Grybauskas, Simonas

Smilkininis apatinio žandikaulio sąnarys (toliau – SAŽS) – tai sąnarys, esantis tarp apatinio žandikaulio ir kaukolės. Kauliniai šio sąnario elementai – tai apatinio žandikaulio galva apačioje ir smilkinkaulis viršuje. Tai du sinoviniai sąnariai: kairysis ir dešinysis smilkininiai apatinio žandikaulio sąnariai.Dauguma sinovinių sąnarių savo paviršiuose turi hialinines kremzles, o SAŽS paviršių dengia tankus, skaidulinis jungiamasis audinys be kraujagyslių. Dažnai manoma, kad dėl tokios audinio struktūros SAŽS yra neatsparus kramtymo spaudimui, nes neturi hialininės kremzlės. Tačiau per pastaruosius 25–30 metų buvo sukaupta pakankamai įrodymų, leidžiančių teigti, kad SAŽS gerai atlaiko krūvį. Tuomet kyla klausimas – kuo ypatingi SAŽS audiniai? Atsakymas į šį klausimą yra tiesiogiai susijęs su evoliucine sąnario raida, kurią atspindi jo ankstyvoji ontogenezė.

The presentation will aim to highlight the importance of cooperation between the surgeon and the orthodontist while treating complex dentofacial deformities. It is mandatory that two specialists understand each other's needs since good orthhodontic setup for surgery may facillitate surgical procedure and may even reduce its extent, whereas precise execution of surgery will proceduce a more stable and easily manageable occlusion for the orthodontist. Etiology of development of asymmetries and various treatment modalities will be reviewed. Forced symmetry and independent A-P planning protocols will be described in detail with subsequent case presentations. A special emphasis will be placed on the importance of the 3D planning in treating facial asymmetries.

Dentofacial deformities are usually treated surgically and virtual hard tissue simulation has been advised for increasing the accuracy of hard tissue repositioning. However, asymmetric patients in addition to different lateral projections of hard tissues (i.e. gonial angles or parasymphyseal areas) may also exhibit a noticeable difference in surrounding soft tissue thickness that may be underdiagnosed. Consequently, symmetrical positioning of the hard tissue framework will not guarantee postoperative soft tissue symmetry. In this paper we introduce a new surgical planning protocol called “forced symmetry” that allows us to predict final soft tissue symmetry by mimicking facial symmetry using clinical rotation of the mandible in unoperated patients. Double cone-beam CT scanning allows surface-based superimposition of virtual head models in centric relation and in forced relation. The resultant composite head model reveals the target lateral projection of proximal fragments that guarantees the best soft tissue symmetry in the gonial areas.

Objectives: Vertical skeletal facial asymmetries caused by hemimandibular overgrowth often result in compensatory dentoalveolar elongation on the affected side. Surgical leveling of dental arches during orthognathic surgery results in incomplete correction of the lower jaw asymmetry and necessitates further simultaneous surgical procedures, such as lower border ostectomy, inferior alveolar nerve lateralization, and grafting. Materials and methods: We present a novel technique for the vertical decompensation of dentoalveolar processes to improve orthognathic surgery outcomes. The technique consists of installing skeletal anchorage into the upper and lower jaws, corticotomies of the alveolar processes, and skeletally-anchored orthodontic molar intrusion by means of custom-made intrusion frameworks. The resultant unilateral posterior open bite enables larger rotation in the frontal plane during surgical repositioning of the lower jaw. Results: A 27-year-old woman with hemimandibular hyperplasia and compensatory elongation of the dentoalveolar processes was scheduled for orthodontic-orthognathic treatment. Four months of surgically-assisted intrusion resulted in a 7 mm unilateral posterior open bite. Two-piece Le Fort I osteotomy, bilateral sagittal split osteotomy (BSSO), condylectomy, genioplasty, and minimal lower border contouring were performed during a single-stage surgery. Conclusions: Surgically-assisted implant-anchored intrusion of the molars is a feasible technique for vertical pre-surgical decompensation in vertical skeletal asymmetries. The degree of unilateral posterior open bite achieved is essential for surgical planning since rotation of the mandible in the frontal plane reduces the degree of lower border ostectomy.

Objectives: Onlay block grafting for atrophied alveolar ridges is a well-established treatment modality that enables oral surgeons to prepare the site for qualitative implant placement. HOwever, the data is controversial regarding the resorbtion rate of the block grafts on the long run. The aim of this study was to perform a quantitative evaluation of the resorbtion rate of onlay block grafts. Material and methods: 125 consecutive onlay block grafts were included into this study of which 84 were fixed in the mandibular region and 41 in the maxillary region. According to the treatment protocol, implants were inserted 4-5 months following grafting procedures and implant uncovering along with vestibuloplasty were performed 4 months later. Before every surgical stage CBCT scan of the selected region was performed as well as 1 year after the surgery up to 3 years after surgery. The 3D CBCT data were processed and the volumes superimposed in order to evaluate the dynamics of the processes of modelling and remodeling of the bone grafts. All images were processed with Simplant Crystal OMS software (Materialise). [...].

Aim: to evaluate the postoperative stability after maxillomandibular orthognathic surgery in different planes with regard to repositioning vector and magnitude as well as rotation of occlusal plane. Materials and methods: 156 patients were included in this study who had undergone maxillomandibular orthognathic surgery from January 2007 to December 2010 and qualified follow-up schedule. Patients were classified according to the amount and direction of surgical repositioning of upper and lower jaws. The stability of maxilla was assessed in vertical and horizontal planes. For the vertical stability patients were subclassified into: anterior downgrafting, posterior downgrafting, anterior impaction, posterior impaction, anterior “no change” and posterior “no change”. The horizontal movements were subclassified into advancement and “no change”. Based on the combination of vertical and horizontal movements, patients were assigned with CW, CCW or linear category of repositioning. For the mandibular surgery, horizontal movements were classified into advancement, “no change” and setback; upward or downward movements or vertical “no change” of incisors, upward or downward movement or “no change” in vertical molar position. Transversal movements were classified into right or left repositioning or “no change” of lower midline, right or left repositioning or “no change” of molars. Evaluation of data: 1. Clinical investigation of occlusion: overjet, overbite and midline concordance in CR. 2. Stability of jaws in 3D were determined by means of superimposition of preoperative, immediate postoperative and follow-up scans and comparison of skeletal landmarks at different time points.

AIM. To evaluate different techniques for aesthetic surgical management of chin in Class II Division 2 patients undergoing orthognathic surgery. MATERIAL AND METHODS. Different types of genioplasty were performed for 7 patients: 2 patients underwent sliding reduction, 3 patients - clockwise downgrafting and 2 patients - clockwise downgrafting with wedge resection and contourplasty. Aesthetic ranking scale was used to assess the aesthetics of facial profile by lay persons. RESULTS AND CONCLUSIONS. The change in facial aesthetics was positively ranked in all 7 patients who underwent genioplasty. Patients ranked best aesthetic scores after maxillo-mandibular clockwise advancement and downgrafting, especially in cases when clockwise downgrafting genioplasty with wedge resection and contourplasty was performed.

Per pastarąjį dešimtmetį sparčiai susiliejome su Europa. Tai rodo pasikeitęs žmonių mąstymas ir reikalavimai gydymo rezultatui. Jei anksčiau daugelio deformacijų gydymo tikslas buvo sugrąžinti formą ir funkciją, tai dabar jau būtina estetika. Ypač aukšti reikalavimai keliami veido sričiai. Dar prieš 10−20 metų dauguma žmonių buvo patenkinti savo dantų ir veido išvaizda, nedaug dėmesio skirdavo savo šypsenai, sąkandžiui. Dabar dauguma žmonių reikalauja estetiškų dantų, gražios šypsenos, taisyklingo sąkandžio ir veido bruožų − visa tai apibendrinus, galima pavadinti − patrauklaus veido. Padidėję žmonių lūkesčiai gydymo rezultatui turi tvirtą pagrindą. Mokslo įrodyta, kad patraukliems žmonėms gyvenime labiau sekasi visose srityse.

Objective> The aim of the present study was to describe the prevalence of periodontal diseases and oral hygiene status among 25-44-year-olds in Kaunas city and to study the secretory function of peripheral venous blood neutrophilic leukocytes (NL) exposed to various antigens in patients with gingivitis and periodontitis. Material and methods. The prevalence of periodontal diseases (according to CPITN), oral hygiene status (according to OHI-S index) was examined in 420 subjects. Secretory function of peripheral venous blood neutrophilic leukocytes (NL) in 112 subjects was determined. Secretory function of NL affected by antigens, such as opsonized zymosane and anatoxine S. aureus was investigated by lysozyme (LZ) activity in patients with gingivitis and periodontitis who were internal diseases free. Lysozyme activity was analyzed by the spectrophotometric method, supplemented with Micrococcus luteus 2665. [...].

Dažnas pacientas, galvojantis apie dantų implantaciją, su nerimu laukia pokalbio su gydytoju. Dažniausiai iškyla klausimai: ar man įmanoma dantų implantacija? ar skaudės po operacijos? ar ilgai būsiu nedarbingas/-a? Taip pat ramybės nuduoda įvairūs pasakojimai apie smarkų tinimą ir mėlynes, ilgai išlikusius pažįstamiems po panašių operacijų. Anksčiau į minėtus klausimus gydytojas ne visada galėdavo duoti pacientui palankius atsakymus, nes seno tipo implantai buvo didelės apimties, nefiziologiški, jiems įsodinti prireikdavo didelės apimties žandikaulio operacijos, po kurios veikas smarkiai patindavo, ir žmogus kuriam laikui prarasdavo darbingumą.