Shoko Kochi

Use of endosseous implants for dental reconstruction of patients with grafted alveolar clefts

PURPOSE The purpose of this study was to investigate the clinical application of endosseous implants placed into grafted alveolar clefts and to evaluate the short-term outcome. PATIENTS AND METHODS Nineteen patients (6 males and 13 females; mean age, 17.9 years; range, 9.7 to 33.6 years at first implant surgery), including 11 with unilateral cleft lip and palate, and eight with unilateral cleft lip and alveolus, were studied. All patients except for one who underwent periosteoplasty received grafts of autogenous particulate cancellous bone and marrow (PCBM) obtained from the llium. After bone bridge formation, orthodontic treatment and preparation for implant placement were performed. RESULTS A total of 21 implants were placed in the bone-grafted alveoli of the 19 patients. The most frequently used length was 15 mm. In five patients with insufficient alveolar bone height, a chin bone onlay graft was combined with simultaneous implant insertion. The follow-up period ranged from 1 year to almost 3 years after implant placement, and the clinical outcome was excellent in all except one patient. In this short-term study, the overall survival rate was 90.5%. CONCLUSION The grafted alveoli were well suited to the placement of endosseous implants, and this treatment was shown to be a viable option for the dental reconstruction of alveolar clefts. However, the interdental alveolar bone height was insufficient for implant installation in a few patients. Further longitudinal studies are required to determine the optimal timing between secondary bone grafting and implant placement.

Surgical Repositioning of the Premaxilla in Combination with Two-Stage Alveolar Bone Grafting in Bilateral Cleft Lip and Palate

OBJECTIVE This paper introduces a surgical technique for premaxillary repositioning in combination with two-stage alveolar bone grafting for the correction of the premaxillary deformity of patients with bilateral cleft lip and palate (BCLP). The paper also reports on two patients with BCLP who underwent this surgical management. SURGICAL PROCEDURE The operation is usually performed when the patient is 8 to 14 years of age. In the first stage of surgery, the side more accessible to the septo-premaxillary junction is selected, and an osteotomy of the premaxilla and unilateral alveolar bone grafting are performed. Approximately 4 to 12 months after the first stage of surgery, contralateral alveolar bone grafting is carried out. CONCLUSION We have found that this surgical procedure is highly effective, because it ensures the blood supply to the premaxilla and minimizes the potential for surgical failure. Moreover, it affords wide exposure of the premaxillary bone surface, facilitating sufficient boney bridging and allowing for orthodontic tooth movement.

Placement of endosteal implants combined with chin bone onlay graft for dental reconstruction in patients with grafted alveolar clefts

Endosteal implants were inserted into grafted alveoli after particulate cancellous bone and marrow grafting in seven patients with cleft lip or palate in conjunction with simultaneous chin bone onlay grafting. In these patients, the alveolar bone height of the bony bridge was insufficient when evaluated by both computed tomographic and periapical radiographic images. The age at first implant surgery ranged from 14 to 28 years. Although four of the seven patients had an uneventful course, three had wound dehiscence, and in all but one of them the exposed chin bone underwent partial or total necrosis. Ultimately all seven implants integrated into the bone, and the alveolar bone height was increased in all but one patient. The results indicate that chin bone onlay grafting with simultaneous implant insertion is useful in patients with cleft lip or palate with insufficient alveolar bone height.

Midfacial Changes Through Distraction Osteogenesis Using a Rigid External Distraction System With Retention Plates in Cleft Lip and Palate Patients

PURPOSE The purpose of this study was to investigate the changes in and stability of the maxilla and soft tissue profile achieved after the application of distraction osteogenesis (DO) by use of rigid external distraction (RED) with a retention plate system in unilateral cleft lip and palate (UCLP) adult patients. We compared 2 treatment methods in the management of maxillary hypoplasia: Le Fort I osteotomy and DO. MATERIALS AND METHODS Six UCLP adult patients who underwent treatment with the RED retention plate system were examined (DO group). Changes in the positions of soft and hard tissue landmarks were calculated from lateral cephalograms taken before distraction, at the removal of the halo, and 1 year after surgery and were compared with those in 7 other UCLP patients who underwent Le Fort I osteotomy (LF1 group). RESULTS The mean maxillary advancement was significantly larger in the DO group than in the LF1 group after distraction. During the follow-up period, the relapse rate of the maxilla was significantly smaller in the DO group. An undesirable labial inclination of the upper incisors was found in the LF1 group, which may have been due to relapse. The DO group tended to have a higher soft tissue-to-hard tissue anterior movement ratio from the time of distraction to follow-up. CONCLUSIONS The RED retention plate system improved the midfacial profile by advancement of soft and hard tissue and minimized the risk of injury to the upper lip. Using the RED system with retention plates prevented the undesirable labial inclination of upper incisors that was found in the LF1 group.

Use of an Osseointegrated Implant for Dental Rehabilitation after Cleft Repair by Periosteoplasty: A Case Report

OBJECTIVE We report here on a patient with unilateral cleft lip and alveolus who underwent dental rehabilitation of cleft alveolus using an osseointegrated implant after cleft repair by periosteoplasty. The patient, whose lateral incisor was congenitally missing, had periosteoplasty, followed by excellent bone formation at the cleft alveolus within 2 years. After the completion of orthodontic alignment of the maxillary dental arch, a Brånemark single-tooth implant was placed into the bone-formed alveolus. CONCLUSION This treatment procedure offers an option of dental rehabilitation for the alveolar clefts of patients with cleft lip and/or palate.

Long-term follow-up of dental implants placed in a grafted alveolar cleft: evaluation of alveolar bone height

OBJECTIVE The purpose of this study was to evaluate the long-term follow-up of dental implants placed in the grafted alveoli of patients with cleft lip or palate clinically. PATIENTS AND METHODS Sixteen patients (8 males and 8 females) who had dental implants placed in alveoli grafted using particulate cancellous bone and marrow (PCBM) from the iliac crest were evaluated. The marginal bone level around the implant was evaluated radiologically at 1 (stage I), 3 (stage II), and 6 years (stage III) after connecting the abutment. The interdental alveolar bone height (IABH) was also evaluated radiologically for up to 6 years. RESULTS During the follow-up period of an average of 8.6 +/- 0.6 years (range: 7.2 to 9.4 years), only 2 implants were lost in 1 patient, the cumulative survival rate was 90.9%, and the clinical outcome was uneventful in all implants. The marginal bone levels around the implants were 0.29 +/- 0.18, 0.29 +/- 0.19, and 0.28 +/- 0.15 mm at stages I to III, respectively. Moreover, IABH was reduced only in 2 of 16 (12.5%) of the implant-placed grafted alveoli, and was maintained after implant placement for up to 6 years. CONCLUSIONS These findings indicate that the use of dental implants placed in grafted alveoli is beneficial for maintenance of the grafted bone in patients undergoing secondary bone grafting for cleft repair.

Treatment of Hypoglossia-Hypodactyly Syndrome without Extremity Anomalies

Three cases of hypoglossia-hypodactyly syndrome without limb deformities are reported. All exhibited different degrees of tongue hypoplasia, micrognathia, retrognathia with a very narrow space between the left and right halves of the mandible, constricted isthmus, and only one lower incisor. Bone lengthening for the midline mandibular hypoplasia and orthodontic treatment were performed in the three cases with satisfactory results.

Characteristics of nonverbal behavior in patients with cleft lip and palate during interpersonal communication

OBJECTIVE This study examined characteristics of nonverbal behavior that patients with cleft lip and palate (CLP) presented during interpersonal communication. DESIGN This was a case-control design comparing nonverbal behavior of adult women with CLP with females without CLP. PARTICIPANTS Subjects were 20 adult women with CLP and 20 noncleft control women matched for age and educational experience. MAIN OUTCOME MEASURES Subject gestures and facial expressions were videotaped during interviews and analyzed with a computer-based kinematic measurement system. RESULTS The clinical group displayed significantly fewer head movements and a lower smile frequency than the control group. Furthermore, head and hand movements and smiles were less coordinated or congruent for the subjects with CLP than for the comparison group. CONCLUSIONS Even slight facial disfigurement could have a harmful effect on communication behavior in female patients with CLP.

Bone graft in alveolar cleft with autogenous particulate cancellous bone

This study was undertaken to estimate the interdental alveolar bone height in regions undergoing bone grafts, and to determine what factors were correlated with the prognosis of the bone graft. A total of 120 alveolar clefts in 107 patients were studied. The alveolar clefts received grafts of autogenous particulate cancellous bone obtained from the iliac bone. The cases were documented by periapical radiographs taken before bone grafting and between 12-18 months after grafting. Successful bone formation (i.e., an interdental alveolar bone height of the grafted portion measuring more than 3/4 of the root length of the upper central incisor adjacent to the cleft), was observed in 70.8% of all clefts. The rate of successful bone formation was significantly higher in the group in which the bone graft was performed at less than ten years old than that in the older group. Unfavorable results were found at a significantly higher rate in cases in which the average width of the alveolar cleft was more than 11 mm. Thus, the age at the time of bone grafting, or the width of the alveolar cleft was definitely shown to affect the prognosis of the bone graft in the alveolar cleft. The eruption stage of the canine on the cleft side, or the cleft type, tended to be related to whether the interdental alveolar bone height was formed successfully or not.

Rigid external distraction using skeletal anchorage to cleft maxilla united with alveolar bone grafting.

Objective Documentation of the application of maxillary distraction osteogenesis using rigid external distraction (RED) with skeletal anchorage combined with predistraction alveolar bone grafting (ABG) in cleft maxilla. Design Case report. Patient A patient with numerous congenital missing teeth and severe maxillary deficiency related to complete bilateral cleft lip and palate with large alveolar bone defect. Intervention The patient received preoperative orthodontic treatment, predistraction ABG, and maxillary distraction osteogenesis using RED with skeletal anchorage. Results Predistraction ABG completely united the cleft maxilla. The united maxilla was successfully advanced by the RED system with skeletal anchorage, despite unsound dentition with numerous congenital missing teeth. Conclusion The present study demonstrates that the combination of predistraction ABG and RED system with skeletal anchorage is effective for the treatment of severe maxillary deficiency related to complete bilateral cleft lip and palate with large bone defect and numerous congenital missing teeth.