Bone grafting and insertion of dental implants followed by Le Fort advancement for correction of severely atrophic maxilla in young patients

Mandibular propulsion and dental implant rehabilitation for an edentulous patient with class II malocclusion and severe obstructive sleep apnea

Introduction: Orthognathic surgery can be a treatment for occlusal, oro-facial functional disorders and esthetics discrepancies as well as for obstructive sleep apnea. It is often practiced after an orthodontic preparation, but in edentulous patients, the preparation can be replaced with implant supported prosthesis to simulate the final occlusion. Observation: A patient presenting severe obstructive sleep apnea, vertical and sagittal insufficiency of the lower third of the face and poor dental health was treated with a guided mandibular advancement and an almost complete implant supported prosthesis rehabilitation. At first, the implants were placed and immediately loaded, giving the patient a class 2 occlusion. Then, an orthognathic surgery was performed, giving the patient a class 1 occlusion, and then the final prosthesis was made. Commentaries: The interest of this case is the combined treatment of the obstructive sleep apnea, the dental and facial deformities by mandibular retrognathia and the edentulous jaws. The gold standard for obstructive sleep apnea is a maxillary and mandibular advancement. In this case, for esthetic and anatomic reasons, a mandible propulsion alone has been performed, showing a positive and stable result for the treatment of obstructive sleep apnea. The use of surgical guide permitted to plan the treatment with more accuracy. Conclusion: This case combines a fixed prosthetic rehabilitation, which permitted to guide the orthognathic surgery and the treatment of obstructive sleep apnea.

Dental Implants Can Facilitate Orthognathic Surgery in a Patient With Severe Maxillary Atrophy

The surgical treatment of dentofacial deformities is performed routinely and predictably in dentate patients. However, when dealing with the edentulous maxilla, treatment becomes more challenging and less predictable. In these cases, the combination of orthognathic surgery and osseointegrated implants could be a viable alternative to enable fixed rehabilitation. A patient with an edentulous and atrophic maxilla with maxillomandibular discrepancy and high esthetic requirement was treated with a combination of osseointegrated implants and orthognathic surgery. The rehabilitative sequence was composed of maxillary grafting procedures, installation of dental implants, placement of a fixed implant-supported prosthesis, and bimaxillary orthognathic surgery. During provisional restoration before orthognathic surgery, smaller teeth were used, allowing achievement of appropriate tooth length for the final restoration, even after natural and expected postoperative relapse. This restorative approach provided an implant-supported fixed prosthesis without prosthetic compensation and with optimum esthetics and biomechanics.

Correction of malocclusion and oral rehabilitation in a case of amelogenesis imperfecta by insertion of dental implants followed by Le Fort I distraction osteogenesis of the edentulous atrophic maxilla

Background

Amelogenesis imperfecta refers a group of hereditary diseases affecting the teeth and can present a variety of clinical forms and appearances, compromising esthetic appearance. Amelogenesis imperfecta variably reduces oral health quality and can result in severe psychological problems.

Case presentation

We present the management of an amelogenesis imperfecta Angle class III malocclusion case with speech, esthetics and functional problems. This is an example of the rarely presented delayed eruption with multiple morphologic dental alterations and edentulous maxilla.

There are only a few available reports in which this method is used method to correct sagittal discrepancies in edentulous patients.

Our treatment plan consisted of a preoperative diagnostic and prosthodontics phase (including preparation of guiding prosthesis), followed by a surgical phase of Le Fort I osteotomy, distraction osteogenesis to correct the malocclusion, implant insertion and a follow up final restorative phase.

Conclusions

Our treatment strategy attempts to serve patient needs, achieving function and esthetics while also minimizing the risk of reconstruction failure. Treatment not only restored function and esthetics, but also showed a positive psychological impact and thereby improved perceived quality of life.

Atrophic jaw reconstruction by means of calvarial bone graft: long-term results

The aim of this work was to investigate the immunohistochemical and histologic patterns occurring in samples obtained from sites reconstructed with calvarial bone graft, 4 months (T1) and 10 years (T2) after grafting, in comparison to those observed in samples from the calvaria taken from the donor sites at the moment of withdrawal for the grafting (T0).Samples underwent immunohistochemical analysis for bone sialoprotein, matrix metalloproteinases 2 and 9, vascular endothelial growth factor, and Bax expressions; terminal-deoxynucleotidyl-transferase-mediated dUTP nick end-labeling analysis to evaluate the number of apoptotic samples; and morphologic evaluation after hematoxylin and eosin staining.The expression levels of all the investigated molecules, such as the apoptotic cells' count, showed a significant (P < 0.05) increase in T1 samples, that is, 4 months after grafting, although their expression levels recorded after 10 years seemed to be comparable to those in the native bone. Moreover, at observation under the light microscope, T1 samples showed a nonuniform morphology, with mineralized areas surrounded by connective tissues where blood vessels could be distinguished. On the other hand, T0 and T2 samples showed a similar aspect, characterized by uniform areas of mineralized extracellular matrix with cavities containing osteocytes.These data suggest that, after approximately 4 months, it is possible to highlight stronger remodeling phenomena, accompanied by new bone formation and new blood vessel proliferation, which are necessary to the host tissue for graft integration. On the contrary, these phenomena could not be observed in samples obtained after a long period (T2), which reveal a morphologic and an immunohistochemical pattern comparable to that recorded in calvarial native bone (T0).