Intermediate bone grafting of alveolar clefts

During the five year period 1980 to 1985 bone grafting was performed in 37 cleft patients before the eruption of the canine tooth (group IBG) and in 30 patients after the eruption of the canine tooth (group SGB). The initial healing was more favourable in the IBG group. In 72.5% of the clefts oro-nasal fistulae were present preoperatively. In all cases the fistulae were successfully closed. In the IBG group with orthodontic closure of the gap in the dental arch the interdental bone height in the grafted area was more than 75% of normal bone height in all clefts. In group SBG this situation was found in only 66% of the bone-grafted areas. There seems to be a clear relation between the age or the developmental stage of the canine tooth on the one hand and the possibility of orthodontic closure of the gap in the dental arch and good interdental bone height on the other hand. This also leads to the suggestion that if bone grafting to the alveolar cleft is required the operation should be performed before the eruption of the canine tooth on the cleft side.     

Prosthodontic management of the hydroxylapatite denture patient: a preliminary report

A 4-year study and evaluation of nonresorbable hydroxylapatite to augment different alveolar ridges has been reported. The technique used resulted in improved contour, height, and width of the alveolar ridge. It was found that denture comfort improved with ridge augmentation as this allowed improved stability, support, and preservation of the ridge. Patient satisfaction was correlated to both surgical and prosthodontic success with the use of hydroxylapatite. The state and health of the tissues were found to be improved with the use of hydroxylapatite or hydroxylapatite and bone marrow. The prosthetic and surgical procedures were found to be easier to perform, and they produced more permanent and superior results than those previously experienced with only bone grafts and other alloplasts.     

Assay of bone morphogenetic protein-2, -4, and -7 in human demineralized bone matrix

Demineralized bone matrix (DBM) is a widely used bone graft material that derives its osteoinductive potential from matrix-associated bone morphogenetic proteins (BMPs). Prior investigations have shown that the osteoinductive potential can vary widely, with influence from both donor and processing sources. Although it is plausible that donor variance in the BMP profile can be an important consideration, the few published studies available have given inconsistent and incomplete information about this. The goal was to (1) characterize the variance of BMP-2, BMP-4, and BMP-7 in fully demineralized DBM derived from 20 appropriately screened (Food and Drug Administration and the American Association of Tissue Banks criteria) donors (male and female, 17-65 years) and (2) using literature review, infer the potential for this to be an important source of variability in graft function. BMPs were extracted with 4 M guanidine hydrochloride, and levels of BMP-2, BMP-4, and BMP-7 were measured using enzyme-linked immunosorbent assay. Measured levels were as follows: BMP-2 = 21.4 +/- 12.0 ng/g DBM, BMP-4 = 5.45 +/- 2.04 ng/g DBM, and BMP-7 = 84.1 +/- 34.4 ng/g DBM, which were significantly different (P < 0.05). There was a positive linear correlation between BMP-2 and BMP-7 (P = 0.0227). DBM derived from female donors had significantly greater concentrations of BMP-2 and BMP-7 than did that derived from male donors (P = 0.0257 and 0.0245, respectively). There was no significant correlation between donor age and the levels of any of the measured BMPs. The magnitude of variance of BMP profile appears to reasonably well correspond to the variance in osteoinductive potential cited by others, suggesting the possibility of using this as a method of donor screening.     

Patient evaluation of outcomes of external rhinoplasty for unilateral cleft lip and palate

Thirty-five patients (range 16-59 years) with cleft-lip nasal deformity treated by external rhinoplasty were evaluated for satisfaction and perception of outcomes. Treatment involved alar base relocation and augmentation of the asymmetric nasal tip with auricular cartilage grafts. The patients completed a satisfaction survey and interview at the 2-year follow-up visit. A visual analogue scale (VAS) numbered 0-10 was also used by the patients to grade outcome compared to preoperative appearance at 4 anatomic sites. Prior to surgery, the nasal tip was perceived as being most deformed (15/35), followed by alar position (12/35) and nasal apertures (8/35). The site on the nose most improved by surgery was the tip (15), followed by alar position (10), symmetry of nostrils (6) and dorsum (4). The highest VAS score was for the tip (8.32), followed by alar position (7.59), dorsum (7.41) and symmetry of nostrils (6.73). No patients suffered long-term pain for more than 2 months following surgery. All patients were prepared to undergo such procedure for a second time, if necessary. The unilateral cleft-lip nasal deformity can be improved in the eyes of the patient, using the combination of external rhinoplasty with alar base relocation, where necessary, and auricular cartilage augmentation of the nasal tip.     

Evaluation of alveolar bone grafting: a survey of ACPA teams.

OBJECTIVE: To evaluate the management of alveolar clefts by cleft palate and craniofacial teams in North America. DESIGN: An anonymous survey was mailed to 240 American Cleft Palate- Craniofacial Association teams across North America regarding alveolar bone grafting. The questionnaire included multiple questions about each team's approach to alveolar bone grafting and options for the missing tooth. RESULTS: Consensus was achieved in three areas: 90% of centers performed secondary alveolar bone grafting, 78% performed grafting between ages 6 and 9 years, and iliac crest donor site was the most popular site (83%). There was no consensus with respect to dental criteria for the timing of grafting, follow-up x-rays, or the use of a grading system for evaluating results. In addition, there was no consensus on the management of the missing tooth. CONCLUSION: There is wide acceptance of secondary bone grafting and there is a consensus for the age of grafting (6 to 9 years) and donor site (iliac crest). The disturbing finding was the lack of postoperative x-ray evaluation of the results. With so much variability in management, the use of a routine, standardized scale to measure postoperative results would allow for better outcome studies in alveolar bone grafting.     

Donor site morbidity of rib graft harvesting in primary alveolar cleft bone grafting

The use of the rib for primary alveolar cleft bone grafting offers one of the few donor sites for grafting under one year of age. Its use in 211 patients in an 11 year period revealed no morbidity other than a small donor scar. Rib grafting in infants differs significantly from that in teenagers and adults with minimal pain, no risk of pneumothorax when properly performed, and more than an adequate stock of bone for the alveolar defect.     

HIV-assoziiertes Lymphom — ungewöhnliche Ursache einer pathologischen Unterkieferfraktur

Despite the introduction of highly active antiretroviral therapy (HAART), diffuse large B-cell lymphoma (DLBCL) remains a common malignancy in human immunodeficiency virus (HIV)-infected patients, especially the plasmablastic variant. About 50% of lymphomas in HIV patients are extranodal and half of them occur in the head and neck area. The main oral symptoms are pain, swelling, numbness and tooth mobility. We report the case of a 52-year-old patient with a known HIV infection and fracture of the angular region of the mandible. The fracture did not unite following open reduction and osteosynthesis. A biopsy performed at the time of revision revealed the diagnosis of a primary lymphoma in the mandible. After chemotherapy had induced complete remission of the lymphoma and autogenous iliac crest bone grafting had been performed the fracture united. Primary lymphoma in the mandible is a disease that presents with a nonspecific radiological appearance which may mimic osteomyelitis or periodontal pathology. A rapid and accurate diagnosis is critical for the appropriate treatment. In our experience HIV-positive patients with mandibular fracture should be treated according to the guidelines established for HIV-negative patients. However, risky compromises such as intraoral approach or hazardous fracture fixation should be avoided.     

Titanium plate reconstruction of the osseous defect after harvest of a composite free flap using the deep circumflex iliac artery

Hernia formation following harvest of bicortical iliac crest bone occurs infrequently as a late complication and may lead to chronic pain at the donor site and rarely to obstruction and strangulation of bowel. We describe the use of a custom-made titanium plate used to reconstruct the iliac donor site following harvest of a DCIA composite free flap. A pre-operative 3D CT and stereolithography model of the ilium are used to fabricate a titanium plate of the desired shape and size. This plate is used to reconstruct the donor site defect at the time of primary surgery. This technique may reduce late complications following DCIA composite free flap harvest.     

Oral cancer awareness for the general practitioner: new approaches to patient care

In Australia, oral cancer accounts for approximately 2-3 per cent of all cancers, and approximately 1 per cent of deaths from cancer. The incidence of intra-oral cancer is gradually increasing. It is now well established that early detection of potentially malignant disease can improve the clinical outcome for patients, and as such it is the responsibility of dentists to identify such lesions early. To facilitate early detection of suspicious oral lesions several clinical methods of detection can be used. In addition to conventional visual screening of oral tissues with the naked eye under projected incandescent or halogen illumination, there are many clinical diagnostic aids that can be undertaken to help detect oral cancer. In this article we explore clinically available modalities that may be used by the general dental practitioner, and highlight their inherent strengths and weaknesses.     

Sliding contact fatigue of graded zirconia with external esthetic glass

Veneer chipping and fracture are common failure modes for porcelain-veneered zirconia dental restorations. We hypothesized that the graded glass/zirconia/glass with external esthetic glass (e-GZG) can increase the lifetime and improve resistance to veneer chipping and fracture relative to porcelain-veneered zirconia, while providing necessary esthetics. Previously, we have demonstrated that a graded glass-zirconia surface possesses excellent resistance to occlusal-like sliding contact fatigue. Here, we investigated the sliding contact fatigue response of this graded glass-zirconia surface with external esthetic glass. This external glass is essential for shade options, for preventing excessive wear of opposing dentition, and for protecting Y-TZP from hydrothermal degradation. e-GZG plates were bonded to composite blocks and subjected to prolonged sliding contact up to 10 million cycles at 200 N in water. The resistance to sliding contact fatigue of e-GZG matches that of monolithic Y-TZP, and both of these materials demonstrated lifetimes that were orders of magnitude longer than that of porcelain-veneered zirconia. Graded e-GZG is a promising restorative material.