Evaluation of Vertical Bone Gain Following Alveolar Distraction Osteogenesis in the Anterior Edentulous Mandible: A Clinical Study

Aim and Objectives

To calculate the gain in bony height and volume of the distracted upper segment using an extraosseous unidirectional device to improve the retention of the future prosthesis.

Materials and Methods

Ten cases with completely or partially edentulous but severely or considerably resorbed anterior mandibles were managed by vertical alveolar distraction osteogenesis. All the patients were evaluated preoperatively, intraoperatively and post-operatively for various parameters clinically and radiographically i.e. on OPG, lateral cephalogram and on CT scan, at different time intervals. In all cases there was increase in vertical bone height.

Results

The study showed mean vertical bone gain (VBG) on OPG as 8.2 mm. The mean VBG on lateral cephalogram was 8.1 mm. The mean VBG on CT scan at right canine was 8.35 mm, at left canine was 8.2 mm and at midline was 8.27 mm.

Conclusion

Alveolar distraction osteogenesis is a predictable method for restoring alveolar ridges prior to implant placement or prosthesis. Distraction osteogenesis is ideally suited for recreating missing tissue in the anterior esthetic zone by increasing vertical bone height as well as good width and soft tissue growth.     

Kapetansky-Juri Technique to Correct the Whistlers Lip in the Multiple Operated Cleft Patient

Purpose

One of the common sequels of a cleft lip repair may be “whistling lip deformity” but other deformities are also seen particularly in failed or multiple resurgery cases. This retrospective study was carried out to evaluate the usefulness of “Kapetansky-Juri” advancement flap technique to correct such deformities.

Methods

Ten patients of bilateral cleft lip with history of minimum five failed cleft lip surgeries and having residual lip deformity were operated using “Kapetansky-Juri” advancement flap technique and were followed up to minimum 36 months.

Results

All patients showed good tissue fullness and complete correction of the deformity. There was no contracture of surrounding skin or vermilion during follow-up period. In eight patients minimal scar formation was seen while two showed midline scar formation.

Conclusion

No tissue loss due to vascular insufficiency was observed. The technique gives good tissue distribution and minimal surface scar formation.     

Maxillary Sinus Augmentation with Autologous and Heterologous Bone Graft: A Clinical and Radiographic Report of Immediate and Delayed Implant Placement

Purpose

The aim of this study was to evaluate cumulative survival rate of implants placed on augmented maxillary sinus using a mixture of autologous bone harvested from the maxillary tuberosity and bovine-derived HA and to assess the height of the grafted material through radiographic evaluation.

Methods

Thirty-five patients were treated with maxillary sinus augmentation and 93 implant fixtures were installed. The height of the augmented sinus and the gain of bone volume were measured by Cone Beam CT Scan and intraoral radiographs immediately after augmentation and up to 48 months subsequently. Changes in the height of the sinus graft material were calculated radiographically.

Results

The cumulative survival rate was 98.92 % in all 93 implants. Additionally, normal healing process without any complication was observed in all patients. The original sinus height was a mean of 4.52 mm (range 2.0–6.4 mm) and the augmented sinus height was a mean of 14.1 mm (range 12.0–16.5 mm) after the surgery. The bone volume gain was a mean 9.613 mm (range 7–13 mm).

Conclusions

Within the limitations of this study, it would appear from the clinical and radiographic results that the sinus lift procedure with autologous bone graft harvested from the maxillary tuberosity combined with deproteinized bovine bone allows for a predictable outcome regarding the amount of bone formation in sinus floor augmentation and the immediate placement of implants, when possible, is recommended.     

Comparative Study of Alveolar Bone Height and Implant Survival Rate Between Autogenous Bone Mixed with Platelet Rich Plasma Versus Venous Blood for Maxillary Sinus Lift Augmentation Procedure

Aim and Objectives

The aim of this study was to evaluate changes in alveolar bone height by means of radiographic examination and Straumann implant survival rate following maxillary sinus lift augmentation using autogenous bone in combination with platelet rich plasma (PRP) versus venous blood (VB).

Methods

Fifty patients requiring sinus lift augmentation procedure included in the study were divided into two groups (n = 25). During the procedure the sub antral sinus cavity was augmented using autogenous bone taken from mandibular ramus area and mixed with PRP in one group and autogenous bone mixed with VB in the other group. Orthopantomograms were taken preoperatively, immediate, at 6 months and 1 year postoperatively. Height of alveolar bone at the site of sinus augmentation was measured on the radiographs. One hundred and twenty-one Straumann dental implants were placed after healing period.

Results

Age of the patients in the study groups ranged from 36 to 69 years. Differences in mean values of bone height measurements recorded in the PRP series revealed significant differences among the three subgroups (P = 0.001). Significant differences were noted between immediate postop and 6 month (P < 0.01), immediate postop and year (P < 0.01). In the VB series also significant differences were revealed among the three subgroups (P = 0.0280). Significant differences were noted between immediate postop and 6 month (P < 0.05). Comparison of results of subgroups of the two series at the three intervals revealed significant differences at ‘immediate postop’ values (P = 0.0002) and ‘sixmon’ values (P = 0.0435). Differences between ‘year’ values were not significant. Two implants were lost in PRP group.

Conclusion

The results of this limited study reveals that both groups recorded a good increase in the alveolar bone height after sinus augmentation and showed no significant differences between these groups when compared to each other at 1 year postoperatively. When both sub groups compared with immediate postop to year, PRP group showed significant difference and blood group showed no significant difference.     

Evaluation of Three-Dimensional Volumetric Changes After Sinus Floor Augmentation with Mineralized Cortical Bone Allograft

Aim

The aim of this retrospective study was to quantify three-dimensional (3D) volumetric bone changes over a two-year period in maxillary sinuses augmented with a mineralized cortical bone allograft material (MCBA) material.

Patients and Methods

Eleven patients (6 males and 5 females) with mean of age of 51.6 (range: 46–61) years were treated to increase the vertical dimension of the alveolar crest by maxillary sinus floor augmentation procedure. Study data were collected from patient records and by analyzing preoperative radiographs and cone beam computed tomography (CBCT) scans taken within the first two weeks after maxillary sinus lift (T0), immediately before implant placement four months after grafting (T1), and after one year of implant loading (T2). All DICOM-formatted images were rendered into volumetric images using software that automatically calculated the volume of the grafted material in cubic centimeters.

Results

Mean graft volume was 16.24 ± 1.54 cm³ at T0, 14.48 ± 1.48 cm³ at T1 and 13.06 ± 1.39 cm³ at T2. Mean volume retraction resulted in 1.76 ± 0.34 cm³ ΔV1 (T0–T1) and 1.42 ± 0.4 cm³ ΔV2 (T1–T2) and was 10.83 % of the initial total volume at (T0–T1) and 9.8 % of the total volume (T1–T2).

Conclusion

The present retrospective investigation demonstrated a 20.63 % decrease in graft volume. Volumetric 3D assessment of CBCT scans with the selected software appeared to be a promising approach to quantifying long-term changes in the grafted area.     

Comparative Analysis of the Anesthetic Efficacy of 0.5 and 0.75?% Ropivacaine for Inferior Alveolar Nerve Block in Surgical Removal of Impacted Mandibular Third Molars

Introduction

Ropivacaine belongs to pipecoloxylidide group of local anesthetics. There are reports supporting the use of ropivacaine as a long acting local anesthetic in oral and maxillofacial surgical procedures, with variable data on the concentration that is clinically suitable.

Materials and Methods

A prospective randomized double-blind study protocol was undertaken to assess the efficacy of 0.5 and 0.75 % ropivacaine for inferior alveolar nerve block in surgical extraction of impacted mandibular third molars. A total of 60 procedures were performed, of which thirty patients received 0.5 % and thirty received 0.75 % concentration of the study drug.

Results

All the patients in both the study groups reported subjective numbness of lip and tongue. The time of onset was longer for 0.5 % ropivacaine when compared to 0.75 % solution. 90 % of the study patients in 0.5 % ropivacaine group reported pain corresponding to VAS ≥3 during bone guttering and 93.3 % patients reported pain corresponding to VAS >4 during tooth elevation. None of the patients in 0.75 % ropivacaine group reported VAS >3 at any stage of the surgical procedure. The duration of soft tissue anesthesia recorded with 0.75 % ropivacaine was average 287.57 ± 42.0 min.

Conclusion

0.75 % ropivacaine was found suitable for inferior alveolar nerve blocks in surgical extraction of impacted mandibular third molars.     

Anterior alveolar dimensions among different classifications of sagittal jaw relationship in Saudi subjects

Sound orthodontic movement of anterior teeth is delineated by the biological dimensions of the anterior alveolus.

Objective

To establish and compare the anterior alveolar dimensions among normal and abnormal sagittal maxillomandibular relationships in a Saudi sample.

Materials and methods

The lateral cephalometric radiographs of 81 Saudi subjects (42 males and 39 females) were used to determine the anteroposterior and vertical dimensions of the anterior alveolus in Class I (N = 30), Class II (N = 24), and Class III (N = 27) cases. The anterior alveolar dimensions were then compared among males and females belonging to the same sagittal classification and between the different sagittal classifications of the same gender.

Results

Significant differences (P < 0.05) in the anterior alveolar dimensions between males and females were demonstrated for the same sagittal jaw classification. Also, significant differences (P < 0.05) were detected between the anterior alveolar dimensions among the different sagittal maxillomandibular classifications of the same gender.

Conclusion

Both the gender and the sagittal maxillomandibular relationship can affect the anteroposterior and vertical dimensions of the anterior alveolus.     

Histological Comparison of New Biodegradable Magnesium-Based Implants for Maxillofacial Applications

Background

A variety of materials have been used for bone augmentation, distraction osteotomy, and in post-cancer patients following tumor removal. However, a temporary metal implant that would resorb after successful treatment is a new concept. Magnesium was suggested as a suitable material for these purposes because it is biocompatible, has better mechanical properties than titanium, and stimulates new bone formation. This study evaluates histological appearance of magnesium-based implants and the surrounding bone.

Materials and Methods

Three magnesium-based biomaterials were tested in a rabbit bone defect model: magnesium–hydroxyapatite (Mg–HA), W4 (96 % magnesium, 4 % yttrium), and pure magnesium (pure Mg). Animals were sacrificed after 6 and 12 weeks and the samples were analyzed histologically and histomorphometrically.

Results

Mg–HA had the highest mean amount of tartrate-resistant acid phosphatase (TRAP) positive cells at the implantation site of all groups. It had shown the fastest degradation rate already at 6 weeks but the least amount of new bone formation. New bone was seen forming in direct contact with pure Mg and W4. The mean gas volume was highest in W4 compared to pure Mg and Mg–HA but this difference was not statistically significant. W4 had the lowest mean number of TRAP-positive cells of all materials.

Conclusion

Pure Mg and W4 were shown to be the most promising materials in this study in respect to the bone response to the implant material. They could be used for screws and plates in bone augmentation procedures.     

The Local Effect of Alendronate with Intra-alveolar Collagen Sponges on Post Extraction Alveolar ridge Resorption: A Clinical Trial

Introduction

Extraction of teeth is followed by resorption of the residual alveolar ridge that continues throughout life resulting in loss of alveolar height and width. Of the numerous techniques that have been used to arrest post extraction alveoloar ridge resorption, the placement of a graft material inside the socket immediately after extraction has been mostly followed. Type 1 collagen is one of the commonly used graft material that prevent resorption by providing dimensional stability to the socket. Bisphosphonates are an anti-osteoclastic drug that prevent resorption by disrupting the membrane ruffling of the osteoclasts. Alendronate a bisphosphonate, is primarily used in diseases with bone loss. It has been used to reduce active bone resorption significantly without interfering with bone mineralization and quality. The need for the study is to examine the inhibitory effect of alendronate on residual ridge resorption when applied locally in combination with type I collagen on alveolar bone immediately following tooth extraction.

Materials and Methods

Twenty patients with age between 30 and 65 years were selected from the out patient department of The Oxford Dental College and Hospital. The patients were divided into two groups. In the first group after extraction of teeth from premolar to midline the sockets were irrigated with saline and sutured. On the left side type I collagen sponge was placed and sutured. In the other group the right side was treated the same way after extraction as in first group where as in the left side sockets type I collagen soaked in 20 mg/ml of alendronate was placed and sutured. Patients were evaluated clinically for any local irritation as well as radiologically with orthopantomograph X-rays were taken immediately after the extraction, 1 month after extraction and 4 months after extraction to determine the amount of bone loss prevented.

Results

The statistically significant bone loss prevented by the collagen alone was 22.8 % and in collagen with alendronate group was 44.38 % at the end of 4 months.

Conclusion

Type I collagen soaked with alendronate when placed in the socket immediately after extraction of teeth prevents post-extraction alveolar ridge resorption.     

Reconstruction of Nasal Cleft Deformities Using Expanded Forehead Flaps: A Case Series

Introduction

Reconstruction of the nasal clefts is a challenging task considering the nasal anatomic complexity and their possible association with craniofacial defects. The reconstruction of these defects needs extensive amounts of soft tissue that warrant the use of forehead flaps. Often presence of cranial defects and low hairline compromise the amount of tissue available for reconstruction warrenting tissue expansion.

Aim

To evaluate the efficacy of tissue expansion in reconstruction of congenital nasal clefts.

Subjects and Methods

9 patients with congenital nasal clefts involving multiple sub units were taken up for nasal reconstruction with expanded forehead flaps. The average amount of expansion needed was 200 ml. The reconstruction was performed in 3 stages.

Results

Expanded forehead flaps proved to be best modality for reconstruction providing the skin cover needed for ala, columella and dorsum with minimal scarring at the donor site.

Conclusion

Expansion of the forehead flap is a viable option for multiple sub unit reconstruction in congenital nasal cleft deformities.     

Horizontal and Vertical Reconstruction of the Severely Resorbed Maxillary Jaw Using Subantral Augmentation and a Novel Tenting Technique with Bone from the Lateral Buccal Wall

Aim

The aim of this study was to evaluate the effect of using the lateral wall bone in sinus lifting two-dimensional reconstruction on bone augmentation.

Patients and Methods

Ten patients affected by class V or VI maxillary atrophy with less than 3 mm of residual horizontal ridge were selected. Using a piezo-ultrasonic surgery tip bony lateral wall was cut. To expose native bone to the bone graft, multiple perforations, made through the cortical plate of the recipient site with a round bur. Once the bony buccal wall was adjusted it was fixed away from the ridge with two 1.5 x 13 mm bone fixation screws. Deficiencies created between the bony buccal wall and the ridge was filled with a mineralized cortical bone. A pericardium membrane was then placed on the graft. A biopsy for histologic evaluation was made.

Results

The data analysis in bone volume changes reported significant differences between the anterior and posterior locations before and after grafting (p < 0.05). The biopsy shows mature cancellous bone with predominantly lamellar structure.

Conclusion

The use of the lateral wall bone in sinus lift surgery showed significant increase in bone volume.     

Cortical Tibial Bone Graft for Nasal Augmentation

Background

This study sought to determine the efficacy of cortical tibial bone graft for nasal augmentation. Nine cases of augmentation rhinoplasty with cortical tibial bone graft are presented.

Methods

This prospective study evaluated the postoperative results of nine patients who underwent augmentation rhinoplasty using cortical tibial bone graft. There were six males and three females aged between 21 and 36 years (mean age 29). All the nine cases were treated through closed rhinoplasty incisions.

Results

Nine patients were operated on and the average follow up was 18 months. The results were favorable. The aesthetic results were gratifying; with good nasal projection in every case without any significant postoperative effects or complications requiring surgery were noted during the follow up.

Conclusion

The findings of this study support the use of cortical tibial bone graft for nasal augmentation although further studies with more sample size are required.     

Long-term outcome of dental implants after maxillary augmentation with and without bone grafting

Background

This study aims to evaluate the technique of sinus bone reformation, which consists of elevating the sinus membrane and placement the implant without bone graft, compared with the widely-used technique involving raising the maxillary sinus and grafting, using animal hydroxyapatite as the filler, while simultaneously fixing the implants.

Material and Methods

This is a retrospective study on two groups of patients who underwent elevation of the sinus membrane and simultaneous placement of the implant. The grafting technique was applied to one group, while the other had no graft. An alveolar ridge height of 4 to 7 mm was necessary. Radiological control was undertaken at 6 months and one year post-prosthetic loading. In each group 38 implants were placed.

Results

No significant behavioural differences were observed in the implants according to the Albrektsson success criteria. Implant failure was observed in 2 implants from the bone grafting group (success rate 93%) and in 1 implant from the reformation group (success rate 97%). In this group, bone formation was observed on both sides of each implant, the bone gain was measured using image management software (2.7±0.9mm mesial and 2.6±0.9mm distal). There was no correlation between mesial and distal bone gain and implant´s length.

Conclusions

The results indicate that bone reformation is a valid technique in cases involving atrophy of the posterior maxilla. Primary stability, maintenance of space by the implant, and the formation of a blood clot are crucial in this technique in order to achieve bone formation around the implant. It is an alternative to the conventional technique of sinus lift with filling material, and has several advantages over this procedure, including a lower infection risk, as it does not involve a biomaterial, reduced cost, a simpler technique, and better acceptance by the patient. Key words:Bone formation, sinus membrane elevation, maxillary sinus, bone grafting.     

Measurements of Implant Stability Following Sinus Lift: A Pilot Clinical Study

Aim

The aim of this study was to evaluate the implant stability of Bredent Sky Blue implants of different diameters following one stage sinus lift procedure.

Material and methods

This study included 9 male patients with an existing indication for unilateral or bilateral sinus lift procedure. As grafting materials, combination of allograft material MinerOss® cortical & cancellous and Ossceram nano were used.

Results

All implants were considered successful and ISQ levels were measured by Osstell ISQ device. The ISQ values were from 68 to 84. The mean values of stability of Bredent Sky Blue implants of different diameters following one stage sinus lift procedure were 77.73 ± 2.93 (MD) and 77.98 ± 2.72 (VO).Key words: dental implants, implant stability, sinus floor augmentation     

Minimally traumatic alveolar ridge augmentation with a tunnel injectable thermo-sensitive alginate scaffold

Injectable bone substitutes and techniques have been developed for use in minimally invasive procedures for bone augmentation.

Objective

: To develop a novel injectable thermo-sensitive alginate hydrogel (TSAH) as a scaffold to induce bone regeneration, using a minimally invasive tunnelling technique.

Material and Methods

: An injectable TSAH was prepared from a copolymer solution of 8.0 wt% Poly(N-isopropylacrylamide) (PNIPAAm) and 8.0 wt% AAlg-g-PNIPAAm. In vitro properties of the material, such as its microstructure and the sustained release of recombinant human bone morphogenetic protein-2 (rhBMP-2), were investigated. Then, with the subperiosteal tunnelling technique, this material, carrying rhBMP-2, was injected under the labial periosteum of the maxillary anterior alveolar ridge in a rabbit model. New bone formation was evaluated by means of X-ray, micro-computed tomography (micro-CT), fluorescence labelling, histological study, and immunohistochemistry study.

Results

: The material exhibited good injectability and thermo-irreversible properties. SEM showed an interconnected porous microstructure of the TSAH. The result of ALP activity indicated sustained delivery of BMP-2 from the TSAH from days 3 to 15. In a rabbit model, both TSAH and TSAH/rhBMP-2 induced alveolar ridge augmentation. The percentage of mineralised tissue in the TSAH/rhBMP-2 group (41.6±3.79%) was significantly higher than in the TSAH group (31.3±7.21%; p<0.05). The density of the regenerating tissue was higher in the TSAH/rhBMP-2 group than in the other groups (TSAH group, positive control, blank control; p<0.05).

Conclusions

: The TSAH provided convenient handling properties for clinical application. To some extent, TSAH could induce ridge augmentation and mineral deposition, which can be enhanced when combined with rhBMP-2 for a minimally invasive tunnelling injection.     

The short-term skeleto-dental effects of a new spring for the intrusion of maxillary posterior teeth in open bite patients

Background

The technology surrounding temporary skeletal anchorage devices has improved in leaps and bounds. However, no specific auxiliary exists for the intrusion of molars in conjunction with these devices and currently clinicians are forced to make do with available force delivery materials. A new intrusion auxiliary, the Sydney Intrusion Spring (SIS), was designed to facilitate intrusion without frequent need for reactivation or tissue irritation.

Methods

The subjects consisted of 16 adolescent patients (12 females and 4 males) with an average age of 13.1 years (range 12.2 to 14.3 years). All patients were in the permanent dentition with an anterior open bite of ≥2 mm. Four self-drilling miniscrews were placed into the posterior maxillary buccal alveolar bone. The intrusion appliance consisted of a bonded acrylic appliance and the SIS, activated to produce an initial intrusive force of 500 g. Cone beam computed tomograms were taken after miniscrew placement and at the end of active intrusion. Rendered lateral cephalograms were produced and measurements were taken and compared.

Results

All study objectives were achieved in 4.91 months (range 2.5 to 7.75 months). The mean molar intrusion was 2.9 ± 0.8 mm (P < .001), resulting in over bite increase of 3.0 ± 1.5 mm (P < .001). The intrusion led to a 2.6° ± 1.3° (P < .001) clockwise occlusal plane rotation and a 1.2° ± 1.3° (P < .01) counter-clockwise rotation of the mandible. Dental measurements showed a significant uprighting and elongation of the incisors. There was no significant extrusion of the lower molars.

Conclusion

The SIS is an effective appliance for the intrusion of maxillary posterior teeth, in conjunction with miniscrews.     

The mandibular incisive canal and its anatomical relationships: A cone beam computed tomography study

Background

To avoid postoperative injuries in the interforaminal region, presence of the Mandibular Incisive Canal (MIC), its extension and canal positioning in relation to the cortical bone and alveolar process were investigated by cone beam computed tomography (CBCT).

Material and Methods

One hundred CBCT examinations obtained by means of the i-CAT CBCT imaging system were analyzed in multiple-plane views (axial, panoramic and cross-sectional) and three-dimensional representations were performed using iCAT CBCT software. The MIC was evaluated for its presence, measurement and proximity to the buccal and lingual plates, alveolar process and inferior border of the mandible.

Results

The MIC was visible in all (100%) CBCT images. The mean length of MIC was 9.8 ± 3.8 mm. The distances between the canal and buccal plate, as well as between the canal and lingual plate of the alveolar bone were 4.62 ± 1.41 mm and 6.25 ± 2.03 mm, respectively. The distances from the canal to the alveolar process, and to the inferior border of the mandible were 10.25 ± 2.27 mm and 7.06 ± 2.95 mm, respectively.

Conclusions

Due to the high prevalence of MIC, its variation in length and distance up to the cortical bone, suggested that preoperative radiographic evaluation of the MIC must be carried out case-by-case using CBCT, which could clearly show the three-dimensional structure and adjacent structure of the MIC. Key words:Diagnosis, anatomy, cross-sectional, tomography.     

Management of Extra-Capsular Temporo-Mandibular Joint Ankylosis: Does Conservative Approach to Treatment Have a Role?

Background

The conventional management of fibrous extracapsular temporo-mandibular joint (TMJ) ankylosis, a debilitating disease, is associated with surgical complications and financial burden on the patients.

Objective

To assess the outcome of conservative approach to the management of fibrous extracapsular TMJ ankylosis.

Patients and methods

This is a prospective study of patients who presented at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Nigeria, during the period from January 1999 to December 2012 with a history of inability to open the mouth diagnosed as fibrous extracapsular TMJ ankylosis.

Results

Twenty-one subjects were treated and their ages ranged from 11 to 22 years with mean at 15.0 years. There were 13 (61.9 %) males and 8 (38.1 %) females with male: female ratio of 1.6:1. The aetiological factor that predisposed to formation of extracapsular TMJ ankylosis was facial trauma. There was no facial asymmetry and the side distribution of the affliction showed that 1 (4.8 %) was bilateral while 20 (95.2 %) were unilateral. Eight cases (38.1 %) were incomplete ankylosis while the rest (n = 13, 61.9 %) were complete. The shorter the duration of fibrous ankylosis and the greater the initial inter-incisal distance before treatment, the better the treatment outcome.

Conclusion

The outcome of treatment suggests that the conservative approach to management of this condition was beneficial to these patients because they presented early. However, randomized controlled clinical trials are needed to validate this treatment option.     

The Effect of Alloplastic Bone Graft and Absorbable Gelatin Sponge in Prevention of Periodontal Defects on the Distal Aspect of Mandibular Second Molars,After Surgical Removal of Impacted Mandibular Third Molar: A Comparative Prospective Study

Aim

Recent studies claim that haemostatic agents can be used as bone graft substitutes. The aim of this study was to compare the efficacy of alloplastic bone graft with absorbable gelatin sponge in prevention of periodontal defects distal to mandibular second molar after the surgical removal of impacted mandibular third molars.

Materials and methods

A prospective, randomized, single-blind split-mouth study was designed. The study consisted of 25 patients requiring surgical removal of bilateral impacted mandibular 3rd molars. The surgical sites were randomly divided into 2 groups: group I: G-graft (hydroxyapatite + collagen, study group) and group II: Abgel (absorbable gelatin sponge, control group). Patients were recalled on lst and 7th postoperative days and 3rd and 6th postoperative months. Probing depth, alveolar bone levels and soft tissue wound healing were evaluated. Paired t test was used to compare pre and post-operative alveolar bone levels and probing depth (PD). Wilcoxon signed ranks test was used to compare the wound healing.

Results

The soft tissue wound healing, PD and the distance between the cemento–enamel junction on the distal aspect of mandibular second molar (point A) and the alveolar crest on the distal aspect of the same tooth (point B) were significantly higher in group I as compared to group II.

Conclusion

This study reveals an increase in the alveolar bone level, improvement of PD and better wound healing in group I. Group II subjects required longer healing time than the normal. The authors disagree the claim that the haemostatic agents can be used as bone graft substitutes. However, long-term, multicenter, randomized controlled clinical trials are required.     

A Comparison of Skin Graft Success in the Head & Neck With and Without the Use of a Pressure Dressing

Background

The success of skin grafting is dependent on the interplay between many factors including nutrient uptake and vascular in-growth. To allow this, it is important that the graft is immobile and traditionally a ‘pressure dressing’ has been placed over the graft to improve outcome and graft ‘take’. We present the findings of our comparative study of full-thickness skin grafts performed in the head, neck and face region over a period of 24 months. We felt that there was an unacceptably high infection rate and graft failure using pressure dressings.

Methods

Data was collected retrospectively from the case notes on 70 patients who had undergone full-thickness skin grafting to the head, neck and face over a 2 year period. Thirty-five patients underwent grafting with pressure dressing and 35 without. The group with the pressure dressing had the same ‘bolster’ specification-type dressing and those without had their graft ‘quilted’ in and chloramphenicol ointment applied topically. Success was determined by the percentage ‘take’ of the grafts and absence of infection i.e. purulence.

Results

Infection in those with a pressure dressing stood at 26 % in contrast to those without, at 9 %. Without a pressure dressing we observed no total graft failures, compared to 6 % in those with a pressure dressing.

Conclusions

The results confirmed the perception that there was a higher infection and graft failure rate where a pressure dressing was applied; however, this was not a statistically significant difference and a randomised control trial with a larger sample size would be required to validate the results.