John D. Moriarty

Delayed bone grafting in the cleft maxilla and palate: A retrospective multidisciplinary analysis

The results of delayed bone-grafting procedures in a group of twenty-four cleft patients are reported. All patients benefitted from closure of their fistulas. The need for a prosthesis was eliminated in twelve patients, and eight of the remaining twelve patients required only a three-unit bridge. Residual movement of the premaxilla in two of the nine bilateral cases included in this study was detectable. The esthetic benefits were difficult to assess since sixteen of the patients simultaneously underwent lip and nasal revisions. In seventeen patients, the graft was placed prior to canine eruption, and in sixteen of these patients, the canine erupted passively into the arch. Not every patient with a cleft is a candidate for delayed bone grafting, but the procedure has been found to be beneficial in selected persons.

Augmentation genioplasty as an adjunct to conservative orthodontic treatment

Augmentation genioplasty can serve as a valuable adjunct to orthodontic treatment. The borderline extraction patient with a good nasolabial angle, protruding lower incisors and a deficient chin often can be treated better by nonextraction orthodontics followed by advancement of the chin than by any regimen involving orthodontic extraction. Genioplasty also can be used to improve facial esthetics in the patient with a short mandibular ramus in whom mandibular advancement might well lead to unstable results. In some instances, genioplasty may be a way to overcome the appearance of facial asymmetry without requiring jaw surgery which would complicate a pre-existing adequate occlusion. As a relatively straightforward and predictable procedure, augmentation genioplasty should be used more often in conjunction with orthodontic treatment than it has been in the past.

Radiographic evaluation of alveolar crest obscured by dental implants

This study evaluated the diagnostic accuracy of periapical, tomographic, and cross-sectional occlusal radiographic techniques in the assessment of facial and lingual bone loss at implant obscured sites. An edentulous dry human mandible was prepared with implants in the incisor, premolar, and molar regions. Successive round bur sizes (No. 1 to 6) were used to create circumferential infrabony periodontal defects in the alveolar crest adjacent to the implants. Periapical radiographs were made with custom stents and imaged each site in a conventional parasagittal orientation. Linear tomograms imaged sites in a cross-sectional coronal orientation. Cross-sectional occlusal radiographs imaged anatomy in the axial plane. Radiographic anatomy mesial and distal to each implant was masked with opaque tape before evaluation by a panel of six observers. Images were displayed in pairs consisting of an image at baseline and a second image having an equal chance of displaying an increment of bone removal or no bone removal. Image pairs were displayed in random order A five-point scale was used to evaluate accuracy of detection of the presence or absence of changes in bone density as well as observer confidence in that assessment. ANOVA demonstrated significant variation due to image modality and increment of bone removal. Cross-sectional occlusal views provided significantly greater mean observer confidence scores than either periapical images or tomograms (P < .01). However, tomograms may provide greater utility in actual clinical practice. (Implant Dent 1995;4:13–18)

Comparison of marginal bone changes with internal conus and external hexagon design implant systems: A prospective, randomized study

A central dental implant success criterion is the marginal bone response as measured longitudinally. Factors that influence marginal bone changes include osseous and soft tissue architecture, occlusal loading factors, implant position, implant design, and inflammatory processes. The evolution of implant design is multifactorial and includes the implant-abutment interface geometries. The primary objective of this study was to compare the proximal marginal bone changes following placement and loading of internal conus design implants (ICI) and external hex design implants (EXI) used in the treatment of posterior partial edentulism. Among 45 enrolled participants, 39 were treated with 47 ICI or 46 EXI implants using a one-stage implant protocol. Prosthetic restoration was completed after 12 weeks using stock titanium abutments and all-ceramic crowns. Follow-up visits including clinical and radiographic examinations were performed 6 months after permanent restoration and then annually for 3 years. Marginal bone level changes, papilla index scores, condition of the peri-implant mucosa, presence of complications, and participant satisfaction were evaluated. The mean marginal bone level change from implant placement to 3 years was -0.25 ± 0.60 mm and -0.5 ± 0.93 mm for ICI and EXI implants, respectively. The change recorded from permanent restoration to 3 years was a gain of 0.31 ± 0.41 mm versus 0.04 ± 0.51 mm for ICI and EXI implants, respectively (P < .05). In the evaluation of interproximal soft tissue 3 years after permanent restoration, 80% of mandibular and 66% of maxillary interproximal ICI sites received papilla scores of 2 and 3, compared with 50% of mandibular and 60% of maxillary interproximal EXI sites. No significant differences in plaque or bleeding scores were recorded. Abutment/healing abutment complications were recorded for 11 EXI versus 1 ICI participant. The vast majority (> 90%) of participants stated they were satisfied or very satisfied with their implant prosthesis and rated function and esthetics highly for both implant types after 3 years in function. Modestly greater marginal bone loss occurred at EXI implants. Further, more positive papilla scores were found between adjacent ICI implants than between adjacent EXI implants. EXI implants displayed more abutment complications than the ICI implants. The implant-abutment interface design may contribute to therapeutic outcome differences. Replacement of missing posterior teeth with unsplinted implants was successful at the implant level and as reported by the participant.