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At least 163 records · Page 9Linked to original sources
PubMed1987

Effect of timing on long-term clinical success of alveolar cleft bone grafts.

Despite the almost universal agreement on the desirability of bone grafting in the cleft alveolar process, there are little long-term data to support preference for grafting at one time versus another. Investigation was undertaken to compare the clinical success of grafts placed at three distinct developmental stages: the "primary" group consisting of 20 rib grafts placed at less than 1 year of age; the "secondary" group consisting of 19 iliac crest grafts placed when the permanent canine was one fourth to one half formed; and the "delayed" group consisting of 18 iliac crest grafts placed after eruption of the permanent canines. Patients were a minimum of 15 years of age at time of final evaluation. Records were made a minimum of 5 years postsurgery. Biometric data and periapical x-ray films were evaluated. There was a trend for the delayed group to have a decreased incidence of successful bony bridging of the graft site compared with the other treatment groups. The primary group exhibited significantly (P less than 0.001) greater ridge height and increased bone attachment than the secondary and delayed groups. There were significantly fewer teeth lost adjacent to the cleft for the primary group compared with the secondary and delayed groups. Before orthodontic treatment, there were no significant differences among groups in incidence of anterior crossbite; posterior crossbites were seen more frequently in the secondary and delayed graft groups than in the primary group (P less than 0.001). At final evaluation, there were significantly fewer anterior and posterior crossbites in the primary group than in the secondary and delayed groups (P less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Guided bone regeneration to repair an alveolar bone defect in a girl whose cleft lip and palate had been repaired.

We report the case of a girl aged 10 years whose alveolar bony defect was closed with a polytetrafluoroethylene membrane, which was incorporated in bone after 4 months. We suggest that the principle of guided bone regeneration can be used to repair cleft defects provided that the mucoperiosteal flaps are handled carefully and that good anti-infective measures are taken to prevent early exposure and microbial contamination of the membrane barrier.

Alveolar Process↗
PubMed2004

The zygomatic bone as a potential donor site for alveolar reconstruction--a quantitative anatomic cadaver study.

The aim of this cadaver study was to evaluate the possibility of using the zygomatic bone as an intraoral bone harvesting donor site and to determine the safety of this harvesting procedure. In addition, the volume of bone material harvested from the zygomatic bone was measured. Twenty fixed adult cadavers were used to yield a total of 40 zygomatic bone harvest sites, from which bone was collected. The volume of bone obtained from the zygomatic harvests was measured with a water displacement method and by compressing the graft into a syringe. The safety of the technique was evaluated by assessing possible encroachment upon the neighbouring structures. After bone harvesting, the zygomatic sites were exposed and evaluated for visible perforations or fractures. Possible damage to the neighbouring tissues was also examined with computed tomography scans at 18 sites in nine cadavers. The average bone graft volume obtained from the zygomatic bone was measured to be 0.53 ml (SD 0.25) with water displacement and 0.59 ml (SD 0.26) with the syringe. The complications in the zygoma included 15 small perforations into the maxillary sinus and 7 perforations into the infratemporal fossa. CT scans showed that bone could be harvested safely without encroaching upon the orbital floor or the surrounding nerves and vessels in the zygoma. The zygomatic bone is a safe intraoral donor site for the reconstruction of small- to medium-sized alveolar defects.

Adult↗
PubMed2006

Alveolar cleft osteoplasty using tissue-engineered osteogenic material.

The use of tissue-engineered osteogenic material comprising platelet-rich plasma and autologous mesenchymal stem cells isolated, expanded and induced to osteogenic potential in bone augmentation procedures as a replacement for autologous bone grafts, offers predictable results with minimal donor-site morbidity. This material was applied for an alveolar cleft osteoplasty of a 9-year-old female patient. Serial computed tomograms showed the regenerated bone extending from the cleft walls after 3 months and bridging the cleft after 6 months, with 79.1% of the grafted region after 9 months at the time when the canine and lateral incisor in the affected side erupted in the reconstructed alveolar ridge.

Alveolar Process↗
PubMed2006

Synthetic, pure-phase beta-tricalcium phosphate ceramic granules (Cerasorb) for bone regeneration in the reconstructive surgery of the jaws.

The aim of this study was to investigate the long-term effect of the ceramic beta-tricalcium phosphate (beta-TCP) at different sites of alveolar reconstruction and to evaluate its properties. From 1997 to 2002, beta-TCP was implanted as bone substitute in 152 patients using a standardized study protocol. Main indications were the filling of large mandibular cysts (n=52), secondary and tertiary alveolar cleft grafting (n=38), periodontal defects (n=24) and maxillary sinus floor augmentation (n=16). For defects exceeding 2cm in diameter, beta-TCP was combined with autologous bone taken from the retromolar area, the maxillary tuberosity or the chin region. A radiological, clinical and ultrasonographical examination was carried out 4, 12 and 52 weeks postoperative. In 16 cases, biopsies were taken after 12 months indicating complete bony regeneration. While wound-healing disturbances occurred in 9.2% of cases, partial loss of the bone substitute material was found in 5.9%, while total loss occurred in only 2%. Complete radiological replacement of beta-TCP by autologous bone was found after approximately 12 months, indicating its osteoconductive properties. Because of its versatility, low complication rate and good long-term results, synthetic, pure-phase beta-TCP is a suitable material for the filling of bone defects in the alveolar region.

Adolescent↗
PubMed2004

Intrauterine autogenous foetal bone transplantation for the repair of cleft-like defects in the mid-gestational sheep model.

AIM: The success of intrauterine surgery in treating non-life-threatening malformations such as myelomeningocoele, has also renewed strong interest in using this technique for treating craniofacial malformations. Nevertheless, the only experimental cleft-like defect models known, are those concerning wound healing of soft tissues. MATERIAL AND METHODS: Attempts were made to repair artificial cleft-like defects including transplantation of 11 autogenous foetal bone grafts from the iliac crest or ulna, and were randomly assigned to three study groups, using the mid-gestational sheep model. In a 4th study group, lyophilized collagen, a bone-regenerating bioresorbable implant material, was used to fill the alveolar defect. RESULTS: In all groups, there was a slight degree of asymmetry and thinning of the lip. Radiological studies demonstrated a variable degree of abnormality of the maxilla, ranging from none to a mild deviation. Three-dimensional computer tomography, two-dimensional maximal intensity projection findings, and histological analysis confirmed bony healing of the alveolar cleft-like defect. DISCUSSION/CONCLUSION: Intrauterine autogenous foetal bone transplantation for the repair of cleft-like defects in the sheep is feasible. This is a reliable and valuable model toward a possible clinical application for intrauterine treatment of clefts.

Absorbable Implants↗
PubMed2004

Microstructured dental implants and palatal mucosal grafts in cleft patients: a retrospective analysis.

BACKGROUND: In cleft patients, implant dentistry has become an integral part of oral rehabilitation. However, a lack of keratinized mucosa is found in many cases which may have adverse effects on the long-term success of dental implants with microstructured surfaces. Therefore, the aim of this study was to evaluate whether mucogingival surgery is of value in the treatment of these patients. PATIENTS: Between 1991 and 2002, a total of 35 microstructured dental implants were inserted in 32 cleft patients. In 18 patients, vestibular scars extended to the rim of the marginal mucosa of the implants and the gingiva of the adjacent teeth. To enhance the soft tissue condition, mucogingival surgery was performed using palatal mucosal grafts. METHODS: In May 2002, 29 implants and 16 mucosal grafts were evaluated. Assessment included radiological and clinical parameters. RESULTS: Three implants were lost. Most mucosal grafts showed shrinkage of up to 30%. Clinical and radiological parameters, however, showed results that were very similar to those from non-cleft patients. CONCLUSION: These results support the hypothesis that keratinized mucosal grafts show long-term success in the cleft region as well. Moreover, it may be concluded that a combination of dental implants with a rough surface and palatal mucosal grafts can be recommended for oral rehabilitation of cleft patients.

Adolescent↗
PubMed2004

Efficacy of platelet-rich plasma in alveolar bone grafting.

PURPOSE: In this study, we performed alveolar bone grafting with autologous iliac cancellous bone incorporation with platelet-rich plasma (PRP) and evaluated its efficacy in osteoregeneration. MATERIALS AND METHODS: Seven alveolar cleft patients with adult dentition (average age, 16.1 years) underwent iliac bone grafting with PRP. Quantitative evaluation of regenerated bone was made with 3-dimensional computed tomography scans and compared with controls. RESULTS: The average of the volume ratio of regenerated bone to alveolar cleft in cases with PRP was higher than in controls (P <.05). There were no complications from the blood draw or PRP. CONCLUSION: PRP was a safe and cost-effective source for growth factors and was easy to extract. It could enhance the osteogenesis of alveolar bone grafting in cleft lip and palate patients and may useful for subsequent orthodontic therapy.

Adolescent↗
PubMed2004

A preliminary morphologic classification of the alveolar ridge after distraction osteogenesis.

PURPOSE: We sought to develop and evaluate a preliminary morphologic classification of the alveolar ridge after distraction osteogenesis. MATERIALS AND METHODS: Twelve patients (7 women and 5 men; mean age, 42.6 years; age range, 30 to 57 years) underwent a total of 17 alveolar ridge distractions before the placement of a total of 44 dental implants. Ridge bone morphology was evaluated and categorized at implant placement, with subsequent evaluation of the frequency and type of complications in each category. RESULTS: Four morphologic categories were identified, as follows. Category I consisted of wide alveolar rim and no bone defects; 7 (41.2%) of the 17 ridges were assigned to this category, and a total of 22 implants were placed with no complications. Category II consisted of wide alveolar rim, lateral bone surface concavity; 4 (24%) of the 17 ridges were assigned to this category, and a total of 8 implants were placed, with fenestration defects being the most frequent complication (2 of 8 implants [25%]). Category III consisted of narrow alveolar rim, lateral bone surface concavity; 5 (29.4%) of the 17 ridges were assigned to this category, and a total of 13 implants were placed, with dehiscence defects being the most frequent complication (4 of 13 implants [31%]). Category IV consisted of distraction transport segment forming a bridge, without bone formed beneath, necessitating guided bone regeneration; 1 (6%) of the 17 ridges was assigned to this category, and following bone regeneration 1 implant was placed, without complications. Subcategory D consisted of lingual deviation of the distraction axis, occurring in any of categories I to IV, and when severe requiring corrective osteotomy to free and reposition the transport segment and neoformed bone; 4 (24%) of the 17 ridges were assigned to this subcategory (ie, to subcategory ID, IID, IIID, or IVD); in 1 case, the deviation was severe, requiring corrective osteotomy; in this case 3 implants were placed, without complications. CONCLUSION: This preliminary morphologic classification of the postdistraction alveolar ridge effectively categorizes the variation observed in our patients and in our experience provides a useful basis for decision-making regarding implant placement. However, further studies are required to confirm the generality of this classification and incidences of complications in each category.

Adult↗
PubMed2004

Horizontal ridge augmentation using human mineralized particulate bone: preliminary results.

PURPOSE: We evaluated the hypothesis that particulate human mineralized bone can be used to augment the thin mandibular ridge followed by implant placement 4 months after augmentation. The thin ridge prevents implant placement without grafting. PATIENTS AND METHODS: Eleven consecutive patients with thin posterior mandibular ridges had approximately 1 cc of particulate human mineralized bone placed through a tunneling approach to augment the ridge width. Thirty-five implants were placed into 13 ridges after graft consolidation, with 1 implant failure. RESULTS: All grafted ridges were able to have at least a 3.25 mm diameter implant placed. One implant failed to integrate. One-year follow-up indicates stability of the augmentation. CONCLUSION: This preliminary report indicates the potential for this technique to substitute for more invasive procedures.

Alveolar Ridge Augmentation↗
PubMed2004

Distraction osteogenesis of the nasal and antral osseous floor to enhance alveolar height.

PURPOSE: The purpose of the study was to obtain information on the possibility of using distraction osteogenesis (DO) to increase the height of posterior atrophic maxillary alveolar ridges by distracting very small alveolar crest bone segments and, secondly, to determine if it is possible to distract the bony antral floor itself, producing new bone between the sinus membrane and the alveolar crest. MATERIALS AND METHODS: Three adult Papio anubis baboons were rendered edentulous in the posterior maxilla. Bilateral osteotomies were performed to produce a thin margin of crestal alveolar bone and in one area, a complete exposure of the antral floor. Distractors were placed against the antral and nasal floors and the thin 1- x 1.5-mm thick alveolar bone crest was distracted 10 mm over a period of 10 days. Animals were labeled with tetracycline at 3 and 4 months and were sacrificed at 5 months. RESULTS: A complete osseous regeneration of the nasal floor and alveolar ridge greater than 10 mm in height was produced in all cases. Histomorphometric analysis of the DO-induced osseous areas revealed cancellous bone with increasing thickness during the third and fourth month and formation of new bone cortices increasing in thickness during the same time. Significant new bone also formed in the antral floor areas that had been purposely interdicted by the osteotomies. CONCLUSION: The results of this study indicate that very small segments of bone of the posterior maxilla can be distracted to produce significant increases in the alveolar bone height and that a new osseous nasal-antral floor enhancement can be produced by this technique.

Alveolar Ridge Augmentation↗
PubMed2004

The "FAD" (Floating Alveolar Device): a bidirectional distraction system for distraction osteogenesis of the alveolar process.

PURPOSE: The following study illustrates preoperative and perioperative vector management in alveolar distraction using a new distraction system--the "Floating Alveolar Device" (FAD). The FAD is a bidirectional alveolar distractor that allows augmentation of an atrophic alveolar process in several planes, assures easy intraoperative positioning of the planned vector of distraction, and provides correction of the horizontal position of the transported segment during and after vertical distraction. PATIENTS AND METHODS: The FAD is composed entirely of stainless steel and has the following basic components: an upper member, a distraction rod, a lower base plate supporting the vertical force of the distraction rod, a jointed hinge that connects the upper and the lower members, and a tightening rod that provides blocking of the hinge. The clinician can manipulate and adjust the tightening rods, allowing a change in the angle of the hinge, thereby altering the transverse dimension of the vector of distraction. A total of 4 patients aged to 19 to 40 years underwent bidirectional alveolar distraction. All procedures were performed in the mandible. RESULTS: In all treated patients, planned distraction height and direction were achieved. In all cases it was possible to place implants at the planned time. CONCLUSIONS: The most common complication, axial displacement, is easily eliminated by moving the bone with the "floating" rod of the FAD during or immediately after the distraction period, according to the principles of the floating bone concept.

Adult↗
PubMed2004

Strategies for management of single-tooth extraction sites in aesthetic implant therapy.

Achieving predictable aesthetic outcomes following the planned removal of a natural tooth suffering from structural, endodontic, or periodontal compromise depends on a multitude of factors that, once identified, guide the implant team in selecting the surgical and prosthetic treatment options best suited for the individual clinical scenario. This article presents pertinent information regarding systematic patient evaluation and special treatment planning considerations for patients facing the loss of a single tooth in an area of high aesthetic importance. The rationale for and details of performing the Bio-Col site preservation technique at the time of tooth removal; guidelines for immediate versus delayed implant placement; selection and sequencing of site-development procedures according to the types of alveolar ridge defects encountered following tooth removal despite the use of site preservation; and a description of prosthetic techniques necessary for the successful management of single-tooth extraction sites in areas of aesthetic concern also are reviewed.

Alveolar Process↗
PubMed2004

Horizontal alveolar distraction: a surgical technique with the transport segment pedicled to the mucoperiosteum.

PURPOSE: The study goal was to describe a surgical technique for performing horizontal alveolar distraction with the aim of increasing the width of alveolar ridges that are too narrow for dental implant placement. MATERIALS AND METHODS: A transport segment is cut from the vestibular side of the ridge, using osteotomes, and maintaining extensive attachment to the mucoperiosteum. The distraction screw is placed through the vestibular mucosa and the transport segment, in vestibular-palatal direction. Distraction is then performed to increase ridge width. RESULTS: We successfully applied this technique in a patient who required 2 dental implants at adjacent sites in the upper jaw but whose alveolar ridge was too narrow for direct implantation. With horizontal distraction, ridge width was successfully increased, allowing placement of the 2 implants (diameter, 3.3 and 4.1 mm). CONCLUSION: This technique shows promise for patients requiring implants in a narrow alveolar ridge. Depending on each patients specific requirements, we suggest that it be taken into account as a possible alternative to existing techniques.

Adult↗
PubMed2004

Horizontal alveolar distraction of the narrow maxillary ridge for implant placement.

PURPOSE: The purpose of this report was to describe a surgical technique for performing horizontal alveolar distraction of the knife-edge maxillary ridge. PATIENT AND METHODS: The patient was a 17-year-old woman with atrophy of the alveolar rim in the anterior upper jaw, which had inadequate width for implant placement. The transport segment was constructed by the osteotomy of the labial cortex of the alveolus. A transport plate of a distractor (LEAD system; Stryker Leibinger, Kalamazoo, MI) was placed on the transport segment. The distraction rod was inserted horizontally, and put in contact with the palatal cortex at the top. A base plate was not placed. RESULTS: The alveolar distraction was successfully performed to gain 6.0 mm in width and 0.5 mm in height, allowing placement of three 14-mm implants. All the implants were integrated so as to support the prosthesis. CONCLUSIONS: Alveolar distraction can be useful for augmenting the narrow ridge horizontally and placement of implants.

Adolescent↗