R. Gilbert Triplett

Autologous bone grafts and endosseous implants: Complementary techniques

PURPOSE This article describes predictable techniques to augment contour- or height-deficient edentulous alveolar processes with autologous bone grafts for simultaneous or secondary placement of endosseous implants. METHODS Augmentation bone grafts harvested from the ilium and mandible were used to reverse alveolar atrophy of the maxilla and mandible. Endosseous implants were either placed simultaneously with the graft or 6 to 9 months after grafting. Implant success was calculated only after an implant-supported prosthesis was in function for a minimum of 12 months. RESULTS One hundred twenty-nine autologous bone grafts were placed in 99 patients. This included 70 grafts in the maxillary sinus, 32 onlay grafts, 14 veneer grafts, 9 saddle grafts, and 4 inlay grafts. Of these, 117 (90.7%) were successful. A total of 364 implants were placed in the grafted areas, 134 at the time of grafting and 230 6 to 9 months after grafting to allow time for osseous healing and remodeling. Three hundred twenty (87.9%) of the 364 implants placed in grafted areas were successful; 112 (83.6%) of the implants placed at the time of bone grafting and 208 (90.4%) of the implants placed secondarily in consolidated grafts. A total of 51 implants were placed in non-grafted areas in the same group of patients. Of these, 49 (96%) were successful. CONCLUSION Autologous bone grafts can be used successfully to improve the ability to place endosseous implants. The successful placement of implants in autologous grafts is more predictable when the implants are placed secondarily, 6 to 9 months after bone grafting. Failure of individual implants does not imply failure of the bone graft. In most instances when implants failed to osseointegrate, enough bone graft remains to allow subsequent successful implant placement 6 to 9 months later.

Pivotal, Randomized, Parallel Evaluation of Recombinant Human Bone Morphogenetic Protein-2/Absorbable Collagen Sponge and Autogenous Bone Graft for Maxillary Sinus Floor Augmentation

PURPOSE The purpose of this prospective study was to evaluate the safety and effectiveness of recombinant human morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS) compared with an autogenous bone graft when used for 2-stage maxillary sinus floor augmentation. The study assessed new bone formation, placement integration, and functional loading after 6 months and long term for 2 years. MATERIALS AND METHODS A total of 160 subjects were randomized, enrolled, and followed from January 1999 to February 2004 at 21 centers in the United States. The subjects with less than 6 mm of native bone height were treated with 1.50 mg/mL rhBMP-2/ACS or with an autograft. The height and density measurements were quantified by computed tomography scans. Core biopsies were obtained at dental implant placement and used for histological analysis. Safety was evaluated by oral examinations, radiographs, serum chemistries, and hematology. RESULTS A significant amount of new bone was formed by 6 months postoperatively in each group. The mean change in bone height in the rhBMP-2/ACS subjects was 7.83 +/- 3.52 mm versus 9.46 +/- 4.11 mm for the bone graft subjects. At 6 months after dental restoration, the induced bone in the rhBMP-2/ACS group was significantly denser than that in the bone graft group. No marked differences were found in the histologic parameters evaluated between the 2 groups. The new bone was comparable to the native bone in density and structure in both groups. The success rate for the rhBMP-2/ACS group was 79% (64 of 81 subjects), and 201 of 251 implants placed in the bone graft group and 199 of 241 implants placed in the rhBMP-2/ACS group were integrated, retained, and functional at 6 months after loading. No adverse events were deemed related to the rhBMP-2/ACS treatment. The autograft group was noted to have a 17% rate of long-term parasthesia, pain, or gait disturbance related to the bone graft harvest. CONCLUSIONS The results of our multicenter, randomized, prospective, clinical trial have shown the effectiveness and safety of rhBMP-2/ACS compared with bone graft for sinus floor augmentation. The studys primary endpoint was exceeded, and the implants placed in rhBMP-2/ACS and bone graft groups performed similarly after functional loading.

Lingual nerve injury associated with overpenetration of bicortical screws used for fixation of a bilateral mandibular sagittal split ramus osteotomy

A rarely described complication of the mandibular sagittal ramus split osteotomy is lingual nerve injury. White et al’ and Schendel and Epke? described lingual nerve injuries during sagittal osteotomies in 1969 and 1980, respectively. In 1990, Hegtvedt and Zuniga3 described the occurrence of lingual nerve anesthesia, which they concluded was caused by direct nerve injury as a complication of a rigidly fixed sagittal ramus osteotomy. They suspected the injury was caused by rotary instrument penetration of the lingual cortical plate of the mandible and failure to protect the soft tissues in the area. Shortly thereafter, Meyer,4 in a letter to the editor of

Arteriovenous Malformation of the Mandible: Survey of Previously Unreported Cases and Case Report

Arteriovenous malformations (AVM) of the mandible are uncommon lesions, but may be life threatening. Fewer than 100 AVMs in the entire maxillofacial area have been reported.’ Their etiology and clinical presentation have been discussed previously, and several different treatment modalities have been recommended. These include embolization of vessels, carotid artery ligation, decortication, curettage and packing, obliteration, radiation therapy, cryosurgery, sclerosing agents, and resection.2-20 The purpose of this report is twofold: 1) to publish the results of a survey regarding treatment of previously unreported mandibular AVMs, and 2) to present a case of a mandibular AVM and its subsequent management.

The effect of local antibiotics in treating chronic osseous Staphylococcus aureus infection

The purpose of this study was to determine if antibiotic-supplemented bone allografts (ASBA) would enhance healing and reduce infection in chronic osteomyelitis. Intramedullary injection of Staphylococcus aureus was used to create osteomyelitis in the tibia of New Zealand white rabbits. Twenty-one days postinoculation, the animals were randomly assigned to one of the following six treatment groups: 1. debridement of the infected tibia; 2. debridement + bone graft; 3. debridement + bone graft + gelatin powder; 4. debridement + bone graft + gelatin powder supplemented with antibiotics; 5. debridement + gelatin powder supplemented with antibiotics; and 6. no surgical intervention. The debrided material was cultured for identification of microorganisms. All groups received cephalothin sodium, 100 micrograms/kg subcutaneously every 12 hours for 21-days. At time of death the tibia were assessed to determine the degree of healing. Radiographs, bacterial cultures and specimens for histologic study were obtained. Qualitative grading demonstrated a significant difference between groups (P less than .001). Groups (4 and 5) receiving local antibiotic supplementation demonstrated improved healing compared with the remaining groups. However, there was no difference between groups 4 and 5. Bacteriologic culturing indicated the greatest reduction in colony-forming units of S aureus in the postsacrifice graft sites to be in groups 4 and 5. Histologic findings paralleled qualitative assessment of healing of the gross specimens. The results of this study suggest that local antibiotic supplementation of graft preparations may be useful for treatment of chronic osseous infection.

Massive macroglossia secondary to angioedema: a review and presentation of a case.

Macroglossia is a rare condition, but can severely affect the oral and maxillofacial region. Angioedema is a condition resulting from multiple mechanisms, all of which can result in macroglossia. This report describes an unusual case of acquired macroglossia in an adult resulting from chronic edema secondary to angioedema in the setting of stroke. The patient had a morbidly enlarged tongue and presented with clinical signs and symptoms consistent with massive macroglossia. She required surgical intervention for acute management of her symptoms and definitive treatment of her macroglossia.

What is the Role of Biofilms in Severe Head and Neck Infections

Most infections of the head and neck and virtually all of those encountered in the practice of dentistry are caused by bacteria that are organized into biofilms. A biofilm is a complex, usually multispecies, highly communicative community of bacteria that is surrounded by a polymeric matrix. Treatment of these types of infections with traditional antibiotics alone is ineffective, and surgical removal of diseased tissue is still necessary.

New Frontiers in Biomaterials

Scientific and technological advances have combined to lead the way into a new era of the ever-developing science of biomaterials and tissue regeneration. This field has rapidly grown and new frontiers have quickly been established. Despite obtaining satisfactory results with current methods, improved techniques that lead to diminished patient discomfort, more favorable long-term prognosis, and decreased health care costs continue to be the goals of researchers, patients, and surgeons. Biomaterials have undergone a rapid evolution from materials that simply replaced tissues to factors that stimulate a biological response in the body.

Virtual Preoperative Planning and Intraoperative Navigation in Facial Prosthetic Reconstruction: : A Technical Note

This technical protocol outlines the use of computer-assisted image-guided technology for the preoperative planning and intraoperative procedures involved in implant-retained facial prosthetic treatment. A contributing factor for a successful prosthetic restoration is accurate preoperative planning to identify prosthetically driven implant locations that maximize bone contact and enhance cosmetic outcomes. Navigational systems virtually transfer precise digital planning into the operative field for placing implants to support prosthetic restorations. In this protocol, there is no need to construct a physical, and sometimes inaccurate, surgical guide. The report addresses treatment workflow, radiologic data specifications, and special considerations in data acquisition, virtual preoperative planning, and intraoperative navigation for the prosthetic reconstruction of unilateral, bilateral, and midface defects. Utilization of this protocol for the planning and surgical placement of craniofacial bone-anchored implants allows positioning of implants to be prosthetically driven, accurate, precise, and efficient, and leads to a more predictable treatment outcome.