Fenestration and dehiscence around dental implant—art and science

494 Free Papers—Oral Presentations Background and Objectives: Ameloblastoma is a benign but invasive odontogenic tumour, grows slowly and persistently. The tumour spreads into the cancellous marrow spaces, without concomitant resorption of the trabecular bone. It is considered to be locally invasive and recurs frequently after surgical procedures. Ameloblastoma of the unilocular type are said to have a better clinical course than are those of the multilocular type. Various type of treatment were done like conservative surgical approach to radical resection of the jaws, depending upon the age, site, radiological and histological type of tumours. The purpose of this study was to find out the clinical data on ameloblastoma in Bangladeshi patients, relationship between histological types and radiological findings and treatment outcome of these patients. Methods: 112 case of ameloblastoma, during the period from 1997 to 2007 were studied in the Department of Oral and Maxillofacial surgery, Dhaka Dental College and Hospital, Dhaka, Bangladesh. Results and Conclusion: The age range of the patients was 8 to 71 years (mean age, 26.63 years). Male patients were higher in comparison to female patients. Mandibular molar-ramus area was the most common site of the lesions. Radiological multilocular types were more common than the unilocular types. The patients were younger in unilocular type of ameloblastoma. Follicular types were more common among the histological types. For treatment of ameloblastoma, conservative surgical approach like enucleation, curettage, simple excision and dredging method had been applied and for radical treatment en-block resection, segmental resection, partial resection, hemi-mandibulectomy done. Discontinuity of the mandible after resection was reconstructed either by reconstruction plate alone or in some cases by iliac bone graft. Follow-up of the patients was one and half years to eleven years. doi:10.1016/j.ijom.2009.03.347

O9.67 Treatment of lower midface concavity by paranasal porous polyethylene implants U. Dede ∗ , C. Ungor, A.M. Tüzüner-Öncül, R.S. Kisnisci Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey

Background and Objectives: Porous polyethylene implants (PPI) have

advantages like insolubility, sufficient pore sizes for tissue in growth, easy contouring and manipulation. Several applications of this material in maxillofacial region have been described. In patients with lower midface concavity, the utilisation of paranasal PPI is an alternative method of Le Fort I osteotomies in patients with dental class1 relationship. Paranasal PPI can simulate the visual effect of Le Fort I advancement. The aim of this study is to expose the efficacy of paranasal PPI in these groups of patients. Methods: 10 Patients, who refer to our clinic for correction of dentofacial deformities, were clinically and radiologically evaluated. After appropriate treatment planning was done for each patient, the patients who had normal dental occlusion and also lower midface concavity were included to the study. The lower midface concavity problems in all patients were managed by PPI applications. Patients were evaluated by preoperative and postoperative photographic records and a satisfaction questionnaire. Results: None of the patients has poor satisfaction. Most satisfied patients were the ones who had PPI application and SSRO combination. In postoperative follow-up period infections of the implants were not observed. Additionally none of the patients experienced material exposure and material acceptance problems. Conclusion: Paranasal PPI can correct lower midface concavity. Lower midface concavity augmentation by PPI imitates the visual effects of skeletal osteotomies. Moreover by this protocol facial balances can be improved without altering dental occlusion. doi:10.1016/j.ijom.2009.03.348

O9.68 Equivalence randomised controlled trial of bioresorbable plates and titanium plates in the osteosynthesis of mandibular fracture—a pilot study K. Bhatt ∗ , A. Roychoudhury, O. Bhutia, A. Seith, A. Trikha, R.M. Pandey Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India

Background and Objectives: Since the reports on efficacy of bioresorbable plates in adult mandibular fracture treatment are sparse, the present study was undertaken to test bioresorbable fixation with tita-

nium for equivalence in terms of bony union, malocclusion, infection and need for second surgery using American Association of Oral and Maxillofacial Surgeons parameters of care. The study design was a randomised controlled equivalence trial with the working hypothesis H0:pT>pS+␦ tested against HA:pT < pS+␦ (pT testgroup complication frequency, pS standard group complication frequency, ␦ maximum clinical acceptable difference was taken as 2%). Methods: 40 adult patients with linear mandibular fractures were equally allocated to group I (titanium) and group II (bioresorbable) using computerised random table. All were plated using Champ’s principles except in group II where 2 weeks maxillomandibular fracture was also used. 8 weeks postoperative was taken as end point of study. Statistical analysis: upper limit of 95% confidence interval for each variable was compared with the predetermined ␦. Results: Male to female ratio was 19:1 in each group, mean age in each group was 27years. In group I: non-union, 0.0%; malocclusion, 11.7%; infection, 5.8%; and 2nd surgery, 33%. Group II: non-union, 3.8%; malocclusion, 11.5%; infection, 0%; 2nd surgery, 0%; and soft tissue deformity, 7.6%. Conclusion: With the limitation of sample size and this being a pilot study it was concluded that bioresorbable plating is not equivalent to titanium plating in terms of clinical union, however since there is no need to undertake a second surgery for plate removal it makes it advantageous. doi:10.1016/j.ijom.2009.03.349

O9.69 Fenestration and dehiscence around dental implant—art and science A. Ismail Mouhamed Private Practice, Bone Institute, Nasr City, Cairo, Egypt

Background and Objectives: The advantages of immediate placement is the reduction in the number of surgical procedures and treatment required, ideal axial orientation of the implants, preservation of bone at the extraction side and optimal soft tissue status. In immediate placement we face two challenges; the coronal gab between the implant and the existent bone and soft tissue management. Methods: 68 patients, age ranging from 18 to 65 years. 81 implants were used. Vertical dimensional height (VDH) defect is taken on the most apical extend of the defect to

Free Papers—Oral Presentations the coronal aspect of the implant collar using William’s periodontal probe. Each implant bony defect augmented by different forms of polylactic and polyglycolic acids (PLA-PGA). Results: All implants were successfully osseointegrated yielding a survival rate of 100%. Measurement of VDH was applied to all sides, with observation of significant decrease in defect height. The main initial defect height was 5.7 mm (standard deviation = 3), after healing the remaining defect height was reduced to 1.1 mm (standard deviation = 2.1). Conclusion: This study demonstrates that PLA-PGA fisiograft can work as an effective augmentation material in the treatment of implants fenestration and dehiscence doi:10.1016/j.ijom.2009.03.350

O9.70 The investigation of low level laser therapy efficacy on temporomandibular joint disorders with magnetic resonance imaging ˙ Görür ∗ , K. Orhan, A. Öztürk, D.I. S. S¸ahin Department of Oral and Maxillofacial Surgery, Ankara University, Ankara, Turkey

Background and Objectives: Temporomandibular disorders (TMD) are conditions that affect the form and/or function of the temporomandibular joint (TMJ), masticatory muscles, and dental apparatus. Often TMD is associated with pain localised in the TMJ and/or in the muscles of the face and neck. The aim of this study is to evaluate the effectiveness of low-level laser therapy (LLLT) both subjectively and objectively with magnetic resonance imaging (MRI) according to pain, mouth opening, subgroups of TMD, and duration of disorders. Methods: This clinical trial was performed in 12 patients, diagnosed with TMD of multiple causes. All patients received both methods of treatment in two consecutive weeks. LLLT was delivered with a custom made TMJ laser apparatus with a 650-nm wavelength and 15 mW output diode laser, and 904 nm infrared laser with 30 mW output. The amplitude of mouth opening was recorded before treatment and immediately after the therapy by using a millimeter rule. Changes in pain were evaluated by self-administered questionnaire with a visual analogue scale. The MR imaging were performed for objective assessment both pre and post laser therapy.

The effusions, signal intensity ratios of TMJ structures were measured. Results: After LLLT, there was a significant increase in the mouth opening, decrease in pain over time. The MR images showed a decrease in effusions in TMJ joint compartments and the SIR of the disk and TMJ condyle were decreased. Conclusion: LLLT can be considered as a useful method for the treatment of TMDrelated pain, and effective to improve mouth opening. The objective evaluation shows that the effusion diminishes from the joint compartment over time with LLLT. doi:10.1016/j.ijom.2009.03.351

O9.71 Pycnodysostosis: a case report, a brief review of the literature and our treatment strategy C. Voisin ∗ , F. Bianchi, A. Balon-Perin, R. Glineur Department of Oral and Maxillofacial Surgery, Erasme University Hospital, Avenue Nellie Melba, Anderlecht, Belgium

Pycnodysostosis is a rare human autosomal genetic disorder. It is mainly characterised by osteosclerosis of the skeleton, severe bone fragility and short stature. This syndrome usually presents very typical craniofacial deformities such as brachycephaly, hypoplastic midface, micrognathia, open mouth posture, anterior crossbite and dental crowding. We present a report of case of pycnodysostosis of a seven year old boy, admitted in our department. Some of the specific craniofacial and radiological findings that are frequent with pycnodysostosis are reported along with a brief report of the literature, followed by a discussion about a treatment strategy in this case. doi:10.1016/j.ijom.2009.03.352

O9.72 Experience in 15 patients with osteochemonecrosis J. Garcia Linares ∗ , J. González-Lagunas, J. Rubio Palau, J. Mareque Bueno, J.A. Hueto Madrid, G. Raspall Martín Department of Oral and Maxillofacial Surgery, Hospital Quiron, Hospital Vall d’Hebron, Sant Just Desvern, Barcelona, Spain

Background and Objectives: We present our experience with the follow-up of 15 patients with osteochemonecrosis in maxilla or mandible. They had been treated

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with bisphosphonates, and complications resulted in almost all of them after a dental procedure. Methods: All the patients were treated at our centre, depending on the exploration, extension, pain, radiographic tests and clinical manifestations like swelling of soft tissues, and depending on these criteria we provided a conservative treatment with oral rinses or surgical bone curettage with culture, antibiogram and pathology. Results: Following treatment, all patients are without pain although almost all of them are with bone exposure. Most of the patients had taken zoledronate (11/15) and these patients are the ones with worst evolution of the disease. Location of the disease was 11 in mandible and 5 in maxilla (1 both in mandiblemaxilla). 85% of patients had undergone an exodontia procedure before developing osteochemonecrosis. We performed curettage in 53% of the patients with good evolution in all of them. Conclusions: Osteochemonecrosis is an idiosyncratic disease that a patient suffers with another disease (bone metastasis of breast cancer in most of patients) and zoledronate is the bisphosphonate with worst evolution, and patients with pain, infection or bone sequestrations improve so much with bone curettage and antibiotics. doi:10.1016/j.ijom.2009.03.353

O9.73 Clinical implications of continued alcohol and tobacco consumption after treatment for oropharyngeal malignancies J. Rajinikanth ∗ , M.E. Thomas Department of Maxillofacial/Head and Neck Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia

Background and Objectives: Despite the clear association of alcohol and tobacco in the aetiology of oral cancers, continuing abuse of these risk factors in patients who have undergone treatment for these cancers is of concern. To better understand this issue, our study was designed with two specific aims: 1) to examine the prevalence and patterns of continued tobacco/alcohol use after initial treatment, and 2) its association with quality of life. Methods: All patients managed for newly diagnosed mucosal squamous cell carcinomas of the head and neck region at the Royal Darwin Hospital, Australia from 2005–2008 were included. Questionnaires on smoking, drinking, depression and on quality of life were employed. The relation