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PubMed1991

Secondary alveolar bone grafting in clefts of the lip and palate.

A short review of the literature is presented outlining the role of alveolar bone grafting in cleft patients. An analysis of a series of 47 secondary alveolar bone grafts in 34 patients is presented. The age range was 7-24 years. At the time of evaluation, 30 canines were in final occlusion and good alveolar bone levels were present in 83% of patients. Of the 13 bilateral cases (26 clefts), 14 canines were in final occlusion and all cases had good alveolar bone levels. No major complications were encountered. The graft was completely resorbed in 3 cases (6.4%) only.

Adolescent↗
PubMed1991

A comparative investigation on autologous mandibular and iliac crest bone grafts. An experimental study in sheep.

Nine Friesian sheep (age 1.5-2 years) were used to evaluate the quality of bone repair in artificial cleft-like maxillary defects repaired with autologous bone grafts of embryologically different origin. After bilateral extraction of the upper first deciduous molar the tooth socket was enlarged resulting in an open connection between the oral and nasal cavities. In the same session a graft, obtained from the iliac crest, was implanted in one of the two bilateral maxillary defects and on the opposite side a graft, obtained from the mandible, was inserted. During the experiment, serial radiographs were taken. After six months the sheep were sacrificed and the bone of the grafted areas was submitted to histological and histomorphometric investigation. Comparing both areas, it appeared that the quality of bone remodelling and alveolar reconstruction was independent of the origin of the grafts.

Alveolar Process↗
PubMed1990

Early secondary bone grafting of alveolar cleft defects. A comparison between chin and rib grafts.

Since 1981 in cleft lip and palate patients a combined surgical-orthodontic procedure has been performed to eliminate the residual alveolar cleft. For early secondary bone grafting (before the eruption of the canine tooth) initially the graft tissue of choice was rib. Since 1984 chin bone has also been used. Sixty one patients with complete unilateral clefts were reviewed (mean age 9.5 years). 15.7% of the rib graft cases showed resorption of the graft of 50% and more. Such resorption was not found in any of the chin graft cases. No complications such as wound dehiscence, sequestration, excessive resorption of bone or recurrence of an oro-nasal fistula were found in the chin graft group. This leads to the conclusion that if enough bone is available in the chin region to bridge the defect, this graft is preferable to a rib graft.

Adolescent↗
PubMed1988

Intermediate bone grafting of alveolar clefts.

During the five year period 1980 to 1985 bone grafting was performed in 37 cleft patients before the eruption of the canine tooth (group IBG) and in 30 patients after the eruption of the canine tooth (group SGB). The initial healing was more favourable in the IBG group. In 72.5% of the clefts oro-nasal fistulae were present preoperatively. In all cases the fistulae were successfully closed. In the IBG group with orthodontic closure of the gap in the dental arch the interdental bone height in the grafted area was more than 75% of normal bone height in all clefts. In group SBG this situation was found in only 66% of the bone-grafted areas. There seems to be a clear relation between the age or the developmental stage of the canine tooth on the one hand and the possibility of orthodontic closure of the gap in the dental arch and good interdental bone height on the other hand. This also leads to the suggestion that if bone grafting to the alveolar cleft is required the operation should be performed before the eruption of the canine tooth on the cleft side.

Adolescent↗
PubMed1996

Long-term results of segmental repositioning of the maxilla in cleft palate patients without previously grafted alveolo-palatal clefts.

Eleven patients (9 UCLP, 2 BCLP) were treated with segmental osteotomies with or without osteotomies at the Le Fort I level and simultaneous bone grafting of the alveolo-palatal clefts at adult age. These patients were clinically and radiographically evaluated after a mean follow-up period of 59 months (range 39-110 months). One patient showed complete dentoalveolar relapse, whereas the skeletal stability after miniplate fixation proved to be adequate in all cases. Only one patient presented with a persisting oro-nasal fistula. In six cases, the alar base asymmetry had improved to such an extent that further nasal corrections were not necessary. The procedure described is a reliable technique to graft the alveolo-palatal cleft and reposition the dentoalveolar segments simultaneously in those adult cleft palate patients who had no previous alveolar bone grafting.

Adolescent↗
PubMed1996

Pain following iliac crest bone grafting of alveolar clefts.

The purpose of this study was to investigate pain following iliac crest bone grafting of alveolar clefts. The study involved 34 consecutive patients requiring secondary alveolar bone grafting. The study population consisted of 21 males and 13 females with a mean age of 11 years (SD = 3.4). Twenty-three patients had unilateral and 11 patients bilateral clefts. The patients were treated in a like manner with harvesting of an iliac crest cortico-cancellous block concurrently with the raising of flaps and cleft closure. All surgery was performed by combinations of the authors. Eighteen patients were placed on postoperative intravenous ketorolac and the remainder were not. All patients received patient controlled analgesia at a dose of 0.015 mg/kg of morphine with an 8 min exclusion period before re-dosing. Total narcotic usage averaged 0.18 mg/kg (SD = 0.19) with 31 patients using less than 0.4 mg/kg. Regular ketorolac did not influence narcotic usage, nor did sex, age or nature of the cleft. Thirty-one patients began ambulating on the first postoperative day and 27 were discharged within 2 days of surgery. No long-term donor site morbidity was observed. Our results suggest that pain following iliac crest bone grafting of alveolar clefts is not severe and is readily alleviated with small quantities of analgesic drugs. It would appear that short-term morbidity following these procedures is frequently overstated and is in itself not a valid reason to change to calvarial or mandibular donor sites.

Age Factors↗
PubMed1997

Analysis of primary gingivoperiosteoplasty in alveolar cleft repair. Part I: Facial growth.

The primary gingivoperiosteoplasty by Millard consists of presurgical active orthognathic treatment ('Latham device') of the alveolar margins at the age of 3 months and of surgical closure of the alveolar cleft with local gingivoperiosteal flaps at the age of 5 months. The aim of this investigation was to analyse the facial growth following this treatment. The following material was studied: lateral head X-rays and plaster casts from 146 patients with unilateral (UCLP) and bilateral (BCLP) clefts of lip and palate from birth to 16 years of age. Ninety-one of these patients formed the control group, who received neither gingivoperiosteoplasty nor pre-surgical active orthognathic treatment. The same surgeon and orthodontist treated all 146 patients. A three-dimensional growth disturbance after gingivoperiosteoplasty was observed: 42% patients with UCLP and 40% patients with BCLP had an 'open bite' following closure of the alveolar cleft (control group 5%/10%). The length of the upper jaw in patients who underwent gingivoperiosteoplasty was shorter than in the control group. The frequency of posterior cross bite was also higher in the gingivoperiosteoplasty group. These results demonstrate that treatment with a 'Latham device' disturbs facial growth. Therefore, this treatment should be abandoned.

Adolescent↗
PubMed1998

Indications and limitations of three-dimensional models in cranio-maxillofacial surgery.

Anatomical, life-like, three-dimensional (3D) models have a definite place in cranio-maxillofacial surgery. Our experience with 541 computer tomography (CT)-based 3D models employed in aiding corrective surgery of tumours, dysgnathia, traumatology, alveolar atrophy, congenital malformation and asymmetrical malformations in our department is discussed. From July 1988 to February 1997, 3D models of 346 patients were used. Most of these were produced at our clinic. The indications, advantages and limitations of 3D-models were analysed retrospectively. In the case of congenital malformations (n = 60), models facilitated precise diagnosis of the skeletal deformity. Simulation surgery allowed prediction and solution of intraoperative problems prior to the actual patient operation. Size, shape and localization of defects caused by trauma (n = 64), osteoradionecrosis (n = 17) or osteomyelitis (n = 2) determined the choice of transplant donor site. In patients suffering from dysgnathia (n = 144), 3D models enabled exact positioning of the jaws. Precise planning could only be accomplished with the help of 3D models, especially for asymmetrical malformations (n = 12). In cases of severe atrophy of the alveolar crest (n = 45), exact measurement of the bone was possible and facilitated the decision as to whether dental implants, bone transplants or a combination of these were indicated. The positioning of transplants and implants was carried out in the ideal relation to the opposite jaw. In tumour patients (n = 186), it is not always possible to identify the tumour borders precisely on the CT scan or 3D model. Therefore, the defect was assumed to be bigger, a longer bridging plate constructed and this measurement corrected according to the intraoperative situation. The advantage of the 3D models consisted of an accurate representation of anatomical structures, bone or soft tissue. This allows precise preoperative diagnosis, operation planning and model operations. Due to this, the correct approach as well as operation technique could be chosen, outcomes of constant high quality were achieved, and there was a reduction in operation time.

Adolescent↗
PubMed1999

Fusion of maxillary and mandibular alveolar process together with a median mandibular cleft: a rare congenital anomaly.

Congenital fusion of the maxillary alveolar process and mandible is a very rare entity. A one day old male newborn was referred to our clinic with a diagnosis of a 'absence of oral cavity'. Physical examination revealed that there was no mouth opening bilaterally in the posterior region due to maxillary and mandibular bone fusion; and in the front there was only 1 mm of mouth opening. Examination of the intraoral space could not be achieved. No other congenital anomaly was detected on general examination. The infant, who was fed via a nasogastric tube for 1 month, was operated on. An intra-oral device which separated maxillary and mandibular alveolar arches from each other was designed and used for 8 weeks to avoid recurrence of the fusion. An adequate mouth opening was obtained and the infant could be fed orally.

Alveolar Process↗
PubMed1996

A comparison of treatment results in complete bilateral cleft lip and palate using a conservative approach versus Millard-Latham PSOT procedure.

Conservative non-presurgical orthopedic treatment in complete bilateral cleft lip and palate (CBCLP) cases were compared with those treated will the Millard-Latham (M-L) method, which involves the presurgical mechanical retraction of the protruding premaxilla using pinned palatal appliances. In conservatively treated cases, a head bonnet with an external elastic is sometimes used before surgical lip closure to ventroflex the premaxilla thereby reducing tension at the surgical sites. The M-L method involves premaxillary bodily retraction followed by a gingivo-periosteoplasty. In both series of cases the palatal cleft (hard and soft) is closed for patients aged 18 to 30 months using a modified von Langenbeck procedure. A secondary alveolar bone graft is only performed in the conservatively treated series for patients aged 7 to 9 years. Although the premaxilla in 2 of 29 conservatively treated cases were retruded and in anterior crossbite by 10 to 12 years of age, all M-L cases were retruded by 9 years of age requiring maxillary protraction. In the M-L cases 90% showed bony bridging of the alveolar cleft with frequent loss of the lateral incisor space; surgical closure of the nasal floor is facilitated, and early aesthetic improvement is followed by midfacial retrusion.

Adolescent↗
PubMed1996

Bone grafting for the alveolar cleft defect.

Seventy-five percent of all cleft lip and palate patients have osseous defects of the alveolus. Bone grafting of this defect normalizes facial and dental function. Failure to reconstruct the osseous deformity may result in oronasal fistula, fluid reflux, speech pathology, anteroposterior deficiency of the maxilla, transverse deficiency of the maxilla, lack of bone support for the incisors and cuspids, dental crowding, and facial asymmetry. Bone grafting unifies the maxilla and is best done after the majority of facial growth is complete and the secondary dentition is erupting. This is known as secondary bone grafting and yields the best results. The dentofacial deformity of cleft lip and palate is best managed by coordination of dental development, surgery and orthodontics.

Adolescent↗
PubMed1998

Scintigraphic evaluation of healing response after heterograft usage for alveolar extraction cavity.

OBJECTIVE: Reconstruction of bone defects remains an important problem in oral and maxillofacial surgery. Restoration of defect sites with various grafting materials is a valuable approach to the solution of this problem. The aim of this study was to evaluate the effects of the use of heterografts on osteoblastic activity by means of a radionuclide technique. STUDY DESIGN: The postextraction alveolar cavities of impacted mandibular third molars on 22 patients were used as a healing model for this study. Granulated freeze-dried heterograft material of bovine origin was used on 11 patients; the other 11 patients constituted a control group. On each patient, three-phase bone scans were performed on postoperative days 7 and 28. RESULTS: Although dynamic and blood pool studies showed similar patterns with respect to the mean values of asymmetry ratios of operation sites to the contralateral sides for the 7th- and 28th-day scans, static-phase bone scans revealed that healing response through osteoinduction was more prominent in the study group than in the control group. A significant increase in the mean value of the ratio from the first scan to the second was observed on static images in the study group (first scan, 1.6 +/- 0.2; second scan, 2.0 +/- 0.5; p < 0.05). However, the same ratio failed to show any significant change in the control group (first scan, 1.5 +/- 0.2; second scan, 1.5 +/- 0.3; p > 0.05). CONCLUSION: Static-phase bone scintigraphy showed that when freeze-dried heterograft material is used to fill alveolar extraction cavities, it stimulates osteoblastic activity, which in turn leads to acceleration of the healing process and helps to maintain the linearity of bony structure. Moreover, radionuclide study can be used to evaluate the viability of freeze-dried heterografts in the 4th postoperative week, at which time no additional increase in perfusion resulting from surgical trauma was found in our series.

Alveolar Process↗
PubMed2001

Sinus lifting procedure. I. One-stage surgery with bone transplant and implants.

A prospective study of one-stage surgery with intrasinus bone transplant and implants has been performed in 26 patients (13 males and 13 females). The aim of the study was to evaluate the success rate with the one-stage sinus lifting procedure in patients with a need for bony augmentation of the alveolar process. Fifteen patients were partially dentate and 11 edentulous. The mean height of the alveolar ridge was 2.5 mm preoperatively (range 1-5.5 mm). 126 fixtures were inserted, 93 in grafted bone and 33 in alveolar bone. Twenty-two patients have been followed for three years, 21 for four years and 11 for five years. The clinical overall survival rate was 69.6% although only 61.2% in grafted bone. Ten of the patients had varying degree of sinusitis post-fixture installation. At the end of the study, 23 patients had permanent bridges. The survival rate was low for inlay supported implants when the one-stage surgical technique was applied. Two-stage surgery may be a safer method.

Adult↗
PubMed2002

Morphofunctional and clinical study on mandibular alveolar distraction osteogenesis.

Alveolar Distraction Osteogenesis (ADO) is a process which forms new alveolar bone to correct alveolar deformities in ridge height and width. This work aims (a). to verify the predictability of the augmentation of height of atrophic alveolar ridges using an extra-alveolar distraction device and (b). to study the bone processes in order to optimize implanto-prosthetic rehabilitation. ADO was performed on 10 patients with ridge deformities to obtain the required ridge augmentation. Clinical and radiological (OPT and CT with densitometric assay) evaluations were carried out during the following 12 weeks, before implant insertion. Biopsies at 40, 60 and 88 days were studied after general, specific and histochemical staining of slides; microradiographs were analyzed to evaluate the Trabecular Bone Volume. Forty days after the end of distraction, soft callus indicated the start of ossification. Sixty days after the end of distraction, the soft callus was largely converted into a network of trabecular woven bone; osteogenic activity was high and TBV was about 50%. Eighty-eight days after the end of distraction, the amount of bone appeared reduced, with a more ordered structure; bone formation activity and TBV also diminished, whereas osteoclast erosion was active. The densitometric assay shows values increasing from the end of distraction, particularly after implant insertion. Histological results show a regression in bone deposition processes 88 days after the end of distraction culminating in a virtual steady-state after a certain time. The results suggest that early implant insertion may be desirable to avoid bone loss due to mechanical unloading.

Absorptiometry, Photon↗
PubMed2000

Osseous resective surgery.

Osseous resective surgery necessitates following certain guidelines for proper recontouring of the alveolar bone and proper management and positioning of the gingival tissues. The results from osseous resective surgery are technique sensitive. It has limited use in treating cases with very deep intrabony or hemiseptal defects, which should be treated with a different surgical approach. If osseous resective surgery is used in advanced lesions, a compromise in the amount of probing depth reduction should be expected. Yet, osseous resective surgery provides the surest method of reducing pockets with an intrabony or hemiseptal osseous component of 3 mm or less, albeit at the expense of some attachment in the neighboring less involved sites. Osseous resective surgery has been and remains one of the principal periodontal treatment modalities because of its proven success (Fig. 17).

Alveolar Bone Loss↗
PubMed2000

The treatment of intrabony defects with bone grafts.

There is substantial clinical and histological evidence that support the concept that extraoral and intraoral autogenous bone grafts and demineralized freeze-dried bone allografts are effective regenerative materials in the treatment of intrabony defects. Moreover, long-term evaluations currently available suggest that the regenerative gains achieved remain clinically stable. Synthetic grafts may result in improved probing depths and clinical attachment levels but have yet to demonstrate the ability to initiate or enhance the formation of a new attachment apparatus.

Alveolar Bone Loss↗
PubMed2001

Clinical application of computer-aided rapid prototyping for tooth transplantation.

The maintenance of healthy periodontal ligament cells in the donor tooth is one of the most important factors for successful tooth transplantation. This is achieved by minimizing the extraoral time during the surgical procedure. If a duplicate form of donor tooth could be obtained before extraction, it would be possible to precontour the recipient alveolar bone compatible with the donor tooth, and thereby reduce the extra-oral time of the donor tooth. We obtained a three-dimensional image with the real dimensions of the donor tooth from a CT Highspeed Advantage, allowing a life-sized resin model of the tooth to be fabricated. From 22 clinical cases, we achieved an average total transplantation time of 7.7 min. The average distance between the transplanted root surface and the alveolar bone from 12 available cases was 0.87 mm at the mesial cervix, 0.91 mm at the mesial apex, 0.98 mm at the distal cervix and 1.16 mm at the distal apex on the postoperative radiographs. Clinical data indicate that computer-aided rapid prototyping may be of value in minimizing the extra-oral time and possible injury to transplanted tooth during the process of autotransplantation.

Adult↗