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Anterior Maxilla (anterior + maxilla)

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Medical Sciences	100%

Selected Abstracts

Esthetic Restoration of the Traumatized and Surgically Reconstructed Anterior Maxilla

JOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 5 2002
DGDP(UK), PAUL A. TIPTON BDS
ABSTRACT: A car accident victim can lose not only anterior teeth but also the soft- and hard-tissue support for these teeth. This article describes a step-by-step approach to the treatment protocol for an accident victim in whom anterior teeth and the supporting tissues have been lost. The protocol is systematic and can be used for most accident cases, where the functional and esthetic demands are very high. CLINICAL SIGNIFICANCE: This article demonstrates how excellent teamwork among the dentist, implant surgeon, and laboratory technician can result in a well-conceived and successful restoration following traumatic injury of the dentition. [source]

Patterns of Innervation of the Anterior Maxilla: A Cadaver Study with Relevance to Canine Fossa Puncture of the Maxillary Sinus,

THE LARYNGOSCOPE, Issue 10 2005
Simon Robinson FRACS
Abstract Objectives/Hypothesis: Complications from canine fossa puncture of the maxillary sinus are caused by damage to the anterior superior alveolar nerve (ASAN) and the middle superior alveolar nerve (MSAN). The aim of this study was to elucidate the pattern of ASAN and MSAN within the anterior maxilla and to secondly determine suitable surgical landmarks to aid in accurately localizing the area of the canine fossa least likely to produce complications when a trocar is passed into the maxillary sinus. Methods: Anatomic dissection of the anterior face of the maxilla from 20 cadaver heads was performed. The pattern and presence of the ASAN and MSAN was identified on each side and tabulated. Landmarks for the safest entry point for canine fossa puncture were determined, and each side had a puncture placed using these landmarks. Any disruption of nerves was noted. Results: Multiple differing patterns of ASAN were identified. The ASAN emerged from its foramen as a single trunk in 30 (75%) sides and in a double trunk in 10 (25%). In 24 (60%), single or multiple branches from the ASAN trunks were identified. A MSAN was identified in 9 (23%) maxillae. The safest entry point for a canine fossa puncture was where a vertical line drawn through the mid-pupillary line was bisected by a horizontal line drawn through the floor of the pyriform aperture. Conclusions: There is significant variation in the pattern of ASAN and MSAN within the anterior face of the maxilla. By using the newly described landmarks when performing a canine fossa puncture, there is reduced risk of damage to these nerves and provides a reliable point to enter the maxillary sinus. [source]

Single Implants and Buccal Bone Grafts in the Anterior Maxilla: Measurements of Buccal Crestal Contours in a 6-Year Prospective Clinical Study

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2005
Odont Dr/PhD, Torsten Jemt DDS
ABSTRACT Background: Patients provided with buccal bone grafts seem to lose a substantial part of the graft in the short term. Purpose: To measure long-term changes in buccal and proximal tissue volumes after local bone grafting and single implant treatment. Materials and Methods: Eight of 10 originally treated male patients were followed up for 6 years after treatment with buccal bone grafts in the central incisor region. After a healing time of 6 months, a two-stage implant surgery procedure was performed followed by single crown placement. Clinical photographs and impressions were taken prior to the surgical interventions and after crown placement and at first and fifth annual checkups. The photographs were analyzed with regard to papilla regeneration by means of a clinical papilla index. The models were used to measure the clinical length of teeth and tooth movements adjacent to the implants. Changes in buccal crest volume during the study period were measured by means of optical scanning of obtained study models. Results: Papillae volume increased significantly (p < .05) during the first year, thereafter showing a slow further increase during the 4 following years. Three of the patients (38%) presented small movements of their adjacent central incisor in a vertical or palatal direction of less than 1 mm during the follow-up period. All patients showed resorption during the first year after grafting (p < .01), in which three patients (38%) had lost basically all of increased volume at second surgery. After abutment or crown placement, all patients showed an increased volume (p < .01), followed by an average reduction during the first year, reaching a significant level in the apical part of the crest (p < .05). Thereafter, a relatively stable average situation was observed during the following 4 years, with individual variations, however. Conclusion: Local bone grafting seems to create sufficient bone volume for implant placement after 6 months, but individual variations in resorption pattern make the grafting procedure unpredictable for long-term prognosis. Instead, the abutment and the crown seem to play a more important role for building up and maintaining the buccal contour in the coronal part of the crest long term. [source]

Segmental osteotomy to reposition multiple osseointegrated dental implants in the anterior maxilla in a trauma patient

DENTAL TRAUMATOLOGY, Issue 1 2007
Shou-Yen Kao
Abstract,,, A 16-year-old young man had severe loss of alveolar bone and lost four teeth in the anterior maxilla because of traumatic injury in a traffic accident. To overcome the surgically compromised condition for implant rehabilitation, the deficient ridge was augmented by autogenous bone graft from the mandibular symphysis. The augmented ridge had much improvement in width but less in vertical height. Four implants were placed to gain initial osseointegration. Segmental osteotomy was performed to occlusally reposition the implants and bone for 5-mm in the anterior maxilla. After 2 years of clinical follow-up, the rehabilitation outcome is satisfactory and stable. [source]

Zygomaticomaxillary buttress reconstruction of midface defects with the osteocutaneous radial forearm free flap

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2008
Patricio Andrades MD
Abstract Background. The purpose of this study was to evaluate morbidity, functional, and aesthetic outcomes in midface zygomaticomaxillary buttress reconstruction using the osteocutaneous radial forearm free flap (OCRFFF). Methods. A retrospective review of 24 consecutive patients that underwent midface reconstruction using the OCRFFF was performed. All patients had variable extension of maxillectomy defects that requires restoration of the zygmatico-maxillary buttress. After harvest, the OCRFFF was fixed transversely with miniplates connecting the remaining zygoma to the anterior maxilla. The orbital support was given by titanium mesh when needed that was fixed to the radial forearm bone anteriorly and placed on the remaining orbital floor posteriorly. The skin paddle was used for intraoral lining, external skin coverage, or both. The main outcome measures were flap success, donor-site morbidity, orbital, and oral complications. Facial contour, speech understandability, swallowing, oronasal separation, and socialization were also analyzed. Results. There were 6 women and 18 men, with an average age of 66 years old (range, 34,87). The resulting defects after maxillectomy were (according to the Cordeiro classification; Disa et al, Ann Plast Surg 2001;47:612,619; Santamaria and Cordeiro, J Surg Oncol 2006;94:522,531): type I (8.3%), type II (33.3%), type III (45.8%), and type IV (12.5%). There were no flap losses. Donor-site complications included partial loss of the split thickness skin graft (25%) and 1 radial bone fracture. The most significant recipient-site complications were severe ectropion (24%), dystopia (8%), and oronasal fistula (12%). All the complications occurred in patients with defects that required orbital floor reconstruction and/or cheek skin coverage. The average follow-up was 11.5 months, and over 80% of the patients had adequate swallowing, speech, and reincorporation to normal daily activities. Conclusions. The OCRFFF is an excellent alternative for midface reconstruction of the zygomaticomaxillary buttress. Complications were more common in patients who underwent resection of the orbital rim and floor (type III and IV defects) or external cheek skin. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source]

Immediate single-tooth implants in the anterior maxilla: a 1-year case cohort study on hard and soft tissue response

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2008
Tim De Rouck
Abstract Aim: The objective of the present study was to assess implant survival rate, hard and soft tissue response and aesthetic outcome 1 year after immediate placement and provisionalization of single-tooth implants in the pre-maxilla. All patients underwent the same strategy, that is mucoperiosteal flap elevation, immediate implant placement, insertion of a grafting material between the implant and the socket wall and the connection of a screw-retained provisional restoration. Material and Methods: Thirty consecutive patients were treated for single-tooth replacement in the aesthetic zone by means of immediate implant placement and provisionalization. Reasons for tooth loss included caries, periodontitis or trauma. At 6 months, provisional crowns were replaced by the permanent ones. Clinical and radiographic evaluation was completed at 1, 3, 6 and 12 months to assess implant survival and complications, hard and soft tissue parameters and patient's aesthetic satisfaction. Results: One implant had failed at 1 month of follow-up, resulting in an implant survival rate of 97%. Radiographic examination yielded 0.98 mm mesial, respectively, 0.78 mm distal bone loss. Midfacial soft tissue recession and mesial/distal papilla shrinkage were 0.53, 0.41and 0.31 mm, respectively. Patient's aesthetic satisfaction was 93%. Conclusions: The preliminary results suggest that the proposed strategy can be considered to be a valuable treatment option in well-selected patients. [source]

Patterns of Innervation of the Anterior Maxilla: A Cadaver Study with Relevance to Canine Fossa Puncture of the Maxillary Sinus,

Five-Year Survival Distributions of Short-Length (10 mm or less) Machined-Surfaced and Osseotite® Implants

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2004
Sylvan Feldman DDS
ABSTRACT Background: In cases of reduced alveolar bone height, implants of short length (10 mm or less) may be employed although there is a perceived risk that because of their small stature they will be unable to tolerate occlusal loads and will fail to osseointegrate. Purpose: This report describes an analysis of prospective multicenter clinical studies evaluating the risk for failure of short-length implants, comparing dual acid-etched (DAE) Osseotite® implants (Implant Innovations, Inc., Palm Beach Gardens, FL, USA) to machined-surfaced implants. Materials and Methods: Admission criteria were the same for both data sets. Baseline variables of demographics including age, gender and smoking status, bone quality, location, implant dimensions, and types of prostheses were compared to ensure balance among groups. Cumulative survival rates (CSRs) were calculated with the Kaplan-Meier estimator. Results: The implant data included 2,294 implants for the DAE series and 2,597 implants for the machined-surfaced series. Patient demographics showed similar percentages of occurrence for all variables. The distributions of implants between short- and standard-length data sets for baseline variables including width, location, and restorative type were similar, qualifying these data sets for comparison of the independent variable of length. Overall, there was a 2.2% difference in 5-year CSRs between the machined-surfaced short- and the standard-length implants. For these implants a 7.1% difference was observed in the posterior maxilla and an 8.5% difference in the anterior maxilla. For DAE implants the overall difference between "standards" and "shorts" was 0.7%, which is not statistically significant. Conclusion: In this analysis the difference in CSRs between short- and standard-length implants was greater for machined-surfaced implants than for DAE implants. [source]

Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients

CLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2006
Thomas Von Arx
Abstract Objective: To analyze the clinical outcome of horizontal ridge augmentation using autogenous block grafts covered with anorganic bovine bone mineral (ABBM) and a bioabsorbable collagen membrane. Material and methods: In 42 patients with severe horizontal bone atrophy, a staged approach was chosen for implant placement following horizontal ridge augmentation. A block graft was harvested from the symphysis or retromolar area, and secured to the recipient site with fixation screws. The width of the ridge was measured before and after horizontal ridge augmentation. The block graft was subsequently covered with ABBM and a collagen membrane. Following a tension-free primary wound closure and a mean healing period of 5.8 months, the sites were re-entered, and the crest width was re-assessed prior to implant placement. Results: Fifty-eight sites were augmented, including 41 sites located in the anterior maxilla. The mean initial crest width measured 3.06 mm. At re-entry, the mean width of the ridge was 7.66 mm, with a calculated mean gain of horizontal bone thickness of 4.6 mm (range 2,7 mm). Only minor surface resorption of 0.36 mm was observed from augmentation to re-entry. Conclusions: The presented technique of ridge augmentation using autogenous block grafts with ABBM filler and collagen membrane coverage demonstrated successful horizontal ridge augmentation with high predictability. The surgical method has been further simplified by using a resorbable membrane. The hydrophilic membrane was easy to apply, and did not cause wound infection in the rare instance of membrane exposure. [source]

Fate of monocortical bone blocks grafted in the human maxilla: a histological and histomorphometric study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2003
Ilara R. Zerbo
Abstract: Local bone defects in the anterior maxilla are commonly grafted with monocortical blocks of autologous bone in order to restore the defect site prior to the placement of dental implants. Increasing evidence suggests that osteocytes are involved in the control of bone remodelling and thus may be important for optimalisation of bone structure around implants, and thus for implant osseointegration. However, it is not well known whether osteocytes will survive when bone blocks are grafted into defects. We grafted 19 patients with monocortical bone blocks derived from the symphysis, to the defect site in the maxillary alveolar process. The bone grafts were left to heal for times varying from 2.5 to 7 months. During implant installation, bone biopsies were removed using a trephine burr, and processed for hard tissue histology. Bone histology and histomorphometry were then carried out in order to gain insight into the density, viability and remodelling of the graft. Clinically, all the bone grafts were successful, with no implant failures, and little resorption was seen. Histologically, bone volume expressed as percentage of tissue volume at the implant site varied from 27% to 57% with an overall average of 41%. Bone fields with empty osteocyte lacunae were observed and measured. The amount of this so-called nonvital bone (NVB) varied between 1% and 34% of the total tissue volume. The amount of NVB decreased significantly with the time of healing. The data suggest that the majority of the osteocytes of the monocortical bone do not survive grafting. The results indicate that the NVB is progressively remodelled into new vital bone 7 months after grafting. Résumé Les lésions osseuses locales dans le maxillaire antérieur sont souvent greffées avec des blocs monocorticaux d'os autogène afin de restaurer le site avant le placement d'implants. Il semble de plus en plus évident que les ostéocytes sont induits dans le contrôle du remodelage osseux et pourraient donc être importants pour optimiser la structure osseuse autour des implants et donc l'ostéoïntégration implantaire. Cependant le taux de survie des ostéocytes lorsque les blocs osseux sont greffés dans les lésions n'est pas suffisament connu. Dix-neuf patients ont été greffés avec des blocs osseux monocorticaux provenant de la symphyse dans le site de la lésion au niveau des alvéoles maxillaires. Les greffons osseux sont restés in situ durant des périodes de 2,5 à 7 mois. Pendant l'insertion des implants des biopsies osseuses ont été prélevées avec un trépan et analysées par histologie. L'histologie osseuse et l'histomorphométrie ont été effectuées afin d'analyser la densité, la viabilité et le remodelage osseux. Cliniquement tous les greffons osseux ont été effectués avec succès sans aucun échec implantaire et peu de résorption. Histologiquement, le volume osseux exprimé en tant que pourcentage du volume tissulaire au site implantaire variait de 27 à 57 % avec une moyenne totale de 41 %. Les champs osseux avec une lacune d'ostéocytes vides ont été observés et mesurés. La quantité d'os non-vivant variait de 1 à 34 % du volume tissulaire total. La quantité d'os non-vivant diminuait significativement avec le temps de guérison. Ces données suggèrent que la majorité des ostéocytes de l'os monocortical ne survivent pas au greffage. Les résultats indiquent que l'os non-vivant est progressivement remodelé en nouvel os vivant en sept mois après le greffage. Zusammenfassung Das Schicksal von monokortikalen Knochenblöcken, welche in die menschliche Maxilla transplantiert werden: eine histologische und histomorphometrische Studie Lokale Knochendefekte in der anterioren Maxilla werden normalerweise mit monokortikalen Blöcken aus autologem Knochen aufgebaut, um den Defekt vor der Eingliederung von dentalen Implantaten aufzufüllen. Aufgrund zunehmender Evidenz wird vermutet, dass Osteozyten an der Kontrolle der Knochenremodellierung beteiligt und daher wichtig für die Optimierung der Knochenstrukturen um Implantate und für die Osseointegration der Implantate sind. Es ist jedoch nicht ausreichend bekannt, ob Osteozyten überleben, wenn Knochenblöcke in Defekte transplantiert werden. Bei 19 Patienten wurden monokortikale Knochenblöcke von der Symphyse in den Defektbereich des Alveolarfortsatzes im Oberkiefer transplantiert. Die Knochentransplantate heilten in einer Zeit zwischen 2.5 und 7 Monaten ein. Während der Implantation wurden mit einer Hohlfräse Knochenbiopsien entnommen und für die Hartgewebshistologie aufgearbeitet. Der Knochen wurde histologisch und histomorphometrisch untersucht, um Einsicht in die Dichte, Vitalität und Remodellierung des Transplantats zu erlangen. Klinisch waren alle Knochentransplantate erfolgreich eingeheilt. Es konnten keine Implantatmisserfolge gesehen werden und es traten nur geringe Resorptionen auf. Histologisch variierte das Knochenvolumen, ausgedrückt als Prozentsatz Gewebevolumen an der Implantatstelle, von 27% bis 57% mit einem Durchschnitt von 41%. Knochenfelder mit leeren Osteozytenlakunen konnten beobachtet und ausgemessen werden. Die Menge dieses sogenannten nicht-vitalen Knochens variierte zwischen 1% und 34% des totalen Gewebevolumens. Die Menge des nicht-vitalen Knochens nahm signifikant mit der Länge der Einheilzeit ab. Die Daten lassen vermuten, dass die Mehrzahl der Osteozyten des monokortikalen Knochens die Transplantation nicht überleben. Die Resultate zeigen, dass der nicht-vitale Knochen innert 7 Monaten nach der Transplantation progressiv in neuen vitalen Knochen umgebaut wird. Resumen Los defectos óseos locales en el maxilar anterior se injertan comúnmente con bloques monocorticales de hueso autólogo en orden a restaurar el lugar del defecto antes de la colocación de implantes dentales. Una creciente evidencia sugiere que los osteocitos están involucrados en el control del remodelado óseo y de este modo ser importantes para la optimalización de la estructura ósea alrededor de los implantes y así para la osteointegración de los implantes. Sin embargo, no se conoce bien si los osteocitos sobrevivirán cuando los bloques óseos sean injertados en los defectos. Hemos injertado a 19 pacientes con bloques de hueso monocortical derivados de la sínfisis al lugar del defecto en el proceso alveolar maxilar. Los injertos óseos se dejaron cicatrizar por un periodo de tiempo que varió entre 2.5 a 7 meses. Durante la implantación se tomaron biopsias óseas usando una fresa de trépano y se procesaron para histología de tejidos duros. Se llevaron a cabo entonces histología ósea e histomorfometría en orden a hacerse una idea acerca de la densidad, viabilidad y remodelado del injerto. Clínicamente, todos los injertos óseos tuvieron éxito sin fracasos de implantes y se observó poca reabsorción ósea. Histológicamente, el volumen óseo expresado como porcentaje de volumen tisular en el lugar del implante varió del 27% al 57% con una media general del 41%. Se observaron y midieron campos óseos con lagunas óseas vacías. La cantidad de hueso no vital disminuyó significativamente durante el tiempo de cicatrización. [source]