Continuous mandibular distraction osteogenesis in minipigs
Goldwaser BR, Magill J, Papadaki ME, Byl M, Kromann R, Yates B, et al. Continuous mandibular distraction osteogenesis: novel device and preliminary results in minipigs. J Oral Maxillofac Surg 2013;71:e168-77
Distraction osteogenesis uses the body’s natural ability to regenerate bone and serves as a surgical treatment option for mandibular hyperplasia. Researchers developed an automated distractor system that adjusts to tissue resistance to maintain a constant 3-dimensional distraction force. The new developments aim to eliminate patient noncompliance and to stimulate faster rates of bone formation. The system consists of a buried curvilinear distractor, an external electronic module, and a handheld computer for the clinician to monitor and adjust the protocol without the need for radiographs. The buried distractor allows 30 N of continuous force with a maximum distraction length of 25 mm. A position sensor measures the distraction gap for 5 seconds every 15 minutes. A power box connected to the sensor receives this signal and uses hydraulic energy to increase the distraction. A handheld computer programs and records the pace of distraction and alerts the clinician when the device has reached certain limits. These devices were placed in cadaver and live minipigs and programmed for specific distraction lengths. Researchers found the device easy to place, with sufficient hydraulic force to provide accurate continuous distraction up to 12 mm. Mechanical failures, blood corrosion of the wire, and infections were complications in the live minipigs. Despite technical problems, this device has many unique features, including the sensor in the distractor, the ability of the clinician to monitor progress noninvasively and without radiographs, and the elimination of patient compliance. Future developments will be focused on improving the strength of the device.
Reviewed by Li-Ping Chew
Incidental findings on cone-beam computed tomography in orthodontic patients
Drage N, Rogers S, Greenall C, Playle R. Incidental findings on cone beam computed tomography in orthodontic patients. J Orthod 2013;40:29-37
As the use of cone-beam computed tomography increases in orthodontics, so does the probability of incidental findings. The purposes of this study were to determine the incidence of these findings in cone-beam computed tomography scans and to examine their impact on orthodontic treatment. Three hundred twenty-nine consecutive i-CAT Classic (Imagine Sciences International, Hatfield, Pa) cone-beam computed tomography scans were reviewed by a dental and maxillofacial radiologist. Regions examined for incidental findings included the dental region, mandible or maxilla, nose, maxillary sinus, temporomandibular joint, ear, cervical spine, and skull. Each incidental finding was given a classification based on whether follow-up was required, and whether the finding had orthodontic significance requiring amendment of the treatment plan. The results showed that 370 incidental findings were discovered in the 329 scans and that 66% of the study participants had at least 1 incidental finding. Less than 1%, or 2 participants, required alterations to their orthodontic treatment plans because of the significance of the finding. Both situations involved root resorption. Approximately 45% of the findings required follow-ups without revisions of the treatment plans. The main area for findings was the dental region, followed in frequency by the maxillary sinus and then the nose and ear. The most common incidental findings in the dental region were retained roots, periapical disease, root anomalies, root resorption, and enamel pearls. The authors stated that the incidence of findings requiring follow-up would certainly have decreased if the medical records or previous radiographs had been consulted during the investigation. The authors concluded that because incidental finding seldom have an effect on the treatment plan, the smallest field of view required to answer the clinical question should be used and thoroughly analyzed.
Reviewed by Jeff A. Kohlmeier