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PubMed2004

Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation.

The anterior maxilla is the most traumatized region during childhood. Posttraumatic complications occasionally lead to tooth loss as well as the need for future implants. Unfortunately, it is contraindicated to place dental implants during childhood. A waiting period of approximately 8 to 10 years before completion of growth is required. For this patient to become a candidate for future dental implants, it is necessary to ensure the continuous growth and to preserve the dimensions of the alveolar process until growth has ceased from time of injury until joint maturation. To achieve these goals, it is essential to coordinate the treatment sequence at the time of trauma. After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth, or tooth extraction and maintaining the gap with a temporary restoration. Orthodontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will usually lead to bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation. Because general rules do not apply, individual treatment plans are necessary.

Adult↗
PubMed1992

Current concepts in the use of bone grafts in facial fractures. Basic science considerations.

In choosing the ideal donor site for bone replacement, attention must be given to the recipient site's revascularization potential and mechanical needs. Based on histologic differences in architecture as related to these two factors, the most appropriate graft type may be harvested. Future potential exists for bone replacement by distraction osteogenesis without the need for remote site harvesting. This may provide for the most identical bone replacement.

Biomechanical Phenomena↗
PubMed2004

[Management of secondary nasolabial deformities after bilateral cleft lip repair].

OBJECTIVE: To evaluate the method to correct the seconary nasolabial deformities after the surgical treatment in the patients with bilateral cleft lip. METHODS: From January 2000 to June 2003, forty patients with secondary deformities following repair of bilateral cleft lip were treated with a combined treatment procedures. AU of the forty cases underwent the following preoperative treatments: alveolar bone graft in 28 cases, preoperative orthodontics in 22 cases, prosthodontics in 20 cases and orthognathic surgery or distraction osteogenesis treatment in 20 cases, respectively. In order to improve the enlongation of nasal column, reconstruction of Cupid's bow, philtrum and correction procedures, continuous incision was made from the vermilion in median of the upper lip, the scar edge, the bilateral sides of the nasal column to the inner side of the nose, even extending the bilateral incision to nasolabial groove and nostril fundus. RESULTS: Forty patients were got the follow-ups for 3 months to 3.5 years and the satisfactory rate reached 95%. CONCLUSION: It is natural to emphasize the setting up of odontomaxillary frame and then utilize the surgical procedure to correct the secondary nasolabial parenchyma deformities. The method could be feasible and reliable for the correction of the secondary nasolabial parenchyma deformities after bilateral cleft lip repair.

Adolescent↗
PubMed2005

[Dissertations 25 years after the date 6. Orthognathic surgery].

In 1979 a thesis on orthognathic surgery was published. Progress of research concerning the surgical orthodontic treatment of dento-facial deformities is discussed with emphasis on the stability of the results, the behavior of the tongue, the temporomandibular joint and the psycho-social aspects. Also some aspects of distraction osteogenesis are mentioned.

Humans↗
PubMed2005

[Dissertations 25 years after the date 7. Temporomandibular joint ankylosis].

Ankylosis of the temporomandibular joint and the possibly associated deformation of maxillofacial bones are functionally and aesthetically serious problems. Despite the developments in oral and maxillofacial surgery, treatment of patients with ankylosis of the temporomandibular joint still remains challenging. This article presents a review of the developments in this treatment, 25 years after the publication of the thesis 'Temporomandibular joint ankylosis'. Nowadays, computer-tomography is the standard for imaging assessment, possibly combined with stereolithography. Resection of the ankylotic mass is the surgery method of choice. The gap is filled by interpositional tissue transfer of temporalis muscle or a fascia flap. Early mobilisation and intensive physiotherapy are needed. In case of maxillofacial asymmetry, distraction osteogenesis has proved to be successful.

Adolescent↗
PubMed2005

[Construction of recombinant plasmid pEGFP-BMP7 and its expression in rat bone marrow mesenchymal stem cells in vitro].

OBJECTIVE: To construct recombinant plasmid pEGFP-BMP7 and determine its expression in rat bone marrow mesenchymal stem cells (MSCs) in vitro. METHODS: cDNA of target gene was obtained from neonatal rat kidney by RT-PCR. After sequencing the target gene, the cDNA was subcloned into a eukaryote plasmid pEGFP-N1 by directed cloning and then digested with two restrictive endonucleases to verify the correctiveness of the recombinant plasmid pEGFP-BMP7. Rat bone marrow MSCs were transiently transfected with the pEGFP-BMP7 and transfection efficiency of the Green Fluorescent Protein (GFP) was determined. RT-PCR and immunocytochemical analysis were also performed to detect the expression of BMP7 in rat MSCs. RESULTS: 1 311 bp cDNA fragment was obtained by RT-PCR and sequence analysis showed it matched perfectly with that of rat BMP7 gene except a single nucleotide change at 756 bp from T to A. Digestion of the recombinant plasmid showed two 1.3 kb and 4.7 kb fragments and their size were same as those of BMP7 and pEGFP. This indicated that BMP7 cDNA was successfully subcloned into pEGFP. Transient transfection showed an efficiency of 33% at day 2 in rat MSCs. After transfection, transcription of BMP7 was detected in MSCs and expression of BMP7 protein was also verified. CONCLUSION: Recombinant eukaryote plasmid pEGFP-BMP7 was successfully constructed and expressed in rat bone marrow MSCs. This procedure may provide a unique method for stimulation of callus formation in distraction osteogenesis and reconstruction of craniofacial bone defects.

Animals↗
PubMed2006

[Recent development of reparative and reconstructive surgery on oral and maxillofacial regions].

OBJECTIVE: To summarize the latest development of the oral and maxillofacial reparative and reconstructive surgery. METHODS: The literature at home and abroad was reviewed and the main creative concepts in this field were summarized and analyzed. RESULTS: In the terms of the oral and maxillofacial reparative and reconstructive surgery, the significant achievements were made in the following aspects: transplantation of revascularized tissues, artificial materials, platelet-rich plasma, distraction osteogenesis, microsurgery on fracture, arthroplasty, dynamic repair, and computer-assisted design. CONCLUSION: Based on the previous achievements, the oral and maxillofacial reparative and reconstructive surgery will have a further development, especially in the individualized treatment.

Humans↗
PubMed2006

Prophylactic external fixation and extensive bone debridement for chronic osteomyelitis.

There is universal agreement that treatment of osteomyelitis should consist of debridement, obliteration of dead space, tissue coverage and antibiotic therapy, with debridement as the most important factor for therapeutic success. Four patients, 27 to 72 years old, with chronic osteomyelitis after a fracture of the femur (two), or of the tibia (two), were included in this study. The patients had already undergone 5 to 15 (mean: 9) surgical procedures. The same surgical technique was used in all of them: sinuses were carefully excised down to the bone, and necrotic bone was aggressively resected until normal bleeding was seen. A prophylactic circular external fixation frame, built on one proximal and one distal ring connected to the bone by thin wires and half pins, was used to protect and support the limbs, significantly weakened by radical debridement. Bone grafting or distraction osteogenesis was not necessary. All wounds healed without complications, and the infection did not recur. The average follow-up period was 43 months (range: 38 to 54).

Adult↗
PubMed2006

[33 cases of craniofacial clefts: experience in diagnosis and treatment with tessier classification].

OBJECTIVE: To introduce our experience in diagnosis and treatment of 33 patients with Tessier craniofacial clefts. METHODS: 33 patients with craniofacial clefts were classified by Tessier classification. According to the type and severity of the clefts, various techniques, from simple local flap transfer to complicated osteotomy and bone grafting were used to correct the deformity in 29 patients. RESULTS: All patients who underwent corrective operation were satisfied with the result, and there were no complications. CONCLUSIONS: (1) Tessier classification is very important for plastic surgeon to find potential craniofacial deformities related to main signs. (2) No. 7 cleft is one of most common Tessier craniofacial clefts. (3) Each Tessier cleft is unique, therefore, the treatment plans cannot be standardized. Specific corrective operation must be performed on each patient according to the type and severity of the cleft, including simple local flap transfer to complicated osteotomy and bone grafting or distraction osteogenesis.

Craniofacial Abnormalities↗
PubMed1991

Imaging in orthopedic surgery and other conditions of the musculoskeletal system.

Interest continues in total joint replacement and its complications. Now that noncemented arthroplasties have been introduced, further radiographic signs are being elucidated. The roles of bone scanning and aspiration arthrography are also being reevaluated. Ultrasonography has become the imaging modality of choice in congenital hip dysplasia and is being used increasingly in the evaluation of other musculoskeletal conditions. The ilizarov distraction osteogenesis technique is also discussed and there has been increasing interest in anterior cruciate ligament reconstruction and its sequelae.

Bone and Bones↗
PubMed1990

Lengthening of below-the-knee amputation stumps using the Ilizarov technique.

Patients with short, traumatic, below-the-knee amputations (BKAs) frequently function as if they have knee disarticulations. The goal of this study was to evaluate the results in patients who had lengthening of their BKA stumps to improved prosthesis fit and increase ambulation. Three patients with traumatic BKAs, who were left with insufficient stumps for proper prosthesis wear, have had their stumps lengthened by Ilizarov's technique of distraction osteogenesis. The lengthening process produced a moderate degree of pain, and all patients had a temporary decrease in their range of motion. Two patients lost a substantial amount of gained length secondary to early full weight-bearing. Despite these difficulties, the procedure produced longer, more durable stumps in all patients with no final loss of knee range of motion.

Adult↗
PubMed1989

Physeal growth arrest of the distal radius treated by the Ilizarov technique. Report of a case.

Growth arrest of the distal radius may follow a severe injury to the growth plate. When the growth of the distal radius ceases in the child, continuing ulnar growth results in radial deviation of the hand and dislocation of the distal radioulnar joint. Treatment options in such a limb-length discrepancy are resection of the physeal bony bridge, lengthening of the shaft of the radius with bone graft using the principle of the Wagner technique, resection or epiphysiodesis of the distal ulna, and lengthening through a metaphyseal corticotomy without the use of bone graft. We report a case of metaphyseal lengthening of the radius employing the Ilizarov external fixator for controlled distraction osteogenesis.

Bone Diseases, Developmental↗
PubMed1995

[Callus distraction].

Fibroblast networks that form collagen and connect the two ends of bone develop in the haematoma after corticotomy. This regenerative tissue is vascularized and distracted. Even during the lengthening, mineralization starts. This starts at the ends created by the osteotomy, in the form of conical bony columns 200 microns thick, which grows towards each other in a manner reminiscent of stalagmites and stalactites, until the central, fibrous inner zone (growth zone) formed during distraction is completely mineralized. Connective tissue and bony bars are arranged lengthwise. As a rule, intramembranous callus formation takes place during distraction osteogenesis with no intermediate cartilaginous step.

Bone Lengthening↗
PubMed1994

[Treatment concepts and results in non-infected post-traumatic pseudarthroses of the femur and tibia].

AIM OF INVESTIGATION: Different methods of internal and external fixation are used to treat aseptic posttraumatic nonunion of the femur and tibia. The advantages and disadvantages of the different methods will be demonstrated by analysing the clinical course and the outcome of our patients. Utilizing these data, a therapeutic concept tailored to the individual situation is recommended. METHODS: Depending on the form of reaction we distinguish between vital and non-vital nonunions. The classification is made according to the clinical course, x-ray-findings and in special cases the results of scintigraphy. Due to anatomic differences in vascularisation and soft tissue coverage nonunion of the femur and the tibia are discussed separately. Stabilisation is achieved by intramedullary nail, plate or external fixator. As new methods the internal plate fixator was used for the femur and the Ilizarov ring fixator for the tibia. If there has been a mistake in the choice of the method of the primary stabilisation a change of method is done. If the indication for the initial method of stabilisation was correct, the therapy of nonunions is limited to the correction of technical mistakes. Additionally, a biologic stimulation is required for the therapy of non-vital nonunion. RESULTS: The clinical data of 77 patients treated from 1985-1993 were analysed retrospectively. Vital nonunions of the femur (11) healed after 9.5 months on the average, those of the tibia (49) after 10 months. The duration of treatment of non-vital nonunions was much longer and required 20 and 16 months, respectively. The treatment of two non-vital nonunions of the tibia could not be completed. For the femur only intramedullary nail (4) and plate (8) were used, for the tibia mainly the fixator (43), of these in 18 cases the Ilizarov-apparatus. Differences in the duration of treatment due to the choice of implant could not be recognized. Complications were pin problems (14) and one lesion of the peroneal nerve in the fixator group and superficial wound infection (2), nerve irritation (1) and fracture (1) in the group treated with intramedullary nailing. CONCLUSIONS: Due to the good soft tissue coverage and vascularisation internal fixation is favored for the treatment of femoral nonunions. The fixator should only be used if distraction osteogenesis is necessary because of a bony defect. Due to the problematic soft tissue situation and poorer vascularisation on the external fixator is preferred in the treatment of tibial nonunions if a change of method is indicated. For this purpose, we currently use predominantly the Ilizarov-apparatus because of its biomechanical properties and the convincing results. Initial problems with its use could markedly be reduced with growing experience.

Adolescent↗
PubMed1994

Treatment of chronic tibial osteomyelitis, segmental bone loss, and soft tissue defect by bone transplant.

New methods of treatment have greatly improved the success of limb salvage in severe lower extremity trauma. We report the use of a microvascular free tissue transfer and distraction osteogenesis in the reconstruction of soft tissue and bone defects complicated by infection. Soft tissue coverage and bony stabilization by external fixation resulted in eradication of the infection. The external fixator also allowed bone transport and regeneration to overcome a bone defect of approximately 6 cm. Bone transportation can be accomplished in a distal to proximal direction if the situation necessitates it. These techniques are extremely versatile and useful in the treatment of bone and soft tissue defect.

Adult↗
PubMed1993

The gradual correction of forearm deformities in multiple hereditary exostoses.

Careful preoperative planning, fixator selection and design, surgical technique, and sustained follow-up care are essential for successful gradual correction of pediatric forearm deformities. The sequence of planning gradual deformity correction can be created by establishing a problem list and using this as the basis for design of the gradual correction. Viewing limb length and deformity correction as a "process," rather than a procedure, is of value. Using a hybrid fixation formula that combines half pins with wires can minimize the potential for neurovascular injury. The combination of radial osteotomy, excision of osteochondromas, and gradual ulnar lengthening by distraction osteogenesis improves forearm appearance and function in most patients with multiple hereditary exostoses.

Biomechanical Phenomena↗
PubMed1993

[Ilizarov method used for the sequela of growth cartilage lesions].

Ilizarov distraction osteogenesis is a good way to correct sequelae of growth plate injury after completion of the growth. There is often both limb length discrepancy and angular deformation in varus, valgus, flexum, and recurvatum after surgery or trauma in childhood. Such deformations of the distal femoral growth plate, both proximal and distal tibial and distal radial will be presented, treated by a one-step Ilizarov method.

Adolescent↗
PubMedDate not supplied

Clinical estimation of ilizarov fixator axial stiffness based on wire and half pin contributions.

A key parameter in the mechanical environment created in distraction osteogenesis is the axial stiffness of the external fixator. Mechanical testing of the frames with wire and half pins has been used to estimate the stiffness contributions of wires based on the span length and of half pins based on the offset length. A summation of the wire and half pin contributions appears to represent a suitable estimate for the axial stiffness of frames composed of a mixture of wires and half pins. Using this estimate, clinicians can make informed decisions regarding frame construction, and it may be possible to investigate the rate of bone formation relative to axial frame stiffness in the clinical setting.

Biomechanical Phenomena↗