Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us?

Objective

In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition.

Materials and methods

A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract.

Results

Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting.

Conclusions

An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting.

Clinical relevance

The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.

     

The use of mineralized bone allograft as a single grafting material in maxillary sinus lifting with severely atrophied alveolar ridge (1–3 mm) and immediately inserted dental implants. A 3- up to 8-year retrospective study

Objective

The primary aim of our study was to evaluate the efficacy of mineralized bone allograft alone in sinus floor augmentation with simultaneous implant placement in cases with severe atrophy of the residual maxillary bone (bone height <?4 mm).

Methods

Thirty-five dental implants were placed in 29 patients who underwent sinus augmentation via traditional lateral window technique from 2008 to 2013. Patients with residual alveolar height between 1 and 3 mm at the site of implantation were included in the study. The height of residual bone was initially estimated by plain panoramic X-ray and reevaluated intraoperatively by precise micrometric measurement at the site of implantation. Implants of 13 mm height and 3.5 or 4.3 mm in diameter were inserted simultaneously. Mineralized bone allograft was used alone to augment the sinus floor.

Results

No wound dehiscence was recorded. In one case there was a postoperative site infection which subsided with antibiotics without implant failure. One implant migrated during the postoperative period to the maxillary sinus and was removed. One implant failed. The remaining 33 implants were successfully loaded. Follow-up ranged from 3 to 8 years.

Conclusions

Maxillary sinus lift in severely absorbed alveolar ridges with simultaneous implant placement could be safely performed using mineralized allograft alone, rendering the procedure less invasive and less time-consuming.

     

Initial changes in alveolar bone volume for sham-operated and ovariectomized rats in ligature-induced experimental periodontitis

Objectives

Osteoporosis is a disease characterized by a reduction in bone mass, poor bone strength, and microarchitectural deterioration primarily in postmenopausal women. With respect to periodontal disease, osteoporosis is thought to contribute to pre-existing alveolar degeneration although the association between both diseases is not fully characterized. The aim of the present study was to observe the initial changes in mandibular alveolar bone for sham-operated and ovariectomized (OVX) rats in ligature-induced experimental periodontitis.

Materials and methods

A total of 64 Wistar rats (7 weeks of age, 180–200 g) were used in this study (32 control sham-operated animals?+?ligature placement, 32 OVX animals?+?ligature placement). Following an 8-week period to induce an OVX model, micro-CT analysis was performed to calculate vertical and furcation bone loss of mandibular first molars at time points 0, 3, 7, and 11 days following ligature placement (six animals per group per time point). Furthermore, histological analysis was performed to calculate the loss of alveolar bone crest height from the cemento-enamel junction, and tartrate-resistant acid phosphatase (TRAP) staining was utilized to calculate the number of osteoclasts.

Results

The results from the present study demonstrate that OVX animals showed significant vertical bone loss at all time points when compared to control sham-operated animals. In the furcation area, no significant difference in bone loss was observed between sham-operated and OVX animals at 0, 3, and 7 days; however by 11 days, a significant decrease in bone volume/total volume and trabecular thickness was observed in the OVX group. The histological analysis also revealed that alveolar bone crest height was significantly reduced in OVX animals, and TRAP staining further revealed the greater number of multinucleated osteoclasts peaking at 3 days postligature placement.

Conclusion

The results from the present study demonstrate a direct correlation between the osteoporotic phenotype and the progression of periodontal breakdown in a diseased-induced animal model.

Clinical relevance

It may be suggested that an osteoporotic phenotype has the potential to speed periodontal breakdown and thus contributes to the overall degeneration of the periodontium in patients suffering from postmenopausal bone loss. Future research from human clinical studies are necessary to further understand the relationship between periodontal disease and osteoporosis.

     

A new approach to treat bone gaps after midfacial and zygomatic fractures with a collagen membrane

Purpose

The aim of the study was to analyze the eligibility of resorbable collagen membrane in the treatment of midfacial fractures to prevent gap formation and subsequent cheek tissue retraction.

Material and methods

We included nine patients (six males, three females; mean age 51; range 20–73 years; mean bone gap size 8.03 × 13.12 mm) in a retrospective study design. The defect size was assessed by ultrasound.

Results

After a healing period of 4 to 55 weeks, treatment resulted in a significant reduction of gap size (residual mean bone gap size 6.14 × 7.32 mm).

Conclusions

Native resorbable collagen membrane is a promising tool to reduce the size of bony gap in midfacial defects.

     

Intraoperative Computed Tomography in Bilateral Sagittal Split Osteotomy

Objectives

The objective of the study was to show the importance of intraoperative computed tomography as an aid for ensuring inferior alveolar nerve safety during bilateral sagittal split osteotomy.

Materials and Methods

This study included ten patients who underwent bilateral sagittal split osteotomy procedure. All patients were treated for orthognathic reasons. The unerupted lower third molars, if present, were removed at least 6 months prior to Sagittal Split Osteotomy. The Sagittal Split Osteotomy surgical technique was previously described in detail. Each patient underwent computed tomography with an Artis Zeego multi-axis system (Siemens AG, Healthcare Sector, Henkestrasse 127 D-91052 Erlangen, Germany) at the beginning of the operation and immediately after placement of the osteosynthesis plates and screws. The neurosensory tests consisted of a light touch test using the 5.07/10-g Semmes Weinstein monofilament (Stoelting Co, Wood Dale, IL), and patient self-reporting.

Results

Eight (80 %) patients presented with hypoesthesia of lower lip at 6 weeks follow up. At 6 month follow up only two patients (20 %) presented with diminished sensation in the lower lip. Labial sensibility was normal in all patients at the last follow-up visit.

Conclusion

Intraoperative computed tomography enables immediate assessment of treatment and the option to modify the treatment if necessary. Our results indicate that intra-operative computed tomography would be a helpful procedure during orthognathic surgery to improve the postoperative health of the inferior alveolar nerve.

     

Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study

Purpose

This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge.

Methods

From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure.

Results

A total of 223 patients (132 women, 91 men; mean age 23.5 years; range 17–65 years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7 % after GBR procedures, 25.9 % after staged horizontal ridge augmentation, and 18.2 % after staged vertical ridge augmentation. Infections were diagnosed in 2 % after GBR procedures, 12.5 % after sinus floor elevation (SFE) (transcrestal technique), 5 % after staged SFE, 11 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2 % after GBR procedures, 37 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7 %), four after GBR procedures (1.6 %), and two (12 %) after staged vertical ridge augmentation.

Conclusions

Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.

     

Increased local recurrence in advanced parotid malignancy treated with mastoidectomy without lateral temporal bone resection

Objective

We analyzed patients with advanced parotid malignancy requiring proximal facial nerve exposure undergoing mastoidectomy versus lateral temporal bone resection to determine differences in local and distant recurrence.

Study design

The study design is a case series with chart review.

Setting

The setting is in Tertiary care practice in Fort Worth, Texas from January1998 to January 2014.

Subjects and methods

The study included 120 patients with advanced parotid malignancy, 82 males between 19 and 87 years, and 38 females between 26 and 83 years. Patients with no overt bone involvement were treated with parotidectomy and mastoidectomy for exposure of the proximal facial nerve, and patients with clinically suspected (radiographic imaging or clinical fixation) bone involvement were treated with parotidectomy and lateral temporal bone resection. Follow up ranged from a minimum of 18 months to 11 years following surgery.

Results

Sixty patients were treated with mastoidectomy and 60 were treated with lateral temporal bone resection. In patients treated with mastoidectomy, 13 had local recurrence and 7 had distal recurrence. In patients treated with lateral temporal bone resection, 2 had local recurrence while 9 had distant recurrence. Statistical analysis revealed that patients treated with mastoidectomy developed local recurrence (p = 0.0022) more commonly than those treated with lateral temporal bone resection. There was no significant difference in distant recurrence between both groups (p = 0.5949).

Conclusions

Patients with advanced parotid malignancy should be treated aggressively with parotidectomy and lateral temporal bone resection regardless of bone involvement due to increased risk of local recurrence in those treated with mastoidectomy alone.

Level of evidence

Level of evidence is a 4 case series.

     

A preliminary study on plasma concentration achieved following intrapterygomandibular space injection of dexamethasone as a route of drug delivery with lignocaine inferior alveolar nerve block–correlation of clinical effects

Purpose

To determine the quantity of dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone when co-administered with inferior alveolar nerve block correlating with the clinical effects in the postoperative phase.

Objective

A preliminary prospective study to evaluate the dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone with 2% lignocaine inferior alveolar nerve block to achieve hemi-mandibular anesthesia for minor oral surgical procedures and derive clinical correlations.

Background

Dexamethasone is a glucocorticoid, chiefly used for the management of postsurgical sequelae like trismus and swelling in maxillofacial surgical practice. Conventionally, parenteral dexamethasone is administered via intravenous or intramuscular route. Intrapterygomandibular space injection is a novel route of steroid delivery described in literature. For minor oral surgical procedures in maxillofacial surgical practice requiring inferior alveolar nerve block, dexamethasone can be administered along with local anesthetic through a single injection as a mixture (twin mix).

Methods

Prospective double-blind randomized clinical trial was designed to evaluative plasma concentration of dexamethasone achieved following injection of a freshly prepared mixture of 1.8 ml of 2% lignocaine with adrenaline (1:200000) and 1 ml (4 mg) dexamethasone [2.8 ml solution of twin mix] in the pterygomandibular space. The 30 candidates included for the trial were randomly split into three study groups (ten each)—(1) control group (C); (2) intramuscular group (IM); (3) intraspace group (IS).

Results

The mean plasma dexamethasone concentration at 30 min postinjection in group IM was 226.41?±?48.67 ng/ml and for IS group it was 209.67?±?88.13 ng/ml. Post hoc (Bonferroni-Holm test) intergroup comparison for plasma dexamethasone concentration (IM and IS) was found statistically insignificant (P?=?0.605).

Conclusion

Intraspace route of drug administration can be utilized to deliver dexamethasonized local anesthetics safely with predictable clinical effects in the patients requiring mandibular minor oral surgery under local anesthesia.

     

Operative time,blood loss,hemoglobin drop,blood transfusion,and hospital stay in orthognathic surgery

Purpose

This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery.

Methods

A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included.

Results

The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night.

Conclusions

In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.

     

Differences in crestal bone-to-implant contact following an under-drilling compared to an over-drilling protocol. A study in the rabbit tibia

Objectives

The objective of this study is to compare bone-to-implant contact (BIC) between implants inserted at high torque due to under-drilling of the crestal bone to those inserted at low torque due to over-drilling of the crestal bone.

Materials and methods

Forty implants with diameters of 3.75 mm (group A) or 3.55 mm (group B) were inserted in the proximal tibiae of NZW rabbits in two separate surgeries on day 0 or 21. Osteotomy of the crestal bone was finalized with a 3.65-mm drill. In group A, implants were inserted at torque ≥35 Ncm (under-drilling) and in group B with torque <10 Ncm (over-drilling). Implants and their surrounding bone were retrieved on day 42, thus creating 3- and 6-week observation periods, processed for non-decalcified histology and stained with toluidine blue. Crestal BIC (c-BIC) and total BIC (t-BIC) were measured. Wilcoxon test was used to evaluate differences between groups.

Results

Three weeks post-surgery, the mean c-BIC in group A was 16.3?±?3.3 vs 31.5?±?3.4 % in group B (P?<?0.05). At 6 weeks, a similar trend was observed (group A: 28.7?±?3.6 %; group B: 38.4?±?4.9 %) (P?>?0.05). No differences in t-BIC were noted at 3 weeks and at 6 weeks between the groups.

Conclusions

Insertion of implants with an over-drilling protocol of the crestal aspect of the osteotomy resulted in increased short-term crestal bone-to-implant contact.

Clinical relevance

Insertion of implants with a high torque following an under-drilling protocol, commonly used for immediate loading, may reduce crestal bone-to-implant contact at early healing stages.

     

Effects of chrondro-osseous regenerative compound associated with local treatments in the regeneration of bone defects around implants: an in vivo study

Objectives

The objective of this study was to evaluate the use of a chondroitin sulfate and glycosaminoglycan-based chrondro-osseous regenerative compound (CORC) with different local treatments for bone regeneration in dehiscence defects. The hypothesis is that CORC can enhance bone regeneration with or without local treatment.

Materials and methods

Twelve mongrel dogs received four implants each in the right femur. Bony defects (4-mm height?×?4-mm width) were created and locally treated as follows: reabsorbable membrane (Mem), hidroxyapatite (HA), hydroxyapatite covered with membrane (HA+Mem), or left untreated (Con). Six dogs received one pill of the CORC daily. After 90 days, the implants were retrieved, and histological sections were obtained. The height of bone formation, new bone area (NBA), and bone to implant contact (BIC) within the threads were evaluated to assess the effects of the use of CORC to promote bone regeneration in the defects. Results were statistically analyzed using ANOVA and Tukey’s test with 5 % significance level.

Results

CORC was not capable to increase the height of bone formation, NBA, and BIC. When the local treatments were analyzed regardless of the use of CORC, HA+Mem and Ha presented higher BIC and height of bone formation. There was no difference for NBA among the local treatments.

Conclusions

The hypothesis was rejected since the use of CORC has not increased any of the parameters evaluated.

Clinical relevance

Dehiscence-like defects can compromise soft tissue support and result in loss of periodontal health and implants. Hydroxyapatite can induce bone regeneration in the defects created. CORC in the formulation used in this study did not promote further bone regeneration in dehiscence-like defects.

     

Modified Le Fort III Osteotomy: Different Applications

Summary

Based on the new concepts of the modified Le Fort III osteotomy (MLFIIIO), Three variations of this technique are implemented: (A) the modified osteotomy Le Fort III Champy (1980) technique to be described with the use of surgical guides, and subciliary approach or an transconjunctival approach. Excellent technique for horizontal advancement no further to 6 mm, without requiring any type of graft.. (B) The modified Le Fort III osteotomy in “Z”: to solve horizontal (posterior anterior) problems of more than 6 mm without bone grafting. It is itself a modification of the technique described by Champy. (C) The modified Le Fort III osteotomy ascending: modified the original technique described by Bell and Epker with interpositional grafts, was modified by the called ascendant, making it higher in cases where the patient has an acceptable nasal bridge, but exorbitism the lateral wall of the orbit. Le Fort III osteotomy combined with a Le Fort I osteotomy and a front implant.

Method

As pointed out in Part I for the modified oblique Le Fort III osteotomy, methods for the design of the osteotomy Le Fort III property will depend on the requirements of individual patients, and this has led us to design specific techniques for the deformity.

Results

Patients have a right projection of the middle third, and protection of the eyeball.

Conclusions

The techniques presented for the advancement of the middle third have excellent results with the ability to be tailored to each patient deformity.

     

Musculoskeletal Changes as a Sequel to Advancement Genioplasty: A Long-Term Cephalometric Prospective Study

Aims

The aim of this study was to evaluate cephalometrically the stability of hard tissues and soft tissue changes of advancement genioplasty 2 years after surgery.

Methods

A prospective study was conducted which comprised of 25 patients, who underwent advancement genioplasty alone with no other orthognathic surgical procedures. Immediate pre-operative, 6 months postoperative, and 2 years postoperative lateral cephalograms were compiled and assessed.

Results

The mean surgical advancement planned was around 8 mm. Six months post-surgery, the relapse rate was 15% of the surgical advancement which was considerably reduced in the following 18 months to 7%. The ratio of soft tissue to bony advancement at pogonion was 0.9:1. There are significant alterations in the soft tissue profile in terms of decrease in the soft tissue thickness, facial convexity angle, deepened mentolabial sulcus and minimal increase in the lower lip height.

Conclusion

Advancement genioplasty was considered as a relatively stable procedure, if adequate muscular pedicle and internal rigid fixation were maintained. The present study was of 2 years, and we can expect further changes in the hard and soft tissues, which are clinically irrelevant.

     

Scientific Abstracts of 40th Annual Conference of Association of Oral and Maxillofacial Surgeons of India

Introduction

Bone marrow (BM) derived pleuripotent undifferentiated stem cells represent a promising population for supporting new concepts in cellular therapy.

Aim

The aim of this study is to evaluate the versatility of pleuripotent undifferentiated stem cells derived from BM aspiration and its applications in oral and maxillofacial surgical procedures.

Materials and Methods

A total of 30 patients out of which 15 were with hard tissue defects (cystic lesions n = 6, post surgical alveolar defects n = 4, peri implant defects n = 3, alveolar clefts n = 2) and 15 soft tissue lesions (leukoplakia and lichen planus n = 6, oral submucous fibrosis n = 7, post traumatic soft tissue loss n = 2) were included in the study on randomized clinical basis. The patients received autologous BM derived mononuclear cells which were being locally delivered into the lesion and followed up. The parameters used were (1) To compare and evaluate the bone regeneration by radiographic assessment at the end of 3rd and 6th month postoperatively. (2) Duration of the procedure. (3) Clinical improvement in the management of soft tissue lesions. (4) Assessment of wound healing by Vancouver burn scar assessment of wound. (5) Safety, postoperative infections and complications.

Results

For hard tissue lesions CT scans and OPG revealed adequate regenerated bone, bridging the defect after 3 months. Hounsfield units of regenerated bone after 6 months were more or less similar to native bone which was statistically significant (unpaired t test = p < 0.05). For soft tissue lesions (1) 7 cases of OSMF showed adequate clinical mouth opening (one way anova test = p < 0.05), reduction in burning sensation and blanching of mucosa, (2) 6 cases of leukoplakia and lichen planus and 2 cases of post traumatic soft tissue defects showed good clinical improvement by Vancouver burn scar assessment of wound index.

Conclusion

The study shows that there is a definite beneficial effect in bone regeneration and soft tissue wound healing with the use of BM-derived mononuclear cells.

     

Reconstruction of tooth-bearing portion of mandible using polyglactin 910 sutures for internal fixation in the third-world: functional and cosmetic outcome

Background

This study analyzed the cosmetic and functional outcome of cases involving reconstruction of tooth-bearing portion of the lower jaw, using a polyglactin 910 suture for fixation.

Patients and method

This prospective intervention study documented the treatment outcome in 25 consecutive adult patients, who underwent immediate mandibular reconstruction following segmental resection of tooth-bearing portion of mandible. Cortico-cancellous bone graft was taken from the inner table of iliac bone, sparing the crest. Use of post-surgical inter-maxillary fixation was avoided.

Results

Twenty-five patients were recruited for the study. Seventeen were males and eight were females. Their ages ranged from 18 to 50 years, with a mean of 30.0 years. Average length of grafted bone was 9.8 cm. Following surgery, all 25 (100%) patients were judged to have satisfactory facial symmetry. One (4.0 %) had altered dental occlusion. Twenty-five (100%) had satisfactory bone union. All of the patients claimed to masticate satisfactorily. Assessment was carried out at the last post-operative follow-up visit for each patient who ranged between 22 and 83 months.

Conclusion

Use of polyglactin 910 suture material for fixation in mandibular reconstruction following segmental resection of tooth-bearing portion has proven to be a cosmetic and functional success. It may serve as alternative for those among whom conventional treatment methods may be contraindicated. This method of bone fixation may serve as a reliable and much cheaper alternative in low-income countries.

Level of evidence

Level IV, therapeutic study.

     

To assess the efficacy of socket plug technique using platelet rich fibrin with or without the use of bone substitute in alveolar ridge preservation: a prospective randomised controlled study

Aim

The purpose of this study is to evaluate the efficacy of Platelet Rich Fibrin (PRF) as a socket plug with or without use of Plaster of Paris (POP) as bone substitute to preserve the alveolar ridge post-extraction.

Material and methods

A prospective randomised single blind controlled study, was conducted for 18 months from November 2014 to May 2016 on 48 patients requiring extraction. All teeth were extracted atraumatically using periotomes and luxators without raising mucoperiosteal flap. Sockets were randomly allotted to groups A, B and C. Group A sockets were chosen as control, where figure of eight suture was placed. In group B sockets, PRF obtained by centrifugation was used as a socket plug and stabilised with figure of eight suture. Group C sockets were filled with POP and then covered with PRF. The socket was then closed with a figure of eight suture. Patients were informed of need for 6 months follow-up.

Results

Ninety sockets in 48 patients were subjected to our study. We found that results in the sockets where we have grafted POP showed better ridge preservation and post-operative comfort even though the difference in ridge resorption between the three groups was not statistically significant. Powered by Editorial Manager® and ProduXion Manager® from the Aries Systems Corporation.

Conclusion

Atraumatic extraction may minimise the post-operative pain and discomfort to patient as well as the post-extraction alveolar height and width changes. The use of PRF and/or bone substitute even though clinically contributes to better post-operative healing and minimal loss of alveolar width and height, the values were not statistically significant.

     

Comparative Evaluation of Er:Cr:YSGG,Diode Laser and Alvogyl in the Management of Alveolar Osteitis: A Prospective Randomized Clinical Study

Introduction

Alveolar osteitis (AO) is a well-known complication following tooth extraction. Plethora of literature is available regarding its treatment modalities signifying that none of the treatment is as effective as any another treatment. LASER on the other hand, has been used to promote soft tissue healing.

Material and method

In order to evaluate the effects of laser on healing of AO we undertook a randomized clinical trial. In the trial, sixty patients diagnosed with AO were randomly divided into three groups viz: alvogyl, diode laser and Er:Cr:YSGG laser (erbium chromium yttrium scandium gallium garnet).

Results

On analyzing the results, diode laser at 1.0 W power settings (energy: 20–25 J/cm²) in non-contact, continuous mode was found to be the most effective for both pain relief and healing improvement.

Conclusion

The diode laser is an acceptable and effective non-dressing treatment modality for alveolar osteitis, which is the most common painful complication following extraction.

     

Cutaneous squamous cell carcinoma of the scalp in the immunocompromised patient: review of 53 cases

Objective

We analyzed outcomes from immunocompromised patients with scalp squamous cell carcinoma (SCC) treated with surgical excision with and without radiation in order to explore 3-year disease-free survival and overall survival.

Study design

The study design was a retrospective chart review.

Setting

This study was conducted in a private practice setting.

Subjects and methods

The study included 53 immunocompromised patients with an average age of 63.2 years, with scalp squamous cell carcinoma. Pre-operative imaging dictated the extent of resection. Patients with bony involvement received wide local excision including full-thickness craniectomy and cranioplasty. Patients without bony involvement underwent wide local excision and outer-table calvarial resection. All patients were recommended to have post-operative radiation. Patients were followed for a minimum of 3 years.

Results

A total of 53 patients were included in the study. Six patients had pre-operative CT showing bone involvement and were treated with full-thickness craniectomy along with post-operative radiation. Fourteen patients without bone involvement on pre-operative CT were found to have positive bone involvement on final pathology. Forty-five patients underwent post-operative radiation. Patients treated with adjuvant radiation demonstrated a 3-year survival of 80 % and the overall survival was 62 %. In the surgery-only group, the 3-year survival was 62.5 % and the overall survival was 32.5 %.

Conclusions

Immunocompromised patients with scalp SCC have a poor prognosis. Early detection and treatment are crucial. Based on our results, we recommend wide local excision with at least outer-table calvarial resection, and post-operative radiation. Despite aggressive therapy, patients may still have distant, local, or regional recurrence.Level of evidence: level 2b (retrospective cohort)

     

Bond strength evaluation of cyanoacrylate-based adhesives and screws for bone fixation

Introduction

Bone graft is a very common procedure that is performed when bone volume needs to be increased before a dental implant. Screws and miniplates are the clinical standards for osteosynthesis. However, some disadvantages for this method have been reported, including artifacts on radiological images, infection, screw loosening, and the need to remove screws that interfere with the dental implants. Bone adhesives are a promising alternative for bone graft surgery.

Purpose

The aim of this study was to compare the shear bond strength of two cyanoacrylate-based adhesives and titanium screws for bone graft fixation.

Methods

Pig jaw samples were cut into rectangular bars (2 × 6 × 20 mm) and bonded with a 5-mm overlap of N-butyl cyanoacrylate and ethyl cyanoacrylate, and 1.5-mm titanium screws were inserted into the center of the contact area. The blocks were fixed on a shear bond strength device that was coupled to a universal testing machine. The maximum force (N) was recorded on a computer and divided by the bonded area (in mm²) in order to calculate the bond strength (MPa). The data were statistically analyzed with ANOVA and Tukey’s test (α = 0.05).

Results

The shear bond strengths of the screws were significantly higher than both cyanoacrylate adhesives, which presented statistically similar bond strength means, and have the biomechanical potential to be used for bone fixation.

Conclusions

Ethyl cyanoacrylate is an inexpensive adhesive that has multiple purposes and can be considered as an alternative for bone fixation.

     

Radiographic outcomes following treatment of intrabony defect with guided tissue regeneration in aggressive periodontitis

Objectives

This study reports the radiographic analysis of a split-mouth, single-blinded, randomised controlled clinical trial which was designed to compare the efficacy of simplified papilla preservation flap (SPPF) with or without guided tissue regeneration (GTR) in patients with aggressive periodontitis (AgP).

Methods

Eighteen AgP patients who had similar bilateral intrabony defects were treated. In all patients, the defects presented with radiographic evidence of an intrabony defect ≥3 and ≥5 mm of periodontal pocket depths (PPD). The surgical procedures included access for root instrumentation using SPPF alone (control) or, after debridement, a placement of resorbable GTR membrane (test). The standardised radiographic assessments were carried out at pre-surgical baseline and at 6 and 12 month post-surgery. Radiographic linear measurements and subtraction radiography were used as the method of analysis.

Results

Both treatments showed significant improvements in linear radiographic bone fill and defect resolution at 6 and 12 months, compared to baseline. The 12-month subtraction radiography at the GTR sites showed a significant improvement compared to the 6-month outcomes.

Conclusions

Both therapies were effective in the treatment of intrabony defects in AgP patients although no significant differences between them could be demonstrated. The finding that the bone fill and resolution of the defect at the GTR sites were significantly higher at 12 months than at 6 months after treatment indicates that bone regeneration is still an ongoing process at 6 months post-surgery.

Clinical relevance

Radiographic assessment of periodontal regeneration should be carried out at 12 months post-surgery in order to evaluate the complete healing of the bony defect.