Management of the mobile fibrous ridge in the atrophic maxilla using porous hydroxyapatite blocks: a preliminary report.
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Biomedical subjects
Publications and source records attributed to J W Frame.
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These were demonstrated using histochemical and biochemical techniques. The presence of hyaluronic acid and chondroitin sulphate was confirmed by enzymic digestion. These substances may arise from inflammation in peri-ductal tissue.
There is considerable interest at present in the potential role of calcium hydroxyapatite as a biomaterial for bone augmentation in oral and maxillofacial surgery. Most of the published work has been on the particulate form, mainly in alveolar ridge procedures. However, hydroxyapatite is also available as solid or porous blocks. The blocks are more predictable in their use than are the particles, and are adaptable and versatile. This paper reviews the biological behaviour of the material and discusses the role of hydroxyapatite blocks in alveolar ridge augmentation and orthognathic surgery.
A procedure is described for reconstructing the body, angle and ascending ramus of the mandible using split autogenous bone grafts from the iliac crest. These compound grafts have been monitored using clinical, radiological and radio-isotope scanning techniques which demonstrated early revascularisation and consolidation. The healing pattern is similar to that of one-piece cortico-cancellous grafts. Good functional and aesthetic results have been obtained, and two patients are presented to illustrate the procedure and the features of remodelling of the bone grafts.
Edentulous areas of dog jaws were augmented with solid or porous particles of hydroxylapatite (HA) alone, or combined with either finely crushed autogenous bone or plaster of paris. At the end of the experiment (24 weeks), the augmented ridges were firm and stable and covered with healthy mucosa. The ridges augmented with only porous particles of HA demonstrated a greater amount of bone ingrowth compared with the solid, dense particles. The new bone formation occurred in those parts of the implants adjacent to the underlying alveolar bone. The addition of autogenous bone to the HA particles did not enhance bony deposition, and none of the autogenous bone chips survived for 24 weeks. The amount of new bone in the ridges augmented with plaster of paris and HA was similar to the other groups, and the plaster did not interfere with healing. There was evidence of resorption of the underlying cortical bone in many of the specimens.
The technique of therapeutic arterial embolisation involves the introduction of a thrombus-inducing material into the lumen of a blood vessel to occlude the vessel and reduce the blood supply to a lesion or to a specific part of the body. It is particularly useful in the maxillofacial region in the management of vascular lesions where marked diminution in blood flow can be achieved. This paper reviews the procedure and the materials for embolisation, and describes four patients for whom it was of considerable assistance.
Hydroxyapatite is a useful biomaterial because of its excellent biocompatibility. It is extremely well tolerated by the hard and soft tissues of the mouth and jaws, and offers great potential for the future. This paper reviews the various physical forms of the material, both solid and porous, its biological behaviour in different implant sites, and the surgical techniques for its implantation. Some of the controversies and doubts about the material are discussed in relation to its use in alveolar ridge augmentation.
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In a double-blind, single dose study of analgesic efficacy, 165 patients who were expected to develop moderate to severe pain following the removal of an impacted mandibular third molar tooth were allocated to receive aspirin, placebo, or an increasing dose of a fixed ratio ibuprofen/codeine combination. The degree of pain experienced prior to medication was noted and the patients were asked to record the degree of pain and of pain relief hourly for the following 5 hours. The study produced clear evidence of the superior efficacy of the combinations when compared to placebo and aspirin. In addition, the high dose combination appeared to be superior with respect to pain relief and the need for additional analgesia compared to the low dose treatment. There were few side effects and only one severe reaction was reported by a patient in the high dose group. To avoid side effects it is suggested that the medium-dose combination, ibuprofen 400 mg/codeine 30 mg, is optimal.
Sagittal splitting of the mandible has been recommended as a means of gaining access for removal of pathological lesions within the body and ramus. However, there are potential problems associated with the technique, and an alternative procedure is discussed.
Salivary calculi occur in the submandibular and parotid glands, and their ducts, and occasionally reach a large size. However, little information is available on the composition of these giant stones. 2 cases are reported of unusually large calculi of the submandibular salivary glands. The glands were excised, and the results of chemical and infrared analysis of the calculi are presented.
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As the CO2 laser becomes more widely available in hospitals, the oral and maxillofacial surgeon will have greater opportunity to use it for the treatment of soft tissue pathologies of the mouth. This paper considers the advantages and disadvantages of the instrument together with indications for its use and reviews 118 patients who had 130 oral lesions removed with the CO2 laser.
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