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Journal of Periodontology Mar 2015Mineralized and demineralized freeze-dried bone allografts (FDBAs) are used in alveolar ridge (AR) preservation; however, each material has advantages and disadvantages.... (Comparative Study)
Comparative Study Randomized Controlled Trial
Histologic healing following tooth extraction with ridge preservation using mineralized versus combined mineralized-demineralized freeze-dried bone allograft: a randomized controlled clinical trial.
BACKGROUND
Mineralized and demineralized freeze-dried bone allografts (FDBAs) are used in alveolar ridge (AR) preservation; however, each material has advantages and disadvantages. Combinations of allografts aimed at capitalizing on the advantages each offers are available. To date, there is no evidence to indicate if a combination allograft is superior in this application. The primary objective of this study is to histologically evaluate and compare healing of non-molar extraction sites grafted with either mineralized FDBA or a 70:30 mineralized:demineralized FDBA combination allograft in AR preservation. The secondary objective is to compare dimensional changes in ridge height and width after grafting with these two materials.
METHODS
Forty-two patients randomized into two equal groups received ridge preservation with either 100% mineralized FDBA (active control group) or the combination 70% mineralized: 30% demineralized allograft (test group). Sites were allowed to heal for 18 to 20 weeks, at which time core biopsies were obtained and dental implants were placed. AR dimensions were evaluated at the time of extraction and at implant placement, including change in ridge width and change in buccal and lingual ridge height. Histomorphometric analysis was performed to determine percentage of vital bone, residual graft, and connective tissue/other non-bone components.
RESULTS
There was no significant difference between groups in AR dimensional changes. Combination allograft produced increased vital bone percentage (36.16%) compared to the FDBA group (24.69%; P = 0.0116). The combination allograft also had a significantly lower mean percentage of residual graft particles (18.24%) compared to FDBA (27.04%; P = 0.0350).
CONCLUSIONS
This study provides the first histologic evidence showing greater new bone formation with a combination mineralized/demineralized allograft compared to 100% mineralized FDBA in AR preservation in humans. Combination allograft results in increased vital bone formation while providing similar dimensional stability of the AR compared to FDBA alone in AR preservation.
Topics: Adult; Aged; Aged, 80 and over; Allografts; Alveolar Process; Alveolar Ridge Augmentation; Alveoloplasty; Biopsy; Bone Transplantation; Connective Tissue; Female; Freeze Drying; Humans; Male; Membranes, Artificial; Middle Aged; Osteocytes; Osteogenesis; Tissue Preservation; Tooth Extraction; Tooth Socket; Wound Healing; Young Adult
PubMed: 25415247
DOI: 10.1902/jop.2014.140483 -
Revue de Stomatologie, de Chirurgie... Nov 2014
Topics: Adolescent; Alveolar Process; Alveoloplasty; Child; Child, Preschool; Cleft Lip; Cleft Palate; Humans; Infant; Maxillofacial Abnormalities; Terminology as Topic
PubMed: 25241078
DOI: 10.1016/j.revsto.2014.08.001 -
The Journal of Prosthetic Dentistry Nov 2014This clinical report describes the fabrication of a maxillary complete removable dental prosthesis with the swing lock system. The patient presented with large undercuts...
This clinical report describes the fabrication of a maxillary complete removable dental prosthesis with the swing lock system. The patient presented with large undercuts on the buccal and labial areas of the edentulous maxillary arch and a history of various failed alveoloplasty procedures that had attempted to remove the exostoses preventing denture insertion. The prosthodontic planning and treatment approach are discussed.
Topics: Aged; Alveoloplasty; Contraindications; Denture Bases; Denture Design; Denture Retention; Denture, Complete, Upper; Exostoses; Follow-Up Studies; Humans; Male; Maxillary Diseases; Patient Care Planning
PubMed: 25086480
DOI: 10.1016/j.prosdent.2014.05.025 -
Journal of Cranio-maxillo-facial... Dec 2014Few publications have described the flap design of the secondary cleft alveoloplasty. In this article we describe a modified technique of the classical flap design with...
BACKGROUND
Few publications have described the flap design of the secondary cleft alveoloplasty. In this article we describe a modified technique of the classical flap design with the purpose of minimizing injury to the dental papillae and periodontium of the involved dentition. We report our long-term experience, specifically with regards to oronasal fistulae recurrence, wound healing and graft exposure and loss.
METHODS
All the patients were operated on using the same technique by a single surgeon. A total of 148 clefts have been operated with this approach, involving 117 patients with complete cleft lip and palate with a follow-up between 12 and 240 months.
RESULTS
The most important finding in this study is the excellent wound healing observed in almost all patients. Only three patients (2%) suffered a dehiscence with oronasal fistulae recurrence and bone loss. Another patient lost the graft without fistula recurrence. Minor dehiscence with partial bone loss occurred in 4 patients (2.7%). These patients did not need surgical closure and only superficial exposed bone particles were lost without compromising the clinical outcome.
CONCLUSIONS
Our modification presents a flap design that is easy to elevate and mobilize, without disturbing the buccal sulcus or the gingival inter-dental papillae.
Topics: Adolescent; Adult; Alveoloplasty; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Gingivoplasty; Graft Survival; Humans; Longitudinal Studies; Male; Mouth Mucosa; Nasal Mucosa; Nose Diseases; Oral Fistula; Postoperative Complications; Recurrence; Respiratory Tract Fistula; Retrospective Studies; Surgical Flaps; Surgical Wound Dehiscence; Treatment Outcome; Wound Healing; Young Adult
PubMed: 25012646
DOI: 10.1016/j.jcms.2014.06.001 -
The Cleft Palate-craniofacial Journal :... Nov 2014Introduction : The benefits or otherwise of late palate repair in older children or adults are uncertain. The outcomes, particularly without appropriate speech therapy,...
International confederation for cleft lip and palate and related craniofacial anomalies task force report: palatoplasty in the speaking individual with unrepaired cleft palate.
Introduction : The benefits or otherwise of late palate repair in older children or adults are uncertain. The outcomes, particularly without appropriate speech therapy, are often disappointing. The issue is of special importance in the poorer countries where these patients are most commonly seen and where limited capacity and facilities may have to be rationed. Method : A task force was set up to report back to the International Congress in Orlando in May 2013. The chairman and some members were nominated by the organizers and further members were added during the discussion process. Some of the members had considerable experience of late palate repair. The task force compiled a report after 9 months of e-mail correspondence. The report includes reports of some previously unpublished studies. A summary of the report was presented at Cleft 2013 in Orlando. Conclusions : There was a general consensus that late palate repair is of benefit for many patients and that, even if normal speech is not attained, outcomes are positive. Outcomes depend on the age of the patient (the younger the better), on the skill of the surgeon and, ideally, on the availability of appropriate speech therapy. A protocol for a prospective international multi-center study is proposed.
Topics: Adolescent; Adult; Advisory Committees; Age Factors; Alveoloplasty; Child; Cleft Lip; Cleft Palate; Congresses as Topic; Humans; Internationality; Speech Disorders; Speech Therapy
PubMed: 25007031
DOI: 10.1597/14-124 -
Journal of Cranio-maxillo-facial... Dec 2014Among numerous techniques that have been described for lip repair, the Tennison-Randall method has gained popularity over time and is preferred by many surgeons due to...
A retrospective evaluation of the aesthetics of the nasolabial complex after unilateral cleft lip repair using the Tennison-Randall technique: a study of 44 cases treated in a single cleft center.
INTRODUCTION
Among numerous techniques that have been described for lip repair, the Tennison-Randall method has gained popularity over time and is preferred by many surgeons due to the predictability of the outcome. This study aims to evaluate the esthetic outcome reached in the nasolabial region following primary lip repair with the use of this method.
MATERIALS AND METHODS
Forty-four patients with unilateral cleft lip (with or without alveolar cleft) were assessed retrospectively through a photographic evaluation by two clinicians with regard to the aesthetics of the lip and nose separately as anatomical subunits as well as of the nasolabial region as an anatomical complex. The collected data were statistically analyzed with regard to the cleft subtype and the performance of corrective surgeries for the lip and/or the nose.
RESULTS
The method was associated with good results, especially when it comes to the appearance of the nose as an anatomical subunit, as well as of the nasolabial region as a complex, regarding cleft lip patients without an alveolar cleft.
CONCLUSION
The Tennison-Randall technique proved to be a very satisfying method in terms of the esthetic long-term outcome in our patient collective.
Topics: Alveolar Process; Alveoloplasty; Child; Child, Preschool; Cicatrix; Cleft Lip; Esthetics; Female; Follow-Up Studies; Humans; Lip; Male; Maxilla; Nasal Bone; Nasal Cartilages; Nose; Photography; Plastic Surgery Procedures; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 24962045
DOI: 10.1016/j.jcms.2014.05.013 -
Journal of Cranio-maxillo-facial... Sep 2014This article describes four new methods as the last resort for reconstruction of the nasal floor in difficult-to-repair alveolar cleft patients, including bone suture...
AIM
This article describes four new methods as the last resort for reconstruction of the nasal floor in difficult-to-repair alveolar cleft patients, including bone suture technique, vascularized interpositional periosteal-connective tissue flap from the palate (VIP-CT flap), anteriorly based inferior turbinate flap, and skinless subcutaneous nasolabial flap, with emphasis on indications and limitations.
METHODS
In a retrospective study, data were obtained from 214 patients referred to the Department of Oral and Maxillofacial Surgery, Mashhad Dental School, Iran, for alveolar cleft bone grafting in 2004-2013. Eighteen patients had been treated using special techniques other than direct suturing for reconstruction of the nasal floor during alveolar cleft bone grafting.
RESULTS
Eighteen patients had been treated using these techniques as the last resort for nasal floor reconstruction; including bone suture technique (50%), inferior turbinate flap (33.3%), VIP-CT flap (11.2%) and nasolabial flap (5.5%). All the patients had a unilateral alveolar cleft, 72.2% of which were located on the left side and 44.5% of the patients were female.
CONCLUSION
Nasal floor reconstruction in 8.4% of alveolar cleft patients needed special techniques and flaps.
Topics: Adolescent; Alveolar Bone Grafting; Alveoloplasty; Child; Cleft Palate; Connective Tissue; Female; Humans; Male; Nasal Cavity; Nasal Mucosa; Periosteum; Plastic Surgery Procedures; Retrospective Studies; Subcutaneous Tissue; Surgical Flaps; Suture Techniques; Turbinates; Young Adult
PubMed: 24842723
DOI: 10.1016/j.jcms.2014.01.022 -
The Journal of Oral Implantology Feb 2016
Topics: Alveolar Process; Alveoloplasty; Bone Transplantation; Follow-Up Studies; Humans; Tooth
PubMed: 24773149
DOI: 10.1563/aaid-joi-D-14-00042 -
The Cleft Palate-craniofacial Journal :... Nov 2015The aim of this study is to describe the prevalence of obstructive sleep apnea (OSA) and its level of severity associated with Orticochea pharyngoplasty in patients with...
BACKGROUND AND PURPOSE
The aim of this study is to describe the prevalence of obstructive sleep apnea (OSA) and its level of severity associated with Orticochea pharyngoplasty in patients with velopharyngeal insufficiency after at least 1 year of the surgical procedure.
DESIGN
Case series prospective descriptive study.
MAIN OUTCOME MEASURES
At FISULAB, a rehabilitation center for patients with cleft palate, we studied 37 patients who were treated elsewhere with Orticochea pharyngoplasty for velopharyngeal insufficiency; these patients may or may not have had clinical symptoms related to OSA. All participants underwent a polysomnography sleep study, which was also done in different institutions. We applied the Epworth Sleepiness Scales during the clinical investigation because it is an effective instrument used to measure average daytime sleepiness. Another questionnaire to identify cases of OSA was used. Among other variables studied, the apnea/hypopnea index was the main outcome, while age and type of cleft were secondary variables.
RESULTS
From 37 patients who were studied (100%), we obtained the following results: normal apnea/hypopnea index: seven patients (18.9%); mild apnea/hypopnea index: 14 patients (37.8%); moderate apnea/hypopnea index: eight patients (21.6%); and severe apnea/hypopnea index: eight patients (21.6%).
CONCLUSIONS
In this study, we found that more than three quarters (81%) of the patients who were treated for velopharyngeal insufficiency with Orticochea pharyngoplasty presented obstructive sleep apnea when analyzing the apnea/hypopnea index in the polysomnography sleep study.
Topics: Adolescent; Adult; Alveoloplasty; Cleft Palate; Female; Humans; Male; Oral Surgical Procedures; Pharynx; Polysomnography; Prevalence; Prospective Studies; Plastic Surgery Procedures; Severity of Illness Index; Sleep Apnea, Obstructive; Surveys and Questionnaires; Velopharyngeal Insufficiency
PubMed: 23952561
DOI: 10.1597/12-049