation, or site of involvement (P > 0.05). Recurrences were common in the first 5 years after the operation. The average follow-up was 86 months since the last operation (range: 18-151 months). Conclusions: Despite the retrospective nature, no control group and a relatively high recurrence rate, our study suggests that enucleation with the aid of computed tomography and adequate postoperative surveillance is a conservative treatment which yields clinically acceptable results. However, the patients must strictly adhere to close follow-ups because recurrences may have serious consequences. Our algorithm for managing OKCs and cyst-like lesions of the jaws is also presented. © 2009 European Association for Cranio-Maxillo-Facial Surgery.
Volume 40, Issue 4, June 2012, Pages 303-309
Sven Otto | Christian Schreyer | Sigurd Hafner | Gerson Mast | Michael Ehrenfeld | Stephen Richard Stürzenbaum | Christoph Pautke
Introduction: Osteonecrosis of the jaw (ONJ) is a serious side-effect of intravenous nitrogen-containing bisphosphonate therapy frequently used in the treatment of malignant diseases. Despite numerous case series published so far studies with detailed investigations into risk factors, the precise localization of ONJ and impact of ONJ on the oncological treatment remain sparse. Patients and methods: This single-centre study collated medical records (2003-2009) of all patients that suffered from ONJ within the Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany. In total, 126 patients fulfilled the case criteria of ONJ and were examined clinically. The complete medical history including detailed questionnaires was collected of 66 patients, focussing in particular on the identification of underlying risk factors, clinical features, ONJ localization as well as the impact on the oncological treatment. Results: The majority of ONJ cases occurred in patients suffering from malignant diseases (n = 117; 92.8%), in particular breast cancer (n = 57; 45.2%), multiple myeloma (n = 37; 29.4%) and prostate cancer (n = 13; 10.3%), all received nitrogen-containing bisphosphonates intravenously. ONJ was also diagnosed in 9 patients (7.1%) suffering from osteoporosis or rheumatoid arthritis. The most prevalent clinical feature was exposed necrotic bone (93.9%) in the oral cavity which was accompanied in 78.8% of cases by pain. A predilection for the mandible and in particular for molar and premolar regions in both jaws was shown. Although no recommendation concerning the oncologic treatment was made, the manifestation of ONJ resulted (in a significant proportion of the patients) in a change of medication and schedule. The most frequent co-medications were steroids and anti-angiogenetic drugs, such as thalidomide. Discussion: The predilection for mandibular molar and premolar regions, and the infectious conditions that often precede the onset of ONJ support recent pathogenesis theories stating that local inflammation and associated pH-changes may trigger the release and activation of nitrogen-containing bisphosphonates ultimately resulting in necrosis. Conclusion: The development of ONJ has a multi-factorial aetiology and the clinical presentation can vary markedly. ONJ cannot only impair the quality of life but also the treatment of the underlying disease. © 2011 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 6, September 2010, Pages 423-430
Juan Camilo Roldàn | Rainer Detsch | Susannne Schaefer | Edward Chang | M. Kelantan | W. Waiss | Torsten Eugen Reichert | Geoffrey C. Gurtner | Ulrike Deisinger
Introduction: Angiogenesis and mesenchymal stem cells (MSCs) promote osteogenesis. The aim of the present study was to evaluate whether bone morphogenetic protein (BMP-7) promoted osteoinduction could be enhanced by combining it with vascular endothelial growth factor (VEGF) or MSCs in highly porous biphasic calcium phosphate (BCP) ceramics. Materials and methods: BCP ceramic blocks were implanted in an ectopic site in 24 mice (BMP-7 vs. BMP-7/VEGF; BMP-7 vs. BMP-7/MSCs and BMP-7 vs. Control; each group n = 8). Specimens were analysed 12 weeks after surgery by environmental scanning electron microscopy (ESEM) and Giemsa staining. Results: In all implanted scaffolds, newly formed bone was observed, even in the control site. No statistical differences in the amount of new bone were found in the presence of BMP-7 compared to BMP-7/VEGF (p = 1.0) or BMP-7/MSCs (p = 0.786). ESEM revealed a degradation of the scaffolds. A higher degradation was observed in areas where no bone-implant contact was present compared to areas where the ceramic was integrated in newly formed bone. Conclusions: Neither VEGF nor MSCs enhanced BMP-7 induced bone formation under the selected conditions. The present ceramic seemed to be osteoinductive and degradable, making this material suitable for bone tissue engineering. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 39, Issue 1, January 2011, Pages 54-64
Jan E. Fischer | Andreas Kolk | Stefan Wolfart | Christoph Pautke | Patrick H H Warnke | Christian Plank | Ralf E H Smeets
The most promising attempts to achieve bone regeneration artificially are based on the application of mediators such as bone morphogenetic proteins (BMPs) directly to the deficient tissue site. BMPs, as promoters of the regenerative process, have the ability to induce de novo bone formation in various tissues, and many animal models have demonstrated their high potential for ectopic and orthotopic bone formation. However, the biological activity of the soluble factors that promote bone formation in vivo is limited by diffusion and degradation, leading to a short half-life. Local delivery remains a problem in clinical applications. Several materials, including hydroxyapatite, tricalcium phosphate, demineralised bone matrices, poly-lactic acid homo- and heterodimers, and collagen have been tested as carriers and delivery systems for these factors in a sustained and appropriate manner. Unfortunately these delivery vehicles often have limitations in terms of biodegradability, inflammatory and immunological rejection, disease transmission, and most importantly, an inability to provide a sustained, continuous release of these factors at the region of interest. In coping with these problems, new approaches have been established: genes encoding these growth factor proteins can be delivered to the target cells. In this way the transfected cells serve as local "bioreactors", as they express the exogenous genes and secrete the synthesised proteins into their vicinity. The purpose of this review is to present the different methods of gene versus growth factor delivery in tissue engineering. Our review focuses on these promising and innovative methods that are defined as regional gene therapy and provide an alternative to the direct application of growth factors. Various advantages and disadvantages of non-viral and viral vectors are discussed. This review identifies potential candidate genes and target cells, and in vivo as well as ex vivo approaches for cell transduction and transfection. In explaining the biological basis, this paper also refers to current experimental and clinical applications. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 40, Issue 4, June 2012, Pages 310-320
Philipp Stockmann | Jung Park | Cornelius Von Wilmowsky | Emeka Nkenke | Endre Felszeghy | Jan Friedrich Dehner | Christian Martin Schmitt | Christian Tudor | Karl Andreas Schlegel
Due to donor side morbidity and the absence of osteogenic properties in bone substitutes, there is a growing need for an alternative to traditional bone grafting within the scope of tissue engineering. This animal study was conducted to compare the in vivo osteogenic potential of adipose-derived (AD), periosteum-derived (PD) and bone marrow-derived (BM) mesenchymal stem/progenitor cells (MSC). Autologous mesenchymal stem/progenitor cells of named tissue origin were induced into osteogenic differentiation following in vitro cell expansion. Ex vivo cultivated cells were seeded on a collagen scaffold and subsequently added to freshly created monocortical calvarial bone defects in 21 domestic pigs. Pure collagen scaffold served as a control defect. The animals were sacrificed at specific time points and de novo bone formation was quantitatively analyzed by histomorphometry. Bone volume/total defect volume (BV/TV) and the mineralization rate of newly formed bone were compared among the groups. In the early stages of wound healing, up to 30 days, the test defects did not show better bone regeneration than those in the control defect, but the bone healing process in the test defects was accelerated in the later stage compared to those in the control defect. All the test defects showed complete osseous healing after 90 days compared to those in the control defect. During the observation period, no significant differences in BV/TV and mineralization of newly formed bone among the test defects were observed. Irrespective of the tissue sources of MSC, the speed and pattern of osseous healing after cell transplantations into monocortical bone defects were comparable. Our results indicate that the efficiency of autologous AD-MSC, PD-MSC and BM-MSC transplantation following ex vivo cell expansion is not significantly different for the guided regeneration of bone defects. © 2011 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 4, June 2010, Pages 255-259
Martin Koš | Joachim Friedrich Kuebler | Klaudiusz Łuczak | Werner Engelke
Introduction: The purpose of this study was to identify factors that influence bisphosphonate-related osteonecrosis of the jaws (BRONJ). Patients and methods: Patients undergoing treatment for BRONJ (n = 34) were evaluated. Sex, age, underlying diagnosis, type of bisphosphonate (BP), duration and route of administration, location of osteonecrosis, clinical symptoms, Actinomyces colonisation, treatment and outcome were recorded. Symptom onset was analysed with respect to BP potency and cumulative dose. Results: Underlying diagnoses indicating BP-treatment included multiple myeloma, breast carcinoma, prostate carcinoma and osteoporosis. In 31 patients, BRONJ was preceded by tooth extraction, root apicotomy, ill-fitting dentures, cystenucleation, implant insertion or trauma; in 3 patients, the precipitating event was not identified. Actinomyces colonisation was observed in 18 patients (53%). The occurrence of BRONJ was not directly related to BP dose or potency. More women with multiple myeloma had BRONJ than did males. BRONJ was observed in osteoporotic patients treated with both corticosteroids and BPs. Conclusions: BRONJ was not primarily associated with BP potency or dose. Factors that increased the risk of osteonecrosis were female sex, oral surgery and corticosteroids plus intravenous or oral BP administration. BP deposition in the jaw bones might enhance BRONJ by promoting bacterial colonisation; however, this hypothesis requires more study. © 2009 European Association for Cranio-Maxillo-Facial Surgery.
Volume 40, Issue 2, February 2012, Pages 162-168
Samir Aboul-hosn Centenero | Federico Hernández-Alfaro
The aim of this article is to determine the advantages of 3D planning in predicting postoperative results and manufacturing surgical splints using CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology in orthognathic surgery when the software program Simplant OMS 10.1 (Materialise ®, Leuven, Belgium) was used for the purpose of this study which was carried out on 16 patients. A conventional preoperative treatment plan was devised for each patient following our Centre's standard protocol, and surgical splints were manufactured. These splints were used as study controls. The preoperative treatment plans devised were then transferred to a 3D-virtual environment on a personal computer (PC). Surgery was simulated, the prediction of results on soft and hard tissue produced, and surgical splints manufactured using CAD/CAM technology. In the operating room, both types of surgical splints were compared and the degree of similitude in results obtained in three planes was calculated. The maxillary osteotomy line was taken as the point of reference. The level of concordance was used to compare the surgical splints. Three months after surgery a second set of 3D images were obtained and used to obtain linear and angular measurements on screen. Using the Intraclass Correlation Coefficient these postoperative measurements were compared with the measurements obtained when predicting postoperative results. Results showed that a high degree of correlation in 15 of the 16 cases. A high coefficient of correlation was obtained in the majority of predictions of results in hard tissue, although less precise results were obtained in measurements in soft tissue in the labial area. The study shows that the software program used in the study is reliable for 3D planning and for the manufacture of surgical splints using CAD/CAM technology. Nevertheless, further progress in the development of technologies for the acquisition of 3D images, new versions of software programs, and further studies of objective data are necessary to increase precision in computerised 3D planning. © 2011 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 8, December 2010, Pages 565-570
Uwe Klammert | Uwe Gbureck | Elke Vorndran | Jan Rödiger | Philipp Meyer-Marcotty | Alexander C. Kübler
Background: The aim of this study was to investigate the processing and the possible use of 3D powder printed calcium phosphate implants for the reconstruction of cranial and maxillofacial defects. Materials: The fabrication of the implants was carried out with a commercial 3D powder printing system. Diluted phosphoric acid was printed onto tricalcium phosphate powder, leading to the formation of dicalcium phosphate dihydrate (Brushite). Hydrothermal conversion of the brushite matrices led to the formation of dicalcium phosphate anhydrous (Monetite). Method: Bony defects were generated using a human cadaver skull. The implants were computer-aided designed (CAD) using a mirror imaging procedure following computed tomography of the skull. Specific implants were manufactured by the 3D powder printing rapid prototyping technique. Result: The processing chain from data acquisition to printing of the implants proved to be practical and uncomplicated. The individual implants showed a high degree of accuracy of fit. Mechanical and physical investigations revealed suitable characteristics. Conclusion: 3D powder printing of calcium phosphate cement material provides a promising new method for the manufacturing of biodegradable synthetic patient-specific craniofacial implants. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 40, Issue 1, January 2012, Pages 2-7
Hossein Behnia | Arash Khojasteh | Masoud Soleimani | Azita Tehranchi | Amir Atashi
The purpose of this study was to evaluate the enhancing effect of recombinant platelet derived growth factor on human mesenchymal stem cells (hMSCs) in secondary alveoloplasty. Three patients with 4 alveolar defects were selected for this study. Mesenchymal stem cells were cultured from a posterior iliac bone aspirate. MSCs were mounted on biphasic scaffolds and combined with platelet derived growth factor (PDGF) in the operating room to make a triad of the scaffold, growth factor, and cells. The triads were placed in anterior maxillary cleft defects and closed with lateral advancement gingival flaps. The postoperative cleft bone volume was measured with cone beam computed tomography scans. A mean of 51.3% fill of the bone defect was calculated 3 months post-operation. Our data suggests the use of recombinant platelet derived growth factor with hMSCs may enhance the regeneration capacity of the cells. © 2011 European Association for Cranio-Maxillo-Facial Surgery.
Volume 40, Issue 2, February 2012, Pages 116-123
Bruno Ramos Chrcanovic | Mauro Henrique Nogueira Guimarães de Abreu | Belini Augusto Villalba Freire-Maia | Leandro Napier De Souza
Objective: To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil. Methods: The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson's chi-square, Bonferroni, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests, and analysis of variance. Results: There were 1,454 mandibular fractures in 1,023 patients. Males of 20-29 years of age sustained the majority of fractures. Traffic accidents were the major causes of trauma, followed by violence and falls. A high incidence of fractures in women due to violence was observed. The condyle region was found to be the most common fracture site in the mandible. A surgical approach was performed in most cases. There were more accidents causing mandibular fractures on the weekends. Conclusion: The individuals with mandibular fractures due to "traffic accidents" were younger than those due to "violence" and "falls". There was a significant statistical association between age and aetiology as well as between sex and aetiology of mandibular fractures. © 2011 European Association for Cranio-Maxillo-Facial Surgery.
Volume 39, Issue 5, July 2011, Pages 343-350
António Manuel De Amaral Monteiro Ramos | A. Completo | Carlos Relvas | Michel Mesnard | José António Oliveira Simões
A 3D finite element model of in vitro intact and implanted mandibles with different temporomandibular joints (TMJ) was analyzed. Three TMJ implant geometries were assessed. The displacements, stress and strain fields on the condyle were obtained for both simulated cases. Strains were also assessed near the screws that fixate the implant to the mandible. The geometry of the mandible was obtained through 3D digitalization of a synthetic model. The TMJ implants studied were modelled considering a commercial implant which was also used to create semi-anatomic and anatomic implants that were analyzed and to assess the influence of the geometry. Numerical finite element models were built and the implants were positioned by an experienced orofacial surgeon. All implants were fixed by four screws which were placed in the same position on the mandible. The boundary conditions were simulated considering the support on the incisive tooth, the loads of the five most important muscular forces and a 5 mm mouth aperture. This study indicates that the deformation on the intact mandible was similar when an anatomic implant was considered in the implanted mandible. However, the anatomic geometry presented some problems concerning the implant integrity due to geometric variations. The geometry of TMJ implant also played a role relatively to the screws structural integration and bone fixation. The geometry of TMJ implant defines the necessary number of screws and position in the mandible fixation. © 2010 European Association for Cranio-Maxillo- Facial Surgery.
Volume 38, Issue 7, October 2010, Pages 511-516
Ioannis A. Iatrou | Nadia Theologie-Lygidakis | Fotios X. Tzerbos
Trauma and facial fractures in a population of children have been analysed in several studies mainly regarding their incidence and much less their treatment modalities. Aim: The aim of this study was to retrospectively analyse the treatment methods and outcome of facial fractures in children and young adolescents during the last decade and to discuss findings and propose treatment protocols. Patients and methods: Patients of the Paediatric Maxillofacial department, treated for fractures of the facial skeleton were included in the study. Open reduction and osteosynthesis plate fixation (titanium and resorbable material) was the main treatment method with conservative treatment saved for selected cases. Titanium plates were removed after bone healing. Intermaxillary fixation (IMF) was not used regularly in mandibular fractures, with the exception of condylar fractures. Results: 156 children and young adolescents with 208 fracture sites in total were treated. 139 fracture sites (66.8%) were treated with open reduction and 69 conservatively. The mandible was affected in 49.0% of the cases, the maxilla in 21.2% (both with the alveolar process fractures included), the zygomatic complex in 10.1%, the orbital walls in 9.6%. There were 38 alveolar process fractures. Conclusion: The results of the fracture treatment verified the usefulness of open reduction and plate fixation in children. There was no need for wire suspension and only occasional need for IMF. Closed reduction was selectively applied in condylar fractures and dento-alveolar trauma. © 2010 European Association for Cranio-Maxillo- Facial Surgery.
Volume 40, Issue 3, April 2012, Pages e75-e81
Ivica Lukšić | Mišo M. Virag | Spoménka Manojlović | Darko Macan
Introduction: The aim of this study was to determine the types, frequency, distribution, and demographic characteristics of salivary gland tumours in a large representative sample. Patients and methods: We retrospectively analysed the medical records of 779 patients with tumours of the salivary glands surgically treated from 1985 to 2009 at a single institution. Results: There were 500 benign and 279 malignant tumours. The average age of patients with benign tumours was 50 years and of malignant salivary gland tumours 56 years. No differences in age and incidence of tumours existed between males and females. The majority of the tumours occurred in the parotid gland (509), followed by the minor salivary glands (212), the submandibular gland (51) and lastly, the sublingual gland (7). Minor salivary gland tumours occurred most frequently on the palate, the pleomorphic adenoma being the most frequent benign tumour type and the adenoid cystic carcinoma being the commonest malignant tumour. Tumours of the sublingual gland were rare, but all were malignant. Malignant tumours were more common in the minor salivary glands and the submandibular gland. Conclusion: This large study of salivary gland tumours in Croatia could improve our understanding of the significant differences in the global distribution of salivary gland tumours which have been reported. © 2011 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 1, January 2010, Pages 4-10
Poramate Pitak-Arnnop | Robert Alexander Sader | Alexander D. Rapidis | Kittipong Dhanuthai | Ute Bauer | Christian Hervè | Alexander Hemprich
Background: Publication bias (PB) diminishes the full distribution of research, distorts and discredits the scientific record, and thus compromises evidence-based practice. The objective of this study was to analyse published controlled trials with regard to PB in leading oral and maxillofacial surgery (OMS) journals. Methods: All controlled trials published in the International Journal of Oral and Maxillofacial Surgery, Journal of Cranio-Maxillofacial Surgery, Journal of Oral and Maxillofacial Surgery, and British Journal of Oral and Maxillofacial Surgery in 2008 were analysed for a primary outcome, country of authors, sample size, gender of the first author, funding source and location of the study. Results: Of 952 published articles, 53 controlled trials (5.7%) were identified. The OMS journals preferentially published controlled trials with a positive outcome (77.4%) and from high-income countries (73.6%). Single-centred trials (86.8%) with low sample size (n < 100; 69.8%) were published more frequently. The majority of the first authors were male (75.5%). Funding source disclosure in most studies (73.6%). Conclusions: Our results suggest the possible existence of PB in the OMS literature. Hence, it should be borne in mind that the published articles may not be representative of all scientific works, especially when systematic reviews and meta-analyses are conducted or read. In the meantime, journals should establish measures to eliminate PB to uphold scientific integrity. However, this study was an observation based on the published articles. An analysis of all submitted manuscripts would provide more accurate estimates of PB. Ethical considerations on PB are also discussed. © 2009 European Association for Cranio-Maxillofacial Surgery.
Volume 38, Issue 3, April 2010, Pages 192-196
Jung Hoon Lee | Byungki Cho | WooJin Park
A number of researchers from various regions have reported statistical and clinical studies of facial fractures. The results of those studies show slight differences depending on regional, cultural, social and economic backgrounds. This report presents a statistical analysis of facial fractures occurring over 4 years on Jeju, Korea. The statistics come from the 318 patients who presented to Cheju National University Hospital for facial fractures, and ours is a retrospective study analyzing patient ages, gender, fracture etiology, alcohol involvement and the anatomical site of the fracture. The most common cause of facial fractures on Jeju was violence (40.9%), followed by traffic accidents (17%). The most frequently fractured site was the nasal bone (42.5%). According to the Jeju Statistics Agency, the people of Jeju are highly dependent on alcohol and previous research has reported the close relationship between alcohol consumption and violence. We paid close attention to violence as a primary cause for facial fractures in the cultural and social context of Jeju. Data analysis regarding facial fractures may provide crucial information for recognition of causes and planning for prevention. © 2009 European Association for Cranio-Maxillo-Facial Surgery.
Volume 39, Issue 2, March 2011, Pages 91-92
Karsten Knobloch | Uzung Yoon | Peter Maria Vogt
Publication bias is a major problem in evidence based medicine. As well as positive outcome studies being preferentially published or followed by full text publication authors are also more likely to publish positive results in English-language journals. This unequal distribution of trials leads to a selection bias in evidence l level studies, like systematic reviews, meta-analysis or health technology assessments followed by a systematic failure of interpretation and in clinical decisions. Publication bias in a systematic review occurs mostly during the selection process and a transparent selection process is necessary to avoid such bias. For systematic reviews/meta-analysis the PRISMA-statement (formerly known as QUOROM) is recommended, as it gives the reader for a better understanding of the selection process. In the future the use of trial registration for minimizing publication bias, mechanisms to allow easier access to the scientific literature and improvement in the peer review process are recommended to overcome publication bias. The use of checklists like PRISMA is likely to improve the reporting quality of a systematic review and provides substantial transparency in the selection process of papers in a systematic review. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 8, December 2010, Pages 571-579
Ralf Gutwald | Jörg Haberstroh | Andres Stricker | Eva Rüther | Florian Otto | Samuel Porfírio Xavier | Toshiyuki Oshima | Eriko Marukawa | Ichiro Seto | Shoji Enomoto | Christiaan Frederik Hoogendijk | Rainer Schmelzeisen | Sebastian Sauerbier
Background: Several studies have reported certain bone morphogenic proteins (BMPs) to have positive effects on bone generation. Although some investigators have studied the effects of human recombinant BMP (rhBMP-2) in sinus augmentation in sheep, none of these studies looked at the placement of implants at the time of sinus augmentation. Furthermore, no literature could be found to report on the impact that different implant systems, as well as the positioning of the implants had on bone formation if rhBMP-2 was utilized in sinus-lift procedures. Purpose: The aim of this study was to compare sinus augmentation with rhBMP-2 on a poly-d, l-lactic-co-glycolic acid gelatine (PLPG) sponge with sinus augmentation with autologous pelvic cancellous bone in the maxillary sinus during the placement of different dental implants. Materials and methods: Nine adult female sheep were submitted to bilateral sinus-floor elevation. In one side (test group) the sinus lift was performed with rhBMP-2 on a PLPG-sponge, while the contralateral side served as the control by using cancellous bone from the iliac crest. Three different implants (Bränemark®, 3i® and Straumann®) were inserted either simultaneously with the sinus augmentation or as a two staged procedure 6 weeks later. The animals were sacrificed at 6 and 12 weeks for histological and histomorphometrical evaluations during which bone-to-implant contact (BIC) and bone density (BD) were evaluated. Results: BD and BIC were significantly higher at 12 weeks in the test group if the implants were placed at the time of the sinus lift (p < 0.05). No difference was observed between the different implant systems or positions. Conclusions: The use of rhBMP-2 with PLPG-sponge increased BIC as well as BD in the augmented sinuses if compared to autologous bone. Different implant systems and positions of the implants had no effect on BIC or BD. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 3, April 2010, Pages 222-230
Alessandro Acocella | Roberto Bertolai | Maurizio Colafranceschi | Roberto Sacco
Background: Localized bone defects in the maxilla are commonly reconstructed with autologous mono-cortical bone blocks prior to the placement of dental implants. This study presents a clinical, histological and histomorphometric analysis on the use of mandibular ramus block grafts for ridge augmentation. Materials and Methods: mono-cortical bone blocks from the mandibular ramus were grafted in 15 patients. The bone grafts were left to heal for period varying from 3 to 9 months. Afterwards, 30 implants were inserted and bone samples were removed for subsequent histological analysis. Results: All the bone grafts were successful and resorption was minimal. There were no implant failures. At graft placement, mean lateral augmentation was 4.6 ± 0.73 mm, which, later, at the time of implant insertion, reduced to 4 ± 0.77 mm. Histological evaluation indicated signs of active remodelling in all specimens. However, the grafted bone contained substantial amounts of non-vital bone (NVB) and generally weak neo-vascularization regardless of the time of biopsies. Conclusions: The outcome of the study suggests that the larger part of osteocytes in mono-cortical bone do not survive grafting and neo-vascularization of non-vital grafted bone is difficult because of the slow remodelling process into new vital. © 2009 European Association for Cranio-Maxillo-Facial Surgery.
Volume 39, Issue 5, July 2011, Pages 330-334
Bettina Hohlweg-Majert | Marc Christian Metzger | Tobias Kummer | Dirk Schulze
Aim: Modified quantitative computed tomography is a method used to predict bone quality and quantify the bone mass of the jaw. The aim of this study was to determine whether bone quantity or quality was detected by cone beam computed tomography (CBCT) combined with image analysis. Materials and procedures: Different measurements recorded on two phantoms (Siemens phantom, Comac phantom) were evaluated on images taken with the Somatom VolumeZoom (Siemens Medical Solutions, Erlangen, Germany) and the NewTom 9000 (NIM s.r.l., Verona, Italy) in order to calculate a calibration curve. The spatial relationships of six sample cylinders and the repositioning from four pig skull halves relative to adjacent defined anatomical structures were assessed by means of three-dimensional visualization software. Results: The calibration curves for computer tomography (CT) and cone beam computer tomography (CBCT) using the Siemens phantom showed linear correlation in both modalities between the Hounsfield Units (HU) and bone morphology. A correction factor for CBCT was calculated. Exact information about the micromorphology of the bone cylinders was only available using of micro computer tomography. Conclusion: Cone-beam computer tomography is a suitable choice for analysing bone mass, but, it does not give any information about bone quality. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 39, Issue 5, July 2011, Pages 364-371
Dror Ben-David | Tali A. Kizhner | Thomas P. Köhler | Ralph Müller | Erella Livne | Samer Srouji
Bone is the second most frequently transplanted tissue in humans and efforts are focused on developing cell-scaffold constructs which can be employed for autologous implantation in place of allogenic transplants. The objective of the present study was to examine the efficacy of a gelatin-based hydrogel scaffold to support osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells (MSCs) and its application in a cranial defect model. MSCs which were cultured on hydrogel under osteogenic conditions demonstrated typical osteogenic differentiation which included cluster formation with positive Alizarin Red S staining, sedimentation of calcium phosphate as defined by SEM and EDS spectroscopy and expression of mRNA osteogenic markers. Empty scaffolds or those containing either differentiated cells or naïve cells were implanted into cranial defects of athymic nude mice and the healing process was followed by μCT. Substantial bone formation (65%) was observed with osteogenic cell-scaffold constructs when compared to the naïve cell construct (25%) and the cell free scaffold (10%). Results demonstrated the potential of hydrogel scaffolds to serve as a supportive carrier for bone marrow-derived MSCs. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 7, October 2010, Pages 488-493
Hans Joachim Nickenig | Manfred Gerhard Wichmann | Jörg F. Hamel | Karl Andreas Schlegel | Stephan Eitner
Purpose: The purpose of this study was to assess the accuracy of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates, and to match the results with those achieved with the conventional free-hand method. Materials and methods: Twenty-three implants were placed in 10 patients with a Kennedy Class II with 3-dimensional (3-D) planned surgical guide template. Manual implantation was performed in anatomical casts of the same patients by a prosthodontist and a maxillofacial surgeon. Postoperative images of casts were superimposed onto the preoperative image of virtual planned ideal position of the implant. Results: The 3-D surgical guide template produced significantly smaller variation between the planned and actual implant positions at the implant shoulder (0.9 mm (0-4.5)) and apex (0.6-0.9 mm (0.0-3.4)) compared with the free-hand implantation (2.4-3.5 mm (0.0-7.0); p = 0.000 and 2.0-2.5 mm (0.0-7.7); p = 0.002). Accuracy of axis was also significantly improved. Conclusions: Accuracy of implant placement after virtual planning of implant position using cone-beam CT data and surgical templates is high and significantly more accurate than free-hand insertion. The demonstrated method of superimposing radiographic images of postoperative casts and virtual planning images is a useful method, which allows reduced patient radiation exposure. © 2010 European Association for Cranio-Maxillo-Facial Surgery.
Volume 40, Issue 3, April 2012, Pages 283-286
HeeSeok Roh | Wook Kim | Youngku Kim | Jeongyun Lee
This study was performed to investigate the relationships between disk displacement, joint effusion, and degenerative changes in patients with temporomandibular disorders using MRI. Randomly selected MRIs of 508 temporomandibular joints of 254 patients (92 males and 162 females, mean age was 30.5 ± 12.0 years) were reviewed retrospectively. Seventy-eight percent (198 out of 254) of the patients complained of joint pain. Compared with joints with a normal disk position, the joints with anterior disk displacement with reduction showed a 2.01 odds ratio (P < 0.01) of degenerative changes and a 2.85 odds ratio (P < 0.001) of joint effusions. The joints with anterior disk displacement without reduction showed a 4.43 odds ratio (P < 0.001) of degenerative changes and a 4.61 odds ratio (P < 0.001) of joint effusions. These results clearly show that the risk of degenerative changes and joint effusions increase with displacement of the disk position in patients with temporomandibular disorders. Although all disk displacement situations do not progress to painful joints and/or degenerative joint diseases, the possibility of an increased risk of progression by a breakdown in the balance between a patient's adaptive capacity and functional loading of the TMJ should be assessed in each and every patient through comprehensive evaluation of various contributing factors. © 2011 European Association for Cranio-Maxillo-Facial Surgery.
Volume 38, Issue 2, March 2010, Pages 122-130
Karsten Kurt Helmuth Gundlach
Introduction: True ankylosis of the temporo-mandibular joint must be differentiated from other reasons why a patient is unable to open his mouth properly. It can be treated by various methods. It is the purpose of this paper to(a)Present various cases with different disorders that had lead to a restricted mouth opening and(b)Report upon the long-term post-operative results achieved by having applied various treatment options for true ankylosis of the temporomandibular joint (TMJ). Material and methods: In 40 patients a true ankylosis was treated surgically by applying one of the two protocols: Either by interposing silastic sheetings or by implanting a TMJ prosthesis made of metal and consisting of 2 parts, a condylar head and a temporal fossa. Twenty patients could be followed up after 113 months on average - 13 patients of these have been treated by interposition of silastic and 7 have received endoprostheses. In 7 other patients, different reasons were found inhibiting freely opening the mouth. Congenital bony ankylosis of upper and lower alveolar processes, congenital or acquired bony fusion of the coronoid process with the zygomatic arch and/or temporal bone, acquired ankylosis between mandible and lateral pterygoid plate, ossifying myositis, or fibrosis of masticatory muscles following tumour irradiation. Not all of these could be operated upon and not all of these could be followed up. However, all patients operated upon followed a strict postoperative physiotherapeutic regimen. Results: Long-term follow-up maximum interincisal distances (MiDs) were callipered: 34 mm (mean; min. 22, max. 52) following silastic sheeting; 18 mm (mean; min. 10, max. 23) following endoprosthesis implantation. In the one of the two patients who could be followed up after ankylosis of the coronoid with the temporal bone, the MiD measured 49 mm 1 year postoperatively. In that one of the two patients who could be operated because of a unilateral bony fusion between the mandible and the pterygoid plate, MiD was only 26 mm 8 years postoperatively. And in the one of the two males who could be followed up 8 years after operation of myositis ossificans, MiD measured 50 mm. Conclusion: There are several possible reasons why a patient cannot open his mouth widely. Six of these have been touched upon, 4 of these have been operated upon. For true ankylosis silastic (sheeting or blocks) is felt to be the best material for interposition following osteotomy. Postoperative physiotherapy is a conditio sine qua non - it is the second most important part for every type of treatment for ankylosis. © 2009 European Association for Cranio-Maxillo-Facial Surgery.