Horseshoe Le Fort I osteotomy in combination with endosteal implants — a median-term follow-up study

Fourteen patients with Class VI resorption of the maxilla were treated with horseshoe Le Fort I osteotomy. In 11 cases, the procedure was followed by the placement of endosteal implants. In six patients, simultaneous placement of implants was carried out, while in five patients this was done in a second procedure. Ten patients wore their implant-supported dentures. In one patient, 5/8 implants were lost due to nonintegration. Three patients lost one implant each. The total number of implants placed was 76, and the survival rate of the implants was 88.1%. In the one-step procedure (n=42), the survival rate was 84.8%; in the two-step procedure (n=34), 92.3%. In comparison of the one-step to the two-step procedure, there was no statistically significant difference (P>0.11) between the amount of marginal peri-implant bone loss and the condition of the peri-implant soft tissues as measured 2 years after implantation.     

Immediate loading of dental implants placed in severely resorbed edentulous maxillae reconstructed with Le Fort I osteotomy and interpositional bone grafting

Background: Reconstruction and rehabilitation of atrophic maxillae with bone grafts is a lengthy and demanding procedure. This study reports the immediate loading of 50 implants placed on six extremely atrophied edentulous maxillae reconstructed with Le Fort I osteotomy and iliac bone grafting. Methods: Six patients, aged 49 to 68 years, with severely atrophied maxillae were treated with Le Fort I osteotomy and iliac bone grafting to allow for implant‐borne prosthetic rehabilitation. Four to 5 months thereafter, 50 implants (seven to 10 per patient) were placed in reconstructed maxillae and immediately functionally loaded with a screw‐retained definitive prosthesis. The patients were followed by clinical and radiographic examinations for 24 months after prosthetic loading. Results: The grafting procedure and healing period before implant placement were uneventful in all patients. Two implants were lost within 2 months after prosthesis insertion in two patients, with an overall survival rate of 96%. The prostheses success rate was 100%. At the end of the follow‐up period, all remaining implants appeared clinically healthy; crestal bone loss was >1.7 mm for six implants, resulting in a cumulative success rate of 84%. Conclusion: Immediate loading of implants placed after Le Fort I osteotomy and interpositional iliac bone grafting could be considered a viable protocol to rehabilitate extremely atrophied edentulous maxillae, considerably reducing the treatment time.     

Guided bone regeneration with autogenous block grafts applied to Le Fort I osteotomy for treatment of severely resorbed maxillae: a 4- to 6-year prospective study

Introduction: Edentulism causes progressive bone resorption of the maxillae, which can lead to altered maxillo‐mandibular relationships. The aim of the study was to evaluate the applicability of guided bone regeneration (GBR) to Le Fort I osteotomies with interpositional bone grafts for treatment of patients with severe maxillary atrophy. Materials and methods: Twenty consecutive patients characterized by severely atrophic maxillae were treated from January 2003 to January 2006 in order to resolve maxillary edentulism. All patients underwent pre‐prosthetic surgery, including a Le Fort I osteotomy associated with autologous interpositional bone grafts to move the alveolar arch forward and to resolve the maxillary atrophy. Barrier membranes were also used to cover the bone grafts and the osteotomy line, favoring the healing process according to GBR principles. Maxilla advancement and alveolar crest augmentation were measured to assess the degree of reconstruction. A total of 154 implants were inserted in reconstructed maxillae 4 months after surgery and were restored with fixed full‐arch dentures after another 4 months. Surgical and prosthetic complications were recorded and previously established implant success criteria were used to assess the success of this treatment protocol. Results: The outcome of pre‐prosthetic surgery and implant‐supported rehabilitation was prospectively evaluated every year. All Le Fort I osteotomies were successfully carried out, with a mean maxilla advancement of 4.2 cm (range: 3.1–5 cm), which appeared to be stable during the follow‐up. After a mean follow‐up of 66.4±18.4 months, only four implants failed according to the success criteria, yielding a cumulative success rate of 95.8%. Discussion and conclusions: Le Fort I osteotomies with the use of barrier membranes to cover the interpositional bone grafts can be a predictable treatment for edentulous patients with severely resorbed maxillae. The study data suggest that this approach makes it possible to compensate for both sagittal and vertical discrepancies due to maxilla atrophy, with a minimum resorption of advanced maxillae and grafted bone. A GBR‐based protocol seems to lead to high implant success rates, although further randomized controlled studies are needed to demonstrate the usefulness and advantageousness of GBR. To cite this article:
De Santis D, Trevisiol L, D'Agostino A, Cucchi A, De Gemmis A, Nocini PF. Guided bone regeneration with autogenous block grafts applied to Le Fort I osteotomy for treatment of severely resorbed maxillae: a 4‐ to 6‐year prospective study.
Clin. Oral Impl. Res. 23 , 2012; 60–69.
doi: 10.1111/j.1600‐0501.2011.02181.x     

A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years

Background Prosthetic rehabilitation with implant‐supported prostheses in the atrophic edentulous maxilla often requires a bone augmentation procedure to enable implant placement and integration. However, a rigid anchorage can also be achieved by using so‐called zygomatic implants placed in the zygomatic arch in combination with regular implants placed in residual bone. Purpose The aim of the present study was to report on the clinical outcome of using zygomatic and regular implants for prosthetic rehabilitation of the severely atrophic edentulous maxilla. Materials and Methods Sixty‐nine consecutive patients with severe maxillary atrophy were, during a 5‐year period, treated with a total of 69 fixed full‐arch prostheses anchored on 435 implants. Of these, 131 were zygomatic implants and 304 were regular implants. Fifty‐seven bridges were screw‐retained and 12 were cemented. The screw‐retained bridges were removed at the examination appointments and each implant was tested for mobility. In addition, the zygomatic implants were subjected to Periotest^® (Siemens AG, Bensheim, Germany) measurements. The patients had at the time of this report been followed for at least 6 months up to 5 years in loading. Results Two regular implants failed during the study period giving a cumulative survival rate of 99.0%. None of the zygomatic implants was removed. All patients received and maintained a fixed full‐arch bridge during the study. Periotest measurements of zygomatic implants showed a decreased Periotest values value with time, indictating an increased stability. Three patients presented with sinusitis 14–27 months postoperatively, which could be resolved with antibiotics. Loosening of the zygomatic implant gold screws was recorded in nine patients. Fracture of one gold screw as well as the prosthesis occurred twice in one patient. Fracture of anterior prosthetic teeth was experienced in four patients. Conclusions The results from the present study show that the use of zygomatic and regular implants represents a predictable alternative to bone grafting in the rehabilitation of the atrophic edentulous maxilla.     

Comparison between patient specific implants and conventional mini-plates in Le Fort I osteotomy with regard to infections: No differences in up to 3-year follow-up

Individually designed osteotomies and milled or printed patient-specific osteosynthesis materials are rapidly becoming a standard in maxillofacial reconstructive surgery. The benefits of using patient-specific implants (PSIs) in orthognathic surgery are especially clear in complex cases, and for this reason they are rapidly becoming common practice. We have earlier reported the benefits related to the use of PSIs as reposition and fixation system in Le Fort I osteotomy. The aim of this study was to compare complications associated with fixation with PSIs (31 patients) versus conventional mini-plates (37 patients) in Le Fort I osteotomy. No statistically significant differences in infection, reoperations or soft tissue problems were observed between the two systems used. Interestingly, three of the 37 patients in the mini-plate group underwent reoperation due to insufficient advancement or malocclusion, whereas none of the patients in the PSI group needed reoperation. In conclusion, PSIs are reliable for use in orthognathic surgery, with no signs of infection associated complications.     

Interpositional bone grafting and Le Fort I osteotomy for reconstruction of the atrophic edentulous maxilla: A two-stage technique

This study presents the results from ten consecutive patients who, because of insufficient bone volume for conventional implant placement in the maxilla, were treated with an interpositional bone graft and Le Fort I osteotomy. The endosteal implants were placed six months after the osteotomy. A total of 60 screw-shaped titanium implants (Brånemark^®) were placed, of which three failed to integrate during the six-month healing period. No further implants were lost during the follow-up period, ranging from 15 to 39 months after placement of the implants. All patients received fixed bridges and all have continued to function efficiently.     

Maxillary sinus recovery and nasal ventilation after Le Fort I osteotomy: a prospective clinical,endoscopic, functional and radiographic evaluation

The condition of the maxillary sinus is not routinely assessed before a Le Fort I osteotomy. Performing this procedure in an infected sinus might account for a considerable proportion of the complications, such as excessive bleeding and sinusitis. The aim of this study was to evaluate the maxillary sinus and nasal ventilation after Le Fort I osteotomy. Twenty patients were evaluated before and 2 months after surgery using validated questionnaires for sinonasal complaints (RSOM-31 and VAS score), nasal endoscopy, peak nasal inspiratory flow (PNIF), and a computed tomography (CT) scan. There were no differences in complaints before and 2 months after surgery (P > 0.24). Also, the PNIF did not change significantly (P = 0.10). On CT evaluation before surgery, a previously unnoted sinusitis was diagnosed in two patients. Postoperatively, a thickened sinus mucosa was present in all patients near the osteotomy line, the osteosyntheses, and around sequesters. This report describes maxillary sinus evaluation after Le Fort I osteotomy in a more comprehensive way by using CT. The Le Fort I procedure did not influence already existing physical or mental complaints, and nasal ventilation was not negatively affected. However, evaluation of sinonasal pathology should be emphasized in the preoperative work-up.     

Le Fort I osteotomy with segmentation for the treatment of maxillary dentoalveolar protrusion: a single-centre, 10-year outcome study

A retrospective study was conducted to evaluate the stability and complications of Le Fort I osteotomy with segmentation for the treatment of bimaxillary dentoalveolar protrusion. A total of 120 consecutive patients who had undergone orthognathic surgery between 2008 and 2017 at a single centre were recruited. Lateral cephalometric radiographs were taken before surgery, within 6 weeks after surgery, and at 2 years after surgery. U1–SN and U1–PP underwent mean uprighting of 8.7° and 9.6°, respectively, and mean relapse of 2.1° and 2.6°, respectively (both P < 0.05). The only significant risk factor for relapse was the use of intermaxillary fixation (risk ratio (RR) 1.2, P = 0.01). The most common complication was wound dehiscence (41.7%), which was a significant risk factor for wound infection (RR 3.3, P < 0.01) and fixation hardware exposure (RR 3.7, P < 0.01). Other common complications were gingival recession (40.8%), periodontal bone loss (40%), and blood loss requiring transfusion (26.7%), the latter of which was associated with the preoperative diagnosis of vertical maxillary excess (RR 2.4, P = 0.01). Some degree of relapse occurred in more than 90% of the patients by 2 years after surgery. The procedure is not without risks and complications but may be useful in severe cases.     

Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study

OBJECTIVES: The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of fully edentulous maxillae and to compare the outcome of axial vs. tilted implants. MATERIAL AND METHODS: Forty-one patients with edentulous maxillae were included in the study. Each patient received a full-arch fixed bridge supported by four axial implants and two distal tilted implants. Loading was applied within 48 h from surgery. Patients were scheduled for follow-up at 6 months, 1 year and annually up to 5 years. Radiographic evaluation of marginal bone-level change was performed at 1 year. RESULTS: One patient died 4 months after surgery. Thirty patients were followed for a minimum of 1 year (range 3-42 months, mean 22.1 months). Three failures were recorded at 1-year follow-up (two axial implants and one tilted). Two more implants (one tilted and one axially placed) were lost within 18 months of loading. The 1-year implant survival rate was 98.8% for both axial and tilted implants. Prosthesis success rate was 100% at 1 year. Marginal bone loss around axial and tilted implants at 12-month evaluation was similar, being, respectively, 0.9+/-0.4 (standard deviation) mm and 0.8+/-0.5 mm. CONCLUSIONS: The present preliminary data suggest that immediate loading associated with tilted implants could be considered to be a viable treatment modality for the atrophic maxilla and that there does not seem to be a different clinical outcome between tilted and axial implants.     

Immediate loading of dental implants placed in severely resorbed edentulous mandibles reconstructed with autogenous calvarial grafts

OBJECTIVE: The aim of this prospective study was to present the clinical outcome of immediately loaded dental implants placed in edentulous, severely atrophied mandibles, after reconstruction with autogenous multilayered calvarial grafts. MATERIALS AND METHODS: Six patients, two males and four females, aged 40-67 years (mean: 56 years) presenting with severely atrophied edentulous mandibles (Cawood and Howell class VI), were reconstructed with multilayered calvarial bone grafts placed in the intraforaminal area of the mandible. Five to 8 months afterwards, 23 dental implants were placed in the reconstructed areas (three to four implants per patient) and immediately loaded with implant-supported overdentures. Patients were followed with clinical and radiographic controls annually. RESULTS: Recovery after the reconstruction was uneventful in all patients. All 23 implants were osseointegrated 1-3 years after the start of immediate loading. The survival and success rates of implants were 100% and 95.7%, respectively. CONCLUSION: Results from this study showed that immediate loading of dental implants placed in severely atrophied edentulous mandibles reconstructed with calvarial bone grafts is a predictable procedure, which permits a successful dental rehabilitation with a shortening of treatment times.     

Dental implants placed in expanded narrow edentulous ridges with the Extension Crest device. A 1-3-year multicenter follow-up study

OBJECTIVE: This study has been designed to evaluate the capability of a new surgical device (Extension Crest) to widen narrow edentulous alveolar ridges and to allow a correct placement of endosseous implants in horizontally atrophied sites. MATERIAL AND METHODS: Forty-five patients, 20 males and 25 females, aged 20-66 years, affected by edentulism associated to horizontal resorption of the ridges, were treated by means of a sagittal osteotomy and expansion of the ridge with a new surgical device (Extension Crest) to obtain a wider bony base for ideal implant placement. In the same procedure in 33 patients, and 1 week afterwards in 12 patients, 110 endosseous titanium implants (ITI TE) were placed. Three to four months later, the patients were rehabilitated with implant-supported prostheses. RESULTS: The success rate of the expansion technique was 97.8%. A total of 110 implants were inserted in the expanded ridges. The mean follow-up after the start of prosthetic loading was 20.4 months. Three implants were removed before the start of prosthetic loading, because of non-integration, while no other implants failed after the completion of the prosthetic rehabilitation. Three implants, although integrated and in function, did not fulfill success criteria: cumulative success and survival rates at the end of the observation period were 95.4% and 97.3%, respectively. CONCLUSION: Within the limits of this study, this technique appeared to be reliable and simple, with reduction of morbidity and times of dental rehabilitation as compared with other techniques such as autogenous bone grafts and guided bone regeneration. Survival and success rates of implants placed in the treated areas are consistent with those placed in native bone.     

Staged autogenous calvarial bone grafting and dental implants placement in the management of oligodontia: a retrospective study of 20 patients over a 12-year period

Oligodontia demands multidisciplinary management due to its repercussions on dentofacial growth. To place implants to realize implant-borne fixed denture, preimplant surgery may be necessary if bone volumes are insufficient. Our aim was to assess bone increase following autogenic bone grafting and to discuss prosthetic options. Twenty patients followed for oligodontia, who underwent bone grafting, were treated from 2008 to 2019. Transversal and vertical bone levels were measured pre- and postoperatively to assess alveolar ridge augmentation. Mean horizontal grafting increase was 4.60 mm [standard deviation (SD) 0.79 mm], mean sinus lift increase was 9.95 mm (SD 2.35 mm). Mean implants placed per patient was 9, mean implants placed on grafted site was 5 per patient. Overall implant survival rate was 100%. All patients benefited from prosthetic procedures when it was planned to perform implant-borne fixed dentures. Within the framework of a complete treatment plan (involving paediatric dentistry, dentofacial orthopaedics, oral and maxillofacial surgery, and prosthodontics), autologous bone grafting combined or not with orthognathic surgery is fully adapted to patients with oligodontia. It allows reconstruction of favourable bone volumes for placement of implants to realize implant-borne fixed dentures, with high implant survival rates and great improvements to quality of life.     

Reconstruction of the extremely atrophied mandible with iliac crest onlay grafts followed by two endosteal implants: a retrospective study with long-term follow-up

Treatment outcomes of implant-retained lower dentures on two endosseous implants placed in severely atrophied mandibles after reconstruction with iliac crest onlay grafts were assessed in a retrospective observational study. All consecutive patients treated between 2000 and 2007 were recalled in 2012 (n = 40). Survival of the implants, the condition of hard and soft peri-implant tissues, and patient satisfaction were scored. One implant was lost after 5.5 years. The mean mandibular symphysis height was 8.9 ± 2.2, 16.4 ± 2.7, 15.7 ± 2.7, and 15.4 ± 2.5 mm at intake, after augmentation, after implantation, and at the last recall visit, respectively. Mean radiographic peri-implant bone loss was 0.6 ± 0.7 mm. Mean clinical index scores were very low. Patient satisfaction was high. Surgical complications related to the donor site were seroma (n = 1), haematoma (n = 2), and sensory disturbance of the lateral femoral cutaneous nerve (n = 1); all had resolved before placement of the implants. Eleven patients reported postsurgical sensory disturbances of the mental nerve, of whom five still experienced some sensory disturbance at the last recall visit. Augmentation of the extremely resorbed mandible with an iliac crest onlay graft followed by placement of two implants 4 months later provides a solid basis for a bar-retained overdenture with favourable clinical and radiographic results.     

Postoperative skeletal stability at the one-year follow-up after splintless Le Fort I osteotomy using patient-specific osteosynthesis versus conventional osteosynthesis: a randomized controlled trial

The purpose of this study was to assess the 1-year skeletal stability of the osteotomized maxilla after Le Fort I surgery, comparing conventional osteosynthesis with patient-specific osteosynthesis. Patients were assigned to a conventional or patient-specific osteosynthesis group using prospective randomization. The primary outcome was the three-dimensional change in postoperative skeletal position of the maxilla between the 2-week and 1-year follow-up cone beam computed tomography scans. Fifty-eight patients completed the protocol for the 2-week postoperative analysis, and 27 patients completed the 1-year follow-up study protocol. Of the 27 patients completing the entire protocol, 13 were in the conventional group and 14 in the patient-specific osteosynthesis group. The three-dimensional translation analysis showed that the use of the patient-specific osteosynthesis resulted in a skeletally stable result, comparable to that of conventional miniplate fixation. For both the patient-specific osteosynthesis and conventional miniplate fixation groups, median translations of less than 1 mm and median rotations of less than 1° were observed, indicating that both methods of fixation resulted in a stable result for the 27 patients examined. For the Le Fort I osteotomy, the choice between patient-specific osteosynthesis and conventional osteosynthesis did not affect the postoperative skeletal stability after 1 year of follow-up.     

Scleral exposure alterations following Le Fort I osteotomy (with and without maxillary impaction) in skeletal class III patients: A before-and-after clinical trial

Purpose

Exposure of sclera below the iris in natural head positions is aesthetically undesirable. Studies on post-surgical changes in inferior scleral exposure following orthognathic surgery are scarce and mostly retrospective. The aim of this clinical trial is to examine the effect of Le Fort I osteotomy, a procedure for correction of malocclusion and maxillo-mandibular deformities, on the inferior scleral exposure and overall scleral surface area in skeletal class III patients.

Immediate and early loading of oxidized tapered implants in the partially edentulous maxilla: a 1-year prospective clinical, radiographic, and resonance frequency analysis study

Background: The use of immediate/early implant loading protocols offers obvious advantages for the patient. Although well documented in the totally edentulous mandible, information about clinical outcomes from such protocols in the partially edentate maxilla is lacking. Purpose: The present study was conducted to clinically and radiographically evaluate a tapered implant design with an oxidized surface for immediate/early loading in the partially edentulous maxilla. The aim was also to correlate implant stability measurements using resonance frequency analysis (RFA) with implant diameter and length, bone quality and quantity, and marginal bone levels and marginal bone loss. Materials and Methods: A total of 32 patients with a need of implant treatment in their partially edentulous maxilla were included in the study. A total of 53 Replace Select TiUnite? implants (Nobel Biocare AB, Göteborg, Sweden) were used in the study; 16 for single tooth replacements in 16 patients and 37 implants for partial bridges in another 16 patients. The single tooth replacements were loaded the same day with a temporary crown, while permanent partial bridges were delivered within 16 days. Intraoral radiographs were taken at surgery and after 1 year for marginal bone measurements. RFA measurements were performed at baseline and after 3, 6, and 12 months. Results: One implant used for a single tooth replacement failed, giving an overall survival rate of 98.1% after 1 year. On average, 1.1 mm (SD 1.0) bone was lost during 1 year; 1.5 mm (SD 1.0) in single tooth and 0.9 mm (SD 1.0) in partial cases. The implant stability increased with time from 63.3 implant stability quotient (ISQ) (SD 6.1) at baseline to 64.3 (SD 5.3), 65.0 (SD 4.6), and 66.8 (SD 5.6) after 3, 6, and 12 months, respectively. The average change from baseline to 1 year was 3.3 ISQ (SD 5.0) and was statistically significant (p < .05). There was no difference between single and partial cases. Implant stability correlated with bone quantity and quality at implant sites, but not with marginal bone level measurements. Conclusions: It is concluded that immediate/early loading can be used in the partially edentulous maxilla with good clinical and radiographic short‐term outcomes. Implant stability at placement correlated with bone quantity and quality, and increased with time as measured with RFA, indicating a favorable bone tissue response to the loaded implants. Any correlations between RFA and marginal bone level measurements were not observed in the present study.     

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.     

Short implants placed one-stage in maxillae and mandibles: a retrospective clinical study with 1 to 9 years of follow-up

Background: The use of short implants (7–8.5 mm) has historically been associated with lower survival rates than for longer implants. However, recent clinical studies indicate that short implants may support most prosthetic restorations quite adequately, but still clinical documentation is sparse. Purpose: The purpose of this study was to report on the placement of short Brånemark implants, testing the hypothesis that short implants in atrophied jaws might give similar long-term implant survival rates as longer implants used in larger bone volumes. Materials and Methods: This retrospective clinical study included 237 consecutively treated patients with 408 short Brånemark implants supporting 151 fixed prostheses. One hundred thirty-one of the implants were 7-mm long, and 277 were 8.5-mm long. Final abutments were delivered at the time of surgery, and final prostheses were delivered 4 to 6 months later. Results: One hundred and twenty six of the 7-mm implants (96%) have passed the 1-year follow-up; 110 (84%), the 2-year follow-up; and 88 (67%), the 5-year follow-up. Five implants failed in four patients before the 6-month follow-up, giving a cumulative survival rate of 96.2% at 5 years. The average bone resorption was 1 mm (SD=0.6 mm) after the first year and 1.8 mm (SD=0.8 mm) after the fifth year of function. Two hundred sixty nine of the 8.5-mm implants (97%) have passed the 1-year follow-up; 220 (79%), the 2-year follow-up; and 142 (51%), the 5-year follow-up. Eight implants failed in seven patients before the 6-month follow-up, giving a cumulative survival rate of 97.1% at 5 years. The average bone resorption was 1.3 mm (SD=0.8 mm) after the first year and 2.2 mm (SD=0.9 mm) after the fifth year of function. Conclusions: The cumulative survival rates of 96.2 and 97.1% at 5 years for implants of 7.0- and 8.5-mm length, respectively, indicate that one-stage short Brånemark implants used in both jaws is a viable concept.