Anterior Maxillary Alveolar Ridge Research Articles

A 5 YEAR-OLD BOY WITH ATYPICAL UPPER LIP SWELLING

<h3>Introduction</h3> Lip swelling is a common chief complaint in the allergy clinic, but not all swelling is angioedema. Clinicians should keep their differential diagnoses broad when evaluating these patients. This is a case of lymphatic malformation (LM) in a boy with atypical upper lip swelling. <h3>Case Description</h3> A 5-year-old boy with a past medical history of asthma, tree nut allergy, allergic rhinitis, and atopic dermatitis presented for evaluation of persistent upper lip and maxillary gingival swelling. His lip swelling started suddenly and persisted for two years. The family reported intermittent "white fluid" drainage from the affected gingiva. Physical examination showed diffuse upper lip swelling and maxillary gingival swelling. Given his clinical history, his family and pediatrician attributed this swelling to an allergic reaction. He reported no improvement with daily antihistamines, but he did experience transient improvement with oral steroids. Contrast enhanced facial MRI was nonspecific, demonstrating a poorly defined area of mucosal thickening involving the upper lip and anterior maxillary alveolar ridge. He was evaluated by pediatric ENT who referred him to pediatric neurointerventional radiology for suspicion of LM. An ultrasound demonstrated a microcystic LM, notable for tiny anechoic areas without internal flow in the superior lip. The parents are considering definitive diagnosis with a biopsy and treatment options such as sclerotherapy. <h3>Conclusion</h3> LMs can be misdiagnosed as angioedema and should be considered in the differential diagnoses in patients with atypical lip swelling. Contrast enhanced MRI and ultrasound with color Doppler imaging are the recommended imaging modalities for evaluation.

EVALUATION OF ANTERIOR MAXILLARY HORIZONTAL RIDGE AUGMENTATION WITH SIMULTANOUS IMPLANT PLACEMENT USING CERABONE® VERSUS CERABONE® COMBINED WITH PLATELET RICH PLASMA (RANDOMIZED CLINICAL TRIAL)

Introduction: Rehabilitation of the anterior maxilla using dental implants is frequently problematic because of the deficiency of alveolar ridge width. Under certain conditions ridge augmentation with simultaneous implant placement is recommended. Objectives: To evaluate horizontal augmentation of narrow anterior maxillary alveolar ridge with simultaneous implant placement using Cerabone® with and without platelet rich plasma (PRP). Materials and Methods: In this study, 14 implants were placed in patients with insufficient alveolar ridge width in the maxillary lateral incisor region. Patients were divided into two groups; In Group “1” Cerabone® only was used as an augmentation material while in Group “2” a mixture of Cerabone® and PRP was used. A collagen membrane was used to cover the grafting material. Postoperative pain was assessed using visual analogue scale. Healing and postoperative edema were evaluated. Cone Beam Computed Tomography (CBCT) was obtained before surgery, immediately postoperatively and after 6 months so that the labial bone width and bone density were evaluated. Osstell was used to evaluate implant stability quotient (ISQ) during surgery and after 6 months. Results: All implants in both groups were successfully osseointegrated and functionally stable. No significant difference in postoperative pain, edema or wound healing was detected between the two groups. The mean percentage of change in ISQ was superior in Group “2” when compared to Group “1”, but statistically there was no significant difference (P=0.898). The labial bone width in Group “2” was significantly higher than that of Group “1” (P=0.002). The mean percentage of change in labial bone density was 57.95% in Group “1” and 112.52% in Group “2” (P=0.848). Conclusion: Cerabone® can be used effectively for guided bone regeneration around dental implant in narrow maxillary anterior alveolar ridges. Moreover, the addition of PRP has a positive effect on bone regeneration around implants.

Assessment of bone quality using buccal and palatal autogenous cortical shells harvested from two different mandibular donor sites for maxillary alveolar ridge augmentation: a histomorphometric randomized clinical trial.

This study aims to compare the quality of free autogenous bone grafts harvested from two different mandibular donor sites, used as onlay shells to augment horizontally and vertically deficient anterior maxillary alveolar ridges. Fourteen patients with edentulous and atrophic anterior maxillae are randomly allocated into two groups. Seven symphyseal chin (group I) and seven retromolar (group II) mandibular bone grafts were harvested and fashioned to construct buccal and palatal frameworks, fixed in place with mini-screws, followed by compacting the inter-positional gaps with an equal particulate mix of xenograft and autogenous cancellous particulates. Six months later, 42 core biopsies, three from each patient, 21 for each study group, were retrieved before the implants' insertion and subjected to histomorphometric bone area percent analysis. The bone area percent of the newly formed bone augmented with the chin shells was 52.53 ± 1.68% versus 47.97 ±1.83% for the retromolar grafts. The mean area percent difference between both groups was statistically significant (p = 0.0004). A higher bone quality and more volumetric stability were associated with the symphyseal cortical shells. The study was registered on www.clinicaltrials.gov (#: NCT03607006) in July 2018 by Ola Alaa El Morsy.

EVALUATION OF ANTERIOR MAXILLARY HORIZONTAL RIDGE AUGMENTATION WITH SIMULTANOUS IMPLANT PLACEMENT USING CERABONE® VERSUS CERABONE® COMBINED WITH PLATELET RICH PLASMA (RANDOMIZED CLINICAL TRIAL)

Introduction: Rehabilitation of the anterior maxilla using dental implants is frequently problematic because of the deficiency of alveolar ridge width. Under certain conditions ridge augmentation with simultaneous implant placement is recommended. Objectives: To evaluate horizontal augmentation of narrow anterior maxillary alveolar ridge with simultaneous implant placement using Cerabone® with and without platelet rich plasma (PRP). Materials and Methods: In this study, 14 implants were placed in patients with insufficient alveolar ridge width in the maxillary lateral incisor region. Patients were divided into two groups; In Group “1” Cerabone® only was used as an augmentation material while in Group “2” a mixture of Cerabone® and PRP was used. A collagen membrane was used to cover the grafting material. Postoperative pain was assessed using visual analogue scale. Healing and postoperative edema were evaluated. Cone Beam Computed Tomography (CBCT) was obtained before surgery, immediately postoperatively and after 6 months so that the labial bone width and bone density were evaluated. Osstell was used to evaluate implant stability quotient (ISQ) during surgery and after 6 months. Results: All implants in both groups were successfully osseointegrated and functionally stable. No significant difference in postoperative pain, edema or wound healing was detected between the two groups. The mean percentage of change in ISQ was superior in Group “2” when compared to Group “1”, but statistically there was no significant difference (P=0.898). The labial bone width in Group “2” was significantly higher than that of Group “1” (P=0.002). The mean percentage of change in labial bone density was 57.95% in Group “1” and 112.52% in Group “2” (P=0.848). Conclusion: Cerabone® can be used effectively for guided bone regeneration around dental implant in narrow maxillary anterior alveolar ridges. Moreover, the addition of PRP has a positive effect on bone regeneration around implants.

Assessment of 3-dimensional bone augmentation of severely atrophied maxillary alveolar ridges using patient-specific poly ether-ether ketone (PEEK) sheets.

This study aimed to analyze the effectiveness of virtually designed polyether-ether ketone (PEEK) sheets to delineate and maintains the three-dimensional patient's maxillary alveolar ridge. Fourteen patients (34 implants) with severely atrophied anterior maxillary alveolar ridges underwent rehabilitation using custom-made CAD/CAM PEEK sheets acting as a containment system for interpositional mix of particulate autogenous and xenogeneic bone graft, fixed by mono-cortical screws. Radiographic Assessment included measurements of linear changes in the vertical and horizontal dimensions on cross-sectional cuts of computed tomography (CBCT) using special software. Wound healing was uneventful for all the patients except one patient that showed wound break down 2 weeks postoperatively, which did not affect the outcome of the procedure. CBCT scans were interpreted to compare the quantity of both vertical and horizontal bone preoperatively and 6 months postoperatively. Statistical analyses demonstrated a significant difference between the results of both time intervals, with a mean vertical and horizontal bone gain was 3.47 mm(±1.46) and 3.42 (±1.1) with a P-value of (.0001). The customized sheets were removed 6 months postoperative with the successful placement of dental implants. The virtual planning of three-dimensional maxillary alveolar ridge augmentation utilizing patient-specific PEEK sheets deemed successful to restore the deficient ridge and to accommodate suitable size dental implants.

Assessment of vertical ridge augmentation and marginal bone loss using autogenous onlay vs inlay grafting techniques with simultaneous implant placement in the anterior maxillary esthetic zone: A randomized clinical trial.

Bony reconstruction and dental rehabilitation of patients with posttraumatic anterior maxillary alveolar defects is a very complicated procedure. The aim of this study is the assessment of vertical ridge augmentation using autogenous onlay vs inlay bone grafting techniques in the anterior maxilla. Sixteen patients (40 implants) with vertically deficient anterior maxillary alveolar ridges were equally allocated into two groups; Autogenous block bone graft was harvested from the chin with simultaneous implant placement was done either onlay (control) or inlay (study). Radiographic assessment was performed preoperatively, 1 week and 6 months postoperatively. Assessment included measurements of linear changes in the vertical height on cross sectional cuts of cone beam computed tomography (CBCT) using special software. Finally, the amount of vertical gain and marginal bone loss in each group was compared to that of the other. Wound healing was uneventful for all cases except three cases of the onlay group showed wound breakdown and graft loss. The mean vertical bone gain in the control group was -0.02 mm while in the study was 3.34 mm. While the mean of the crestal bone loss of the control group was 4.77 mm and that of the study group was 1.65 mm. The final vertical bone gain was statistically significant in the study group, so the inlay bone grafting technique with immediate implant placement could be used successfully for vertical alveolar ridge augmentation in the esthetic zone.

Comparative assessment of anterior maxillary alveolar ridge preservation with and without adjunctive use of enamel matrix derivative: A randomized clinical trial.

The aim of this randomized, controlled, parallel-arm study was to evaluate the (a) radiographic bone dimensional changes, (b) postoperative discomfort, and (c) early soft tissue wound healing outcomes, following extraction of maxillary anterior teeth (central and lateral incisors) and treatment with alveolar ridge preservation (ARP) with and without the adjunctive use of enamel matrix derivative (EMD). Thirty extraction sockets were randomly assigned to two groups: deproteinized bovine bone mineral with 10% collagen covered with collagen membrane with the adjunctive use of EMD (test group) and without EMD (control group). Bone dimensional changes were measured using cone beam computed tomography at 3 and 5months after ARP. The severity and duration of pain and swelling were evaluated using self-reported questionnaires, and soft tissue wound healing outcomes were assessed clinically. Chi-square tests and t tests were conducted to compare differences between the two groups. Radiographic and clinical analyses showed no significant differences in horizontal and vertical bone dimensional changes and soft tissue wound healing outcomes (including spontaneous bleeding, persistent swelling, and ulceration) between the two groups. There were no significant differences in the severity of pain and swelling between the two groups, but the durations of pain (difference [df]=1.20, 95% CI=0.33-2.06; p=.008) and swelling (df=1.06, 95% CI=0.11-2.01; p=.029) were significantly reduced in the test group. Alveolar ridge preservation with the adjunctive use of EMD reduced the durations of postoperative pain and swelling following maxillary anterior teeth extraction.

Comparative assessment of anterior maxillary alveolar ridge preservation with and without adjunctive use of enamel matrix derivative‐ a randomized clinical trial

Comparative assessment of anterior maxillary alveolar ridge preservation with and without adjunctive use of enamel matrix derivative‐ a randomized clinical trial

Feasible Advantage of Bioactive/Bioresorbable Devices Made of Forged Composites of Hydroxyapatite Particles and Poly-L-lactide in Alveolar Bone Augmentation: A Preliminary Study.

Purpose: We aimed to document the clinical usefulness of uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA) composite materials and their advantageous properties.Methods: Between April 2016 and March 2018, five patients required anterior maxillary alveolar ridge augmentation using fixation with u-HA/PLLA screws for an onlay block bone graft harvested from the mandibular ramus at our institute. Bone biopsies were obtained from the dental implantation site following bone healing for histomorphometric and immunohistochemical (IHC) measurements.Results: Many stromal cells were positive for Osterix, RUNX2, and SOX9 but were negative for CD68. On cell counting, based on IHC staining for Osterix, RUNX2, SOX9 and CD68 from peripheral u-HA/PLLA screw or bone areas, both areas consistently showed no significant difference in terms of Osterix, RUNX2, and SOX9. Hematoxylin-eosin staining revealed direct bone connection to the biomaterials, and no inflammatory cells infiltrated the areas surrounding the bone or artificial material. Area between the bone and u-HA/PLLA screw was seamless with no boundary. Round small cells and immature fibroblasts were noted. The new bone showed the presence of bone lamellae, normal osteocytes, and osteoblasts.Conclusion: The u-HA/PLLA materials showed excellent biodegradability and bioactive osteoconductivity. In addition, this material induced no apparent inflammatory or foreign body reactions following implantation, and it directly bonded to the human bone. Therefore, this u-HA/PLLA material seems ideal and most suitable for use as a substitute for osteosynthesis.

Titanium and polyether ether ketone (PEEK) patient-specific sub-periosteal implants: two novel approaches for rehabilitation of the severely atrophic anterior maxillary ridge

The aim of this study was to assess two new protocols for single-stage rehabilitation of the severely atrophic maxillary ridge using customized porous titanium or polyether ether ketone (PEEK) sub-periosteal implants. Ten patients with a severely atrophic anterior maxillary alveolar ridge were divided randomly into two groups (five patients in each) to receive customized sub-periosteal implants fabricated via CAD/CAM technology: group 1, porous titanium implants; group 2, PEEK implants. Prosthetic loading with fixed acrylic bridges was performed 1 month postoperative. The implants were followed-up for 12 months and evaluated for the presence of any sign of radiographic bone resorption, mobility, infection, prosthetic fracture, or implant exposure. The immediate postoperative period was uneventful except for one case complicated by wound dehiscence in group 1. At 12 months, all implants were functionally stable and the patients were comfortable with the prostheses. No signs of radiographic bone resorption, mobility, infection, or prosthetic fracture were observed. Within the limitations of this study, the application of customized porous titanium and PEEK sub-periosteal implants produced through CAD/CAM technology appears to be an acceptable method for single-stage prosthetic rehabilitation of the severely atrophic edentulous anterior maxilla.This study was awarded the best case study at the academy of osseintegration annual meeting 2017, Orlando, Florida.

Assessment of vertical ridge augmentation in anterior aesthetic zone using onlay xenografts with titanium mesh versus the inlay bone grafting technique: A randomized clinical trial

The aim of this study was to evaluate the final vertical gain at the deficient anterior maxillary alveolar ridges using onlay bone grafts with titanium mesh versus inlay bone grafting. This was a single institutional randomized comparative clinical trial. The study population included 16 patients, with edentulous anterior maxillary alveolar ridges (40 implant sites) who were presented and treated at the Faculty of Oral and Dental Medicine in Cairo University from September 2013 to August 2015. Selected patients were randomly divided into two equal groups. The control group received onlay particulate xenograft together with titanium mesh as a space-maintaining device while the study group received inlay block xenograft (sandwich osteotomy) fixed with mini-plates. Assessment using cone beam computed tomography (CBCT) included the mean percentage of vertical gain at the proposed implant sites after 6 months taken from cross-sectional cuts. A total of 40 delayed implant placements were done. Results showed that there was no statistical significance between the two groups (P=0.2); the mean percentage of 6 months postoperative vertical bone gain in the control group was 20.7% and that in the study group was 31.6%.

Epulis presenting as congenital multiple polypoidal oral mass lesion: A surprising case report

A newborn infant with congenital epulis (CE) can be a striking miserable sight for both parents and health care professionals involved in neonatal care. These tumours of the infant mouth can be remarkably large, occupying much of the oral cavity and posing a risk of airway obstruction or interfering with feeding with marked facial deformity. Neumann first described congenital epulis of newborn in 1871. It is most frequently located on the anterior maxillary alveolar ridge with slight female predilection. It clinically appears as a pedunculated protuberant mass. In cases with large lesions, mechanical oral and nasal obstruction can impair fetal deglutition and neonatal respiratory efforts resulting in polyhydramnios prenatally or respiratory impairment postnatally. Histologically Congenital epulis shows characteristic large cells with granular cytoplasm and spindle cells resembling fibroblasts. The exact histogenesis is still uncertain, various theories of origin are epithelial, undifferentiated mesenchymal cells, pericytes, fibroblast, smooth muscle cells and nerve related cells. Herein we report a newborn female child with Multiple Congenital epulis arising from maxilla and mandible with investigation, management and follow-up.

Location and classification of Canalis sinuosus for cone beam computed tomography: avoiding misdiagnosis.

The aim of this study was to assess the presence, location and, multiplanar distance of the canalis sinuosus (CS) between the incisive foramen and the anterior maxillary alveolar ridge using cone beam computed tomography (CBCT). Therefore, 500 CBCT maxillary images obtained from male and female patients aged 20 to 80 years were selected to assist in the dental treatment. Low-quality tomographic images were discarded. All images were captured with the i-CATTM Classic tomograph and assessed using the XoranCatTM software. The axial sections were analyzed at the incisive foramen in order to verify the CS presence in laterality and location. Furthermore, linear measurements of the nasal cavity floor, buccal cortical bone, and alveolar ridge crest were made. All the collected data were statistically analyzed. Results show a variation of the CS in relation to the classification and distance of anatomical structures, but no significant difference between the right and left sides. It should be highlighted that CBCT is necessary before invasive procedures in order to preserve important anatomical structures. In conclusion, the location of the CS varies in relation to the alveolar ridge crest and buccal cortical bone, assuming that it is going to be located by the upper lateral incisor palatine.

The nasal lift technique for augmentation of the maxillary ridge: technical note

Placement of dental implants in a severely resorbed anterior maxillary alveolar ridge is limited by the fact that implants may penetrate the nasal cavity. However, when the maxilla shows unusual anatomical changes, reconstruction with implants can be a challenge. Options to increase the bone in this region to permit placement of implants include: maxillary onlay bone graft, Le Fort I interpositional bone graft, and augmentation of the nasal floor, which is a procedure where only the piriform rim and the anterior nasal spine are exposed through an intraoral approach. In our case we modified this to what we call the nasal lift technique, which is a combination of turbinectomy followed by lifting of the anteroposterior nasal floor through a lateral window using autogenous bone or bone substitutes to augment the space.

Assessment of marginal bone loss using full thickness versus partial thickness flaps for alveolar ridge splitting and immediate implant placement in the anterior maxilla

The aim of this study was to evaluate the effectiveness of maintaining the periosteal attachment of the facial and palatal cortical plates on crestal bone loss that occurs at the margin of dental implants placed immediately in split anterior maxillary alveolar ridges. This was a prospective randomized comparative clinical trial. The study population included 22 patients with edentulous anterior maxillary alveolar ridges who presented for treatment during the period March 2012 to September 2013. The selected patients were divided randomly into two equal groups. All patients underwent a maxillary ridge splitting technique; a total of 43 implants were placed immediately. A full thickness mucoperiosteal flap was performed in the control group patients, while a split thickness mucosal flap was done in the study group patients. Assessments included measurements of the linear changes in the marginal bone surrounding the implants immediately postoperative and after 6 months. Measurements were taken from cross-sectional and longitudinal cone beam computed tomography images using special software. The partial thickness flap used in the study group decreased the percentage of bone loss by 9.5% for the labial bone plate, 7.9% for the palatal bone plate, and 3.5% for the mesiodistal bone plate.

Solitary S-100–Positive Congenital Granular Cell Tumor of the Tongue

Congenital granular cell tumors (CGCTs), which are rare benign lesions in newborns, locate predominantly on the anterior maxillary alveolar ridge of female neonates. However, this lesion rarely occurs on the tongue, and only 9 cases have been reported in the English literature. Of the 9 cases, which have been tested for S-100 protein, 4 were immunonegative to S-100 protein. In this present case, we reported a rare case of a 4-day-old Chinese girl with a CGCT on the anterior dorsum of the tongue. The lesion was excised under general anesthesia when the newborn was 3 months old. Histologically, pseudoepitheliomatous hyperplasia of the overlying mucosa was noted in this lesion. Immunohistochemical stains showed that the granular cells were diffusely strongly positive to S-100 protein, neuron-specific enolase, and vimentin. Depending on these findings, it was diagnosed as CGCT.

Multiple congenital epulis in alveolar ridges of maxilla and mandible in a newborn: a rare case report.

Congenital granular cell lesion (CGCL) or congenital epulis is an uncommon benign of the oral cavity tumor appearing at birth with typical clinical and pathologic features. It predominately affects females, mainly on the anterior maxillary alveolar ridge, and occurs usually as a single mass, although sometimes as multiple. The left side incisor area is the most common site. The etiology and histogenesis of the lesion remain obscure. Though it is a benign lesion, the tumor may cause feeding and respiratory problems if there are too large or multiple tumors. We report a case of a three-day-old, female newborn, who was referred to our hospital with multiple congenital oral swellings arising from the maxilla and mandible. The tumors caused a feeding problem and, hence, they were resected by surgical excision under general anesthesia.

Coordinated reconstruction with bilateral condylar replacement and dental implant rehabilitation: A clinical report

The evaluation of complex facial-cranial trauma and subsequent restoration requires multidisciplinary treatment planningfor optimal success and patientsatisfaction. Patients with bilateral subcondylar fractures and facial-dental trauma are invariably challenging. Consideration of total joint replacement, along with the comprehensive evaluation of facial-dental esthetics and occlusion is critical for an optimal long-term outcome and for patient comfort. This patient treatment illustrates team cooperation and an optimal patient treatment outcome with long-term follow-up in the reconstruction of a complex cranial-facial injury from an unrestrained motor vehicle accident. The treatment included bilateral temporomandibular joint replacement with computer-aided design and computer-aided manufacturing fitted total temporomandibular joint reconstruction, grafting of a deficient anterior maxillaryalveolar ridge, and dental implant placement and subsequent restoration with a partial fixed dental prosthesis.

Expect the Unexpected

A FULL-TERM, 3.5-kg neonate was transferred for management of a large, mobile intraoral mass. The infant demonstrated no signs of airway obstruction or respiratory distress and had normal oxygen saturation without support. The child did not seem dysmorphic and the mass was isolated to the anterior maxillary alveolar ridge, easily mobilized out of mouth. A prenatal ultrasound at 20 weeks did not identify any anomalies.Adequate ventilation was achieved after mobilizing the mass extraorally and achieving adequate mask seal. At this point, a mask induction with spontaneous ventilation was performed, followed by uneventful intubation. The mass was considered low risk for airway obstruction during induction because it did not disturb the airway anatomy, and was easily mobilized out of the mouth.Epulis, or congential granular cell tumor, is a rare tumor of variable size and number originating from gingival epithelial tissue seen in newborn infants, affecting female infants 8:1, and is rarely malignant.1,2 Differential diagnosis for neonatal oral masses includes teratoma, hemangioma, lymphatic malformation, or congenital malformation or neoplasm.3 When diagnosed prenatally, consideration for airway obstruction at birth may require intervention upon delivery. However, prenatal diagnosis is not always achieved. Considerations before induction of anesthesia focus on the anatomic location of the mass, distortion or obstruction of the airway, and signs of airway obstruction. Although computed tomography or magnetic resonance imaging studies may yield information about airway involvement, the infant may require an airway intervention before or during the study.

Role of Cone Beam Computed Tomography in Rehabilitation of a Traumatised Deficient Maxillary Alveolar Ridge Using Symphyseal Block Graft Placement

Deficiencies in the alveolar ridges cause multiple problems in achieving aesthetic and functional outcome of implant therapy and are commonly restored by using onlay graft from intraoral source. Careful assessment of the recipient as well as the donor site using cone beam computed tomography (CBCT) is a prerequisite to ideal treatment planning. This paper highlights the critical role of CBCT in planning a successful rehabilitation of traumatised deficient anterior maxillary alveolar ridge using autogenous block graft from mandibular symphysis, followed by implant placement. A 21-year-old male reported with missing right maxillary lateral incisor due to traumatic avulsion 6 months back. A concavity was found on the labial aspect of edentulous area. Serial transplanar images on CBCT revealed gross irregular radiolucency in place of labial cortical plate. Using CBCT, size of the required block was estimated, and mandibular symphyseal area was evaluated for the feasibility of harvesting a graft of suitable dimension. Onlay block graft was harvested from mandibular symphysis and placed at the edentulous site to augment the alveolar ridge. Implants were placed 5 months later and loaded successfully after osseointegration. After 1 year of followup, implant-based prosthesis is working well, without any complications.