H. Dexter Barber

Evaluation of osseointegration of endosseous implants in radiated, vascularized fibula flaps to the mandible: A pilot study☆

PURPOSE This study clinically evaluated the osseointegration of implants placed into vascularized fibula flaps used in mandibular reconstruction of cancer patients following radiation treatment and subsequent hyperbaric oxygen (HBO) therapy. MATERIALS AND METHODS Five head and neck cancer patients had mandibular resection and immediate reconstruction with a vascularized fibula flap. Subsequent therapy included greater than 50 Gy of radiation to the fibula flap over a 6 to 8-week period. Two to 6 weeks following radiation therapy each patient received 20 90-minute daily sessions of HBO at 2.4 atmosphere pressure. Stage 1 implant surgery was performed placing two to six implants (15 mm in length and 3.75 to 4.0 mm in width) into each fibula flap. This was followed by 10 postoperative HBO sessions using the previously mentioned protocol. The stage 2 procedure was performed 6 months after the stage 1 procedure. Osseointegration was assessed clinically using manual force and an electronic device at the time the implants were uncovered and monthly over a 6-month period. RESULTS All 20 implants placed in the fibula flaps were osseointegrated clinically at the time the implants were uncovered and during the 6-month follow-up. CONCLUSION In this pilot study, mandibular reconstruction with a vascularized fibula flap and endosseous osseointegrated implants, following radiation of the fibula, was successful. It was concluded that factors such as the graft having its own blood supply and the use of HBO contributed to the successful osseointegration of these implants.

Evaluation of anterior maxillary alveolar ridge resorption when opposed by the transmandibular implant

Fifteen edentulous patients with complaints regarding denture comfort and/or function were treated with the transmandibular implant. All patients were restored with conventional maxillary dentures opposed by implant-supported removable prostheses. Two to 4 years after surgery, these patients were evaluated for vertical and horizontal maxillary bone loss with a radiographic analysis developed by the authors. With this technique, attention was focused on vertical alveolar ridge resorption in the anterior maxilla. Although the sample size was small, the findings from this study indicate that vertical bone loss in the anterior maxilla does occur when a maxillary denture is opposed by an implant-supported overdenture. Comparison of these results with a previous study that evaluated anterior maxillary resorption when a complete maxillary denture opposed natural mandibular anterior teeth and a distal extension removable partial denture demonstrated no statistically significant difference.

Orbital Infections: Clinical and Radiographic Diagnosis and Surgical Treatment

Orbital infections are uncommon sequelae of sinusitis, odontogenic infections, or orbital trauma and may have devastating consequences if they are unrecognized or if aggressive treatment is delayed. The authors present a systematic classification of orbital infections, and discuss the pathogenesis and treatment of orbital abscesses.

Non-Hodgkin's lymphoma involving the inferior alveolar canal and mental foramen: Report of a case

Abstract Lymphomas are malignant lesions derived from proliferating lymphoid and/or reticuloendothelial cells and their derivatives.1–3 It is believed that most non-Hodgkins lymphomas arise in a unifocal or multifocal pattern from nodal tissue and then spread to distant nodal and visceral sites.4 Lymphoma of the oral cavity is an uncommon finding,4–10 and the specific means by which these extranodal lymphomas occur has not been identified.3,7 Of the non-Hodgkins lymphomas that occur in the oral cavity, 15% to 45% have occurred in the maxilla and mandible,8,11–13 with the mandible the less frequent site.9,14 In this article, we present a case of non-Hodgkins lymphoma of the mandible involving the inferior alveolar canal and mental foramen, with an unusual radiographic presentation. A review of the radiographic presentations of non-Hodgkins lymphoma of the mandible is also presented.

Double-degree oral and maxillofacial surgeons: Was it worth it?

A survey was conducted of oral and maxillofacial surgeons with double degrees who are members of the American Association of Oral and Maxillofacial Surgeons (AAOMS). The survey consisted of questions related to obtaining their MD degree; comparing the difficulty of medical school versus dental school and oral and maxillofacial surgery residency; and to whether they thought pursuing an MD degree was worthwhile and would they recommend the pursuit of an MD degree to interested DDS/DMD oral and maxillofacial surgery residents. The results showed that those surveyed thought that obtaining an MD degree was worthwhile and, if they had a chance to do it over again, would do so.

Comparison Of Periotest Values Of Integrated Implants With And Without Healing Abutments: A Pilot

The role of the Periotest in the clinical evaluation of osseointegration has been well documented. Some clinicians have used the initial Periotest values at second-stage surgery as a baseline to measure changes in integration at the bone-implant interface over time. The purpose of this pilot study was to compare Periotest values made with and without healing abutments in place. A statistically significant difference was found between the Periotest values that were recorded with and without healing abutments, with the values without the healing abutments being more negative and suggestive of greater osseointegration.