Esthetic and functional rehabilitation in patients with cleft lip and palate.

Oral rehabilitation of missing teeth in cleft patients has acceptable success rates. A two-stage approach is indicated; however, timing of implant placement in the grafted maxilla varies within existing protocols. This case highlights successful implant osseointegration and esthetic oral rehabilitation following placement of two implants at 5 months after maxillary grafting (alveolar bone grafting) with a corticocancellous block obtained from the iliac crest. A 31-year-old male patient had already undergone repair of his bilateral cleft lip and soft palate according to established guidelines for cleft patients. Initial closure of his alveolar clefts and further correction of the maxillary hypoplasia with a bi-maxillary osteotomy were completed in 2002. However, bone resorption due to infection in 2003 necessitated removal of all maxillary incisors. The patient was not satisfied with the removable partial denture provided. In 2007, he did undergo anterior maxillary augmentation under general anesthesia, and 5 months later two implants were placed. A 3-unit bridge did replace functional and esthetic demands. Postoperative recovery was uneventful, and overall bone loss, and oral health remain within standards 28 months following implant placement. Optimal outcome is achievable when replacing missing teeth in cleft patients when timing does not exceed approximately a 6-month interval from bone grafting to implant placement. This article demonstrates that overall esthetic and functional rehabilitation is feasible in cleft lip and palate patients. In this patient, overall oral treatment was achieved with an implant prosthesis.

Segmental maxillary distraction with a novel device for closure of a wide alveolar cleft.

Treatment of a wide alveolar cleft with initial application of segmental distraction osteogenesis is reported, in order to minimise cleft size prior to secondary alveolar bone grafting. The lesser maxillary segment was mobilised with osteotomy at Le Fort I level and, a novel distractor, facilitated horizontal movement of the dental/alveolar segment along the curvature of the maxillary dental arch. Following a latency period of 4 days distraction was applied for 7 days at a rate of 0.5 mm twice daily. Radiographic, ultrasonographic and clinical assessment revealed new bone and soft tissue formation 8 weeks after completion of the distraction phase. Overall the maxillary segment did move minimising the width of the cleft, which allowed successful closure with a secondary alveolar bone graft.

Nasal obstruction as the first symptom in a patient with a calcifying epithelial odontogenic tumour (CEOT).

UNLABELLED: Calcifying epithelial odontogenic tumour (CEOT), also known as Pindborg tumour, is a rare, benign odontogenic neoplasm. A case of an intra-osseous CEOT in the maxilla is presented in which unilateral nasal obstruction and progressive difficulty in breathing were the first clinical symptoms. Dental practitioners might be the first clinicians to come across such tumours, during investigation of missing or non-erupted maxillary teeth, ie canines, and they should be alerted by any unilateral nasal obstruction symptoms. Diagnostic features and treatment options of the tumour are discussed in relation to its histological typing. CLINICAL RELEVANCE: This manuscript highlights the importance of accurate clinical and radiographic investigation for the dental practitioner when assessing missing maxillary teeth.

Immediate functional loading of single-tooth TIO2 grit-blasted implant restorations: a controlled prospective study in a porcine model. Part I: Clinical outcome.

BACKGROUND: Although favorable integration occurs with immediately loaded implants, the relationship between implant outcome, levels of occlusion, and diet requires optimization. PURPOSE: Pertubating load on single implant restorations immediately after placement by a hard food diet will increase the strains at the bone-implant interface, increasing the risk for failure. MATERIALS AND METHODS: Forty-eight implants replaced the first and third mandibular premolars in 12 pigs, allocated into two groups based on soft- and hard-diet feeding. Cylindrical and tapered implants replaced the first and third premolars, respectively. Each animal received at random four different masticatory loading conditions (group 1 control]: implant with either a cover screw or a healing abutment, and group 2 test]: implant with a crown either with or without occlusal contacts). RESULTS: Thirteen implants out of 44 failed in 11 animals (one with a cover screw, one with a healing abutment, three with nonocclusal, and eight with occlusal restorations). The failure rate of restored implants (either in occlusion or not) was significantly higher in the third premolar sites (p=.007), although diet had no significant effect (p=.421). CONCLUSIONS: While diet had no effect on the failure pattern of immediately loaded single implants, the position and type of load under the masticatory mode were significant. Immediately loaded implants both in and out of occlusion were less successful than the controls, and this is probably attributed to detrimental strain induced on the bone-implant interface.

Immediate functional loading of single-tooth TiO2 grit-blasted implant restoration. A controlled prospective study in a porcine model. Part II: Histology and histomorphometry.

BACKGROUND: Evidently, there is a fast-moving shift from delayed to immediate implant loading. The hypothesis to be tested was that bone reactions adjacent to single TiO2-microthreaded implants exposed to immediate masticatory loading for 10 weeks after placement would modulate osseointegration. MATERIALS AND METHODS: Cylindrical- and tapered-designed implants (Astra Tech AB, Mölndal, Sweden) replaced first and third mandibular premolars respectively in 12 pigs. The animals were allocated into two groups based on soft and hard diet feeding. Each animal received, at random positions, four different masticatory loading conditions: implant with either (1) a cover screw only, (2) a healing abutment, (3) an implant with a crown without occlusal contact, or (4) an implant with a crown in contact with the antagonistic teeth. RESULTS: Histomorphometry showed that there were no statistically significant differences in bone-implant contact (BIC), bone mass inside/outside of the threads and soft tissue ingrowth ratio for all the implants at 10 weeks after placement irrespective of masticatory loading condition. Bone loss showed a trend of progressive increase for implants with a healing abutment toward implants with occlusal contact. CONCLUSIONS: The results of this study rejected the hypothesis and could be explained by the fact that grit-blasted acid-etched implants were already placed in dense bone.