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Jaw fractures in children.

From a total of 350 jaw fractures treated in 1980-1984 at Kuopio University Central Hospital, 20% were in children. These injuries were evaluated retrospectively regarding age, sex, incidence and etiology. Forty-five of the patients were boys and 25 girls. The frequency of maxillary and mandibular fractures in 70 young patients was 28.6%. The most common type of bone fractures was fracture of the alveolar process, which was prevalent in persons with mixed dentition. Before the age of 7 years, falls from height were the common causes of jaw fractures. The major cause of the jaw fractures in children from 7 to 15 years old was road accidents (47.1%), especially in boys. Most of these were cycling accidents, only a few patients were victims of automobile accidents. In addition, about one third (25.7%) of the patients were treated in the hospital because of multiple injuries to other organs.

Adolescent↗

Mucogingival problems, prevalence and therapy in children.

The clinical impressions of the authors and a survey of mucogingival problems in children lead to the following conclusions: 1. Mucogingival problems occur in children. 2. The prevalence of such problems is 12 to 19% in sample of 100 patients examined. 3. Insufficient keratinized tissue is developmentally related to: a. eruption pattern of the permanent incisors. b. buccolingual width of the alveolar process. 4. The autogenous free gingival graft is recommended as an acceptable procedure to prevent incipient mucogingival problems from progressing. 5. Where orthodontic therapy is anticipated and coincidentally insufficient keratinized tissue exists, a free gingival graft should be performed prior to tooth movement. 6. Grafts would be recommended in children with 1 mm or less of keratinized tissue. 7. Grafts would not be recommended in children when there is over 2 mm of keratinized tissue. 8. Grafts would not be recommended in children with greater than 1 mm of attached gingiva.

Adolescent↗

The chin as a donor site in early secondary osteoplasty: a retrospective clinical and radiological evaluation.

26 unilateral cleft palate patients received an autogenous bicortical chin bone graft for early reconstruction of the alveolar process. In the evaluation of the donor site, 4% of the anterior teeth showed a negative pulpal sensibility, less than 1% a peri-apical granuloma and 12% pulp canal obliteration. The tooth buds of the canines showed developmental disturbances in 6%. Exposure of unerupted canines should be avoided, and a 5 mm safety margin is advised. Based on its architecture, topographic accessibility, minimal post-operative morbidity and absence of visible scars, the chin can be considered to be a very useful donor site in bone grafting procedures.

Alveolar Process↗

The residual ridge in partially edentulous patients.

The residual ridge which forms after the extraction of teeth is characterized by a loss of substance when compared with the dentulous ridge. The residual ridge shrinks in an apical direction and shifts lingually. This remodeling pattern takes place mainly at the expense of the bony crest, the buccal plate of the alveolar process, and the gingival tissues covering it. The lingual positioning of the residual ridge crest was observed in maxillary and mandibular specimens in all the regions of the jaws and regardless of the number of teeth missing. Cross sections of the residual ridge were square, parabolic, or tapered. The base of the pontic for a fixed partial denture should be made buccolingually as the mirror image of the crest of the residual ridge it is to contact, and it should follow mesiodistally the contour and length of the clinical crowns of the adjacent abutment teeth.

Alveolar Process↗

Clinical and radiographic findings following placement of single-tooth implants in young patients--case reports.

Single-tooth implants were inserted in the maxillary anterior segments of three young patients aged 11.5 to 13 years. The patients were monitored for a period of 2.5 to 4.5 years. All implant-supported crowns ended up in an infraocclusion position relative to the adjacent teeth because of the continued vertical growth of the maxillary alveolar process. Between base-line examination and the date of recall, the distance from a fixed reference point located on the fixture to the crestal bone on the proximal surfaces of teeth adjacent to the implant sites increased up to 3 mm. Transverse growth changes were also observed. Although the prostheses could be removed and modified to compensate for the resulting soft and hard tissue changes, complications may occur altering the health of the mucogingival unit and the esthetic appearance of implant-supported restorations, and requiring further soft tissue correction procedures.

Adolescent↗

[Role of peroxidase in the pathogenesis of parodontosis].

In order to study the role of peroxidase in pathogenesis of periodontosis clinical observations were carried out in 132 patients with inflammatory-dystrophic form of periodontal disease and eight species of laboratory and domestic animals were used in experiments. In the patients studied a distinct increase in peroxidase activity was observed in mixed saliva and in gum tissues, which correlated with the severity of the periodontal disease. Inflammatory-dystrophic impairment of cat periodontium was accompanied by an increase in the peroxidase activity only in gum and alveolar process tissues; cats are characterized by the highest amounts of exogenous peroxidase in oral tissues as compared with other laboratory animals. High amounts of exogenous peroxidase did not affect the periododontal tissues of rats during long-term experiments. The main protective effects of the enzyme were as follows: bacteriostatic influence on streptococci in oral cavity and inhibition of leukocyte emifration. Estimation of the peroxidase activity in saliva may be considered as a diagnostic test for periodontosis and may be used to monitore the course of treatment.

Adult↗

A case of secondary syphilis with mucous patches on the hard palate.

A rare case of secondary syphilis showing mucous patches on the hard palate is reported. A 31-year-old male had two erosive patches which were slightly raised on his hard palate. A linear lesion was also present on the inside of his right alveolar process. Many red-brown macules on his abdomen and bilateral inguinal lymphadenopathy accompanied these symptoms. The serological tests for syphilis were positive: VDRL test 1:512, TPHA test 1:20,480, and IgM-FTA-ABS test 1:40. Immunohistochemical staining with rabbit monoclonal antibody to Treponema pallidum by the biotin-streptoavidin system detected treponemal organisms in the paraffin-embedded specimen from his mucous patch. A diagnosis of secondary syphilis was made, and he was given amoxicillin (AMPC) at 750 mg per day for 4 weeks. His eruptions, including the mucous patch, healed in a week.

Adult↗

Tooth and bone development in a Danish medieval mandible with unilateral absence of the mandibular canal.

A Danish anthropological collection of medieval human skeletons excavated in 1986 involves a mandible (No. 212) from an adult female born without the lower alveolar nerve and mandibular canal. It is believed that the defect has resulted in lack of tooth development on the affected side and that the mylohyoid nerve has partially compensated for this defect by development of teeth in localized areas. The defective mandibular dentition has caused a compensatory development of the alveolar process in the maxilla. The missing occlusal support has altered muscular traction on the mandible. This has caused an alteration in mandibular shape. Whether the asymmetric development of the mandible is caused by muscular dysfunction, by failure in angular growth apposition, or by a combination of these factors is discussed. The case presents valuable data in the ongoing discussion about the interaction between nerve tissue and tooth formation and about the interaction between occlusion, jaw morphology, and muscular traction. The study shows how archeological material in an interdisciplinary cooperation between archeological, embryological and orthodontic research can contribute to the clarification of current biological problems.

Alveolar Process↗

Comparative study of clinical manifestation, plain-film radiography, and computed tomographic scan in arteriovenous malformations of the jaws.

OBJECTIVE: The purpose of this study was to summarize the clinical manifestation, plain-film radiography, and computed tomographic (CT) scan features of arteriovenous malformations (AVMs) of the jaws on the basis of a series of 12 patients. STUDY DESIGN: This study group comprised twelve patients with AVM of the jaws from February 1996 to February 2001. Seven cases were located in the mandible, and 5 in the maxilla. Both plain-film radiography and CT scan were available for all cases. For the patients with lesions in the mandible, panoramic, posterioanterior, and lateral mandibular views were applied. Waters' position view and panoramic radiography were indicated for AVMs of the maxilla. RESULTS: Each patient with AVM of the maxillary bone had involvement of adjacent soft tissues. Various radiographic signs were noted, including erosion, coarse trabeculae, and apparent lack of any radiographic change, and CT scans featured cystic expansion of alveolar process with broken cortex. The radiographic signs and CT scan features of AVMs in the mandible were related to involvement of surrounding soft tissues. If involvement of the adjacent soft tissues was found, "soap bubble" radiolucency was shown radiographically and osteolytic expansion with perforation of cortex was present on CT scan. In cases without surrounding soft tissue involvement, the various radiographic signs included multilocular or unilocular radiolucency or coarse trabeculae; osteolytic expansions with intact cortex were found on CT scan. CONCLUSION: AVMs of the jaws showed intraosseous osteolytic expansion on CT scan but had variable appearance on plain-film radiographs.

Adolescent↗

Dual X-ray absorptiometry for alveolar bone: precision of peri-implant mineral measurements ex vivo.

The precision of measurements of minor mineral changes in alveolar bone mineral content (ABMC) and alveolar bone mineral density (ABMD) on implant surfaces was determined in small regions (0.03 +/- 0.005 cm2) using dual X-ray absorptiometry (DXA). Dog hemimandibles with alveolar processes containing 17 implants were studied ex vivo. The precision was expressed as the coefficient of variation in percent (c.v. %). The ultra-high resolution protocol was applied to the mesial, distal and apical subregions of each implant. The line spacing was 0.0254 cm and the point resolution was 0.0127 cm. The mean c.v. (%) +/- s.d. for the ABMC in the mesial, distal and apical regions were 0.42 +/- 17, 0.47 +/- 0.21 and 0.48 +/- 0.18, respectively. For the ABMD these values were 0.42 +/- 0.16, 0.47 +/- 0.19 and 0.48 +/- 0.16. For each region approximately 68% of the 17 c.v. values were distributed within 1 s.d. from the mean c.v. These results indicate that measurements are highly reproducible (better than 0.48%) and that there are no differences in precision between several peri-implant regions. Changes as small as 0.85% in ABMC and ABMD in small areas adjacent to implant surfaces are measurable with a confidence level of 95%. Therefore the DXA technique will be expedient for our research evaluating the efficacy of the ceramic hydroxyapatite implant releasing agents affecting or inducing alveolar bone- and root cementum-like materials on its surface.

Absorptiometry, Photon↗

Combined orthodontic-surgical treatment of alveolar clefts.

After more than four years of postoperative follow-up, 224 patients receiving secondary bone grafting of alveolar clefts were examined. Patients were classified into three groups according to age and eruption stage of the cleft side canine tooth at surgery. Each group was then subdivided according to the diagnoses cleft lip alveolar process only, unilateral cleft lip and palate, and bilateral cleft lip and palate. The treatment results were evaluated with respect to bone level in the cleft area, gingival and periodontal condition, orthodontic treatment result, growth of the jaws after surgery, and complications. The best results were achieved when the bone grafting was performed before eruption of the cleft side canine. In half of these patients orthodontic treatment could be finished with a closed dental arch without the need for prosthodontic treatment. The sagittal growth of the jaws was unaffected by the bone grafting, whereas the anterior height of the maxilla was reduced apparently without any clinical significance.

Adolescent↗

[Abnormalities of the maxillary sinus in type 1 neurofibromatosis].

AIM: The aim of this study was to determine the malformations of the maxillary sinus in neurofibromatosis type 1 patients (NF1). MATERIAL AND METHODS: Twenty-two patients with NF1 were investigated clinically and radiologically: 11 had an unilateral trigeminal plexiform neurofibroma and 11 had multiple cutaneous neurofibromas. The histological type of NF was ascertained in all cases following tumor resections. The malformation of the maxillary sinus was assessed on plain radiographs and computed or magnetic resonance tomograms. Intraindividual side comparison was used to judge the size of the sinus and its position in the midface. RESULTS: In patients with cutaneous neurofibromas the maxillary sinus appeared symmetrical in size and position. The pneumatization of the sinus had no abnormalities on the radiographs. Malformations of the maxillary sinus were restricted to plexiform neurofibromas. On the side affected by a plexiform NF, the sinus appeared hypoplastic and caudally displaced due to an enlarged ipsilateral orbit. The expansion of the sinus to the lateral side was impaired, obviously due to tumor masses. Consecutively, the alveolar process of the affected side was also displaced leading to a complex malocclusion. DISCUSSION: Malformations of the face are frequently presented as case reports in the literature. Emphasis is given to the elephantiasis-like tumor growth of the face in certain patients with NF1. The underlying pathology has not yet been fully understood. This report provides evidence that in the midfacial region the overgrowth is predominantly caused by the plexiform neurofibroma itself and that the bones can even be hypoplastic and show scoliosis-like malformation compared to the nonaffected side. These findings are relevant when debulking procedures of the face are planned for NF1 patients.

Adolescent↗

Etiology and incidence of maxillofacial fractures in the north of Jordan.

OBJECTIVE: The objective of this investigation was to determine the causes and incidence of maxillofacial fractures in the country of Jordan. DESIGN: A retrospective review of patient records and radiographs for the 5-year period from 1992 to 1997 was conducted. Data regarding age, gender, cause of fracture, anatomic site, and treatment modalities were reviewed. RESULTS: During the 5-year period, 563 patients with 756 maxillofacial fractures were treated. The age range was 5 to 73 years (mean, 28.8 years). Of the 563 patients, 75.3% were male, with the peak incidence occurring in the age group 20 to 29 years. The bone of fracture was most frequently the mandible (seen in 419 cases, or 74.4% of the total), followed by the maxilla (76 cases; 13.5%), the zygomatic arch (60 cases; 10.7%), and the alveolar process (8 cases; 1.4%). Of the fractures, 55.2% were due to traffic accidents, 19.7% to accidental falls, and 16.9% to assaults. Most patients (82.3%) were treated by closed reduction surgery (45.2% with eyelet wiring; 54.8% with arch bars and intermaxillary fixation). Only 17.7% of patients were treated by open reduction surgery. All maxillary fractures were treated by orbital and circumzygomatic suspension with interdental wiring and intermaxillary fixation. Of the zygomatic complex fractures, 26 cases were treated with Gillies' temporal approach, 20 with percutaneous hook elevation, and 14 with observation alone. CONCLUSION: The findings support the view that both the causes and the incidence of maxillofacial fractures vary from one country to another.

Accidental Falls↗

A histomorphologic study of the effects of periodontal inflammation on the maxillary sinus mucosa.

Twenty blocks of human jaws obtained at autopsy and containing maxillary molar teeth with the contiguous maxillary sinus intact were prepared utilizing conventional histopathologic techniques and were studied by light microscopy. The purpose of this investigation was to confirm earlier clinical reports suggesting a close association between human periodontitis and maxillary sinus thickening and to morphologically document the nature of the sinus changes. Seventeen of 20 jaw specimens demonstrated moderate to advanced periodontal destruction with pervasive extension of the inflammatory infiltrate through the alveolar process beyond the apices of the teeth and extending to the region of the antrum. Of the 20 histologic specimens, 10 showed extensive thickening of the sinus membrane, 9 had moderate hyperplastic changes, and only 1 specimen demonstrated a normal appearing sinus. Pathologic changes in the sinus membrane included inflammatory cell infiltration, edema, fibrosis of the tunica propria, mucous-serous gland proliferation, interstitial pseudo-cyst formation, polyp formation, hyalinization of the connective tissue lining, thrombosis of blood vessels, and metaplastic and degenerative changes in the epithelial lining. This study, based on histopathologic changes, suggests an apparent direct relationship between moderate and severe periodontitis of the maxillary molar teeth and pathologic changes resulting in thickening of the maxillary sinus mucosa.

Alveolar Bone Loss↗

Evaluation of the pathophysiology of odontogenic maxillary sinusitis using bone scintigraphy.

The inflammatory changes in the maxillary sinus mucosa and wall (mucosal and bony lesions) were evaluated to identify the pathophysiology of odontogenic maxillary sinusitis. Out of 80 patients who underwent CT, 32 patients were examined using single photon emission computerized tomography (SPECT) bone scintigraphy (bone SPECT) with 99mTc-hydroxymethylene-diphosphonate. Mucosal and bony lesions were evaluated morphologically on both images. SPECT data were used to assess the bone activity by calculating the count ratios of the causative alveolar process over the cervical vertebrae. The relationships with clinical symptoms, mucosal changes around the maxillary ostium (ostial lesions), and radiolucencies around the causal teeth (periapical lesions) were assessed. Bone SPECT showing the causal site was valuable for aiding a definitive diagnosis. Mucosal lesions tended to exceed bony lesions horizontally and vertically. Bony lesions tended to extend posteriorly and then anteriorly. The vertical extent of mucosal lesions and the horizontal and vertical extent of bony lesions were correlated with the presence of facial symptoms, ostial lesions, and periapical lesions. Bone activity was significantly correlated with the horizontal and vertical extent of mucosal lesions, horizontal extent of bony lesions, and presence of infraorbital symptoms, ostial lesions, and periapical lesions. Bone activity caused by alveolitis affects the pathophysiology of this disease.

Alveolar Process↗

Sonographic measurement versus mapping for determination of residual ridge width.

To achieve long-term success of dental implants, evaluation of the dimensions of the resorbing alveolar process must be accurate because an implant should be surrounded by at least 1 mm of bone. Estimating the thickness of bone is more difficult because the mucosal contour can mask the actual dimension of the residual ridge. With ultrasound, it is possible to analyze and visualize the diameter of maxillary or mandibular residual ridges. Data obtained from ultrasound measurement of residual ridges were compared with the data from ridge mapping with the Wilson bone caliper and the Spoerlein caliper. The ultrasound measurement produced nearly the same data at all measurement points as ridge mapping. Ultrasound also provides exact information about the location of the mental foramen and the maxillary sinus. By using all three methods the initial stage of implant treatment can be planned.

Aged↗

[The atrophic jaw from the prosthodontist's point of view].

The uncritical acceptance of the functional impression and of gnathological concepts are among the greatest hindrances when attempting to build full dentures on atrophic alveolar processes. To provide the most atraumatic transfer of the vertical and horizontal chewing forces from the atrophic jaw to the denture the denture bearing mucosa has to be perfectly adapted to the bony relief by the special kind of mucostatic impression as described in this article. Utterly inadequate is the jaw relation in retruded position, in which no human with or without natural teeth ever chews. This is the reason why prosthetics on edentulous jaws must observe mastication centric with freedom to the most retruded position of the mandible. In addition prosthetics on edentulous, atrophic jaws must observe the muscle grip on polished denture surfaces, the autonomous chewing stability and an occlusal pattern conforming to the masticatory movements. To this end, the author has created and developed the Condylator articulator and the Condyloform teeth.

Aged↗

Dental arch dimensions in patients with unilateral cleft lip and palate.

In this investigation, dental arch dimensions during different ages were studied in 72 children with unilateral cleft of the lip, alveolar process, and palate and were compared with those of normal children. All the children with clefts were treated surgically by surgeons of the Lancaster Cleft Palate Clinic. The dental arch dimensions were studied with the use of dental casts during the time of full deciduous dentition (3 to 4 years of age), mixed dentition (8 to 9 years of age), and permanent dentition (12 years of age). The major findings were: (1) all maxillary interdental widths and lengths were significantly smaller than the normal dimensions at all ages, except for intermolar width at age 12 years; and (2) the mandibular arch dimensions seemed to be related to changes in the maxillary arch; however, the influence of surgical procedures in the maxillary arch is not reflected severely in mandibular arch dental position.

Alveolar Process↗