Use of sequential bone scintigraphy for monitoring onlay grafts to grossly atrophic jaws.

OBJECTIVES: To evaluate the capability of sequential bone scintigraphy for assessing the viability of avascular onlay grafts in combination with primary or secondary implant placement. METHODS: Forty-six patients with severe alveolar ridge atrophy received full-arch onlay grafts from the iliac crest. Twenty patients received primary insertion of endosseous implants, while secondary implant placement was performed in 26 patients after an average interval of 95 days. In cases of primary implant placement, bone scintigraphy was performed after grafting and before abutment connection. In patients with secondary insertion, bone scans were performed after grafting, before and after implant placement and before abutment connection. For bone scintigraphy, 8 MBq 99mTc-MDP/kg body weight were administered intravenously and anterior views of the skull were obtained 3 h later. Regions of interest were drawn over the grafted area and over the calvarium as a reference area. Ratios of count densities between jaw and calvarium were calculated as a measure of tracer uptake. RESULTS: Bone grafts with primary insertion of implants showed a significant decrease (P = 0.0001) in ratios calculated for the whole graft from a mean of 3.53 after grafting to 2.35 before abutment connection. In cases of secondary implant placement, ratios decreased significantly after grafting from 4.04 to 2.78 before implant placement (P = 0.0001). After implant placement, there was a significant increase to 3.28 (P = 0.0062), which was followed again by a significant decrease to a mean ratio of 2.58 (P = 0.0437). CONCLUSIONS: Sequential bone scintigrams can provide information about the viability of the graft at the time of implant insertion and may thus indicate the ability of the grafted bone to accomplish osseointegration.

[Growth disorders following fractures of the midface in children]. / Wachstumsstörungen nach Frakturen des Mittelgesichtes im Kindesalter.

12 patients who had suffered mid face fractures during their childhood were examined for skeletal deformities of the facial skull. The cephalometric data showed that neither the position nor the inclination of the maxilla were significantly different from normal anatomy. No correlation was found between the age, the severity of injuries and surgical treatment and resulting deformities.

[Pain as an indication for functional TMJ surgery]. / Der Schmerz als Indikation fur die funktionelle Kiefergelenkchirurgie.

In 113 patients presenting with painful impediment of jaw function, which did not respond to non-surgical treatment, several kinds of functional surgery of the temporomandibular joint were applied. Comparison of the pre- and postoperative pain profiles of these patients show that good results from the surgery methods used could generally be expected when the patient, preoperatively, had pain restricted to the TMJ area with function. More unfavorable results were shown in patients with pain already present for years, muscular or bilateral pain as well as pain not related to function or pain at night. Continuous pain should only be seen as an indication for surgery with rheumatoid arthritis of the TMJ.

[Selection of the approach to the TMJ under esthetic aspects]. / Zur Wahl des Zugangsweges zum Kiefergelenk aus ästhetischer Sicht.

The esthetic results of 128 TMJ surgeries are reported. 81 TMJs were treated via the preauricular, 47 via the retroauricular approach. The preauricular approach with a curved or modified line of incision is characterized by an almost unnoticeable scar, particularly if the incision is placed into a preauricular crease or pit. Leaving the scar in an invisible area, the retroauricular approach is esthetically superior to all other procedures. Both approaches involve a minimum risk for complications, if the correct technique avoiding traumatization of the marginal branch of the facial nerve is used. Considerations related to the choice of the different approaches are discussed with respect to their characteristic features.