Gunnar Persson

A follow-up study of apicoectomized teeth with total loss of the buccal bone plate

Opinions differ as to whether or not teeth with advanced marginal bone loss should be subjected to periapical surgery. The purpose of this retrospective investigation was to study the results after apicoectomy on teeth that showed total buccal bone loss at the time of the operation. The material consisted of twenty-seven teeth in 27 patients, fifteen males and twelve females, 23 to 63 years old at the time of the operation. The observation time varied from 0.5 to 7 years (mean, 3 years). Ten operations (37%) were regarded as successful, nine (33%) as uncertain, and eight (30%) as unsuccessful. The success rate was not so low that an apicomarginal communication should be regarded as a contraindication for apicoectomy. Apicoectomy should be performed, especially if the alternative is an otherwise unnecessary prosthetic reconstruction.

Retrograde root filling with amalgam and Cavit.

In a 3-year review of 218 teeth with retrograde root filling with amalgam orCavit, the results obtained with the former proved significantly better than those obtained with the latter. The difference seemed to be due to a better obliteration of the canal by amalgam. The obliterating effect of amalgam probably eliminates the need for revision of incomplete othograde root filling, for example, in cases with a post in the root canal. Irrespective of type of filling materials, the results were less good in cases with marginal bone loss.

Idiopathic bone cavities: A report of four cases

Abstract Four new cases of the so-called idiopathic bone cavity in the mandible have been reported. Each case was treated surgically, and the contents of the cavities were examined histologically in all cases with different results. In Case 1 lymphatic and fatty tissues were identified; in Cases 2 and 3 the bone cavities were empty and covered by a fibrous capsule; and in Case 4 the cavity contained fibrous and fibromatous connective tissue. The cause of such bone cavities is obscure.

Bone-Plates for Stabilizing Le Fort I Osteotomies

16 adults were treated by inferior repositioning of the maxilla. Miniaturized plates were used for stabilizing the jaw in its new position. No interpositional bone grafts were used but the osteotomy spaces were covered by strips of cancellous iliac bone. Healing was uncomplicated. Retrospective cephalometric study of the results of treatment showed a mean frontal vertical relapse of about 20% (range 0-100%). The relapse occurred during the early postoperative period. No linear correlation was found between the amount of vertical repositioning and the anterior vertical relapse. We consider that the mini-plate technique is more advantageous than previous methods.

Results of apicoectomy of maxillary canines, premolars and molars with special reference to oroantral communication as a prognostic factor

Abstract A total of 276 patients with 314 apicoectomized canines, premolars and molars from the maxilla were reviewed. Oroantral communication (OAC) was noted in 41 (13 %) of the cases. All patients were followed-up clinically and radiographically. The results of the operation proved successful in 54 %, uncertain in 25 % and unsuccessful in 21 %. No difference was found between the results in the OAC group and the rest of the material. The best results were noted for the canines, while the frequency of success was lowest for the first premolars. Such factors as retrograde root filling, the quality of the orthograde root filling, preoperative root resorption and the extent of periapical destruction had no demonstrable effect on the later course. In the group where the periapical lesion was a radicular cyst, the frequency of success was 25 % higher. In four of 26 cases the tomograms showed no bony partition between the apical region and the maxillary sinus. In three of these cases the result was regarded as successful on the basis of conventional radiographs.

Periapical surgery of molars

Abstract Periapical surgery and retrograde root filling with amalgam in a series of 26 molars, had a successful result in 73% and uncertain and unsuccessful results in 15 and 12% of cases, respectively. In the experienced surgeons hand, periapical surgery of molars should be regarded as the method of choice when orthograde endodontic therapy cannot be performed.

Remarkable recurrenceof a keratocyst in a bone-graft

Abstract After repeated enucleation an odontogenic keratocyst (primordial cyst) of the ramus of the mandible in a 60-year-old man was treated by total extirpation of the left ramus and part of the body of the mandible, followed by reconstruction with bone from the iliac crest. Four years later the superior part of the bone graft was found to be destroyed. Biopsy and later histologic examination of the extirpated part of the bone graft revealed the classical characteristics of an odontogenic keratocyst. Possible causes of the recurrence of the keratocyst in the bone graft and certain aspects of the surgical treatment of odontogenic keratocysts are discussed

A clinical-radiographic review of treated oro-antral communications

Abstract A review of 112 patients with 113 oro-antral communications is reported. Of these communications, 88 had occurred in association with tooth extractions, 9 following surgical removal of retained teeth or osteoplasty, 9 following surgical removal of cystic lesions and 7 following apicoectomy. The majority of the communications in the extraction group was closed by a buccal flap ad modum Rehrmann. In those cases where the communication had been closed within 48 hours the success rate was approximately 90 %. When the closure had been delayed, the success rate was approximately 75 % among those without, and 55 % among those with, maxillary sinusitis. Persistent reduction of the vestibular sulcus was noted in approximately 50 % of the cases treated with Rehrmanns technique. Such reduction was often associated with bone defects extending through the entire alveolar process. Six of the 14 denture wearers with persistent flattening of the vestibule complained of instability of the denture, but none of the 24 without such flattening. The oro-antral communications occurring following removal of impacted teeth or apicoectomies healed without complications, while 2 out of 9 that had occurred at operations because of cysts had proved unsuccessful. At the follow-up examination 1–14 years after operation, healing had failed in only one case, due to sinusitis.

Surgical treatment of nasopalatine duct cysts: A follow-up study

Abstract In a clinical-radiological study, 43 operated and histopathologically verified incisive canal cysts were subjected to follow-up investigation. The clinical investigation revealed no subjective symptoms. Abnormalities of the sensibility to the anterior part of the palate were noted in four cases, hyposensibility in three cases and hypersensibility in the fourth. The radiological investigation showed that bone regeneration occurred 1 year postoperatively at the earliest. After 3 years, two-thirds of the patients showed complete bone regeneration. Large cysts (diameter >10 mm) showed the same tendency for bone regeneration as small cysts. The five patients in whom no bone regeneration had occurred were subjected to reoperation. The histologic investigation of these patients revealed scar tissue.

Mandibular reconstruction with bone grafts

A total of 23 patients with partly resected mandible were repaired with autogenous bone grafts from the iliac crest and ribs. The reasons for reconstruction are presented in Table 1. The grafts healed without complications in 21 cases. With the exception of two of the cases with gunshot wounds, all patients recovered good mobility of the jaw and satisfactory mandibular contours. The patients had been folloed up for 6 months to 11 years. Radiographic examination at the last examination showed that resorption of the graft had been only slight or moderate. Through marrow-spongious bone grafts are regarded as best from an osteogenetic point of view, our cases showed that good results can be achieved also with solid block grafts. The authors discuss the use of plate osteosynthesis without IMF instead of other types of graft fixation and IMF. In six cases where the area of the graft was loaded with a prosthesis, resorption was not more extensive than in the other cases.