Horseshoe Le Fort I osteotomy in combination with endosteal implants--a median-term follow-up study

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

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.

Simultaneous Le Fort I osteotomy and computer-guided implant placement

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.

Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy

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.

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

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.

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

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.

The value of a diagnostic setup for full fixed maxillary implant prosthetics

The concept of prosthesis-directed implant-supported restoration is well accepted. The implementation of this principle for patients requesting full fixed implant-supported maxillary prosthetics has not been thoroughly described. We present a technique for the evaluation and preprosthetic surgical management of patients who are edentulous in the maxilla and wish to have fixed implant-supported crown and bridge prosthetics.

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

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.

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

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.

Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants

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.

Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study

OBJECTIVE

The aim of this study was to determine the long-term outcome of implant insertion in the augmented severely atrophied maxilla.

STUDY DESIGN

Three hundred and twenty-four implants were inserted in 35 patients (eight males, 27 females, average age 57.6 years) in extremely atrophied maxillae after osteotomy and interposition of iliac crest bone. One hundred implants were installed in 12 patients simultaneously with the osteotomy and grafting; 224 implants were placed in 23 patients in a second procedure 6-12 months later. Implant parameters like osseointegration and peri-implant bone loss; peri-implant tissue parameters like bleeding, gingival and plaque index; and patients' satisfaction were evaluated.

RESULTS

Of 324 implants, 29 (8.9%) were lost during the entire follow-up: 14 in six patients of the one-step and 15 in 11 patients of the two-step group. The overall input-output survival in 141.1 months was 91.1%. The overall 2-year failure-free fraction of implants was 95.5%; the 5-year failure-free fraction was 89.3%. In the one-step group, the 2 (5)-year failure-free fraction was 95.9% (86.9%), and in the two-step group 95% (91.3%) (log-rank test P=0.57). Marginal peri-implant bone loss was 1.7+/-1.3 mm mesial and 1.8+/-1.3 mm distal.

CONCLUSION

Implant insertion after osteotomy and iliac bone grafting is a reliable operation method for the dental rehabilitation of the severely atrophied maxilla showing good long-term results.

Rehabilitation of the severely atrophied maxilla by horseshoe Le Fort I osteotomy (HLFO)

OBJECTIVE

The purpose of this study was to determine the long-term outcome of the horseshoe Le Fort I osteotomy (HLFO) as a preprosthetic operation technique for implant insertion in the extremely atrophied maxilla.

STUDY DESIGN

36 patients (8 male, 28 female, average age 57.6 years) underwent HLFO combined with iliac crest bone grafting. They were divided into 2 groups: group A with 12 patients who simultaneously received 100 implants; group B with 24 patients where 176 implants were inserted in 18 patients in a second-stage procedure. Clinical and radiographic outcome with regard to implant osseointegration, alveolar bone height in the canine and molar regions, peri-implant bone loss and satisfaction of patients (esthetics, masticatory function, overall treatment) were investigated in all cases.

RESULTS

The overall 2-year failure-free fraction of implants was 95.5%; the 5-year failure-free fraction was 89.3%. In the 1-step group the 2-year and 5-year failure-free fractions were 95.9% and 86.9%, respectively, in the 2-step group 95.0% and 91.3% (log rank test P=.57). A total of 27 implants were lost during the entire follow-up: 14 in 6 patients of the 1-stage and 13 in 9 patients of the 2-stage group. The mean loss of alveolar bone after augmentation in the canine and molar regions was almost equal in both groups (overall means for the 2 regions 3.67 +/- 2.77 and 4.42 +/- 2.72 mm, respectively). The relationship between the jaws and thereby the esthetic profile could be improved in all cases. All patients were satisfied with the dental rehabilitation and the achieved new esthetic appearance.

CONCLUSIONS

HLFO combined with iliac bone grafting is a feasible preprosthetic technique prior to implant insertion in cases of severe atrophy of the maxillary alveolar ridge, leading to satisfying implant survival and rehabilitation of function.

Stability of bone grafting and placement of implants in the severely atrophic maxilla

A severely atrophic maxilla can be restored by bone grafts to allow the insertion of implants. We present 30 consecutive patients treated with autogenous inlay and onlay bone grafts from the iliac crest to the floor of the maxillary sinus and the alveolar crest. A total of 200 implants were inserted 4-6 months after bone grafting. A mean vertical increase in bone thickness of 14mm was achieved. After a mean bone loss of 1.3mm during the first year after bone grafting only minimal resorption was observed during the second and third year. Seven implants failed to integrate and a further four implants were lost during follow-up.

A novel modular retention system for midfacial distraction osteogenesis

Distraction osteogenesis of the midface offers new possibilities for the treatment of large sagittal discrepancies between the upper and lower jaws. The use of an extraoral halo-borne distractor, which allows free three-dimensional vector control, may cause problems in the connection between the midface and the distractor. To overcome these difficulties, we present a new modular retention system to gain bone anchorage whenever a toothborne appliance is not suitable. Distraction osteogenesis with an extraoral appliance is therefore possible even in edentulous elderly patients. We have used this system successfully in 11 patients.