Late reconstruction of orbital and naso-orbital deformities.

Acute orbital fractures and naso-orbital ethmoid fractures can result in chronic orbital and naso-orbital deformities. Understanding the acute injury is the first step in reconstructing the established late deformity. The best management strategy for reconstruction of orbital hypertelorism is to avoid late complications by repairing these deformities early near the time of the original fractures. New technologies from computer-guided surgical planning and additive manufacturing technology produce passive fitting implants tailored for patient-specific needs.

Outcome of treatment of implant-retained overdenture in patients with extreme mandibular bone resorption treated with bone grafts using a modified tent pole technique.

PURPOSE: To evaluate the outcome (prosthetic maintenance, survival of implants, patient satisfaction, and quality of life) of prosthetic treatment using an implant-retained overdenture and a modified tent pole procedure for severe mandibular resorption. MATERIAL AND METHODS: Seventeen edentulous patients (mean age, 68 yr; range, 54 to 77 yr) with severely resorbed mandibles were treated with autogenous bone grafts using a modified tent pole technique and implant overdentures. A bar was used to splint the implants and the final prostheses with implant connection were completed approximately 7 months after surgery. The mean follow-up time was 5 years (1.5 to 7.4 yr). Patients filled out the Oral Health Impact Profile-14 questionnaire concerning their oral health-related quality of life, and then panoramic radiographs were taken during clinical examination. RESULTS: The stability of the overdenture was good in 58.8% of cases and retention was good in 64.7%. The most usual prosthetic complication was loosening of the attachment component, which occurred in 7 cases (41.2%). The amount of plaque and bleeding was more remarkable on the lingual surface of the implants and less remarkable on the buccal surface. Pocket depth around the implants seemed to correspond to intraoral implantation. The radiographs depicted excellent grafted bone survival. The patients' oral health-related quality of life was found to be good after treatment. CONCLUSIONS: Implant placement with bone grafting using a modified tent pole technique enables the achievement of a good prosthetic solution and the rehabilitation of occlusion, thereby improving the functionality of the prostheses and quality of life.

Tent-pole approach to treat severely atrophic fractured mandibles using immediate or delayed protocols: preliminary case series.

PURPOSE: To investigate the outcomes of patients with severely resorbed fractured mandibles who were managed with a modified tent-pole procedure. PATIENTS AND METHODS: Four edentulous patients (2 male and 2 female; mean age, 59.5 years; range, 52 to 64 years) with a severely atrophic fractured mandible and less than 10 mm of vertical height of the body of the mandible were treated with an immediate or a delayed protocol (n=2 in each group). In the immediate group, a transcutaneous submental approach was used to provide open reduction with rigid fixation, immediate dental implant placement in the anterior mandible, and an autogenous particulate iliac bone grafting harvested from the posterior iliac crest. In the delayed protocol group, the fractures were treated with an open reduction and rigid fixation. Six months after fracture treatment, the fixation hardware was removed and a tent-pole approach was used to place the dental implants to the anterior mandible with an autogenous bone graft harvested from the posterior iliac crest. Implant fixtures were loaded at 3 months as the patients were fitted with healing caps, and the dental implants were loaded using provisional screw-retained acrylic resin prostheses and bar-retained overdentures afterward. The mean follow-up was 19.8 months (range, 13 to 28 months). RESULTS: The postoperative course and healing of the 4 patients was uneventful, without any fracture nonunion. The average alveolar augmentation±standard deviation was 7.5±1.17 mm (range, 6.6 to 9.0 mm). There was no bone resorption around any of the endosseous implants on follow-up. All 4 patients wore their dental implant-supported prosthesis comfortably. CONCLUSIONS: This preliminary evidence indicates that the modified tent-pole technique may be a safe and effective method to manage the fractured severely resorbed mandible using an immediate or a delayed protocol. Much larger-scale prospective evidence is required to further validate this observation.

Long-term follow-up of severely resorbed mandibles reconstructed using tent pole technique without platelet-rich plasma.

PURPOSE: To investigate the results of edentulous patients with severely resorbed mandibles who were treated with a modified tent pole procedure. PATIENTS AND METHODS: Twenty-two edentulous patients (3 men, 19 women; mean age, 62 yr; range, 51 to 72 yr) with a history of conservative prosthodontic treatment failures were included this study. Using a transcutaneous submental approach, 4 endosseous dental implants were placed in the anterior mandible of each patient and covered with autogenous bone grafts harvested from the posterior iliac crest without the addition of platelet-rich plasma. Follow-up ranged from 3 to 9 years. RESULTS: The postoperative course of the patients was uneventful, without any surgical infections. At 3 months postoperatively, the density of the grafted bone appeared to closely resemble that of the surrounding alveolar bone on panoramic radiographs. The average alveolar augmentation was 6.3 mm (standard deviation, 1.59 mm; range, 4 to 10 mm) and long-term follow-up showed no bone resorption around the endosseous implants. CONCLUSIONS: The modified tent pole technique without the addition of platelet-rich plasma is a safe and effective method to reconstruct the severely resorbed mandible.

Performance of six bone collectors designed for dental implant surgery.

OBJECTIVES: The aim of this study was to perform an in vitro comparison of six bone collectors for harvesting of particulate bone. MATERIAL AND METHODS: Four commercially available bone collectors (Frios, Osseous Coagulum Trap, ACE Autografter, Bone Trap) and two custom-designed models were tested. Three different in vitro tests were performed to determine the harvesting capabilities of the collectors. In test I, a bovine mandible was drilled and the bone collectors were used to collect bone chips. The harvested bone volumes and dry weights were measured after harvesting. In test II, three dental implant sites were prepared in a bovine mandible. The bones from the implant osteotomies were collected, and bone volumes and dry weights were measured. In test III, 1 ml of bone chips was mixed with water, and suctioned through the bone collectors. The volumes of the bone chips retained were measured to determine the efficiency of each collector. RESULTS: The Osseous Coagulum Trap and the custom-made collectors were the most effective instruments in test I. The mean volumes ranged from 0.17 to 0.38 ml. In test II, the difference between the collectors was small and the bone volume ranged from 0.28 to 0.37 ml. In test III, the Bone Trap became blocked before the other collectors, and its bone procurement was therefore limited. CONCLUSION: Comparison of six different bone collectors in this in vitro study showed that all collectors are usable in clinical situations but their effectiveness varies.

Safety of zygomatic bone harvesting: a prospective study of 32 consecutive patients with simultaneous zygomatic bone grafting and 1-stage implant placement.

PURPOSE: The purpose of this prospective study was to evaluate the safety of zygomatic bone harvesting and to determine whether a particulated zygomatic bone graft can be used simultaneously with 1-stage dental implants to reconstruct resorbed edentulous alveolar ridges. MATERIALS AND METHODS: Altogether, 82 dental implants were placed in 32 patients. Particulated bone grafts harvested from the zygomatic process were used in 72 of the implant sites. The volume of bone harvested, intraoperative complications, morbidity, and complications on follow-up visits were recorded. Implant survival was examined prospectively. RESULTS: As a harvest site, the zygoma yielded enough bone to complete the reconstructions in each case. The average zygomatic bone graft volume was 0.90 mL (SD 0.30). Perforation of the maxillary sinus occurred at 11 zygomatic sites. None of these perforations led to postoperative problems. No paresthesias or other complications were noted during follow-up examinations. Mean duration of postoperative swelling was 4.5 days, and patients used pain medication for a mean duration of 4 days. After the mean follow-up period of 26.9 months postplacement, 80 of 82 implants were osseointegrated (survival rate 97.6%). DISCUSSION: [corrected] Zygomatic bone is an alternative donor site for bone harvesting with low morbidity. The bone graft yielded is sufficient for use in 2 to 3 implant sites. CONCLUSIONS: The zygoma was a safe intraoral bone harvesting donor site in this patient population. Further, the use of simultaneous particulated zygomatic bone grafts and 1-stage implant placement appears to be an effective procedure.

Management of a patient with an accessory maxilla and congenital facial fistula.

Although accessory jaws are a rare occurrence, the presence of such accessory tissue may cause some bothersome symptoms. This case report helps identify these unusual developmental lesions so that dentists can refer such patients for definitive care and management.

Preservation of ridge dimensions following grafting with coral granules of 48 post-traumatic and post-extraction dento-alveolar defects.

This prospective clinical analysis reports on the use of coral granules in alveolar ridge preservation procedures in a population of young, growing patients. The sample consisted of 21 patients, 12 females and 9 males, with a mean age of 13.6 years. These 21 patients had 48 dento-alveolar defects suitable for augmentation with coral granules, and were followed clinically and radiographically for 3-7 years after augmentation. There were two areas of augmentation: 17 defects in the anterior maxilla resulted from traumatic tooth loss, and 31 defects in the posterior maxilla and mandible resulted from the extraction of ankylosed retained primary molars with no permanent succedaneous teeth. Between 1-2 ml of coral granules were implanted into the alveolar bone defects left by the extraction of teeth in both the areas. This was in order to preserve the remaining edentulous ridge from further alveolar ridge resorption. The goal of the procedure was to preserve the alveolus so that in the future, a dental implant could be placed to replace the missing tooth, after jaw growth had stopped, without the need for a bone graft. The coral granules appeared to be totally replaced by the host bone on follow-up clinical and radiographic examinations. The two areas of the jaws behaved quite differently. In the anterior maxilla, where tooth loss was secondary to trauma, the coral granules restored the alveolar ridges temporarily. However, over the years of follow-up in this study, the coral granules failed to provide sufficient bone to support the placement of a dental implant without using a bone graft in 14 of the 17 defects or 82.4% of sites. In the posterior maxilla and mandible, where tooth loss was due to the elective removal of ankylosed primary molars, 29 of the 31 defects or 93.5% of sites were successful as they were able to support the placement of an osseo-integrated dental implant without the use of a bone graft. The alveolar sparing technique was more successful in maintaining an alveolar ridge sufficient for the placement of a dental implant without bone grafting in the posterior maxilla and mandible, where tooth loss was secondary to the elective removal of ankylosed deciduous molars than in the anterior maxilla, where tooth loss was secondary to trauma. Coral granules seem to be more suitable in the posterior maxilla and mandible where there were ankylosed deciduous teeth and congenitally absent permanent teeth than in the traumatized anterior maxilla. In successful sites, coral granules can spare the alveolus from residual ridge atrophy or resorption, obviating the need for a bone graft. This reduces patient morbidity, as a second surgical donor site is avoided because bone graft harvesting is made unnecessary.

Augmentation of the narrow traumatized anterior alveolar ridge to facilitate dental implant placement.

Traumatic tooth loss leads to alveolar resorption especially in sagittal direction. This can be due to avulsion of bone substance during the accident itself or due to resorption of the alveolar crest that takes place afterwards. Shortage of bone can prevent proper positioning of dental implants unless the volume of bone is increased before implantation. In the maxillary anterior area, this is also an esthetic problem. Several treatment modalities have been presented to augment the bone. This report reviews the latest literature on bone grafting, bone substitutes, guided bone regeneration, osteocompression and distraction which are potentially useful in the anterior maxilla. A special emphasis is paid to the versatility of using a crestal split osteotomy, by means of chisels and osteotomes to widen the narrow ridge. Three examples are illustrated showing onlay grafting, preservation of alveolar width with alloplastic coral material and lateral widening of a narrow maxillary alveolar ridge, using the crestal splitting technique.

Zygomatic bone: an additional donor site for alveolar bone reconstruction. Technical note.

This article describes a procedure to harvest bone from the zygoma for alveolar bone reconstruction. A detailed description of the bone harvesting procedure and a preliminary report of 3 patients undergoing alveolar bone reconstruction and simultaneous dental implant placement in the maxillary anterior area is presented. The technique is indicated when a modest amount of bone is needed, for example, to cover exposed implant threads and expand a narrow alveolar ridge. It also could be used as an additional source of bone with other intraoral donor sites. Surgical access to the zygoma is simple and can be performed using local anesthesia. Postoperative complications after zygomatic bone harvest are minimal.

Fracture of glenoid fossa and traumatic dislocation of mandibular condyle into middle cranial fossa.

Traumatic mandibular condyle dislocations into the middle cranial fossa are rare. Thirty-three cases of middle cranial fossa injuries caused by condylar dislocations have been reported in the literature. A case report of a patient with a traumatic dislocated condyle into the middle cranial fossa, which was treated conservatively, is presented.

Management of traumatic dislocation of the mandibular condyle into the middle cranial fossa.

Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of facial trauma that can have neurological and life-threatening implications. This article discusses the anatomic features that predispose patients to this type of injury, as well as the clinical features and mechanism of injury for this rare type of condylar deformity, to help practitioners recognize this easily overlooked injury and avoid disastrous complications. The article summarizes previously published case reports of this rare complication of condylar trauma and presents a case for which initial diagnosis and a management protocol are described.