Alveolar Defects Research Articles

Customized CAD/CAM titanium meshes for the guided bone regeneration of severe alveolar ridge defects: Preliminary results of a retrospective clinical study in humans

To present the results of guided bone regeneration (GBR) of atrophic edentulous ridges with customized CAD/CAM titanium meshes. Forty-one patients, presenting with 53 atrophic sites, were enrolled between 2018 and 2019. GBR was obtained with titanium meshes filled with autogenous bone chips and bovine bone mineral (BBM). After a mean of 7months (range: 5-12months), meshes were removed and 106 implants placed. After a mean of 3.5months (range: 2-5months), implants were uncovered and prosthetic restorations started. The outcomes were vertical and horizontal bone augmentation changes, biological complications and implant survival. Out of 53 sites, 11 underwent mesh exposure: eight of them were followed by uneventful integration of the graft, while three by partial bone loss. The mean vertical and horizontal bone gain after reconstruction was 4.78±1.88mm (range 1.00-8.90mm) and 6.35±2.10mm (range 2.14-11.48mm), respectively. At the time of implant placement, mean changes of initial bone gain were -0.39±0.64mm (range -3.1 to+0.80mm) and -0.49±0.83mm (range -3.7 to +0.4mm), in the vertical and horizontal dimensions, respectively. Reduction of bone volume was significantly higher (p<.001 for both dimensions) in the exposed sites. The mean follow-up of implants after loading was 10.6±6.5months (range: 2-26months). The survival rate of implants was 100%. Customized titanium meshes can represent a reliable tool for GBR of severely atrophic sites, with simplification of the surgical phases.

Closure of large alveolar defect by maxillary alveolar distraction using a vector-controlled distractor appliance in cleft patients: A pilot study

ObjectiveTo assess the treatment outcome of custom made maxillary transport distractor appliance for closure of large alveolar clefts. MethodA pilot study was conducted on 12 large alveolar cleft defects present in 11 non-syndromic cleft lip and palate patients (1 bilateral and 10 unilateral) in the age group of 16–25 years. All the subjects underwent pre-surgical orthodontics followed by alveolar distraction using custom-made distractor appliance. Study models, lateral cephalogram, panoramic radiograph and cone beam computed tomograms were obtained pre-surgically (T0) and after distractor removal (T1). The reduction in the width and volume of the alveolar cleft defect and change in the mesiodistal axial inclination of the teeth in transport segment following distraction were recorded. P value ​< ​0.05 was considered statistically significant. ResultsSignificant reduction in cleft width (9.18 ​mm), volume (89.82 ​mm3) and the change in the mesiodistal axial inclination of the teeth in the transport segment (3.05°) (P ​< ​0.05) were observed. SNA (1.75°), ANB (1.58°), maxillary length (1.58 ​mm), upper incisor inclination (3°) and distal movement of anchorage teeth (0.95 ​mm) also showed significant change (P ​< ​0.05). ConclusionThe custom-made tooth borne distraction appliance successfully closed the large alveolar cleft defect with minimal or no inadvertent effects on the oral tissues.

How well do integrated 3D models predict alveolar defects after treatment with clear aligners?

To evaluate the accuracy of integrated models (IMs) constructed by pretreatment cone-beam computed tomography (pre-CBCT) in diagnosing alveolar defects after treatment with clear aligners. Pre-CBCT and posttreatment cone-beam computed tomography (CBCT) scans from 69 patients who completed nonextraction treatment with clear aligners were collected. The IMs comprised anterior teeth in predicted positions and alveolar bone from pre-CBCT scans. The accuracy of the IMs for identifying dehiscences or fenestrations was evaluated by comparing the means of the defect volumes, absolute mean differences, and Pearson correlation coefficients with those measured from post-CBCT scans. Defect prediction accuracy was assessed by sensitivity, specificity, positive predictive values, and negative predictive values. Factors possibly affecting changes in mandibular alveolar defects were analyzed using a mixed linear model. The IM measurements showed mean deviations of 2.82 ± 9.99 mm3 for fenestrations and 3.67 ± 9.93 mm3 for dehiscences. The absolute mean differences were 4.50 ± 9.35 mm3 for fenestrations and 5.17 ± 9.24 mm3 for dehiscences. The specificities of the IMs were higher than 0.8, whereas the sensitivities were both lower (fenestration = 0.41; dehiscence = 0.53). The positive predictive values were unacceptable (fenestration = 0.52; dehiscence = 0.62), and the overall reliability was low (<0.80). Molar distalization and proclination were positively correlated with significant increases in alveolar defects at the mandibular incisors after treatment. Alveolar defects after clear aligner treatment cannot be simulated accurately by IMs constructed from pre-CBCT. Caution should be taken in the treatment of crowding with proclination and molar distalization for the safety of alveolar bone at the mandibular incisors.

Tooth shell technique: A proof of concept with the use of autogenous dentin block grafts.

Autogenous bone block graft is considered the gold standard for lateral bony defects. Dentin has been identified to be a suitable autogenous bone graft material due to its structural and chemical similarities to the alveolar bone. This proof of concept study describes the clinical application of the tooth shell technique in 24 sites with 27 implants of 22 patients. A tooth shell was fixed laterally to the defect with microscrews. Distance between the shell and the residual bone was filled with particulate remnants of the tooth root. Implant was inserted simultaneously. Cone beam computed tomography was done after implant insertion (T1) and 3months later at time of implant exposure (T2). Target parameters were biological complications and the resorption of hard tissue graft. Even though a graft exposure occurred in one case (4.5% on patient-level), all implants showed enough implant stability and were able to be loaded. At T2, the evaluation of the X-rays showed no case with hard tissue loss at the mesial or distal implant shoulder. All implants were completely osseointegrated. The tooth shell technique showed promising results for the reconstruction of lateral alveolar crest defects. It may be considered to serve as an alternative material to avoid bone harvesting procedures.

Preliminary evaluation of BMP-2-derived peptide in repairing a peri-implant critical size defect: A canine model

A synthetic bone morphogenetic protein (BMP)-2-derived peptide has been discovered to promote bone regeneration. The present study investigated the potential of the BMP-2 peptide combined with hydroxyapatite (HAp)/β-tricalcium phosphate (TCP)/collagen (Col) composite in repairing a peri-implant critical size defect. Twenty-four saddle-type alveolar defects (10mm mesiodistally and 4mm apicocoronally) were surgically prepared in edentulous ridges in four male beagle dogs. Following implant placement, the defects with vertically exposed implant fixtures received (a) HAp/TCP/Col composite, (b) HAp/TCP/Col+4mg/mL BMP-2 peptide, (c) HAp/TCP/Col+20mg/mL BMP-2 peptide, or (d) HAp/TCP/Col+0.2mg/mL recombinant human BMP-2 (rhBMP-2). Bone regeneration and mineralization were assessed using radiography, micro-computed tomography (micro-CT), fluorescence labeling, and histologic analyses after healing for 4 or 8 weeks. Implant stability was measured using resonance frequency analysis. The 20mg/mL BMP-2 peptide groups demonstrated a distinguishable advantage in bone regeneration potential over the control groups, as observed on radiographic imaging and histologic examination, although no significant difference was found in implant stability and histomorphometric analysis of mineralization levels. However, the performance of the 20mg/mL BMP-2 peptide groups were inferior to that of the 0.2mg/mL rhBMP-2 groups. The BMP-2 peptide may accelerate peri-implant bone regeneration. The BMP-2 peptide at 20mg/mL still cannot complete bone repair of peri-implant critical size defect. The BMP-2 peptide at 20mg/mL has similar osteoinductive performance to the rhBMP-2 at 0.02mg/mL.

Soft Tissue Ridge Augmentation – A Perio-Prostho Interdisciplinary Approach

Introduction: Aesthetics play a major role in the favorable outcome of any dental-related treatment. It provides patient satisfaction, boosts dentist’ confidence and achieves a long-term favorable therapeutic prognosis. These results cannot be achieved single-handedly but through a combination of interdisciplinary skills and approaches of various fields of dentistry. A tooth loss is often accompanied by a deformity of the alveolar ridge leading to a compromised esthetic and functional outcome. Therefore, various grafting procedures could be considered for the reformation and reconstruction of the deficient alveolar ridges. This case report discusses an approach for correction of a Siebert’s class III alveolar ridge defect in the anterior mandibular region prior to the placement of fixed partial denture in order to establish better esthetic and functional outcome. Case Report: A 42-year-old male patient reported to the Outpatient Department of Periodontology and Oral Implantology, at D.Y. Patil School of Dentistry, Navi Mumbai with a chief complaint of missing lower front teeth since 6 months. The edentulous space appeared asymptomatic and normal. The medical history obtained was non-contributory. The missing tooth was 41. Conclusion: Localized alveolar ridge defects may create physiological and pathological problems. Correction of a localized ridge defect with soft tissue augmentation is a promising therapeutic measure in a fixed prosthodontic therapy. It not only improves the mucogingival aesthetics of the pontic region, especially in the anterior segments of maxilla/mandible but also prevents further phonetic &amp; functional problems.

The effectiveness of mineralized plasmatic matrix in the closure of alveolar clefts with volumetric assessment.

Objectives: The purpose of this study is to assess the effectiveness of mineralized plasmatic matrix in the soft tissue closure of naso-alveolar fistula, to estimate the postoperative bone fill and volume of the graft placed in the alveolar cleft defect using cone-beam computed tomography (CBCT) at 3rd- month and 6th- month. Material and methods: 10 patients, in the age group of 15‑30 years were included in this study. They were diagnosed with unilateral cleft lip and alveolus defects with or without a cleft palate requiring late secondary alveolar bone grafting. Alveolar cleft defects were closed with mineralized plasmatic matrix (MPM), a combination of autogenous iliac bone graft and platelet rich plasma (PRP) and platelet rich fibrin (PRF). Results: The mean defect volume pre-operatively is 0.75 cm3 and at the end of 3rd-month postoperatively is 0.51 cm3 and at 6th-month postoperatively is 0.27 cm3. The average percentage of bone fill between preoperative (A) & 3th- month postoperatively (B) is 33.4% and between 3rd-month (B) and 6th-month post operatively (C) is 49.5%. Conclusions: Utilization of this new matrix (MPM), has shown to be effective in the closure of the cleft defect, oro-nasal fistula and also reduction in the volume of the residual cleft defect seen with sequential cone-beam computed tomography (CBCT) radiographs.

Preparation and biodegradable properties of hydroxyapatite nanoparticle composite coated with poly lactic-co-glycolic acid/polyvinyl alcohol for bone regeneration.

Bone loss rapidly increases 6 months post tooth extraction, which causes the atrophy of the alveolar bone. Two kinds of biomaterials which can stimulate bone regeneration are bioceramics and polymers. Making a composite of biomaterials results in better physical and biomolecular characteristics in comparison with a bioceramic or a polymer alone. Hydroxyapatite nanoparticles (HANPs) are one of the bioceramics commonly used for bone regeneration; they can degrade faster than hydroxyapatite (HA) microparticles, but have an insufficient pore size. Polyvinyl alcohol (PVA) and poly lactic-co-glycolic acid (PLGA) are polymers which have been used for biomedical applications. However, PLGA alone has insufficient cell attachment and PVA alone slowly degrades in the bone tissue. The aim of the present study was to analyze the biodegradation properties of the HANP/PLGA/PVA composites and investigate the pore size. The HANP/PLGA/PVA composites were prepared using the freeze-drying method, with 20% (w/w) of HANP and 20% (w/w) of PLGA. Morphology and the pore size were determined by means of the field emission scanning electron microscopy (FE-SEM) analysis. Biodegradation properties were determined by calculating water uptake and water loss for 1, 3 and 6 weeks. Statistical analysis was performed based on the one-way analysis of variance (ANOVA) at p < 0.05. The HANP/PLGA/PVA composites had the greatest mean pore size and a rougher surface than others (176.00 ±61.93 μm; p < 0.05). Moreover, the HANP/PLGA/PVA composites had the greatest water uptake, significantly in the 3rd (730.46%; p < 0.05) and 6th weeks (731.07%; p < 0.05), and water loss in the 6th week (67.69%; p < 0.05). The HANP/PLGA/PVA composites have optimal pore size, morphology and degradability, which shows their high potential as an effective bone scaffold to repair the alveolar defect post tooth extraction.

Timing of force application on buccal tooth movement into bone-grafted alveolar defects: A pilot study in dogs

The aim of this pilot study was to evaluate the effect of the timing of postoperative orthodontic force application on bone remodeling during tooth movement into surgical alveolar defects with bone grafts in beagle dogs. Six beagle dogs underwent surgery for buccal dehiscence-type defects (width, 5mm; height, 6mm) on the distal root of maxillary second premolars bilaterally for 12 defects. After 1-month healing, bone-augmentation procedures were undertaken at the dehiscence defects. The second premolars were protracted buccally for 6weeks into the surgical sites immediately (F-0), at 4weeks (F-4), or 8weeks (F-8) after grafting. Orthodontic tooth movement was monitored using digital models. Remodeling of alveolar bone was evaluated by histology, histomorphometry, immunohistochemistry, microcomputed tomography, and fluorescence microscopy. Group F-0 showed significant expansion (mean, 2.42mm) and tipping (mean, 9.03°) after completing orthodontic tooth treatment. The vertical bone defect was significantly lower in groups F-4 and F-8 than that in group F-0 (mean, 2.1, 2.7, and 4.5mm, respectively). In group F-4, the formation of new bone and mineralization were significantly greater than those in groups F-0 and F-8 (P<0.05). Group F-4 showed a minimal amount of bone-material remnants. Immunohistochemistry showed the highest expression of collagen-1 and osteopontin in group F-4, followed by group F-8 and group F-0, which demonstrated high osteoblast activity and enhanced bone remodeling in group F-4. Orthodontic force application at 4weeks after an augmentation procedure provided the best functional stimulation for an alveolar bone graft. This strategy enhanced new-bone regeneration and degradation of bone substitutes and, eventually, promoted bone remodeling in the bone-grafted area.

Effectiveness of Bone Graft for an Alveolar Defect on Adjacent Second Molar After Impacted Mandibular Third Molar Extraction

This retrospective study examined distal bone healing on the adjacent secondmolar between the demineralized bone matrix incorporated with recombinant human bone morphogenetic protein-2 (DBM/rhBMP-2) and a collagen sponge in the mandibular third molar extraction socket. From 2018 to 2020, 26 extraction patients (male, average 21.5years), who received a graft (each of 13 using DBM/rhBMP-2 and collagen plug, respectively) on the extraction socket without primary closure, were enrolled in this study. The bony defect was measured by computed tomography before and 6 months after the extraction. The difference in the bone healing was analyzed between the DBM/rhBMP-2 and collagen plug groups using a Mann-Whitney U test. No complications, such as infection and food packing, were encountered. The DBM/rhBMP-2 and collagen plug groups showed a similar distribution of preoperative bony defect (median 5.8 and 5.0mm, respectively). After 6 months, more bone healing was observed in the DBM/rhBMP-2 group than in the collagen plug group (median 3.85 and 2.37mm, respectively, P=.029) CONCLUSIONS: A DBM/rhBMP-2 graft after a third molar extraction does significantly alter the bony defect on the distal aspect of the secondmolar compared with a collagen plug.

Schwann Cells Contribute to Alveolar Bone Regeneration by Promoting Cell Proliferation.

The plasticity of Schwann cells (SCs) following nerve injury is a critical feature in the regeneration of peripheral nerves as well as surrounding tissues. Here, we show a pivotal role of Schwann cell-derived cells in alveolar bone regeneration through the specific ablation of proteolipid protein 1 (Plp)-expressing cells and the transplantation of teased nerve fibers and associated cells. With inducible Plp specific genetic tracing, we observe that Plp+ cells migrate into wounded alveolar defect and dedifferentiate into repair SCs. Notably, these cells barely transdifferentiate into osteogenic cell lineage in both SCs tracing model and transplant model, but secret factors to enhance the proliferation of alveolar skeletal stem cells (aSSCs). As to the mechanism, this effect is associated with the upregulation of extracellular matrix (ECM) receptors and receptor tyrosine kinases (RTKs) signaling and the downstream extracellular signal-regulated kinase (ERK)/mitogen-activated protein kinase (MAPK) pathway and the phosphoinositide 3-kinase-protein kinase B (PI3K-Akt) pathway. Collectively, our data demonstrate that SCs dedifferentiate after neighboring alveolar bone injury and contribute to bone regeneration mainly by a paracrine function. © 2022 American Society for Bone and Mineral Research (ASBMR).

Clinical study on bilamina cortical grafting technique for reconstruction of severely atrophic alveolar ridges in anterior maxillae

Objective: To evaluate the efficacy and long-term outcome of the bilaminar cortical wall building grafting technique for reconstruction of vertical and horizontal alveolar ridge defects in the esthetic zone. Methods: The retrospective study was conducted between January, 2007 and December, 2015. The sample was composed of 24 patients who received bilaminar cortical wall building augmentation in the esthetic zone in Department of Fourth Clinical Division, Peking University School of Stomatology. The 24 patients (11 female and 13 male) had age of (37.8±13.4) years (20-54 years). A bone block harvested from the lateral aspect of the mandibular ramus was bisected into two cortical laminae, which were then used to reconstruct the buccal and palatal walls of an alveolar ridge defect. The inter-laminar space was filled with particulate autogenous bone and the whole graft was covered with anorganic bone graft and collagen membrane. Bone width and vertical measurements were measured at the time of surgery and reentry surgery. Integration of the graft, implant survival rates and complications were recorded. Results: Overall, 24 patients with 35 sites who were included were followed for (7.1±1.9) years. Graft integration (24/24) and implant survival rates (35/35) were determined as 100%. The average horizontal and vertical bone gain was (6.47±2.46) and (5.01±1.12) mm with resorption rates of 9.0% and 10.9%, respectively. One patient showed soft-tissue dehiscence with peri-implant mucositis were observed 9 years after surgery. More than 1.5 mm of buccal bone plate were observed using cone beam computed tomography. Conclusions: This technique was effective and reliable for three-dimensional reconstruction of severely atrophic alveolar ridges in anterior maxillae. Autogenous graft combined with coverage by allogeneic bone graft and collagen membrane provided successful augmentation with low bone resorption.

Cone-Beam Computed Tomography (CBCT) Imaging for the Assessment of Periodontal Disease

Cone-beam computed tomography (CBCT) imaging has become a significant imaging modality in periodontology, and its applications to dentoalveolar disease and conditions are frequently updated. This review highlighted some of the current evidence of the use of CBCT scans for imaging the most common conditions related to periodontal diseases. CBCT imaging should not be the first choice for the routine assessment of vertical or horizontal bone loss, and its use should be preferable for cases where clinical information and conventional 2D images are insufficient or unclear for diagnosis and treatment decision. On the other hand, the use of CBCT appears to be prudent for an accurate diagnosis of furcation defects in patients with advanced periodontal disease, and in cases where dehiscence and fenestration are suspected. Should volumetric evaluation of those periodontal bone defects be required, it is important to use small voxel sizes for a more accurate measurement. CBCT exams provide little additional benefit in the decision-making and disease managing in most cases of periodontal disease, being advocated only on patient-specific situations involving more complex conditions such as alveolar defects with intricate morphology, dehiscence, and fenestration.

Resorbable membrane of polyethylene glycol in Wistar rats for guided bone regeneration - Experimental study

Purpose: The aim of the present study was (1) to test whether or not the application of an in situ formed synthetic hydrogel, made of polyethylene glycol (PEG) used as a resorbable membrane for guided bone regeneration, will result in more amount of bone regeneration compared with an uncovered defect and (2) to evaluate if it can prevent the soft-tissue ingrowth into alveolar defects. Materials and Methods: Two critical size defects were created in seven Wistar rats. In the right side, an in situ formed hydrogel PEG membrane (Straumann MembraGel) was applied into the defect and the left one was kept empty as a control. After 60 days, animals were sacrificed and the calvarial bone was removed. The area of newly formed bone was determined by histomorphometrical analysis. For statistical analysis, the Mann-Whitney-U test was applied to model the amount of new bone formation. Results: The quantitative histomorphometric analysis obtained a percentage of newly formed bone for the test defects of 61,8% +/-22,2% and 53,8% +/-22,9% in the control group. The observed differences were not statistically significant. Conclusions The experimental PEG membrane was biocompatible and prevented soft-tissue ingrowth. There were no statistically significant differences between the groups.

Vertical Ridge augmentation in posterior mandible - Case report

Purpose: This clinical case describes a successful use of a non-resorbable membrane and mixture of autogenous particulated bone with anorganic bovine bone-derived mineral (ABBM) in a severe posterior mandible alveolar defect. Case report: A combined vertical and horizontal alveolar ridge augmentation was successfully achieved. Detailed clinical steps were described and demonstrated. The patient was rehabilitated with implant supported fixed partial denture with no pink ceramic. This two-staged procedure provides the amount of horizontal ridge width and vertical height to successfully place in the correct position the implants and achieve long term results. Conclusions: Multicenter, randomised clinical trials are necessary to compare this procedure with other potential clinical solutions.

Bone Growth Capacity of Human Umbilical Cord Mesenchymal Stem Cells and BMP-2 Seeded Into Hydroxyapatite/Chitosan/Gelatin Scaffold in Alveolar Cleft Defects: An Experimental Study in Goat.

To evaluate bone regeneration in alveolar defects treated with human umbilical cord-derived mesenchymal stem cells (hUCMSCs), hydroxyapatite/chitosan/gelatin (HA/CS/Gel) scaffold, and bone morphogenic protein-2 (BMP-2) in Capra hircus models. Randomized posttest-only control group design. Animal Hospital at Bogor Agricultural Institute. Healthy and equally treated 24 female Capra hircus/goats. Animals were randomly assigned to 3 experimental group design (iliac crest alveolar bone graft/ICABG [control], HA/Cs/Gel+BMP-2 [Novosys], and HA/Cs/Gel+BMP-2+UCMSCs). Graft materials were implanted in surgically made alveolar defects. Postoperative functional score and operating time were assessed. New bone growth, bone density, inflammatory cells recruitment, and neoangiogenesis were evaluated based on radiological and histological approach at 2 time points, week 4 and 12. Statistical analysis was done between treatment groups. Operating time was 34% faster and functional score 94.5% more superior in HA/Cs/Gel+BMP-2+hUCMSC group. Bone growth capacity in HA/Cs/Gel+BMP-2+UCMSCs mimicked ICABG, but ICABG showed possibility of bone loss between week 4 and 12. The HA/Cs/Gel+BMP-2+UCMSCs showed early bone repopulation and unseen inflammatory cells and angiogenesis on week 12. The HA/Cs/Gel+BMP-2+hUCMSCs were superior in enhancing new bone growth without donor site morbidity compared to ICABG. The presence of hUCMSCs in tissue-engineered alveolar bone graft (ABG), supported with paracrine activity of the resident stem cells, initiated earlier new bone repopulation, and completed faster bone regeneration. The HA/Cs/Gel scaffold seeded with UCMSCs+BMP-2 is a safe substitute of ICABG to close alveolar bone defects suitable for patients with cleft lip, alveolus, and palate.

Vertical-guided bone regeneration with a titanium-reinforced d-PTFE membrane utilizing a novel split-thickness flap design: a prospective case series

ObjectivesTo evaluate the feasibility of a newly proposed minimally invasive split-thickness flap design without vertical-releasing incisions for vertical bone regeneration performed in either a simultaneous or staged approach and to analyze the prevalence of adverse events during postoperative healing.Materials and methodsFollowing preparation of a split-thickness flap and bilaminar elevation of the mucosa and underlying periosteum, the alveolar bone was exposed over the defects, vertical GBR was performed by means of a titanium-reinforced high-density polytetrafluoroethylene membrane combined with particulated autogenous bone (AP) and bovine-derived xenograft (BDX) in 1:1 ratio. At 9 months after reconstructive surgery, vertical and horizontal hard tissue gain was evaluated based on clinical and radiographic examination.ResultsTwenty-four vertical alveolar ridge defects in 19 patients were treated with vertical GBR. In case of 6 surgical sites, implant placement was performed at the time of the GBR (simultaneous group); in the remaining 18 surgical, sites implant placement was performed 9 months after the ridge augmentation (staged group). After uneventful healing in 23 cases, hard tissue fill was detected in each site. Direct clinical measurements confirmed vertical and horizontal hard tissue gain averaging 3.2 ± 1.9 mm and 6.5 ± 0.5 mm respectively, in the simultaneous group and 4.5 ± 2.2 mm and 8.7 ± 2.3 mm respectively, in the staged group. Additional radiographic evaluation based on CBCT data sets in the staged group revealed mean vertical and horizontal hard tissue fill of 4.2 ± 2.0 mm and 8.5 ± 2.4 mm. Radiographic volume gain was 1.1 ± 0.4 cm3.ConclusionVertical GBR consisting of a split-thickness flap and using titanium-reinforced non-resorbable membrane in conjunction with a 1:1 mixture of AP+BDX may lead to a predictable vertical and horizontal hard tissue reconstruction.Clinical relevanceThe used split-thickness flap design may represent a valuable approach to increase the success rate of vertical GBR, resulting in predicable hard tissue regeneration, and favorable wound healing with low rate of membrane exposure.

Presurgical Maxillary Orthopedics and Primary Alveolar Closure: Protocol and Long-term Effects on Midfacial Growth in Patients With Complete Unilateral and Bilateral Clefts

BACKGROUND: In a complete cleft lip and palate, a defect exists in the alveolar segment of the maxilla. In order to achieve successful restoration of the maxillary arch, several techniques have been employed with the ultimate goal of achieving continuity and adequate bone stock across the alveolus. Passive orthodontic appliances (POA) and gingivoperiosteoplasty (GPP) are adjuncts utilized by some surgeons with primary cleft lip repair. POA aligns the alveolar segments prior to cleft lip repair, and GPP is utilized to achieve bony union across the cleft at the time of primary lip repair. The use of these treatments remains controversial. Along with the surgical technique of the cleft lip and palate repair, they have the possibility of impacting midface growth. Here, we present our protocol for cleft lip and palate repair utilizing GPP and POA for complete unilateral and bilateral cleft lip and palate patients. We also report preliminary treatment results in complete unilateral and bilateral cleft patients, evaluating midface growth at mixed dentition. METHODS: Ten consecutive complete unilateral and 10 consecutive complete bilateral cleft lip and palate patients were recruited. All presurgical molding was performed by a single individual, and all surgical treatments were performed by the senior author. Patients underwent POA treatment (initiated at 7 days) for 35 weeks. The nasal component was incorporated after 6 weeks. GPP was performed by elevating flaps in the subperiosteal or supraperiosteal plane and closing the alveolar defect. Unilateral cleft patients underwent rotation advancement repair at approximately 6 months, whereas bilateral cleft patients underwent staged repair with a similar technique at approximately 6 and 9 months of age. Cephalometric analysis of lateral radiographs of patients at mixed dentition was performed to evaluate maxillary and mandibular growth (SNA, SNB, ANB) and facial growth relative to the facial axis (facial axis angle). RESULTS: Twenty patients underwent POA, cleft lip closure with GPP and cephalometric analysis. Mean age at time of surgery for all patients was 6.8 months ± 2.6 months of GE with a range of 5–14 months of age. Mean cephalometric values were within age-specific normal values for SNA (80° ± 3.7°), SNB (74° ± 3.4°), ANB (4° ± 1.4°), and the facial axis angle (90° ± 3.5°). One unilateral patient and zero bilateral patients exhibited skeletal Class III malocclusion. CONCLUSION: Although controversy exists regarding the impact of GPP and POA on midface growth in cleft patients, our results demonstrate that GPP and POA do not interfere with maxillary grow or cause a Class III malocclusion at mixed dentition in most patients. POA, combined with GPP at the time of cleft lip repair, leads to normal maxillary development in unilateral and bilateral cleft lip and palate patients at mixed dentition. We feel that the normal maxillary growth justifies continuing the use of GPP and POA, especially when considering the potential advantageous that they can afford at the time of primary cleft lip repair, such as allowing for closure of the alveolus and anterior palate and achieving bony union across the cleft.

Assessment of Alveolar Ridge Defects based on Sibert’s Classification - A Retrospective Study

Alveolar ridge defect may occur due to injury,trauma,normal healing after extraction, denture wear andperiodontitis. Based on sibert’s classification, it can be classified into three classes: class I (buccolingual lossof tissue), class II (apico coronal loss of tissue) and class III (both loss of tissue). It is important to close theridge defect by replacing the tooth loss and to achieve good esthetic, phonetic and mastication. The aim ofthis study was to assess the prevalence of alveolar ridge defects using seibert’s classification among partiallyedentulous patients.This study was conducted in a university setting among the outpatient population of adental college.We reviewed patients records and analysed the data of 86000 patients between June 2019 andMarch 2020. 32,837 patients data were included from 86000 patients and were assessed and the data wastabulated in excel and later was imported to SPSS software by IBM and descriptive statistics were doneand results were analysed graphically. The statistical analysis were performed using chi-square test.Basedon the results, 50.5% males,51.4% females and 40% transgender have class I alveolar ridge defects; 0.7%male,0.8% females and 0% transgender have class II alveolar ridge defects;1.3 % males,1.4% females and0% transgenders have class III alveolar ridge defects; 47.5% males, 46.4% females and 60% transgenderhave normal edentulous ridge.To conclude, the Sibert’s classification helps in suggesting a proper treatmentplan for the patient to ensure that the treatment outcomes turn out to be successful.

Effect of Platelet Rich Plasma (PRP) on Bone Graft in Alveolar Cleft Repair

Background: Ultimate repair of alveolar defects is a greatchallenge in practical field, many bone graft materials havebeen evolved in the literatures for alveolar defect reconstructionas autogenous, allogenic, xenogenic, and alloplastic grafts[1], autogenous iliac crest bone graft is the gold standardamong other graft materials evaluated. However, the procedureassociated with a potential risk of early complications suchas graft resorption, graft leakage, infection, or graft failure,failure rate is about 30% [2].Objectives: To assess the efficacy of using Platelet RichPlasma (PRP) in alveolar cleft reconstruction; in combinationwith Iliac Crest Bone Graft (ICBG) in comparison to theconventional Iliac Crest Bone Grafting (ICBG).Patients and Methods: 20 patients underwent alveolarcleft reconstruction at the age of mixed dentition over a 3-year's period; their mean age was 8.8±2.3 years years andtheir mean post-operative follow-up was 13.4 months. Ofthese, 10 patients treated with ICBG combined with PRP(Group I), and 10 patients repaired by ICBG alone Group II(control group) results were assessed by rating the radiographsobtained 3, 6, and 12 months post-operatively according tocone beam CT (CBCT) volume and density assessment.Results: Alveolar cleft repairs using PRP combined cancellousbone (Group I) were 90 percent successful, alveolarcleft repairs using cancellous bone (Group I) were 70 percentsuccessful as regard; bone resorption reduction, bone volumegaining and improved bone density in CBCT at 3, 6, and 12months post-operative with decreased post-operative complicationrates.Conclusion: Application of PRP enhances bone formationin alveolar clefts when admixed with autologous bone graftharvested from the iliac crest as it leads to early bone formation,increased bone density, decreases bone resorption, low infectionrate and least post-operative complications.