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Biomedical subjects

P J Stoelinga

Publications and source records attributed to P J Stoelinga.

At least 19 recordsLinked to original sources

Composite grafting of the maxillary sinus for placement of endosteal implants. A preliminary report of 48 patients.

The maxillary sinuses in 48 patients were grafted with dense, non-resorbable hydroxylapatite (HA) particles combined with autologous, cancellous bone. After 3 months of healing, HA-coated titanium endosteal implants were placed in the maxilla, and following an additional 3-5 month healing period, the dentitions were restored with various prostheses. Of the 267 maxillary implants placed, 18 (6.4%) failed. Thirteen (6.4%) of the 203 implants placed in the grafted floor of the sinus failed, and 5 (7.8%) of the 64 implants placed in the anterior maxilla failed. Simultaneous lateral and anterior onlay grafting of the alveolar process with the same composite graft material was required in 36 (75%) patients because the width of the alveolar process was considered insufficient for placement of endosseous implants. The mean follow-up period was 17 months (range 12-32). Results from this preliminary study indicate that composite grafting of the maxillary sinus with onlay grafting of the alveolar ridge will provide the bony structure necessary for placement of endosseous implants. Further follow-up of these patients is necessary to determine the long-term stability of this technique; however, these results are promising.

Adult

Long-term stability after inferior maxillary repositioning by miniplate fixation.

Nineteen patients underwent Le Fort I osteotomy and inferior maxillary repositioning. Miniplates were used to maintain the maxilla in its new position. The patients were followed from 12 to 58 months, postoperatively. Fourteen patients were considered to be stable over the long term. Five patients had a long-term relapse of more than 30%. A tendency towards greater relapse was seen in patients with more than 5 mm inferior repositioning, and in patients who had concurrent segmental osteotomies of the maxilla. In spite of the use of miniplates, there continues to be an element of unpredictability with regard to vertical relapse after inferior maxillary repositioning, and this may be related to soft-tissue influences.

Adolescent

The contributing role of condylar resorption to skeletal relapse following mandibular advancement surgery: report of five cases.

The contribution of condylar resorption to relapse following mandibular advancement surgery has not been fully evaluated, yet may contribute substantially to postoperative occlusal and skeletal changes too often considered simply as "relapse." Five cases showing a typical relapse pattern are presented, illustrating the role of condylar resorption. Preoperative factors that may contribute to the development of condylar resorption (age, sex, high preoperative mandibular plane angle, and the presence of preoperative temporomandibular joint disease), as well as intraoperative and postoperative factors, are discussed. A target group is defined in which special considerations should be made with regard to preoperative and postoperative management.

Adult

Reconstruction of the severely resorbed mandible prior to vestibuloplasty or placement of endosseous implants. A 2 to 5 year follow-up.

Ninety-two patients underwent augmentation of the severely resorbed mandible using corticocancellous bone grafts in the symphysis and a mixture of autogenous cancellous bone chips and hydroxylapatite particles in the posterior area. This study, extending from 2 to 5 years, shows that predictable and stable results were achieved. The average loss of height measured at 3 reference points was approximately 20%. Slight sensory disturbance was present in 19 patients (23%). Benefits derived from augmentation of the atrophic mandible include: improvement of facial form due to the renewed support of the collapsed circumoral muscles, a decrease in the intermaxillary distance, and restoration of mandibular bone bulk that will accommodate endosseous implants of maximum size.

Alveolar Ridge Augmentation

Surgical orthodontic treatment of anterior skeletal open bite using small plate internal fixation. One to five year follow-up.

Thirty-eight patients with skeletal open bite were studied retrospectively to assess stability of surgical-orthodontic treatment when small plate internal fixation was used. 86% of the sample population showed stable clinical results. Follow-up was from 1-5 years. Only 1 patient experienced skeletal relapse (3%) and 5 patients (13%) dento-alveolar relapse. Fifty percent of relapses were due to transverse relapse of orthodontically expanded maxillary arches. No relapse was seen with surgically assisted orthodontic expansion or surgical expansion at the time of osteotomy. Stable results can be achieved in treating skeletal open bite when small plate internal fixation is used and proper consideration given to the cause of skeletal open bite when planning treatment.

Adolescent

Late management of secondarily grafted clefts.

34 patients (40 sides) received alveolo-palatal bone grafts for closure of the residual cleft, thus guiding a lateral incisor or canine into the arch. Long-term follow-up shows that in 41% of the patients uninterrupted arches were achieved with a normal relationship by orthodontic treatment only. 38% needed segmental osteotomies to eliminate the edentulous space, and in only 20% were bridges made to restore the dental arch. 9 (25%) patients still required a Le Fort I advancement osteotomy, despite optimal orthodontic treatment. The use of segmental osteotomies for eliminating edentulous spaces in cleft palate patients is discussed, and their advantage in relation to nasal base support is emphasized. It should be the aim to achieve in every cleft palate patient a complete archform without the need for bridges or removable prostheses. A rational orthodontic-surgical approach to the cleft, lip and palate patient is suggested with respect to naso-maxillary growth and development.

Alveolar Process

Facial trauma.

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Facial Bones

Management of malunited mandibular condylar fractures.

The non-surgical treatment of mandibular condylar fractures, may occasionally result in articular imbalance and temporomandibular joint dysfunction. This may be attributed to condylar head displacement and resorption, resulting in a shortened vertical ramus and lost posterior vertical facial height. Restoring the vertical ramus height is essential in the treatment of such dysfunction, and may be accomplished by unilateral, or bilateral ramus osteotomies. Four examples of patients treated with mandibular ramus osteotomies to restore vertical ramus height, with subsequent improvement in occlusal balance and function are presented. The use of the sagittal split mandibular osteotomy and the external vertical ramus osteotomy, stabilized with small osseous plates, and monocortical screws, is discussed.

Adolescent

[The role of the dentist in the prevention and early detection of oral carcinoma].

Based on data derived from the Arnhem Regional Health area, the number of patients with a primary oral squamous cell carcinoma in the Dutch population has been estimated to be approximately 400 per year. Given the population of almost 15 million, the incidence can be estimated to be 2.8 per 100,000. The role of the dentist in the prevention and early detection of cancer of the mouth is discussed. The need for regular check-ups on the target group of patients, being heavy alcohol consumers and smokers, is emphasized. Simple methods for elimination of local irritating factors are recommended.

Adult

Interposed bone-graft augmentation of the atrophic mandible (a progress report).

A follow-up study on 41 patients who had augmentation of the atrophic mandible by interposed bone graft is presented. Special emphasis has been put on the prosthetic implications. The rapid reduction in height measured postoperatively appeared almost to cease after 6 months. Some of the possible causes of this phenomenon are discussed.

Adult

Interpositional bone graft augmentation of the atrophic mandible: a preliminary report.

The mandible is sectioned in an oblique direction and an iliac crest graft is placed between the fragments for augmentation of an atrophied mandible. The technique was used in 12 patients; follow-up examinations included serial panoramic radiographs and recording of changes in mandibular height. A 10% to 27% loss of the height gained occurred between three and 12 months postoperatively.

Adult