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PubMed2000

An anatomic study of the lingual nerve in the third molar region.

PURPOSE: The aim of this study was to determine the location of the lingual nerve in the lower third molar region. PATIENTS AND METHODS: In this study, 669 nerves from 430 fresh cadavers were examined. Measurements on each cadaver were made using a micrometer caliper to determine the horizontal and vertical position of the lingual nerve in the lower third molar region. RESULTS: In 94 cases (14.05%), the nerve was above the lingual crest, and in 1 case (0.15%), the nerve was in the retromolar pad region. In the remaining 574 cases (85.80%), the mean horizontal and vertical distances of the nerve to the lingual plate and the lingual crest 2.06 +/- 1.10 mm (range, 0.00 to 3.20 mm) and 3.01 +/- 0.42 mm (range, 1.70 to 4.00 mm), respectively. In 149 cases (22.27%), the nerve was in direct contact with the lingual plate of the alveolar process. CONCLUSIONS: This study confirms the relatively unsafe position of the lingual nerve in relation to some oral and maxillofacial surgery procedures.

Adult↗
PubMed1989

Standardized panoramic radiography in assessment of mandibular augmentation with hydroxylapatite material: preliminary report.

This study evaluates the usefulness of a head-positioner/cephalostat in producing standardized panoramic radiographs by assessing the reproducibility of the radiographs and comparing the standardized panoramic radiographic findings with those obtained from 45 degrees right and left lateral cephalograms. Comparison of measurements indicated that this cephalostat produced reproducible panoramic radiographs. Measurements on each panoramic radiograph showed standard deviations ranging from 0.0 to 0.24 mm (pooled SD = 0.12), whereas the SDs for the 45 degrees lateral cephalograms ranged from 0.0 to 0.45 (pooled SD = 0.14). This indicates that the panoramic radiographs obtained with this head-positioner/cephalostat were comparable to those obtained by 45 degrees lateral cephalograms.

Alveolar Process↗
PubMed1989

Multicenter follow-up study of the transmandibular implant.

The purpose of this multicenter study was to review the results of treatment and identify complications in edentulous patients who were treated with the transmandibular implant. A total of 190 patients were treated in four university departments. These patients presented for treatment with mandibular bone heights that ranged from 4 to 18 mm (mean, 10 mm). After postoperative periods that ranged from 3 months to 5 years, 182 of the 190 implants (95.8%) were stable and functional. Three implants were removed due to perioperative fractures in mandibles with 4 to 6 mm of bone height. Five were removed due to infection which occurred within the first 3 months after surgery. Reversible complications that developed in 22.2% of the patients were treated successfully. The 182 implants in function demonstrated no mobility and no infrabony pockets around any of the transmucosal posts. The results of this study demonstrate that the transmandibular implant has acceptable predictability and reliability for reconstruction of patients with severe atrophy of the mandibular alveolar process.

Bone Resorption↗
PubMed1996

Prospective study of the quality of life of cancer patients after intraoral tumor surgery.

PURPOSE: The aim of this prospective study was to determine the quality of life of patients with oral cancer after intraoral ablative surgery. PATIENTS AND METHODS: Eighty-five consecutive patients with squamous cell carcinoma of the floor of the mouth were enrolled in the study. Reconstruction of intraoral soft tissues was accomplished by local tissue (67.8%), jejunal grafts (16.9%), and cutaneous and myocutaneous flaps (15.3%). Soft tissue resections were combined with resections of the alveolar process of the mandible in 35.0% and mandibular discontinuity resections in 31.7% of the cases. A self-administered, standard questionnaire consisting of 22 visual analog scale items with a maximum index value of 154 was used to determine the physical functional status, the psychological status, and social functioning of cancer patients (Functional Living Index--Cancer). The questionnaire was administered preoperatively and 3, 6, and 12 months postoperatively. RESULTS: The Functional Living Index score increased significantly toward the end of the first postoperative year because of an increase in all three factors of the scale. All modes of soft tissue reconstruction achieved nearly equal levels of life quality in patients with median or lateral defects at the end of the observation period. Only patients with large bilateral defects exhibited lower preoperative and postoperative values because of extensive loss of functionally important soft tissue. Patients with discontinuity resections of the mandible took longer to regain the same level of life quality as patients without bone resections. Persistence of dysphagia, reflux of liquids, limitations to liquid food, and sleep disorders had a significant negative effect on the score. CONCLUSIONS: It is concluded that rehabilitation of oral cancer patients is particularly difficult in the case of large soft tissue defects and is not always accomplished completely even with primary microsurgical tissue repair.

Activities of Daily Living↗
PubMed1997

Survival analysis of endosseous implants in bone grafts used for the treatment of severe alveolar ridge atrophy.

PURPOSE: The aim of the current study was to evaluate the long-term results of endosseous implants placed into autogenous bone grafts in severely atrophic alveolar ridges. PATIENTS AND METHODS: A total of 871 implants were placed in 137 patients. The success rate was determined using survival analysis, log rank tests, and a cox regression analysis. RESULTS: Seventy-four implant failures were encountered in 23 patients. Most implants were lost because of a lack of osseointegration at the time of abutment connection or by asymptomatic loosening during the first months thereafter. The overall 1-year cumulative survival rate (CSR) was 83.4%, with a decrease to 67.8% after 5 years. The only parameter of prognostic relevance in the multivariate analysis of the whole study population was the patients' gender, with a significantly worse prognosis in female patients (5-year CSR, 62.3%). However, when the patients were divided into edentulous and partially edentulous jaws, a change was observed in the overall significance of the parameters introduced into the analysis. In edentulous patients, the maxilla appeared to over-rule all other parameters, with a 5-year cumulative survival rate of 48.8%, whereas the mandible presented a significantly higher rate of implant survival (5-year CSR, 89.3%). CONCLUSION: This study shows a poorer success rate in females than in males, probably because of differences in the quality of the bone grafts.

Adolescent↗
PubMed1997

Mandibular anterior ridge extension: a modification of the Kazanjian vestibuloplasty technique.

PURPOSE: A modification of the secondary epithelization vestibuloplasty technique described by Kazanjian that eliminates the sharp V in the depth of the extended vestibule and counteracts shallowing of the sulcus is presented. PATIENTS AND METHODS: Ten consecutive patients indicated for anterior mandibular secondary epithelization vestibuloplasty were treated. A bipedicled mucosal flap was developed in the labioalveolar mucosa for lining the extended vestibular depth. A comparison was made of the vestibular depth measured from the crest of the ridge to the junction of the attached mucosa both preoperatively and postoperatively. RESULTS: Healing of raw surfaces was uneventful. The mean preoperative anterior mandibular vestibular depth was 3.5+/-1.1 mm. After 6 months, the mean anterior mandibular vestibular depth was 9.2+/-1.7 mm, a statistically significant difference (P < .05). The mean gain in vestibular depth was 5.7+/-2.2 mm. CONCLUSION: Overcorrection is unnecessary with this modification. Elimination of the sharp V in the extended vestibular depth enables denture fabrication with better flange extension and improved oral hygiene.

Alveolar Process↗
PubMed1975

Malignant melanoma of the oral cavity.

Mucosal malignant melanomas of the oral cavity are rare and the present series comprising 23 patients is one of the largest ever published. The poor prognosis of these tumors appears from the fact that only two of the 23 patients could be presumed to have been treated sucessfully. The survival time of the 21 patients who died during the follow-up period was short in all but one patient, surviving 35 years after the first symptom of the tumor despite regional lymph node metastases in an early stage of the disease and repeated local recurrences. This indicates the importance of a regular lifelong follow-up and surgical activity concerning local recurrences and regional lymph node metastases. The poor prognosis may be explained by the patients' delay in seeking medical advice, which is stressed by the deep and massive infiltration of the extensive primary lesions as well as by the fact that metastases already were demonstrable in most patients at the first examination. A necessary condition for radical surgical therapy, and therefore an improvement in the very bad prognosis of oral malignant melanomas, is an earlier diagnosis than in the present series. As oral malignant melanomas almost exclusively appear in the palate and superior alveolar process, particular attention must be paid to lumps, ulcerations and pigmented spots occurring in this region.

Adult↗
PubMed1977

Absolute augmentation of the mandible.

In spite of all the attempts that have been made so far to bring about an absolute augmentation of the mandible, this procedure remains more or less at the experimental stage. The greatest difficulty in the known techniques is that the transplanted bone is resorbed to a great extent in a relatively short time. In the last 2 years at our department we have developed a new technique in which the resorption has up to now been minimal. Bone is no longer transplanted subperiosteally on the alveolar process, but the resorbed mandible is split into cranial and caudal portions from the region of the left 3rd molar to the region of the right 3rd molar, and between these two fragments the bone transplant is placed. In this way the resorption after 2 years is practically nil and, moreover, the patient can wear a normal prothesis.

Atrophy↗
PubMed1980

Le Fort I ostectomy (using miniplates) for correction of the long face.

The increased middle face height, with a short upper lip and visible upper alveolar process, is an indication for removing a slice of bone from the maxilla. Planning of the operation and operative procedures will be described. It is shown that osteosynthesis with miniplates without the need for intermaxillary fixation is possible, provided that the planning is painstaking and that a precise operative technique is used.

Bone Plates↗
PubMed1981

Submergence of roots for alveolar ridge preservation. A failure (4-year follow-up study).

A 4-year clinical and radiographic follow-up study of 20 cases of crown-resected root-filled roots, covered by mucosal flaps, distributed among 15 patients, has been carried out. Only cases of uneventful submergence of the root with intact healthy mucosa were regarded as successful. This study shows that: (1) The number of failures increases with the years; from 3 cases at the 1-year to 11 cases at the 4-year follow-up, corresponding to 53% (8/15) of the patients. In the failures, an exposure of the root-surface was seen, but without inflammation in the surrounding tissue. These roots could be extracted without bone loss. (2) Alveolar ridge atrophy is not prevented by retained roots, and is probably the primary reason for failure of coverage. The 11 failures showed alveolar ridge atrophy, which was observed before failure in 6 cases. None of the successful cases showed alveolar ridge atrophy. The present method cannot be recommended as a routine procedure.

Alveolar Process↗
PubMed1982

Healing of experimental excisional wounds in the rat palate. (I) Histological study of the interphase in wound healing after sharp dissection.

Healing of standardized, excisional wounds in the rat palate has been studied in 40 rats for a period of 3 weeks. The excisional wound were made with a specially constructed biopsy instrument with a diameter of 3 mm. The soft tissue was removed by sharp dissection and uncovered bone tissue was left for secondary healing. 5 rats were killed at 0, 1, 3, 5, 7, 19, 14 and 21 days after the surgical procedure. Photometric measurements were made of the wound at the different control times and serial sections from blocks including the palate, alveolar process and teeth were subjected to light-microscopical examination. Clinical healing was completed within 3 weeks. Photometric measurements showed an almost 50% reduction of the defect between the 7th and 10th days. Histological examination initially revealed a pronounced inflammatory reaction both in the sub-epithelial connective tissue and in the haversian canals of the bone tissue. The epithelialization progressed from the wound borders, the epithelial cells trying to avoid interference with the inflammatory cell infiltrate. Reduction of the wound surface proceeded by contraction of the wound margins as well as by epithelial cell migration. Empty osteocyte lacunae in the surface layer of the bone tissue beneath the wound and the presence of small nectrotic bone fragments indicated that damage to the bone tissue had occurred during the exposure period. After 3 weeks, the defect was completely covered with epithelium although epithelial rete pegs had not yet developed in the central part of the former defect.

Animals↗
PubMed1986

Multiple primary tumours in oral cancer.

In 210 cases of oral cancer, 38 (17.6%) second primary tumours were found. Males had a higher chance of developing a second primary than females (21.4% versus 12%). The difference was not statistically significant (p = 0.11). When the index tumour was in the lower part of the oral cavity (floor of mouth, retromolar trigone, inferior alveolar process), a higher rate of second primaries was found than in cancer of the rest of the oral cavity (tongue, buccal mucosa and palate) (26.6% versus 11.5%). In male patients, this difference was statistically significant (p less than 0.05). 4 tumours were synchronous. In those 4 patients, panendoscopy would not have contributed to an earlier diagnosis. Routine panendoscopy in oral cancer therefore seems not valid.

Female↗
PubMed1976

Structures of the midface on cylindrical pantomograms.

The paper presents the anatomical structures of the middle third of the face as they are visualized in cylindrical pantomograms, in the projections found to give maximum information in my earlier experimental study (Altonen 1972). The pantomograms are taken with the prototype equipment developed since the earlier study, which can be used to take orthopantomograms, concentric patomograms of the desired shape, and linear tomograms. With this equipment, the patient can be examined while lying down, and experiments with corpses of road traffic victims have shown that it is particularly useful for diagnosing fractures in the middle third of the face. Maximum information is given by a projection in which the radiation beam traverses the region to be visualized parallel to the Frankfort plane, and in which the diameter of the cylindrical image layer corresponds to the width of the middle third of the face. The central part of the middle region is visualized best in ca. 30 degrees retroversion, with the exception of the alveolar process of the maxilla, the hard palate and the dentition. The best reproduction of the lateral areas of obtained in ca. 25 degrees anteversion. The contusing shadows cast by the cranial base in radiography of the middle facial region can be shifted from the area to be examined by tilting the head forward or backward, or positioning the rotational axis of the beam dorsally to the porion-porion line. Thin shadows can also be shifted by using stereoscopic pantomography.

Face↗
PubMed1985

Recent developments in interpositional bone-grafting of the atrophic mandible.

A clinical study on 54 patients, who underwent augmentation of the atrophic mandible by interposed bone-grafts, but in whom routine follow-up vestibuloplasty was deliberately avoided, is presented. The results show a reduced rate of bone resorption in the anterior region and less interference with lip and chin sensibility. An additional study is included concerning the fate of the elevated ridge and associated bone-graft in the body region posterior to the mental foramen. Results suggest that the resorption pattern in this area is very similar to that of a subperiosteal bone-graft. Modification of surgical technique in this regard has produced encouraging results.

Adult↗
PubMed1985

The growth characteristics of multilocular ameloblastomas. A histological investigation with some inferences with regard to operative procedures.

The growth characteristics of multilocular ameloblastomas and the reaction of the surrounding tissues were studied by means of a histological examination of 31 surgical specimens. Infiltration of spongy bone was observed frequently whereas there was little tendency to invade cortical bone. The periosteum largely prevented extension of the tumour. However, in the region of the mucosa overlying the alveolar process apparent encapsulation was absent. There were indications that the infiltrative growth pattern exhibited by an ameloblastoma within spongy bone was due to secondary enclosure of tumour tissue by remodelled bone.

Ameloblastoma↗
PubMed1986

Mandibular ridge augmentation by visor osteotomy combined with a subperiosteal rib graft.

A technique is described of true rebuilding of the mandibular crest using a combination of the visor-osteotomy (Härle, 1975) and a subperiosteal rib graft (Obwegeser, 1963 b). A preliminary report on 25 patients with a mean follow-up of 30 months leads to the following conclusions: the resorption in the anterior part ist 52% of the initial gain after 43 months. In the lateral regions 61% is lost. This compares favourably with other techniques. Impairment of sensibility, although usually acceptable, is the main drawback of the procedure.

Adult↗
PubMed2000

Clinical applications of composite intramembranous bone grafts.

The aim of this article is to introduce the composite intramembranous bone graft mixed with demineralized bone matrix to the clinician and to demonstrate its various clinical applications in the field of clinical orthodontics in the form of case reports. Understanding the mechanism of healing of this composite bone graft provides sound experimental precedent that allows this graft material to become a predictable part of our future orthodontic management. The cases highlighted here took advantage of the several properties of the composite intramembranous demineralized bone matrix graft. An accidental loss of the buccal plate of bone occurred during extraction of a buccally placed premolar for orthodontic purposes. The defect was repaired using chin bone mixed with demineralized bone matrix, and the teeth were successfully moved into the grafted area. A 5-year follow-up showed a stable gingival condition at the grafted area. In this report, ridge augmentation with intramembranous demineralized bone matrix as an adjunct to orthodontic treatment allowed successful placement of endosseous implants. In conclusion, the same graft material was successfully used in the repair of a massive alveolar cleft. Long-term follow-up of these cases showed that this graft is a promising graft material that could be integrated into our orthodontic practice.

Adult↗
PubMed1994

Orthodontic management of ankylosed permanent posterior teeth: a clinical report of three cases.

Ankylosed permanent posterior teeth may have a better prognosis than has been generally assumed. Three case reports offer testimony to the effectiveness of surgical luxation (loosening) with forced eruption induced by elastic force. Individual teeth, the occlusion, and the alveolar process may be preserved by early and aggressive treatment. The prognosis may be questionable, but the effect is preferable to premature extraction.

Adolescent↗