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PubMed1992

[Treatment of (pre)-edentulous patients. After care and directives].

It can be expected that the percentage of edentulous people wil decrease in the coming decades as a result of an improved oral health, whereas the number of edentulous people will not decrease as a result of the strong increase of the ageing population. If the preservation of the natural dentition is no longer possible, the remaining teeth of a mutilated dentition have to be extracted according to some specific principles. But also the aftercare of the edentulous patient has to be extended according to some specific guidelines, within the framework of the so-called "preventive-prosthetic-treatment-strategy". Preservation of the alveolar process is the main goal in both cases.

Aftercare↗
PubMed1990

The significance of the width and thickness of the gingiva in orthodontic treatment.

The results of the studies reviewed have shown that, while the apico-coronal width of the gingiva is unlikely to affect the development of a recession defect, the thickness of the marginal soft tissue may be essential for the prevention of soft tissue recession in conjunction with orthodontic therapy. The clinical implication of these findings is that tooth movement--particularly tooth movement in facial/lingual direction--should be preceded by careful examination of the dimensions of the tissues covering the "pressure side" of the teeth to be moved. As long as the tooth can be moved within the envelope of the alveolar process, the risk for harmful side-effects in the marginal soft tissue is minimal, irrespective of dimensions or quality of the soft tissue. If, however, the tooth movement is expected to result in the establishment of an alveolar bone dehiscence, the volume (thickness) of the covering soft tissue must be considered as a factor which may influence the development of soft tissue recessions during, as well as after, the phase of active orthodontic therapy. A thin gingiva may serve as a locus minorus resistentiae to developing soft tissue defects in the presence of bacterial plaque. This means that in tooth regions with a thin covering soft tissue, the patient must be encouraged to carry out effective but at the same time non-traumatic plaque control measures. If surgical intervention is considered in order to reduce the risk for development of soft tissue recession following orthodontic therapy, this should aim at increasing the thickness of the covering tissue (e.g. by the use of connective tissue grafts) and not the apico-coronal width of gingiva.

Dental Plaque↗
PubMed1999

Menopause-related oral alveolar bone resorption: a review of relatively unexplored consequences of estrogen deficiency.

OBJECTIVE: The alveolar processes of the maxilla and mandible provide the bony framework for tooth support. Osteoporotic changes of these bones may directly affect tooth stability and retention. This report reviews studies that have evaluated the relationship between systemic osteoporosis and oral alveolar bone mass as well as the effect of estrogen use on oral alveolar bone and tooth retention. DESIGN: Ten years (1989-1998) literature review. RESULTS: Studies reviewed demonstrate a positive correlation between systemic bone mass and systemic osteoporosis to oral bone resorption. Estrogen replacement therapy affects oral bone in a manner similar to the way it affects other sites. CONCLUSIONS: It is evident that postmenopausal estrogen users may retain more teeth after menopause. Sustained oral health and better tooth retention are potentially additional benefits for hormone replacement therapy users after menopause.

Aged↗
PubMed2004

Rotated palatal flaps: A functional and aesthetic solution in endentulous sites.

Resorption of alveolar process generally occurs following tooth extraction, and this process may cause a variety of jaw deformities. Bone deformities in the aesthetic zone impair the appearance, quality, and prognosis of the definitive restoration. The rotated palatal flap is a surgical modality that can be used to reduce or prevent alveolar resorption and assist in the repairing of exisiting defects. This presentation demonstrates the application of the rotated palatal flap in a variety of clinical cases as a means of addressing such resorption.

Adult↗
PubMed1993

Differences two years after tooth extraction in mandibular bone reduction in patients treated with immediate overdentures or with immediate complete dentures.

In a randomized controlled clinical trial, 74 patients who required immediate dentures were randomly treated with immediate overdentures on two lower canines or with immediate complete dentures. Mandibular bone reduction was measured by use of oblique lateral cephalometric radiographs made at baseline and the results compared with those of one year and two years after denture treatment. Analysis of the data showed that the average bone reduction in the lower canine regions in the first year was 0.9 mm in the immediate-overdenture group and 1.8 mm in the immediate complete-denture group. In the posterior parts of the mandible, the bone reductions were, respectively, 0.7 mm and 1.9 mm. The differences were statistically significant in all measured regions. During the second year, no significant differences in bone reduction were found. The sums of differences in the first two years were significant in all regions except the molar region, preserving the initial difference. Retention of roots of canines beneath a mandibular denture in immediate denture patients, even when they were in poor condition, reduced the collapse of the alveolar processes in all regions of the mandible.

Alveolar Bone Loss↗
PubMed1993

[Jawbone reduction in immediate prostheses. A comparison between overdentures and complete dentures].

In a randomized controlled clinical trial 74 patients who required immediate dentures were randomly treated with immediate overdentures on 2 lower canines or immediate complete dentures. Mandibular bone reduction was measured using oblique lateral cephalometric radiographs made at base-line and the results compared with those of one year and two years after denture treatment. Analysis of the data showed that the average bone reduction in the lower canine regions in the first year was 0.75 in the immediate overdenture group and 1.90 mm in the immediate complete denture group. In the posterior parts of the mandible the bone reduction was respectively 0.77 and 1.77 mm. The differences were statistically significant in all measured regions. The differences in the first two years were significant in all regions except the molar region. Retention of roots of canines beneath a mandibular denture in immediate denture patients, even when they were in poor condition, reduced the collapse of the alveolar processes in all region of the mandible.

Alveolar Bone Loss↗
PubMed1984

The body and processes of the fetal maxilla.

Development of the maxilla has been studied based on 50 fetal maxillae. The morphological findings are supplemented with data of measurements where necessary. The frontal surface of the maxilla was examined, and its measurements were compared to those of the surrounding structures in fetal life and in adults. A detailed analysis deals with the alveolar process, its walls (laminae), the topography and measurements of the maxilla and the zygomatic bone, the relationship between the frontal process and the nasal bone as well as the frontal bone, with special regard to postnatal changes in these relations, followed by the morphology of the palatine process and the canine fossa. Some of the morphological findings are explained by ontogenetic and phylogenetic factors.

Female↗
PubMed1991

[The osteoplastic care of the cleft jaw--an advance for the orthodontic treatment of cleft patients?].

This survey deals with problems of osteoplastic supply of the cleft from the orthodontic point of view. Remarkable parallels exist between primary and secondary osteoplasty: The involution stability of the alveolar process is only presented in a space-less tooth line. Therefore, the primary goal is to guarantee tooth eruption in the former cleft area. However, the antalogous bone graft in the former cleft area has to have a similar structure as adjacent alveolar bone. If tooth germs pass through the bone graft, an own parodont can be built up in the course of eruption. This is applicable to both dentitions. Accordingly, the osteoplasty of clefts is the most important prerequisite for stable treatment results and a healthy dentition.

Bone Transplantation↗
PubMed2006

[Assessment of traumatic tooth injuries in the emergency room].

Many patients with facial injuries are first seen by doctors in the emergency room. Injuries affecting teeth and alveolar process are common in children; approximately half of all children have sustained such an injury before adulthood. Dentoalveolar trauma does not pose a significant morbid risk for the trauma patient. However, failure to recognise or obtain appropriate consultation can result in premature tooth or alveolar bone loss, resulting in problematic prosthetic rehabilitation. Emergency room doctors should know the initial treatment guidelines for traumatic dental injuries to provide optimal treatment before the patient can seen by a dentist. An avulsed tooth should be replanted immediately, or kept moist until it can be replanted. Prognosis is related to storage media and the length of the extra-alveolar period. Teeth replanted within 5 minutes have the best prognosis. If the primary consultation is by phone the patient, or the parent, should be informed to replant the avulsed tooth. If this is not feasible the tooth should be stored in milk, saliva (oral cavity) or physiologic saline until replanted. Primary teeth are not replanted.

Child↗
PubMed2004

Use of the sandwich osteotomy plus an interpositional allograft for vertical augmentation of the alveolar ridge.

INTRODUCTION: Vertical augmentation of the alveolar ridge is necessary for extensive resorption of the alveolar ridge. AIM: To evaluate treatment outcome after alveolar ridge augmentation by a sandwich osteotomy combined with an interpositional allograft. PATIENTS AND METHODS: The deficient alveolar ridges were augmented by a sandwich osteotomy combined with bovine collagen matrix as an interpositional allograft placed between the basal bone and the osteotomized fragment without fixation. Standardized lateral cephalographs were taken of nine patients, before surgery, immediately postoperatively and 3 months after augmentation to evaluate the level of augmentation, bone loss and stability of the osteotomized fragment. RESULTS: The augmentation ranged between 8.4 and 11.0mm (mean 9.8mm). Bone resorption in the crestal bone height ranged from 1.5 to 3.0mm (mean 2.1mm) after 3 months. Bone resorption in thickness of the osteotomized fragment ranged from 0.3 to 2.0mm (mean 1.0mm). CONCLUSION: Although there was some resorption of the superior and anterior parts of the reconstructed alveolar process, it was concluded that this procedure of augmentation is safe.

Adolescent↗
PubMed1991

Influence of teeth loss on morphometric characteristics of the maxilla.

Using Martin and Saller's method in analyzing 90 skulls which belonged to adults of both sexes established are twelve basic morphometric characteristics of maxillas in the recent population of Croatia. Presented are differences in the morphology of dentate and edontulous jaws. Morphometric characteristics of maxillas in the recent population of Croatia do not significantly differ from maxillar characteristics of other white ethnic groups of the same absolute age. By the change of biomechanical conditions and interaction of forces caused by the loss of teeth, reabsorption of bones occurs. The alveolar process atrophies the first, causing the reduction in the maxillar length and width in the molar, as well as in the anterior part of the bone. Although the width of the palate is constant, the reduction of its length occurs. The foramen infraorbitale approaches the alveolar margin of the bone due to the reabsorption of the alveolar ridge, but its distance from the orbital edge gets reduced too, due to the overall atrophy the bone. Advancing of age, if not accompanied with the loss of teeth, does not significantly influence morphometric characteristics of the maxilla.

Adult↗
PubMed2000

Three-dimensional planning of alveolar ridge distraction by means of distraction implants.

OBJECTIVE: In recent years, three-dimensional (3D) CT-based planning methods have increasingly been implemented in oral and maxillofacial surgery. Alveolar ridge distraction is accomplished by unidirectional distraction devices which in turn must be positioned optimally in all three dimensions. It is the aim of this study to demonstrate 3D planning of alveolar ridge distraction by means of distraction implants. PATIENTS AND METHODS: In 1997, nine patients were treated with distraction implants for a deficient alveolar ridge. A CT-scan-based 3D milled model of the facial skull was prepared for each patient to enable preoperative diagnosis and operative planning. RESULTS: Exact preoperative diagnosis of the alveolar ridge defect and atrophy was enabled by the 3D polyurethane model. Correct positioning of the distraction implants and predictability of the course of distraction was facilitated by preoperative planning according to the 3D model. CONCLUSION: Three-dimensional planning according to a milled model is an indispensable aid to positioning of distraction implants and therefore to directed augmentation of the alveolar ridge. Correct distractor positioning is vital for optimal subsequent prosthetic treatment.

Adult↗
PubMed1981

Sagittal chin rotation of the prognathic edentulous mandible.

In edentulous patients with a prognathic mandible, a pronounced chin and extensive resorption of the lower alveolar ridge, the commonly used techniques of ramus osteotomy and chin reduction will not give optimal results in the majority of cases. The solution of this problem can be obtained by mandibular body ostectomy and a sagittal rotation of the frontal part of the lower jaw. By this operation the originally horizontally orientated upper plane of the chin area is placed in a more vertical position. This operative technique gives a better predictable facial contour than the conventional methods. It causes no unfavorable displacement of the lower lip and, which is very important, it gives an absolute increase of height of the lower alveolar ridge and a more favorable inclination of the frontal part of the alveolar process from a prosthetic point of view. The problems encountered and the results obtained by this technique will be demonstrated by a short case presentation.

Adult↗
PubMed1988

Guided tissue regeneration in degree II furcation-involved mandibular molars. A clinical study.

The present clinical trial was designed to evaluate the regenerative potential of the periodontal tissues in degree II furcation defects at mandibular molars using a surgical treatment technique based on the principles of guided tissue regeneration. The patient sample included 21 subjects, 22-65 years of age. The patients selected had periodontal lesions in the right and left molar regions including advanced periodontal tissue destruction within the interradicular area. After an initial examination, each patient received a series of full-mouth scalings and root planings. 2-3 months later, they were recalled for a baseline examination including assessment of plaque, gingivitis, probing depths and probing attachment levels. The furcation involved molars were randomly assigned in each patient to either a test or a control treatment procedure. The test procedure included the elevation of mucoperiosteal flaps at the buccal and lingual aspect of the alveolar process. The inner surface of each flap was carefully curetted to remove epithelium and granulation tissue. The root surfaces were scaled and planed. A teflon membrane was adjusted to cover the entrance of the furcation area and the adjacent root surfaces as well as a portion of the alveolar bone apical to the crest. The flaps were repositioned and placed on the outer surface of the membrane and secured with interdental sutures which were removed after 10 days of healing. Following surgery, the patients were instructed to rinse the mouth twice daily with chlorhexidine gluconate. A second surgical procedure was performed after a healing period of 1-2 months to remove the teflon membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Blood supply to the maxillary sinus relevant to sinus floor elevation procedures.

The maxillary blood supply is essential for preserving the vitality of the affected maxillary region, integration of the grafting material, and wound healing such as following sinus floor elevation. Although it is well established that edentulous maxillae demonstrate a decreasing vascularity as bone resorption progresses, the vascular conditions relevant to sinus floor elevation procedures have not been investigated yet. This study deals with maxillary arteries relevant to sinus floor elevation surgery and examines the vascularization of the lateral maxilla after tooth loss. The vessels of the lateral maxilla of 18 maxillary specimens (10 male, 8 female, mean age 67 years) were prepared anatomically and the local main arteries, the number of macroscopically discernible branches and anastomoses, their calibers, and the distance between the caudal main branches and the alveolar ridge recorded. The lateral maxilla is supplied by branches of the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) that form an anastomosis in the bony lateral antral wall, which also supplies the Schneiderian membrane. This intraosseous anastomosis was found in all of the specimens. Eight of 18 also showed an extraosseous anastomosis between PSAA and IOA, vestibular to the antral wall, giving off an average of 3 branches cranially and 5 branches caudally. The two anastomoses form a double arterial arcade to supply the lateral antral wall and, partly, the alveolar process. The PSAA had a mean caliber of 1.6 mm and exhibited an average of 2 endosseous and 1 extraosseous branches. The IOA had a mean diameter of 1.6 mm and showed an average of 1 endosseous and 3 extraosseous branches. The mean distance between the intraosseous anastomosis and the alveolar ridge was 19 mm in 2 defined measuring sites. Its mean length was 44.6 mm. The epiperiosteal vestibular anastomosis was situated further cranially at a mean distance of 23 to 26 mm from the alveolar ridge and had a mean length of 46 mm. The rather large caliber of the vessels supplying the lateral antral wall seems to be crucial to the fact that the periosteal blood supply is maintained even in severe maxillary atrophy and after complete disappearance of the centro-medullary vessels.

Aged↗
PubMed2003

Osteoporosis: the effect on maxillary bone resorption and therapeutic possibilities by means of implant prostheses--a literature review and clinical considerations.

Osteoporosis is a systemic disease in which the skeletal condition is characterized by a decreased mass of normally mineralized bone. It is considered the most common metabolic bone disease, and it constitutes a major public health problem. Given the evidence that alveolar processes provide the bony framework for tooth support, the decline of skeletal mass has to be correlated with an increased risk of oral bone loss and has a negative consequence on tooth stability. Data from past research confirm that aging and estrogen depletion have a negative influence on both tooth retention and residual alveolar crest preservation. The goal of the present article is, however, to underline how the morphostructural evolution of the edentulous maxilla is mainly due to mechanical factors as the result of alterations in maxillary function. The advantages of prosthetic rehabilitation supported by osseointegrated implants are also considered, focusing the therapeutic role of this procedure on preserving the residual alveolar ridge from atrophy.

Alveolar Bone Loss↗
PubMed1996

A review of residual ridge resorption and bone density.

Residual ridge resorption is a common and often incapacitating problem, particularly for persons with edentulous mandibles. Several studies suggest a correlation between ridge resorption and osteoporosis. Recent radiologic studies indicate that the mineral density of the cortex and the bone mass in the mandible are correlated with skeletal bone density. Most resorption occurs in the alveolar process, whereas the basal portion remains relatively intact. On the other hand, radiologic measurements of bone density primarily yield information after the basal portion, where the bone mass of the mandible is greatest and functional stresses of mastication may affect bone density. Ironically, radiologic measurements may not accurately indicate the effect of osteoporosis on alveolar resorption. Apparently, excessive occlusal force can also produce extensive atrophy without systemic impact. Not until muscular function decreases does real osteoporosis develop in edentulous jaws. Not only does the volume of the ridge decrease, but also the density of the basal portion decreases as a result of diminished function. This article reviews the literature on residual ridge resorption and components that may affect the rate of resorption.

Aged↗
PubMed1999

Malignant spindle cell tumor arising in the mandible of a patient with florid osseous dysplasia.

Florid osseous dysplasia is a non-neoplastic condition of the alveolar processes of the jaws characterized by the replacement of multiple foci of bone by fibrous connective tissue, accompanied by gradual deposition of cementum, bone, or both. The lesions are not associated with inflammatory diseases of the dental pulp or periodontal tissues. In fully developed florid osseous dysplasia, there are multiple lobulated masses in the alveolar bone bilaterally in the mandible and sometimes in the maxilla. This is the first report of a malignancy originating within the jaws of a patient with florid osseous dysplasia. A spindle cell malignancy was diagnosed in the mandible of a 54-year-old black woman whose jaw was affected by florid osseous dysplasia bilaterally. Despite extensive surgery and radiotherapy, the patient died 20 months after diagnosis of the malignancy.

Fatal Outcome↗