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John Stella, DDS, FACS

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Restoration of the atrophied posterior mandible with transverse alveolar maxillary/mandibular implants: technical note and case report.

Wed, 01/30/2019 - 08:25
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Restoration of the atrophied posterior mandible with transverse alveolar maxillary/mandibular implants: technical note and case report.

Int J Oral Maxillofac Implants. 2002 Nov-Dec;17(6):873-9

Authors: Stella JP, Abolenen H

Abstract
Restoration of the atrophied posterior mandibular alveolus has been a surgical challenge in the past. Many treatment options have been published, each with unique shortcomings. This study will review and compare these techniques to a new type of implant, the transverse alveolar maxillary/mandibular implant (TAMMI). Using modified Nobel Biocare Brånemark System zygomatic implants that were shortened to 11.5, 13, 15, 18, 20, 22.5, or 25 mm, the authors reconstructed atrophied posterior mandibles. These TAMMIs were placed at a 45-degree angle, engaging both the crest of the ridge and the buccal cortex. Using TAMMIs, atrophied posterior mandibular alveoli as small as 9 mm have been successfully restored without complication to the inferior alveolar nerve.

PMID: 12507249 [PubMed - indexed for MEDLINE]

An innovative method for accurate positioning of the proximal segment in sagittal split osteotomies.

Wed, 01/30/2019 - 08:25
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An innovative method for accurate positioning of the proximal segment in sagittal split osteotomies.

Int J Adult Orthodon Orthognath Surg. 2000;15(1):59-63

Authors: Burye MT, Stella JP

Abstract
Ten patients underwent bilateral sagittal split ramus osteotomy for the correction of mandibular retrognathia. Prior to the surgery, predictive cephalometric tracings were completed, utilizing horizontal and vertical reference guides. The anticipated horizontal and vertical changes were determined from the predictive tracings, and these results were recorded on the prediction tracing. During surgery, corresponding reference marks were made on the lateral surface of the mandible. These reference marks were utilized to position the proximal segment during surgery, prior to placement of stabilization screws. A postoperative lateral cephalometric radiograph was taken within 24 hours in each case. The positions of the proximal segments were compared pre- and postsurgically. The results of this study indicate that this simple method results in accurate positioning of the proximal segments.

PMID: 11307224 [PubMed - indexed for MEDLINE]

Predictability of bimaxillary orthognathic surgery using "piggyback" intermediate splints.

Wed, 01/30/2019 - 08:25
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Predictability of bimaxillary orthognathic surgery using "piggyback" intermediate splints.

Int J Adult Orthodon Orthognath Surg. 2000;15(1):25-9

Authors: Stefanova N, Stella JP

Abstract
Ten consecutive patients underwent bimaxillary surgery including segmental Le Fort I and bilateral sagittal split ramus osteotomies. All 10 patients were symmetric skeletal Class II malocclusion with an anterior open bite. Asymmetry cases were excluded. Dimensional changes depicted on the cephalometric prediction tracing were reproduced in the model surgery and then transferred to the patient during the operative procedure using a "piggyback" intermediate splint. All dimensional changes, except vertical, were transferred from the model surgery to the patient intraoperatively by using a "piggyback" intermediate splint. The accuracy of this transfer and final skeletal result was examined. All the data clearly showed that in no case was any discrepancy greater than 2 mm, which demonstrates the predictable results that can be achieved by using a "piggyback" intermediate splint in bimaxillary orthognathic surgery.

PMID: 11307219 [PubMed - indexed for MEDLINE]

The predictability of inferior medial canthus as a stable external vertical reference point in maxillary repositioning surgery.

Wed, 01/30/2019 - 08:25
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The predictability of inferior medial canthus as a stable external vertical reference point in maxillary repositioning surgery.

Int J Adult Orthodon Orthognath Surg. 2000;15(4):305-8

Authors: Stefanova N, Stella JP

Abstract
The purpose of this study was to investigate the predictability of using the inferior medial canthus as a stable external reference point for establishment of the vertical dimension in maxillary orthognathic surgery. Ten consecutive patients with skeletal Class II malocclusion and open bite who underwent orthognathic reconstructive surgery were included in the study. Prediction tracings were completed preoperatively and superimposed on an immediate postoperative lateral cephalometric radiograph. In 7 patients, the vertical positioning of the maxillary incisal edge on the immediate postoperative lateral cephalometric radiograph showed no difference from the superimposed preoperative prediction tracing. One patient showed 1 mm difference and 2 patients showed 2 mm difference from the preoperative prediction tracings. All cases resulted in acceptable maxillary incisal exposure relative to upper lip stomion. It is concluded that the inferior medial canthus can be used as a reproducible external vertical reference for orthognathic surgery when the technique described herein is used.

PMID: 11307188 [PubMed - indexed for MEDLINE]

Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note.

Wed, 01/30/2019 - 08:25
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Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note.

Int J Oral Maxillofac Implants. 2000 Nov-Dec;15(6):889-93

Authors: Stella JP, Warner MR

Abstract
The zygomaticus dental implant, designed by Nobel Biocare for the Brånemark System, is indicated primarily for the severely resorbed maxilla. Though the zygomaticus implant has had a remarkable success rate in a very difficult patient population, there are some shortcomings to the protocol for placement. The sinus slot technique described herein provides a simplified approach to zygomaticus implant placement, as compared to the currently recommended protocol.

PMID: 11151591 [PubMed - indexed for MEDLINE]

Geometric considerations when planning an asymmetric genioplasty.

Wed, 01/30/2019 - 08:25
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Geometric considerations when planning an asymmetric genioplasty.

Int J Adult Orthodon Orthognath Surg. 1999;14(3):175-80

Authors: Stefanova N, Stella JP

Abstract
The sliding osteotomy of the inferior border of the mandible, otherwise known as genioplasty, has often been described in the world literature with regard to diagnosis and treatment planning. However, the treatment of the asymmetric chin has received little attention. Moreover, diagnosis and treatment planning of asymmetric chins with concomitant orthognathic surgery is completely lacking from the literature. The complexity of surgically correcting asymmetric chins, compounded with complex, bimaxillary orthognathic surgery, is an extremely challenging task. This article looks at geometric considerations when planning the surgical correction of an asymmetric chin following a protocol of data collection, model surgery, diagnosis, and treatment planning. Clinical experience in the form of a case presentation will demonstrate the millimetric precision that can be achieved when planning corrective genioplasty in an asymmetric patient undergoing concomitant orthognathic surgery.

PMID: 10686841 [PubMed - indexed for MEDLINE]

Modification of sagittal split ramus osteotomy to avoid unfavorable fracture around impacted third molars.

Wed, 01/30/2019 - 08:25
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Modification of sagittal split ramus osteotomy to avoid unfavorable fracture around impacted third molars.

Int J Adult Orthodon Orthognath Surg. 1998;13(3):183-7

Authors: Marquez IM, Stella JP

Abstract
The dental literature recognizes that performing sagittal ramus osteotomy when impacted third molars are present significantly increases the risk of unfavorable fractures of both the proximal and distal segments. Many articles have described how to repair unfavorable fractures of sagittal split segments, but few to date specifically address how to modify the osteotomy design to reduce the potential for unfavorable fractures. Moreover, techniques for removal of impacted third molars after the completion of a sagittal split ramus osteotomy have received little attention in the literature, yet it is obviously a common occurrence. This paper describes a modification of the sagittal split ramus osteotomy when a fully formed impacted third molar is present at the time of the sagittal ramus osteotomy. A technique is also described for removing the impacted third molar after the sagittal split is completed. Clinical experience has demonstrated these techniques to have several advantages.

PMID: 9835817 [PubMed - indexed for MEDLINE]

Osteoplasty and advancement genioplasty for widening of the chin.

Wed, 01/30/2019 - 08:25
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Osteoplasty and advancement genioplasty for widening of the chin.

J Oral Maxillofac Surg. 1997 Dec;55(12):1493-6

Authors: Stella JP, Davis ME

PMID: 9393415 [PubMed - indexed for MEDLINE]

Cephalometric profile evaluations in patients with cleft lip and palate.

Wed, 01/30/2019 - 08:25
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Cephalometric profile evaluations in patients with cleft lip and palate.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Aug;80(2):137-44

Authors: Chaisrisookumporn N, Stella JP, Epker BN

Abstract
This study was done to determine those abnormal cephalometric features found in adult cleft lip and palate patients. The sample population consisted of 30 randomly selected white patients with cleft lip and palate who were treated by the same team that had been accredited by the American Cleft Palate-Craniofacial Association. Twenty patients had unilateral complete clefts, and 10 had bilateral complete clefts. Thirteen different cephalometric parameters were measured and compared with normal. The results from this study showed that there were few statistically significant differences between the unilateral and bilateral cleft palate patient populations. There were only three measurements that had statistically significant differences between the unilateral cleft patients and the bilateral cleft patients: subnasale-stomion, subnasale-stomion: stomion-soft-tissue menton, and subnasale-lower lip vermillion: lower lip vermillion-soft tissue menton. However, 10 of the 13 measurements had statistically significant variations from normal. These measurements included subnasale=stomion; stomion=soft tissue menton, subnasale=lower lip vermillion; lower lip vermillion=soft tissue menton, interlabial distance, subnasale-perpendicular to upper lip, subnasale-perpendicular to lower lip, subnasale-perpendicular to chin, angle formed between sella turcica=nasion and nasion=A=point, maxillary depth angle, A-point to nasion-pogonion, and angle formed between A=point=nasion and nasion=B=point. The data indicated that a multiplicity of vertical and horizontal abnormalities exist in the person with cleft lip and palate in addition to the well-known transverse deficiencies, and that cephalometric abnormalities are not limited to anteroposterior maxillary deficiency.

PMID: 7552875 [PubMed - indexed for MEDLINE]

Anthropometric profile evaluation of the midface in patients with cleft lip and palate.

Wed, 01/30/2019 - 08:25
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Anthropometric profile evaluation of the midface in patients with cleft lip and palate.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Aug;80(2):127-36

Authors: Chaisrisookumporn N, Stella JP, Epker BN

Abstract
This study was done to determine those profile anthropometric measurements that are abnormal in the midface profile in patients with cleft lip and palate. The sample population consisted of 30 randomly selected skeletally mature white patients with cleft lip and palate who had been treated by the same team who were accredited by the American Cleft Palate-Craniofacial Association. Twenty patients had unilateral and 10 had bilateral complete clefts. None of these patients had previously undergone orthognathic surgery or definitive rhinoplasty surgery. Fifteen facial anthropometric features were measured on each person's face. The result from this study showed that in patients with cleft lip and palate right versus left side differences did not exist and only four statistically significant differences existed between the unilateral and bilateral cases. However, in all patients, four of these esthetic facial features were consistently and significantly abnormal: obtuse nasofrontal angle: obtuse nasomental angle; a posteriorly positioned infraorbitale relative to globe; and an obtuse general facial angle. Several other features were abnormal in a high percentage of persons in this study. These were lack of supratip break, flat to concave paranasal contour, increased subnasale-alargroove:subnasale-pronasale ratio, decreased nasal protrusion:nasal length ratio, decreased nasolabial angle ratio, decreased maxillary length ratio, increased nasal bridge projection:nasal protrusion ratio, and deficient cheek contour. This data indicates that the major deformity in persons with adult cleft lip and palate exist in the nose and secondarily in other components of the midface.

PMID: 7552874 [PubMed - indexed for MEDLINE]

Changes in condylar position following bilateral sagittal split ramus osteotomy with setback.

Wed, 01/30/2019 - 08:25
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Changes in condylar position following bilateral sagittal split ramus osteotomy with setback.

Int J Adult Orthodon Orthognath Surg. 1995;10(2):137-45

Authors: Magalhães AE, Stella JP, Tahasuri TH

Abstract
The purpose of this study was to evaluate the changes in condylar position following bilateral sagittal split ramus osteotomy with 5- and 10-mm setback in 1 symmetric human cadaver mandibles. A Plexiglas device was constructed to determine the mandibular morphology and the movements of the condyle and the proximal segments before and after surgery. There was no statistically significant relationship between mandibular morphology or the magnitude of setback and changes in condylar position postsurgery. All condyles and rami tipped in a highly variable fashion in the coronal plane. In the axial plane, the lateral pole of the condyles rotated predominantly anteriorly; the left side rotated significantly more than did the right. In the sample studied, the position of the condylar and proximal segments was altered in a highly variable and unpredictable manner, regardless of the magnitude of setback or the morphology of the mandible.

PMID: 9081999 [PubMed - indexed for MEDLINE]

The modified superior based pharyngeal flap. Part III. A retrospective study.

Wed, 01/30/2019 - 08:25
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The modified superior based pharyngeal flap. Part III. A retrospective study.

Oral Surg Oral Med Oral Pathol. 1990 Sep;70(3):256-67

Authors: Tharanon W, Stella JP, Epker BN

Abstract
A retrospective study of 31 patients who had diagnosed velopharyngeal incompetence and were surgically managed with the modified superior based pharyngeal flap was completed. The following were analyzed: age at time of operation, gender, physical status, diagnostic protocol, length of operation (length of total surgery) and length of superior based pharyngeal flap, length of postoperative hospital stay, length of total hospital stay, length of follow-up, speech results, complications, patient care, and medication. The result showed that the optimal timing for correction of velopharyngeal incompetence was between 3 and 6 years of age. The mean length of total hospital stay was 2.7 days, postoperative complications were minimal, and speech results were generally good.

PMID: 2216352 [PubMed - indexed for MEDLINE]

A precise radiographic method to determine the location of the inferior alveolar canal in the posterior edentulous mandible: implications for dental implants. Part 2: Clinical application.

Wed, 01/30/2019 - 08:25
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A precise radiographic method to determine the location of the inferior alveolar canal in the posterior edentulous mandible: implications for dental implants. Part 2: Clinical application.

Int J Oral Maxillofac Implants. 1990;5(1):23-9

Authors: Stella JP, Tharanon W

Abstract
An analysis of implant placement in the posterior region of eight edentulous cadaver mandibles was performed. The results demonstrated that the radiographic technique developed can be employed to safely place implants adjacent to the inferior alveolar nerve in the posterior mandible by using radiographic laminography and a specially designed intraoral reference splint.

PMID: 2391136 [PubMed - indexed for MEDLINE]

A precise radiographic method to determine the location of the inferior alveolar canal in the posterior edentulous mandible: implications for dental implants. Part 1: Technique.

Wed, 01/30/2019 - 08:25
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A precise radiographic method to determine the location of the inferior alveolar canal in the posterior edentulous mandible: implications for dental implants. Part 1: Technique.

Int J Oral Maxillofac Implants. 1990;5(1):15-22

Authors: Stella JP, Tharanon W

Abstract
In severely atrophic or osteoporotic mandibles, the location of the inferior alveolar nerve may vary considerably, both superoinferiorly and mediolaterally. A clinician's ability to reliably locate this nerve within the mandible would permit the surgical planning of implant placement in the posterior edentulous mandible. Eight edentulous cadaver mandibles were studied. A technique that precisely locates the inferior alveolar nerve within the mandible is described. The technique will aid the surgeon in planning a surgical approach to the posterior mandible with reduced risk of injury to the inferior alveolar nerve.

PMID: 2391135 [PubMed - indexed for MEDLINE]

Reconstruction of frontal and frontal-nasal deformities with prefabricated custom implants.

Wed, 01/30/2019 - 08:25
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Reconstruction of frontal and frontal-nasal deformities with prefabricated custom implants.

J Oral Maxillofac Surg. 1989 Dec;47(12):1272-6

Authors: Epker BN, Stella JP

Abstract
The use of prefabricated custom silicone rubber implants for frontal and nasofrontal deformities produces predictable esthetic results with minimal operative and postoperative morbidity and/or complications in selected patients. Over the past 8 years, 15 custom silicone rubber implants have been placed with good to excellent results. Only one implant was removed due to postoperative infection. This implant was successfully replaced upon resolution of the infection.

PMID: 2585179 [PubMed - indexed for MEDLINE]