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Biomedical subjects

R W McNeill

Publications and source records attributed to R W McNeill.

At least 19 recordsLinked to original sources
PubMed1987

Stability of mandibular advancement osteotomy using rigid internal fixation.

Forty-three patients who underwent surgical lengthening of the mandible using an inverted L osteotomy, bone grafting, and rigid internal fixation between the mandibular segments were evaluated by retrospective cephalometric analysis for longitudinal skeletal and dental changes. Postoperative response (means = 1 year 9 months) was found to demonstrate a high level of stability with some individual variability. No propensity for relapse was observed in any postoperative time interval. Condylar repositioning postoperatively appeared to be an important factor in those patients who exhibited any relapse tendency. Overall postoperative stability of this surgical/fixation technique appears to be significantly improved compared with previously documented techniques.

Adolescent↗
PubMed1987

Hygiene status associated with different types of bonded, orthodontic canine-to-canine retainers. A clinical trial.

The present study was performed to test whether bonded, orthodontic canine-to-canine retainers made of spiral wire tended to accumulate more plaque than retainers made of plain wire, and whether the presence of such retainers caused any damage to the teeth involved. 44 patients were classified in eight strata according to age, gender and gingival status. From each stratum, the patients were randomly divided into 4 groups, each of which received either retainers made of thick plain wire bonded only to the canines, thick twisted wired bonded only to the canines, thin twisted wire bonded to each tooth or removable retainers. Accumulation of plaque and calculus along the gingival margin and gingival inflammation were scored in lingual areas from canine to canine at time of fixed appliance removal and again 4 months after retainer insertion. In addition, accumulation of plaque and calculus and development of caries along the retainer wires were scored after 4 months. The results revealed no differences between the groups for any of the variables. No differences in accumulation of plaque was found between baseline and follow-up examinations. Gingival bleeding was scored less frequently after 4 months in retention than at time of debonding.

Adolescent↗
PubMed1986

Personality characteristics as predictors and sequelae of surgical and conventional orthodontics.

The aims of this study were to determine the effects of surgical and conventional orthodontics on patients' body image and self-esteem and the association between personality characteristics and postoperative reports of pain, paresthesia, swelling, and satisfaction among 90 patients who underwent surgical orthodontics. Patients who underwent surgery completed questionnaires before their operations and up to 6 months after surgery. Self-esteem and body image were compared longitudinally between these patients and 33 persons who were undergoing orthodontic treatment only and 33 persons who had decided against treatment. Results suggest that patients' self-esteem, body image, and degree of extroversion are unrelated to postsurgical satisfaction and discomfort. Neuroticism was correlated with satisfaction, so that patients who scored in the higher range on a scale of neuroticism were less satisfied immediately after surgery and at removal of fixation wires. Neurotic patients also were more likely to complain of pain and swelling 6 months after surgery. Surgical patients held a more negative facial image and were more introverted than those in the other two groups but were similar in other personality traits before surgery. Both surgical and orthodontic patients improved significantly in body image over time, with the greatest increase among the former. Similar shifts in self-esteem occurred for the three groups, suggesting that surgery per se may not be the major determinant of longitudinal changes in self-esteem. Notably, the positive effect of surgery and orthodontic treatment on body image is an important motive for many persons seeking treatment. Results of this study provide important insights into how to prepare and counsel patients undergoing orthodontic treatment with and without surgery.

Body Image↗
PubMed1985

Perceptions of facial profile and their influence on the decision to undergo orthognathic surgery.

Eighty patients, who had previously been evaluated by an oral surgeon and an orthodontist as requiring orthognathic surgery, completed questionnaires rating their perceptions of their own profiles. Half of the patients had decided to undergo surgical correction of their jaw deformities, while the other half had decided against surgical treatment. In addition, booklets containing pretreatment photographs of all 80 patients were mailed to 37 oral surgeons, 46 orthodontists, and 43 lay persons. These three groups of evaluators rated the patients' profiles, using the same rating scales that the patients had used. Cephalometrically, the two patient groups were statistically the same in all skeletal and soft-tissue measures except for ANB (mean difference = 1.8 degrees) and soft-tissue AN-pogonion (mean difference = 2.4 degrees). Differences in these dimensions were considered in subsequent data analyses. Results of this study support the following conclusions: In spite of the fact that surgical treatment may be recommended by dental specialists and indicated by cephalometric measurements, self-perceptions of profile are more important in the patient's decision to elect surgical correction; the perception by others that the profiles of patients deciding against surgery are closer to ideal may have some influence on their decision against surgical correction of their jaw deformities; oral surgeons and orthodontists evaluate facial profiles similarly, but surgeons are more likely to recommend surgical correction; lay persons are more likely to rate an individual's profile as being normal than are dental specialists in orthodontics and oral surgery; in contrast, individuals perceive their own profiles differently than orthodontists, oral surgeons, and lay persons, particularly with respect to the mandibular and dentoalveolar dimensions.

Adolescent↗
PubMed1985

The emotional impact of orthognathic surgery and conventional orthodontics.

Previous research by the authors has pointed to depressive reactions among orthognathic surgery patients during the fixation-removal stage and up to 9 months later. However, less is known about emotional shifts among persons who choose to undergo conventional orthodontic treatment after considering surgical orthodontics. In the current study, a standard measure of mood states was applied to 90 surgical patients and 66 who had considered surgery but decided against it. Of these, 33 were undergoing orthodontic treatment and 33 were having no treatment. The mood scale and measures of personality were first applied before surgery and then during orthodontic treatment, just after surgery, at fixation removal, and 6 months after surgery. Nonsurgical respondents completed questionnaires at the same time as their matched surgical respondents. Scores on tension and fatigue increased significantly among surgical patients from before surgery to immediately after surgery and dropped to presurgical levels when fixation was removed. Anger-hostility increased at fixation removal but declined within 5 months. Postsurgical discomfort, pain, and paresthesia, and interpersonal and oral function problems were correlated with postsurgery emotional state. On the later questionnaires, which corresponded to the later periods of orthodontic treatment, patients who had opted for conventional orthodontic treatment reported that they experienced greater depression, anger, and tension. These patients may be particularly vulnerable to emotional problems because their orthodontic treatment may be more complex and of longer duration than that of the typical orthodontic patient. These results point to the importance of continued psychological support for both orthodontic and surgical patients throughout their course of treatment.

Adolescent↗
PubMed1984

Psychologic changes in orthognathic surgery patients: a 24-month follow up.

This report describes the final, two-year follow up in a longitudinal study of 74 patients who underwent orthognathic surgery for developmental deformities. Data for all six measurement periods were available for 46 patients. Complaints of functional problems decreased significantly from before surgery to 24 months after, although 49% of the patients continued to report lip paresthesia. The incidence of postsurgical problems had no effect on the satisfaction expressed with surgical outcomes, which remained high throughout the postoperative course. Self-esteem appeared to rise in anticipation of surgery, only to decline significantly at nine months after surgery, to rise again by 24 months (but not as high as before surgery). In some components, self-esteem remained significantly lower after surgery than before. Body image also showed a decline at nine months, although overall body image and profile image 20-26 months after surgery were significantly more positive than before surgery. These results point to the importance of continued contact with orthognathic surgery patients by surgeons and orthodontists for at least two years after surgery, particular attention being paid to the intermediate stages (six to 12 months) after surgery. This period of psychologic upheaval appears to be related to the patient's desire to complete postsurgical orthodontics.

Adolescent↗
PubMed1984

Orthodontics and orthognathic surgery: adjuncts to restorative and periodontal therapy.

Orthodontic and orthognathic surgical procedures are important adjuncts to the provision of optimum restorative and periodontal care. Dentoalveolar and skeletal abnormalities of either developmental or acquired origin can be corrected primarily, thus eliminating the necessity for compromise in prosthetic design. Dental relationships that are contributory to irreversible periodontal deterioration can be normalized to facilitate stabilization of the periodontal condition and to increase the longevity of the natural dentition. Maxillofacial surgical treatment is technically complex but is more conservative than many traditionally accepted treatment procedures. It is based on the rationale of conservation of natural structures rather than their radical ablation or their sacrifice to uncontrollable progressive disease processes. Patient participation to establishment of treatment objectives and extensive patient education are essential ingredients in such treatment. Interdisciplinary communication and coordination contribute to a mutual appreciation of treatment possibilities and limitations. Thus, orthodontic and orthognathic surgical options should be considered in planning the solution to a wide variety of periodontal and restorative treatment problems.

Adult↗
PubMed1983

Recreational and social activities of orthognathic surgery patients.

The present study examined changes in recreational and social activities after orthognathic surgery. Because this is often an expectation of patients seeking surgery, it was hypothesized that activity levels would increase gradually after surgery, particularly for patients who become more extroverted and for unmarried patients. Information on the frequencies of recreational and social activities, and the persons with whom these activities were performed, were obtained from 53 patients in a self-administered questionnaire administered at least 2 days before surgery and again 3 weeks, 4 months, and 9 months after surgery. In addition, patients were assessed on introversion-extroversion before and after surgery. The results indicated that (1) for both married and single patients, recreational and social activities dropped immediately after surgery and gradually increased to a level similar to that prior to surgery at nine months after surgery; (2) contrary to expectations, the single patients over age 15 did not increase their recreational and social activities with friends of the opposite sex after surgery; and (3) the degree of change in introversion-extroversion after surgery was not associated with the degree of change in recreational and social activities performed with others. Implications for postsurgical adjustment of orthognathic patients and recommendations for future research are discussed.

Adolescent↗
PubMed1982

The psychological impact of orthognathic surgery: a 9-month follow-up.

In an attempt to determine the impact of surgical orthodontics on patients' personality and perceptions of oral function, fifty-five patients were examined longitudinally. Patients completed five questionnaires during the course of treatment, from 1 month before to 9 months after surgery. Orthodontic appliances were still being worn by 56.1 percent at the 9-month assessment. Satisfaction with surgery, self-esteem, and body image were high throughout the postsurgical stage but showed significant changes. Satisfaction peaked at 4 months but declined at 9 months postsurgery, as did self-esteem and facial body image. Most of this decline was attributable to patients being still under orthodontic treatment, but those with continuing problems of pain, paresthesia, and oral dysfunction were not more likely to report psychological dissatisfaction. Results are examined from the perspectives of integration of body image and patient expectations from orthognathic surgery.

Adolescent↗
PubMed1982

Predicting psychologic responses to orthognathic surgery.

A longitudinal study was conducted of the psychologic characteristics of 74 persons undergoing orthognathic surgery. The effects of neuroticism, locus of control, and expectations upon postsurgical outcomes were examined. The majority of patients scored in the normal range of most personality variables. The findings suggest a generally intact ego and accurate self-concept among orthognathic surgery patients. Expectations of pain and parasthesia were the best predictors of postsurgical outcomes, while neuroticism and locus of control scores predicted some outcomes in the early postoperative stages. The results indicate the importance of preparing orthognathic surgery patients against unrealistic expectations before surgery is undertaken, and of counseling certain patients during the early postoperative period.

Adolescent↗
PubMed1982

Surgical correction of vertical maxillary excess: a re-evaluation.

Correction of vertical maxillary excess by Le Fort I osteotomy has become a widely accepted practice. Although the downfracture method is used almost exclusively in most major centres, the total maxillary alveolar osteotomy still has its advocates. Two patients surgically treated by total maxillary alveolar osteotomy and presented in this journal are re-evaluated with respect to the long-term stability of maxillary intrusion. Literature pertaining to the stability of the maxilla following intrusion by Le Fort I osteotomy and after various combinations of anterior and posterior maxillary ostectomy is reviewed. The advantages of the downfracture method are discussed. An alternative method of achieving the desired degree of intrusion is presented, which ensures more intimate bone contact.

Adult↗
PubMed1981

Surgical mandibular advancement: a cephalometric analysis of treatment response.

Fifty-two cases of surgical advancement of the mandible were evaluated by retrospective cephalometric and computer analysis for longitudinal skeletal and dental changes an average of 3 1/2 years after surgery. Postsurgical treatment response appeared to be a multifactorial biologic phenomenon with considerable individual variability. Results showed generally good stability after mandibular advancement, with a minimal to moderate tendency toward skeletal relapse during intermaxillary fixation. Positional change of the proximal segment was the most important parameter in determining stability or relapse of the advanced mandible. Anteroinferior displacement of the condyle and increased posterior facial height were found to be important factors in the skeletal relapse observed during the period of intermaxillary fixation. The magnitude of mandibular advancement was a reliable surgical predictor of postsurgical relapse. Preoperative mandibular plane angle, postfixation intersegment instability, and patient's age cannot be isolated as being solely responsible for specific postsurgical changes.

Adolescent↗
PubMed1981

Diagnosis and treatment planning: a coordinated effort between oral and maxillofacial surgery and orthodontics.

Recent years have seen broad technical advancements in the field of orthognathic surgery. Recognition that conventional orthodontic-orthopedic treatment is ineffective in resolving facial-skeletal deformities and associated malocclusions has led to the development of cooperative therapeutic efforts. Joint diagnosis and treatment planning and analysis of longitudinal treatment responses based on traditional orthodontic principles have contributed to continuing advancement of knowledge and improvement in standards of care. A team approach to the management of patients requires the sharing of knowledge, skills, and responsibility. By combining these with a high level of education of patients, cosmetic and functional changes of lasting benefit can be achieved.

Face↗
PubMed1979

Condylysis in a patient with a mixed collagen vascular disease.

Condylysis has not previously been described as a complication of a mixed collagen vascular disease. A case is presented in which apertognathia and mandibular retrognathism occurred secondary to condylysis in a 26-year-old woman with features of rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and Sjögren's syndrome. The disease was manifested by polyarthritis, morning stiffnes, subcutaneous nodules, and acrosclerosis. Important laboratory findings included RA slide latex negative, increased DNA binding, ANA positive, ENA negative, and an abnormal parotid scan. The malocclusion secondary to condylysis was corrected by surgical procedures usually employed for the treatment of mandibular retrognathism and apertognathia on a developmental basis.

Adult↗