Joseph F. Piecuch

Experimental Ridge Augmentation With Porous Hydroxyapatite Implants

A new hydroxyapatite ceramic implant material for restoration of atrophic edentulous ridges was tested in a canine animal model The structure of this material is unique, in that it is produced from the skeleton of a coral, and in that it is penetrated by a uniform network of interconnected pores. Results indicate that bone penetrates its structure to a greater degree than had been observed with similar implants constructed of different materials. Implant insertion through a simple surgical technique involving minimal morbidity is a viable method of placement.

Extraskeletal of a Porous Hydroxyapatite Ceramic

Coralline replamineform hydroxyapatite implants were placed in canine subcutaneous tissues in an attempt to clarify whether the hydroxyapatite matrix acted as a passive matrix for osseous ingrowth when placed in same inherent bone induction capacity. The implants were well-tolerated and elicited no deleterious host response. Connective tissue rapidly infiltrated the pores, but no evidence of hone formatian was noted in any of the specimens. It was concluded that this implant material does not act to induce bone formation.

Long-term effects of orthognathic surgery on the temporomandibular joint : comparison of rigid and nonrigid fixation methods

Sixty-six patients were examined between 2 and 9.5 years after bilateral sagittal split mandibular ramus osteotomy. Thirty-two patients had nonrigid fixation consisting of superior border wires and intermaxillary fixation, while 34 patients had rigid plate fixation of the osteotomy sites with immediate function. There were no demonstrable long-term differences between the two groups with respect to mandibular vertical opening, crepitance, and temporomandibular joint pain. Masticatory muscle pain and temporomandibular joint clicking improved with rigid fixation and worsened with nonrigid fixation.

Long-term evaluation following temporomandibular joint arthroscopy with lysis and lavage

Although temporomandibular joint arthrocentesis has been utilized for almost 20 years, most papers which evaluate the success of this procedure present relatively short-term data (less than two years). The purpose of this paper is to present the longer-term condition of 22 patients who were re-examined 2 to 10.8 years after arthroscopic surgery with lysis and lavage. Assessment of symptoms reported by the patient as well as of objective signs noted on clinical examination confirms resolution of pain on movement and increased vertical opening. These findings suggest that arthroscopic surgery of the temporomandibular joint is successful in the long term for patients with painful motion.

Long-term retrospective analysis of twenty-three Proplast®-Teflon® temporomandibular joint interpositional implants

This retrospective analysis reviews 15 patients with a total of 23 Proplast-Teflon interpositional implants. Most of the implants have been removed because of implant fragmentation and giant-cell inflammatory reaction. Recommendations for continued long-term care of patients with such implants are offered.

The sagittal ramus osteotomy stability of fixation with internal miniplates

Radiographs of 15 patients who underwent sagittal split mandibular ramus osteotomy with rigid miniplate fixation for mandibular lengthening were studied. Evaluation of postoperative stability of the mandibular lengthening at 6 months to 2 years revealed minimal postoperative changes.

Perioperative rehydration in ambulatory anesthesia for dentoalveolar surgery.

OBJECTIVE Patient recovery after anesthesia is dependent not only on the lingering pharmacologic effects of sedatives but also on the physiologic effects that patients experience after surgery. Preoperative fasting results in a perioperative dehydration that may contribute to these physiologic effects, resulting in complaints of headache, nausea, vomiting, fatigue, lightheadedness, dizziness, and thirst. The purpose of this study was to investigate the effects of perioperative hydration in the ambulatory oral and maxillofacial surgery patient who receives deep sedation or general anesthesia (nonintubated). STUDY DESIGN This was a prospective, randomized, blinded study that administered either a high volume (16-17 mL/kg) or a low volume (1-2 mL/kg) of an isotonic solution to each of 77 patients who were scheduled to have their third molars extracted with deep sedation or general anesthesia. Each patient completed 3 postoperative questionnaires designed to evaluate potential adverse outcomes. RESULTS Nonparametric analysis of the data demonstrated a more favorable outcome with respect to subjective feelings for the high volume hydration group; this was evident both during the immediate postoperative period and in the evening of the day of surgery, and it persisted into the first postoperative day. CONCLUSIONS This study demonstrated that appropriate perioperative rehydration decreases postoperative adverse outcomes and improves the patients perception of the postoperative period.

Morphologic analysis of upper lip area following maxillary osteotomy via the tunneling approach

Preservation of favorable upper lip morphology is a critical factor in assessing the success of maxillary osteotomy surgery. Unesthetic postsurgical lips often appear thin and tight, with the vermilion border shortened and rolled inward. Clinical observation of patients who had undergone total maxillary alveolar process osteotomies by means of vertical buccal incisions and a tunneling approach suggests that presurgical lip morphology is minimally changed. This study investigates the presence and degree of change in upper lip morphology following this technique. Pre- and postoperative cephalometric radiographs of ten patients were compared by superimposition of acetate tracings on cranial base landmarks. Cross-sectional lip area was calculated by compensating polar planimetry presurgically and at four intervals following intervention: 1 to 3 days, 1 to 3.5 months, 6 to 9 months, and more than 10 months. Analysis showed the cross-sectional upper lip area, compared to the presurgical baseline, to be as follows: Immediately following surgery, the area increased by a mean of 27.8% (range, 15.0% to 36.9%; SE = 4.72). At 1 to 3.5 months postsurgery, the increase was reduced to 3.3% (range, 0 to 7.7%; SE = 0.82). At 6 to 9 months, lip area remained minimally increased, at + 0.78% (range, -5.0% to 7.6%; SE = 1.68). At 10 months or longer, the mean increase from preoperative values was 0.61% (range, -6% to 6.4%; SE = 1.38). The results of this study indicate that the upper lip cross-sectional area returns to its presurgical value at 6 months following surgery and remains constant at subsequent measurements. The performance of maxillary surgery with this flap design appears to preserve presurgical lip morphology.

What strategies are helpful in the operative management of third molars

PURPOSE The purpose of this review was to investigate and report strategies that might improve patient recovery after third molar (M3) surgery. MATERIALS AND METHODS This was a literature review on various topics to identify the methods of improving outcomes after M3 removal. Numerous topics were reviewed, including patient age, flap design, effect of smoking, use of antibacterial rinses, pre-emptive analgesia, and the role of antibiotics and corticosteroids in recovery. RESULTS Increased patient age appears to be a factor in a higher complication rate, but the literature is sparse. The results of studies on flap design are contradictory, but there is no difference in long-term periodontal health. Systematic reviews clearly show that longer periods of smoking cessation decrease surgical complications, but few studies have addressed M3 surgery. Likewise, the role of pre-emptive analgesia, although beneficial in a general surgical setting, has not been studied thoroughly with regard to M3 surgery. The use of chlorhexidine rinses to prevent alveolar osteitis and surgical site infection has been studied extensively, but meta-analyses have not convincingly proved this effect. The evidence is convincing that antibiotics decrease alveolar osteitis and surgical site infection. Similarly, it is clear that corticosteroids decrease postoperative trismus and edema; however, the role of steroids in decreasing pain is not proved. CONCLUSION This review found various factors associated with improving recovery and minimizing complications in M3 surgery.

Results of soft-tissue surgery over implanted replamineform hydroxyapatite

Sixteen replamineform hydroxyapatite implants were inserted subperiosteally on the residual ridge in five dogs, and various soft-tissue procedures were performed at intervals of one, two, three, and 27 months after implantation. Three implants served as controls. Twelve of the 13 surgical sites healed normally, including four of the five vestibuloplasties and all eight exposure sites. All 16 implants were still in place and firmly attached to the alveolar bone at the time of sacrifice. A normal stratified squamous epithelium was formed in all specimens in which complete healing occurred. No evidence of an inflammatory reaction was found in response to the soft-tissue surgery in the specimens that healed. The favorable results of this study form the basis for proposed human clinical trials to evaluate the response of the implant and the overlying soft tissues to a dental prosthesis.