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An interim report on osseous contour reconstruction using alloplastic materials and particulate bone grafting.
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Rebuilding of deficient edentulous alveolar ridge with porous ceramic implants.
Porous ceramic (Al2O3) implants with a pore size of 100--750 mum were used in the surgical treatment of four patients at the Department of Oral Surgery and Oral Medicine, Dental Faculty, University of Oslo. In two of the cases, ceramic implants were placed in small surgical defects in the edentulous maxillary alveolar ridge, while two patients were treated with mandibular ridge augmentation. All four individuals healed uneventfully, and the implants were firm and immovable 3 weeks postoperatively. No adverse tissue reactions were observed. Dentures were inserted over the implants 8 days to 6 weeks after implantation. In one of the cases, reoperation was performed because of 2 X 2 mm zone of exposure of the ceramic 4 weeks after denture insertion. Examination after observation times up to 15 months revealed clinically normal soft tissue over the implants. There were no complaints about wearing of the dentures. Radiographs at varying intervals after implantation did not disclose any pathologic changes or signs of resorption of bone adjacent to the ceramic implants.
Alveolar atrophy and decreased skeletal mass of the radius.
Using absorptiometry, the bone calcium mass (BCM) at two different sites of the radius was measured in 12 male patients referred for vestibuloplasty of the mandible. The most distal site contained both cortical and cancellous bone while the other site contained cortical bone only. The BCM values were compared with those for normal patients of the same age. The patients with mandibular atrophy all had less bone in the radius than their age-matched controls (p less than 0.01). This is indicative of a systemic factor or factors operating both in the mandible and in the radius. The examination prior to oral surgery should therefore include an evaluation for diseases causing general bone loss.
Transplantation of free tibial periosteal graft on alveolar bone defect in adult rabbit.
The healing of bone defect in eight adult rabbits was studied. The age range of animals was 5-23 months. The bone defects were made symmetrically in the inferior surface of the mandibles. At the defect site the root surface of continuously erupting mandibular incisors was exposed. On the left side, the bone defect was covered with a local periosteal flap (control side) and on the right side the defect was covered with a free periosteal graft from the tibia (test side). The healing of bone defects and the amount of new bone were studied. The quality of the bone formed was investigated histologically. The findings of this investigation led to the following conclusions: (1) The bone defects healed on both sides. The amount of bone on the control side was identical to that in the anatomical region. On the test side the amount of bone formed was in seven cases two to threefold that formed on the control side. (2) The histological study proved that the bone formed was lamellar bone, being identical on both the control and the test side. (3) The ages of the animals or the length of follow-up time did not affect the amount of new bone, the healing of the defect or the quality of new bone. (4) The eruption of the incisors was symmetrical. In this study the free periosteal graft from the tibia led to better bone formation than the local periosteal flap in the induced bone defects of the tooth-bearing region in the mandible of the adult rabbit.
Secondary bonegrafting in unilateral cleft lip palate patients: indications and treatment procedure.
A consecutive series of 62 complete unilateral cleft lip and palate patients were investigated with respect to indication for a secondary bone grafting. 2 major indications for secondary bone grafting were established. One was a symptomatic oro-nasal fistula, the other one being a bony defect in the alveolar process, which could impair orthodontic treatment and prosthodontic rehabilitation in the cleft area. The average age for bonegrafting was 12 years. After surgery, fistula-related discomfort was eliminated and speech disorders were drastically reduced. Orthodontic uprighting of teeth and correction of mid-line deviations indicated in 50% of the patients were facilitated. In 10% of the cases with extensive defects in the alveolar process, the graft enhanced the possibility for later prosthodontic treatment. Secondarily, periodontal conditions improved. When bonegrafting was performed before canine eruption, total dental rehabilitation by orthodontic treatment was often sufficient, thus decreasing the need for later prosthodontic restoration of the cleft area. Patients who had surgery after eruption of the cleft side canine exhibited more complications. The optimal treatment sequence therefore appears to be transversal expansion of the maxilla in the late mixed dentition, followed by bone grafting. Maxillary expansion must be retained until final orthodontic and prosthodontic treatment is carried out.
Secondary bone-grafting for repair of residual cleft defects in the alveolar process and hard palate. A new surgical technique.
A new surgical technique for secondary bone-grafting for closure of residual clefts in the alveolar process and hard palate is described. The technique improves the anatomy in the cleft region and, thus improves the possibility of total dental rehabilitation. The treatment results based on experiences with 293 patients will be published in a future paper, and must be estimated as promising. The technique minimizes hospitalization as well as post-operative discomfort.
Long term ridge augmentation with rib graft.
Results of ten cases are reported to indicate the bone augmentation that may be expected in three to six years using transoral rib grafting. Some augmentation was present in all cases. This is an improvement over the continued resorption that would have taken place in these already thin mandibles. Function was improved in all cases. This modality falls short of the ideal aid to these patients, but is an available holding procedure.
Orthodontically induced eruption of the permanent canine combined with alveolar cleft osteoplasty: a new procedure illustrated by a case with stereophotogrammetric reconstructions.
A new technique is suggested which will allow secondary bone grafting to be carried out at approximately 10 years of age when some potential of active tooth eruption and maxillary alveolar growth remains. Surgery is followed during the healing phase by orthodontic traction of the unerupted canine through the bone graft. This allows the reconstruction of the dental arch, while the bone graft is maintained by the osteogenic influence of the canine root. The technique is detailed and illustrated and a case report presented. A stereophotogrammetric reconstruction demonstrates the improvement in integumental contour following the technique described.
Surgical correction of unilateral posterior bimaxillary malocclusion. A case report.
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Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications.
Defects in the posterior alveolus and hard palate up to a diameter of 4 cm can sometimes be closed by covering them with the buccal fat pad and grafting the latter with a split thickness skin graft. In addition local flaps may be necessary. 4 cases have been treated so far with complete success.
The alveolar flap for the repair of the cleft alveolus -- related to the development of the upper jaw.
A new method for the repair of the cleft alveolus employing the alvolar flap, was carried out in 33 patients with a unilateral total cleft. Alternating primary osteoplastic repairs were performed in in aqual number of patients. The postoperative interval varies between 8 and 9 years. The patients were followed up with attention beng paid to the further growth of the upper jaw.
Follow-up investigation of surgical correction of the atrophic alveolar ridge by visor-osteotomy.
In 1975, a method of operation was described whereby the alveolar ridge of the mandible is osteotomied and moved on the visor principle. The two parts are fixed together with wires, thereby increasing the absolute height of the mandibular alveolar ridge. The visor-osteotomy in conjunction with vestibuloplasty and lowering of the floor of the mouth, significantly improves the denture bearing area, without the need for, and risk incurred by free bone transplantation. During the course of prosthetic treatment, one should bear in mind that there will be a temporary disturbance of sensation of the mucosa. Check-ups should be frequent. The post-operative results after three years were recorded in ten patients. There was 18% resorption of the augmented alveolar ridge over the first year. In the second year 10% and in the third year 8% or 0.6 mm. The same amount of mandibular resorption occurs following a simple, total vestibuloplasty. Three years after a visor mandibular ridge augmentation, the mandible shows physiological resorption.
Interpositional "grafting" with autogenous bone and coralline hydroxyapatite.
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Recent developments in interpositional bone-grafting of the atrophic mandible.
A clinical study on 54 patients, who underwent augmentation of the atrophic mandible by interposed bone-grafts, but in whom routine follow-up vestibuloplasty was deliberately avoided, is presented. The results show a reduced rate of bone resorption in the anterior region and less interference with lip and chin sensibility. An additional study is included concerning the fate of the elevated ridge and associated bone-graft in the body region posterior to the mental foramen. Results suggest that the resorption pattern in this area is very similar to that of a subperiosteal bone-graft. Modification of surgical technique in this regard has produced encouraging results.
Immediate repair of mandibular defects following surgery for carcinoma of the lower alveolus and gingiva using a pectoralis major osteomyocutaneous flap.
During the two years from 1981 to 1983, a pectoralis major myocutaneous island skin flap, with the 5th rib or sternum, has been used for immediate repair of mandibular defects following surgery in five cases of carcinoma of the lower alveolus and gingiva. In these 5 patients with segmental and hemimandibulectomy, immediate mandibular reconstruction was performed simultaneously using a flap with the 5th rib or the sternum. Thereafter, in 3 of them, the contour and function of the mandible were restored by prosthetic appliances. In the remaining 2 patients prostheses could not be used because of mandibular discontinuity due to removal of a portion of the graft because of postoperative infection and pseudo-arthrosis. Mandibular reconstruction using the osteomyocutaneous flap is advantageous in the restoration of the contour and function of the mandible. Some problems concerning the reconstruction will be reported.
The reconstruction of anterior residual bone defects in patients with cleft lip, alveolus and palate. A review.
A re-evaluation is presented more than a decade after the 1973 review by Koberg of bone grafting in cleft palate. The various indications for, and aims of the procedure, are enumerated. The optimal age for grafting is discussed as well as operative procedures. Results of a few more detailed studies are included in the review. In the conclusion the present shifts of emphasis are mentioned: An in depth analytical study of numerical comparisons between the many studies covering this subject is hardly appropriate. Initially, primary and early secondary osteoplasties became very popular, thereafter late secondary or tertiary osteoplasty found general favour. At present a clear trend exists to operate at a younger age again: secondary osteoplasty being performed at 6-12 years of age. However, in a number of cleft centres primary osteoplasty remains in favour. The overall results of the different procedures appears to continue to improve, though the ideal solutions are still not exactly known, nor generally agreed upon. For the time being, a good overall result should be obtained in more than 80% of cases, complete failures should not be seen in more than 5% of a series. Autogenous bone appears to be by far the best graft material. Disagreement exists on the viability of autogenous bone from different donor sites. Periodontal criteria and parameters are used more frequently in a number of recent publications for assessment of the results of the different procedures. Osteoplasty has a relatively high chance of success, especially in the younger age groups. In most institutions, however, too early an age at operation is considered to cause disturbance in growth and development of the middle third of the face. Nevertheless, in this respect operative technique and/or orthodontic treatment seem to play an important role.
Reconstruction of an alveolar cleft for orthodontic tooth movement.
Bone grafting to repair an alveolar cleft has long been an integral part of the treatment of persons with unilateral and bilateral clefts of the lip and alveolus. The presence of the cleft places a limitation on the orthodontist who would like to move teeth in the area of the cleft. Various grafting materials have been placed in alveolar clefts in an attempt to solve this problem. The case to be presented is a patient with a Class II, Division 2, malocclusion with a left unilateral alveolar cleft and a repaired cleft lip. Ten months after initiating orthodontic treatment, a free gingival graft procedure was performed because of insufficient vestibular depth and the narrow width of the keratinized attached gingiva at the left maxillary lateral and central incisor region. Two months after periodontal surgery, a mix of decalcified freeze-dried bone allograft and a granular bioactive glass graft material (1:1) were applied subperiostally on the buccal aspect of the edentulous cleft region. Six months later, the teeth adjacent to the grafted alveolar cleft were orthodontically moved into the edentulous area. The treatment results indicated that orthodontic, periodontal, and surgical interventions resulted in a successful closure of the alveolar cleft as well as improved periodontal conditions of the teeth adjacent to the cleft area. From the orthodontic point of view, tooth movement can be achieved successfully into a bone graft made of freeze-dried bone and bioactive glass.