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PubMed2005

Surgical success of intraoral autogenous block onlay bone grafting for alveolar ridge augmentation.

This article evaluates the surgical success of alveolar bone augmentation using intraoral block bone graft prior to dental implantation and measures the amount of bone accumulation using this technique. A consecutive retrospective study was conducted on patients who had onlay bone grafts from 1999 to 2001. Files of 56 healthy patients reporting 64 bone graft operations were reviewed. Medical history, smoking status, area of surgery, bone origin (donor sites) and complications were recorded. Panoramic and tomographic radiographs were measured for the vertical and horizontal bone addition and mesiodistal dimension of the graft. Graft exposure or/and graft removal were defined as failure; hematoma, swelling, inflammation, or temporary paresthesia were defined as complications. The average vertical addition was 5.6 mm measured from the bottom of the vertical lesion before bone grafting to the top of the graft. The average faciolingual addition was 3.8 mm. The mesiodistal graft length ranged from 4 mm to 67 mm (average 15.2 mm). According to our criteria, 56 (87.5%) of the 64 bone grafts were successful, 46 (71.9%) were totally uneventful, and 10 (15.6%) had complications. Smoking and diabetes were associated with a high rate of complications and graft failure. More complications were observed in the vertical than in the horizontal bone grafts. Intraoral bone block graft is a predictable operation with high success rates that provides faciolingual and vertical bone addition. Onlay bone grafting has a low rate of complications and failures. Intraoral bone graft should not be recommended for diabetic patients and smokers.

Adolescent↗
PubMed2005

Postoperative tomographic assessment of veneer bone grafting with implant placement in the maxillary anterior region.

Various ridge augmentation and sinus lift procedures were performed in severely resorbed alveolar crests of a maxilla to provide some volume for implant treatment. It was reported that the outcome of maxillary sinus lift procedures was evaluated with conventional tomography or computerized tomography, and that grafted bone around implants markedly progressed in resorption, particularly at the implant apex. However, veneer bone grafting with implant placement has not been evaluated after treatment with imaging techniques. Therefore, the purpose of this study was to assess veneer bone grafting after maxillary anterior implant treatment. Seven patients with a mean age of 24 years, with implants placed in the maxillary anterior region with or without autogenous veneer bone grafting were postoperatively examined using conventional tomography. On tomograms, the ratio of bone-to-implant contact and the area of bone were measured in labial bones with bone grafts, and they were compared with the values without bone grafts. In cases with bone grafting, the average ratio of bone-to-implant contact was 63.6%, whereas 81.8% was formed in cases without bone grafting. The average area of bone was 12.9 mm and 23.4 mm in patients with and without bone grafting, respectively. No significant difference was found between the implants with and without bone grafts. Resorbed labial bone was observed in the maxillary anterior region with and without veneer bone grafting.

Adolescent↗
PubMed2006

Pericardium membrane and xenograft particulate grafting materials for horizontal alveolar ridge defects.

PURPOSE: The purpose of this study was to evaluate the clinical feasibility of using a native collagen physical resorbable barrier made of bovine pericardium to augment localized alveolar ridge defects for the subsequent placement of dental implants. MATERIALS & METHODS: There were 8 systemically healthy patients with 19 implant sites (aged 35 to 68 years), with inadequate dental alveolar ridge widths, selected for study. All patients completed initial therapy, which included scaling, root planning, and oral hygiene instruction. All ridge defects were augmented with bovine xenograft and a collagen pericardium membrane. Horizontal (width) hard tissue measurements were taken the day of ridge augmentation surgery, or implant placement and augmentation (baseline), and at the 6-month (reentry or uncovering) surgery. RESULTS: The change in ridge width varied from a loss of 0.2 mm to a gain of 7.8 mm, measured clinically with a mean value of 3.0368 and a median of 2.8 mm from baseline. CONCLUSIONS: The results suggested that pericardium collagen membrane may be a suitable component for augmentation of localized alveolar ridge defects in conjunction with different xenografts.

Adult↗
PubMed2006

An alternative sinus floor elevation procedure: trephine osteotomy.

Today, the sinus floor elevation procedure is not only being used on a routine basis, but clinicians are reporting high success rates. The sinus floor graft has become an important option in the treatment of the edentulous posterior maxilla, where vertical bone height is less than ideal. A review of maxillary sinus floor elevation as an integral part of restoring the posterior maxillary is discussed. The related anatomy of the area and current osteotomy techniques are reviewed. This article describes a trephine osteotomy, which is an alternative technique to the existing lateral antrostomy approach currently being used.

Alveolar Process↗
PubMed2006

Hereditary gingival fibromatosis: aggressive 2-stage surgical resection in lieu of traditional therapy.

INTRODUCTION: Hereditary gingival fibromatosis (HGF) is a rare condition characterized by progressive enlargement of the gingiva. Most cases follow autosomal dominant genetics, with a reported incidence of 1 in 750,000. In addition to cosmetic concerns, the compromised oral cavity may cause difficulty with eating, speech, hygiene, and oral competence. In addition, social consequences can be dramatic, forcing patients to lead isolated, reclusive lives. Traditional therapy uses serial gingival resections ("quadrantectomies") with primary closure. However, this method is associated with frequent recurrence and additional resections. We report on a family of 12 siblings, 8 of whom, including monozygotic twins, are affected with HGF. We describe corrective surgery for 3 siblings, as well as their long-term follow-up. METHODS: Three sisters suffered from severe maxillary and mandibular gingival hyperplasia. All complained similarly of weight loss, difficulty with articulation, and social isolation. Physical examination revealed massive overgrowth of both maxillary and mandibular gingiva, as well as multiple ectopic teeth. Following diagnostic biopsy, all 3 patients underwent staged resections. The first stage involved resection of the maxillary component, followed by a planned second-stage resection of the mandibular component. All resections included gingivectomies, odontectomies, and alveolar ridge ostectomies. The oral cavity was allowed to heal by secondary intention. RESULTS: All 3 patients were female, and ages ranged from 34-48 years (mean: 43). Follow-up on the 3 patients ranged from 3-18 months (mean: 11 months). There has been no evidence of recurrence to date. The gingiva remucosalized uneventfully within several weeks, and all patients are tolerating solid food. All patients report dramatically improved speech, oral hygiene, and self-confidence. CONCLUSIONS: In an effort to address the high recurrence rate, we describe our aggressive surgical approach, including resection of the hypertrophied gingiva and alveolar processes. Two-staged gingival resection, as opposed to the more traditional 4-stage quadrantectomy approach, has resulted in no recurrence to date, suggesting an improved outcome over the traditional techniques.

Adult↗
PubMed1993

Experimentally induced dentoalveolar ankylosis in rats.

Dentoalveolar ankylosis is a common complication after replantation of teeth with injured periodontal ligaments. This is a serious complication for the tooth since it leads to progressive root resorption. In young individuals it may also cause infra-occlusion and reduced development of the alveolar process. The purpose of this study was to develop a method applicable to rats in order to follow the effect of systemic and local factors on the development of ankylosis and their possible effect on the length of the functional period of the ankylosed tooth before exfoliation. The maxillary first molars in adult rats were extracted. The periodontal ligaments were devitalized or removed before replantation of the teeth. Dentoalveolar ankylosis was clinically established 2 weeks after replantation. Induction was most reproducible after devitalization or removal of the PDL cells with Dakin's solution and after keeping the rats on a liquid diet up to 3 weeks after replantation. Exfoliation of the teeth usually occurred 6 weeks after replantation. Histological examination showed that the PDL was replaced by bone. The ankylosed teeth showed root resorption to a varying degree. The resorption was in some cases occasionally located in the supra-crestal part of the tooth. A bone-like tissue in the root canal was a rather common finding. In one of the ankylosed teeth cartilage formation was found adjacent to the cementum.

Animals↗
PubMed1992

Enamel defects in primary canines related to traditional treatment of teething problems in Sudan.

In parts of Sudan and some other countries, teething is thought to be the cause of severe health problems in infants, and a traditional treatment involves lancing the alveolar process over the unerupted canines with a heated needle, a procedure known as 'haifat'. Three hundred and ninety-eight children aged 4-8 years were examined for the presence of enamel defects on primary canines, and their parents or guardians were questioned regarding past teething problems and their treatment. Two hundred and fifty-eight (65%) of the children had experienced health problems that had been attributed to teething, and 89 (22%) had been subjected to 'haifat'. 'Haifat' had been practised by all socio-economic groups, but was most prevalent in the lower groups. Enamel defects on the buccal surface of the primary canines were found in 25 (28%) of the children in the 'haifat' group and in 25 (8%) of the other children.

Chi-Square Distribution↗
PubMed1996

The oro-facial manifestations of trisomy 8 mosaicism: a case report.

Trisomy 8 mosaicism is a relatively common autosomal chromosomal disorder characterized by features such as mental retardation, characteristic facies, skeletal abnormalities and congenital heart disease. The case of a 4-year-old boy is described with particular reference to the oro-facial manifestations, which included cleft palate, pronounced anterior open bite, complete reserved unilateral buccal cross-bite, slightly increased width of alveolar processes, and gingival enlargement.

Child, Preschool↗
PubMed2004

Osteosarcoma of the jaws in children.

Two cases of osteosarcoma of the jaws in children are reported. One patient was a 13-year-old girl whose first symptoms included nasal and maxillary sinus congestion, followed by epistaxis. She was found to have chondroblastic osteosarcoma extending through the left maxillary alveolar process and sinus. Following surgery and chemotherapy, the patient has been free of disease for 7 years. The second patient, an 8-year-old boy, was diagnosed with juxtacortical (parosteal) osteosarcoma of the mandible, which is a less aggressive variant of the neoplasm. It is believed that this is the youngest patient reported to date with juxtacortical osteosarcoma of the jaws. He was treated by block resection of the right side of the mandible and is free of disease 3(1/2) years later.

Adolescent↗
PubMed2004

Melanotic neuroectodermal tumour of infancy in the maxilla: a case report.

A 4.5-month-old Chinese boy presented with a bulging mass in the anterior right maxillary region. Clinical features and incisional biopsy examination confirmed the diagnosis of melanotic neuroectodermal tumour of infancy (MNTI). The lesion had first been noted a month before the biopsy. The extent of the lesion was defined via computed tomography, and surgical excision was accomplished through a partial maxillectomy under general anaesthesia. The patient has been irregularly followed-up over the past 8 years, and no evidence of recurrence has been found, either by clinical examination or serial computed tomography scans. A bony defect and a lack of alveolar process were noted on the right side of the anterior maxilla. The patient displayed social withdrawal at school as a result of his partial anodontia. There have only been a limited number of reports on the dental rehabilitation of postoperative MNTI. We report a case of maxillary MNTI in which the need for dental rehabilitation was emphasized.

Biopsy↗
PubMed1989

Alveolar ridge augmentation with bioactive glass ceramics: a histological study.

A particulate BGC (bioactive glass ceramics), has been developed as a new bone graft biomaterial for alveolar ridge augmentation and has been evaluated by simulated animal models. Five beagle dogs were used in this investigation. Prior to augmentation the mandibular posterior teeth of the animals were extracted. Three months after the extractions, the porous BGC particles were packed into the subperiosteal tunnels in the ridges with a special syringe. The animals were killed at different time intervals and the specimens were examined by light microscopy, scanning electron microscopy (SEM), and X-ray energy dispersive analysis (EDAX), respectively. The results of this study indicate that the BGC particles are firmly combined with the adjacent hard and soft tissues by the bone bonding interface between the implants and the alveolar bone, and by the ingrowth of bone or fibrous connective tissue into the interspaces and the pores of the particles. The results have demonstrated that particulate BGC with pores is an excellent implant material for alveolar ridge augmentation because of its very good biocompatibility.

Alveolar Process↗
PubMed2006

Enhanced vertical alveolar bone augmentation by recombinant human bone morphogenetic protein-2 with a carrier in rats.

This study aimed to evaluate the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on vertical bone regeneration of edentulous ridge. Bilateral upper first and second molars of 8-week-old Wistar rats were extracted and the ridges were allowed to heal for 3 weeks. Compressed poly(lactic-co-glycolic acid) copolymer/gelatin sponge (PGS) was used as a carrier of rhBMP-2. PGS alone (control group) or PGS with 5 mug rhBMP-2 (test group) was implanted at the top part of alveolar ridge. The sham group received no implantation. The rats were killed at 1, 2, 4, 8 and 12 weeks after implantation and examined histologically and histomorphometrically. In the test group, significant bone augmentation was evident on the alveolar ridge throughout the experimental period. Histomorphometric analysis revealed greater tissue volume and height of alveolar bone in the test group compared with the control and sham groups (P < 0.05) from 4 weeks onward and the augmented tissues (5 mm3 in tissue volume and 1.5 mm in bone height) were maintained until 12 weeks. Osteoblast surface increased at 2 and 4 weeks and osteoid thickness reached a peak (25 microm) at 2 weeks. Dynamic variables, which represented calcification, were higher in the test group than the control and sham groups at 4 and 8 weeks (P < 0.05). These results suggest that use of rhBMP-2/PGS may achieve vertical bone augmentation, and stabilizes denture prosthesis or makes up for inadequate bone mass for implant prosthesis.

Alveolar Process↗
PubMed2004

Vertical distraction osteogenesis of the mandible applied to an iliac crest graft: report of a case.

OBJECTIVES: This clinical case represents a particular application of vertical distraction osteogenesis of the mandible. The surgical technique was applied to an iliac crest bone graft previously positioned on an anterior mandibular defect with the aim to restore the vertical height after a partial resorption in a trauma patient. CASE REPORT: Distraction osteogenesis was applied because it was necessary to restore the mandibular height in a young male patient who presented with a post-trauma anterior mandibular bony deficiency. Because of the irregularity of the mandibular surface and the depth of the defect, the patient first underwent an iliac crest bone grafting that, after 3 months, showed partial resorption. Vertical distraction osteogenesis was performed on the grafted mandible in order to obtain a satisfactory bony height of the mandibular ridge. Then the patient was successfully rehabilitated by means of an implant-supported prosthesis. CONCLUSION: Vertical distraction osteogenesis appears to be a versatile surgical procedure, which can be applied as a secondary treatment in patients presenting with mandibular trauma sequelae.

Adult↗
PubMed2005

Efficacy of dental implants placed into fibula-free flaps for orofacial reconstruction.

OBJECTIVES: The transfer of the osseofasciocutaneus fibula-free flap has become a routine procedure in the reconstruction of comprehensive orofacial defects. Besides its length, major advantages of the fibula-free flap include the trigonal diameter of the fibular bone, which usually allows the placement of dental implants. PATIENTS AND METHODS: In a prospective study, 16 consecutive patients who received free fibula grafts and in total 51 dental implants between 1999 and 2001 were examined. All implants were inserted secondary after bone grafting and loaded after 3 months of submerged healing. The observation period extended 2.5 years on average. The implant success was controlled clinically, radiographically and by resonance frequency analysis. RESULTS: One implant that was located at the interface between the fibula graft and the mandible was lost due to dehiscence and local infection during the healing period. In two other patients, one implant had to remain unexposed as 'sleeper' due to an unfavourable soft tissue situation. The success rate calculated by Kaplan-Meier analysis was 96.1% after an observation period of 1400 days. Resonance frequency analysis (ISQ-values) revealed significant differences related to the orientation (vestibulo-oral/mesio-distal; vo/md) of the transducer unit (P < 0.01). In general, a high primary stability for implants placed in free fibula grafts could be achieved (vo/md 66/74.1), which on average increased slightly during the healing period (vo/md 67.4/75.4) and within 12 month of functional loading (vo/md 72.1/79.9). Additional augmentation with iliac bone grafts or reconstructions with a double barred fibula resulted in an improved reconstruction of the alveolar process, thus allowing superior individual implant positions or angulations, but no elevation of the ISQ-values. CONCLUSION: The fibula-free flap provides a consistent bone graft that allows a reliable and predictable restoration with dental implants.

Adult↗
PubMed2005

Root repair after injury from mini-screw.

Mini-implants and mini-screws are commonly used in orthodontics to provide extra anchorage. One potential insertion site is between the roots in the alveolar process, which results in a risk of damaging the roots of neighbouring teeth. In an animal-experimental study, 20 mini-screws (bracket screw bone anchors, BSBAs) were inserted into the mandible of five beagle dogs. Each dog received two BSBAs in each lower quadrant, between the roots of the second and third, and third and fourth premolars. Sequential point labelling was performed every 6 weeks with vital stains, and apical X-rays were taken every 6 weeks. Radiographic examination demonstrated damage at three roots because of insertion of the BSBAs. Histological examination at these three roots demonstrated an almost complete repair of the periodontal structure (e.g. cementum, periodontal ligament and bone) in a period of 12 weeks, following removal of the screws.

Animals↗
PubMed2005

Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score.

AIM: In this study, the reproducibility of a newly developed pink esthetic score (PES) for evaluating soft tissue around single-tooth implant crowns was assessed. The effect of observer specialization was another point of interest. MATERIAL AND METHODS: Twenty observers (five prosthodontists, five oral surgeons, five orthodontists and five dental students) were given photographs of 30 single-tooth implant crowns. Seven variables were evaluated vs. a natural reference tooth: mesial papilla, distal papilla, soft-tissue level, soft-tissue contour, alveolar process deficiency, soft-tissue color and texture. Using a 0-1-2 scoring system, 0 being the lowest, 2 being the highest value, the maximum achievable PES was 14. Each observer was requested to make two assessments at an interval of 4 weeks. At the second assessment, the photographs were scored in the reverse order. RESULTS: The mean PES of evaluations at the first assessment (n=600) was 9.46 (+/-3.81 SD), and 9.24 (+/-3.8 SD) at the second one. The difference between these two means was not significant statistically (P=0.6379). Implant-related mean PES for single-tooth implants varied from 2.28 to 13.8, with standard deviations between 0.46 and 3.51. Very poor and very esthetic restorations showed the smallest standard deviations. The mean total PES was 10.6 for the prosthodontists, 9.2 for the oral surgeons, 9.9 for the dental students and 7.6 for the orthodontists. CONCLUSIONS: The PES reproducibly evaluates peri-implant soft tissue around single-tooth implants. Thus, an objective outcome of different surgical or prosthodontic protocols can be assessed. Orthodontists were clearly more critical than the other observers.

Adult↗
PubMed2006

Vertical distraction osteogenesis in the human mandible: a prospective morphometric study.

Vertical distraction osteogenesis has received considerable interest as a way to augment bone prior to implant placement. However, very little is known regarding the appropriate distraction protocols in the human mandible. In this study, we evaluate the effect of the distraction rate and the duration of neutrofixation on bone formation and closure of the gap in the human mandible. Vertical distraction was performed in the atrophic mandible of 16 edentulous patients, aged 62+/-6 years. The bone was distracted for approximately 10 mm at a rate of either 0.5 or 1 mm/day. Bone biopsies were taken after 7-20 weeks of neutrofixation. Histological analysis demonstrated newly formed bone in the distraction gap in all biopsies. The bone was predominantly of the woven type. After 10 weeks of neutrofixation, the gap was bridged by new bone in two out of three intact samples in the 0.5 mm/day group, but not in two intact samples of the 1 mm/day group. Histomorphometry revealed longer bone trabeculae (P=0.02) and a somewhat increased bone volume in the area where new bone formation started (P=0.07) in the group of patients having the 0.5 mm/day of distraction rate than in the 1 mm/day group. We conclude that in elderly patients, a distraction rate of 0.5 mm/day results in faster osteogenesis in the distraction gap than a rate of 1 mm/day. A minimum of 10 weeks of neutrofixation seems to be needed to close a 10 mm gap after cessation of distraction.

Aged↗
PubMed2006

Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients.

OBJECTIVE: To analyze the clinical outcome of horizontal ridge augmentation using autogenous block grafts covered with an organic bovine bone mineral (ABBM) and a bioabsorbable collagen membrane. MATERIAL AND METHODS: In 42 patients with severe horizontal bone atrophy, a staged approach was chosen for implant placement following horizontal ridge augmentation. A block graft was harvested from the symphysis or retromolar area, and secured to the recipient site with fixation screws. The width of the ridge was measured before and after horizontal ridge augmentation. The block graft was subsequently covered with ABBM and a collagen membrane. Following a tension-free primary wound closure and a mean healing period of 5.8 months, the sites were re-entered, and the crest width was re-assessed prior to implant placement. RESULTS: Fifty-eight sites were augmented, including 41 sites located in the anterior maxilla. The mean initial crest width measured 3.06 mm. At re-entry, the mean width of the ridge was 7.66 mm, with a calculated mean gain of horizontal bone thickness of 4.6 mm (range 2-7 mm). Only minor surface resorption of 0.36 mm was observed from augmentation to re-entry. CONCLUSIONS: The presented technique of ridge augmentation using autogenous block grafts with ABBM filler and collagen membrane coverage demonstrated successful horizontal ridge augmentation with high predictability. The surgical method has been further simplified by using a resorbable membrane. The hydrophilic membrane was easy to apply, and did not cause wound infection in the rare instance of membrane exposure.

Adolescent↗