Bone Graft Substitutes in Maxillofacial Reconstruction - Structural and Biomechanical Perspectives

Reconstruction of a maxillofacial skeletal defect in the recent past has witnessed a paradigm shift in the process of treatment planning. It has now become a collaboration between the surgeon and the bioengineer to provide a customised stable reconstruction. Understanding maxillofacial skeleton from an architectural and biomechanical perspective would not only guide the surgeon in planning a reconstruction but also the bioengineer to select the biomaterial and design an ideal reconstruction. This paper intended to provide an insight into scientific concepts which needed to be considered during the designing of biomaterials for reconstruction of maxillofacial skeletal defects. Any object in the world, from a mechanical perspective is seen only as a material of varying physical and chemical (organic / inorganic) properties dwelling in a dynamic three-dimensional environment. Bone continuously has been re-modelling by adapting to the dynamic loading environment through an established force distribution pattern of equilibrium. 1 Hence, for a patient requiring reconstruction of defects of varying dimensions within the craniomaxillofacial skeleton, its architectural complexity should be seen from both the surgeon’s and bioengineer’s perspective. Such multidisciplinary approach would provide a customized comprehensive reconstructive and rehabilitative solution.

Could Vitamin D3 Deficiency Influence Malocclusion Development?

The abnormal growth of the craniofacial bone leads to skeletal and dental defects, which result in the presence of malocclusions. Not all causes of malocclusion have been explained. In the development of skeletal abnormalities, attention is paid to general deficiencies, including of vitamin D3 (VD3), which causes rickets. Its chronic deficiency may contribute to skeletal malocclusion. The aim of the study was to assess the impact of VD3 deficiency on the development of malocclusions. The examination consisted of a medical interview, oral examination, an alginate impression and radiological imaging, orthodontic assessment, and taking a venous blood sample for VD3 level testing. In about 42.1% of patients, the presence of a skeletal defect was found, and in 46.5% of patients, dentoalveolar malocclusion. The most common defect was transverse constriction of the maxilla with a narrow upper arch (30.7%). The concentration of vitamin 25 (OH) D in the study group was on average 23.6 ± 10.5 (ng/mL). VD3 deficiency was found in 86 subjects (75.4%). Our research showed that VD3 deficiency could be one of an important factor influencing maxillary development. Patients had a greater risk of a narrowed upper arch (OR = 4.94), crowding (OR = 4.94) and crossbite (OR = 6.16). Thus, there was a link between the deficiency of this hormone and the underdevelopment of the maxilla.

Double-barrel Free Fibula for Segmental Defect of Ulna and Radius: Case Report

Introduction - Post traumatic complex defects of the forearm require multiple operations and prolonged rehabilitation. Segmental bony defects of the radius and ulna are occasionally seen as part of these complex wounds. There are a few options in bridging the skeletal defect. These include corticocancellous bone grafting, creation of a one bone forearm and vascularised fibula. Vascularised bone grafting is superior in an ischemic and fibrosed area as it enhances local blood supply. The fibula is usually used to bridge the defect in one bone i.e. the radius. Case presentation – A young male presented with an open comminuted fracture of radius and ulna following a crush injury to the left upper limb. The reconstruction was done in two stages – first a pedicled thoracoumbilical flap for soft tissue and in later stage a double barrel free fibula flap for segmental bone loss. Conclusion – The above approach offered the best chance of skeletal healing in a complex defect. The patient was able to gain reasonably good upper extremity function with the described technique.

Botulinum toxin in the treatment of gummy smile

A gummy smile is an excessive exposure of the gums while smiling. There are four types: anterior- excessive gum exposure from canine to canine, posterior — excessive gum exposure in the lateral segment, mixed — combining the anterior and posterior components, and asymmetrical — with a disproportion between the right and left side. The causes of gingival smile include: skeletal defect, delayed passive tooth eruption, nasal septal dysplasia, and excessive muscle activity. A simple, fast and minimally invasive method of gummy smile therapy caused by excessive muscle activity is the supply of botulinum toxin type A to the muscles responsible for a given type of smile. A favorable aesthetic effect can be achieved with a good knowledge of application sites and individually selected doses. When determining the dose, which is described in the literature between 2 IU and 10 IU onabotulin per page, researchers take into account not only the type of corrected smile, the number of puncture points, but also gender and age of the patient.

Influence of Vitamin D3 Deficiency on the Development of Malocclusions

Background: Insufficient or excessive growth of the craniofacial bone leads to skeletal and dental defects, which in turn result in the presence of malocclusions. To date, all causes of malocclusion have not been fully explained. In the development of skeletal abnormalities, attention is often paid to general deficiencies - including vitamin D3 deficiency, which causes rickets in growing people. It is suspected that its chronic deficiency may also affect the development of skeletal malocclusion. The aim of the study was to prospectively assess the impact of vitamin D deficiency on the development of malocclusions.Methods: The examination consisted of three parts - (1) medical interview, (2) orthodontic examination along with an alginate impression and radiological imaging, (3) taking a venous blood sample for vitamin D3 level testing.Results: In about 42,1% patients the presence of a skeletal defect was found. In 46,5% of patients presence of dentoalveolar malocclusion occurred. The most common skeletal defect was jaw narrowing in turn, among malocclusions most often retrogenia was diagnosed.Conclusions: A relatively small number of patients in the study group was diagnosed with skeletal malocclusion. Due to effects of vitamin D on the development and metabolism of bones, including jawbones, and the relationship with, for example, rickets, we believe that it would be worthwhile to conduct a study fully focused on the group of patients with skeletal defects.

Botulinum toxin in the treatment of gummy smile

A gummy smile is an excessive exposure of the gums while smiling. There are four types: anterior- excessive gum exposure from canine to canine, posterior — excessive gum exposure in the lateral segment, mixed — combining the anterior and posterior components, and asymmetrical — with a disproportion between the right and left side. The causes of gingival smile include: skeletal defect, delayed passive tooth eruption, nasal septal dysplasia, and excessive muscle activity. A simple, fast and minimally invasive method of gummy smile therapy caused by excessive muscle activity is the supply of botulinum toxin type A to the muscles responsible for a given type of smile. A favorable aesthetic effect can be achieved with a good knowledge of application sites and individually selected doses. When determining the dose, which is described in the literature between 2 IU and 10 IU onabotulin per page, researchers take into account not only the type of corrected smile, the number of puncture points, but also gender and age of the patient.