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Secondary bone grafting of alveolar cleft.

AIM: The study evaluates the repair of residual alveolar cleft through secondary bone graft, consisting in the transplantation of autologous bone to restore the continuity of the maxillary arch and achieve normal functioning and esthetics. METHODS: During 2001-2002, 15 patients (age range 9-26 years; 7 males, 8 females) were submitted to secondary bone graft at the Maxillo-facial Surgery Operative Unit, University Hospital, Sassari. Eleven patients had complete unilateral cleft, 4 had complete bilateral cleft. All patients were operated upon by the same surgeon; they received a graft of autologous bone from the iliac crest. For preoperative and postoperative evaluation at 1 year, the following were utilised: plaster casts of the tooth arches, OPT, photographs and complete clinical documentation. RESULTS: Postoperative results were: 100% formation of a bone bridge between the maxillary segments; 70% closure of oro-nasal fistula; 100% maxillary stability; 80% spontaneous eruption of the canine within the graft; 70% height of alveolar ridge level I, 25% level II, 5% level III; 70% orthodontic closure; 80% optimal periodontal condition and 20% presence of gingival recession. In 1 subject the graft site became infected, in 4 cases an oro-nasal fistula remained. CONCLUSION: This method was found to be the most valid one at present. The best period to intervene is during late childhood (9 years). Results and functional and esthetic recovery were satisfactory and encouraging to continue utilising this technique.

Adolescent↗

Primary fibrinolysis after oral surgery.

A case report of a patient with primary fibrinolysis resulting in hemorrhage after an oral surgical procedure has been presented. A comparison was made between DIC and primary fibrinolysis in patients with carcinoma of the prostate gland; etiology, clinical findings, diagnosis, and treatment were discussed.

Aged↗

Osseous response following resective therapy with piezosurgery.

A piezoelectric instrument vibrating in the ultrasonic frequency range was investigated for its potential use in periodontal resective therapy. The rate of postoperative wound healing (baseline and 14, 28, and 56 days after surgery) in a dog model following surgical ostectomy and osteoplasty was the marker used to compare the efficacy of this instrument (PS) with a commonly used carbide bur (CB) or a diamond bur (DB). The surgical sites treated by CB or DB lost bone, in comparison to baseline measurements, by the 14th day, while the surgical sites treated by PS revealed a gain in the bone level. By day 28, the surgical sites treated by all three instruments demonstrated an increased bone level and regeneration of cementum and periodontal ligament. However, by day 56, the surgical sites treated by CB or DB evidenced a loss of bone, versus a bone gain in the PS-treated sites. Thus, it appears that PS provided more favorable osseous repair and remodeling than CB or DB when surgical ostectomy and osteoplasty procedures were performed. Therefore, PS could be regarded as being efficacious for use in osseous surgery.

Alveolar Bone Loss↗

Treatment protocol for unilateral cleft lip and palate patients: questioned by two case reports.

BACKGROUND: The types and severity of clefts as well as palatal development and growth in children with repaired cleft lip and palate deformities can vary greatly. Independent of the technique used surgery produces scar tissue, which restricts palatal growth so that by the second decade many patients have an underdeveloped maxilla. Experience has shown that the maxillary retrognathism found in many cleft patients is not amenable to nonsurgical correction. Few long-term studies have evaluated the procedures, sequencing and timing of the treatment methods found to give the best results. This lack of reliable information means there is a serious gap in our ability to assess the value of different treatment modalities. AIMS AND METHODS: From the viewpoint of orthodontics, this article describes the treatment protocol used by the cleft lip and palate team at the University Hospitals of the KU Leuven. The present treatment protocol is illustrated and questioned by two cases. The roles of prediction of facial growth and distraction osteogenesis are discussed.

Alveoloplasty↗

A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots.

The objective of this investigation was to determine the fate of thin buccal bone encasing the prominent roots of maxillary anterior teeth following extraction. Resorption of the buccal plate compromises the morphology of the localized edentulous ridge and makes it challenging to place an implant in the optimal position for prosthetic restoration. In addition, the use of Bio-Oss as a bone filler to maintain the form of the edentulous ridge was evaluated. Nine patients were selected for the extraction of 36 maxillary anterior teeth. Nineteen extraction sockets received Bio-Oss, and seventeen sockets received no osteogenic material. All sites were completely covered with soft tissue at the conclusion of surgery. Computerized tomographic scans were made immediately following extraction and then at 30 to 90 days after healing so as to assess the fate of the buccal plates and resultant form of the edentulous sites. The results were assessed by an independent radiologist, with a crest width of 6 mm regarded as sufficient to place an implant. Those sockets treated with Bio-Oss demonstrated a loss of less than 20% of the buccal plate in 15 of 19 test sites (79%). In contrast, 12 of 17 control sockets (71%) demonstrated a loss of more than 20% of the buccal plate. In conclusion, the Bio-Oss test sites outperformed the control sites by a significant margin. No investigator was able to predict which site would be successful without the grafting material even though all were experienced clinicians. This leads to the conclusion that a patient has a significant benefit from receiving grafting materials at the time of extraction.

Alveolar Bone Loss↗

The treatment of interproximal vertical bony defects with porous hydroxyapatite.

It is apparent that the use of reconstructive procedures in the treatment of vertical interdental defects offers a significant clinical advantage over conventional nonregenerative procedures. This article reviews in depth the various studies in which porous hydroxyapatite was used in interproximal vertical bony defects.

Alveoloplasty↗

Clinical use of the Er,Cr: YSGG laser for osseous crown lengthening: redefining the standard of care.

UNLABELLED: To design the optimal outcome for a patient during aesthetic enhancement, the restorative dentist must seek to create a symmetrical and harmonious relationship between the lips, gingival architecture, and the positions of the natural dentate forms. In the author's experience, the Er,Cr: YSGG laser has been a useful adjunct for performing aesthetic surgical crown lengthening procedures. This article will highlight the associated biological principles and demonstrate techniques for the application of this laser in closed and open crown lengthening procedures. LEARNING OBJECTIVES: This article demonstrates the use of the Er,Cr: YSGG laser for osseous crown lengthening . Upon reading this article, the reader should have: Enhanced awareness of criteria for developing a biologically stable free gingival margin. Greater familiarity with the open and closed crown lengthening procedures, including case selection and surgical approaches.

Alveolar Process↗

Case report: surgeon and orthodontist work together from patient's birth.

This case report presents one of the initial participants of a new treatment protocol started in 1965 for children born with complete clefts of the lip, alveolus, and palate at Children's Memorial Hospital, Chicago, USA. The surgeon and orthodontist worked together and in tandem from the time of the patient's birth. The protocol involves lip and palate closure, along with the placement of a passive maxillary prosthesis and minimal primary osteoplasty to the alveolus to help stabilize the maxillary segments. This case is noteworthy in that the patient had a number of congenitally missing teeth, and treatment required moving a tooth into and through an area originally cleft. The patient is now 40 years of age. Intra- and extraoral photographs, cephalometric radiographs, occlusal dental radiographs, and dental casts through the treatment stages are presented.

Alveolar Process↗

Craniofacial development in cleft lip and palate children related to different treatment regimes.

Outcome of treatment in 85 children with unilateral cleft, lip, alveolus, and palate who had been treated according to four regimes was studied using lateral skull radiographs, extra oral photographs, intra oral radiographs and orthopantographs. The treatment regimes differed with regard to: the inclusion of presurgical orthopaedics in one group, the type of lip closure, the type and timing of palatal closure, and timing of bone grafting to the alveolus. A method of pooling subgroups and comparing lateral skull radiographs from different centres was developed to obtain more meaningful comparisons between centres. The maxillary, mandibular, and vertical hard tissue development as well as the soft tissue profile were studied using lateral skull radiographs. The appearance of the extraoral soft tissue was assessed by a panel using photographs. The tooth status and the success of transplants in the cleft area were evaluated using intra oral radiographs and orthopantographs. Treatment regimes that did not include bone grafting seemed to be most favourable for maxillary and mandibular development. Treatment regimes without bone-grafting and those that included bone grafting at 10 years of age seemed to be most favourable for the vertical skeletal proportions. The soft tissue profile was developed best after regimes that included bone grafting at 10 years of age. Facial appearance was equally good in the group that received bone grafts at 6 months after presurgical orthopaedics and in the group that received bone grafts at 10 years of age. Tooth status and the percentage of successful transplants were best in the group that received bone grafts after the eruption of the incisors but before the eruption of the canines.

Adolescent↗

Ridge recontouring and crown lengthening prior to bridge placement.

This report describes crown lengthening and ridge recontouring to facilitate the provision of an aesthetic bridge pontic. A short clinical crown on one of the abutment teeth and a prominent edentulous ridge were probably related to a traumatic episode which caused the avulsion of the missing incisor in childhood.

Adult↗

Healing and repair of osseous defects.

This article has discussed most of the modalities currently in use for the filling of bony defects. No one modality or combination of methods or materials has yet surfaced as the definitive means of treatment for filling these defects.

Alveoloplasty↗