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Schneider B, Pfaffeneder-Mantai F, Grün P, Meller O, Dobbertin K, Turhani D. Melolabial interpolated island flap for reconstruction of an anterior oronasal fistula after horseshoe Le Fort I osteotomy with iliac bone grafts interposition - A case report. Int J Surg Case Rep 2022; 93:106939. [PMID: 35303603 PMCID: PMC8928081 DOI: 10.1016/j.ijscr.2022.106939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Horseshoe Le Fort I osteotomy (HLFO) in combination with iliac bone grafts interposition is an established and very effective procedure for reconstructing the severely atrophic maxilla. However potential complications connected to this method, such as oronasal fistula (ONF), have not been described in the literature to date. CASE PRESENTATION We report the case of a female patient with severe atrophy of the edentulous maxillary alveolar ridge with type 2 diabetes (T2D). Initially, a sinus floor augmentation was performed, followed by a failed placement of dental implants. Afterwards, HLFO with simultaneous interposition of iliac bone grafts was conducted. Subsequently, an oronasal communication occurred in the antral maxilla. As several local flaps had not achieved sufficient results, a melolabial interpolated island flap was carried out, yielding satisfactory results. DISCUSSION Failed implant treatment or bone augmentation procedures in combination with T2D may have resulted in significant tissue irritation and subsequent wound healing complications in the antral maxilla, leading to an ONF. CONCLUSION In this case, an ONF occurring after HLFO was described for the first time. The melolabial interpolated island flap proved to be an outstanding long-term solution for the management of an anterior ONF occurring after HLFO over a period of 10 years. Less invasive treatment options including zygomatic implants should be taken into consideration for the treatment of such patients.
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Affiliation(s)
- Benedikt Schneider
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Florian Pfaffeneder-Mantai
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria; Division for Chemistry and Physics of Materials, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Pascal Grün
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Oliver Meller
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Katharina Dobbertin
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria
| | - Dritan Turhani
- Center for Oral and Maxillofacial Surgery, Faculty of Medicine/Dental Medicine, Danube Private University, Krems, Austria.
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Abraha SM, Geng YM, Naujokat H, Terheyden H. Modified Le Fort I interpositional grafting of the severe atrophied maxilla - a retrospective study of 106 patients over 10 years. Clin Oral Implants Res 2022; 33:451-460. [PMID: 35175642 DOI: 10.1111/clr.13905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/14/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate a modified Le Fort I interpositional grafting followed by dental implants for the rehabilitation of edentulous atrophied maxillae (Cawood classes IV and V). The surgical modification was a bilateral sinus floor augmentation prior to the osteotomy. This generated a closed recipient bed which allowed the use of particulated bone grafts (xenogenic bone mineral) and a reduced amount of autologous iliac bone grafts. MATERIALS AND METHODS 106 patients with maxillary interpositional bone grafts were included in this retrospective analysis between 2006 and 2020. The panoramic radiographs and lateral cephalograms were analysed to assess the gain and stability of the maxillary bone and the peri-implant bone loss. In addition, the observational period of up to 14 years implant survival and success was evaluated. RESULTS A stable vertical bone height with mean 0.63 ± 1.41mm resorption over 5 years after implant loading was observed. A mean of 0.20 ± 0.37mm marginal bone loss was noted after 5 years. The implant survival was 96.4% after 5 years and implant success can be rated 91.7% in a mean follow-up period of 93 months and 168 months maximal observation time. Perioperative complications included sinus membrane perforation (59.43%), wound healing disturbances (25.47%) and transient primary complications (13.78%). All receded apart from two subtotal graft losses (1.8%). CONCLUSIONS The modified Le Fort I osteotomy with interpositional bone grafts is a predictable procedure in terms of bone and implant stability. Patients with atrophic maxillae who are fit for surgery should be informed about risks and benefits of this treatment alternative.
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Affiliation(s)
- Sophia Mulugeta Abraha
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein - UKSH, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,Private practice, Rosenkavalierplatz 18, 81925, München, Germany
| | - Yuan-Ming Geng
- Department of Stomatology, Zhujiang Hospital, Southern Medical University, Gongyedadaozhong Road 253, 510282, Guangzhou, China
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein -UKSH, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Hendrik Terheyden
- Department of Oral and Maxillofacial Surgery, Helios Hospital Kassel, Hansteinstraße 29, 34121, Kassel, Germany
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Ewers R. The incisal foramen as a means of insertion for one of three ultra-short implants to support a prosthesis for a severely atrophic maxilla - A short-term report. Heliyon 2019; 4:e01034. [PMID: 30603683 PMCID: PMC6310776 DOI: 10.1016/j.heliyon.2018.e01034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022] Open
Abstract
As a continuation of our prospective cohort study for a total of 18 patients with 72 implants in severely atrophic maxillae corresponding to Cawood and Howell class V and VI (1988) [1] with four 4.0 × 5.0 mm ultrashort locking taper implants Ewers et al., 2018 [2], we now present a prospective cohort study with a total of 9 patients. The special feature of this newly modified study is the reduction of the number of implants to only three 4.0 × 5.0 mm or 4.5 × 6.0 mm or 5.0 × 6.0 mm calcium phosphate-coated Bicon Integra CP implants. Reducing the number of implants is possible by inserting the middle implant into the incisal foramen and the nasopalatine canal. All patients were restored with metal-free prostheses made of a glass fiber-reinforced hybrid resin material. Neither were any implants lost during the observation period, nor did any patient experience any sensory alteration due to the placement of an implant into the nasopalatine canal. Three implants were sufficient in all patients to stabilize their 12-unit prosthesis.
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Affiliation(s)
- Rolf Ewers
- Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- CMF Implant Institute Vienna, Schumanngasse 15, 1180, Vienna, Austria1
- Corresponding author.
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Batista Mendes GC, Laskarides C, Ayub EA, Ribeiro-Junior PD. Dental Implants Can Facilitate Orthognathic Surgery in a Patient With Severe Maxillary Atrophy. J Oral Maxillofac Surg 2018; 77:730-739. [PMID: 30528122 DOI: 10.1016/j.joms.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Gabriel Cury Batista Mendes
- Professor, Department of Dental Anesthesiology, Universidade de Itaúna, Minas Gerais, Brazil; PhD Student, Department of Oral and Maxillofacial Surgery, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil.
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Chiapasco M, Casentini P. Horizontal bone-augmentation procedures in implant dentistry: prosthetically guided regeneration. Periodontol 2000 2018; 77:213-240. [DOI: 10.1111/prd.12219] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Schlund M, Nicot R, Lauwers L, Raoul G, Ferri J. Le Fort 1 osteotomy and calvarial bone grafting for severely resorbed maxillae. J Craniomaxillofac Surg 2016; 44:859-67. [DOI: 10.1016/j.jcms.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 03/08/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022] Open
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Apaydin A, Sermet B, Ureturk S, Kundakcioglu A. 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. BMC Oral Health 2014; 14:116. [PMID: 25227161 PMCID: PMC4176856 DOI: 10.1186/1472-6831-14-116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 09/09/2014] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Aysegul Apaydin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Istanbul, Istanbul, Turkey.
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Pingarron-Martin L, Arias-Gallo J, Ong HS, Chamorro Pons M. Le fort I osteotomy with bone grafts in preprosthetic surgery: technical note. Craniomaxillofac Trauma Reconstr 2014; 6:143-6. [PMID: 24436751 DOI: 10.1055/s-0033-1333876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 05/20/2012] [Indexed: 10/27/2022] Open
Abstract
Background Being edentulous causes progressive bony resorption in maxillae, which can lead to altered maxillomandibular relationships. Discussion should consider Le Fort I osteotomy with inlay grafts for a better success rate. Thus, this article introduces a technical note in improving the success rate. Case Report The presented technical note permits transformation of the surgery in a conventional Le Fort I with a simple fixation not only of the grafts but also of the osteotomy. The surgical steps are explained as well as the follow-up results. Discussion Adding additional wire anchorage around bone grafts greatly improved our success rate and reduced our operative time. Bone grafting concurrently with Le Fort I osteotomy immediately improved the facial skeletal profile. Several in vitro studies have shown that galvanic corrosion does not play a significant role when combining stainless steel and titanium. Our novel technique is relatively simple and can be easily picked up by young surgeons.
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Affiliation(s)
- Lorena Pingarron-Martin
- Oral and Maxillofacial Surgery, Hospital Sanitas La Moraleja, Madrid, Spain ; Oral and Maxillofacial Surgery, Ninth People Hospital, Shanghai, China
| | - Javier Arias-Gallo
- Oral and Maxillofacial Surgery, Hospital Sanitas La Moraleja, Madrid, Spain
| | - Hui Shan Ong
- Oral and Maxillofacial Surgery, Ninth People Hospital, Shanghai, China
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Almeida EO, Rocha EP, Freitas Júnior AC, Anchieta RB, Poveda R, Gupta N, Coelho PG. Tilted and short implants supporting fixed prosthesis in an atrophic maxilla: a 3D-FEA biomechanical evaluation. Clin Implant Dent Relat Res 2013; 17 Suppl 1:e332-42. [PMID: 23910435 DOI: 10.1111/cid.12129] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE This study compared the biomechanical behavior of tilted long implant and vertical short implants to support fixed prosthesis in an atrophic maxilla. MATERIALS AND METHODS The maxilla model was built based on a tomographic image of the patient. Implant models were based on micro-computer tomography imaging of implants. The different configurations considered were M4S, four vertical anterior implants; M4T, two mesial vertical implants and two distal tilted (45°) implants in the anterior region of the maxilla; and M6S, four vertical anterior implants and two vertical posterior implants. Numerical simulation was carried out under bilateral 150 N loads applied in the cantilever region in axial (L1) and oblique (45°) (L2) direction. Bone was analyzed using the maximum and minimum principal stress (σmax and σmin ), and von Mises stress (σvM ) assessments. Implants were analyzed using the σvM . RESULTS The higher σmax was observed at: M4T, followed by M6S/L1, M6S/L2, M4S/L2, and M4S/L1 and the higher σvM : M4T/L1, M4T/L2 and M4S/L2, M6S/L2, M4S/L1, and M6S/L1. CONCLUSIONS The presence of distal tilted (all-on-four) and distal short implants (all-on-six) resulted in higher stresses in both situations in the maxillary bone in comparison to the presence of vertical implants (all-on-four).
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Affiliation(s)
- Erika O Almeida
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Herford AS, Cicciù M. Bone resorption analysis of platelet-derived growth factor type BB application on collagen for bone grafts secured by titanium mesh over a pig jaw defect model. Natl J Maxillofac Surg 2013; 3:172-9. [PMID: 23833493 PMCID: PMC3700152 DOI: 10.4103/0975-5950.111374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The aim of this investigation was to evaluate whether the addition of the platelet derived growth factor type BB (PDGF-BB) to a collagen matrix applied on a titanium mesh would favor healing and resorption onto the grafted bone. A histologic and radiographic study of two different groups (test and control) was performed. Designs: A surgical procedure was performed on 8 pigs to obtain 16 bilateral mandibular alveolar defects. All the defects were then reconstructed with a mixture of autogenous bovine bone using titanium mesh positioning. Two groups, with a total of 16 defects were created: The first to study collagen sponge and PDGF-BB and the second to control collagen only. The collagen matrix was positioned directly over the mesh and soft tissue was closed without tensions onto both groups without attempting to obtain primary closure. Possible exposure of the titanium mesh as well as the height and volume of the new bone was recorded. Results: New bone formation averaged about 6.68 mm in the test group studied; the control group had less regenerated bone at 4.62 mm. Conclusion: PDGF-BB addition to the collagen matrix induced a strong increase in hard and soft tissue healing and favored bone formation, reducing bone resorption even if the mesh was exposed.
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Affiliation(s)
- Alan Scott Herford
- Department of Oral and Maxillofacial Surgery, Loma Linda University, Loma Linda, CA, USA
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Abstract
BACKGROUND Since 1977, osseointegrated implants have played a strong role in oral rehabilitation. Despite the large success of this technique for the edentulous maxilla and mandible with sufficient bone height, patients with atrophic jaws continue to be the challenging cases for an adequate reconstruction of aesthetics and functionality. Orthognathic surgical procedures have been developed to reposition the jaws and have been traditionally used in the dentate patient to correct a skeletal malocclusion; these procedures can be used on the edentulous patient to correct the discrepancies between the jaws followed by the placement of implants to rehabilitate the oral cavity. Recently, surgeons can use a computer-assisted software package that enables them to insert implants after a digital analysis of the residual alveolar and basal bone that makes for greater implant osseointegration. We describe a one-step oral rehabilitation with Le Fort I osteotomy and computer-guided implant placement to correct a posttraumatic deformity. CLINICAL REPORT The first step of the definitive treatment, the implant placement, was planned with the aid of a computer-assisted surgery software package (NobelGuide; Nobel Biocare AB, Goteborg, Sweden). Ten computer-planned implants (Nobel Biocare AB) were inserted (6 on the maxillary arch and 2 on each posterior area of the mandible). Simultaneously, the patient underwent a Le Fort I osteotomy to correct the maxillary deficiency without any bone grafts. DISCUSSION The use of Le Fort I osteotomy as a preprosthetic procedure for the atrophic edentulous maxilla has been well accepted. This is a technically demanding procedure, and there are some described complications such as unfavorable fractures of the maxilla, oroantral fistulas, bone exposure, and low implant survival rates. However, in selected cases, this reconstructive method has the advantages over the other commonly used preprosthetic techniques of simultaneously allowing the placement of osseointegrated implants while correcting an unfavorable intermaxillary relationship and improving facial aesthetics. Computer-assisted surgery offers to the surgeons the possibility to visualize anatomic structures, evaluate implant position and inclination, insert accurately implants, prefabricate prosthesis, and avoid the morbidity of bone grafting procedures. CONCLUSIONS One-step oral rehabilitation by Le Fort I and computer-guided implant placement can be used in selected patients. Despite the difficulty of this procedure, this approach enabled the authors to solve simultaneously a double problem: the malocclusion and the partially atrophic and edentulous jaws. According to the literature, this is the first case of a simultaneous Le Fort I osteotomy and computer-guided implant placement. The patient introduced had a posttraumatic deformity, but we think that this procedure could be extended in the future to manage other situations.
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De Santis D, Trevisiol L, D'Agostino A, Cucchi A, De Gemmis A, Nocini PF. Guided bone regeneration with autogenous block grafts applied to Le Fort I osteotomy for treatment of severely resorbed maxillae: a 4- to 6-year prospective study. Clin Oral Implants Res 2011; 23:60-9. [DOI: 10.1111/j.1600-0501.2011.02181.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chiapasco M, Romeo E, Coggiola A, Brusati R. Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy. Clin Oral Implants Res 2010; 22:83-91. [PMID: 20868451 DOI: 10.1111/j.1600-0501.2010.01999.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE the objectives of this study were to evaluate (a) the clinical outcome of revascularized fibula flaps used for the reconstruction of extremely atrophic jaws and (b) the survival rates of dental implants placed in the reconstructed areas. MATERIALS AND METHODS between 1999 and 2004, 12 patients presenting with extreme atrophy of the edentulous jaws were reconstructed with fibula free flaps. Five to 12 months after the reconstructive procedure, 75 titanium dental implants were placed in the reconstructed areas, while prosthetic rehabilitation was started 4-6 months afterward. The mean follow-up of patients after the start of prosthetic loading was 77 months (range: 48-116). RESULTS an uneventful healing of the bone transplants occurred in all patients. One out of the 75 dental implants placed was not loaded due to prosthetic reasons. No dental implants failed to integrate before prosthetic loading, while three were removed during the follow-up period. Despite the high survival rate of dental implants (95.8%), a relevant number of them presented relevant peri-implant bone-level loss, ranging from 1 to 7 mm for maxillary dental implants and from 1 to 4.5 mm for mandibular dental implants. CONCLUSION although no failures of the bone transplants occurred and a high long-term survival rate of dental implants were observed, this study showed that fibula free flaps do not guarantee dimensional stability of peri-implant bone, despite the immediate blood supply delivered by the vascular pedicle. The peri-implant bone resorption was higher when compared with the one related to dental implants placed in native bone.
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Affiliation(s)
- Matteo Chiapasco
- Unit of Oral Surgery, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy.
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Viscioni A, Rigo L, Franco M, Brunelli G, Avantaggiato A, Sollazzo V, Carinci F. Reconstruction of Severely Atrophic Jaws Using Homografts and Simultaneous Implant Placement: A Retrospective Study. J ORAL IMPLANTOL 2010; 36:131-9. [DOI: 10.1563/aaid-joi-d-09-00025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
In the past decade, several investigators have reported that implants inserted in autografts in the same operation (ie, simultaneously inserted implants [SIIs]) have achieved excellent results. However, no report regarding SIIs placed in fresh frozen bone (FFB) is available. Thus, the authors planned a retrospective study on a series of SIIs placed in homologue FFB (but not immediately loaded) to evaluate their clinical outcome. In addition, a comparison with implants inserted in FFB in a second stage (ie, delayed inserted implants) was performed. Seventeen patients were grafted with FFB, and 48 implants were inserted in the same operation. Implant diameter and length ranged from 3.25 to 4.0 mm and from 10.0 to 15 mm, respectively. Data were compared with 302 implants inserted in FFB in a second operation during the same period in 64 patients. Analyzing SIIs, it was noted that only 3 implants were lost (ie, survival rate [SVR] = 93.7%), and no differences were detected among the studied variables by using lost implants as a predictor of clinical outcome. On the contrary, by using crestal bone resorption around the implant's neck and specific cutoff values, it was possible to demonstrate that prosthetic restoration (ie, removable overdentures) correlated with a statistically significant lower delta insertion abutment junction (ie, reduced crestal bone loss) and thus with a better clinical outcome. By comparing SIIs with implants inserted in a second stage in FFB, a better outcome for delayed implants was demonstrated. Implants inserted simultaneously with FFB grafts had a high survival and success rate. SIIs inserted in FFB can be considered reliable devices, although a higher marginal bone loss is to be expected when fixed prosthetic restorations are used. Implants inserted in a second surgical stage have a better SVR and success rate than SIIs.
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Ribeiro-Junior P, Padovan LM, Gonçales ES, Nary-Filho H. Bone grafting and insertion of dental implants followed by Le Fort advancement for correction of severely atrophic maxilla in young patients. Int J Oral Maxillofac Surg 2009; 38:1101-6. [DOI: 10.1016/j.ijom.2009.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 08/06/2008] [Accepted: 06/01/2009] [Indexed: 11/17/2022]
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Marchetti C, Felice P, Lizio G, Rossi F. Le Fort I osteotomy with interpositional graft and immediate loading of delayed modified SLActive surface dental implants for rehabilitation of extremely atrophied maxilla: a case report. J Oral Maxillofac Surg 2009; 67:1486-94. [PMID: 19531422 DOI: 10.1016/j.joms.2009.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 03/08/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe a successful clinical case of immediate prosthetic loading of modified sandblasting and acid-etching surface ITI dental implants inserted in a grafted maxilla after Le Fort I osteotomy. MATERIALS AND METHODS A 59-year-old man with a severely atrophied maxilla was treated with Le Fort I osteotomy and interpositional iliac bone graft. Thirteen weeks later, 7 modified sandblasted and acid-etched surface ITI dental implants were inserted with immediate application of a screw-fixed prosthetic acrylic device kept in functional loading for 3 months until a definitive fixed prosthesis was inserted. RESULTS After 20-month follow-up there has been no implant failure, with minimal bone loss and healthy peri-implant soft tissues; the patient is functionally and esthetically satisfied. CONCLUSIONS Immediate loading of implants placed after Le Fort I osteotomy and interpositional iliac bone grafting could be an applicable protocol to rehabilitate extremely atrophied edentulous maxillas.
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Affiliation(s)
- Claudio Marchetti
- Department of Oral and Dental Sciences, University of Bologna, Bologna, Italy
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Muñoz-Guerra MF, Naval-Gías L, Capote-Moreno A. Le Fort I osteotomy, bilateral sinus lift, and inlay bone-grafting for reconstruction in the severely atrophic maxilla: a new vision of the sandwich technique, using bone scrapers and piezosurgery. J Oral Maxillofac Surg 2009; 67:613-8. [PMID: 19231789 DOI: 10.1016/j.joms.2008.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 09/06/2008] [Indexed: 11/16/2022]
Abstract
Severe atrophy of the edentulous maxilla and progressive pneumatisation of the maxillary sinus can compromise the insertion of dental implants. In this context, ideal implant positioning is limited by inadequate height, width, and quality of the bone. Le Fort I osteotomy and interpositional bone graft is an excellent treatment concept for the dental rehabilitation of patients with atrophied maxilla and reversed intermaxillary relationship. In this report, we indicate the transcendent aspect of elevation and preservation of maxillary sinus and nasal mucosa, modifying the sandwich technique by the useful of bone scrapers and piezosurgery. The procedure is described including a 1-stage approach using cortico-cancellous bone blocks through which implants are placed. In the extremely atrophied alveolar process of the maxilla, this technique provides the desired gain of bone, allows for the ideal placement of dental implants, and improves any discrepancy between the upper and lower arches.
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Affiliation(s)
- Mario Fernando Muñoz-Guerra
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, Madrid, Spain.
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A 9–14 year follow-up of onlay bone grafting in the atrophic maxilla. Int J Oral Maxillofac Surg 2009; 38:111-6. [DOI: 10.1016/j.ijom.2008.10.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 10/28/2008] [Indexed: 11/20/2022]
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Reconstruction of the atrophic maxilla with interpositional bone grafting/Le Fort I osteotomy and endosteal implants: A 11–16 year follow-up. Int J Oral Maxillofac Surg 2009; 38:1-6. [PMID: 19046853 DOI: 10.1016/j.ijom.2008.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 10/28/2008] [Indexed: 11/20/2022]
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Rosén A, Gynther G. Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study. J Oral Maxillofac Surg 2007; 65:1010-6. [PMID: 17448855 DOI: 10.1016/j.joms.2006.11.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 08/09/2006] [Accepted: 11/16/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate retrospectively the surgical outcome of tilted implants in severely resorbed edentulous maxillas as an alternative to bone grafting and the prosthodontic outcome of posterior extension bridges on tilted implants. PATIENTS AND METHODS A total of 33 consecutive patients with severely resorbed edentulous maxillas participated in the study. In these patients, the maxillary bone volumes were insufficient for conventional placement of implants to support a fixed prosthesis. As an alternative to bone transplantation, a surgical technique with fenestration of the maxillary sinus to visualize the total amount of maxillary bone was used, followed by implant placement in a tilted manner along the anterior maxillary sinus wall. Thus, 4 to 6 implants of optimal length could be installed in each patient. Nineteen patients were included in this long-term follow-up study and were eligible for clinical evaluation at 8 to 12 years (mean, 10 years) after second-stage surgery. Each patient was examined clinically and radiographically. RESULTS The 19 patients had a total of 103 implants. In 2 of these patients, 3 fixtures were lost during the first year after second-stage surgery. All other patients had all implants intact with functionally fixed dental prostheses, corresponding to a success rate of 97%. Radiographic examination showed bone resorption in 10% of the implants (10 implants in 5 patients with a total number of 27 implants), with a mean bone loss of 1.2 mm. Mucositis was seen in 47% of the patients. CONCLUSIONS This long-term follow-up study (mean time, 10 years) demonstrates that patients with a severely resorbed maxilla can be treated successfully with conventional implant treatment. This simplified surgical technique can be an alternative to the more resource-demanding technique with bone grafting.
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Affiliation(s)
- Annika Rosén
- Department of Oral and Maxillofacial Surgery, Karolinska Institute/Karolinska University Hospital, Huddinge, Sweden.
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Chiapasco M, Brusati R, Ronchi P. Le Fort I osteotomy with interpositional bone grafts and delayed oral implants for the rehabilitation of extremely atrophied maxillae: a 1?9-year clinical follow-up study on humans. Clin Oral Implants Res 2007; 18:74-85. [PMID: 17224027 DOI: 10.1111/j.1600-0501.2006.01287.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this clinical follow-up study was to report the clinical outcome of osseointegrated implants placed in extremely atrophied edentulous maxillae after Le Fort I osteotomy and interpositional autogenous iliac bone grafts. PATIENTS AND METHODS In a 10-year period (1995-2004), 39 patients, 18 males and 21 females, aged from 32 to 76 years, presenting with severely atrophied edentulous maxillae were treated with Le Fort I osteotomy and interpositional iliac bone grafts. Four to 8 months after the reconstructive procedure, 281 osseointegrated implants were placed in the reconstructed maxillae. Four to 8 months afterwards, abutments were connected and the prosthetic rehabilitation started. The mean follow-up period of implants after the start of prosthetic loading was 45.9 months (range: 12-108 months). RESULTS The reconstructive procedure was successful in 38 of 39 patients. In one patient, partial loss of the inlay graft occurred before implant placement. Six patients (42 implants) dropped out of the study. Fifteen implants were removed during the follow-up period, due to loss of integration. Thirty-two implants, although integrated, presented with peri-implant bone-level changes higher than those proposed for successful implants. Cumulative survival and success rates of implants were 94.5% and 82.9%, respectively. CONCLUSION Results from this study showed that Le Fort I osteotomy with interpositional bone grafts followed by delayed implant placement is an acceptable means to rehabilitate edentulous patients affected by extremely atrophied edentulous maxillae. Survival rates of implants are consistent with those related to implants placed in native, non-reconstructed bone. Conversely, the success rate of implants resulted to be lower as compared with those obtained for implants placed in native bone.
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Affiliation(s)
- Matteo Chiapasco
- Unit of Oral Surgery, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy.
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Depprich RA, Handschel JGK, Naujoks C, Hahn T, Meyer U, Kübler NR. Sinus lifting before Le Fort I maxillary osteotomy: a suitable method for oral rehabilitation of edentulous patients with skeletal class-III conditions: review of the literature and report of a case. Head Face Med 2007; 3:2. [PMID: 17204134 PMCID: PMC1774560 DOI: 10.1186/1746-160x-3-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 01/04/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional rehabilitation of patients afflicted with severe mandibular and maxillary alveolar atrophy might be challenging especially in malformed patients. METHODS Treatment planning using sinus lifting and implant placement before Le Fort I maxillary osteotomy in a patient with severe mandibular and posterior maxillary alveolar atrophy and skeletal class-III conditions due to cleft palate are described. RESULTS A full functional and esthetic rehabilitation of the patient was achieved by a stepwise surgical approach performed through sinus lifting as the primary approach followed by implant placement and subsequent Le Fort I maxillary osteotomy to correct the maxillo-mandibular relation. CONCLUSION Stabilisation of the maxillary complex by a sinus lifting procedure in combination with computer aided implant placement as preorthodontic planning procedure before Le Fort I maxillary osteotomy seems to be suitable in order to allow ideal oral rehabilitation especially in malformed patients.
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Affiliation(s)
- Rita A Depprich
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Jörg GK Handschel
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Christian Naujoks
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Tobias Hahn
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Ulrich Meyer
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Norbert R Kübler
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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Chiapasco M, Zaniboni M, Boisco M. Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants. Clin Oral Implants Res 2006; 17 Suppl 2:136-59. [PMID: 16968389 DOI: 10.1111/j.1600-0501.2006.01357.x] [Citation(s) in RCA: 357] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyze publications related to augmentation procedures and to evaluate the success of different surgical techniques for ridge reconstruction and the survival/success rates of implants placed in the augmented areas. MATERIAL AND METHODS Clinical investigations published in English involving at least 5 patients and with a minimum follow-up of 6 months were included. The following procedures were considered: a) Guided bone regeneration (GBR); 2) Onlay bone grafts; 3) Inlay grafts; 4) Bone splitting for ridge expansion (RE); 5) Distraction osteogenesis (DO); and 6) Revascularized flaps. Success rates of augmentation procedures and related morbidity, as well as survival and success rates of implants placed in the augmented sites were analyzed. RESULTS Success rates of surgical procedures ranged from 60% to 100% for GBR, from 92% to 100% for onlay bone grafts, from 98% to 100% for ridge expansion techniques, from 96,7% to 100% for DO, and was 87.5% for revascularized flaps, whereas survival rates of implants ranged from 92% to 100% for GBR, from 60% to 100% for onlay bone grafts, from 91% to 97.3% for RE, from 90.4% to 100% for DO, and, finally, was 88.2% for revascularized flaps. CONCLUSION On the basis of available data it was shown that it was difficult to demonstrate that a particular surgical procedure offered better outcome as compared to another. The main limit encountered in this review has been the overall poor methodological quality of the published articles. Therefore larger well-designed long term trials are needed.
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Affiliation(s)
- Matteo Chiapasco
- Unit of Oral Surgery, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy.
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Smolka W, Bosshardt DD, Mericske-Stern R, Iizuka T. Reconstruction of the severely atrophic mandible using calvarial split bone grafts for implant-supported oral rehabilitation. ACTA ACUST UNITED AC 2006; 101:35-42. [PMID: 16360606 DOI: 10.1016/j.tripleo.2005.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 03/01/2005] [Accepted: 03/23/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This article describes reconstruction of the severely atrophic mandible using calvarial bone grafts for implant-supported prosthetic oral rehabilitation. The study aim was to evaluate the efficacy of the treatment by determining implant survival and complication rates, and the extent of the postoperative graft resorption. STUDY DESIGN Ten patients who underwent the treatment were followed clinically and radiologically using panoramic radiographs and CT scans during a mean postoperative period of 30 months. RESULTS Good bone healing was observable 6 months postoperatively. The height reduction measured on panoramic radiographs was insignificant (mean 0.68 mm). Only minor complications occurred. Implant survival was 95%. Prosthodontic treatment was successfully performed in all cases, resulting in an improvement of oral function. Histological analysis of 1 bone biopsy showed minimal resorptive changes in otherwise very dense bone. CONCLUSION Augmentation using calvarial grafts is a promising treatment alternative for the severely atrophic mandible.
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Affiliation(s)
- Wenko Smolka
- Department of Cranio-Maxillofacial Surgery, University of Berne, Switzerland.
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