2012 Apr-Jun; Vol 3, No 2
Interproximal Papillae Reconstruction around Implant Using Subepithelial Connective Tissue Graft in Maxillary Anterior Region: A Case Series
J Oral Maxillofac Res 2012 (Apr-Jun);3(2):e1
Objectives: The present study was undertaken to evaluate the effectiveness of interproximal papillae reconstruction around early loaded single implant using subepithelial connective tissue graft in maxillary anterior region.
Material and Methods: Ten systemically healthy patients (mean age = 29.3 [SD 7.9] years) in need of dental implants in maxillary anterior region were included in the study. Interproximal papillae reconstruction around single implant using subepithelial connective tissue graft was applied. The donor palatal tissue was harvested by a ‘trap door approach’. Subepithelial connective tissue graft was inserted in the pouch created on mesial and distal site of implant. Clinical and radiographic parameters were recorded around the each implant, including papillary height and papillary gingival contour, at baseline, 3 and 6 months after operation.
Results: The mesial papilla height was increased by 1.9 (SD 0.87) mm, P = 0.005 at 3 month and maintained at 1.5 (SD 0.97) mm, P = 0.007 at 6 months. The distal papilla height was increased by 2 (SD 0.66) mm, P = 0.004 at 3 month and maintained at 1.2 (SD 0.78) mm, P = 0.010 at 6 months. Assessment of papilla contour index showed 90% aesthetic success both for mesial and distal papilla at 6 months.
Conclusions: It can be concluded that subepithelial connective tissue graft may be used to successfully augment the gingival papillae adjacent to single tooth implant restoration.
Keywords: dental papilla; dental implant; single-tooth dental implant; early dental implant loading; tissue grafts; tissue transplants.
Approaches to Proximal Tibial Bone Harvest Techniques
J Oral Maxillofac Res 2012 (Apr-Jun);3(2):e2
Objectives: The iliac crest is the standard site for harvesting bone; however, this procedure may require another specialist and a general anaesthetic. The proximal tibial bone harvest has gained popularity for harvesting autogenous bone. An analysis of the clinical literature regarding the various regions for harvesting bone demonstrates that the use of the proximal tibia led to shorter hospital stays, lower morbidity rates, and a shorter learning curve for the surgeon. The purpose of this study was to analyze the clinical anatomy of a proximal tibial bone harvest graft to provide the anatomical architecture supporting a safe procedure.
Material and Methods: Dissection of 58 lower limbs from embalmed cadavers was conducted to determine the anatomy of a proximal tibial bone harvest (PTBH).
Results: Dissection revealed that the medial approach has fewer clinically relevant neurovascular structures in harms way, and a larger surface area, providing the clinician a confident surgical window to perform the procedure.
Conclusions: The anatomical basis of this study suggests that the medial proximal tibial bone harvest approach would have fewer serious structures in harm’s way compared to the lateral; however, the lateral approach may be preferred for a subgroup of patients.
Keywords: bones and bone tissue; augment bone graft; tibia; bone transplantation.
A Retrospective Study of Cleft lip and palate Patients´ Satisfaction after Maxillary Distraction or Traditional Advancement of the Maxilla
J Oral Maxillofac Res 2012 (Apr-Jun);3(2):e3
Objectives: To compare cleft lip and palate patients’ satisfaction with aesthetics and functional parameters after conventional advancement of the maxilla or by the use of distraction osteogenesis.
Material and Methods: Case series observational study. Group of distraction osteogenesis (DO) consisted of 15 patients treated with distraction osteogenesis while group conventional (CONV) included 10 patients treated with traditional advancement of the maxilla. Patients were asked to fill out a questionnaire about their subjective evaluation of satisfaction with facial aesthetics and functional parameters on a continuous visual analog-scale (VAS) when the treatment was finished.
Results: The total response rate was 76%. Preoperatively the two groups did not differ significantly according to group characteristics. At follow-up both groups were satisfied with aesthetics and functional parameters. The DO group was less satisfied with the duration of the treatment than the CONV group. There were no statistically significant differences among the groups regarding functional parameters or facial aesthetics.
Conclusions: Cleft lip and palate patients experienced a high level of satisfaction with functional parameters and aesthetics as a result of surgical maxillary advancement. The patients treated with distraction osteogenesis were less satisfied with the duration of the treatment. Further studies are needed.
Keywords: distraction osteogenesis; quality of life; cleft lip; cleft palate; Le Fort osteotomy.
A Comparison of Equivalent Doses of Lidocaine and Articaine in Maxillary Posterior Tooth Extractions: Case Series
J Oral Maxillofac Res 2012 (Apr-Jun);3(2):e4
Objectives: Local anaesthesia is the standard of care during dental extractions. With the advent of newer local anesthetic agents, it is often difficult for the clinician to decide which agent would be most efficacious in a given clinical scenario. This study assessed the efficacy of equal-milligram doses of lidocaine and articaine in achieving surgical anaesthesia of maxillary posterior teeth diagnosed with irreversible pulpitis.
Material and Methods: This case-series evaluated a total of 41 patients diagnosed with irreversible pulpitis in a maxillary posterior tooth. Patients randomly received an infiltration of either 3.6 mL (72 mg) 2% lidocaine with 1:100,000 epinephrine or 1.8 mL (72 mg) 4% articaine with 1:100,000 epinephrine in the buccal fold and palatal soft tissue adjacent to the tooth. After 10 minutes, initial anaesthesia of the tooth was assessed by introducing a sterile 27-gauge needle into the gingival tissue adjacent to the tooth, followed by relief of the gingival cuff. Successful treatment was considered to have occurred when the tooth was extracted with no reported pain. Data was analyzed with the Fisher’s exact test, unpaired t-test and normality test.
Results: Twenty-one patients received lidocaine and 20 received articaine. Forty of the 41 patients achieved initial anaesthesia 10 minutes after injection: 21 after lidocaine and 19 after articaine (P = 0.488). Pain-free extraction was accomplished in 33 patients: 19 after lidocaine and 14 after articaine buccal and palatal infiltrations (P = 0.226).
Conclusions: There was no significant difference in efficacy between equivalent doses of lidocaine and articaine in the anaesthesia of maxillary posterior teeth with irreversible pulpitis.
Keywords: lidocaine; articaine; teeth; pulpitis; local anesthesia; anesthesia.
A Novel Surgical Template Design in Staged Dental Implant Rehabilitations
J Oral Maxillofac Res 2012 (Apr-Jun);3(2):e5
Background: The philosophy of a gradual transition to an implant retained prosthesis in cases of full-mouth or extensive rehabilitation usually involves a staged treatment concept. In this therapeutic approach, the placement of implants may sometimes be divided into phases. During a subsequent surgical phase of treatment, the pre-existing implants can serve as anchors for the surgical template. Those modified surgical templates help in the precise transferring of restorative information into the surgical field and guide the optimal three-dimensional implant positioning.
Methods: This article highlights the rationale of implant-retained surgical templates and illustrates them through the presentation of two clinical cases. The templates are duplicates of the provisional restorations and are secured to the existing implants through the utilization of implant mounts.
Results: This template design in such staged procedures provided stability in the surgical field and enhanced the accuracy in implant positioning based upon the planned restoration, thus ensuring predictable treatment outcomes.
Conclusions: Successful rehabilitation lies in the correct sequence of surgical and prosthetic procedures. Whenever a staged approach of implant placement is planned, the clinician can effectively use the initially placed implants as anchors for the surgical template during the second phase of implant surgery.
Keywords: dental implantation; dental implant; implant-supported dental prosthesis; temporary dental restoration.