John Jensen

Autogenous mandibular bone grafts and osseointegrated implants for reconstruction of the severely atrophied maxilla: A preliminary report

The purpose of this study is to present results obtained with a new procedure for reconstruction of the severely atrophied maxillary alveolar ridge that involves the use of intramembranous corticocancellous bone grafts obtained from the mandibular symphysis fixed to the residual bone by endosseous implants. A total of 107 implants were installed in grafted regions in 26 patients. The follow-up period ranged from 6 to 32 months, with a mean of 16 months. In partially edentulous patients the bone grafts were fixed with implants to the residual bone as 1) onlay graft to the alveolar ridge (8 implants in 4 patients); 2) grafts to the nasal and/or sinus floor after a transoral exposure and elevation of the mucosa of the maxillary sinus and/or the nasal mucosa (33 implants in 11 patients); or 3) a combination of these two (5 implants in 2 patients). In totally edentulous patients, implants and grafts were used as a combination of grafting to both the alveolar ridge and nasal and/or sinus floor sites (61 implants in 9 patients). One hundred of 107 implants showed normal clinical and radiologic healing, whereas 7 implants in 4 patients (6.5%) were lost prior to loading. Seventeen patients have had the implants and bone grafts loaded by a prosthodontic reconstruction from 6 to 26 months (mean, 14 months) without loss of any implants. Postoperative marginal resorption of the onlay bone graft of less than 15% was observed. These findings suggest, that the previously observed rapid resorption of endochondral iliac crest onlay bone grafts and the number of lost implants can be significantly reduced if bone from the mandibular symphysis firmly anchored with titanium implants is used.

Varying treatment strategies for reconstruction of maxillary atrophy with implants: results in 98 patients.

This report describes the outcome of maxillary implant reconstruction in 98 consecutively treated patients assigned to three groups based on the degree of maxillary atrophy as noted on radiographic examination and method of treatment. In group 1, 33 patients had 83 implants installed following sinus and/or nasal mucosal lift procedures. In group 2, 26 patients had 56 implants placed that penetrated the sinus and/or nasal cavities. The penetrating portion of the implant was covered with autogenous particulate bone harvested from the lateral aspect of the ipsilateral sinus. In group 3, 39 patients had 152 implants fixed to autogenous mandibular bone grafts placed either in the antral and/or nasal floors and/or as an onlay over the residual alveolar ridge. The age range of the patients was 15 to 76 years, with a mean of 56 years. Follow-up periods ranged from 12 to 58 months, with a mean of 26 months. Of the 291 implants installed, 19 have been lost. The importance of considering different treatment strategies when reconstructing the edentulous maxilla is discussed.

Reconstruction of the severely resorbed maxilla with bone grafting and osseointegrated implants: A preliminary report

This article describes a surgical procedure for rehabilitation of the severely atrophic maxillary alveolar ridge by bone grafting to the maxillary sinus and nasal floor followed by installation of implants in the grafted regions at a second operation. Five treated cases are presented. Further data are considered necessary to evaluate the procedure before it can be recommended for routine use.

Mandibular bone graft material for reconstruction of alveolar cleft defects: long-term results.

OBJECTIVEnTo analyze the long-term effect of mandibular bone as donor material in bone grafting of the alveolar process defect in patients with unilateral cleft lip and palate (UCLP), compared with iliac crest cancellous bone.nnnMETHODnDuring a 7-year period, 101 UCLP patients were bone grafted, 57 cases with iliac crest cancellous bone and 44 with mandibular symphyseal bone. The long-term results with an observation time of more than 4 years were analyzed with respect to marginal bone level and dental and gingival condition in the grafted area. Complications were recorded.nnnRESULTSnThe bone level in the grafted area was satisfactory in both groups. Impaction of cleft-side canines was found in 35% of the patients in both groups. Patients with agenesis of the cleft side lateral incisor had significantly more impacted canines, compared with patients with a cleft-side lateral situated in the lesser maxillary segment, probably due to the fact that the lateral incisors help in guiding the canine down through the grafted area. The number of complications was scarce, although both groups demonstrated some gingival retraction with a longer crown length at the cleft side central incisor.nnnCONCLUSIONnThe findings of this study have changed our strategy in bone grafting. Timing of orthodontic treatment and bone grafting has been more varied depending on the position and presence of teeth in the cleft area. Bone grafting of the alveolar process is not just a local treatment of a bony defect, but in respect to the burden of treatment, bone grafting of the alveolar process has to be planned in accordance with orthodontic treatment and maxillofacial growth.

A comparative study of treatment of keratocysts by enucleation or enucleation combined with cryotherapy: A preliminary report

In the present study, the recurrence rates found after treatment of keratocysts by enucleation or enucleation combined with cryotherapy are compared. Despite the relatively short follow-up period, this study indicates that there is no difference in recurrence rate between the two treatment methods.

Motives for surgical-orthodontic treatment and effect of treatment on psychosocial well-being and satisfaction: a prospective study of 118 patients.

PURPOSEnA prospective, controlled study of consecutive surgical-orthodontic patients was performed to assess how treatment affects the patients psychosocial well-being. We evaluated patients treatment motivations and motive fulfillment in relation to their satisfaction with the treatment and assessed the correlation between their satisfaction and their psychosocial well-being.nnnPATIENTS AND METHODSnA total of 118 adult patients (51 men and 67 women, mean age 25 years) who had undergone surgical-orthodontic treatment were examined before the preoperative orthodontic treatment and 12 months after surgery or later. The motives for treatment, fulfillment of those motives, psychosocial well-being, and degree of post-treatment satisfaction were assessed using questionnaires validated for Danish patients. A total of 47 age- and gender-matched subjects without any current or previous need for orthodontic or surgical-orthodontic treatment served as the controls.nnnRESULTSnThe patients stated oral function and appearance as their main treatment motives, and most reported that their motives had been fulfilled. Both their motives and the actual fulfillment of their motives influenced their treatment satisfaction. Another significant outcome of treatment was improved self-concept and social interaction. The more self-concept and social interaction were improved by treatment, the greater the post-treatment satisfaction the patients expressed.nnnCONCLUSIONSnSurgical-orthodontic treatment has significant potential to improve patients psychosocial well-being. Patients satisfaction with treatment correlated with the post-treatment psychosocial status. However, pretreatment motives significantly influenced the overall satisfaction after treatment. Thus, patients who weighted oral function motives greatest expressed the lowest degree of treatment satisfaction.

Reconstruction of residual alveolar cleft defects with one-stage mandibular bone grafts and osseointegrated implants

PURPOSEnThis study evaluates a treatment regimen for reconstruction of residual maxillary alveolar cleft defects consisting of mandibular bone grafting and immediate implant installation.nnnPATIENTS AND METHODSnSixteen cleft patients (five female and 11 male) had residual cleft defects of the alveolar ridge reconstructed with bone grafts from the mandibular symphyseal region. The bone graft was pretapped at the donor site before fixation in the residual ridge with Brånemark implants. Twenty implants were installed according to this concept. The period of observation ranged from 36 to 69 months, with a mean of 48 months after implant installation.nnnRESULTSnFive patients developed wound dehiscenses that resulted in total or partial bone graft sequestration. Two implants were lost, one due to sequestration and the other due to mobility at the abutment procedure; 18 implants were still well functioning at the end of the observation period. However, all patients showed significant periimplant bone resorption after this one-stage treatment.nnnCONCLUSIONnBecause of the observed complication rate, the one-stage procedure may not be optimal for reconstructing residual cleft defects.

Complications after mandibular distraction osteogenesis: a retrospective study of 131 patients

OBJECTIVESnThe objectives of this study were to evaluate the occurrence and severity of complications after mandibular distraction osteogenesis (DO) with internal devices.nnnSTUDY DESIGNnThe study was a retrospective analysis of 131 patients (mean age: 16.2 years) consecutively treated by mandibular DO from 1998 to 2009. Ninety-two patients had unilateral and 39 had bilateral distraction, yielding a total of 170 procedures. The mean follow-up period was 21 months. Severity of complications was ranked in terms of need of intervention and risk of a compromised outcome.nnnRESULTSnMinor, moderate, and severe complications occurred in 58%, 8%, and 3% of the patients, respectively. Most minor complications were related to device activation or temporary hypesthesia. Moderate complications often related to hardware, whereas severe complications occurred in 4 patients with sensory deficit or temporomandibular joint problems.nnnCONCLUSIONSnAlthough minor complications were frequent, they did not compromise treatment outcome, so mandibular DO is considered a safe method for correction of mandibular deformities. Moreover, some of the complications could be prevented by proper precautions.

Risk Factors Affecting Somatosensory Function After Sagittal Split Osteotomy

PURPOSEnThe aim of this study was to evaluate potential individual and intraoperative risk factors associated with bilateral sagittal split osteotomy (BSSO) and to correlate the findings with postoperative changes in somatosensory function.nnnPATIENTS AND METHODSnA total of 18 men and 29 women (mean age, 31 +/- 10 years) scheduled for BSSO participated in 1 session before BSSO and 5 sessions after BSSO (at 2 and 14 days and 3, 6, and 12 months). At each session, subjective oral sensation was scored and quantitative sensory tests were performed.nnnRESULTSnThe results showed that complete exposure and free dissection of the inferior alveolar nerve during BSSO increased self-reported changes in lower lip sensation and lower lip tactile threshold after BSSO (P < .01). Long surgical movements reduced self-perceived jaw-opening function and impaired 2-point discrimination (P < .05). Significant correlations were noted between preoperative values for somatosensory function and changes in these variables after BSSO. Patients with low sensory thresholds before BSSO experienced more impairment than those patients with higher preoperative sensory thresholds.nnnCONCLUSIONnThese findings imply that somatosensory function after BSSO is dependent on both intraoperative risk factors and preoperative sensation levels.

Rigid fixation in reconstruction of craniofacial fractures

Ninety-four patients had either isolated fractures of the skull or midface, or combined fractures of the skull, periorbit, and/or midface. Thirty-five of these patients were treated by conventional methods, including maxillomandibular fixation (MMF) 4 to 6 weeks postoperatively, wire osteosynthesis, suspension ligatures, or a head frame. The remaining 59 patients were treated with either mini-, low-profile, micro-, or 3-D titanium plate fixation (rigid internal fixation [RIF]) and comprise the patient population for this study. Of the 59 patients, 11 were female and 48 male, ranging in age from 6 to 85 years, with a mean age of 34 years. Six patients had isolated skull fractures, 9 had combined skull and periorbital fractures, 31 had isolated midface fractures, and 13 patients had combined skull and midface fractures. The follow-up period ranged from 3 to 48 months. Patients with midface fractures were placed in MMF intraoperatively, and MMF was released at the completion of the procedure. At 2 to 4 days postoperatively, the occlusion was evaluated. Fifteen of the 38 dentate patients with either midface or combined skull and midface fractures were without MMF postoperatively. Twenty-three patients showed slight occlusal discrepancies and were treated with elastic MMF for 3 to 28 days (mean, 10 days). All reductions were judged to be stable throughout the postoperative course. Based on the results, use of RIF is recommended for primary reconstruction in craniofacial trauma patients whenever possible, thereby achieving three-dimensional stability, sufficient functional and cosmetic results, and often avoiding or reducing the need for MMF.