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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↗
PubMed1988

Paleopathology in Australopithecus africanus: a suggested case of a 3-million-year-old prepubertal periodontitis.

The fossil remains of a juvenile Australopithecus africanus specimen from Sterkfontein Member 4 temporally confined on faunal grounds to 2.5-3.0 million years before the present (Myr B.P.) show pathological alterations of the periodontal alveolar process consistent with a case of prepubertal periodontitis. This diagnosis is based on macroscopic features of alveolar bone loss distribution, pattern of periodontal bone destruction, migration of the affected deciduous molars, and on stereomicroscopic and scanning electron microscopic evidence of alveolar bone destruction. Differential diagnoses and pathological exclusions are discussed in terms of localized patterns of periodontal bone destruction and presumptive survival rate. The reported case appears to be the first detailed description of a recognized disease in early hominid evolution.

Africa↗
PubMed2000

Anesthesia and pain management.

Acute orofacial pain is usually managed by the administration of local anesthetics, systemic analgesics, or a combination of the two methods. In an emergency, intraoral maxillary nerve blockade is helpful for controlling pain in the midface, although infiltrations may be more suitable for discomfort originating from individual teeth or portions of the alveolar process. Mandibular anesthesia can be achieved by open or closed-mouth techniques for inferioral alveolar-lingual nerve blockade. Systemic pain relief is optimized by using full analgesic doses of NSAIDs, with opioids serving to increase the degree of analgesia if required, or to be used, often with acetaminophen, in patients intolerant to NSAIDs.

Analgesics↗
PubMed2005

Bi-directional distraction osteogenesis of the alveolar bone using an extraosseous device.

OBJECTIVES: In alveolar distraction, the bone segment tends to incline palatally or lingually, making rigid control of the segments difficult. The aim of this study was to evaluate the usefulness of a newly developed bi-directional extraosseous alveolar distractor (Medartis V2-Alveolar distractor) for pre- and perioperative vector management. MATERIAL AND METHODS: Seven patients with segmental alveolar atrophy following traumatic tooth loss were treated using the distraction device. The patients were followed up clinically and radiologically. Preoperatively, the initial vector for distraction was determined using CT by measuring the cross-section of the bone. The morphology of the alveolar bone was also analyzed in relation to the planned implant position. Postoperatively, the rate of osteogenesis was monitored with plane radiographs and CT scan. RESULTS: All cases had bone deficit at the anterior surface of the alveolar ridge, showing a typical inclination of the long axis of the bone. Using the distractor, vertical distraction and positioning of the segments with labial orientation was possible. After a consolidation period of 12 weeks on average, sufficient bone formation for implant installation was radiologically observable. Histologic and histomorphometric analysis of one bone biopsy showed very dense mineralized bone (area fraction=78%) with a multidirectional, complex architecture. Implant-supported prosthetic oral rehabilitation was successfully performed in all cases. CONCLUSION: All complications observed in this study were related to the bone deficiency at the anterior surface of the alveolar process. If the technique can be improved, this type of bi-directional distraction is a promising method for alveolar bone repair.

Adult↗
PubMed1987

An ultrastructural study on the multinucleation process of mouse alveolar macrophages induced by 1 alpha,25-dihydroxyvitamin D3.

The multinucleation process of isolated alveolar macrophages induced by 1 alpha,25-dihydroxyvitamin D3 [1 alpha,25(OH)2D3] was examined using a scanning electron microscope (SEM) and a transmission electron microscope (TEM). At the beginning of culture, most of the macrophages were spherical in shape. During incubation with 1.2 X 10(-8) M 1 alpha,25(OH)2D3, spreading macrophages appeared among the spherical macrophages, and they increased in number. Spreading macrophages extended many cytoplasmic processes toward adjacent macrophages, and interdigitations of these processes between those of neighboring cells were often seen. Two types of cell contact have been observed in the 1 alpha,25(OH)2D3-treated cells. In some, cytoplasmic processes were put into the cytoplasm of the adjacent cells, where clathrinlike structures were observed at the inner membrane of the concave portion. In others, spreading macrophages occasionally came in contact with adjacent cells by a peripheral rim of their cytoplasm with gap junctions. Cytoplasmic continuity was rarely observed at the boundaries between the closely associated cells. The two types of cell contact were also found, though not frequently, in the untreated cells. These results indicate that 1 alpha,25(OH)2D3 promotes multinucleation of alveolar macrophages through spreading forms with the formation of gap junctions and the coated membrane invagination.

Animals↗
PubMed2003

Maxillary sinus augmentation with deproteinated bovine bone and platelet rich plasma with simultaneous insertion of endosseous implants.

PURPOSE: To investigate the clinical applicability of using deproteinated bovine bone mixed with autologous platelet rich plasma (PRP) in human maxillary sinus augmentations in severely resorbed posterior maxillary alveolar processes with simultaneous insertion of endosseous dental implants. MATERIALS AND METHODS: Fifteen patients with less than 5 mm of residual alveolar bone height in the posterior maxillary alveolus underwent a total of 24 maxillary sinus augmentations. Seventy endosseous implants were inserted simultaneously in the grafted sinuses. The implants were uncovered and loaded 4 months after insertion and the sinus augmentation. An osseous biopsy specimen was obtained from the augmented maxillary sinus in 1 patient. In 3 patients, computed tomography scans of the grafted maxillae were obtained and the bone density quantified and compared with native bone density using SIMPlant 7 (Columbia Scientific, Columbia, MD) software 4 months postoperatively. RESULTS: Although a total of 5 implants in 4 patients were lost, this did not result in the loss of any of the restorations, for an overall success rate of 92.9 %. Follow-up for patients in this study after insertion of the permanent restoration was between 6 and 36 months. The bone biopsy from the patients showed evidence of viable new bone formation in close approximation to the xenograft. The bone density of the grafted bone was similar or exceeded the bone density of the surrounding native maxillary bone. CONCLUSION: Based on our clinical experience, we believe that the use of platelet rich plasma in combination with deproteinated bovine bone is effective for maxillary sinus augmentation with simultaneous insertion of endosseous dental implants in severely resorbed posterior maxillae.

Alveolar Bone Loss↗
PubMed1999

Operator agreement in the use of a descriptive index of edentulous alveolar ridge form.

CAWOOD & HOWELL have proposed a classification of the anatomical form of the residual alveolar processes of edentulous patients. The purpose of this study was to test observer agreement in the clinical assessment of edentulous alveolar ridge form using this classification. This was tested in a pilot study involving 57 edentulous patients, and subsequently in a study of 557 edentulous patients. High levels of observer agreement were found when using this classification for upper and lower edentulous alveolar ridges, suggesting that the classification may be useful as a research tool.

Alveolar Bone Loss↗
PubMed2003

Treatment planning in a case of restoration of the maxilla and mandible using osseointegrated implants with four types of bone graft.

A case is reported of a 66-year-old woman who could not use a conventional, full upper denture because of a gag reflex. In the maxillary alveolar ridge, restoration was performed on a moderately atrophied, edentulous anterior area and a small defect in the right-side posterior area. In the mandibular alveolar ridge, restoration was performed on a moderate osseous defect in each molar area resulting from tooth extraction due to severe periodontal disease. Based on careful treatment planning, four types of bone graft were used with previously designed osseointegrated implants. The atrophied maxillary alveolar ridge was restored with veneer iliac bone grafts to avoid fenestration during implant placement, while alveolar process deficiency was restored using inlay and sinus bone grafts as placements for long implant fixtures. The defects in the mandibular alveolar bone were filled with corticocancellous bone chips at the implant placement sites. A combination of immediate and secondary placement of Brånemark fixtures was used. Bone-anchored bridge-type implant prostheses were fitted approximately twelve months after surgery. Three years later, there had been no failure of implant fixtures and satisfactory functional and cosmetic restoration had been maintained.

Aged↗
PubMed1995

[Structural changes in the periodontal tissues under measured exposure to intra- and extraoral orthodontic appliances in the unstable bite].

Study of the histological characteristics of the teeth, dental rudiments, and periodontal tissues of animals during distraction of the maxilla and distal dislocation of the mandible by "minor", "medium", and "strong" force showed that the type and degree of morphological changes are related to the strength of exposure and duration of orthodontist device application. The minor (1.2 H) and medium (2.5 H) force did not injure the studied structural elements of the periodical complex. Exposure of osseous tissues to a strong (5.0 H) force surpassing the compensatory potential of this tissue caused a complex of changes characterized by predominance of the processes of destruction of bone matter, specifically, by its resorption over its regeneration. These processes were the most evident during distal dislocation of the mandible. Appreciable foci of resorption were observed not only in the alveolar process bone, but in hard tissues (dentin and cement) of deciduous teeth as well. These results demonstrate the necessity of a careful approach to the choice of the intensity of force developed by various orthodontist devices.

Animals↗
PubMed2005

[Controlled orthodontic extrusion with subsequent implantation].

Controlled orthodontic extrusion constitutes a non-surgical technique to increase alveolar bone material. Prosthetic reconstruction alone frequently does not achieve sufficient long-term aesthetics. An adequate implantation bed is indispensable to meet aesthetic demands. Controlled orthodontic extrusion represents an alternative to pre-implantological augmentation of the vertically reduced alveolar process and its soft tissue.

Adult↗
PubMed1989

A histomorphometric analysis of the alveolar bone resorption process in calcium-deficient rats.

The present study was carried out to investigate the morphological changes in the alveolar bone in rats fed a low calcium diet, in order to establish an experimental model of alveolar bone resorption. Male Wistar rats (70-85 g in body weight) were either fed a low calcium diet (0.05% Ca, 0.35% P) or a control diet (0.5% Ca, 0.35% P) by using a pair feeding technique. The rats were sacrificed at intervals of 3, 6, 9 and 20 days. No difference was found in the growth rate between the control and the low calcium group. In the low calcium group, the bone area significantly reduced at day 3 and progressively decreased to 46% of that of the controls by the end of the experiment. The bone resorption was obvious in the cancellous bone during the early period of the experiment and then the cortical bone was seen to resorb. However, the contour of bone and the rate of bone apposition did not change. At day 20, bone still remained in three regions: the alveolar bone proper that surrounds the tooth sockets, a few cancellous bones and a thin wall-like cortical bone. These results suggest that the process of alveolar bone resorption is related to the mechanical forces induced by the occlusal function of the tooth and, further, that this experimental model might be useful for investigating the mechanism of alveolar bone resorption and disorders of the alveolar bone.

Alveolar Bone Loss↗
PubMed1989

[Studies on the development and growth of the human maxilla--special references to the anterolateral, infratemporal and orbital surfaces].

Morphological and macroscopical studies were made on the lateral surface of the human maxilla. The materials consist of 128 cases of human fetuses ranging from the fourth to the tenth month and 306 cases of human juveniles and adults. The earliest month in which the loci with the scientific name (Nomina Anatomica) of the maxilla was observed was as follows; the frontal process, zygomatic process, anterior nasal spine and the nasal notch were first observed on the fourth fetal month. The infraorbital foramen and anterior lacrimal crest were first observed in some cases on the fourth fetal month and in all cases on the fifth fetal month. The infraorbital suture, lacrimal notch and alveolar process were first observed on the fifth to the sixth fetal month. The infraorbital sulcus and infraorbital canal were first formed on the fifth to the seventh fetal month. The following loci on the lateral surface of the maxilla which are related to the development of the maxillary teeth were first observed after birth as follows; the alveolar foramina were first observed in 3 to 7 years after birth and the maxillary tuberosity was first observed in 6 to 7 years after birth. The canine fossa was first observed in 6 years after birth. As far as the development of the maxilla is concerned, the frontal process and infraorbital margin were first observed and secondly the alveolar part was observed and finally the maxilla body which involved the maxillary sinus was formed.

Adolescent↗
PubMedDate not supplied

Ground-glass opacity: interpretation of high resolution CT findings.

Ground-glass opacity (GGO) is a common finding on high resolution CT, characterised by areas of hazy increased attenuation of the lung with preservation of bronchial and vascular margins; it is not to be confused with consolidation, in which bronchovascular structures are obscured. It correlates with several pathogenic processes, such as like partial filling of air spaces, inflammatory or fibrotic interstitial thickening, increased capillary blood volume. Infiltrative GGO can representing either interstitial or alveolar processes. GGO is a nonspecific finding; however, the correlation with any of the associated CT findings (nodular lesions, consolidation, septal thickening, fibrosis, vessels or airway calibre alterations, air trapping), and clinical data is helpful in narrowing the range of diagnostic possibilities, or even in suggesting a specific diagnosis. GGO can indicate a potentially treatable disease, help guide the type and location of biopsy and evaluate the effectiveness of therapy. This review discusses the types of lung disease associated with GGO, and the differential diagnosis between GGO caused by infiltrative processes and the mosaic patterns of lung attenuation caused by primary vascular diseases or airway abnormalities. This distinction can be made by evaluating the vessel calibre and air trapping on expiratory scans.

Adult↗
PubMed1996

Autologous bone grafts and endosseous implants: complementary techniques.

PURPOSE: This article describes predictable techniques to augment contour- or height-deficient edentulous alveolar processes with autologous bone grafts for simultaneous or secondary placement of endosseous implants. METHODS: Augmentation bone grafts harvested from the ilium and mandible were used to reverse alveolar atrophy of the maxilla and mandible. Endosseous implants were either placed simultaneously with the graft or 6 to 9 months after grafting. Implant success was calculated only after an implant-supported prosthesis was in function for a minimum of 12 months. RESULTS: One hundred twenty-nine autologous bone grafts were placed in 99 patients. This included 70 grafts in the maxillary sinus, 32 onlay grafts, 14 veneer grafts, 9 saddle grafts, and 4 inlay grafts. Of these, 117 (90.7%) were successful. A total of 364 implants were placed in the grafted areas, 134 at the time of grafting and 230 6 to 9 months after grafting to allow time for osseous healing and remodeling. Three hundred twenty (87.9%) of the 364 implants placed in grafted areas were successful; 112 (83.6%) of the implants placed at the time of bone grafting and 208 (90.4%) of the implants placed secondarily in consolidated grafts. A total of 51 implants were placed in non-grafted areas in the same group of patients. Of these, 49 (96%) were successful. CONCLUSION: Autologous bone grafts can be used successfully to improve the ability to place endosseous implants. The successful placement of implants in autologous grafts is more predictable when the implants are placed secondarily, 6 to 9 months after bone grafting. Failure of individual implants does not imply failure of the bone graft. In most instances when implants failed to osseointegrate, enough bone graft remains to allow subsequent successful implant placement 6 to 9 months later.

Adolescent↗
PubMed1999

[Stomatologic and maxillofacial pathology in a medieval population (10th-12th centuries) of southwestern France].

We present an assessment of the dental and maxillofacial pathology in a medieval population in southwestern France. One hundred and ninety eight mandibles and 29 craniofacial complexes were analysed. Dental and periodontal infectious pathology predominated. Third molar agenesia was quite frequent, concerning 25% of the mandibles. Third molar eruption was almost constant and in a normal position. Condylar process degeneration concerned 6% of the population. Three cases of traumatic pathology were observed, one case of long mandible was noted, and two cases of hypertrophic inferior alveolar process. Dento-mandibular maladjustment was uncommon. No unwedging of the maxillo-mandibular bone basis was observed.

Adult↗
PubMed1991

ROC analysis of observer-response subjective rating data--application to periodontal radiograph assessment.

Many physical anthropological studies require that an observer or device discriminate between states that can be easily confused. Receiver operating characteristic (ROC) analysis currently offers the best method for determining the accuracy of such choices, particularly for small sample sizes. Although ROC analysis is widely accepted in psychophysical and biomedical testing, its use in anthropological studies has not been reported. ROC analysis is used here to determine the usefulness of enhanced dental radiographs to assess vertical alveolar bone defects for quantitative studies of human variation with regard to periodontal disease. The presence or absence of vertical-bony defects (truth) for 75 human skulls was established by the consensus of two trained observers. Dental bitewing-radiographs were taken of the alveolar processes, the radiographs digitized, and the brightness and contrast of the digital images enhanced. The two observers who established truth then rated 1) plain bitewing radiographs, 2) unenhanced digital images of bitewings, and 3) enhanced digital images of bitewings for vertical bony defects. The rating scale varied from 1 (vertical defect definitely or almost definitely present) to 5 (definitely or almost definitely absent). ROC analysis was used to compared the diagnostic value of the 3 imaging modalities. All modalities had nearly identical diagnostic performance, measured as Az values (areas beneath ROC curves) that were less than 0.80, which indicates only moderate usefulness. It is concluded that enhancement does not increase success in vertical-bony-defect diagnosis from digital dental radiographs processed in this manner. Moreover, it is suggested that conventional bitewing radiographs may be unsuitable for accurate quantification of such defects.

Alveolar Bone Loss↗
PubMed1998

Possible routes of spread of carcinoma of the maxillary sinus to the oral cavity.

Carcinomas arising in the maxillary sinus, occasionally present clinically in the oral cavity along the occlusal ridge of the upper alveolus. The mechanism of this spread has not been investigated but it may resemble invasion of the mandible by oral carcinomas, which tend to invade the soft tissues rather than eroding through bone. In Britain, such patients are usually edentulous. This project examines deficiencies in the bony walls of the maxillary sinus to determine possible routes of spread. Maxillae were obtained from one side of 17 dissecting room cadavers, aged 71-95 years; 15 were edentulous. The roof of the maxillary sinus was removed in all specimens. Five maxillae were each cut into six slices, 0.5 cm thick, in a vertical bucco-lingual plane. In all, soft tissues were removed by treatment in dilute bleach. Histological sections, cut in the horizontal plane, were prepared of a further three maxillae. Several possible routes were identified by which tumors could spread from the sinus to the oral cavity: 1) directly through foramina in its floor; 2) through numerous foramina in its floor to the marrow cavity of the alveolar process, which mostly contained fat amongst narrow bony trabeculae. (The marrow cavity, in turn, had numerous communications with the occlusal surface); 3) through foramina which carried branches of the superior alveolar nerves and vessels; 4) through deficiencies in the bony walls of the sinus at the neurovascular grooves and elsewhere.

Aged↗
PubMed2004

Socket augmentation: rationale and technique.

The consequences of exodontia include alveolar bone resorption and ultimately atrophy to basal bone of the edentulous site/ridges. Ridge resorption proceeds quickly after tooth extraction and significantly reduces the possibility of placing implants without grafting procedures. The aims of this article are to describe the rationale behind alveolar ridge augmentation procedures aimed at preserving or minimizing the edentulous ridge volume loss. Because the goal of these approaches is to preserve bone, exodontia should be performed to preserve as much of the alveolar process as possible. After severance of the supra- and subcrestal fibrous attachment using scalpels and periotomes, elevation of the tooth frequently allows extraction with minimal socket wall damage. Extraction sockets should not be acutely infected and be completely free of any soft tissue fragments before any grafting or augmentation is attempted. Socket bleeding that mixes with the grafting material seems essential for success of this procedure. Various types of bone grafting materials have been suggested for this purpose, and some have shown promising results. Coverage of the grafted extraction site with wound dressing materials, coronal flap advancement, or even barrier membranes may enhance wound stability and an undisturbed healing process. Future controlled clinical trials are necessary to determine the ideal regimen for socket augmentation.

Alveolar Bone Loss↗