Severely resorbed mandible treated with iliac crest autogenous bone graft and dental implants: 17-year follow-up

Severe bone atrophy in the mandible may result in weakening of the jaw, unstable dentures, and dysfunction of the inferior alveolar nerve. These conditions were diagnosed in a 65-year-old woman who presented with a severely resorbed mandible. The interforaminal region of the mandible was augmented with an onlay graft harvested from the iliac crest. Four dental implants stabilized the graft by anchoring it inferiorly to the residual mandibular basal bone. Implants later served as abutments for a fixed 12-unit implant-supported prosthesis. The patient was followed for 17 years, during which the mandibular prosthesis was replaced twice. Despite the initial questionable prognosis, oral rehabilitation was successful, with no detectable clinical signs of bone loss over the 17-year follow-up period.     

腓骨肌皮复合组织瓣的临床手术解剖研究

了解腓骨肌皮复合组织瓣血供特点,手术实施种植义齿的可行性,为其临床应用提供临床手术解剖 基础。方法对１０例病人切取腓骨肌皮复合组织瓣以供修复下骨及周围软组织,观察腓骨肌皮复合组织瓣的（１）血供特点;（２）手术操作要点;（３）手术并发症;（４）腓骨与种植义齿的关系。     

The fabrication and use of an extraoral surgical guide for implant placement coincident with soft tissue matrix expansion grafts: a clinical report

During soft tissue matrix expansion (tent pole) graft (STMEG) surgery, the traditional intraoral surgical guide for dental implant placement cannot be used because the surgery is initiated and maintained outside the oral cavity. The essential records established from an intraoral surgical guide must be transferred to an extraoral surgical guide. This clinical report describes the fabrication and use of an extraoral surgical guide employed during STMEG surgery.     

游离腓骨肌皮复合组织瓣一期修复下颌骨及软组织缺损

目的寻找一种既能满足下颌骨及软组织复合缺损重建需要，又不影响供区功能的新的修复材料。方法对１０例各种原因所致的下颌骨及周围软组织缺损患者，采用游离腓骨肌皮复合组织瓣进行修复重建。所切取的腓骨平均长度９１ｃｍ，肌皮瓣平均大小为４５ｃｍ×６２ｃｍ。结果术后２周经９９ｍＴｃＯ－４骨扫描等证实，９例（９／１０）骨肌皮瓣成活，患者下颌功能与外形良好，行走无障碍。结论腓骨肌皮复合组织瓣骨量充足，骨质坚硬，腓骨血供具二重性，利于塑形，可以用作下颌骨及软组织缺损的修复。     

Reconstruction of the severely resorbed mandible with interposed bone grafts and hydroxylapatite. A 2-3 year follow-up

A follow-up study on 55 patients, who underwent an augmentation of their severely resorbed mandible, using a mixture of autogenous bone and HA-granules, is discussed. The method combines an interposed bone graft technique in the symphyseal area with a subperiosteal tunneling in the region posterior to the mental foramina. The results show a maximum height loss of approximately 30% in both the symphysis and the bicuspid-molar region after 2 to 3 years, from which most occurred in the first 6 months. The method is relatively safe with regard to potential nerve damage and provides excellent aesthetic results. The option for subsequent placement of implants is entirely possible.     

Metastatic mandibular retinoblastoma in a child reconstructed with soft tissue matrix expansion grafting: a preliminary report.

PURPOSE: Retinoblastoma is a congenital malignant neoplasm of retinal tissue. Reports of metastasis to the mandible are rare. Successful retinoblastoma management has led to a dramatic improvement in survival rates. Increasing numbers of surviving patients require reconstruction of the defects caused by the ablation of such metastasis. PATIENT AND METHODS: This article describes the management of a pediatric mandibular defect secondary to the resection of a metastatic retinoblastoma. RESULTS: A unique application of the soft tissue matrix expansion technique, otherwise known as the "tent-pole" graft, which has been previously described in adults with severe mandibular atrophy, was utilized in the pediatric patient. CONCLUSION: The soft tissue matrix expansion grafting technique can be successfully utilized in the reconstruction of ablative defects in pediatric patients.     

游离排骨肌皮复合组织瓣一期修复下颌骨及软组织缺损

寻找一种既能满足下颌骨下软组织复合缺损重建需要，又不影响供区功能的新的修复材料。方法对１０例各种原因所致的下颌骨及周围软组织员虱，采用游离腓骨肌皮复合组织瓣进行修复建建。     

Bisphosphonate-associated osteonecrosis of the mandible: reliable soft tissue reconstruction using a local myofascial flap

For the treatment of bisphosphonate-associated osteonecrosis of the jaw (BP-associated ONJ), poor cure rates are reported. In many cases, repeated osseous exposition and infection may occur. The currently recommended management of affected patients is antibiotic treatment and bony decortication, which is often complicated by soft tissue deficits due to chronic infection. In severe cases osteonecrosis can be managed often only by continuity resections of the mandible. For this purpose, we developed a new surgical procedure, which allows an effective closure of difficult jaw wounds in the lateral mandible. In the last 3 years, 20 patients with BP-associated osteonecrosis of the lower jaw were treated successfully with a modified defect-covering method using a myofascial flap. A mylohyoid muscle flap was detached from mylohyoid line and used to cover the bony defect. During 19 months mean follow-up, 90% of patients were asymptomatic, the oral mucosa was intact, and no exposed bone was observed. In consequence, we are able to demonstrate that a mylohyoid muscle flap provides a reliable wound closure in the lower jaw in patients treated with BPs. Although there are still no consensual therapy guidelines for patients affected by BP-associated ONJ, the results of the presented study provide evidence for an effective surgical therapy with long-term success. Covering compromised bone with well-vascularized tissue, a muscle flap, increased healing chances by enabling and supporting the necessary nutrition and defense against opportunistic infections. This therapy concept showed a good clinical outcome.     

Tissue expansion reconstruction of soft tissue avulsions of the face: report of two cases

A technique utilized to increase the amount of skin available for repair of soft tissue defects with local flaps has been described. Indications for the use of tissue espansion and the surgical technique and possible disadvantages have been discussed. Two case reports are presented to illustrate the use of the tissue expander to repair avulsive craniofacial defects.     

Managing soft tissue fenestrations in bone grafting surgery with an acellular dermal matrix: a case report.

The success of bone grafting procedures depends largely on the management and integrity of the gingival flaps. Soft tissues aid in the protection of the bone graft, participate in the revascularization of the newly formed hard tissues, and play an important role in the esthetic outcome of the reconstructive phase. Acellular dermal matrix (ADM) is a material obtained from human skin and used in plastic and reconstructive surgery as an allograft. It acts as a bioactive substrate for cell attachment and proliferation. The outcome of the use of ADM as a dressing material to treat flap fenestrations in bone grafting surgery is presented.     

Aggressive juvenile fibromatosis involving the mandible: surgical excision with immediate reconstruction.

Aggressive juvenile fibromatosis involving the facial bones is rare, difficult to diagnose clinically, histologically confusing, and requires aggressive surgical treatment. Only four cases involving the mandible have been previously reported. A review of the literature is presented here in conjunction with a case report of this rare tumor.     

Onlay bone grafting of the mandible after periosteal expansion with an osmotic tissue expander: an experimental study in rabbits

Objectives: To evaluate the space‐maintaining capacity of a titanium mesh or a bioresorbable mesh after periosteal expansion and to assess bone formation under a titanium mesh or a bioresorbable mesh on the lateral border of the mandible by qualitative and quantitative histological analysis. Material and methods: In 13 rabbits, a self‐inflatable soft tissue expander was placed intraorally, bilaterally under the mandibular periosteum via an extra oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft was placed and covered by a titanium mesh or a bioresorbable mesh. After 3 months, the animals were sacrificed and specimens were collected for histology. Results: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone had formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, soft tissue dehiscence was recorded in two of the sites with bioresorbable meshes. The mean bone fill was 65% under the titanium mesh and 85% under the bioresorbable mesh (P<0.05). There was no significant difference between the titanium mesh and the bioresorbable mesh regarding the height of the meshes, mesh area and mineralized bone area. Scanning electron microscopy shows that new bone is growing in direct contact with the resorbable mesh and the titanium mesh. Conclusion: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue and that new bone can be generated under a titanium mesh or bioresorbable mesh. To cite this article:
Abrahamsson P, Isaksson S, Gordh M, Andersson G. Onlay bone grafting of the mandible after periosteal expansion with an osmotic tissue expander: an experimental study in rabbits.
Clin. Oral Impl. Res 21 , 2010; 1404–1410.
doi: 10.1111/j.1600‐0501.2010.01967.x     

Triple immediate therapy (ridge expansion, soft tissue augmentation, and provisional restoration) of maxillary anterior single implant

BACKGROUND: Immediate restoration during implant placement in the premaxillary area can achieve a favorable esthetic result. However, the treatment always poses a great challenge to clinicians, especially for patients with preexisting soft and hard tissue deficiencies. The aim of this clinical report was to present a protocol for a multidisciplinary approach to provide an immediate implant restoration for patients with ridge deficiency. METHODS: A 21-year-old female presented with a mesial shift of the maxillary right canine due to loss of a lateral incisor at an early age. The treatment protocol included orthodontic space redistribution to open a canine space for implant placement. Subsequently, ridge expansion and implant placement combined with connective tissue grafting for the reconstruction of the soft tissue profile were performed, and an immediate provisional prosthesis was delivered simultaneously. A definitive University of California at Los Angeles-style ceramometal crown was completed 6 months later with periodical clinical maintenance. RESULTS: The 18-month postoperative follow-up revealed that the implant was stable, and the buccal depression of the surgical area was reconstructed. Papillae were augmented, and a harmonious soft tissue margin was achieved in the esthetic zone. Radiographs demonstrated a normal vertical osseous height and excellent osseointegration of the implant. CONCLUSIONS: The combination technique of ridge expansion and soft tissue augmentation can be applied to immediate implant restoration cases without the need for complicated bone grafting surgeries in atrophic ridges. This triple immediate strategy enabled us to reduce the number of surgeries, which simplified the overall procedure without compromising the esthetic results.     

Le Fort I osteotomy with interpositional bone grafts and implants for rehabilitation of the severely resorbed maxilla: a 2-stage procedure.

A surgical procedure for the rehabilitation of severely resorbed maxillae is described. Twenty-five patients, made up of a development group of 5 and a routine group of 20, were treated with Le Fort I osteotomy using interpositional bone grafts from the iliac crest and, in a second stage, titanium implants. Altogether, 181 Br?nemark implants were placed, and the patients were followed for up to 5 years. The implant survival rate for the development group was 60.0% after 5 years. Life table analysis for the routine group showed a 5-year survival rate of 85.6%. Twenty-two patients received fixed prostheses and 2 received overdentures. One patient lost all implants and was rehabilitated with a prong denture.     

Immediate Occlusal Loading (IOL) of dental implants: predictable results through DIEM guidelines.

For years, dental implants have been loaded immediately upon implant placement with varying degrees of success. As clinicians' understanding of the biological and mechanical factors involved in immediate occlusal loading (IOL) has evolved, the success of these procedures has increased--particularly as a treatment option for the restoration of the edentulous mandible or the mandible that will be rendered edentulous during treatment. Due to increasing interest in this treatment alternative, the authors have provided a clear definition of the terminology associated with IOL and have demonstrated the DIEM Guidelines used to increase the success and predictability of such treatment. This presentation also introduces new implant components that simplify the clinical application of the immediate loading concept, enhancing its benefits and acceptance among dental patients and practices alike.