Calvarial Bone Grafting for Three-Dimensional Reconstruction of Severe Maxillary Defects: A Case Series.

PURPOSE: To evaluate the efficacy, associated morbidity, and results of a three-dimensional reconstruction technique for repairing severe defects of the maxilla using a calvarial autogenous bone graft and a soft tissue double-layered surgical approach in preparation for placing dental implants. MATERIALS AND METHODS: Bone defects of the maxilla consecutively reconstructed with calvarial autologous graft in the authors' institution were retrospectively evaluated. Patients with combined maxilla alveolar ridge defects with a width less than 4 mm and a height less than 7 mm (to the level of the maxillary sinus or the nostril), with at least three teeth involved, were included in the study. Calvarial bone blocks were sagittally sectioned in fine layers and fixed three-dimensionally in a boxlike structure with particulate bone inside. The purpose was to obtain an adequate amount of vertical and horizontal alveolar bone to enable restoration with dental implants at least 3.4 mm in diameter and 11 mm in length. RESULTS: Eleven reconstructive procedures were performed in 10 patients. Bone graft integration was successful in all of them. No major complications were observed in the donor cranial site. A mean bone gain of 5.04 mm (range, 3.4 to 7.8 mm) in height was obtained (standard deviation [SD], 1.69). The implant surgery was performed between the 15th and 19th weeks. A total of 28 implants were placed, and the mean follow-up time was 45 months (range, 23 to 65 months; SD, 12). The mean graft vertical resorption was 0.78 mm (range, 0.50-1.50 mm; SD, 0.00) 41 months after implant fixation. CONCLUSION: Three-dimensional reconstruction technique using calvarial bone grafts to restore severe segmental or crestal bone defects in the maxilla is an effective and predictable procedure that can increase the horizontal and vertical bone volume in preparation for the successful placement of dental implants.

Osteonecrosis maxilar asociada a bisfosfonatos e infección por Actinomyces / Bisphosphonate related osteonecrosis of the jaw and infection with Actinomyces

Fundamento y objetivo: La osteonecrosis maxilar asociada a bisfosfonatos (OMAB) ha centrado mucho interés desde su reciente descripción. Su patogenia aún no está aclarada; hasta hace poco tiempo se la consideraba una complicación no infecciosa, pero estudios recientes parecen implicar a bacterias del género Actinomyces. El objetivo del trabajo es analizar los casos de OMAB de nuestra institución. Pacientes y método: Revisión de historias clínicas de los pacientes con diagnóstico de OMAB en la consulta de Cirugía Maxilofacial de nuestro hospital. Resultados: Hemos encontrado 11 casos de OMAB: 4 mujeres en tratamiento con alendronato o risedronato oral por osteoporosis y 7 pacientes oncológicos en tratamiento con ácido zoledrónico intravenoso. En todos ellos se demostró invasión ósea por bacterias del género Actinomyces. En 9 casos se realizó tratamiento prolongado con amoxicilina con evolución clínica favorable en todos ellos, si bien 3 han fallecido por su neoplasia. Por el contrario, una paciente con alergia a betalactámicos y tratamiento irregular con eritromicina y tetraciclinas mantiene una evolución crónica de las lesiones. En otro paciente no hay información. Conclusiones: Actinomyces desempeña un papel importante en el desarrollo de OMAB y el tratamiento antibiótico específico mejora el pronóstico de este proceso(AU)

Background and objective: Bisphosphonate related osteonecrosis of the jaw (BRONJ) has raised considerable interest since its recent description. Its pathogenesis is not yet clarified; formerly it has been considered a non-infectious complication, but recent studies seem to implicate bacteria of the genus Actinomyces. The objective of this study is to analyze the cases of BRONJ in our institution. Patients and methods: Review of medical records of patients diagnosed of BRONJ in the Maxillofacial Surgery Unit of our hospital. Results: We have found 11 cases of BRONJ in our hospital: 4 women taking oral alendronate or risendronate for osteoporosis and 7 cancer patients treated with intravenous zolendronic acid. All of them showed bone invasion by bacteria of the genus Actinomyces. Nine patients underwent prolonged treatment with amoxicillin with favourable clinical outcome in all of them, but 3 died of their malignancy. By contrast, one patient with beta-lactamic allergy and irregular treatment with erythromycin and tetracycline had a chronic evolution of the lesions. There was no information for other patient. Conclusions: Actinomyces play an important role in the development of BRONJ and specific antibiotic treatment improves the prognosis of this process(AU)

[Bisphosphonate related osteonecrosis of the jaw and infection with Actinomyces]. / Osteonecrosis maxilar asociada a bisfosfonatos e infección por Actinomyces.

BACKGROUND AND OBJECTIVE: Bisphosphonate related osteonecrosis of the jaw (BRONJ) has raised considerable interest since its recent description. Its pathogenesis is not yet clarified; formerly it has been considered a non-infectious complication, but recent studies seem to implicate bacteria of the genus Actinomyces. The objective of this study is to analyze the cases of BRONJ in our institution. PATIENTS AND METHODS: Review of medical records of patients diagnosed of BRONJ in the Maxillofacial Surgery Unit of our hospital. RESULTS: We have found 11 cases of BRONJ in our hospital: 4 women taking oral alendronate or risendronate for osteoporosis and 7 cancer patients treated with intravenous zolendronic acid. All of them showed bone invasion by bacteria of the genus Actinomyces. Nine patients underwent prolonged treatment with amoxicillin with favourable clinical outcome in all of them, but 3 died of their malignancy. By contrast, one patient with beta-lactamic allergy and irregular treatment with erythromycin and tetracycline had a chronic evolution of the lesions. There was no information for other patient. CONCLUSIONS: Actinomyces play an important role in the development of BRONJ and specific antibiotic treatment improves the prognosis of this process.