Larry M. Wolford D.M.D.

Ebrahim, F. H., A. C. O. Ruellas, B. Paniagua, E. Benavides, K. Jepsen, L. Wolford, J. R. Goncalves and L. H. S. Cevidanes (2017). “Accuracy of biomarkers obtained from cone beam computed tomography in assessing the internal trabecular structure of the mandibular condyle.” Oral Surg Oral Med Oral Pathol Oral Radiol 124(6): 588-599.

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OBJECTIVE: The aim of this study was to validate the ability of cone beam computed tomography (CBCT) to measure condylar internal trabecular bone structure and bone texture parameters accurately. STUDY DESIGN: Sixteen resected condyles of individuals undergoing temporomandibular joint replacement were collected and used as samples. These condyles were then radiographically imaged by using clinically oriented dental CBCT and research oriented micro-computed tomography (micro-CT). The CBCT scans were then compared with the gold standard micro-CT scans in terms of 21 bone imaging parameters. Descriptive histologic investigation of the specimens was also performed. RESULTS: Significant correlations were found for several imaging parameters between the CBCT and micro-CT images, including trabecular thickness (r = 0.92), trabecular separation (r = 0.78), bone volume (r = 0.90), bone surface area (r = 0.79), and degree of anisotropy measurements (r = 0.77). CONCLUSIONS: Measurements of trabecular thickness, trabecular separation, bone volume, bone surface area, and degree of anisotropy obtained from high-resolution dental CBCT images may be suitable bone imaging biomarkers that can be utilized clinically and in future research.

Gomes, L. R., L. H. Cevidanes, M. R. Gomes, A. C. Ruellas, D. P. Ryan, B. Paniagua, L. M. Wolford and J. R. Goncalves (2017). “Counterclockwise maxillomandibular advancement surgery and disc repositioning: Can condylar remodeling in the long-term follow-up be predicted?” Int J Oral Maxillofac Surg 46(12): 1569-1578.

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This study investigated predictive risk factors of condylar remodeling changes after counterclockwise maxillomandibular advancement (CCW-MMA) and disc repositioning surgery. Forty-one female patients (75 condyles) treated with CCW-MMA and disc repositioning had cone beam computed tomography (CBCT) scans taken pre-surgery, immediately after surgery, and at an average 16 months post-surgery. Pre- and post-surgical three-dimensional models were superimposed using automated voxel-based registration on the cranial base to evaluate condylar displacements after surgery. Regional registration was performed to assess condylar remodeling in the follow-up period. Three-dimensional cephalometrics, shape correspondence (SPHARM-PDM), and volume measurements were applied to quantify changes. Pearson product-moment correlations and multiple regression analysis were performed. Highly statistically significant correlation showed that older patients were more susceptible to overall condylar volume reduction following CCW-MMA and disc repositioning (P

Angelieri, F., L. Franchi, L. H. S. Cevidanes, J. R. Goncalves, M. Nieri, L. M. Wolford and J. A. McNamara, Jr. (2017). “Cone beam computed tomography evaluation of midpalatal suture maturation in adults.” Int J Oral Maxillofac Surg 46(12): 1557-1561.

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The aim of this study was to evaluate midpalatal suture maturation in adults, as observed in cone beam computed tomography (CBCT) images. CBCT scans from 78 subjects (64 female and 14 male, age range from 18 to 66 years) were evaluated. Midpalatal suture maturation was verified on the central cross-sectional axial slice in the superior-inferior dimension of the palate, using methods validated previously. Intra-examiner agreement was analyzed by weighted kappa test. Multinomial logistic regression was used to test whether sex and chronological age (adults <30 years or >/=30 years) could be used as a predictor for the maturational stages of the midpalatal suture. The majority of the adults presented a fused midpalatal suture in the palatine (stage D) and/or maxillary bones (stage E). However, the midpalatal suture was not fused in 12% of the subjects. Sex and chronological age were not significant predictors of the maturational stages of the midpalatal suture. The individual assessment of midpalatal suture maturation by way of CBCT images may provide reliable information critical to making the clinical decision between rapid maxillary expansion and surgically assisted rapid maxillary expansion for the treatment of maxillary atresia in adults.

Albilia, J. B., H. Weisleder and L. M. Wolford (2017). “Treatment of posterior dislocation of the mandibular condyle with the double mitek mini anchor technique: A case report.” J Oral Maxillofac Surg: 2017 Oct [Epub ahead of print].

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Posterior dislocation of the mandibular condyle is a rare disorder caused by trauma to the chin accompanied by damage to the external auditory canal. Treatment of posterior condylar dislocation (PCD) is directed at repositioning the condyle into the glenoid fossa, preventing recurrent dislocations, and maintaining patency of the ear canal. With early intervention, closed reduction with manual manipulation is successful but could be ineffective for chronic protracted PCD. This case report describes an elderly patient with a chronic protracted PCD resulting from a blow to the chin and in which manual reduction was unsuccessful. An open arthroplasty for condylar reduction and application of a “reverse” double Mitek mini anchor technique was required to prevent recurrence of PCD, with a successful outcome.

Al-Moraissi, E. A., L. M. Wolford, D. Perez, D. M. Laskin and E. Ellis, 3rd (2017). “Does orthognathic surgery cause or cure temporomandibular disorders? A systematic review and meta-analysis.” J Oral Maxillofac Surg 75(9): 1835-1847.

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PURPOSE: There is still controversy about whether orthognathic surgery negatively or positively affects temporomandibular disorders (TMDs). The purpose of this study was to determine whether orthognathic surgery has a beneficial or deleterious effect on pre-existing TMDs. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 major databases to locate all pertinent articles published from 1980 to March 2016. All subjects in the various studies were stratified a priori into 9 categories based on subdiagnoses of TMDs. The predictor variables were those patients with pre-existing TMDs who underwent orthognathic surgery in various subgroups. The outcome variables were maximal mouth opening and signs and symptoms of a TMD before and after orthognathic surgery based on the type of osteotomy. The meta-analysis was performed using Comprehensive Meta-Analysis software (Biostat, Englewood, NJ). RESULTS: A total of 5,029 patients enrolled in 29 studies were included in this meta-analysis. There was a significant reduction in TMDs in patients with a retrognathic mandible after bilateral sagittal split osteotomy (BSSO) (P = .014), but no significant difference after bimaxillary surgery (BSSO and Le Fort I osteotomy) (P = .336). There was a significant difference in patients with prognathism after isolated BSSO or intraoral vertical ramus osteotomy and after combined BSSO and Le Fort I osteotomy (P = .001), but no significant difference after BSSO (P = .424) or bimaxillary surgery (intraoral vertical ramus osteotomy and Le Fort I osteotomy) (P = .728). CONCLUSIONS: Orthognathic surgery caused a decrease in TMD symptoms for many patients who had symptoms before surgery, but it created symptoms in a smaller group of patients who were asymptomatic before surgery. The presence of presurgical TMD symptoms or the type of jaw deformity did not identify which patients’ TMDs would improve, remain the same, or worsen after surgery.