Rajesh Gutta

Reconstruction of the Maxilla and Mandible With Particulate Bone Graft and Titanium Mesh for Implant Placement

PURPOSE The purpose of the study was to evaluate the magnitude of ridge augmentation with titanium mesh, overall graft success, anatomic location of ridge defects and their relationship to mesh exposure. MATERIALS AND METHODS This retrospective study evaluated 44 patients who received mandibular or maxillary reconstruction with autogenous particulate bone graft and titanium mesh for the purpose of implant placement. Autogenous bone graft was harvested from the iliac crest, tibia, and mandibular symphysis. A total of 45 sites were included in the study. Average augmentation bone heights were measured and compared. Statistical analysis was done with ANOVA and Students t test. Histomorphometric analysis was performed on the soft tissue specimen found between the mesh and the bone graft. RESULTS Twenty-nine sites underwent mandibular reconstruction and 16 underwent maxillary reconstruction. The mean augmentation in partial maxillary defects was 11.33 +/- 1.56 mm, and in complete maxillary augmentation, the height achieved was 14.3 +/- 1.39 mm. In the mandible, mean increase in height for partial defects was 14 +/- 1.42 mm and for complete augmentation it was 13.71 +/- 1.14 mm. The mean augmentation for all sites was 13.7 mm (12.8 mm in the maxilla and 13.9 mm in the mandible). A total of 82 implants were placed in the maxilla and 92 implants were placed in the mandible. In the maxillary group, 7 sites had exposure of the titanium mesh and 16 sites were exposed in the mandible. The success of the bone grafting procedure was 97.72%. CONCLUSIONS Porous titanium mesh is a reliable containment system used for reconstruction of the maxilla and the mandible. This material tolerates exposure very well and gives predictable results.

Barrier membranes used for ridge augmentation: is there an optimal pore size?

PURPOSE To identify the optimal pore size of barrier membranes for successful alveolar ridge reconstruction procedures, to determine if cortical perforations have any effect on bone regeneration, and to reiterate that bone graft containment is an important parameter for successful regeneration. MATERIALS AND METHODS This was a prospective, randomized, controlled study performed on hound dogs. Corticocancellous tibial bone grafting was performed to the lateral border of the mandible and protected with barrier membranes (meshes). The experiment analyzed three different pore sized meshes, compared with controls without the mesh. Two meshes (macroporous and microporous) were made of titanium, and one was a resorbable mesh. Meshes were preformed into the shape of a cube with one face open. Each side of the cube measured approximately 10 mm. Cubes were open-faced on one side, to facilitate packing of the graft material. The dogs received bilateral ramus grafts. Cortical perforations were created on the left ramus of all the dogs and compared with the right side, which did not have perforations. The dogs were randomly divided into 3 groups and sacrificed at intervals of 1, 2, and 4 months. Before sacrifice, all dogs received 2 doses of tetracycline as a marker for new bone formation. Histomorphometry was performed by using Bioquant image-analysis software. Areas of new bone and soft tissue were measured. The rate of mineral apposition was also calculated. All values obtained via histomorphometry were statistically analyzed with a t test. RESULTS Thirty-one experimental sites were evaluated. The amount of new bone growth into the macroporous mesh was significantly higher than in the other groups. The mean area of new bone formation in large and small meshes was 66.26 +/- 13.78 mm(2) and 52.82 +/- 24.75 mm(2), respectively. In the resorbable mesh group, the mean area of new bone formed was 46.76 +/- 21.22 mm(2). The amount of new bone formed in the control group was 29.80 +/- 9.35 mm(2). There was no significant difference in amount of bone formation between left and right sides (P = .3172). Resorbable meshes had significant soft tissue ingrowth (23.47 mm(2)) compared with macroporous mesh (16.96 mm(2)) and microporous mesh (22.29 mm(2)). Controls had the least amount of soft tissue ingrowth (9.41 mm(2)). Mineral apposition rate was found to be higher in the resorbable group (2.41 microm/day), and the rate was lowest (1.09 microm/day) in the large pore mesh group. CONCLUSION Macroporous membranes facilitated greater bone regeneration compared with microporous and resorbable membranes. Macroporous mesh also prevented significant soft tissue ingrowth compared with other meshes. Containment of a bone graft is the most critical parameter in successful bone regeneration. Cortical perforations did not have any effect on the quantity of regenerated bone. Further research should be directed toward identifying a critical pore size and manufacturing a reliable mesh that would prevent excessive soft tissue ingrowth in ridge augmentation procedures.

Bone Graft Harvesting from Regional Sites

Bone grafts are widely used in the reconstruction of osseous defects in the oral and maxillofacial region. Successful osseointegration of dental implants requires sufficient bone surrounding the implant. Although bone substitutes and augmentation techniques offer viable prognoses for achieving the required amount of hard tissue augmentation, autologous bone is the gold standard with regard to quantity, quality, and an uneventful healing. Autogenous bone grafts are generally obtained from the ilium, the rib, and the calvarium. Alternative sources for local harvesting in the mandible can be evaluated by careful clinical and radiographic examinations of the patient. This article discusses the various sources of grafts and the techniques used to harvest bone.

Cranial bone grafting and simultaneous implants: a submental technique to reconstruct the atrophic mandible

Results after treatment of severe maxillary and mandibular atrophy (Cawood classes V and VI) are often unsatisfactory and unpredictable. Reconstruction of such severely resorbed edentulous jaws represents a challenge. In maxillofacial surgery, bone grafts from the skull (split calvarial bone grafts) are commonly used for reconstruction of large bone defects of the midface. In the 1990s, various authors reported alveolar-ridge augmentation using calvarial bone grafts. This is the first report of its kind describing an extraoral approach for cranial bone grafting with simultaneous implant placement to the atrophic mandible.

Sjögren Syndrome: A Review for the Maxillofacial Surgeon

Sjögren syndrome is a multisystemic condition that predominantly involves the salivary and lacrimal glands. Also known as sicca complex, the disease often is underdiagnosed and poorly understood. This article provides a comprehensive review on Sjögren syndrome, with an emphasis on diagnosis and treatment modalities.