Biomedical subjects

G M Raghoebar

Publications and source records attributed to G M Raghoebar.

At least 19 recordsLinked to original sources

PubMed2005

Bone quality at the implant site after reconstruction of a local defect of the maxillary anterior ridge with chin bone or deproteinised cancellous bovine bone.

The purpose of this study was to investigate the quality of bone at grafted implant sites in the anterior maxilla. Grafting of these sites was necessary because of insufficient bone volume in a buccopalatinal direction (width at the top of the crest 1-3mm). Reconstruction was performed with chin bone (N=5), chin bone and a resorbable Bio-Gide GBR membrane (N=5) or Bio-Oss spongiosa granules in combination with a Bio-Gide GBR membrane (N=5). Biopsies were taken prior to implantation, i.e. 3 months after grafting with chin bone, and 6 months after grafting with Bio-Oss. Evaluation was done by assessing the histological and histomorphometric characteristics of full-length biopsies taken from the actual implant site. Both areas with non-vital bone and areas with apposition of bone and remodelling phenomena were observed in the chin bone group at the time of placement of the implants. Similar results were observed at implant sites reconstructed with a chin bone graft covered by a membrane. In the chin bone group without and with a GBR membrane, the mean total bone volume (TBV) was 55.2+/-6.8% and 57.7+/-11.5%, respectively; the marrow connective tissue volume (MCTV) was 44.8+/-6.8% and 42.3+/-11.5%, respectively. Remnants of the resorbable GBR membrane were not detected. In the Bio-Oss((R)) group, at implant placement some newly formed bone was observed in the connective tissue surrounding the Bio-Oss((R)) particles (mean TBV (newly formed bone) 17.6+/-14.5%), but most particles were surrounded by connective tissue. No convincing signs of remodelling were observed (mean remaining Bio-Oss volume 40.5+/-9.3%; mean MCTV 41.9+/-13.1%). No implants were lost during follow up (12 months). At the time of placement of the implants the grafting material (either chin bone or Bio-Oss is still not fully replaced by new vital bone. In case of Bio-Oss, most of the grafting material is even still present. Despite these differences, the 1-year clinical results were very good and comparable between the various grafting techniques applied.

Adolescent↗

PubMed2005

Masticatory function in patients with an extremely resorbed mandible restored with mandibular implant-retained overdentures: comparison of three types of treatment protocols.

The objective of the present study was to analyse the effects of implant supported overdentures on masticatory function in patients with an extremely resorbed mandible, and to compare the masticatory function in these patients using three differing types of implant treatment protocols. The mandibular overdentures were retained by a transmandibular implant, by four endosseous implants following augmentation of the mandible, and by four short endosseous implants, respectively. Sixty patients (50 women, 10 men, mean age 59.4 years) were randomly allocated to one of the three treatment groups. Masticatory function was assessed before and after treatment using a questionnaire, a masticatory performance test, and a structured interview. The patient-based masticatory function improved significantly. Concerning these parameters there were no significant differences between the three groups before and after treatment. A significant difference existed between the three groups for the laboratory-assessed masticatory function before treatment, but after treatment this difference was no longer significant. From this study it can be concluded that patients with an extremely resorbed mandible and functional complaints of their lower denture report significant improvement in masticatory function after implant-overdenture treatment. Differences in masticatory function between the three studied modalities were not significant after treatment.

Aged↗

PubMed2005

Morbidity of chin bone transplants used for reconstructing alveolar defects in cleft patients.

OBJECTIVE: The aim of this study was to evaluate the objective and subjective morbidity of symphyseal chin bone harvesting used for reconstruction of alveolar defects in young cleft patients. DESIGN: All patients who had undergone chin bone harvesting for alveolar cleft reconstruction in the period from 1992 through 2000 at the Department of Oral and Maxillofacial Surgery of the University Hospital Groningen, Groningen, The Netherlands, were invited to participate in this retrospective study.Patients' acceptance, perioperative and postoperative morbidity were evaluated. A survey of the medical records was performed. In addition, the patients completed a questionnaire for their appreciation of the procedure. They were also subjected to a clinical and radiographic examination. PATIENTS: Thirty patients (21 males and 9 females; mean age 11.8 +/- 3.6 years) participated in this study. RESULTS: Neither the medical records nor the experiences of the patients showed significant morbidity. The procedure was appreciated with 6.8 +/- 3.5 (scale 0 to 10). Postoperative pain was scored as 1.2 +/- 2.5 (scale 0 to 10). Three patients reported transient sensory disturbances at the donor site. Two patients showed a slight sensibility disorder in the symphyseal region. In three patients, an endodontic problem had developed in a lower incisor. CONCLUSION: This study showed that chin bone harvesting for reconstructing alveolar cleft in young patients is a well-accepted procedure with low objective and subjective morbidity. Notwithstanding this low morbidity, the patients (and their parents) have to be informed about the risk of objective and subjective disturbances of the sensibility in the donor region and the risk of dental pulp necrosis.

Adolescent↗

PubMed2005

[Implant-retained overdentures compared with complete dentures with or without preprosthetic surgery. A prospective study followed over 10 years].

The aim of this prospective randomized clinical trial was to evaluate and compare a set of clinical items and satisfaction of a group of edentulous patients during a ten-year follow-up. They were treated according to one of the following modalities: 61 patients with a mandibular overdenture on two implants (IMP-group), 60 patients with conventional complete dentures (VP-group) and 28 patients with a complete denture after preprosthetic surgery (MVP-group). It can be concluded that enosseous implants, serving as retention for a mandibular overdenture, have a high survival rate after ten years of follow-up (93%). The mean satisfaction score of the VP-group was lower than that of the IMP-group. The mean satisfaction score of the MVP-group was lower than that of the IMP-group.

Dental Implantation, Endosseous↗

PubMed2005

[Sports and orofacial injuries].

Many people enjoy sports, it is healthy and relaxing. There is, however, an inherent risk of sustaining injuries and fractures of the maxillofacial skeleton. Adequate diagnostics and treatment are mandatory to minimize the possible long-term consequences of injuries. Dentists may become primary involved in the diagnosis of such traumas, particularly when injuries are limited to the orofacial region. In addition, they can play an important role in caring for sportsmen with orofacial injuries, for instance by endodontic, restorative, and prosthodontic treatments. This paper discusses the assessment and treatment of fractures of the mandible, the zygoma, the mid-face, the orbital bones, the nose, and the frontal sinus. The assessment must followed by treatment as soon as possible. Treatment options of orofacial fractures are conservative treatment by exercising and/or oral splints and surgical reposition, either or not using osteosynthetic materials.

Athletic Injuries↗

PubMed2004

Implantology and the severely resorbed edentulous mandible.

Patients with a severely resorbed edentulous mandible often suffer from problems with the lower denture. These problems include: insufficient retention of the lower denture, intolerance to loading by the mucosa, pain, difficulties with eating and speech, loss of soft-tissue support, and altered facial appearance. These problems are a challenge for the prosthodontist and surgeon. Dental implants have been shown to provide a reliable basis for fixed and removable prostheses. This has resulted in a drastic change in the treatment concepts for management of the severely resorbed edentulous mandible. Reconstructive, pre-prosthetic surgery has changed from surgery aimed to provide a sufficient osseous and mucosal support for a conventional denture into surgery aimed to provide a sufficient bone volume enabling implants to be placed at the most optimal positions from a prosthetic point of view. The aim of this paper is to review critically the literature on procedures related to the severely resorbed edentulous mandible and dental implant treatment. The study includes the transmandibular implant, (short) endosseous implants, and reconstructive procedures such as distraction osteogenesis, augmentation of the mandibular ridge with autogenous bone, and bone substitutes followed by the placement of implants. The number of patients participating in a study, the follow-up period, the design of the study, the degree of mandibular resorption, and the survival rate of the dental implants all are considered evaluation parameters. Although numerous studies have described the outcome results of dental implants in the edentulous mandible, there have been few prospective studies designed as randomized clinical trials that compare different treatment modalities to restore the severely resorbed mandible. Therefore, it is not yet possible to select an evidence-based treatment modality. Future research has to be focused on long-term, detailed follow-up clinical trials before scientifically based decisions in treating these patients can be made. This will contribute to a higher level of care in this field.

Alveolar Bone Loss↗

PubMed2004

Rhino-sinusitis related to endosseous implants extending into the nasal cavity. A case report.

Rhino-sinusitis may develop as a result of an altered airflow in the nasal cavity causing irritation of the nasal mucosa. A patient is presented who developed recurrent rhino-sinusitis complaints following placement of endosseous implants in the maxilla. Inspection of the nasal floor revealed that two implants had perforated the floor of the nasal cavity. The part of the implants protruding in the nasal cavity was surgically resected via an endonasal approach whereupon the rhino-sinusitis complaints disappeared.

Aged↗

PubMed2004

The use of implant retained mandibular prostheses in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning.

Surgical treatment of malignancies in the oral cavity (tongue, floor of the mouth, alveolus, buccal sulcus, oropharynx) often results in an unfavourable anatomic situation for prosthodontic rehabilitation. The outcome is a severe disturbance of oral functioning despite the improved surgical techniques for reconstruction that are currently available. Radiotherapy, which often is applied postsurgically, worsens oral functioning in many cases. Main problems that may hamper proper prosthodontic rehabilitation of these patients include a severe reduction of the neutral zone, an impaired function of the tongue, and a very poor load-bearing capacity of the remaining soft tissues and mandibular bone. Many of these problems can, at least in part, be diminished by the use of endosseous oral implants. These implants can contribute to the stabilisation of the prostheses and intercept the main part of the occlusal loading. Surgical interventions after radiotherapy are preferably avoided because of compromised healing, which may lead to development of radionecrosis of soft tissues and bone as well as to increased implant loss. If surgical treatment after radiotherapy is indicated, measures to prevent implant loss and development of radionecrosis have to be considered e.g. antibiotic prophylaxis and/or pre-treatment with hyperbaric oxygen (HBO). To avoid this problem, implant insertion during ablative surgery has to be taken into consideration if postoperative radiotherapy is scheduled or possibly will be applied. This approach is in need of a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. The primary curative intent of the oncological treatment and the prognosis for later prosthodontic rehabilitation have to be taken into account too.

Dental Implantation, Endosseous↗

PubMed2004

[Oral surgery in general dental practice 1. Preface].

Delegation of basic dental treatment to well-trained oral hygienists, dental nurses, and dental technicians will result in more time for the general practitioner to treat more specialized dental problems. In two issues of this journal, some surgical treatments which can be delivered by a dentist with special skills on this topic, are discussed. This first issue concentrates on the treatment of odontogenic abscesses, the removal of teeth and roots, the treatment of a perforation of the maxillary sinus floor, and apectomies.

Delivery of Health Care↗

PubMed2004

[The odontogenic abscess. Aetiology, treatment and involvement in the orofacial region].

Odontogenic infections are a common problem in daily practice. Occasionally, an odontogenic infection evolves an abscess. This article discusses the aetiology, the treatment and the involvement of odontogenic abscesses in the oro-facial region. Their occurrence, course and treatment are depending on the patient's immune response, and on microbial and environmental factors.

Abscess↗

PubMed2004

[Dentoalveolar surgery for the dentist: removal of teeth and root tips].

The indication for surgical removal of teeth or roottips is often made in dental practice. In some cases a general practitioner will decide to perform the surgical procedure himself, while in other cases he will refer the patient to an oral and maxillofacial surgeon. Level of difficulty of the treatment and the experience, the time available, the availability for postoperative care, and the personal interest of the dentist are factors involved in decision making. It is likely that with increased experience, the dentist will be able to perform more complicated treatments. This article supports this process. Surgical removal of teeth and roottips is systematically described, with emphasis on technical aspects. Presurgical management, removal of singlerooted and multirooted teeth, woundcare and postoperative management are the subjects covered.

Decision Making↗

PubMed2004

[Dentoalveolar surgery for the dentist: removal of third molar].

In contrast to removal of other teeth and roottips, a third molar is mostly removed for preventive reasons. There is still debate about the correct indications for removal of third molars. As soon as the decision to remove a third molar surgically is made, the dentist has to decide between performing the surgical procedure himself or referring the patient to an oral and maxillofacial surgeon. Level of difficulty of the treatment and experience, available time, availability for postoperative care, and personal interest of the dentist are issues influencing this decision. This article describes systematically the indications, for instance using preoperative radiodiagnostics, the factors determining the technical surgical plan, as well as the practical surgical procedures.

Decision Trees↗

PubMed2004

[Oral surgery in general dental practice 2. Preface].

In two issues of the journal, some surgical treatments which can be delivered by a dentist with special skills on this topic, are discussed. This second issue concentrates on interventions occurring less frequently or not treated by every dentist in general practice. It concerns dental traumas, eruption disorders, removal of a hypertrophied frenulum of the upper lip and reconstructive preprosthetic surgery. Finally, some complications of dentoalveolar surgery are discussed.

Delivery of Health Care↗

PubMed2004

[Dentoalveolar traumatology].

The dentist will be confronted unexpectedly with a dentoalveolar trauma patient. This patient has to be seen immediately and has to be treated adequately. The risk of overlooking trauma-related signs when examining these patients, can be minimized by following a strict protocol. This article describes a protocol for examination and treatment of a patient with a dentoalveolar trauma. The prognosis after treatment of the trauma is discussed. Also some recommendations regarding aftercare and prevention are presented.

Alveolar Process↗

PubMed2004

[Eruption disturbances].

Eruption disturbances of teeth should not be considered as a curiosity. Acquaintance with these phenomena should form a substantial component of the dentist's, orthodontist's and oral and maxillofacial surgeon's basic expertise. Early detection of these disturbances followed by treatment in due time, can minimise progressive negative effects, such as the development of severe malocclusion. Treatment modalities are described.

Child↗

PubMed2004

[Reconstructive preprosthetic surgery 1. Corrections of soft tissues and bone].

The aim of reconstructive preprosthetic surgery is the creation of an environment of hard and soft tissue which is favourable to the function of an aesthetically optimal prosthesis, with or without oral implants. In this paper, various preprosthetic surgical treatments for correcting soft and hard tissues are discussed.

Alveolar Bone Loss↗

PubMed2004

[Reconstructive preprosthetic surgery 2. Pre-implantologic surgery].

Reconstructive preprosthetic surgery is, amongst others, aimed at the creation of an environment which is favourable to the construction of an implant supported prosthesis. Not in all cases the pre-existent volume of bone is sufficient to place an implant in the planned position. In this paper various techniques to augment local bone defects for reliable implant placement are described.

Alveolar Bone Loss↗

PubMed2004

[Distraction osteogenesis of the maxilla in cleft patients. Worth considering].

Three cleft patients were treated with RED-distraction for maxillary hypoplasia. In all patients, the desired advancement could be achieved easily. The occlusion, the lip relation and the facial profile improved remarkably post treatment. Although the treatment was well tolerated by the patients, some limitations of the treatment were also noted, such as a nasal speech and discomfort by the head frame. Distraction osteogenesis in the maxilla has several advantages when compared to the conventional Le Fort 1-osteotomy: atraumatic advancement of the maxilla, absence of need for an autogeneous bone transplant, and applicability at relatively young age. The advantages and disadvantages of distraction osteogenesis must be considered for each individual patient.

Adolescent↗