Re: Effect of timing on long-term clinical success of alveolar bone grafts.
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Alveoloplasty↗
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Iliac apophyseal cartilage augmentation of the deficient piriform rim and maxilla in alveolar cleft grafting.
This article presents a new approach to cleft lip and cleft palate repair, where the retained bulk of alveolar cleft grafts is augmented by simultaneous cartilage augmentation of the deficient maxilla. Nine patients who provided 10 cleft sites underwent secondary bone grafting of the clefted alveolus by this technique. This study evaluates the following: (1) the postoperative esthetic results, (2) the quantity of bone in the grafted area, and (3) the provision of bone support for unerupted teeth, for teeth adjacent to the cleft, and for orthodontic tooth movement when the secondary bone grafting of the cleft is integrated with the onlay augmentation of the deficient maxilla. Photographic and radiographic investigations were undertaken. The photographic evaluation showed that all patients exhibited improved facial esthetics in the area of the cleft, particularly in the paranasal area of the maxilla; improved alar base support, symmetry of the columella, and less deviation of the tip of the nose were seen. The radiographic evaluation indicated the following: (1) the average percentage of the alveolar bone height of the grafted area was equal to 76% of the normal side; (2) nine canines erupted or were erupting through the grafted area; there were no adequate records to evaluate the fate of the remaining canine; (3) no teeth involved in the cleft area were ankylosed, because of inadequate records, so evaluators could not determine the status of one tooth; (4) all patients had adequate quantity of bone for orthodontic tooth movement through the grafted area; and (5) the periodontal support of the teeth involved in the cleft was adequate.
Alveolar Process↗
Long-term evaluation of porous hydroxyapatite blocks for alveolar ridge augmentation.
Eleven patients, with a combined total of 14 atrophic edentulous ridges, underwent subperiosteal ridge augmentation with porous hydroxyapatite blocks. Clinical evaluation was continued for 4.5 to 6.5 years. All patients suffered long-term complications. The authors recommend that this material not be used for this purpose in the future.
Alveolar Ridge Augmentation↗
Implant position following HA-augmentation of the mandible.
The transverse inclination, height and width of 20 lingually placed hydroxylapatite (HA) implants, to augment the atrophic mandibular ridge, were examined using computed tomography of cross sections through the first molar region. Favourable prosthetic conditions are achieved if the HA-implants are placed in a lingual position. This is the case when the transverse inclination varies from 65 to 85 degrees.
Alveolar Ridge Augmentation↗
Anterior maxillary osteoplasty to broaden the narrow maxillary ridge.
The application of endosseous implants has extended the range of options and effectiveness of reconstructive preprosthetic surgery. Placement of endosseous implants in the edentulous maxilla is often restricted due to lack of available bone. Exposure of the underlying anterior maxillary bone frequently reveals a ridge form which is adequate in height but too narrow to accommodate endosseous implants. A horseshoe type osteotomy extending from the ridge crest into the floor of nose has been developed which allows advancement of the outer cortex to restore lost facial form and placement of an interpositional bone graft and endosseous implants to restore lost function.
Adolescent↗
Experience with e-PTFE membrane application to bone grafting of cleft maxilla.
Previous clinical studies and animal experiments have demonstrated that the placement of expanded polytetrafluoroethylene (e-PTFE) membranes (GORE-TEX) may be valuable for bone regeneration in nonosteogenic areas. This study aimed to explore the application of this technique to bone grafting of wide alveolopalatal clefts. Ten patients with bilateral clefts were selected and during a 2-week period, all received autogenic cancellous iliac bone bilaterally. The membrane was placed nasally and orally on the larger cleft side and removed after 3-6 months. All patients have been followed for 14 months. Bone graft incorporation was successful except for one patient (membrane side), who was regrafted 1 year later. However, soft-tissue problems with membrane exposure occurred in the majority of patients, while on the nonmembrane side, healing was uneventful in all cases. Further research in membrane technology is necessary before this method can be accepted for cleft grafting.
Adolescent↗
Autogenous maxillary bone grafts in conjunction with placement of I.T.I. endosseous implants. A preliminary report.
Small bone defects due to atrophic, traumatic or periodontal bone loss can be grafted with autologous bone grafts taken from the maxillary tuberosity. This study presents a 1-3 years follow-up of 22 patients who were treated according to this technique. Thirty-two implants were placed 6 months after bone grafting. All implants were functioning well at the time of investigation.
Adult↗
Use of subperiosteal implants with distal filling ports in the correction of the atrophic alveolar ridge.
A subperiosteal tissue expander with a filling port attached to the distal end of the prosthesis has been successfully used on 10 patients during the past 2 years. The design has resulted in eliminating the dehiscence problem encountered when the midline incision was used to insert the original expander and its centrally placed filling port. The ability to use a bilateral incision or expander insertion has minimized the incidence of inferior alveolar nerve damage in the severely atrophic mandible.
Adult↗
Primary reconstruction of the mandibular alveolar ridge following resection.
Standard techniques of mandibular reconstruction aim at the restoration of function. However, the height and shape of the alveolar ridge are often neglected and reconstruction often results in difficulty in subsequent denture wear. Immediate reconstruction of the alveolar process with particulate autologous iliac bone is described, a technique used in 10 patients since 1978.
Adolescent↗
Osseointegrated dental implants in conjunction with bone grafts.
This paper relates to the experience with 12 patients who received osseointegrated dental implants of the Branemark design associated with bone grafts. 4 patients had iliac crest grafts, 2, of which were inserted together with the implants. Two had metatarsal reconstruction of the anterior mandible with the implants installed at a later date. 2 patients had particulate marrow grafts with immediate installation of the implants. Of the remainder, 1 had a late implantation of a myo-osseous flap utilizing the clavicle and the other delayed implantation of a split rib graft. The mean age of the patients in this series is 49.5 years. The mean loading time for completed cases is 18 months. 7 patients have had their dentition successfully restored, 3 lost the initial implants, 2 of which have been re-operated. One patient died prior to loading and one awaits the final surgical procedure. The results of the particulate marrow and split rib grafts were disappointing. The remainder suggest that osseointegrated dental implants may be utilized with appropriate bone grafting techniques to restore the dentition in patients with severe bone loss or following the surgical ablation of malignant disease.
Adult↗
Long-term results of the two-stage palatoplasty/Hotz' plate approach for complete bilateral cleft lip, alveolus and palate patients.
PURPOSE: To investigate the effects of the two-stage palatoplasty combined with the Hotz' plate on craniofacial development in patients with bilateral complete clefts. MATERIAL AND METHODS: Lateral and frontal cephalograms of two-stage palatoplasty/Hotz' plate group (n=10), one-stage palatoplasty group (n=11), and a non-cleft group (n=11), were evaluated at 6, 8, 10 and 12 years of age. The unpaired Student's t-test and Scheffe's F test (p<0.05) were applied. RESULTS: At 6 years the posterior upper facial height (PUFH) and PUFH/PFH ratio were greater in the two-stage group. At 10 years the PUFH, maxillary depth, convexity and ANB angle were greater in the same group. At 12 years, maxillary depth and ANB angle were also greater in this group. In the one-stage group, the L1/Mp. angle, PUFH and PUFH/PFH ratio were smaller when compared with the non-cleft group, whereas the palatal plane/SN angle was greater. In both cleft groups, the I.I. angle and tongue-PTM' distance were greater, and the U1/SN angle was smaller when compared with non-clefts. The UC-UC' and the ratios UC/MAX and UC/LC of both cleft groups were also smaller when compared with non-clefts. The ratio UM/MAX of the one-stage group was smaller when compared with the non-cleft group. CONCLUSION: The two-stage palatoplasty in combination with application of the Hotz' plate had good effects on the maxillary growth up to the age of 12 years.
Alveolar Process↗
Reconstruction of residual alveolo-palatal bone defects in cleft patients. A retrospective study.
The results of reconstruction of residual alveolo-palatal bone defects in 40 patients are evaluated clinically and radiographically in a retrospective study. Age at the time of surgery varied from 7.4 to 32.7 years. The patients were divided into two age groups: before and after 12 at the time of operation. Free autogenous anterior iliac crest bone grafts were used in 26 patients and free autogenous mandibular symphyseal bone grafts were used in 14 patients. The results show unsuccessful closure of the oronasal communication in the alveolo-palatal area of the cleft in 3 out of 31 patients. In 3 out of 40 patients, radiographic incorporation of the bone graft was unsuccessful. The radiographic success was not related to increasing experience of the surgeons. The study indicates that the best grafting results are achieved when grafting is performed before 12 years of age. The radiographic results of mandibular symphyseal bone grafts tend to be slightly better compared with results obtained with anterior iliac crest bone.
Adolescent↗
Timing and transplant materials for closure of alveolar clefts. A clinical comparison of 296 cases.
A retrospective study of bone grafting of 296 clefts (165 unilateral and 131 bilateral was required) to answer questions about the most favourable timing and the most appropriate bone graft material. The results as such are not exceptional in comparison with earlier publications by the same or other authors, but it is of special interest that operations with different graft materials applied at different times in development, in (usually) a sufficient number of cases, can be compared together. The patients have been operated on during a period of 11 years, by the same surgeons, applying the same principles and techniques. It is shown that early secondary grafting, before the eruption of the canine, results in by far, the highest success rate. Similarly, chin bone is considerably better than any other type of transplant. Aspects of general planning, timing, technique and failures are extensively discussed. Besides the afore-mentioned most significant findings, it is also concluded that the results of grafting during osteotomies are better than they appear; that tertiary grafting is extremely difficult, and requires special surgical skill; that rib grafts score as high as iliac crest grafts and that materials other than these three types of bone should be avoided.
Alveolar Process↗
Endosseous implants for prosthetic rehabilitation in bone grafted alveolar clefts.
The authors report their experience in the surgical and prosthetic rehabilitation of three patients affected by sequelae of cleft lip and palate, with residual alveolar cleft and absence of maxillary anterior teeth. The patients were treated by means of late secondary bone grafting of the alveolar cleft, followed by the insertion of endosseous titanium plasma-sprayed implants (IMZ). After a further healing period (6-12 months) fixed dental prostheses were constructed. Preliminary results from this series have shown how dental prostheses supported by endosseous implants in grafted alveolar clefts are a very reliable possibility in dental rehabilitation of this malformation.
Adolescent↗
Maxillary alveolar ridge augmentation with onlay bone-grafts and immediate endosseous implants.
Management of the atrophic maxilla can be a taxing surgical problems. One treatment alternative is to use autogenous bone transplants and immediate titanium fixture implantation. Despite the extensive literature on routine implant treatment of the edentulous jaws, only very few reports have dealt with the outcome of bone graft reconstructive surgery as part of the dental implant restoration. This study presents the treatment and healing results of 8 consecutive patients, who, over a period of 2 years and 8 months, were treated using onlay iliac bone grafts to atrophic maxillary alveolar ridges with immediate implant insertion. The patients were followed for 32-64 months. 83% of the fixtures (n = 46) were well-integrated. Two fixtures in each of 2 patients were lost due to traumatic bone-graft fractures. Palpatory bone-graft volume and prosthetic function were, with the exception of 1 patient, good. Radiological examination demonstrated preservation of the major part of the vertical dimension of the grafted bone. Patient's assessment was of good aesthetics and intraoral function; 2 patients had minor phonetic problems. In conclusion, similar success to routine maxillary implant treatment can be achieved in the event of extreme maxillary bone deficiency, by bone grafting and immediate fixture insertion.
Adult↗
Frontal cephalometric study of dentofacial morphology in children with bilateral clefts of lip, alveolus and palate.
The transverse dentofacial morphology of 36 children with bilateral cleft lip, alveolus and palate was studied by means of a frontal proportional cephalometric analysis at the ages of three, eight and twelve years. Comparison of the variables of the cleft group was made with the normal dimensions as obtained from the Bolton cephalometric templates. The results indicated that the BCLP group presented characteristics and significant differences from the normal in the dimensions of the nasal septum width and the mandibular intergonial width as they are both related to the interorbital width, the maxillary intermolar width as it is related to the mandibular intermolar width and the maxillary width as it is related to the mandibular intergonial width at all three ages. The maxillary base and intermolar widths, although significantly different at the ages of three and eight years, showed no significant deviation from normality at the age of twelve years. Following orthodontic treatment between the ages of seven to twelve years, the maxillary intermolar width of the treated subgroup was significantly larger than in the untreated subjects.
Alveolar Process↗
Autogenous rib graft for reconstruction of alveolar bone defects in cleft patients. Long-term follow-up results.
In a retrospective study (mean follow-up 76 months), the use of a free autogenous rib graft for reconstruction of anterior residual bone defects in seventeen cleft patients is evaluated on a long term basis. The results show recurrence of a palatal oronasal fistula in 2 out of 17 patients. 6 patients had acceptable results, while 9 had good to excellent scores at all sites. The costal graft material does not prevent permanent upper cuspids from erupting into this bone, after its incorporation. It is concluded that autogenous rib bone is a good material for secondary bone grafting of the residual alveolar and palatal defect in cleft patients.
Alveolar Process↗
Early secondary osteotomy-stabilization of the premaxilla in bilateral clefts.
Using the same arguments as for early bone grafting of the alveolar process in unilateral clefts, the cleft team of the University of Nijmegen started about 10 years ago to apply early osteotomy-stabilization of the premaxilla to bilateral clefts. A series of 13 cases with a minimum follow-up of 15 months is presented. The patients were operated on at the age of 8 2/12 to 12 5/12 years. The results are considerably better than when doing the same operation in the adult. More than 90% are successful. In comparison with adults we additionally register more favourable eruption of the canine, the possibility of closing the dental arch without prosthetic appliances and in some cases also the elimination of a psychological handicap. The inhibition of growth by this operation seems not to be important. If need be, Le Fort I osteotomies are possible after completion of growth. They will be in one piece which is technically easier than the usual three-segment Le Fort I. In conclusion we prefer early secondary osteotomy and stabilization of the premaxilla to the tertiary operation.
Alveoloplasty↗