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Allogenic bone grafting of small and medium defects of the jaws
028B - Maxillofacial reconstruction O28B - Maxillofacial reconstruction
1. The Vertical Sandwich Procedure of the Upper Jaw Combined with Dental Screw Implants
Gratz, K., Sailer, H. Department of Cranio-Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland
91
Conclusion Fibular osteocutaneous flap is one of the most excellent reconstructive procedures for maxillo-mandibular defects because of the flexible design to cover both soft tissue and bony defects; the possibility to reconstruct for wide bony defect even following semi-total mandibulectomy, to reform an ideal mandibular contour using osteotomy at several portions of the fibula, and also fibular bone itself is strong and has enough size to be installed by dental implant.
Indication for this procedure is an alveolar ridge of adequate height but too narrow to use dental implants. Especially in posttraumatic cases where the labial and buccal alveolar ridge were lost this procedure is of great advantage.
3. Al!ogenic Bone Grafting of Small and Medium Defects of the Jaws
Surgical technique A crestal incision is made dissecting in a strictly submucosal plane to raise a buccal mucosal flap. The labiobuccal part of the ridge remains pedicled to the submucosal tissue and the periosteum. The mucoperiostenm is degloved on the palatal aspect of the ridge. The upper alveolar crest is split using a fine oscillating blade. With fine chisels, the labiobuccal part of the crest is mobilized delicately in toto or in 2 or 3 parts and displaced buccally. Autologous bone from the iliac crest or a horseshoe formed from split rib or lyophilized bone or cartilage is interpositioned and is fixed using small perforating wires or miniscrews. This technique enables the simultaneous insertion of endosseous implants which are placed in the bone grafts extraorally. At the end of the operation, a submucosal vestibuloplasty with fixation sutures is performed. The abutment operation is carried out 6 months postoperatively. In cases of a partial vertical sandwich, bone from the chin region or from the angle of the lower jaw can be used. The procedure combines the broadening of the upper jaw with simultaneous insertion of endosseous screw implants and results in a restoration of the transverse intermaxillary relationship. The results in 10 cases over 5 years shows clearly that less bone resorption occurs.
Oral and Maxillofacial Surgery Clinic, Larissa General Hospital, Larissa, Greece
2. Fibular Osteocutaneous Flap for Maxillo-Mandibular Reconstruction: Anatomical Study and Clinical Applications
Mataga, L, Ishihara, O.
Semergidis, T., Sereti, 3/1., Spyropoulos, L
The aim of this study is to present our experience from the reconstruction of small and medium sized cystic defects of the maxilla and the mandible, by the use of an allogenic bone graft (Tutoplast | following a protocol of diagnosis, surgical treatment and follow-up. Placement of osseointegrated implants was the main purpose of edentulous area reconstruction. We have treated in a period of 21 months (January 1997 September 1998), 36 patients using allogenic bone chemically prepared and preserved. 21 were male (15 to 65 years old) and 15 were female (12 to 57 years old). Mean age was 42.3 years. Postoperatively, patients were examined clinically at 7 and 15 days and then at 1, 2, 3, 6 and 12-month intervals. Orthopantomograms were also obtained at 1, 2, 3, 6 and 12 months. Results were evaluated regarding volume, texture and contour of the grafted site. 'Wound and bone healing was normal and there were no cases of sloughing, graft rejection or clinically apparent absorption. Three cases of dehiscence were resolved with local wound care. There was one case of transient mental nerve hypesthesia in a large cyst of the mandibular body and one case of infection of the grafted area in the mandible, treated with antibiotics with no sequelae to the graft. After 6 months, lamellar patterns were observed in most patients, especially in the mandible. Although autogenous bone is considered to be the optimum restorative material, our experience from this group of patients suggests that allogenic bone grafting is a useful, simple and safe alternative method.
The Nippon Dental University School of Dentistry at Niigata, Department of Oral and Maxillofacial Surgery H Objectives and methods Anatomical investigation on the fibular osteocutaneous flap from 60 legs of 30 cadavers, and clinical study of fourteen patients, thirteen with oral cancers and one with ameloblastoma, have primarily or secondarily reconstructed maxillomandibular bony defects since 1992 in our department based on the results of anatomical investigations. Of seven patients, endosseous implants were employed into the fibula. These results will be retrospectively discussed in this presentation.
4. Genioplasty: A Long Term Follow Up by NIorphometrie, Cephalometrie and Sensory Analysis
Kearns, G., Troulis, M., Perrott, D., Kaban, L. Massachusetts General Hospital, Boston, Massachusetts
Since the first description of an advancement genioplasty, numerous variations in surgical exposure, osteotomy design
1. The Vertical Sandwich Procedure of the Upper Jaw Combined with Dental Screw Implants
Gratz, K., Sailer, H. Department of Cranio-Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland
91
Conclusion Fibular osteocutaneous flap is one of the most excellent reconstructive procedures for maxillo-mandibular defects because of the flexible design to cover both soft tissue and bony defects; the possibility to reconstruct for wide bony defect even following semi-total mandibulectomy, to reform an ideal mandibular contour using osteotomy at several portions of the fibula, and also fibular bone itself is strong and has enough size to be installed by dental implant.
Indication for this procedure is an alveolar ridge of adequate height but too narrow to use dental implants. Especially in posttraumatic cases where the labial and buccal alveolar ridge were lost this procedure is of great advantage.
3. Al!ogenic Bone Grafting of Small and Medium Defects of the Jaws
Surgical technique A crestal incision is made dissecting in a strictly submucosal plane to raise a buccal mucosal flap. The labiobuccal part of the ridge remains pedicled to the submucosal tissue and the periosteum. The mucoperiostenm is degloved on the palatal aspect of the ridge. The upper alveolar crest is split using a fine oscillating blade. With fine chisels, the labiobuccal part of the crest is mobilized delicately in toto or in 2 or 3 parts and displaced buccally. Autologous bone from the iliac crest or a horseshoe formed from split rib or lyophilized bone or cartilage is interpositioned and is fixed using small perforating wires or miniscrews. This technique enables the simultaneous insertion of endosseous implants which are placed in the bone grafts extraorally. At the end of the operation, a submucosal vestibuloplasty with fixation sutures is performed. The abutment operation is carried out 6 months postoperatively. In cases of a partial vertical sandwich, bone from the chin region or from the angle of the lower jaw can be used. The procedure combines the broadening of the upper jaw with simultaneous insertion of endosseous screw implants and results in a restoration of the transverse intermaxillary relationship. The results in 10 cases over 5 years shows clearly that less bone resorption occurs.
Oral and Maxillofacial Surgery Clinic, Larissa General Hospital, Larissa, Greece
2. Fibular Osteocutaneous Flap for Maxillo-Mandibular Reconstruction: Anatomical Study and Clinical Applications
Mataga, L, Ishihara, O.
Semergidis, T., Sereti, 3/1., Spyropoulos, L
The aim of this study is to present our experience from the reconstruction of small and medium sized cystic defects of the maxilla and the mandible, by the use of an allogenic bone graft (Tutoplast | following a protocol of diagnosis, surgical treatment and follow-up. Placement of osseointegrated implants was the main purpose of edentulous area reconstruction. We have treated in a period of 21 months (January 1997 September 1998), 36 patients using allogenic bone chemically prepared and preserved. 21 were male (15 to 65 years old) and 15 were female (12 to 57 years old). Mean age was 42.3 years. Postoperatively, patients were examined clinically at 7 and 15 days and then at 1, 2, 3, 6 and 12-month intervals. Orthopantomograms were also obtained at 1, 2, 3, 6 and 12 months. Results were evaluated regarding volume, texture and contour of the grafted site. 'Wound and bone healing was normal and there were no cases of sloughing, graft rejection or clinically apparent absorption. Three cases of dehiscence were resolved with local wound care. There was one case of transient mental nerve hypesthesia in a large cyst of the mandibular body and one case of infection of the grafted area in the mandible, treated with antibiotics with no sequelae to the graft. After 6 months, lamellar patterns were observed in most patients, especially in the mandible. Although autogenous bone is considered to be the optimum restorative material, our experience from this group of patients suggests that allogenic bone grafting is a useful, simple and safe alternative method.
The Nippon Dental University School of Dentistry at Niigata, Department of Oral and Maxillofacial Surgery H Objectives and methods Anatomical investigation on the fibular osteocutaneous flap from 60 legs of 30 cadavers, and clinical study of fourteen patients, thirteen with oral cancers and one with ameloblastoma, have primarily or secondarily reconstructed maxillomandibular bony defects since 1992 in our department based on the results of anatomical investigations. Of seven patients, endosseous implants were employed into the fibula. These results will be retrospectively discussed in this presentation.
4. Genioplasty: A Long Term Follow Up by NIorphometrie, Cephalometrie and Sensory Analysis
Kearns, G., Troulis, M., Perrott, D., Kaban, L. Massachusetts General Hospital, Boston, Massachusetts
Since the first description of an advancement genioplasty, numerous variations in surgical exposure, osteotomy design