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Medicina Oral, Patologia Oral Y Cirugia... Jul 2010Cleft lip and palate is a congenital facial malformation with an established treatment protocol. Mixed dentition period is the best moment for correct maxillary bone...
OBJECTIVE
Cleft lip and palate is a congenital facial malformation with an established treatment protocol. Mixed dentition period is the best moment for correct maxillary bone defect with an alveoloplasty. The aim of this surgical procedure is to facilitate dental eruption, re-establish maxillary arch, close any oro-nasal communication, give support to nasal ala, and in some cases allow dental rehabilitation with osteointegrated implants.
STUDY DESIGN
Twenty cleft patients who underwent secondary alveoloplasty were included. In 10 of them autogenous bone graft were used and in other 10 autogenous bone and platelet-rich plasma (PRP) obtained from autogenous blood. Bone formation was compared by digital orthopantomography made on immediate post-operatory and 3 and 6 months after the surgery.
RESULTS
No significant differences were found between both therapeutic groups on bone regeneration.
CONCLUSION
We do not find justified the use of PRP for alveoloplasty in cleft patients' treatment protocol.
Topics: Alveoloplasty; Bone Regeneration; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Combined Modality Therapy; Female; Humans; Male; Platelet-Rich Plasma
PubMed: 20038881
DOI: 10.4317/medoral.15.e619 -
Progress in Orthodontics Dec 2019Maxillary incisor protrusion is a prevalent dental deformity and is often treated by upper incisor intrusion and retraction. The mechanical loading triggers the...
BACKGROUND
Maxillary incisor protrusion is a prevalent dental deformity and is often treated by upper incisor intrusion and retraction. The mechanical loading triggers the resorption and apposition of the bone. Alveolar bone remodeling is expected to follow orthodontic tooth movement in a one-to-one relationship. However, in many cases, the outcomes are different. Alveolar bone might still remain thick causing lip protrusion and other aesthetic problems after treatment. Additional corrective procedures such as alveoloplasty. On the other hand, if the labial bone becomes too thin, periodontal problems like gingival recession might occur. The unpredictability of the treatment result and the risk of requiring corrective procedures pose significant challenges to both the providers and patients. The aim of this study is to determine factors that can help to predict the alveolar bone reaction before maxillary incisor intrusion and retraction.
METHODS
The cohort included 34 female patients (mean age 25.8 years) who were diagnosed with skeletal class II malocclusion with upper incisor protrusion. These patients underwent extraction and orthodontic treatment with upper incisor intrusion and retraction. Lateral cephalograms at pre-treatment and post-treatment were taken. Linear and angular measurements were analyzed to evaluate the alveolar bone changes based on initial conditions.
RESULTS
The study found that the relative change, calculated as change in alveolar bone thickness after treatment divided by the initial alveolar thickness, was inversely correlated with the initial thickness. There was a significant increase of labial alveolar bone thickness at 9-mm apical from cementoenamel junction (B3) (P < 0.05) but no statistically significant change in the thickness at other levels. In addition, the change in angulation between the incisor and alveolar bone was inversely correlated with several initial angulations: between the initial palatal plane and upper incisor angle, between the initial palatal plane and upper incisor labial surface angle, and between the initial palatal plane and bone labial surface angle. On the other hand, the change in labial bone thickness was neither significantly correlated with the initial thickness nor significantly correlated to the amount of retraction.
CONCLUSION
The unpredictability of alveolar bone remodeling after upper incisor intrusion and retraction poses significant challenges to treatment planning and patient experience. The study showed that the initial angulation between the incisor and alveolar bone is correlated with the change in angulation after treatment, the initial thickness of the alveolar bone was correlated with the relative change of the alveolar bone thickness (defined as change in thickness after treatment divided by its initial thickness), and the amount of intrusion was correlated with the alveolar bone thickness change at 9-mm apical from the cementoenamel junction after treatment. The results of the present study also revealed that the change in labial alveolar bone thickness was neither significantly correlated with the initial thickness nor significantly correlated to the amount of retraction.
Topics: Adult; Bone Remodeling; Cephalometry; Esthetics, Dental; Female; Humans; Incisor; Maxilla; Tooth Movement Techniques
PubMed: 31867679
DOI: 10.1186/s40510-019-0300-2 -
Journal of Dental Anesthesia and Pain... Dec 2015A majority of patients who sustain injuries to the peripheral sensory nerves of the face and jaws experience a slow but gradual return of sensation that is functional...
A majority of patients who sustain injuries to the peripheral sensory nerves of the face and jaws experience a slow but gradual return of sensation that is functional and tolerable, if not the same as before the injuries. However, long-term effects of such injuries are aggravating for many patients, and a few patients experience significant suffering. In some of these patients, posttraumatic symptoms become pathological and are painful. The predominant painful components are (1) numbing anesthesia dolorosa pain, (2) triggered neuralgiaform pain, (3) burning and aching causalgiaform pain, and (4) phantom pain. This is a case report of conservative management of traumatic neuralgia and neuritis as part of posttraumatic pain syndromes in geriatric patients who have undergone the teeth extraction and alveoloplasty.
PubMed: 28879286
DOI: 10.17245/jdapm.2015.15.4.241 -
Nigerian Journal of Clinical Practice Jul 2022Bone reduction and shelf preparation is a common procedure to establish a new alveolar plane before implant surgery, which might effect the primary stability.
BACKGROUND
Bone reduction and shelf preparation is a common procedure to establish a new alveolar plane before implant surgery, which might effect the primary stability.
AIM
Primary stability was questioned in terms of bone reduction and shelf preparation. The suitability of immediate loading was compared between the implants placed on crests, which underwent alveoloplasty, and the implants placed on a naturally healed alveolar bone.
PATIENTS AND METHODS
We designed and implemented a retrospective cohort study. Twenty patients (mean age 49.2 years) were treated with 160 dental implants. The primary predictor variable was extraction and bone reduction. The secondary predictor variables were bone density and the implant surface. The outcome variables were resonance frequency analysis (RFA) and insertion torque (IT) values.
RESULTS
There was no statistically significant difference between groups regarding RFA and IT (P > 0,05). Interactions of surface area with the RFA and IT in both groups were not statistically significant; however, bone density presented a statistically significant effect on outcome variables for both groups.
CONCLUSION
IT and RFA are not influenced by bone reduction, shelf preparation, or the implant surface. Primary stability is mostly affected by bone density in the immediate load of 4 implants to support a full-arch prosthesis.
Topics: Bone Screws; Dental Prosthesis; Humans; Maxilla; Middle Aged; Retrospective Studies; Torque
PubMed: 35859469
DOI: 10.4103/njcp.njcp_1630_21 -
Clinical Oral Investigations Jun 2011The alveolar cleft in patients with clefts of lip, alveolus and palate (CLAP) is usually reconstructed with an autologous bone graft. Harvesting of autologous bone... (Review)
Review
Reconstruction of the alveolar cleft: can growth factor-aided tissue engineering replace autologous bone grafting? A literature review and systematic review of results obtained with bone morphogenetic protein-2.
The alveolar cleft in patients with clefts of lip, alveolus and palate (CLAP) is usually reconstructed with an autologous bone graft. Harvesting of autologous bone grafts is associated with more or less donor site morbidity. Donor site morbidity could be eliminated if bone is fabricated by growth factor-aided tissue engineering. The objective of this review was to provide an oversight on the current state of the art in growth factor-aided tissue engineering with regard to reconstruction of the alveolar cleft in CLAP. Medline, Embase and Central databases were searched for articles on bone morphogenetic protein 2 (BMP-2), bone morphogenetic protein 7, transforming growth factor beta, platelet-derived growth factor, insulin-like growth factor, fibroblast growth factor, vascular endothelial growth factor and platelet-rich plasma for the reconstruction of the alveolar cleft in CLAP. Two-hundred ninety-one unique search results were found. Three articles met our selection criteria. These three selected articles compared BMP-2-aided bone tissue engineering with iliac crest bone grafting by clinical and radiographic examinations. Bone quantity appeared comparable between the two methods in patients treated during the stage of mixed dentition, whereas bone quantity appeared superior in the BMP-2 group in skeletally mature patients. Favourable results with BMP-2-aided bone tissue engineering have been reported for the reconstruction of the alveolar cleft in CLAP. More studies are necessary to assess the quality of bone. Advantages are shortening of the operation time, absence of donor site morbidity, shorter hospital stay and reduction of overall cost.
Topics: Alveolar Process; Alveoloplasty; Bone Density; Bone Morphogenetic Protein 2; Bone Morphogenetic Proteins; Bone Transplantation; Cleft Lip; Cleft Palate; Collagen Type I; Humans; Mesoderm; Osteogenesis; Recombinant Proteins; Tissue Engineering; Tissue Scaffolds; Transforming Growth Factor beta
PubMed: 21465220
DOI: 10.1007/s00784-011-0547-6 -
Journal of Pharmacy & Bioallied Sciences Jun 2021Dental treatment in patients on antiplatelet drug therapy is a long standing debate. Discontinuation of medication increases the risk of thrombotic complications,...
BACKGROUND
Dental treatment in patients on antiplatelet drug therapy is a long standing debate. Discontinuation of medication increases the risk of thrombotic complications, whereas continuation leads to increased postoperative bleeding.
AIM
We conducted this prospective cross-sectional study to assess risk of bleeding in patients continuing antiplatelet medication while performing minor oral surgical procedures such as single or multiple teeth extraction, transalveolar extraction of third molar, biopsy, and alveoloplasty.
MATERIALS AND METHODS
We calibrated the steps taken to achieve hemostasis, time taken to arrest bleeding, and correlated time taken to achieve hemostasis in patients under antiplatelet drug therapy (Group A [n = 64] - aspirin, Group B [n = 36] - aspirin and clopidogrel) and in patients without any drug therapy (Group C [n = 100] healthy patients).
RESULTS
Out of 200 patients, Level 1 hemostatic measures were required for 129 (64.5%) patients, Level 2 hemostatic measures were taken for 68 (34.0%) patients, and Level 3 hemostatic measures were taken for 3 (1.5%) patients. Chi-square test conducted to compare the local hemostatic measures taken for minor oral surgical procedure for all groups was statistically significant ( ≤ 0.001).
CONCLUSION
Overall, there was no postoperative bleeding within 24 h of extraction in any patient group. In conclusion, surgical procedures can be safely accomplished in patients receiving single or dual antiplatelet therapy when appropriate local hemostatic measures are taken.
PubMed: 34447048
DOI: 10.4103/jpbs.JPBS_554_20 -
Journal of Prosthodontics : Official... Mar 2021Fabricating an immediate complete denture can be very challenging in some clinical situations. This clinical report describes a digital workflow to fabricate a printed...
Fabricating an immediate complete denture can be very challenging in some clinical situations. This clinical report describes a digital workflow to fabricate a printed maxillary immediate complete denture for a patient with a severely compromised maxilla. Digital data obtained by using an intraoral scanner was utilized to reconstruct the three-dimensional (3D) image of the jaws at the desirable vertical dimension of occlusion. After performing the virtual teeth extraction and alveoloplasty, the denture base and teeth were designed. The resulting data were exported to a 3D printer for denture fabrication and the 3D printed (additively manufactured) denture was successfully inserted immediately after the surgery. After initial healing and confirmation of good retention and function, a new printed denture was fabricated by digitally duplicating the relined denture maintaining the same teeth positions but adjusting the base to a new intraoral scan of the healed ridge.
Topics: Computer-Aided Design; Dental Occlusion; Denture, Complete; Denture, Complete, Immediate; Humans; Maxilla; Printing, Three-Dimensional; Rhabdomyosarcoma
PubMed: 33325048
DOI: 10.1111/jopr.13305 -
Australian Dental Journal Jun 2003The contemporary treatment of cleft lip and palate involves a sequence of surgical procedures and orthodontic management. Alveolar bone grafting (ABG) is usually...
BACKGROUND
The contemporary treatment of cleft lip and palate involves a sequence of surgical procedures and orthodontic management. Alveolar bone grafting (ABG) is usually undertaken after orthodontic expansion of the maxillary segments between the ages of eight and 12 years. Two of the important goals of alveolar bone grafting are the provision of bony support for the eruption of the canine and the closure of residual oro-nasal fistulae. The purpose of this study was to retrospectively evaluate the root development and eruption of the canine following ABG.
METHODS
Group 1: radiographic and clinical records of a sample of 19 cleft patients who underwent alveolar bone grafting procedures, performed between 1996 and 1999 were reviewed. Group 2: a random sample of 15 cleft patients attending for routine dental review were clinically examined. The age of patient, degree of root development and eruption status of the canine, and presence of oronasal fistulae pre and post alveolar bone grafting were evaluated.
RESULTS
Most cleft canines had continued root development and descended in the alveolus towards eruption following ABG. Four canine teeth (8 per cent) were impacted and required surgical exposure and orthodontic treatment following failure of eruption. Closure of anterior oro-nasal fistulae at the time of grafting was maintained post-operatively.
CONCLUSIONS
This study demonstrated that canine root development and eruption continued satisfactorily through grafted alveolar clefts in most cases and closure of anterior oro-nasal fistulae was achieved in all cases.
Topics: Adolescent; Age Factors; Alveoloplasty; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Cuspid; Female; Humans; Incisor; Male; Nose Diseases; Odontogenesis; Oral Fistula; Respiratory Tract Fistula; Retrospective Studies; Tooth Eruption; Tooth Root; Tooth, Impacted
PubMed: 14649402
DOI: 10.1111/j.1834-7819.2003.tb00020.x -
The Angle Orthodontist 1996Grafting of the alveolar ridge with autogenous bone is an integral stage of contemporary management of complete cleft lip and palate cases. Alveolar bone grafting... (Review)
Review
Grafting of the alveolar ridge with autogenous bone is an integral stage of contemporary management of complete cleft lip and palate cases. Alveolar bone grafting restores continuity of the dental arch, closes oronasal fistulae, supports the alar base, and facilitates spontaneous eruption of permanent teeth adjacent to the cleft. However, timing of the graft and the selection of materials have been topics of much debate in the literature. This article discusses an alternative donor site in cases where rehabilitation has passed the recommended time. Harvesting bone from the third molar regions allows not only the removal of impacted third molars during the same surgical procedure, but also eliminates the morbidity associated with additional surgical sites such as the ilium or mandibular symphysis. This report should not be interpreted as a recommendation for the use of this alternative site in cases where grafting is carried out within the optimal time period, which is usually in the mixed dentition stage. However, when grafting is necessary in young adults suffering from complete cleft lip and palate, the third molar region may provide another acceptable donor site.
Topics: Adolescent; Adult; Alveolectomy; Alveoloplasty; Bone Transplantation; Cleft Lip; Cleft Palate; Female; Humans; Lip; Molar, Third; Nose; Palate; Tooth Extraction; Tooth, Impacted
PubMed: 8678350
DOI: 10.1043/0003-3219(1996)066<0009:ADSFAB>2.3.CO;2 -
Mediators of Inflammation 2015Chronic periodontitis is a multifactorial inflammatory disease that affects supporting structures of the teeth. Although the gingival response is largely described,...
Chronic periodontitis is a multifactorial inflammatory disease that affects supporting structures of the teeth. Although the gingival response is largely described, little is known about the immune changes in the alveolar bone and neighboring tissues that could indicate periodontal disease (PD) activity. Then, in this study we identified the ongoing inflammatory changes and novel biomarkers for periodontitis in the tissues directly affected by the destructive disease in PD patients. Samples were collected by osteotomy in 17 control subjects during extraction of third molars and 18 patients with advanced PD, in which alveoloplasty was necessary after extraction of teeth with previous extensive periodontal damage. Patients presented mononuclear cells infiltration in the connective tissue next to the bone and higher fibrosis area, along with increased accumulation of IL-17(+) and TRAP(+) cells. The levels of TNF-α and MMP-2 mRNA were also elevated compared to controls and a positive and significant correlation was observed between TNF-α and MMP-2 mRNA expression, considering all samples evaluated. In conclusion, nongingival tissues neighboring large periodontal pockets present inflammatory markers that could predict ongoing bone resorption and disease spreading. Therefore, we suggested that the detailed evaluation of these regions could be of great importance to the assessment of disease progression.
Topics: Adult; Biomarkers; Chronic Periodontitis; Female; Humans; Interleukin-17; Male; Matrix Metalloproteinase 2; Middle Aged; RNA, Messenger; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha
PubMed: 26063981
DOI: 10.1155/2015/983782