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Evaluation of prophylactic alveolar trephination to avoid pain.
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Antibiotic prescribing in third molar surgery.
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Histometric evaluation of interproximal bone responses to electrosurgical mucoperiosteal incisions in dogs.
The periosteal and endosteal interproximal bone remodeling activity following clinically simulated blade and electrosurgical mucoperiosteal incisions was investigated by histologic and morphometric analyses. Undecalcified histologic sections were prepared and evaluated using standard bone morphometric techniques. Periosteal and endosteal bone surfaces subjacent to incisions were examined and the percentages of forming, resorbing, and quiescent surfaces, and the number of osteoclasts per millimeter of bone surface, were calculated. Based on indices of bone remodeling activity, the potentials for activation of interproximal bone remodeling by clinically appropriate blade and electrosurgery incisions in dogs appear to be similar.
A primate model for producing experimental alveolar cleft defects.
A simplified surgical technique to create an alveolar cleft defect with oronasal communication was developed in 12 female rhesus monkeys. The defects fulfilled the following criteria: 1) a bilateral alveolar cleft with a minimal width of 1 cm; 2) presence of an oronasal communication lined by epithelium; 3) absence of any clinical signs of inflammation within the cleft defect area; and 4) presence of functional teeth on each side of the created defect.
Wound healing after anterior and posterior subapical osteotomy.
Changes in the process of wound healing and in the dental pulp were examined following anterior and posterior mandibular subapical osteotomies in pig-tailed macaque monkeys. Results of microangiographic and histologic investigations indicated that degenerative pulpal changes may occur following mobilization and repositioning of small dentoalveolar segments. The potential significance of such degenerative pulpal changes and the need for routine dental radiographic checkups following anterior and posterior mandibular dentoalveolar surgery are discussed.
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.
Comparative evaluation of function after surgery for cancer of the alveolobuccal complex.
PURPOSE: The current study was undertaken to assess the functional deficit after hemiresection of the mandible and to determine whether lateral segment resection with reconstruction was a functionally superior alternative in the management of patients suffering from alveolobuccal cancer. PATIENTS AND METHODS: Eighty-three patients were assigned to one of two main groups: Group I, hemiresection of the mandible (n = 47), and group II, lateral segment defects (n = 36). Functional assessment of patients included subjective evaluation of overall well-being, feeding, and cosmesis, as well as objective assessment of mastication, speech, and cosmesis. Mean scores for each of these categories were compared across groups using the Duncan Multiple Range Test with .01 confidence intervals. RESULTS: Subjective assessment of overall well-being, feeding, and cosmesis did not yield statistically significant differences between groups. Objective evaluation of mastication showed significantly better function after hemiresection in dentate patients as compared with their edentulous counterparts. However, masticatory scores for hemimandibulectomy patients with intact residual dentition were not significantly different from those for patients whose lateral segmental defects had been reconstructed. Although objective cosmetic scores for reconstruction of lateral segment defects were significantly better than those for hemiresection of the mandible, most patients in the latter group accepted the resultant deformity as a consequence of their treatment and did not let it affect their routine activities. CONCLUSION: Until functional results in patients undergoing lateral segmental resection for alveolobuccal cancer can be improved by better prosthetic techniques, hemiresection of the mandible remains a simple, safe, reliable, and cost-effective option that produces acceptable postoperative function.
Prospective evaluation of morbidity associated with iliac crest harvest for alveolar cleft grafting.
PURPOSE: This study prospectively evaluated the morbidity associated with iliac crest bone harvest when performed for alveolar cleft grafting. PATIENTS AND METHODS: Twenty-two consecutive patients who underwent an alveolar cleft graft with iliac crest bone harvest were evaluated. The estimated blood loss, length of hip incision, and volume of bone that was harvested were recorded. The duration of time until postoperative ambulation and the length of hospitalization were measured. RESULTS: All patients tolerated the iliac harvest without major complication, and the volume of bone was sufficient in all but one case. Postoperatively, ambulation occurred at an average of 3 hours 18 minutes. Twenty-one patients were discharged the day after surgery; one patient had the surgery performed as an outpatient. CONCLUSIONS: Harvesting cancellous bone from the iliac crest does not result in delayed ambulation or prolonged hospitalization. The morbidity that has been reported to occur with iliac crest bone harvest was not consistent with the results of this study.
Modified Wunderer's osteotomy to approach palatal tumors.
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Surgical exposure and bracketing technique for uprighting impacted mandibular second molars.
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The vitreous carbon tooth root replacement system: a surgical discipline.
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Restoration of deficient edentulous ridges by bone grafting and the use of subperiosteal metal implants.
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Management of the displaced root in the maxillary sinus.
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Feasibility of osteotomies in fibrous dysplasia of the jaws.
Two examples are presented of osteotomies performed simultaneously with surgical recontouring in cases of fibrous dysplasia of the jaws. Osteotomies are necessary when a coexistent discrepancy in jaw relationship is present. This provides a functional as well as aesthetic result. Rigid miniplate fixation was utilised, and dysplastic bone healing was uneventful, and found clinically not to differ from that of normal bone. Osteotomy is thus feasible in dysplastic bone, and may complement recontouring in achieving a better result.
Primary reconstruction of the mandibular alveolar ridge following resection.
Standard techniques of mandibular reconstruction aim at the restoration of function. However, the height and shape of the alveolar ridge are often neglected and reconstruction often results in difficulty in subsequent denture wear. Immediate reconstruction of the alveolar process with particulate autologous iliac bone is described, a technique used in 10 patients since 1978.
The bony lid approach for the apical root resection of lower molars.
The apical root resection of mandibular molars is an operation seldom performed and then one limited primarily to the lower first molars. Although the first paper on this topic was published at the beginning of the 20th century, little progress has been observed since then. This is due to the thickness of the buccal bony plate in the lower molar region which makes surgery very difficult and leads to a substantial loss of bone. The resultant limitation of the operating field prevents good vision. The aim of our approach is to minimize or to eliminate these problems by opening a bony lid above the roots which are to be resected. This can be made large enough for the surgeon to have easy access and good vision during apical surgery. At the end of the operation the same lid is replaced in order to avoid a bony defect and to facilitate the healing process. Of the 75 patients treated using this technique during a 3-year period, only one post-operative complication has been observed. A complete healing of the bone was observed in the majority of cases within 6 months.
Polyactive as a bone-filler in a beagle dog model.
Calcification is a crucial step in the bone-bonding mechanism of PEO/PBT hydrogel copolymers (Polyactive, a new generation of bone-fillers. A beagle dog study was conducted to determine whether the preoperative presence of a calcium phosphate layer (precalcification) on a PEO/PBT 80/20 copolymer would further increase the bone-bonding rate. Standard bone cavities were filled with either precalcified or nonprecalcified porous cylindric PEO/PBT 80/20 implants, or hydroxyapatite granules held together with PEO/PBT 70/30, or were left unfilled. A significantly higher percentage of mineralized component was present in the cavities filled with the precalcified PEO/PBT 80/20 copolymer than in the control defects. As a result of swelling by fluid-uptake, the press-fit inserted copolymer implants showed a significant reduction in pore size, thus preventing optimal bone ingrowth. Both precalcification of the copolymer and underfilling of the defect, to create space for the copolymer to increase in diameter, stimulate postoperative calcification and bone ingrowth in PEO/PBT 80/20 copolymers.