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In vivo bone regeneration using third molar sockets to provide harvestable bone for grafting alveolar defects
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Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26–S116
of hurling helmets. Our theories for a new helmet will be presented. doi:10.1016/j.bjoms.2011.03.074 P67 Theatre revisited: a study into the volume of orthognaphic patients, which required a further unplanned visit back to the operating table D. Drysdale ∗ , L. Moranzoni, P. Johnson Royal Surrey County Hospital, United Kingdom Purpose: The purpose of this study was to evaluate the number of patients who were taken back to theatre following orthognathic surgery. Patients and methods: From September 2008 to September 2010, 400 patients (150 male, 250 female) from the Royal Surrey County Hospital who had been treated with orthognathic surgery were identified. Results: 20 patients were taken back to theatre for varying general surgical reasons and complications which requiring further surgery i.e. incorrect occlusion. Conclusions: 5% of patients at the RSCH required further operative treatment over a 2 year period at the royal surrey county hospital. doi:10.1016/j.bjoms.2011.03.075 P68 Lingual necrosis due to mucormycosis R. Dua ∗ , T. Poate, K. Ghahreman King’s College Hospital, London, United Kingdom Mucormycosis is a rare fungal infection with a high mortality rate that affects immunocompromised patients. A 69 year old female with poorly controlled diabetes mellitus and aplastic anaemia was transferred to King’s College Hospital for treatment with anti-thymocyte globulin. At the time of transferral she was known to have pulmonary mucormycosis. During her admission the anterior one-third of the tongue became necrotic and several days later separated from the remaining healthy part of the tongue. The palate also became ulcerated. Investigations confirmed this to be mucormycosis of the tongue. Effective treatment of mucormycosis generally requires control of risk factors, systemic antifungal therapy, and surgical debridement. Due to the co-morbidities and poor prognosis of this lady at the time of presentation surgical debridement was not considered advisable. She was managed with systemic antifungals, optimal control of her diabetes mellitus and granulocyte infusions. Over the next two weeks the tongue, although deformed by the separation of the necrotic tip, returned to a healthy, pink colour and the palatal
ulceration resolved. Her general condition improved and she was transferred back to her local district general hospital for continued management of the aplastic anaemia. This interesting case is particularly worthy of discussion as lingual mucormycosis is extremely rare with only two cases previously documented. doi:10.1016/j.bjoms.2011.03.076 P69 In vivo bone regeneration using third molar sockets to provide harvestable bone for grafting alveolar defects S. Duggineni ∗ , R. Bhandari, S. Stagnell, N. Ali Barts and The London NHS Trust, United Kingdom Introduction: Hypoplastic areas of the alveolar ridge in edentulous areas pose considerable difficulty for restoration with dental implants. Traditionally block bone grafting from extra oral sites such as iliac crest or intraoral sites such as the mandibular ramus or chin have been used as donor sites. The intraoral donor sites have significant advantages but the ramus is preferable to the chin due to reduced morbidity. However, sometimes the ramus site cannot be used due to the presence of third molars at or very close to the preferred site. If these are removed and bone simultaneously harvested then the volume of the graft attainable can be compromised. The authors show cases where third molars were removed using an atraumatic surgical technique to preserve the buccal plate height and allow substantial bone regeneration within the socket. This newly created bone was subsequently harvested and used for block bone grafting of alveolar defects. This novel idea has not been previously described. Method and results: The surgical technique and procedure is illustrated using clinical cases. The method of atraumatic bone preserving tooth removal is described and the use of the regenerated bone demonstrated. Conclusion: The authors report brings to light an innovative and novel approach to regenerating bone in vivo using the extraction sockets of impacted lower wisdom teeth. This technique provides a greater volume of bone for harvesting whilst avoiding the chin and extra-oral sites. We recommend this indication is added to the NICE guidelines for third molar removal. doi:10.1016/j.bjoms.2011.03.077
Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26–S116
of hurling helmets. Our theories for a new helmet will be presented. doi:10.1016/j.bjoms.2011.03.074 P67 Theatre revisited: a study into the volume of orthognaphic patients, which required a further unplanned visit back to the operating table D. Drysdale ∗ , L. Moranzoni, P. Johnson Royal Surrey County Hospital, United Kingdom Purpose: The purpose of this study was to evaluate the number of patients who were taken back to theatre following orthognathic surgery. Patients and methods: From September 2008 to September 2010, 400 patients (150 male, 250 female) from the Royal Surrey County Hospital who had been treated with orthognathic surgery were identified. Results: 20 patients were taken back to theatre for varying general surgical reasons and complications which requiring further surgery i.e. incorrect occlusion. Conclusions: 5% of patients at the RSCH required further operative treatment over a 2 year period at the royal surrey county hospital. doi:10.1016/j.bjoms.2011.03.075 P68 Lingual necrosis due to mucormycosis R. Dua ∗ , T. Poate, K. Ghahreman King’s College Hospital, London, United Kingdom Mucormycosis is a rare fungal infection with a high mortality rate that affects immunocompromised patients. A 69 year old female with poorly controlled diabetes mellitus and aplastic anaemia was transferred to King’s College Hospital for treatment with anti-thymocyte globulin. At the time of transferral she was known to have pulmonary mucormycosis. During her admission the anterior one-third of the tongue became necrotic and several days later separated from the remaining healthy part of the tongue. The palate also became ulcerated. Investigations confirmed this to be mucormycosis of the tongue. Effective treatment of mucormycosis generally requires control of risk factors, systemic antifungal therapy, and surgical debridement. Due to the co-morbidities and poor prognosis of this lady at the time of presentation surgical debridement was not considered advisable. She was managed with systemic antifungals, optimal control of her diabetes mellitus and granulocyte infusions. Over the next two weeks the tongue, although deformed by the separation of the necrotic tip, returned to a healthy, pink colour and the palatal
ulceration resolved. Her general condition improved and she was transferred back to her local district general hospital for continued management of the aplastic anaemia. This interesting case is particularly worthy of discussion as lingual mucormycosis is extremely rare with only two cases previously documented. doi:10.1016/j.bjoms.2011.03.076 P69 In vivo bone regeneration using third molar sockets to provide harvestable bone for grafting alveolar defects S. Duggineni ∗ , R. Bhandari, S. Stagnell, N. Ali Barts and The London NHS Trust, United Kingdom Introduction: Hypoplastic areas of the alveolar ridge in edentulous areas pose considerable difficulty for restoration with dental implants. Traditionally block bone grafting from extra oral sites such as iliac crest or intraoral sites such as the mandibular ramus or chin have been used as donor sites. The intraoral donor sites have significant advantages but the ramus is preferable to the chin due to reduced morbidity. However, sometimes the ramus site cannot be used due to the presence of third molars at or very close to the preferred site. If these are removed and bone simultaneously harvested then the volume of the graft attainable can be compromised. The authors show cases where third molars were removed using an atraumatic surgical technique to preserve the buccal plate height and allow substantial bone regeneration within the socket. This newly created bone was subsequently harvested and used for block bone grafting of alveolar defects. This novel idea has not been previously described. Method and results: The surgical technique and procedure is illustrated using clinical cases. The method of atraumatic bone preserving tooth removal is described and the use of the regenerated bone demonstrated. Conclusion: The authors report brings to light an innovative and novel approach to regenerating bone in vivo using the extraction sockets of impacted lower wisdom teeth. This technique provides a greater volume of bone for harvesting whilst avoiding the chin and extra-oral sites. We recommend this indication is added to the NICE guidelines for third molar removal. doi:10.1016/j.bjoms.2011.03.077