Implant Rehabilitation for Extremely Atrophic Maxillae (Cawood Type VI) with Le Fort I Downgrafting and Autogenous Iliac Block Grafts: A 4-year Follow-up Study.

PURPOSE: The aim of this 4-year retrospective follow-up study was to investigate treatment outcomes, including implant survival rate and marginal bone loss, in patients with maxillary Cawood type VI atrophy pattern who underwent Le Fort I downgrafting and iliac block augmentations for implant rehabilitation. MATERIALS AND METHODS: Retrognathic edentulous Class III patients with severe maxillary resorption (Cawood VI) were enrolled. Reconstructive procedures performed included Le Fort I maxillary osteotomy, iliac block grafting, labial sulcoplasties, and dental implant placement. Panoramic radiographs were used to assess marginal bone loss. The Nobel Biocare Replace and GMI Frontier dental implant systems and fixed partial dentures were used for dental rehabilitation. Statistical analyses were made using NCSS 2007 statistical software, with significance set at P < .05. RESULTS: Ten patients (six men and four women) with a mean age of 50.4 ± 12.55 years underwent maxillary osteotomy (advancement: 9 ± 1.4 mm; inferior repositioning: 8 ± 1.0 mm) and iliac block sandwich grafting (posterior ilium: n = 3; anterior ilium: n = 7) from 2009 to 2015. Nine patients were treated with a two-stage protocol. The mean graft healing period was 5.9 ± 0.73 months. A total of 98 implants were placed, 80 in maxillae and 18 in mandibles. The Nobel Biocare Replace system was used in two patients (n = 29 implants) and GMI Frontier system was used in eight patients (n = 69 implants). Implant numbers in the maxilla were: 6 implants in 2 patients, 8 implants in 6 patients, and 10 implants in 2 patients. The mean follow-up period was 47.8 ± 3.4 months. The success rate was 93.75%, with a 6.25% fail ratio (n = 9 implants) at a follow-up of 4 years. Marginal bone resorption was 1.8 ± 1.0 mm at the postoperative year 1 and 3.75 ± 0.85 mm at postoperative year 4. Marginal resorption in the 8-implant group was found to be higher than that in the 6-implant group and 10-implant group at the postoperative year 1 (P = .045, P = .026, P < .05, respectively). CONCLUSION: Le Fort I osteotomy and simultaneous iliac block grafting (downgrafting) is a valuable option for implant rehabilitation in extremely atrophic maxillae (Cawood VI). It showed a high survival rate (93.75%) at 4 years of follow-up in this study.

Hyaluronic Acid Versus Ultrasonic Resorbable Pin Fixation for Space Maintenance in Non-Grafted Sinus Lifting.

PURPOSE: An ultrasonic resorbable pin (SonicWeld, KLS Martin, Mühlheim, Germany) was compared with hyaluronic acid (Hyaloss Matrix, Anika Therapeutics, Bedford, MA) for their ability to maintain space in non-grafted sinus lifting. MATERIALS AND METHODS: A comparative split-mouth study was designed and implemented. Six women and 4 men were included (mean age, 56.7 yr). The primary predictors hyaluronic acid (HA) application and ultrasonic resorbable pin fixation (URPF) were coded as binary variables. The primary outcome variables were height of alveolar bone (HAB) and reduction in sinus volume (RSV). Secondary outcomes were bone density and implant survival. RESULTS: The postoperative mean HAB was significantly higher than the preoperative mean HAB on the 2 sides (P < .05). Mean increases in HAB and RSV on the URPF side were significantly greater than those on the HA side (P < .05). In total, patients were treated with 40 implants. No type I bone quality was identified; 14 (35%) implants were inserted in type II bone, 22 (50%) in type III bone, and 6 (15%) in type IV bone. There was no statistically meaningful difference between the 2 sides for implant survival or bone quality. At 6 months, all implants were clinically stable and the definitive prostheses were functional, resulting in a survival rate of 100%. CONCLUSIONS: There was sufficient bone height to eventually place implants on the 2 sides in all patients. The 2 techniques yielded predictable outcomes in implant survival and bone quality. However, HAB and RSV were considerably greater on the URPF side.

Effect of submucosal application of tramadol on postoperative pain after third molar surgery.

The aim of this study was to evaluate the effectiveness of submucosal application of tramadol, for acute postoperative facial pain, following the extraction of impacted third molar teeth. This prospective, double-blind, randomised placebo-controlled study included 60 ASA I-II patients undergoing impacted third molar surgery under local anaesthesia. Following the surgical procedure, patients were randomly divided into two groups; group T (1 mg/kg tramadol) and group S (2-mL saline). Treatments were applied submucosally after surgery. Pain after extraction was evaluated using a visual analogue scale (VAS) 0.5, 1, 2, 4, 6, 12, 24, and 48 h postoperatively. The time at which the first analgesic drug was taken, the total analgesic dose used, and adverse tissue reactions were also evaluated. In group T, postoperative VAS scores were significantly lower compared to that in group S (p < 0.05). This study demonstrated that post-operative submucosal application of tramadol is an effective method for reducing acute post-operative facial pain after impacted third molar surgery.

Comparison of the Effects of Topical Ketamine and Tramadol on Postoperative Pain After Mandibular Molar Extraction.

PURPOSE: This study compared the analgesic efficacy of postoperative tramadol versus ketamine for preventing pain after mandibular molar extraction. PATIENTS AND METHODS: Ninety patients who had undergone molar extraction were randomly divided into 3 groups: group T (tramadol 1 mg/kg), group K (ketamine 0.5 mg/kg), and group P (saline 2 mL). The treatment was applied to the extraction sockets using resorbable gelatin sponges. Pain after extraction was evaluated using a visual analog scale (VAS) 0.5, 1, 2, 4, 6, 12, 24, and 48 hours postoperatively. RESULTS: The VAS scores after extraction were statistically higher in group P than in either treatment group. Group K had the lowest pain intensity. CONCLUSION: This study shows that topical tramadol and ketamine are effective alternatives for decreasing pain after molar extractions.

Does ultrasonic resorbable pin fixation offer predictable results for augmentation eminoplasty in recurrent dislocations?

PURPOSE: To assess the outcome of interpositional calvarial block grafting fixed with an ultrasonic resorbable system (SonicWeld, KLS Martin, Mühlheim, Germany) for augmentation eminoplasty in chronic recurrent condylar dislocations. PATIENTS AND METHODS: We designed and implemented a retrospective cohort study. Eight female patients (mean age 48 years) were treated. The primary predictor variable was time (preoperative vs postoperative). The primary outcome variable was cessation of dislocation. The secondary outcome variables were the height of the articular eminences (HAE), maximum interincisal opening, pain score (visual analog scale [VAS]), postoperative magnetic resonance imaging (MRI) findings, and facial nerve paralysis. RESULTS: All 8 patients had been experiencing recurrent dislocations a mean of 10 times each month preoperatively. None of the patients had experienced a dislocation at 2 years postoperatively. The preoperative mean HAE was 5.75 and the VAS score for pain was 72.5. The mean vertical HAE was 15.75 mm, and the mean VAS score for pain was 11.2 at 12 months postoperatively. Complete resorption of the SonicWeld pins was observed on the first year follow-up computed tomography scans. Of the 8 patients, 3 presented with disc displacement without reduction and 2 with disc displacement with reduction on the postoperative MRI scan, and none of the patients had a facial nerve deficit at 24 months of follow-up. CONCLUSIONS: Fixation of cortical calvarial grafts using the ultrasonic resorbable system for augmentation eminoplasty provided sufficient stabilization and favorable outcomes. Degradation of the osteosynthesis material and the absence of intermaxillary fixation were the most advantageous parts of the technique.