Saat melakukan segala jenis prosedur bedah, ahli bedah perlu mengetahui kemungkinan variasi dalam konfigurasi anatomi kanalis mandibula dan nervus alveolaris inferior (IAN) [1,2,3] Hal ini terutama terjadi saat melakukan reseksi akar, pencabutan gigi bungsu atau pengambilan cangkok tulang autologus. .
Teknik yang berbeda dijelaskan untuk rekonstruksi area tulang yang hilang sebelum atau selama pe...
Fig. 6. Position of the right mental foramen
Fig. 5. Position of the left mental foramen
Fig. 4. Left (l) and right (r) mandibular bone thickness (bt) in the four age groups (group 1, 0–20 years old; group 2, 21–40 years old; group 3, 41–60 years old; group 4, 61 and older) in men (0) and women [1]
Fig. 3. Left (l) and right (r) mandibular bone thickness in all patients
Fig. 2. Definition of the position of the mental foramen
Fig. 1. Measurement of mandibular bone thickness, defined as the distance between the lateral wall of the mandibular canal and the lateral mandibular compact bone (solid turquoise line)
Age groupTotal1234SexMale41363930146Female44513538168Total 85877468314Table 1 Number of men and women in each age group (group 1, 0–20 years old; group 2, 21–40 years old; group 3, 41–60 years old; group 4, 61 and older)
Valdec, S., Borm, J.M., Casparis, S. et al. Vestibular bone thickness of the mandible in relation to the mandibular canal—a retrospective CBCT-based study.
Int J Implant Dent 5, 37 (2019). https://doi.org/10.1186/s40729-019-0189-z
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Received: 04 June 2019
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Published: 15 November 2019
DOI: https://doi.org/10.1186/s40729-019-0189...
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Silvio Valdec and Jan Borm are equally contributing first authors.
The study was approved by the cantonal ethics committee of the canton of Zurich (KEK 2018-01691).
Not applicable.
Silvio Valdec, Jan Borm, Stephanie Casparis, Georg Damerau, Michael Locher and Bernd Stadlinger declare that they have no competing interests.
Silvio Valdec and Jan M. Borm contributed equally to this work.
Clinic of Cranio-Maxillofacial and Oral Surgery, Centre for Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
Silvio Valdec, Jan M. Borm, Stephanie Casparis, Georg Damerau, Michael Locher & Bernd Stadlinger
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This study was conducted without external funding.
The authors thank Jacquie Klesing, Board-Certified Editor in the Life Sciences (ELS), for editing assistance with the manuscript. Further, we thank Malgorzata Roos for supporting the statistical analysis.
Namano S, Behrend DA, Harcourt JK, Wilson PR. Angular asymmetries of the human face. Int J Prosthodont. 2000;13(1):41–6.
Phillips JL, Weller RN, Kulild JC. The mental foramen: 2. Radiographic position in relation to the mandibular second premolar. J Endod. 1992;18(6):271–4.
Pyun JH, Lim YJ, Kim MJ, Ahn SJ, Kim J. Position of the mental foramen on panoramic radiographs and its relation to the...
Nucera R, Lo Giudice A, Bellocchio AM, Spinuzza P, Caprioglio A, Perillo L, et al. Bone and cortical bone thickness of mandibular buccal shelf for mini-screw insertion in adults. Angle Orthod. 2017;87(5):745–51.
Scomparin L, Soares MQ, Rubira CM, Yaedu RY, Imada TS, Centurion BS, et al. CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: importance to sa...
Benninger B, Miller D, Maharathi A, Carter W. Dental implant placement investigation: is the anterior loop of the mental nerve clinically relevant? J Craniomaxillofac Surg. 2011;69(1):182–5.
Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol. 2006;77(12):1933–43.
Kuribayashi A, Watanabe...
Ozturk A, Potluri A, Vieira AR. Position and course of the mandibular canal in skulls. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(4):453–8.
Agbaje JO, de Casteele EV, Salem AS, Anumendem D, Lambrichts I, Politis C. Tracking of the inferior alveolar nerve: its implication in surgical planning. Clin Oral Investig. 2017;21(7):2213–20.
Zahedi S, Mostafavi M, Lotfirikan N. Anatomic stud...
Bone thickness
Cone-beam computed tomography
Digital Imaging and Communications in Medicine
Inferior alveolar nerve
The original datasets supporting the findings are available.
The results of this study support the relevance of a preoperative CBCT to allow detailed planning of a surgical intervention that may potentially touch the area of the mandibular canal. This applies to surgical procedures like wisdom tooth removal, root resection, implant placement and bone block harvesting. A CBCT allows the exact determination of the horizontal bone thickness vestibular to the I...
In a study comparing measurements between cadavers and CT images, the distance between the upper edge of the mandibular canal and the alveolar ridge showed possible over- and underestimations. The quantification showed a possible overestimation of up to 1.05 mm and a possible underestimation of up to 1.36 mm [34]. This discrepancy is of relevance in preoperative planning. Intraoperatively, a r...
The IAN is an important anatomical structure whose course affects the preoperative planning of a bone graft or implant insertion in the mandible. Knowledge on the bone thickness between the lateral wall of the mandibular canal and the lateral mandibular compact bone as well as of the position of the mental foramen facilitates decision-making [24]. Furthermore, for many other surgical procedures, t...
The median age of the patients was 40.2 years (range 12.6–84.4 years). Patients were distributed almost evenly across the age groups (see Table 1).
Figure 3 clearly shows the median vestibular bone thicknesses (bt) at 2-mm intervals throughout the anterior to posterior course of the canal on both the right (bt2 r to bt66 r) and left (bt2 l to bt66 l) side of the mandible. The maximum di...
In addition, the position of the mental foramen was determined relative to the roots of the neighbouring teeth. This was assessed by defining regions of interest in the area of the first premolar, second premolar and first molar by extending the respective mesial and distal points of the cement-enamel junction caudally along the tooth axis. The position of the midpoint of the mental foramen was th...
Three hundred fourteen cone-beam computed tomograms (CBCTs) from 168 (53.5%) females and 146 (46.5%) males from the database of the Department of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Switzerland, from the years 2008 to 2013 were analysed. Patients were divided into 4 age groups: group 1 = 0–20 years, group 2 = 21–40 years, group 3...
The mandibular canal is a bilateral, intraosseous opening through which the IAN runs from the mandibular foramen to the mental foramen. The nerve innervates the teeth, the mucous membranes in the area of the mental foramen and the skin around the chin [14, 15]. Anatomical variations of the mandibular canal, such as bifid canals and an anterior loop of the mental nerve, are common [16, 17] and have...
When performing any kind of surgical procedure, a surgeon needs to be familiar with the possible variations in the anatomical configurations of both the mandibular canal and inferior alveolar nerve (IAN) [1,2,3]. This is particularly the case when performing root resections, removing wisdom teeth or harvesting autologous bone grafts.
Different techniques are described for reconstruction of missin...
Fig. 4. PPS mean crestal bone level change plotted against time (mean, 95 % CI)
Fig. 4. PPS mean crestal bone level change plotted against time (mean, 95 % CI)
Fig. 3. Participant flow diagram
Fig. 3. Participant flow diagram
Fig. 2. Restorative flow diagram
Fig. 2. Restorative flow diagram
Fig. 1. Clinical pictures in each procedure. a Before implant placement. b After abutment connection. c Temporary prosthesis. d Final prosthesis
Fig. 1. Clinical pictures in each procedure. a Before implant placement. b After abutment connection. c Temporary prosthesis. d Final prosthesis
Indicator
Prosthetic comforta
Appearanceb
Ability to chewc
Ability to tasted
Fittinge
General satisfactionf
Treatment arm
...
Treatment arm
Summary statistics
Baseline
6 months
Change from baseline to 6 months
...
Characteristics
Early loading arm
Conventional loading arm
Total
(N = 38)
(N =...
Loading criteria 1
Loading criteria 2
• Sufficient oral hygiene
• At least 1 mm bone volume around the implanta
• No major dehiscence (
Inclusion criteria
Age over 20 Patient who have missing teeth in premolar or molar site Good oral hygiene Predicted implant site has 1–3 quality of bone densityand enough quantity of bone Extraction socket in predicted implant site is completely healed (16 weeks or more)
...
Dard, M., Shiota, M., Sanda, M. et al. A randomized, 12-month controlled trial to evaluate non-inferiority of early compared to conventional loading of modSLA implants in single tooth gaps.
Int J Implant Dent 2, 10 (2016). https://doi.org/10.1186/s40729-016-0040-8
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Received: 25 September 2015
Accepted: 23 March 2016
Published: 04 April 2016
DOI: https://d...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Michel Dard, Makoto Shiota, Minoru Sanda, Yasutomo Yajima, Hideshi Sekine, and Shohei Kasugai state that there are no conflicts of interest.
MD mainly prepared the manuscript and figures. MS arranged this study, participated in its design and coordination, and helped to draft the manuscript. YY, HS, and SK managed the data collection from each centers of Tokyo Dental College Chiba Hospital (TDCC)...
College of Dentistry, New York University, New York, NY, USA
Michel Dard
Tokyo Medical and Dental University, Tokyo, Japan
Makoto Shiota, Minoru Sanda & Shohei Kasugai
Suidobashi Hospital, Tokyo Dental College, Tokyo, Japan
Yasutomo Yajima
School of Dentistry, Ohu University, Fukushima, Japan
Hideshi Sekine
Department of Oral Implantology and Regenerative Dental Medicine, Tokyo Medical ...
This trial was sponsored by Straumann Japan KK. The authors would like to acknowledge the assistance of Eusaku Watanabe and Nariyuki Maezawa (both Straumann Japan KK) for their contributions to the study.
Krebs M, Schmenger K, Neumann K, Weigl P, Moser W, Nentwig GH. Long-term evaluation of ANKYLOS® dental implants, part I: 20-year life table analysis of a longitudinal study of more than 12,500 implants. Clin Implant Dent Relat Res. 2013. doi:10.1111/cid.12154.
Lops D, Bressan E, Pisoni G, Cea N, Corazza B, Romeo E. Short implants in partially edentulous maxillae and mandibles: a 10 to 20 years ...
Salvi GE, Gallini G, Lang NP. Early loading (2 or 6 weeks) of sandblasted and acid-etched (SLA) ITI implants in the posterior mandible. A 1-year randomised controlled clinical trial. Clin Oral Implants Res. 2004;15:142–9.
El-Sheikh AM, Shihabuddin OF, Ghoraba SM. A prospective study of early loaded single implant-retained mandibular overdentures: preliminary one-year results. Int J Dent. 2012. ...
Morton D, Bornstein MM, Wittneben JG, et al. Early loading after 21 days healing of nonsubmerged titanium implants with a chemically modified sandblasted and acid-etched surface: two-year results of a prospective two-center study. Clin Implant Dent Relat Res. 2010;12:9–17.
Cochran DL, Jackson JM, Bernard JP, et al. A 5-year prospective multicenter study of early loaded titanium implants with a ...
Bornstein MM, Wittneben JG, Brägger U, Buser D. Early loading at 21 days of non-submerged titanium implants with a chemically modified sandblasted and acid-etched surface: 3-year results of a prospective study in the posterior mandible. J Periodontol. 2010;81:809–18.
Ganeles J, Zöllner A, Jackowski J, ten Bruggenkate C, Beagle J, Guerra F. Immediate and early loading of Straumann implants wit...
Bornstein MM, Valderrama P, Jones AA, Wilson TG, Seibl R, Cochran DL. Bone apposition around two different sandblasted and acid-etched titanium implant surfaces: a histomorphometric study in canine mandibles. Clin Oral Implants Res. 2008;19:233–41.
Lai HC, Zhuang LF, Zhang ZY, Wieland M, Liu X. Bone apposition around two different sandblasted, large-grit and acid-etched implant surfaces at site...
Esposito M, Grusovin MG, Maghaireh H, Worthington HV. Interventions for replacing missing teeth: different times for loading dental implants. Cochrane Database of Syst Rev. 2013;3:CD003878.
Esposito M, Grusovin MG, Willings M, Coulthard P, Worthington HV. The effectiveness of immediate, early, and conventional loading of dental implants: a Cochrane systematic review of randomized controlled clini...
Blanes RJ, Bernard JP, Blanes ZM, Belser UC. A 10-year prospective study of ITI dental implants placed in the posterior region. I: clinical and radiographic results. Clin Oral Implants Res. 2007;18:699–706.
Covani U, Chiappe G, Bosco M, Orlando B, Quaranta A, Barone A. A 10-year evaluation of implants placed in fresh extraction sockets: a prospective cohort study. J Periodontol. 2012;83:1226–...
In conclusion, this study demonstrated that early implant loading was non-inferior to conventional implant loading in terms of crestal bone level change in a Japanese patient population in short follow-up period and single tooth gaps in molar regions. High implant survival and patient satisfaction rates, and a good safety profile, were also achieved.
Early loading of the implants showed a good safety profile, with a similar incidence in AEs between the early and conventional loading groups. The benefits to the patient for the early loading procedure were demonstrated by the patient satisfaction question “What does the patient think about the time taken until occlusal loading was started after implantation surgery?” All patients in the earl...
The implant survival rate of 100 % after 12 months is also in line with the results from previous studies with chemically modified SLA implants in various situations, including 100 % survival in early loading of mandibular overdentures [55], 100 % survival in single-tooth applications in the anterior maxilla [56], 96.8 % with maxillary sinus floor augmentation [57], and 98 and 97 % with imme...
This was a randomized, controlled, multicenter clinical trial to investigate whether the outcomes for chemically modified SLA implants in terms of change in crestal bone level from implant surgery to 6 months were non-inferior with early loading (25 ± 3 days) compared to conventional loading (13 ± 1 weeks). The difference in mean crestal bone level change between the early loading and...
In the PPS and FAS, the implant survival rate was 100 % after 12 months. In the PPS, the implant success rate was 100 % at all time points in both the conventional and early loading arms; however, in the FAS, the success rate in the conventional loading arm was 100 % at all time points, while in the early loading arm, success was 100 % at suture removal at 12-month follow-up and 95 % at the ...
The study enrolled 84 Japanese patients who had single missing tooth in the molar region. Since four patients were withdrawn due to the exclusion criteria (systemic disease, adjacent teeth with probing pocket depth deeper than 4 mm, mental disorder, and bone deficiency, respectively), 80 patients underwent implant placement. Two further patients were withdrawn before randomization because the ins...
In addition, periodontal examination, in the form of probing depth (PD) and bleeding on probing (BoP), was performed at pre-screening and at the 12-month follow-up.
Descriptive summary statistics were computed for all parameters, and quantitative parameters were described using mean, standard deviation, median, quartiles, minimum, and maximum. For qualitative variables, absolute and relative freq...
The primary endpoint was a change of crestal bone level between implant surgery (baseline) and final restoration (6 months), assessed by measuring the distance from the implant shoulder to the first bone-to-implant contact both mesially and distally to the implant.
Bone level was measured by a single reader on standardized periapical radiographs taken at baseline (day 0), suture removal (7–14...
When a patient fulfilled all inclusion criteria and had no exclusion criteria, then he/she got implant surgery and checked the condition met first criteria for loading (loading criteria 1 (LC1)) (Table 2).
All patients received Ti grade IV Straumann Standard Plus Regular Neck (SP RN) implants, 4.1 mm in diameter and 8, 10, or 12 mm in length, with SLActive® surface (Institut Straumann AG, Bas...
This study was designed as a randomized, controlled, multicenter clinical trial to evaluate non-inferiority of early loading compared to conventional loading of dental implants with a chemically modified SLA surface placed in single tooth gaps, involving three centers in Japan (Tokyo Medical and Dental University (TMDU), Tokyo Dental College Chiba Hospital (TDCC), and Tokyo Dental College Suidobas...
Early loading protocols have become relatively common procedures in many countries for implant restoration, but the procedure is much less common in Japan. The purpose of this study, therefore, was to investigate whether the chemically modified SLA implant with early loading was non-inferior to conventional loading, based on the amount of crestal bone change between baseline and 6 months after su...
The use of dental implants to replace missing or compromised teeth has been well documented clinically over many years. High implant survival rates have been demonstrated for over 10 [1–3], 15 [4], and 20 years [5, 6]. Long-term survival rates for single-tooth implants have been shown to be greater than those for tooth-supported restorations, e.g., fixed partial dentures (FPDs) [7, 8]. Good lon...
The aim of the study was to evaluate whether early loading of implants with a chemically modified sandblasted, large-grit, acid-etched (SLA) (SLActive®) surface was non-inferior to conventional loading in terms of change in crestal bone level.
This was a randomized, controlled, multicenter study. Patients requiring single-tooth rehabilitation in the posterior maxilla or mandible received implant...
Fig. 3. Site of evaluation. (1) Corner of the mouth: 5 mm below the corner of the mouth. (2) Lower lip: 5 mm laterally from the midline. (3) Mental region: at the midpoint of the perpendicular from the lower edge to the lower lip to the chin and 5 mm laterally from the midline
Fig. 3. Site of evaluation. (1) Corner of the mouth: 5 mm below the corner of the mouth. (2) Lower lip: 5 mm lat...
Fig. 2. started from a filament of 0.165 mm in diameter of the most weak force, and performed three times at one site
Fig. 2. a SW perception tester is composed of different diameters (a: 0.165 mm, b: 0.215 mm, c: 0.315 mm). b The use of SW perception tester started from a filament of 0.165 mm in diameter of the most weak force, and performed three times at one site
Fig. 1. Alveolar nerve repositioning in a partially edentulous mandible. a Preoperative radiograph. b The inferior alveolar nerve was transposed from the mental foramen. c Postoperative radiograph after implant insertion
Fig. 1. Alveolar nerve repositioning in a partially edentulous mandible. a Preoperative radiograph. b The inferior alveolar nerve was transposed from the mental foramen. c Po...
No.
Sex
Age (years)
Range of IAN lateralization (width)
Implant site
Follow-up period (months)
...
Stage 0
Complete sensory loss
Stage 1
Advent of deep pain
Stage 2
Some degree of tactile recovery and pain ...
Nishimaki, F., Kurita, H., Tozawa, S. et al. Subjective and qualitative assessment of neural disturbance after inferior alveolar nerve transposition for dental implant placement.
Int J Implant Dent 2, 14 (2016). https://doi.org/10.1186/s40729-016-0047-1
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Received: 25 July 2015
Accepted: 26 April 2016
Published: 14 May 2016
DOI: https://doi.org/10.1186/s40...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Fumihiro Nishimaki, Hiroshi Kurita, Shinya Tozawa, Yuji Teramoto, Rishiho Nishizawa, and Shin-ichi Yamada declare that they have no competing interests.
FN and HK conceived and designed the study, performed the experiments, and wrote the manuscript. ST and YT performed data analysis. RN and SY participated in manuscript preparation. All authors read and approved the final version of the manuscrip...
Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-3-1, Asahi, Matsumoto-shi, Nagano, 390-0804, Japan
Fumihiro Nishimaki, Hiroshi Kurita, Shinya Tozawa, Yuji Teramoto, Rishiho Nishizawa & Shin-ichi Yamada
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Morrison A, Chiaro M, Kirby S. Mental nerve function after inferior alveolar nerve transposition for placement of dental implants. J Can Dent Assoc. 2002;62:46–50.
Vetromilla BM, Moura LB, Sonegi CL, et al. Complications associated with inferior alveolar nerve repositioning for dental implant placement: a systematic review. Int J Oral Maxillofac Surg. 2014;43(11):1360–6.
Eggers G, Klein J, e...
Levin L, Sadet P, Grossmann Y. A retrospective evaluation of 1387 single-tooth implants: a six-year follow-up. J Periodontol. 2006;77:2080–3.
Levin L. Dealing with dental implant failures. J Appl Oral Sci. 2008;16:171–5.
Lorean A, Kablan F, Mazor Z, et al. Inferior alveolar nerve transposition and reposition for dental implant placement in edentulous or partially edentulous mandibles: a mult...
In conclusion, we investigated the quality of postoperative neurosensory function after IAN transposition for dental implant placement. IAN transposition is a useful method for placing implants in the atrophic posterior mandible. However, the procedure is complicated, with the possibility of some degree of neurosensory disturbance, although in most of our cases, it resolved within a clinically acc...
Dental restoration by means of dental implants can provide good functional rehabilitation, particularly in patients with atrophic mandibles. IAN lateralization is a useful method for placing implants in the atrophic posterior mandible. However, there is a possibility of the neurosensory function of the IAN being disturbed, although in most cases, it resolves within a clinically acceptable period.
...
Although the previous studies reported good results concerning ND in IAN transposition surgery, the methods for evaluating ND differed, and most of the studies did not fully describe the evaluation procedure. The evaluation of ND of the IAN can be performed by purely subjective (questionnaire), relatively objective (static light touch, 2-point discrimination, etc.), and purely objective methods (t...
IAN reposition may serve as a viable treatment option in the severely resorbed mandibles. Repositioning is performed via one of the two surgical techniques, lateralization, or transposition, with lateralization yielding lower degrees of nerve deficiency. In lateralization, the IAN is exposed and retracted laterally, held in this position during implant placement, then released to rest against the ...
In total, eight IAN transposition procedures were performed in seven patients. One patient underwent bilateral surgery. Surgery was performed under general anesthesia in four patients and under local anesthesia in three patients. The IAN was lateralized for a four-tooth breadth on one side, three-tooth breadth on three sides, and two-tooth breadth on three sides. In total, 22 dental implants were ...
This study was conducted in compliance with the principles of the Declaration of Helsinki, and was approved by the Committee for Ethics at Shinshu University School of Medicine. Patients who underwent dental rehabilitation by insertion of dental implants between 2000 and 2012 in our hospital were reviewed. Of these, seven patients underwent transposition of the IAN for dental implant placement and...
Tooth loss is one of the common causes of reduced quality of life in adults. Dental implants have become a widely accepted treatment option for both partially and completely edentulous patients [1–3]. However, in cases of posterior mandibular atrophy, suitably sized implants cannot be placed without encroaching on the inferior alveolar nerve (IAN). In such cases, restorative options include the ...
The purpose of this retrospective study was to accumulate data regarding the quality of postoperative neurosensory function after inferior alveolar nerve (IAN) transposition for dental implant placement.
The study included seven consecutive patients who underwent IAN transposition surgery for the insertion of a dental implant into the atrophic posterior mandible. Of these, six patients (seven sid...
Pemasangan implant gigi pada rahang bawah posterior dengan resorpsi yang parah bisa menimbulkan kerusakan pada saraf alveolar inferior. Teknik reposisi saraf telah dipakai untuk menciptakan peluang agar pemasangan implant gigi dengan panjang yang memadai bisa sukses dalam kasus semacam ini. Dalam kasus punggungan mandibula posterior atrofi, teknik reposisi saraf alveolar inferior jadi alternatif ...
Anatomi jalur saraf alveolar inferior sangat penting bagi dokter gigi, dokter saraf, radiolog, dan patolog guna membantu diagnosis, penanganan, perencanaan bedah, dan penerapan anestesia lokal. Demikian disampaikan oleh Polland et al. dalam penelitiannya pada tahun 2001.
Kerusakan saraf alveolar inferior menghasilkan dampak yang negatif pada kualitas sensibilitas fasial dan kemampuan pasien unt...