Treatment outcomes of implants performed after regenerative treatment of absorbed alveolar bone due to the severe periodontal disease and endoscopic surgery for maxillary sinus lift without bone grafts.

OBJECTIVE: We have developed a regenerative medicine therapy for the alveolar bone and endoscopic surgery for maxillary sinus lift without bone grafts, in patients experiencing severe periodontal disease with significant absorption of the maxillary alveolar bone, in which more than 10 mm of bone thickness in the maxillary bone was attained, with satisfactory results. The objective of this study was to examine the treatment outcomes of implants that were performed after these therapies. PARTICIPANTS AND METHODS: The participants were 36 patients with severe periodontal disease, who cannot be cured with any other treatments except the extirpation of all teeth. The 36 patients are all patients who underwent regenerative treatment of the alveolar bone through tooth replantation and transplantation of the iliac cancellous bone (the bone marrow) as well as endoscopic surgery for maxillary sinus lift from May 2003 to July 2007 in our clinic. A total of 120 implants were placed in these patients when the replanted teeth fell out because of root resorption, and the success rate was examined. RESULTS: The success rates of the implants were 16 of 33 (48%) in the group when surveyed less than 2 years after the surgery and 84 of 87 (96.5%) in the group when surveyed more than 2 years after the surgery. A statistically significant difference was found between the 2 groups (Chi-squared test, P < 0.001). CONCLUSIONS AND CONSIDERATIONS: It was believed that it takes approximately 2 years for the bones in the maxillary sinus floor, augmented through endoscopic surgery for maxillary sinus lift, to attain the thickness and hardness required for implant placement. Therefore, although the implant treatment should be performed later than 2 years after surgery, chewing is possible during this period, with the replanted teeth that were used for regenerative treatment of the alveolar bone. It is believed that this is an extremely effective treatment method to improve the patients' quality of life.

New regenerative treatment for tooth and periodontal bone defect associated with posttraumatic alveolar bone crush fracture.

We developed a new regenerative treatment of tooth and periodontal defect and tooth dislocation associated with posttraumatic alveolar bone crush fracture in the region of the maxillary anterior teeth. Using this method, dislocated teeth are first extracted and crushed alveolar bone is debrided. The dislocated teeth are then reimplanted, and cancellous iliac bone (bone marrow) is grafted to the area surrounding the teeth to regenerate periodontal bone. Tooth reimplantation was completely successful in 2 cases, and periodontal bone regenerated to a sufficient height with the iliac bone graft. Compared with the general method of treatment with a prosthesis (bridge), when using this method to treat cases such as these, there is no sacrifice of healthy teeth adjacent to the defect, and sufficient esthetic and functional recovery is possible. It is thought that this method could be applied as a new treatment of alveolar bone fracture in the future.

New regenerative surgical treatment of cystic diseases of the jaw by utilizing grafting of cancellous iliac bone and replanting of patient's teeth.

The authors developed a new regenerative surgical technique for cystic diseases of the jaw. In this surgery, all teeth that are rooted in or located adjacent to the cyst are extracted for replanting, and attached soft tissues, including cystic wall as well as dental pulp, are completely removed. Gingiva is cut open at the alveolar crest and abraded subperiosteally, the jaw on the cystic lesion is widely exposed, and cortical bone on the frontal wall of the cystic lesion is dissected. After the entire cyst is exposed, it is completely removed with scrapers and bars. The defect is reconstructed by the following procedures: the extracted and treated teeth are replanted; cancellous iliac bone (bone marrow) is grafted around the teeth and in the defect; and after thorough washing and making numerous small holes, the frontal wall of the cortical bone is returned to the original position and fixed. Three to 4 months later when the jaw has regenerated and the replanted teeth have taken, a prosthesis is set on the replanted teeth and biting is started. This technique was applied to a 16-year-old male patient who had odontogenic keratocysts on the lower right teeth (numbers 6, 5, 4, 3, 2, and 1), the lower left teeth (numbers 1, 2, 3, and 4), and the upper right teeth (numbers 5, 4, 3, and 2). The patient regained normal biting capability, and the esthetic outcome was also satisfactory. This technique would be a useful treatment method for cystic diseases of the jaw.

Regenerative treatment of serious periodontosis with grafting of cancellous iliac bone and gingival flaps and replanting of patients' teeth.

The purpose of this study was to assess the ability of serious periodontosis patients to regain satisfactory biting function, using the patients' own teeth, by regeneration of the alveolar bone. Twelve serious periodontosis patients whose alveolar bone was markedly absorbed and whose teeth were quite unstable were treated with replanting of their teeth and grafting of cancellous iliac bone and gingival flaps by the clinical team, which consisted of plastic surgeons and dentists. No patients developed postoperative complications (e.g., infections), and grafted iliac bone took in all patients. The total number of replanted teeth was 65, and only 4 of them fell off (92% take rate). Three to 4 months after surgery, the replanted teeth received prosthetic treatment so that the patients could begin biting. Ten patients were monitored for 5 months or longer, and they started to eat normal food after the fifth month. Regained biting function and satisfaction of having food were almost the same as before the periodontosis became severe in these 10 patients. Regeneration of alveolar bone was confirmed in later radiographs. To date, the maximum follow-up period is 2 years and 8 months (average = 1 year and 6 months). All patients have good biting function, and there have been no findings of absorption of reconstructed alveolar bone or of the root of replanted teeth. This treatment method would be quite useful for patients with serious periodontosis.