Anterior Ridge Research Articles

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.

Methotrexate-induced oral mucositis in rheumatoid arthritis disease: Therapeutic strategy in a case report/Methotrexat-induzierte orale Mukositis bei rheumatoider Arthritis: Therapeutische Strategie in einem Fallbericht

AbstractThe aim of this case report is to evaluate the efficacy of low-level laser therapy (LLLT) in the treatment of oral mucositis induced by methotrexate (MTX).A 52-year-old male patient, affected by rheumatoid arthritis and treated with corticosteroids and MTX, complained about severe oral pain and lesions for two months. He had been treated with topical and systemic corticosteroid therapy and chlorhexidine rinses with no significant improvement. He was not able to eat solid food or to wear his dental prosthesis. Examination of the oral cavity revealed retro-commissural and labial bilateral ulcerations and erythema and a 2-cm wide fibrous white lesion on the lower anterior vestibular ridge. Blood tests showed mild pancytopenia, and oral biopsies evidenced a “non-specific inflammatory condition” excluding any precancerous or paraneoplastic lesion or autoimmune diseases of the oral cavity. Previous medical records revealed that MTX had been discontinued many times due to mucositis since 2006, when the therapy had been started. This suggested a correlation between the onset of oral mucositis and MTX accumulation. LLLT was carried out for 4 consecutive days and three once-a-week follow-ups were performed.Lesions had completely healed during the second follow-up and the patient referred no pain at all from the 4th laser session on, therefore, the discontinuation of MTX had not been necessary.LLLT could represent an innovative technique to relieve pain related to MTX side effects thus avoiding dangerous discontinuation of therapy.

A Prosthetic Alternative Treatment for Severe Anterior Ridge Defect using Fixed Removable Partial Denture Andrew's Bar System

ABSTRACTIt has been well documented that anterior ridge defects present in a patient are very difficult to treat properly. These defects have been treated with great amount of planning and complexities while using the conventional treatment approaches like removable or fixed prosthesis and options of implant. Though totally implant-supported restorations are very successful, dentists may resort to prescribe implant overdentures because of functional, anatomical economical or esthetic considerations. However, the loading conditions of the partially implant- supported overdenture may affect the long-term predictability of this type of restoration. The concept of the Andrew's bar system can be utilized. In some cases the Andrew's bar system is superior to the implant-supported fixed partial denture and other techniques for implant overdentures. The purpose of this article is to evaluate and describe the Andrew's bar system (a fixed removable partial denture), to treat a class III anterior ridge defect using natural teeth as abutments for its fixed component followed a removable component. The use of Andrew's bar system over implants offered the dentist another option in meeting patient's needs.How to cite this articleJain AR.A Prosthetic Alternative Treatment for Severe Anterior Ridge Defect using Fixed Removable Partial Denture Andrew's Bar System. World J Dent 2013;4(4):282-285.

Comparative evaluation of three different methods for evaluating alveolar ridge dimension prior to implant placement: An in vivo study

Background: During treatment planning for dental implant placement, there is a need for assessment of alveolar bone. Bone evaluation limited to the use of panoramic and or periapical radiographs may be insufficient, as it provides only two-dimensional information about the implant sites. Computed tomography (CT) provides three-dimensional information. The measurement of alveolar ridge dimensions can be accomplished using ridge-mapping technique. This technique involves penetrating the buccal and lingual mucosa down to the alveolar bone (following the administration of local anesthetic) with calipers and measures the bucco-lingual width of the underlying bone. Purpose: The aim of the study is to compare the techniques, i.e. ridge mapping, direct surgical exposure, and CT scan, which are used to measure the alveolar ridge bone width, and determine their accuracy in the clinical application. Materials and Methods: The study was conducted on 20 patients who reported to the Out-patient Department (OPD) of Prosthodontics and Crown and Bridge, PGIDS, Rohtak (Haryana) for replacement of edentulous span with dental implant. Width of alveolar ridge was studied by three techniques, i.e. CT scan procedure, ridge mapping, and direct surgical exposure at two points (3 mm from the crest of ridge and 6 mm from the crest of ridge), and then taking measurements of surgical exposure as the control group, the measurements obtained from the other two techniques were compared and then accuracy of these methods was assessed. The mean, standard deviation, standard error of mean, and degree of freedom were calculated and subjected to statistical analysis using Student's unpaired t test. Results: Results suggested that there is no significant difference in the measurements obtained by direct surgical exposure technique, ridge-mapping technique, and CT technique. Conclusion: Use of ridge-mapping technique along with panoramic and intraoral radiograph is adequate in cases where the pattern of resorption appears more regular and where mucosa is of more even thickness. It is suggested to use CT scan technique in situations where the alveolar ridges are resorbed, there is presence of maxillary anterior ridge concavities, vestibular depth is inadequate, and ridge mapping is not feasible.

Slow Orthodontic Teeth Extrusion to Enhance Hard and Soft Periodontal Tissue Quality before Implant Positioning in Aesthetic Area

Approaching bone defects of jaws treatments, hard and soft tissue augmentation could be considered as a goal for clinicians when performing dental implant placement. The increase in patients who want cosmetic treatment puts practitioners in an awkward position when choosing the best therapy to obtain the most desirable results. A private dentist referred a young patient to the Department of Implantology in Milan in order to place implants in the upper jaw. Radiographic evaluation of the two upper anterior incisors confirmed that the teeth had a poor prognosis The anterior ridge volume was clinically analyzed and several therapeutic choices were evaluated. Rapid extractions and immediate implant positioning were not considered due to the vertical and horizontal components of the bone defect. Therefore, the surgical team decided on increasing the bone volume by using slow orthodontic teeth extrusion technique.After 3 months of orthodontic treatment, the angular intra-bony defects of 1.1 tooth was completely healed. Implant guided positioning, associated with a small bone graft, showed optimal results at the time of healing screw placement. The soft tissue conditioning was obtained by a provisional acrylic crown. The final application of two integral ceramic crowns showed excellent aesthetic results. Radiographic investigation at a 24 month follow-up confirmed the integration of the dental implants and the recovery of the bone defects. Several safe surgical techniques are available today for reconstructing atrophic jaws. However, the same technique applied on the posterior area did not give the same predictable results as in the anterior areas of the jaw.

Calcium-binding proteins and metabolic activity in thalamotelencephalic parts of the turtle visual system

Distribution of three calcium-binding proteins (CaBPr) calbindin (CB), calretinin (CR) and parvalbumin (PV) in parallel with metabolic activity (cytochrome oxidase, CO) was studied in telencephalic projection zones of the tecto- and thalamofugal visual pathways in experiments on the Horsfield's terrapin Testudo horsfieldi and the pond turtle Emys orbicularis. It was shown that the nucleus rotundus (Rot) and dorsal lateral geniculate nucleus (GLd) terminal fields in both zones (dorsolateral region of the anterior ventricular ridge, Advrdl and dorsolateral cortex, Cxdl, respectively) were CB-immunoreactive (-ir) in the both studied turtle species. The highest density of CB-ir terminals and the focus of rotundal projections in the Advrdl core coincided precisely. The GLd terminal field in Cxdl also was CR-ir. The PV contribution to innervation of both projectional zones was much lower, especially to innervation of Cxdl from GLd. In spite of similar CB-ir innervation, the projectional field of the tectofugal pathway of Advrdl had the much higher CO activity than of that of the thalamofugal pathway in Cxdl. The neurons immunoreactive to all three CaBPr types were distributed in Cxdl in different ratios in each of layers. In the visual Advrdl area the overwhelming majority were PV-ir neurons, whereas CB-ir neurons were absent. The conclusion is made that in spite of the CB- or CB/CR-immunoreactivity predominates over the PV-immunoreactivity in both thalamotelencephalic pathways of the visual system, the tectofugal (rotundo-Advrdl) pathway having the higher metabolic activity.

Flabby Ridge Correction Using an Auxiliary Technique With Connective Tissue Graft

A common finding in patients with edentulous maxilla and partially dentate mandible is mainly the presence of flabbiness in the anterior edentulous alveolar ridge that can compromise the retention and stability of a denture. Thus, this case report presents the correction of a flabby ridge, using an auxiliary technique combining surgical excision and autogenous connective tissue grafting. The technique improved the quality of the osteomucosal support of the alveolar ridge and increased the vestibule deepness, whose result increased the success rate of the new conventional total prosthesis.

Facteurs prédictifs de l’éruption des dents de sagesse

We studied the prognosis of upper and lower third molar evolution. Seventy-eight patients were included after a clinical examination, dental casts, panoramic and lateral cephalometric radiographs on inclusion (T1) and two years after (T2). Five parameters were studied: retromolar space (RMS) between the third molar (M3) and the anterior ridge of the ramus; RMS/M3 crown diameter ratio, distances (PTV-M(1)) and (X(i)-Mi(2)); and third molar angle with occlusal plane. They were noted at T1 and T2. The gain of retromolar space from T1 to T2 reached 1.2 to 2.2mm without extraction, 2 to 2.7mm with PM extraction, and 4.5 to 6.8mm with M1 extraction. The "RMS/M3 diameter" ratio increased in the maxilla from 0.6 to 0.8 and from 0.5 to 0.8 in the mandible (P=0.01) between T1 and T2. PTV-M1 increased significantly from 17.1 to 19.9mm (P<0.001), and Xi-M2i increased significantly from 18.5 to 22.4mm (P<0.001) between T1 and T2. The extraction of premolars has little influence on the variation of the retromolar space; conversely first molar extraction increases that space. Prognosis techniques for the evolution of third molars are helpful when considering avulsion.

Effectiveness of Human Amnion as a Graft Material in Lower Anterior Ridge Vestibuloplasty: A Clinical Study

The aim of this study is to evaluate the clinical use of amnion as a biodegradable graft material for lower anterior ridge vestibuloplasty. Ten patients who had been referred for preprosthetic surgery underwent mandibular anterior ridge vestibuloplasty using Clark's technique and amniotic membrane as a graft material. Preoperative vestibular depth was measured. Fresh amniotic membrane was placed in the surgical site and sutured with 4-0 vicryl. In all ten cases suction catheter stent was used and was secured in the depth of the vestibule by using 1-0 mersilk percutaneous sutures. Vestibular depths were measured using a divider and a scale. Post operative measurements were taken at the end of 10th day, 1st month and 3rd month. And an average gain of 4-6mm in the depth of the labial vestibule was noted. Amniotic membrane can be a favorable graft material for vestibuloplasty, promoting healing and preventing relapse. It is easily available and preserved and a cost effective material.

Reviews of Current Literature

Lozada JL, Goodacre C, Al-ardah AJ, Garbadea A. Lateral and crestal bone planing antrostomy: a simplified surgical procedure to reduce the incidence of membrane perforation during maxillary sinus augmentation procedures. J Prosthet Dent. 2011;105:147–153.This clinical report of 2 patients presents a variation to conventional surgical techniques for opening the maxillary sinus antrum via lateral and crestal approaches. This procedure, described as a lateral/crestal bone planing antrostomy (LBPA, CBPA) involves the use of specially designed rotary instruments that plane away the bone in thin layers. This technique has the potential to reduce the perforation rate of the maxillary sinus membrane during the access process. The authors provide a good review of conventional lateral wall and crestal access techniques and discussion concerning the most common surgical complication of sinus membrane perforation. Two clinical case reports (one LBPA and one CBPA) with detailed stepwise procedural details are presented using bone planing. Excellent color photographs enhance the reader's ability to understand the surgical process.These case reports provide an interesting alternative to existing techniques, however controlled clinical studies with randomized designs are needed before a definitive conclusion can be drawn concerning wide spread acceptance of the technique.James L. RutkowskiEditor-in-Chief, Journal of Oral ImplantologyChairman, Clarion Research GroupFellow AAIDDiplomat ABOI/IDSilverstein LH, Kurtzman D, Shatz PC. Principles of Hard Tissue Regeneration and Implant Therapy: A Complete Step-by-Step Guide. Newton, Pa: Aegis Communications.This textbook is a comprehensive step-by-step manual available to teach surgical hard tissue regeneration for implant dentistry including: socket grafting, ridge augmentation, and maxillary subantral augmentation using either a Caldwel-Luc or crestal approach. The authors describe each procedure in detail with 7 layered animation type visual technology illustrations. One such procedure illustrated describes how to split a posterior ridge for facial expansion and an anterior ridge labially. Instructions are provided on “how-to-do” mono cortical ridge grafting with either the ramus or symphysis as the donor site. Multiple grafting techniques are covered.Readers are shown all steps for each procedure, from administering local anesthetic, to the specific surgical blades, blade angles, sites, and parameters of where the incisions should be made. All surgical procedural steps are explained in detail with corresponding illustrations. Each procedure details the description of suturing; which needles, threads, surgical knots, and specific techniques to use. Specific postoperative instruction sheets are provided that can be copied and given to the patient.The text was refereed and has received CERP accreditation. After successful completion of the test located at the back of the book and proper submission of the CE form, the clinician will receive three hours of Continuing Education credit.This textbook provides a thorough step-by-step outline for multiple hard tissue regeneration procedures as they apply to implant dentistry and should be a well-used reference by all clinicians. This is a must-have text for the Implant Dentist's library.James L. RutkowskiEditor-in-Chief, Journal of Oral ImplantologyChairman, Clarion Research GroupFellow AAIDDiplomat ABOI/ID

Three-Column Fixation for Complex Tibial Plateau Fractures

1) To introduce a computed tomography-based "three-column fixation" concept; and 2) to evaluate clinical outcomes (by using a column-specific fixation technique) for complex tibial plateau fractures (Schatzker classification Types V and VI). Prospective cohort study. Level 1 trauma center. Twenty-nine cases of complex tibial plateau fractures were included. Based on routine x-ray and computed tomography images, all the fractures were classified as a "three-column fracture," which means at least one separate fragment was found in lateral, medial, and posterior columns in the proximal tibia (Schatzker classification Types V and VI). The patients were operated on in a "floating position" with a combined approach, an inverted L-shaped posterior approach combined with an anterior-lateral approach. All three columns of fractures were fixed. Operative time, blood loss, quality of reduction and alignment, fracture healing, complications, and functional outcomes based on Hospital for Special Surgery score and lower-extremity measure were recorded. All the cases were followed for average 27.3 months (range, 24-36 months). All the cases had satisfactory reduction except one case, which had a 4-mm stepoff at the anterior ridge of the tibial plateau postoperatively. No case of secondary articular depression was found. One case had secondary varus deformity, one case had secondary valgus deformity, and two cases of screw loosening occurred postoperatively. No revision surgery was performed. Two cases had culture-negative wound drainage. No infection was noted. The average radiographic bony union time and full weightbearing time were 13.1 weeks (range, 11-16 weeks) and 16.7 weeks (range, 12-24 weeks), respectively. The mean Short Form 36, Hospital for Special Surgery score, and lower-extremity measure at 24 months postoperatively were 89 (range, 80-98), 90 (range, 84-98), and 87 (range, 80-95), respectively. The average range of motion of the affected knee was 2.7° to 123.4° at 2 years after the operation. Three-column fixation is a new fixation concept in treating complex tibial plateau fractures, which is especially useful for multiplanar fractures involving the posterior column. The combination of posterior and anterior-lateral approaches is a safe and effective way to have direct reduction and satisfactory fixation for such difficult tibial plateau fractures.

Catheter ablation of persistent atrial fibrillation solely guided by complex fractionated atrial electrograms in a patient with persistent left superior vena cava

Catheter ablation in patients with persistent atrial fibrillation (AF) is challenging. There are few reports of catheter ablation for persistent AF with persistent left superior vena cava (PLSVC). We report an ablation case of persistent AF with PLSVC solely guided by complex fractionated atrial electrogram (CFAE). The subject was a 65-year-old man. Electroanatomic mapping system was used to integrate computed tomography data with 3D mapping data. We identified the CFAE sites on the electroanatomic mapping. Radiofrequency ablation was applied to the CFAE sites; the posterior aspect of left superior pulmonary vein (LSPV), the anterior ridge of left atrial appendage, and the roof at the anterior to the LSPV. After those ablations, AF was finally terminated by ablation in the middle of the PLSVC. Previous investigators have reported that pulmonary vein antrum isolation (PVAI) is effective for the management of patients with either paroxysmal or persistent AF. However, some patients experience episodes of AF despite successful PVAI, which implies that important triggers and perpetuators remain in the posterior left atrium, crista terminalis, superior vena cava, coronary sinus ostium, interatrial septum, and the ligament of Marshall/PLSVC. In conclusion, CFAE ablation was useful in a patient with persistent AF with PLSVC.

Congenital epulis

Congenital epulis of the newborn is a very rare and unique tumor first described in 1871 by Neuman. It has a female predilection. It is a tumor with no tendency to recur after excision. The histogenesis of the lesion is unknown, but it is believed to be of mesenchymal origin. We report a 2-day-old female with tumor mass on the anterior mandibular alveolar ridge, which demonstrated immunoreactivity for vimentin, S-100 and neuron-specific enolase; thus, suggesting a similar histogenesis with granular cell tumor.

Nice Guidelines on Preoperative Tests in Elective Ent Surgery: A Prospective AudiT

Nice Guidelines on Preoperative Tests in Elective Ent Surgery: A Prospective AudiT

Placode Formation and Generation of Gonadotropin-Releasing Hormone (GnRH) Neurons in Ascidians

Neurogenic placodes, a chordate innovation, generate several neuronal populations, including gonadotropin-releasing hormone (GnRH) neurons which are crucial for vertebrate and solitary ascidian urochordate reproduction. The dorsal strand placode of ascidians Is derived from the anterior ridge of the embryonic neural plate and thus shares a common developmental origin and expression of various transcription factors with vertebrate placodes. Despite their importance for understanding vertebrate origins, the evolutionary and developmental origins of the neurogenic placode remain obscure. Here I demonstrate the formation of an elaborate neurogenic placode, which forms the dorsal strand, on part of the neural gland epithelium in a solitary ascidian urochordate, Halocynthia roretzi. Two modes of GnRH neurogenesis in the dorsal strand (a peripheral organ) and the migration of GnRH neurons into the brain along the visceral nerve are also described. Ontogenetically, GnRH neurons are first detected in the dorsal strand and cerebral ganglion of very young Juveniles at almost the same time, demonstrating that ascidians possess morphological and developmental features in common with vertebrates. These results further indicate that the onset of peripheral GnRH neurogenesis and the ability of neurons to migrate into the brain predate the divergence of ascidians and vertebrates. Thus, based on the generation of GnRH neurons, the dorsal strand in ascidians may be homologous to the vertebrate olfactory placode. These organs are derived from the anterior region of the embryonic neural plate, which expresses several transcription factors that invertebrate chordates and vertebrates have in common. These results provide unequivocal support for the clade Olfactories (tunicates + vertebrates).

56th Annual Meeting of the American Academy of Implant Dentistry and the World Congress of Oral Implantology 7 Abstracts, 2007

56th Annual Meeting of the American Academy of Implant Dentistry and the World Congress of Oral Implantology 7 Abstracts, 2007

Finite element analysis, mechanical assessment and material comparison of two volar slab constructs

Introduction In order to help prevent joint stiffness, the injured or postoperative hand is splinted in the intrinsic-plus position. We aimed to determine the strongest type of volar slab construct that would be appropriate in this treatment. Methods Two constructs were compared, a double-ridged and a non-ridged slab. Two materials were used, plaster of Paris (POP) and resin. We performed finite element analysis (FEA) and mechanical assessment to establish which combination of construct and material resulted in the strongest volar slab. We were unable to form ridges on the resin slab, and therefore this construct was not tested. Results Finite element analysis showed that most stress occurred at the wrist region, where all the slabs failed. The double-ridged POP slab was found to be 5.3 times stronger than the non-ridged POP slab and 1.4 times stronger than the non-ridged resin slab ( p < 0.001). Conclusion To improve strength of the conventional POP volar slab, we suggest forming two anterior ridges in the plaster.

Management of Biomechanical Complication of Implant-Supported Restoration of a Patient With Combination Syndrome: A Case Report

Combination syndrome (CS) is a pathologic condition of the stomatognathic system characterized by an edentulous maxilla with an atrophic anterior ridge, maxillary papillary hyperplasia, hypertrophic maxillary tuberosities, super-erupted mandibular anterior teeth, as well as atrophic mandibular posterior ridges. This condition can present a challenging situation to the clinician who needs to assemble evidence from all aspects of dentistry to formulate an appropriate treatment plan. One of the possible treatment choices for the fully edentulous patient with a CS is a full-arch implant-supported reconstruction for both maxilla and mandible. The purpose of this study is to illustrate and discuss a biomechanical complication-fractured maxillary meso bar in a patient with CS, and to present a description of how this complex case was corrected and successfully completed. The analysis of implant-supported and implant-retained full arch restorations in edentulous patients with CS is presented and treatment recommendations are given. A necessity of individualized approach for every implant reconstruction case, especially complicated with a CS, is suggested.

Myxoid calcified hamartoma and natal teeth: A case report

We report the case of a 4-month-old Caucasian male baby who presented an uncommon mass in the anterior mandibular ridge. The patient was born with two natal mandibular incisors, which exfoliated some weeks after birth, followed by a growth of nodular lesion in the same region. Based on the clinical and histopathological features, the diagnosis was of myxoid calcified hamartoma. Immunohistochemical and scanning electron microscopic analysis of the lesion were performed. Hamartomas in the mandibular ridges associated with natal teeth are rare, but they must be considered in the differential diagnosis of common lesions, such as congenital granular cell epulis.

Bipolar Order

The Drosophila wing has proven valuable in understanding planar cell polarity (PCP), the phenomenon that dictates the packing geometry and polarity of cells in a polarized epithelium. Each cell of the dorsal wing epithelium produces a single hair, and the Frizzled (Fz) PCP pathway aligns all the hairs along the proximodistal (PD) wing axis. Doyle et al. report that mutations that disrupt Fz PCP signaling also caused defects in the alignment of wing ridges. In the posterior wing compartment, ridges are oriented along the PD axis, but in the anterior compartment they are oriented along the anteroposterior (AP) axis, thus making hairs and ridges aligned in the posterior compartment but orthogonal in the anterior compartment. To address the question of how a single PCP pathway could generate two different patterns in the same polarized epithelium, the group focused on Spiny legs (Sple) and Prickle (Pk), two different protein isoforms encoded by the pk gene. Through loss- and gain-of-function genetic experiments, the authors found that disrupting PCP signaling early in wing development [up to 18 hours after pupal formation (APF)] did not affect hair polarity but did affect posterior ridge orientation and that disrupting late PCP signaling (more than 18 hours APF) affected hair polarity all over the wing but only altered ridge orientation in the anterior compartment. The authors propose a model in which the early Sple-dependent phase of PCP patterning establishes a cell-packing pattern that orients all ridges along the PD axis; during the late Pk-dependent phase of PCP, hair polarity is established and the anterior compartment ridges are reoriented. The differential use of two closely related isoforms of a PCP pathway component enables the system to function biphasically. K. Doyle, J. Hogan, M. Lester, S. Collier, The Frizzled Planar Cell Polarity signaling pathway controls Drosophila wing topography. Dev. Biol. 317 , 354-367 (2008). [PubMed]