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PubMed1997

Long-term assessment of early alveolar bone grafts using three-dimensional computer-assisted tomography: a pilot study.

Fifteen patients with complete unilateral cleft lip and palate who had primary alveolar bone grafting were studied with computer-assisted tomography at a mean age of 12 years. Keeping the maxillary alveolar crest parallel to the plane of the scan, 1.5-mm cuts of the maxilla were made from the infraorbital rim to the gingival third of the crowns of the teeth. A single operator reformatted the data into three-dimensional images using the Maxiview 3200 computer workstation. This allowed examination of the position, size, and spatial relationship of the grafted area and quantification of the amount of bone coverage of root surface and bone height of the alveolus in or adjacent to the graft site. Ten patients showed a lateral incisor in the line of the cleft. The average bony coverage of these tooth roots was 76.5 percent. In the five patients in whom there was lateral incisor agenesis, the canine root had average bony coverage of 82.6 percent. The average height of bone at the lateral incisor was 8.7 mm; at the canine, 14.1 mm. In two patients in whom there was only 42 percent tooth root coverage, the teeth were still viable, stable, and without mobility. Computed tomographic (CT) scans of the 15 patients demonstrated good graft survival with adequate volume. The functional and aesthetic status of the dentition in the area of the cleft also was demonstrated.

Adolescent↗
PubMed2000

Postextraction ridge preservation using a synthetic alloplast.

Ridge preservation is the prevention of the 40% to 60% jaw-bone atrophy that normally takes place 2 to 3 years postextraction and continues at a rate of 0.25% to 0.5% per year until death. It is achieved by the immediate grafting of the extraction socket with or without the use of an immediate implant. It offers the dentist the ability to preserve the alveolar ridge for future implant and restorative dentistry, to achieve anterior esthetics, and to prevent postoperative pain and bleeding. The practice of ridge preservation involves advanced extraction therapy and replacement therapy.

Alveoloplasty↗
PubMed2001

The modified trephine/osteotome sinus augmentation technique: technical considerations and discussion of indications.

A technique is presented, which uses trephines of various external diameters followed by an osteotome to implode a core of maxillary posterior alveolar bone before placement of regenerative materials, in anticipation of subsequent implant placement. A mathematical formula is presented, which relates the depth of core displacement to the apico-occlusal dimension of alveolar bone coronal to the floor of the sinus presurgically. Seventy-one sites have been treated. All sites exhibited sufficient regeneration for implant placement. Two of the sites required additional augmentation at the time of implant placement. Fifty-one of the implants have been restored and are in function for up to 3 years. All are functioning successfully, as defined by the Albrektsson criteria. The technique and its indications and contraindications are described in detail.

Aged↗
PubMed2002

Management of deficient anterior maxillary alveolus with mandibular parasymphyseal bone graft for implants.

This paper discusses the use of autogenous bone graft from the symphyseal region of the mandible to widen the deficient anterior maxilla. Compressing short or narrow implants into deficient ridges is a poor technique that often fails to correctly replace ridge anatomy or afford stable restorations. Patients who were missing a maxillary incisor, and exhibiting a loss of supporting bone in the area, were found suitable for this technique. Ten patients were included in the study. In the anterior maxilla, the thin cortices can be split, and a corticocancellous bone graft from the mandibular symphyseal region can be positioned on the labial-buccal cortex. This surgical procedure enables implant placement in previously deficient bone within the maxilla. In comparison with other techniques, the use of a mandibular symphysis graft technique offers ease of access, good bone quantity for localized repair, a corticocancellous block graft morphology, low morbidity, decreased complaints of postoperative sensory disturbances and discomfort, and minimal graft resorption. An improved bone density results along with a shorter healing time as compared with other methods for bone repair. A success rate of 81.2% was obtained after a mean follow-up period of 3 years.

Adult↗
PubMed2003

Combination syndrome: treatment with dental implants.

Occlusal plane problems are often not evaluated adequately. They can be left untreated or improperly treated. This article reviews one such problem known as Combination Syndrome. The treatment method described involves using a fixed mandibular prosthesis over implants that have been placed immediately after dental extractions.

Alveoloplasty↗
PubMed2006

Alveolar distraction osteogenesis before placement of dental implants.

Distraction osteogenesis of the edentulous alveolar ridges may be considered an alternative to many other augmentation oriented surgical techniques. It is now being widely used for treating severe forms of alveolar ridge atrophy, especially before the placement of dental implants. Leibinger Endosseous Alveolar Distraction System (LEAD; Stryker Leibinger, Kalamazoo, MI) is an intraosseous distraction device used for edentulous ridges. In this study, the healing was uneventful in all 5 cases that were treated except 1, in which the vitality of the distraction segment could not be maintained. No complications related to the prosthodontic restoration were observed.

Adolescent↗
PubMed2005

Surgical technique for primary alveolar bone grafting.

Bone grafting of the alveolar cleft is an important component of the comprehensive care of the cleft lip and palate patient. Although debate exists regarding the optimal timing of the procedure, one approach is the placement of a rib graft in the alveolar cleft before eruption of the deciduous canine (primary alveolar bone graft). Since 1982, primary alveolar bone grafting has been performed at our institution in more than 300 patients. Because little is reported in the literature on primary alveolar bone grafting in general, an experienced surgical technique and protocol are lacking. Our surgical technique for rib graft harvest as well as alveolar bone graft placement in the infant cleft alveolus is described.

Alveolar Process↗
PubMed2005

Repair of alveolar clefts with recombinant human bone morphogenetic protein (rhBMP-2) in patients with clefts.

This article demonstrates the feasibility of using recombinant human bone morphogenetic protein (rhBMP-2) as a substitute for autogenous iliac crest bone for repair of congenital facial clefts in humans. In this series, 50 cleft sites were repaired in 43 patients using rhBMP-2 without the use of autogenous graft tissue. Successful osseous union was achieved in 49 of the 50 sites. In one patient, the graft failed to consolidate. Severe clefts were managed by combining distraction osteogenesis and rhBMP-2. Eliminating the need to harvest autogenous iliac crest bone resulted in substantial decrease in morbidity. The constructed alveolus performed clinically as normal bone and responded to natural tooth eruption and orthodontic movement. Histology of the tissue constructed showed normal, vital bone. Although additional investigation is warranted to determine the optimum protocol for the use of this material in alveolar cleft repair, the technique should be considered as a viable treatment option in cases in which avoiding iliac crest harvesting is desirable.

Adolescent↗
PubMed2005

Retrospective analysis of secondary alveolar cleft grafts using iliac of chin bone.

The osseous closure of alveolar clefts is an integral component of a comprehensive rehabilitation of patients with cleft lip and palate and has assumed an essential position in the reconstruction of cleft deformity. Our study consists of 35 patients aged between 7 and 11 years who received secondary bone grafting of their cleft alveolus over a 30 month period from July 1999 to December 2003. There were 22 (62.9%) males and 13 (37.1%) females. In 25 cases, bone graft was harvested from the iliac crest and in 10 others, from the mandibular symphysis. A total number of 41 osteoplasties was performed in the 35 patients. Twenty osteoplasties maintained an alveolar height up to 75% and approximately that number showed resorption varying between 50% and 75%. There was no case of complete resorption of graft. There were no serious periodontal pockets found. In all cases, the wound healed well, and there was no complication. Our experience demonstrates that secondary alveolar bone grafting is an efficacious method of rehabilitating patients with alveolar clefts.

Alveolar Process↗
PubMed1977

Reconstruction of alveolar ridge and jaw defects resulting from gunshot wounds.

Reconstruction and rehabilitation of acquired defects of the oral cavity is an important dental service. Severe deformities of the jaws may result secondary to gunshot wounds of the oral-facial region. New advances in soft and hard tissue surgical reconstruction can be of great benefit to the patient when coupled with prosthetic rehabilitation. In recent years there has been a significant increase in the incidence of gunshot wounds in the civilian population in the United States, and those of the mouth and jaws are relatively common-place. Gunshot wounds to the face and jaws may cause gross destruction of tissues. Although immediate definitive treatment of wounds reduces the mutilating effect, a significant number of patients require extensive reconstructive procedures. In addition, prosthetic rehabilitation is almost always needed. The purpose of this paper is to briefly review some recent advances in reconstruction of the maxilla and mandible following gunshot injuries.

Alveolar Process↗
PubMed2001

A nontraditional technique for obtaining optimal esthetics for an immediate denture: a clinical report.

Bimaxillary protrusion and severe labioversion of anterior teeth complicate impression procedures and increase the difficulty in making esthetic predictions for the immediate complete denture patient. The presented technique, performed in reverse order of traditional methods, is accomplished in stages in which the anterior and nonessential posterior teeth are extracted and interim removable partial dentures placed. An opportunity is thus created to evaluate esthetics, phonetics, and anterior tooth function before extraction of the remaining dentition and delivery of immediate complete dentures. This technique facilitated the determination of the need for alveoplasty of the anterior maxilla.

Alveoloplasty↗
PubMed2004

Anterior tooth replacement with implants in grafted alveolar cleft sites: a case series.

When a residual edentulous space in the anterior region remains after surgical and orthodontic treatment of alveolar cleft patients, implant placement with or without additional grafting is a treatment option. We placed a total of 10 implants in nine consecutive alveolar cleft patients (five females, four males) with residual anterior edentulous spaces and non-restored neighbouring teeth. Patient age generally varied from 18 to 22 years. Additional (tertiary) bone grafting, implant placement after 3 months of graft consolidation and implant uncover after no less than 6 months was the favoured surgical protocol in the five most recent cases. Ample time was allowed to evaluate and guide the development of soft tissues, following second-stage surgery. For this purpose, temporary crowns were fabricated, adjusted and left in place for over 3-4 months in seven out of nine cases. No implants were lost after a mean observation period of 3.4 years and all implants function without objective (radiographic) or subjective problems. Aesthetics were considered acceptable in seven out of nine cases. Unsatisfactory aesthetic results originated from poor implant positioning or alignment in two patients who did not undergo tertiary bone grafting. We conclude that implant placement in alveolar cleft sites is a comprehensive but viable treatment option. Tertiary grafting of the site is recommended to achieve better ridge contour and bone height. This allows optimal implant placement and alignment.

Adolescent↗
PubMed2005

Therapy of peri-implantitis with resective surgery. A 3-year clinical trial on rough screw-shaped oral implants. Part I: clinical outcome.

The purpose of this randomized clinical trial was to compare the clinical outcome of two different surgical approaches for the treatment of peri-implantitis. Seventeen patients with ITI(R) implants were included consecutively over a period of 5 years. The patients were randomized with a lottery assignment. Ten patients were treated with resective surgery and modification of surface topography (test group). The remaining seven patients were treated with resective surgery only (control group). Clinical parameters (suppuration, modified plaque index - mPI, modified bleeding index - mBI, probing pocket depth - PPD, pseudopocket - DIM, mucosal recession - REC, probing attachment level - PAL) were recorded at baseline, as well as 6, 12, 24 and 36 months after treatment. The cumulative survival rate for the implants of the test group was 100% after 3 years. After 24 months, two hollow-screw implants of control group were removed because of mobility. Consequently, the cumulative survival rate was 87.5%. The recession index in the control group was significantly lower than in the test group at 24 months (Student's t-value of -2.14). On the contrary, control group showed higher PPD, PAL and mBI indexes than test group (Student's t-values of +5.5, +2.4 and +9.61, respectively). The PPD and mBI indexes for the implants of the control group were significantly higher at baseline than 24 months later (Student's t-values of +3.18 and +3.33, respectively). Recession and PAL indexes resulted in values significantly lower than baseline (Student's t-values of -4.62 and -2.77, respectively). For the implants of the test group PPD and mBI indexes were significantly higher at baseline than 36 months after (Student's t-values of +11.63 and +16.02, respectively). Recession index resulted in values significantly lower at baseline (Student's t-value of -5.05). No statistically significant differences were found between PAL index measurement at baseline and 36 months later (Student's t-value of +0.89). In conclusion, resective therapy associated with implantoplasty seems to influence positively the survival of oral implants affected by inflammatory processes.

Alveoloplasty↗
PubMed2005

Surgical advantages with ITI TE implants placement in conjunction with split crest technique. 18-month results of an ongoing prospective study.

Implant rehabilitation of the edentulous maxilla may be somewhat problematic because of anatomic situations involving insufficient bone thickness. One approach in this situation is localized ridge augmentation with the split crest technique. This surgical approach allows the external cortical plate of the maxilla to be moved in a labial direction to gain an increase in width to introduce implants of appropriate diameter. This ongoing prospective study evaluated: (i) the surgical advantages that the new ITI TE implants have showed compared with the ITI standard solid-screw implants when placed in conjunction with the split crest technique and (ii) the implant success rate associated with 42 ITI TE implants and 40 ITI standard solid-screw implants placed in 40 patients in conjunction with the split crest technique. ITI TE implants have shown direct and indirect advantages in reducing the risk of fracture of the labial cortical plate during all the three fundamental surgical steps of this technique: (a) the ridge expansion with osteotomes; (b) implant site preparation with drills and (c) implant insertion. The overall success rates of ITI TE implants and standard screw implants were 100% and 95%, respectively. Based on the preliminary results of the present study, it can be concluded that ITI TE implants inserted in conjunction with split crest technique seem to be a promising surgical procedure to treat selected anatomic situations involving insufficient maxillary bone thickness.

Adult↗
PubMed2006

Intermittent loading improves results in mandibular alveolar distraction osteogenesis.

AIM: To evaluate clinical and morphological effects on distractive callus after application of an original protocol of bone stimulation. MATERIAL AND METHODS: Traditional or mechanically stimulated alveolar-distraction osteogenesis was studied on 16 highly selected subjects subdivided into two groups. Clinical, radiological, densitometric and histological (on biopsies) analyses were performed 6, 8 and 12 weeks after distraction was completed. RESULTS: In subjects undergoing stimulated alveolar-distraction osteogenesis, bone density was higher and at histology, bone with ordered structure was observed after 6 weeks. Moreover, bone trabeculae with oriented architecture and greater amounts of lamellar bone were observed after 8 and 12 weeks in the same subjects. DISCUSSION AND CONCLUSIONS: In conclusion, although osteogenic processes were similar in both groups, they were induced earlier and were better structured in subjects undergoing stimulated alveolar-distraction osteogenesis. These encouraging results can only be achieved and preserved by strict monitoring of distractive vectors.

Absorptiometry, Photon↗
PubMed1978

Osseous repair in infrabony periodontal defects.

The present investigation was undertaken to quantitate the osseous changes which occur throughout the entire circumferential extent of infrabony periodontal defects in patients with optimal plaque control. Fifteen defects were selected in nine patients. Periodontal surgery was scheduled after each patient had shown an ability to practice efficient plaque removal. Muco-periosteal flaps were raised and the osseous defects debrided. The dimensions of each defect were measured at several specific location points within the defect. The flaps were replaced at their original location and, post-operatively, optimal plaque control was maintained in the area (Mean Plaque Index 0.04). Six to 8 months after the initial surgery all areas were re-operated and the osseous defects were remeasured at the same specific location points. Each defect showed osseous regeneration at every location point. The mean initial osseous defect depth at a location point was 3.5 mm and the mean amount of bone regeneration which occurred was 2.5 mm. Crestal alveolar bone resorption occurred at almost half of the location points and averaged 0.7 mm. Eleven of the 15 defects had resolved completely. There were isolated areas where a shallow defect persisted in the remaining four defects. The behavior of an osseous defect throughout its circumferential extent was characterized by a combination of coronal bone regeneration (mean 77%) and marginal bone resorption (mean 18%). Infrabony periodontal defects may predictably remodel after surgical debridement and establishment of optimal plaque control.

Adult↗
PubMed1980

Histometric evaluation of periodontal surgery. II. Connective tissue attachment levels after four regenerative procedures.

The present study was undertaken to determine the effect of four periodontal regenerative procedures on the connective tissue attachment level. The procedures tested were: 1) the modified Widman flap procedure, 2) the modified Widman flap procedure combined with transplantation of previously frozen autogenous red marrow and cancellous bone, 3) the modified Widman flap procedure in combination with implantation of beta tricalcium phosphate, and 4) periodic root planing and soft tissue curettage. Eight adult Rhesus monkeys, divided into four equal groups, were used. Periodontal pockets were produced around contralateral teeth in a standardized manner. In each group of animals, the pockets on one side of the jaws were subjected to one of the above-mentioned surgical treatments, while the contralateral pockets remained as unoperated controls. Three weeks before surgery, a carefully designed plaque control program was instituted and continued until the animals were sacrificed 12 months after surgery. In histologic sections, linear measurements along the root surfaces were made from the cemento-enamel junction (CEJ) to the most apical cells of the junctional epithelium (JE). These measurements from operated and unoperated sites were then compared. The data revealed that healing following the four different regenerative procedures resulted in the reformation of an epithelial lining (long junctional epithelium) along the treated root surfaces, with no new connective tissue attachment.

Alveoloplasty↗