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At least 199 records · Page 11Linked to original sources
PubMed2003

Alveolar distraction before insertion of dental implants in the posterior mandible.

We investigated the efficacy of alveolar distraction for reducing crown height:implant length ratio in the posterior mandible. Ten alveolar distractions were done in seven patients. The pre-distraction ratio of required crown height to bone height available for implantation was in all cases > or =1. Two implants were placed in each distracted area (total 20 implants). Before distraction, the mean (SD) predicted crown height was 12.8 (2.1) mm; mean bone height available for implantation was 7.8 (1.5) mm. After distraction and insertion of implants, mean crown height was 8.1 (1.9) mm, and mean implant length was 11.3 (1.9) mm. Before distraction, the mean required crown height:available bone height ratio was 1.7 (0.3); after distraction and insertion of implants, the mean crown:implant ratio was 0.7 (0.2) (P<0.0005). Alveolar distraction is effective for increasing the height of the alveolar ridge in the posterior mandibular region, and should be considered when the height of the predicted crown that is required is greater than or equal to the maximum height of bone available for implantation.

Adult↗
PubMed1997

Bone grafting of the floor of the maxillary sinus for the placement of endosseous implants.

This study describes and evaluates a technique to augment the floor of the maxillary sinus and to widen the alveolar crest of the atrophic posterior maxilla with autogenous bone. The subjects were 43 patients whose maxillary alveolar crest was not high enough to permit reliable placement of endosseous implants in the posterior maxilla. Large autogenous cancellous bone grafts (n = 37) or smaller grafts from the mandibular symphyseal area (n = 5) or the maxillary tuberosity (n = 1) were harvested. The operations were done in either one stage (n = 20 patients, 36 sinuses) or two (bone grafting followed by placement of implants, n = 23, 45 sinuses). In 28 cases the sinus membrane was perforated with no subsequent problems. Nine of the 171 Brånemark implants that were inserted were lost during follow-up (mean 26 months, range 8-62 months). Augmentation of the maxillary sinus with autogenous bone is a reliable way of achieving placement of an implant.

Adolescent↗
PubMed2003

Analysis of bone resorption after secondary alveolar cleft bone grafts before and after canine eruption in connection with orthodontic gap closure or prosthodontic treatment.

PURPOSE: We sought to analyze the success rate of secondary alveolar cleft bone grafts before and after canine eruption in connection with orthodontic gap closure or gap opening. PATIENTS AND METHODS: Sixty-eight secondary alveolar cleft bone grafts with iliac crest spongiosa were carried out in 57 patients (mean age, 9 years; age range, 8 to 11 years) with 11 bilateral and 46 unilateral clefts of the lip, alveolus, or palate. Gap closures were carried out after 53 bone grafts (78%), and gap openings with subsequent dental implants were carried out with 15 bone grafts (22%). The parameters acquired radiologically (orthopantomograms) at the time of the surgery and the follow-up examination (mean age, 3 years; age range, 7 months to 9 years) were 1) bone resorption in relation to the interdental height of the alveolar process in the vicinity of the cleft and 2) root growth of the teeth in the vicinity of the cleft. The statistically significant differences (P <.05) were monitored with a software program. Resorption grades I and II (>50% of the interalveolar bone height) were considered to be a success. RESULTS: Resorption was grade I in 69%, grade II in 19%, grade III in 10%, and grade IV in 1% of cases. Thus, the overall success rate was 88%. At the time of the osteoplasty, the root growth of the tooth in the immediate vicinity of the cleft was fully completed in 27 teeth (39%), three-quarters completed in 23 teeth (26.5%), and semicompleted in 18 teeth (33.8%). Twelve teeth (18%) in the vicinity of the cleft (lateral incisors/canine) remained unerupted and displaced after the surgery. It was necessary to expose unerupted teeth surgically to reposition them orthodontically. The resorption losses were significantly lower with gap closures than with gap openings (P <.001). However, bone grafts performed before canine eruption were largely carried out with the objective of orthodontic gap closure, in contrast to the bone grafts that were carried out after canine eruption (P <.02). CONCLUSION: Gap closures provide more favorable results than do gap openings in regard to resorption. Controlled dental eruptions or orthodontic gap closures reduce the graft resorption. The exact timing of surgery proved to be only a secondary consideration.

Alveolar Process↗
PubMed1993

Defects of the rat premaxilla as a model of alveolar clefts for testing bone-inductive agents.

Critical-sized defects were made in the premaxillary bone of Wistar male rats using a surgical trephine and a low-speed dental engine as a model of the maxillary alveolar cleft for testing bone-inductive agents. The defects were treated with either 7 mg of demineralized bone matrix (DBM) or were left nongrafted. The nongrafted group healed mainly with fibrous connective tissue, with a small amount of bone formation at the periphery. There was no significant change in alkaline phosphatase activity and 45Ca incorporation. The DBM-grafted group produced new bone with osseous bridging in the defect by day 35. Alkaline phosphatase activity increased significantly from day 10, reaching a maximum on day 14, and 45Ca incorporation increased on day 14. These results indicate that this nonhealing bony wound of the premaxilla in rats may be useful as a model for studying the effect of bone-inductive agents on the healing of alveolar clefts.

Alkaline Phosphatase↗
PubMed1992

Simultaneous split-thickness skin grafting and placement of endosteal implants in the edentulous mandible: a preliminary report.

Reconstruction of the edentulous atrophic mandible continues to be a treatment problem for the oral and maxillofacial surgeon. Clearly, endosteal osseointegrated implants are indicated for rehabilitation, but a total implant-supported prosthesis may not always be possible. The implant-supported overdenture is an excellent alternative, but modifications of the unfavorable residual ridge may be necessary. Attached crestal soft tissue, resistant to mechanical trauma, and improvement of the residual ridge anatomy are provided by adding a split-thickness skin graft vestibuloplasty (VSG) and lowering of the floor of the mouth (LFM). Simultaneous VSG and LFM with placement of endosteal implants provides the optimal condition for maximal rehabilitation of the atrophic mandible with specific indications. Results of four skin grafts and eight implants simultaneously placed are reported.

Alveoloplasty↗
PubMed1983

Results of soft-tissue surgery over implanted replamineform hydroxyapatite.

Sixteen replamineform hydroxyapatite implants were inserted subperiosteally on the residual ridge in five dogs, and various soft-tissue procedures were performed at intervals of one, two, three, and 27 months after implantation. Three implants served as controls. Twelve of the 13 surgical sites healed normally, including four of the five vestibuloplasties and all eight exposure sites. All 16 implants were still in place and firmly attached to the alveolar bone at the time of sacrifice. A normal stratified squamous epithelium was formed in all specimens in which complete healing occurred. No evidence of an inflammatory reaction was found in response to the soft-tissue surgery in the specimens that healed. The favorable results of this study form the basis for proposed human clinical trials to evaluate the response of the implant and the overlying soft tissues to a dental prosthesis.

Alveoloplasty↗
PubMed1997

Survival analysis of endosseous implants in bone grafts used for the treatment of severe alveolar ridge atrophy.

PURPOSE: The aim of the current study was to evaluate the long-term results of endosseous implants placed into autogenous bone grafts in severely atrophic alveolar ridges. PATIENTS AND METHODS: A total of 871 implants were placed in 137 patients. The success rate was determined using survival analysis, log rank tests, and a cox regression analysis. RESULTS: Seventy-four implant failures were encountered in 23 patients. Most implants were lost because of a lack of osseointegration at the time of abutment connection or by asymptomatic loosening during the first months thereafter. The overall 1-year cumulative survival rate (CSR) was 83.4%, with a decrease to 67.8% after 5 years. The only parameter of prognostic relevance in the multivariate analysis of the whole study population was the patients' gender, with a significantly worse prognosis in female patients (5-year CSR, 62.3%). However, when the patients were divided into edentulous and partially edentulous jaws, a change was observed in the overall significance of the parameters introduced into the analysis. In edentulous patients, the maxilla appeared to over-rule all other parameters, with a 5-year cumulative survival rate of 48.8%, whereas the mandible presented a significantly higher rate of implant survival (5-year CSR, 89.3%). CONCLUSION: This study shows a poorer success rate in females than in males, probably because of differences in the quality of the bone grafts.

Adolescent↗
PubMed1997

Use of endosseous implants for dental reconstruction of patients with grafted alveolar clefts.

PURPOSE: The purpose of this study was to investigate the clinical application of endosseous implants placed into grafted alveolar clefts and to evaluate the short-term outcome. PATIENTS AND METHODS: Nineteen patients (6 males and 13 females; mean age, 17.9 years; range, 9.7 to 33.6 years at first implant surgery), including 11 with unilateral cleft lip and palate, and eight with unilateral cleft lip and alveolus, were studied. All patients except for one who underwent periosteoplasty received grafts of autogenous particulate cancellous bone and marrow (PCBM) obtained from the llium. After bone bridge formation, orthodontic treatment and preparation for implant placement were performed. RESULTS: A total of 21 implants were placed in the bone-grafted alveoli of the 19 patients. The most frequently used length was 15 mm. In five patients with insufficient alveolar bone height, a chin bone onlay graft was combined with simultaneous implant insertion. The follow-up period ranged from 1 year to almost 3 years after implant placement, and the clinical outcome was excellent in all except one patient. In this short-term study, the overall survival rate was 90.5%. CONCLUSION: The grafted alveoli were well suited to the placement of endosseous implants, and this treatment was shown to be a viable option for the dental reconstruction of alveolar clefts. However, the interdental alveolar bone height was insufficient for implant installation in a few patients. Further longitudinal studies are required to determine the optimal timing between secondary bone grafting and implant placement.

Adolescent↗
PubMed1997

Prospective evaluation of morbidity associated with iliac crest harvest for alveolar cleft grafting.

PURPOSE: This study prospectively evaluated the morbidity associated with iliac crest bone harvest when performed for alveolar cleft grafting. PATIENTS AND METHODS: Twenty-two consecutive patients who underwent an alveolar cleft graft with iliac crest bone harvest were evaluated. The estimated blood loss, length of hip incision, and volume of bone that was harvested were recorded. The duration of time until postoperative ambulation and the length of hospitalization were measured. RESULTS: All patients tolerated the iliac harvest without major complication, and the volume of bone was sufficient in all but one case. Postoperatively, ambulation occurred at an average of 3 hours 18 minutes. Twenty-one patients were discharged the day after surgery; one patient had the surgery performed as an outpatient. CONCLUSIONS: Harvesting cancellous bone from the iliac crest does not result in delayed ambulation or prolonged hospitalization. The morbidity that has been reported to occur with iliac crest bone harvest was not consistent with the results of this study.

Adolescent↗
PubMed1997

Facial growth and the need for orthognathic surgery after cleft palate repair: literature review and report of 28 cases.

PURPOSE: Controversy still exists regarding the optimal timing and surgical technique for primary cleft lip and palate (CLP) repair, and treatment protocols vary considerably. This study reviews the literature on timing and technique for primary repair and reports on the outcome for a consecutive group of patients treated by a single surgical protocol at the Sunnyview Cleft Palate Clinic. PATIENTS AND METHODS: Twenty-eight patients treated by a standardized clinical protocol from infancy through adolescence were evaluated with respect to the need for orthognathic surgery to correct jaw size discrepancy. For each patient, data was collected regarding type of cleft deformity, total number of surgical procedures from infancy, surgeon performing the primary repair, and the need or indication for orthognathic surgery. RESULTS: Twenty-five percent of patients treated by this protocol required orthognathic surgery because of anteroposterior jaw size discrepancy. The number of prior operations was not a significant factor. The need for orthognathic surgery was seen in all types of CLP deformity. Different primary surgeons varied considerably in the percentage of their patients who ultimately required orthognathic surgery. CONCLUSION: The results of this study parallel other larger cohort studies with respect to the percentage of patients requiring orthognathic surgery. The number of prior operations does not significantly affect the later need for orthognathic surgery.

Adolescent↗
PubMed1998

Reconstruction of residual alveolar cleft defects with one-stage mandibular bone grafts and osseointegrated implants.

PURPOSE: This study evaluates a treatment regimen for reconstruction of residual maxillary alveolar cleft defects consisting of mandibular bone grafting and immediate implant installation. PATIENTS AND METHODS: Sixteen cleft patients (five female and 11 male) had residual cleft defects of the alveolar ridge reconstructed with bone grafts from the mandibular symphyseal region. The bone graft was pretapped at the donor site before fixation in the residual ridge with Brånemark implants. Twenty implants were installed according to this concept. The period of observation ranged from 36 to 69 months, with a mean of 48 months after implant installation. RESULTS: Five patients developed wound dehiscenses that resulted in total or partial bone graft sequestration. Two implants were lost, one due to sequestration and the other due to mobility at the abutment procedure; 18 implants were still well functioning at the end of the observation period. However, all patients showed significant periimplant bone resorption after this one-stage treatment. CONCLUSION: Because of the observed complication rate, the one-stage procedure may not be optimal for reconstructing residual cleft defects.

Adolescent↗
PubMed2001

[Vertical alveolar distraction osteogenesis of the posterior edentulous mandible: a case report].

When it is necessary to increase the vertical height of the residual alveolar ridge, alveolar distraction osteogenesis has numerous advantages compared to other preprosthetic surgical procedures. It is frequently used for this purpose in the anterior region because of the obvious accessibility. The authors present a clinical case of edentulous posterior mandible, with insufficient vertical alveolar bone height, treated by alveolar distraction osteogenesis leading to three titanium fixtures. They explain their choice and discuss the preliminary results.

Alveolar Process↗