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PubMed1990

[Vertical changes in the lateral teleroentgenographic image after functional orthodontic therapy].

We looked for vertical changes in lateral cephalometric X-rays of patients who had been treated with Andresen and Häupl appliances to correct distal occlusion. Thus, a therapy using functional appliances for orthodontic correction has the following effects on the vertical proportions of the visceral cranium. 1. The alveolar processes show additional vertical growth in the area of the incisors of the upper jaw and the molars of the lower jaw. 2. In conjunction with 1, increased vertical growth of the anterior facial heights compared to the posterior facial height causes an opening of the bite which, however, is not significant in terms of the Jarabak ratio. 3. Functional therapy has an effect on the spina plane, and, in addition, causes active vertical growth in the area of both upper facial heights, i.e., of the entire nasomaxillary complex. This additional growth is a little bit more pronounced anteriorly than posteriorly. Therefore the effect of functional orthodontic appliances on the nasomaxillary complex seems to be more complex than previously believed. 4. We did not observe any additional growth in the area of the ascending rami and/or condyles of the lower jaw during activator treatment. Our studies showed that the influence of functional orthodontic therapy on the vertical growth of the lower jaw is rather insignificant; the significant vertical changes were seen in the area of the mandibular molars and of the anterior facial heights. 5. Our findings thus support the assumption that the main vertical effect of the activator can be described as a relative inhibition of the development of the nasomaxillary complex with simultaneous normal progression of mandibular growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Activator Appliances↗
PubMed1997

[Multi-local angiosarcoma of the oral mucosa].

A 64-year-old man presented with a bluish, livid swelling in the region of the lateral alveolar processes of all four quadrants. Evaluation and histopathological findings resulted in the diagnosis of an angiosarcoma at multiple sites. A survey of the literature and an epidemiologic review of our own patients prove this to be an extremely rare occurrence. A partial resection of the maxilla and the mandible on both sides was performed in sano. After discharge, however, a sarcoma was detected in the region of the right scapula 5 months after surgery. Therefore radiation treatment was initiated. The patient died 4 weeks later. The course confirms the poor prognosis of this tumor.

Bone Neoplasms↗
PubMed1999

Inflammatory mechanisms in neonatal chronic lung disease.

UNLABELLED: Chronic lung disease (CLD) of preterm infants has a multifactorial aetiology. Oxygen toxicity, mechanical injury (barotrauma), volutrauma as well as prenatal and postnatal infections most likely contribute to pulmonary injury in the immature lung of preterm infants. There is sufficient evidence that respiratory distress syndrome and CLD are associated with a significant inflammatory response of the airways and the interstitium of the lungs; besides neutrophils, alveolar and interstitial macrophages immunoreactive for tumour necrosis factor-alpha (TNF-alpha) are found in large numbers. Phagocyte influx is possibly mediated by chemotactic and chemokinetic factors present in the broncho-alveolar secretions: interleukin-8, leukotriene B(4), C5a, elastin fragments, macrophage-inflammatory protein-1alpha and other chemokines. Increased concentrations of soluble selectins and intercellular adhesion molecule-1 in broncho-alveolar secretions and the serum of infants with CLD possibly reflect neutrophil diapedesis. Lipid mediators including leukotrienes, prostacyclin, platelet activating and other mediators such as the pro-inflammatory cytokines TNF-alpha, interleukin-1 and -6, exert various effects on the airways and the vascular system by increasing the microvascular permeability which is one of the most important pathophysiological factors of early CLD. Pulmonary cells of preterm infants may be unable to downregulate inflammation through the expression of the anti-inflammatory cytokine interleukin-10. Inflammatory cells can cause severe lung damage by release of potent proteases (elastase), cytokines and by generation of toxic oxygen radicals (O(2)-, (*)OH). The presence of free elastase activity and the protease-antiprotease imbalance has been well documented. In fact, increased concentrations of products of elastolytic fibre degradation and of oxygen radical mediated lipid peroxidation were detected in infants with CLD. CONCLUSION: The complex interaction between mediators of inflammation and fibrosis has still to be defined. Moreover, the possible interference of inflammation with postnatal lung development especially with the alveolarization process has not been evaluated yet.

Chronic Disease↗
PubMed1999

[Significance of the height and width of the alveolar ridge in implantology in the edentulous maxilla. Analysis of 95 cadaver jaws and 24 consecutive patients].

Consideration of alveolar profiles and clinical experience demonstrate that the transversal dimension has been neglected in dental implantology so far. For a comprehensive evaluation of the impact of alveolar bone height and width, 95 edentulous bony maxillae with standardized, measured, and classified cross-sections were analyzed. With four types of implants (minimum length, 10 mm), 1076 insertions were simulated at 269 cross-sections and evaluated with regard to type of implant, position of cross-section, and class of atrophy. Similar evaluation was carried out in the clinical part of the study on 24 consecutive patients with edentulous maxillae. Implant insertion could only be simulated in 35% of the cadaver cross-sections, but had been expected in an additional 4.5% based on their sufficient bone height; length reductions were necessary in another 6%. These results depended largely on the class of atrophy. Anterior cross-sections offered better conditions than posterior ones. In contrast, implant insertion was impossible in all 24 patients. Height was primarily inadequate in 22 patients, and in two patients with sufficient bone height inadequate transversal dimensions were only recognised intraoperatively. These results allow a quantification of the impact of vertical and transversal maxillary alveolar bone dimensions. This impact primarily depends on bone height, but even with sufficient height, reductions of implant length often become necessary. Both for the cadaver maxillae (12% of the cross-sections with expected implant insertion) and for the patients (8%), alveolar profiles remain in which height measurement alone leads to incorrect assessment and may even result in the interruption of precisely planned surgical procedures. The complexity and expense of implant-borne rehabilitation and the consequences resulting from incorrect preoperative planning therefore generally justify extended cross-sectional diagnostic measuring.

Alveolar Process↗
PubMed1999

[Endosseous implants for functional masticatory rehabilitation in the extremely atrophied edentulous maxilla].

PURPOSE: The aim of this retrospective study was to evaluate the long-term survival rate of dental implants in edentulous patients suffering from severe atrophy of the alveolar ridges in the upper jaw. PATIENTS AND METHODS: In total, 964 implants were inserted in 140 patients. A total of 481 implants were combined with an osteoplastic augmentation of the maxilla, and 483 implants were inserted directly in the atrophic bone. The success rate was determined using survival analysis, log rank tests and a Cox regression analysis. RESULTS: The overall survival rate for all implants was 42.2% during an observation period of 11 years. Between implants combined with an osteoplasty and implants inserted in local bone tissue there were no significant differences in the survival rate. The survival rate of implants combined with an osteoplasty was significantly reduced in women and in the case of repeated insertion or augmentation. Interestingly, a few of the patients treated with an osteoplasty demonstrated high numbers of individual implant failures. Those patients were postmenopausal women exclusively. Among them there is probably a certain group with a very high risk of implant failures. CONCLUSION: This study shows that oral rehabilitation with osteointegrated implants in patients with severely atrophic alveolar ridges in the upper jaw is still problematic.

Alveolar Bone Loss↗
PubMed1999

[Horse shoe Le Fort I osteotomy. Surgical technique for reconstruction of the extremely atrophied maxilla].

Twenty-three patients with class VI atrophy of the maxilla were treated with horseshoe Le Fort I osteotomy. In ten patients, simultaneous placement of the implants was carried out, and in 12 the implantation was done in a second procedure 6-9 months later. A total of 178 implants were placed, and 15 were lost. In one patient, five implants were lost due to an oronasal fistula, leading to loss of part of the bone graft. The implant survival rate for all the implants was 89.0-88.2% in the one-step procedure and 90.0% in the two-step procedure. There was no difference between the one-step and the two-step procedure with respect to the peri-implant soft tissues in follow-up of least 2 years after implantation. We favor the two-step procedure because it allows more precise positioning of implants.

Adult↗
PubMed1999

[Follow-up studies of 3-dimensional osteoplastic reconstruction of the extremely atrophied maxilla combined with implants].

In the severely resorbed maxilla, a 10-year success rate of only 49-74% of implants in combination with autogenous bone grafts has been reported. We developed a modified technique of antral inlay grafting and lateral and vertical onlay grafting of the severely resorbed maxilla for inserting implants to retain dentures. The clinical and radiologic results are presented. In 21 patients with severely resorbed edentulous maxillae, a total of 20 bilateral and one unilateral antral inlay graftings and lateral and vertical onlay graftings were performed after a prosthodontic setup. We opened the maxillary sinus by removing a bony window from the anterolateral wall and, after elevation of the sinus lining, grafted the sinus floor with corticocancellous iliac crest bone grafts. The maxilla was also augmented in the lateral and vertical direction. The bone grafts were fixed by osteosynthesis. After a median of 5 months, a total of 134 implants (Brånemark) were placed and later loaded by prosthodontic rehabilitation. Computed tomography (CT) scans were taken before the grafting procedure, immediately after grafting, after 4 months, and every year thereafter. A total of 94.8% of the implants were successful at the time of the abutment operation. After loading, two additional failures were seen in an average follow-up period of 2.5 years. Most patients were provided with implant-borne dentures. CT scans showed an average initial gain of vertical bone height of 3.7-17.7 mm. One year after grafting, a loss of 1.3 mm or 7% occurred. In the following 2 years, no major atrophy was observed. Statistical analysis showed no correlation between sex, bone height before augmentation, augmented bone height, and resorption of the grafted bone. We observed undisturbed healing and obtained large vertical bone heights, a high success rate, minimal resorption, and fully satisfactory prosthodontic rehabilitation; we can thus recommend our modified technique of reconstruction of the severely resorbed maxilla for routine use.

Alveolar Bone Loss↗
PubMed1999

[Prosthetic scintigraphic study of healing of implants combined with bone transplantation in extreme atrophy and after tumor resection].

The aim of the present study was to evaluate the healing of onlay grafts to edentulous jaws and after tumor ablation in conjunction with osseointegrated implants using sequential bone scintigraphy and single photon emission computed tomography (SPECT). A total of 24 patients were examined after onlay grafting of extremely atrophic edentulous jaws and after tumor ablation with secondary implant placement 21.4 weeks after grafting. Technetium-99m (MDP) scintigrams were performed immediately after grafting, before and after implant placement, and before abutment connection. Tracer accumulation was assessed semiquantitatively by calculating ratios of count densities between the uptake over the calvaria and over the grafted jaws. There was a significant decrease in tracer uptake during graft healing, which was followed by a significant increase after implant placement and a subsequent decrease during implant healing. In patients with complicated healing, tracer uptake in areas of subsequent graft infection immediately after grafting was significantly lower compared with patients with uneventful healing. These areas also showed a lower increase in tracer accumulation after implant placement due to inferior graft quality, followed by a significant increase of tracer uptake at the time of abutment connection, representing inflammatory peri-implant bone reaction. Sequential bone scintigrams and bone SPECT have the prognostic potential to detect areas of inferior graft revascularization leading to graft infection or failure in the osseointegration of implants. Only bone SPECT allows an exact localization of areas with complicated healing.

Adult↗
PubMed1999

[Augmentation of the extremely atrophied maxilla and mandible by autologous calvarial bone transplantation].

Rehabilitation in patients with severe alveolar ridge atrophy of the maxilla or mandible is problematic and can often only be achieved by long-term treatment. In most cases, autologous bone grafting with iliac crest bone has been used to augment severely atrophied upper jaws. In our experience, iliac bone grafts are less useful, since iliac bone appears to be of inferior quality; in elderly osteoporotic women, the bone is soft, indentable, and of poor osteogenic potency. In our department, we have been using only autologous calvarial bone grafts for augmentation of alveolar ridge atrophy since 1993. The bone is removed from the outer table of the skull only, trimmed to the alveolar ridge, und fixed with titanium lag scews. The skull defect created is covered with crushed bone or a titanium mesh to avoid aesthetic problems. Insertion of dental implants follows after a healing period of the bone grafts of 5-6 months. A total of 63 patients underwent calvarial split-graft augmentation; augmentation of the maxilla and mandible was carried out in 15 of these patients, of the maxilla only in eight, and of the mandible only in 40. The investigations 1 year later showed a resorption rate of approximately 10%. This is lower than when using iliac bone grafting. The resorption results were stable between 6 and 12 months after augmentation. Using dental implants (12 patients with 32 implants), the resorption rate was low and constant. We have never seen total loss of bone grafts or intracranial complications. All patients were pleased with the treatment. In our opinion, severe alveolar atrophy of the maxilla or mandible should be compensated for by augmentation with autologous calvarial bone grafts to obtain good long-term results.

Adult↗
PubMed1999

[The maxilla--a poor implant site?].

In the maxilla, it is sometimes necessary to use implants to achieve a good prosthetic result. However, an increased failure rate of maxillary implants seems to be a common clinical experience. This experience was investigated in a retrospective statistical analysis. In a retrospective study of 665 patients between 1987 and 1997, 2484 implants were examined. The implants in the upper jaw were compared to those in the lower jaw. Implants with and without autogenous bone grafts and fixtures in patients with alveolar ridge atrophy, tumor, or trauma were explored. In particular, the data obtained from the orthopantomograms after completion of the prosthetic superstructures were controlled for peri-implantary bone loss evaluation. A total of 40% of the fixtures were placed in the maxilla, and 30% of these implants were combined with a local or an iliac bone graft. Out of 2484 implants, 207 were lost, largely during the healing period. The failure rates in the groups of patients with alveolar ridge atrophy, tumor, and trauma were between 6 and 27.5%, and the differences between these groups were higher than the difference between the upper and the lower jaw. Especially in the maxilla and after osteoplasty, horizontal peri-implantary bone loss was increased, with some cases of dramatic bone loss and decrease of the osseous integration of the fixtures. There was no statistic evidence of a significantly higher failure rate in the upper jaw than in the lower jaw. However, besides the rate of implant loss, additional markers should also be considered for adequate evaluation of implant prognosis in the maxilla.

Alveolar Bone Loss↗
PubMed1999

[Comparative studies of sinus floor elevation with autologous or allogeneic bone tissue].

In 63 patients, 82 elevations of the maxillary sinus were performed. As augmentation, materials autografts from the iliac crest (combined with alveolar ridge augmentations in 16 sinus lifts) were transplanted in 39 cases and osteoinductive, allogeneic bone powder (AAA bone (autolyzed, antigen-extracted, allogeneic bone): n = 8, DFDBA (demineralized freeze-dried bone allograft) and/or Grafton (demineralized bone matrix gel): n = 35) were used in 43 cases. Some 4-6 months after implantation, osteoinductive, allogeneic (demineralized) bone implants showed radio-opaque areas as an equivalent of bone formation. Histological examinations revealed that osteoinductive implants were completely transformed into patients' own bone tissue. The average augmentation height after autograft transplantations was 14 (+/- 3) mm in comparison with 9 (+/- 3) mm after allograft implantations. Histologically as well as radiologically no differences of the bone quality could be determined between the two augmentation materials. Endoscopic controls showed, in both groups, nonirritated mucous membranes. On an average 2 endosseous implants (Bone Lock or ITI-screw implants) were inserted into the augmentated maxillary sinus floors in both groups. No osseointegration was achieved in 4 out of 67 dental implants when bone autografts were used and in 2 out of 74 dental implants of the allogeneic bone group. Patients with bone autografts suffered from postoperative complaints on an average of 19 (+/- 9) days (without consideration of 2 patients with postoperative complaints persisting for more than 90 days). The average postoperative complaints of recipients of allogeneic bone implants continued for 3 (+/- 5) days. The 13 patients who underwent an ambulant sinus lift procedure with allogeneic bone powder were already symptom-free several hours after the operation. Under critical consideration of all investigated parameters, osteoinductive bone implants are preferable to iliac bone autografts for maxillary sinus augmentations in those cases in which no additional alveolar ridge augmentation is required.

Alveolar Bone Loss↗
PubMed1999

[Roentgenologic, endoscopic and ultrasound evaluation of the maxillary sinus after sinus lift with simultaneous endosseous implantation].

X-ray, ultrasound, and endoscopy were used in follow-up after sinus floor augmentation. In 23 out of 63 patients, healing was uneventful. Water's view revealed opacification of the maxillary sinus 1 week postoperatively in 40 patients, and opacification persisted in four patients. In these patients, endoscopy showed inflammatory reactions of the mucosa. Ultrasound proved to be a valuable tool in follow-up. Sinusitis occurred in three patients and was due to migration of bone chips in two of these. Out of 132 inserted implants, eight were lost during the healing period and three more during the loading period.

Alveolar Bone Loss↗
PubMed1999

Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants.

Placement of endosseous implants in the atrophic maxilla is often limited because of a lack of supporting bone. A technique to augment the floor of the maxillary sinus with autogenous bone graft seems to be a new reliable treatment modality. The morbidity and complication rate of augmentation of the maxillary sinus floor was studied in 75 patients. The sinus floor was augmented with iliac crest (n = 65, 128 sinuses, 276 implants), mandibular symphysis (n = 8, ten sinuses, 21 implants), or maxillary tuberosity grafts (n = 2, two sinuses, two implants). The width of the alveolar crest had to be reconstructed in 52 patients, while in the other 23 patients augmentation and implantation were performed simultaneously. Perforation of the sinus membrane occurred in 45 patients, but this did not predispose them to the development of sinusitis. Loss of bone particles and sequesters were observed in one (diabetic) patient only, in whom a mucosal dehiscence occurred. A second augmentation procedure was successful. Symptoms of transient sinusitis were observed in two of the seven patients with a predisposition for sinusitis. These symptoms were successfully treated with decongestants and antibiotics. One patient developed a purulent sinusitis which resolved after a nasal amrostomy. The bone volume was sufficient for insertion implants in all patients. Twenty of 299 patients (6.7%) in whom Brånemark implants had been inserted were lost to follow-up (mean, 32 months); no sinus pathology was observed. The patients received implant-supported overdentures (58 patients) or fixed bridges (17 patients) and experienced no complaints with regard to the grafts or implants. We conclude that the morbidity and complication rate of bone grafting of the floor of the maxillary sinus floor with autogenous bone is low.

Adolescent↗
PubMed1999

[Minimally invasive sinus lift. Limits and possibilities in the atrophic maxilla].

The minimal invasive sinus lift is a procedure done by osteotome technique via a crestal approach in contrast to the sinus elevation via lateral osteotomy to achieve adequate bone-height for setting of implants. The purpose of this anatomical and clinical study was to evaluate by endoscopic control if the minimal sinus lift is practicable by a residual bone height of less than 8 mm without mucosal damage. An endoscopic controlled sinus lift was done on 10 fresh cadavers. The original bone height was 3-6 mm in the lateral maxilla. The sinus mucosa was elevated by an osteotome at least up to 10 mm. A sinus augmentation was performed with a bone substitute material (Algipore) over the implant bed. There was no tear visible on endoscopic control. Finally, the maxilla was removed and the mucosa inspected. No laceration of the mucosa was found in any case. The clinical study included 7 patients. 5 Patients had bone condensation, augmentation of bone and implantation of 13 mm implants in a one stage procedure. The originally bone height was between 6-8 mm in all patients. One of the five patients did show a small perforation of the mucosa during mucosal elevation at one implant-bed. The implant was inserted and an endoscopic control after 6 weeks showed regular mucosa. 2 patients received augmentation only at a primary bone height of only 3-5 mm. A post-operative CT-scan showed that the bone height was augmented to a total height of 13-16 mm. As a result of our study a sufficient bone height can be achieved by the minimal invasive sinus lift procedure. The advantage of this crestal approach is the protection of the intraosseous vessels in the maxilla and less postoperative morbidity. As a disadvantage, the insertion of bone material limited only to the area surrounding the implant bed, might be discussed.

Aged↗
PubMed1999

[Initial experiences with a new distraction implant system for alveolar ridge augmentation].

The masticatory rehabilitation of patients is dependent on the quality and volume of residual jaw bone. Loss of volume caused by tumor-related mandibular ridge resection or age-related atrophies may cause considerable problems. Reconstructive methods using free iliac bone, external tabula, or sandwich plasties are only a few examples of the common surgical treatment modalities. Doing without bone grafts, alveolar ridge augmentation by means of distraction osteogenesis might become a value method to improve the denture-bearing area. A new distraction implant system is shown and its first clinical use reported. Two distraction implants were inserted after an anterior segmental osteotomy. The alveolar ridge was then elevated 1 mm each day until the required augmentation of about 8 mm was achieved. After a latency period for pre-ossification of the callus, the distraction implants were replaced by the endosseous implants. The implant system and the surgical technique are shown, and the results are discussed. We believe that the implant distraction procedure will make useful contribution to the management of masticatory rehabilitation.

Alveolar Bone Loss↗
PubMed2006

Dental findings in patients with ectodermal dysplasia.

BACKGROUND: Ectodermal dysplasia is an inherited disease causing malformations of all tissues originating from the ectoderm. The significance of this disease lies in severe hypodontia, and an accompanying hypoplasia of the alveolar process. The clinical situation is aggravated by a significant xerostomia. It was the aim of this study to document the distribution of hypodontia and tooth malformation. Furthermore, we aimed to elucidate the clinical impact of these findings. PATIENTS AND METHODS: Records of 30 patients (19 males, 11 females) suffering from ectodermal dysplasia were included. Their age ranged between 7 and 23 years. All patients had been examined clinically and radiographically. In every patient, a record was made of which teeth were missing or malformed, and which deciduous teeth persisted. Additionally, the entire treatment procedure was assessed. RESULTS: The third molars were missing in all of the patients. The number of aplastic permanent teeth ranged from 2 to 26. The maxillary lateral incisors were most frequently absent, followed by the mandibular central incisors. The most stable teeth were the central incisors of the upper jaw, and the canines and first molars in both jaws. However, the maxillary central incisors and canines were the teeth most affected by malformation. Deciduous canines and second molars were the most often persisting teeth due to agenesis of the maxillary lateral permanent incisors and mandibular second premolars. In two-thirds of the patients, missing teeth were replaced by removable dentures. Half of the patients received orthodontic treatment. CONCLUSIONS: Hypodontia and malformation are almost regular dental characteristics in patients suffering from ectodermal dysplasia. The distribution of absent teeth deviates remarkably from the general population. Treatment requires an interdisciplinary approach including orthodontics, prosthodontics and oral surgery.

Adolescent↗
PubMed1997

The role of alveolar ridge width in dental implantology.

Sometimes, preoperative planning in dental implantology, based on sufficient alveolar height, cannot be verified due to transversal deficiencies. A total of 102 bony mandibles and 95 maxillae were analysed after classification of atrophy, simulating implant insertion at 518 standardised edentulous cross sections with regard to anterior/posterior, mandible/maxilla and class of atrophy. Furthermore, the relation of alveolar height to possible implant length in 86 patients was evaluated retrospectively. Implant length reduction compared with alveolar height was necessary in 10% (mandibles) and 7.5% (maxillae) of the bony-jaw sections and 52.5% (mandibles) and 41.5% (maxillae) of the patients' implant regions. In this respect, the class of atrophy of the bony jaws was more important than the region of simulation. However, the highest differences were observed between mandibles and maxillae, both clinically and experimentally: simulation was possible in all mandibles and 42.5% of the maxillae, but clinical implantation was only possible in 86% of 62 mandibles and 0% of 24 maxillae, mostly due to reduced alveolar height. Alveolar ridge width primarily affected the possible implant lengths. Nevertheless, in four (two mandibular and two maxillary cases) of 58 patients (7%) with sufficient height, a surgical procedure that had already been started had to be stopped. It is expected that cross-sectional radiographical techniques of implantation planning, including ridge-width determination, will gain importance in the future.

Alveolar Bone Loss↗
PubMed2002

[The FAMI screw for temporary intermaxillary fixation. Report of experiences for extending indications].

The aim of this study was to demonstrate the suitability of the FAMI screw (fixation and adaptation in mandibular injuries) for maxillomandibular fixation in the maxillofacial area in orthognathic and trauma surgery. This FAMI screw was used in 28 patients for maxillomandibular fixation with wiring or elastics. The screw is inserted into the labial or buccal surfaces of the alveolar process without predrilling. Adequate intermaxillary fixation with balanced occlusion was created intraoperatively in all patients. In comparison with conventional splinting methods, this technique was far less time-consuming. The use of the FAMI screw has the advantage of being quick and simple, particularly if only a brief period of maxillomandibular immobilization is planned. Furthermore, the risk to the surgeon of sustaining a puncture injury from wire ligatures is distinctly reduced. Screws can be removed without local anesthesia. The above-mentioned method is minimally traumatic, effective, timesaving, and hence inexpensive. It can be used for maxillomandibular immobilization in dentate as well as in edentulous patients.

Bone Screws↗