Eugene E. Keller

Mayo clinic consensus statement for the use of bisphosphonates in multiple myeloma.

Bisphosphonates are effective in the prevention and treatment of bone disease in multiple myeloma (MM). Osteonecrosis of the jaw is Increasingly recognized as a serious complication of long-term bisphosphonate therapy. Issues such as the choice of bisphosphonate and duration of therapy have become the subject of intense debate given patient safety concerns. We reviewed available data concerning the use of bisphosphonates in MM. Guidelines for the use of bisphosphonates in MM were developed by a multidisciplinary panel consisting of hematologists, dental specialists, and nurses specializing in the treatment of MM. We conclude that intravenous pamidronate and intravenous zoledronic acid are equally effective and superior to placebo in reducing skeletal complications. Pamidronate is favored over zoledronic acid until more data are available on the risk of complications (osteonecrosis of the jaw). We recommend discontinuing bisphosphonates after 2 years of therapy for patients who achieve complete response and/or plateau phase. For patients whose disease is active, who have not achieved a response, or who have threatening bone disease beyond 2 years, therapy can be decreased to every 3 months. These guidelines were developed in the Interest of patient safety and will be reexamined as new data emerge regarding risks and benefits.

Maxillary antral and nasal one-stage inlay composite bone graft: Preliminary report on 30 recipient sites

A one-stage antral and nasal inlay composite bone grafting procedure is described. Preliminary statistical data (1 to 6 years experience with the procedure) is presented for 30 recipient sites in 20 patients. A complete bone-supported fixed prosthesis was used and has provided continuous function in all patients to date. Implant survival has approached that of implants placed in uncompromised maxillary or mandibular bone.

Implant reconstruction in the posterior mandible: A long-term retrospective study

STATEMENT OF PROBLEM Because there is a lack of long-term data, it is unclear whether the determinants of implant and prosthesis survival include the location, angle, design, or number of implants and use of prosthesis cantilevers. PURPOSE This retrospective study evaluated the long-term outcome, determinants of outcome, and the type and prevalence of prosthetic complications in a series of patients treated consecutively with Brånemark implants in the partially edentulous posterior mandible. MATERIAL AND METHODS A total of 392 consecutively placed Brånemark implants were inserted in 152 partially edentulous patients and restored with 56 single-tooth and 168 fixed partial dentures restorations. RESULTS The cumulative success rates of implants and prostheses were 89.0% +/- 0.03% and 81.9% +/- 0.03%, respectively, at 6 years, with no further decrease in success noted during the remainder of the 10-year study. Significantly fewer major complications were found in prostheses supported by one or more implants, located exclusively in premolar sites, versus prostheses supported by either molar implant(s) or both premolar and molar implants. In single-tooth restorations, fewer major complications were seen in the cemented restorations, compared with the screw retained. CONCLUSION The results were strongly influenced by the phase of experience.

Endosseous implants in an irradiated tissue bed

Endosseous implants have been placed at the Mayo Clinic Department of Dental Specialties for over 12 years. On the basis of the clinical success of the osseointegration program, the use of implants has been expanded to include placement into tissue beds that have been exposed to therapeutic radiation. This article details preliminary data regarding implant survival in the previously radiated tissue beds. Presurgical evaluation and surgical technique are described and postprosthetic reconstruction complications are also related. Consideration is given to the relatively small number of patients in this review. It is suggested that the results should be shared among multiple institutions to create a meaningful data bank.

Dental Implants: Tissue-Integrated Prosthesis Utilizing the Osseointegration Concept

As an alternative to conventional removable dentures, osseointegrated dental implants can now be used in carefully selected edentulous or partially edentulous patients. The implant consists of a dental prosthesis and an anchorage unit made up of screw-connected components. The implantation procedure is performed in two phases: fixture installation and fixture uncovering and abutment connection. After completion of these surgical procedures, the dental prosthesis is fabricated and inserted. Follow-up examinations are scheduled at 1, 3, and 6 months and then annually thereafter. During a 2-year period at the Mayo Clinic, 358 osseointegrated dental fixtures were implanted in 70 patients. The overall success rate in this consecutive series of patients was 98%, and the associated complications were minimal and easily resolved.

Reconstruction of mandibular discontinuity with autogenous iliac bone graft: Report of 34 consecutive patients

This article reviews 34 consecutive reconstructions of mandibular discontinuity defects done between 1972 and 1988. All reconstructions were performed secondarily with use of free iliac crest bone grafting. The technique is described, three cases are presented in detail, and results for the entire series are tabulated. These results show a 100% graft incorporation rate along with low overall morbidity.

Quadrangular Le Fort I osteotomy: surgical technique and review of 54 patients:

Technical aspects and indications for the quadrangular Le Fort I osteotomy are described. The records of 54 consecutive patients who underwent this procedure for primary correction are reviewed in general terms, and those of 3 patients with significant follow-up are presented in some detail. The procedure gave predictable results, provided acceptable midfacial aesthetic improvement, and was surgically reproducible with few complications. Low surgical and postoperative morbidity was documented. This procedure was used in a similar patient population as the quadrangular Le Fort II osteotomy, and the rationale for choosing between these two procedures is discussed.

Intraoral quadrangular Le Fort II osteotomy

The technical aspects of the intraoral quadrangular Le Fort II osteotomy are described, and the anesthetic technique, blood loss, operating time, intraoperative and postoperative complications, length of hospitalization, and length of fixation in seven cases are reported. This procedure was predictable and reproducible with few complications, had low surgical and postsurgical morbidity, exhibited excellent initial skeletal stability, provided esthetics superior to those achieved with lower osteotomy and onlay bone grafting techniques, and demonstrated versatility within limits.

Surgical management of primary chronic osteomyelitis: a long-term retrospective analysis.

PURPOSE The purpose of this study is to present an extensive review of primary chronic osteomyelitis (PCO) and present long-term treatment results in 4 patients. PATIENTS AND METHODS This is a retrospective case study analysis of 4 patients with documented PCO who were treated by a standardized surgical technique by 1 surgeon and were followed clinically and radiographically for a mean of 22 years. RESULTS Based on follow-up visits to date and correspondence to the surgeon who treated these patients, there have been no radiographic recurrences of PCO in 4 patients followed 5, 23, 26, and 34 years, respectively. Complete symptomatic relief has been achieved in 3 of 4 patients; the fourth patient exhibits persistent recurrent myofascial pain. CONCLUSION The surgical technique discussed herein provides a viable alternative in the range of potential treatment options for this uncommon disease of unknown etiology.

Craniofacial and Dental Manifestations of Proteus Syndrome: A Case Report

The Proteus syndrome is a rare congenital hamartomatous condition that is characterized by a wide range of malformations, sometimes involving the face. Common manifestations include partial gigantism, congenital lipomas, and plantar hyperplasia. In this report we describe the craniofacial clinicopathological development in a girl with Proteus syndrome from age 6 to 20 years. The patient had pronounced hemifacial hypertrophy, exostoses in the left parietal region, and enlargement of the inferior alveolar nerve and mandibular canal in the affected region. The dental development of the affected left mandible and maxilla was characterized by extremely premature development and eruption of the primary and permanent teeth and by pronounced idiopathic root resorptions. The multidisciplinary management of the patient and the treatment outcome is reported. A review of the Proteus patients in the literature who exhibited manifestation in the craniofacial region is presented.