Reconstruction of mandibular vertical defects for dental implants with autogenous bone block grafts using a tunnel approach: clinical study of 50 cases.

The objective of this study was to evaluate the outcomes of mandibular vertical defect reconstruction with autologous bone and the use of a sub-periosteal tunnel approach in preparation for dental implant insertion. Forty-three consecutive patients with an atrophic posterior mandible were reconstructed using this method. Two thin laminae of cortical bone, obtained by splitting blocks harvested from the retromolar area, were fixed in a box-like framework containing cancellous and particulate bone. The goal was to achieve an alveolar ridge width of ≥5.5mm and an effective bone height (EBH) of ≥10.5mm for dental implant insertion (≥3.4mm diameter, ≥9.5mm length). Fifty reconstruction procedures were performed. The mean EBH was 7.1±1.3mm pre-treatment and 12.3±1.1mm post-treatment (mean increase 5.2±1.4mm). Complete graft loss was recorded in two cases; the remaining complications were minor. After a mean consolidation period of 3.5 months, 96 dental implants were placed. No failure of osseointegration was observed at follow-up (mean 32.9 months). The average bone height reduction was 0.9mm (graft vertical resorption 17.4%). Reconstruction of posterior mandibular vertical defects using two autogenous cortical bone blocks with particulate bone between them, combined with a tunnelling technique, provided good healing with no wound dehiscence and minimum resorption of the grafted bone, favouring a substantial vertical bone gain.

Hospital dental practice in special patients.

Dental patients with special needs are people with different systemic diseases, multiple disorders or severe physical and/or mental disabilities. A Medline search was made, yielding a total of 29 articles that served as the basis for this study, which offers a brief description of the dental intervention protocols in medically compromised patients. Dental treatment in patients with special needs, whether presenting medical problems or disabilities, is sometimes complex. For this reason the hospital should be regarded as the ideal setting for the care of these individuals. Before starting any dental intervention, a correct patient evaluation is needed, based on a correct anamnesis, medical records and interconsultation reports, and with due assessment of the medical risks involved. The hospital setting offers the advantage of access to electronic medical records and to data referred to any complementary tests that may have been made, and we moreover have the possibility of performing treatments under general anesthesia. In this context, ambulatory major surgery is the best approach when considering general anesthesia in patients of this kind.

[Osseous orbitotomies using a coronal flap: a retrospective study of 87 intraorbital lesions]. / Orbitotomías óseas mediante abordaje coronal: estudio retrospectivo de 87 lesiones intraorbitarias.

OBJECTIVE: To present our experience in 80 patients with intraorbital tumours and lesions who underwent 87 osseous orbitotomies with coronal incision during a 12 year period. MATERIAL, METHODS AND RESULTS: Hemangioma was the most frequent histologic diagnosis, being the intraconical retrobulbar compartment the most common location. Bilateral presentation of lesions occurred in 7 patients. Lateral and supero-lateral orbitotomies were preferably applied (87.35%). In 90.80% of cases some kind of osteosynthesis was employed, 51.75% with bio-resorbable plates. Intraoperative exposure or dura mater breakage occurred in 10 patients. 45 transitory and 21 permanent postoperative complications were seen, being the nervous ones (diplopia and ptosis) the most frequent. Most of these were spontaneously solved in a short time period. 15 patients required multi-disciplinary collaboration with neurosurgery. CONCLUSIONS: Coronal incision allows any bone orbitotomy, with security, guarantee and good aesthetic and functional results. Lateral and supero-lateral orbitotomies provide an ideal extradural approach to the retrobulbar compartment. An approach to the apex, orbital channel and medial compartment to the optic nerve, usually requires a combined neurosurgical approach through anterior cranial fossa. Orbitotomy fixation with bio-resorbable ostheosynthesis is an alternative to titanium plates. They can even be a first choice in paediatric age. The morbidity of this surgical technique is low.

Orbitotomías óseas mediante abordaje coronal: estudio retrospectivo de 87 lesiones intraorbitarias / Osseous orbitotomies using a coronal flap: A retrospective study of 87 intraorbital lesions

Objetivo. Presentar nuestra experiencia en 80 pacientes con tumores y lesiones intraorbitarias en los que se realizaron 87 orbitotomías óseas mediante abordaje coronal, durante un período de 12 años. Material, métodos y resultados. El diagnóstico histológico más frecuente fue el hemangioma, y la localización anatómica más frecuente la retrobulbar intracónica. La presentación bilateral de lesiones ocurrió en 7 pacientes. Las orbitotomías más utilizadas fueron la lateral y supero-lateral (87,35%). En un 90,80% de los casos se realizó algún tipo de osteosíntesis, un 51,75% con placas bio-reabsorbibles. La exposición o rotura de la duramadre intraoperatoria ocurrió en 10 pacientes. Se recogieron 45 complicaciones postoperatorias transitorias y 21 permanentes, las más frecuentes fueron las nerviosas (diplopia y ptosis) que se resolvieron espontáneamente en su mayoría en un corto intervalo de tiempo. En 15 pacientes se requirió colaboración multidisciplinar con neurocirugía.Conclusiones. La incisión coronal permite realizarcualquier orbitotomía ósea con seguridad, garantía ybuen resultado estético y funcional. Las orbitotomíaslateral y supero-lateral proporcionan un abordaje idealextradural al espacio retrobulbar. El acceso al ápex,canal orbitario y zona medial nervio óptico requierecomúnmente un abordaje combinado neuroquirúrgicoa través de fosa craneal anterior. La fijación de las orbitotomías mediante osteosíntesis biorreabsorbible constituye una alternativa a las placas de titanio, incluso puede ser de primera elección en la edad pediátrica. La morbilidad de esta cirugía es baja

Objective. To present our experience in 80 patients with intraorbital tumours and lesions who underwent87 osseous orbitotomies with coronal incision during a12 year period.Material, methods and results. Hemangioma wasthe most frequent histologic diagnosis, being the intraconical retrobulbar compartment the most commonlocation. Bilateral presentation of lesions occurred in 7patients. Lateral and supero-lateral orbitotomies werepreferably applied (87.35%). In 90.80% of cases somekind of osteosynthesis was employed, 51.75% withbio-resorbable plates. Intraoperative exposure or duramater breakage occurred in 10 patients. 45 transitoryand 21 permanent postoperative complications wereseen, being the nervous ones (diplopia and ptosis) themost frequent. Most of these were spontaneously solvedin a short time period. 15 patients required multi-disciplinary collaboration with neurosurgery.Conclusions. Coronal incision allows any bone orbitotomy,with security, guarantee and good aesthetic andfunctional results. Lateral and supero-lateral orbitotomies provide an ideal extradural approach to the retrobulbar compartment. An approach to the apex, orbitalchannel and medial compartment to the optic nerve,usually requires a combined neurosurgical approachthrough anterior cranial fossa. Orbitotomy fixationwith bio-resorbable ostheosynthesis is an alternative totitanium plates. They can even be a first choice in paediatric age. The morbidity of this surgical technique is low

[Gingival hyperplasia associated with amlodipine]. / Hiperplasia gingival asociada a amlodipino.

Drug-induced gingival hyperplasia is a well documented unwanted side effect within the literature. It has been associated with the use of three different types of pharmaceutical agents, including phenytoin, cyclosporine and calcium channel blocking agents. Amlodipine belongs to the dihydropyridine-derived calcium blocking agents that may cause the side effect of drug-induced gingival hyperplasia. In the present study the possible pathogenic mechanisms, clinical and histologic presentation and therapeutic indications of amlodipine-induced gingival hyperplasia are discussed.

Mandibular fractures in children. A retrospective study of 99 fractures in 59 patients.

Fifty-nine children younger than 16 years with mandibular fractures were studied by age, sex, type of fracture, cause, methods of treatment, and complications. The cases were divided into three age groups. The male-to-female ratio was 2.9:1. Motor vehicle accidents were the most common cause of mandibular fractures. Associated injuries were more common in young children. The condyle was involved in 43.3% of fractures. Intermaxillary fixation was the most common treatment used. Complications appeared to be rare.