Split Bone Research Articles

Influence of bone augmentation procedures on the short‐term prognosis of simultaneously placed implants

The purpose of this study was to investigate the effect of simultaneous bone-augmentation procedures, and their combination, on the survival of dental implants and on the incidence of complications. Within a retrospective analysis, 958 implants placed in 404 patients (mean age 58.18) were selected from a prospective clinical study. In 304 cases of reduced bone width, bone spreading (n=217) with hand osteotomes, or bone splitting (n=15), or guided bone regeneration (n=72) combined with autogenous bone grafts were also performed. Eighty-eight implants were placed in combination with simultaneous internal sinus floor elevation without using graft material. For 194 additional implants, several augmentation procedures were combined because of extensive bone deficits. Three-hundred and seventy-two conventionally placed implants served as controls. Implant failures and complications were recorded after a mean observation period of 2.1years (maximum 6.9years). Seventeen failures and nine additional implant-related complications were observed. After 4years, Kaplan-Meier curves revealed a probability of survival without complication of 97.5% for conventionally placed implants, and 95.8% for implants placed in combination with a single augmentation technique. If several augmentation techniques were combined, success decreased to 94.1%. Complication-free survival differences between combined augmentation techniques and conventionally placed implants were significant (P=0.004). Age, gender, and location showed no effect on implant survival. It can be concluded that simultaneous bone-augmentation techniques slightly reduce short-term prognosis for dental implants. This effect was more pronounced when advanced defects required the combination of several augmentation procedures.

A New Method to Improve Defects of the Mandibular Angle Using an Asymmetrical Bone Distraction Technique

M J Oral Maxillofac Surg 2012. The contour of the mandibular angle is reduced in some congenital malformations (eg, facial microsomia) and in old age. Treatment of an ill-defined mandibular angle is a complicated problem. Augmentation of the mandibular angle has been performed with alloplastic implants, orthognathic proceures, rhytidectomy and liposculpturing techniques, bone splitting and bone grafting techniques, and distracion osteogenesis (DO). DO was successfully used for the first time by McCarthy et al to correct bone atrophy in a patient with craniofacial microsomia. This technique is a bone-generating process between 2 bone parts that are gradually separated by progressive traction. A allus forms between the separated bone segments, nd traction facilitates the callus tissues being tretched with new bone growth. In 1995, Penler et al studied skeletal distraction of hypoplasic mandibles in 6 young adult patients and found hat gradual distraction offers some advantages over rthognathic surgery for patients with micrognahia; remarkably, the use of DO techniques resulted n a decrease in the steep gonial angle. It is clear that mandibular distraction can modify he shape of the mandible. Mandibular distraction has ecome a well-established method for the correction f mandibular hypoplasia and facial asymmetry. DO

下顎枝矢状分割術における骨の分割と骨片固定に関連して生じた偶発症の検討

Sagittal splitting ramus osteotomy (SSRO) is commonly used to treat jaw deformities. We must avoid the occurrence of problems that may disrupt the social relationships of our patients.We investigated cases involving unfavorable bone splitting or fixation and studied their causes and measures to prevent these problems.In the last 13 years, 261 SSROs have been performed in our department, of which 11 were problematic cases associated with bone splitting or fixation. The problems consisted of six unfavorable fractures during surgery, one unfavorable fracture postoperatively, and one case each of a screw loosening postoperatively, a miniplate breaking postoperatively, a miniplate loosening postoperatively, and lateral dislocation of the condyle.The most frequent problem was an unfavorable fracture during surgery. The six cases included five bad splits and one incorrect horizontal cut in the lingual aspect of the mandibular ramus. The unfavorable postoperative fracture also resulted from an incorrect cut in the lingual aspect of the mandibular ramus. We treated these cases with re-fixation of the mandible, additional intermaxillary fixation, or both. In all cases, we confirmed bone healing within 1 year. In the case of lateral dislocation, although the patient has had symptoms for a long time, no functional problems have occurred.The loosening or breaking of the miniplate or screw was caused by an incorrect drilling angle into cortical bone or inadequate mobility of the proximal segments due to insufficient dissection of masticatory muscles. The surgeons' skill also affected the results. In each case, the problem might have been avoided if the ramus shape had been known preoperatively and the operation simulated. The basic technique of SSRO has not changed, but the methods and materials used for bone fixation are improving. To avoid these problems, it is essential to understand the patient's anatomy, to simulate surgery and to become proficient with the surgical techniques.

Alveolar split osteotomy for the treatment of the severe narrow ridge maxillary atrophy: a modified technique

Alveolar bone splitting and immediate implant placement have been proposed for patients with severe atrophy of the maxilla in the horizontal dimension. A new modification of the classical alveolar bone splitting for the treatment of the narrow ridge in the maxilla is provided. Thirty-three dental implants in eight consecutive patients were evaluated retrospectively following the described modified split-crest osteotomy. Inclusion criteria were: inadequate maxillary buccolingual dimension, 3-4mm of crestal width, and sufficient height from alveolar ridge tip to maxillary sinus floor. Primary stability was calculated using resonance frequency analysis (RFA). Alveolar bone height was measured in the panorex pre- and postoperatively. Histological bone examination was assessed following trephine bone harvesting during the second operation. Mean follow-up was 28.33 months. Bone regeneration of the inter-cortical gap occurred in 98% of implant sites (implant survival rate 100%). Mean implant stability quotient (ISQ) for the whole series of implants was 69.48. At the second operation, mean loss of the alveolar bone height was 0.542mm. Predictable results are obtained using the modified split-crest osteotomy. This technique provides an acceptable inter-cortical gap, decreases the risk of necrosis of the outer cortex, and provides a firm-wall box for the placement of particulate bone grafting.

Reconstruction of skull base defects in sphenoid wing dysplasia associated with neurofibromatosis I with titanium mesh

Sphenoid wing dysplasia occurs in 3–7% of patients with neurofibromatosis type 1 (NF1). The typical radiological features are partial or complete absence of the greater wing of the sphenoid. This condition is slowly progressive and may result in temporal lobe herniation into the orbital cavity, producing pulsating exophthalmos and gross facial deformity. Thus, reconstruction of the orbit is important for both cosmetic and functional reasons. Traditional surgical treatment of sphenoid dysplasia involves split bone grafting and repair of the anterior skull base defect. However, several reports have demonstrated complications of graft resorption and recurrence of proptosis and pulsating exopthalmos. In this case series, we present two patients suffering from pulsating exophthalmos due to sphenoid dysplasia. Radiological and MRI studies demonstrated orbital enlargement and complete absence of the greater wing of the sphenoid. Surgical management of these patients involved dural defect repair, and the use of titanium mesh in conjunction with bone graft to act as a barrier between the orbit and the middle cranial fossa. The mesh was fixed by fine screws. Proptosis improved markedly post-operatively and resolved within a few weeks. Ocular pulsation subsided and remained quiescent with at least 1-year follow-up.

Island Osteoperiosteal Flap for Alveolar Bone Reconstruction

The island osteoperiosteal flap (I-flap) is introduced as a modified alveolar split bone grafting technique used to gain width and modify the facial or buccal bone plate position. Three case examples are shown as well as animal histology indicating the possible development of this new surgical procedure as an adjunct for alveolar augmentation and implant therapy.

Evaluation of the ankle function following reconstruction of the donor defect with a split fibular bone after a vascularized fibular flap transfer

To validate the hypothesis that the reconstruction of the missing segment of the fibula using a redundant split fibular graft after a vascularized fibular flap transfer may have a better effect on ankle function. Of the 24 head and neck cancer patients who received a free fibula flap for mandible reconstruction, 14 patients underwent the conventional method of donor site closure, in which the redundant fibular bone was discarded (Group I). Ten patients underwent longitudinal osteotomy of the redundant non-vascularized fibular portion to bridge the donor site defect (Group II). Postoperative subjective satisfaction level was evaluated with a self-constructed questionnaire in 10 parameters (ambulation with assistance, ankle instability, ankle stiffness, muscle weakness, leg edema, foot numbness, ankle pain, other sites of pain besides the ankle, and restriction to run) and the 4 voluntary motions (dorsiflexion, plantar flexion, eversion, and inversion) of both ankles were measured using a CYBEX II dynamometer. The muscle peak torque of the donor leg was significantly lower at ankle plantar flexion (P = 0.002), eversion (P = 0.002), and inversion (P = 0.0002) in Group I as well as at dorsiflexion (P = 0.031), plantar flexion (P = 0.016), and inversion (P = 0.002) in Group II against the contralateral non-operated leg. The muscle power was significantly greater when performing ankle eversion (P = 0.049) in those who underwent split fibular bone reconstruction. There was no difference in the subjective satisfaction score between these two groups. The reconstruction of the donor site with a split fibular bone graft led only a slight improvement in ankle eversion.

Donor site morbidity of anterior iliac crest for reconstruction of the jaw

Introduction: The iliac crest has been the accepted place to obtain bone for reconstruction in oral and maxillofacial surgery. The iliac cres t has many advantages because of its accessibility, large amount of cancellous bone, relative ease of bone harvest, possibility of two tea m approach and ability to close the wound primarily. This study evaluated retrospectively the morbidity of bone harvesting from the anterior iliac crest to provide a logical guide for recognizing the complications and morbidities of an iliac crest bone graft. Materials and Methods: Fifty healthy patients (mean age of 35.5 years; range 7 to 59) underwent iliac crest bone harvesting for a maxillofacial reconstruction from January 2007 to September 2009 at the Department of Oral and Maxillofacial Surgery in Kyungpook National Un iversity Hospital. Age, sex, size and kind of grafted bone, duration of pain on donor site, duration of gait disturbance, sensory defici t, scar, contour defect were measured in each patients by retrospective research. Results: The mean duration of pain is 6.7 days, and mean duration of gait disturbance is 7.2 days. Most patients were free from gait dis turbances and pain within 2 weeks and there was no correlation between the size of the harvesting block bone and the duration of gait disturb ance or pain. However, this study showed that the duration of pain is associated with gait disturbance. In addition, most patients had no complaints r egarding their surgical scar and contour defect, and only one patient had permanent impairment of the sensory function. Moreover, an iliac bone graft d id not extend the length of hospitalization. Conclusion: This study suggests that split thickness bone harvesting from the inner table of the anterior iliac crest is a well accepted pr ocedure with relatively low morbidity.

Intraoral approach for abrasive mandibular reduction osteoplasty

Objective To verify the clinical reliability of a simple abrasive method for reduction mandibular osteoplasty.Methods A total of 598 cases of reduction mandibular osteoplasty were performed by using the abrasive method since 2002.Through intraoral incisions,the low part of mandibular ramus,angle region,buucal cortice and inferior border of mandible were exposed and abrasive osteoplasty was taken with special designed retractors,rasp and grinding burs with protecting sheath.The inferior alveolar nerve could be preserved.Results There was no nerve injury and only one hemorrhage case during operation without unfavorable result.In 6 to 1～2 months follow-up for 168 cases,the satisfactory rate for contour results was 95.24%.Conclusion Through the intraoral approach,the abrasive mandibular reduction osteoplasty is a simple,safe and effective method for mandibular osteoplasty.It is not to correct the prominent mandibular angle but to reduce the thickness of the mandibular ramus and body.This method could contribute the same results of angle ostectomy and split cortical bone ostectomy and result a good contour of the jaw region. Key words: Abrasion; Intraoral approach; Mandibular osteoplasty

Sternocleidomastoid myocutaneous flap and sternocleidomastoid myocutaneous calvarial split bone flap for soft tissue and mandibular reconstruction after tumour surgery

Sternocleidomastoid myocutaneous flap and sternocleidomastoid myocutaneous calvarial split bone flap for soft tissue and mandibular reconstruction after tumour surgery

Dental restoration with osseointegrated implants after jaw reconstruction: beyond the fibular height deficiency by distraction osteogenesis and/or prosthodontics

ackground and Objectives: Complex efect is caused by block resection of oral arcinoma frequently, how to reconstruct s challenge work for specialists in oral nd maxillofacial surgery. This research is o investigate clinical effect and prognosis f the sternocleidomastoid myocutaneous ap (MSCM) and sternocleidomastoid yocutaneous with clavicular split bone MSCMCSB) for reconstruction of opertive soft and mandibular defect after oral arcinoma resection, to summarise the feaures, clinical values and intraoperative otes. ethods: Between April 2001 and July 008, in our department, 68 patients who ad operative soft defect or combined ith bone defects after oral carcinoma blation underwent reconstruction with SCM myocutaneous flap and five atients with MSCSB. Postoperatively, hree-dimensional computed tomography nd emission computed tomography, as ell as the postoperative complication heck were used to detect the outcome of he methods. esults: Among the patients a part of he skin underwent necrosis in 3 patients, cases were defaulters. There are no ecroses in the rest 61 cases. All MSCSB hat reconstruct the soft tissue combined ith mandibular defects alive excellent. he donor side can be closed by direct uture. Grafted bone heals satisfactory fter 4 month. 90% of patients were satsfied with their appearance and oral diet. onclusion: MSCM myocutaneous flap nd MSCSB are simple to perform and arely complication rate so that is effecive in reconstruction for operative defects n patients after oral carcinoma resection. hese methods provide the sufficient soft issue and alveolar bone for dental implant at secondary stage. It is alternative to free flap such as free iliac flap and free fibular flap and reasonable to rehabilitate the function of oral and maxillofacial region and improving the quality of life for patients with oral carcinoma.

Accuracy of Ultrasound Measurements for Skull Bone Thickness Using Coded Signals

The knowledge of skull bone thickness would be helpful for a great variety of surgical interventions of the head. Ultrasound (US) can offer this information intraoperatively in real time. A-mode US measurements of skull bone thickness were performed with different pulse characteristics: 1) in water and 2) by directly coupling a 2.25-MHz US transducer integrated in a handpiece with a soft delay line using coded excitation (CE) (SonoPointer). Mechanical measurements by calipers served as controls. The specimen were 16 nonselected human cadaveric skull bones preserved with formaldehyde. The average difference between the bone thickness measured by the SonoPointer and the mechanical control measurements was 0.04 +/- 0.62 mm. The 95% limits of agreement between the two methods were -1.18 and 1.25 mm. However, even the gold standard of two repeated caliper measurements had limits of agreement of -0.4 and 0.42 mm. Using a standard US pulse in water, only 62.5% sample points were measurable, whereas the SonoPointer produced the thickness measurement in 97.9% of points. CE proved to be superior to single burst or needle US pulses. A-mode US measurements of skull bone thickness using the SonoPointer are feasible. It may provide valuable information on skull bone thickness, e.g., for osteosynthesis, calvarial split bone harvesting, implantation of hearing devices, osseointegrated titanium fixtures, and skull base surgery.

Horizontal alveolar ridge augmentation using distraction osteogenesis: comparison with a bone-splitting method in a dog model

Although horizontal alveolar distraction osteogenesis (DO) appears to be a viable option for implant placement in a narrow alveolar ridge, relatively few reports exist on horizontal DO. Horizontal DO using a titanium mesh plate is similar to alveolar bone splitting, but without a bone graft. Therefore, this study compared 2 methods of bone augmentation, horizontal DO and a bone-splitting (BS) method with bone graft, using an experimental dog model. Five beagle dogs were studied. The experiments were designed in a spit-mouth manner. One side of the alveolar ridge of the mandible was 4 mm expanded using horizontal DO, followed by implant placement 2 months after augmentation. The other side of the ridge of the mandible was 4 mm augmented using a bone splitting (BS) method with a bone graft combined with simultaneous implant placement. The average amount of bone gain on the DO side (2.7 mm) was significantly greater than that on the BS side (1.7 mm) (P = .008) The keratinized soft tissue gain on the DO side (2.8 mm) was significantly greater than that on the BS side (0.6 mm) (P = .02). Resonance frequency analysis revealed that implants placed in the distracted area achieved good stability compared with those on the BS side. The implants were fully embedded in mature lamellar bone, and direct bone contact with the implant surface was seen 3 months after implant placement in the distracted area. Horizontal alveolar ridge distraction appears be an effective technique for the placement of implants in a narrow alveolar ridge.

Single-Tooth Replacement in the Esthetic Zone With Ridge Expansion Osteotomy: A Clinical Report and Radiographic Results

Maxillary alveolar atrophy often limits the placement of dental implants. The bone splitting and bone widening by osteotome technique is a more obvious method for the immediate placement of implants in those cases in which the dimensions of the residual ridge are reduced by only a small degree. Few studies have been performed that are aimed at the radiographic results shown after the osteotome technique by a low-dose computed tomography scan and assessment of objective improvement of the bone density using Misch's classification. The aim of this clinical case was to analyze the radiographic data of the osteotome technique on the change of bone density and to demonstrate efficacy of the ridge expansion crest to bypass bone fenestrations of the buccal plate in the esthetic zone. The advantages of this technique for patients include less surgical trauma and a shorter treatment time.

Comparison of morbidity following the removal of mandibular third molar by lingual split, surgical bur and simplified split bone technique

The methods frequently used for surgical removal of impacted third molars are bur technique, lingual split and simplified split bone technique. The morbidity rates following the use of these different surgical techniques are not completely resolved. The use of a surgical method with minimum postoperative complication is needed. This study was conducted to compare the morbidity rates of the three different surgical techniques and their efficacy with regard to postoperative pain, swelling, labial and lingual sensation. Ninety patients with a symptomatic impacted mandibular third molar with the age range of 14-62 years were divided into three groups of 30 patients each for surgical bur technique, lingual split technique and simplified split bone technique. All patients were operated by the same surgeon under local anesthesia (2% lignocaine) in the dental chair. The severity of pain and swelling was recorded on a visual analogue scale and the presence or absence of sensory disturbance at 6, 24, 48 hours and seven days after operation. The pain was scored according to a visual analogue 4-point scale. Patients were asked to indicate which side was more swollen and to record this assessment on the swelling scale. Lingual split technique was more painful than the other two techniques. Surgical bur technique had more swelling than the other two techniques. Labial and lingual sensations were not altered in all the techniques. The simplified split bone technique had the least morbidity than the lingual split and surgical bur technique.

Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants

To analyze publications related to augmentation procedures and to evaluate the success of different surgical techniques for ridge reconstruction and the survival/success rates of implants placed in the augmented areas. Clinical investigations published in English involving at least 5 patients and with a minimum follow-up of 6 months were included. The following procedures were considered: a) Guided bone regeneration (GBR); 2) Onlay bone grafts; 3) Inlay grafts; 4) Bone splitting for ridge expansion (RE); 5) Distraction osteogenesis (DO); and 6) Revascularized flaps. Success rates of augmentation procedures and related morbidity, as well as survival and success rates of implants placed in the augmented sites were analyzed. Success rates of surgical procedures ranged from 60% to 100% for GBR, from 92% to 100% for onlay bone grafts, from 98% to 100% for ridge expansion techniques, from 96,7% to 100% for DO, and was 87.5% for revascularized flaps, whereas survival rates of implants ranged from 92% to 100% for GBR, from 60% to 100% for onlay bone grafts, from 91% to 97.3% for RE, from 90.4% to 100% for DO, and, finally, was 88.2% for revascularized flaps. On the basis of available data it was shown that it was difficult to demonstrate that a particular surgical procedure offered better outcome as compared to another. The main limit encountered in this review has been the overall poor methodological quality of the published articles. Therefore larger well-designed long term trials are needed.

Neurosensory Alteration in the Lower Lip and Chin Area After Orthognathic Surgery: Bilateral Sagittal Split Osteotomy Versus Inverted L Ramus Osteotomy

This study investigated neurosensory disturbances in patients after orthognathic surgery in relation to differences in mandibular splitting methods and degree of surgical skill. Forty-five patients who had undergone bilateral sagittal split ramus osteotomies (SSRO), and 21 (group L) who had undergone intraoral inverted L ramus osteotomies (ILRO), were examined for postsurgical neurosensory disturbances. Twenty-two (group S1) of the SSRO patients were treated by 11 surgeons who had little experience, and the others (23 patients; group S2) were treated by 2 skilled surgeons who had considerable experience. One of the 2 skilled surgeons was the only surgeon carrying out the ILRO procedure. The neurosensory tests employed included light touching using a Semmes-Weinstein monofilament tester (SW tester), electrical stimulation, and a questionnaire to determine changes in subjective sensations, at the time of each sensory evaluation. Neurosensory examinations were carried out bilaterally (132 sides) at 1, 3, 6, and 12 months after surgery. More patients showed abnormal thresholds for the 2 measurement techniques in the SSRO group than in the ILRO group, and furthermore there were more such patients in group S1 than in group S2, at each measurement point. At 6 months after surgery, the number of patients with reduced sensitivity was significantly higher in group S1 than in group L (P < .05). In the SSRO group at each measurement point, the thresholds for the lower lip and chin were unrelated to the set-back (or advance) distance. By contrast, in group L only at the 1-month evaluation point, the thresholds for the lower lip and chin were significantly raised in patients whose setback distances were larger than average (P < .05). Postsurgical neurosensory disturbances of the lower lip and chin occur more frequently in SSRO patients treated by surgeons having little experience than in those treated by skilled surgeons, although the difference is not significant. Long-term prognosis for resolution of postsurgical neurosensory disturbances is better in ILRO patients than in SSRO patients. Although the width of movement of the split bone fragments has an influence on postsurgical neurosensory disturbances immediately after ILRO, the relationship becomes less obvious with time.

Piezosurgery—a new safe technique in cranial osteoplasty?

All surgical interventions on the neurocranium bear the risk of injury of the dura mater and development of a cerebrospinal fluid fistula. Therefore, despite careful preparation, damage to the dura mater cannot always be omitted. Especially after surgery and in patients with increased intracranial pressure (craniosynostoses) there is a high risk of perforating the dura. In this article a new surgical technique for osteotomy (Piezosurgery) that avoids perforation of the dura is presented. Ultrasonic microvibrations allow a selective cut of only mineralized structures without damage to the soft tissue. Even in case of accidental contact the dura remains undamaged. This advantage is also useful for bone splitting, to separate the tabula externa from the tabula interna in situ, without any risk of dura perforation even in case of the very thin bones in an infantile skull. The present work shows the applicability of piezoelectric surgery in high-risk patients after osteotomy, avoiding perforation of the dura mater.

Piezosurgery: Basics and Possibilities

Useful in a variety of oral surgery procedures, piezosurgery has therapeutic features that include a micrometric cut (precise and secure action to limit tissue damage, especially to osteocytes), a selective cut (affecting mineralized tissues, but not surrounding soft tissues), and a clear surgical site (the result of the cavitation effect created by an irrigation/cooling solution and oscillating tip). Because the instrument's tip vibrates at different ultrasonic frequencies, since hard and soft tissues are cut at different frequencies, a "selective cut" enables the clinician to cut hard tissues while sparing fine anatomical structures (e.g., schneiderian membrane, nerve tissue). An oscillating tip drives the cooling-irrigation fluid, making it possible to obtain effective cooling as well as higher visibility (via cavitation effect) compared to conventional surgical instruments (rotating burs and oscillating saws), even in deep spaces. As a result, implantology surgical techniques such as bone harvesting (chips and blocks), crestal bone splitting, and sinus floor elevation can be performed with greater ease and safety.

Reconstruction of the severely atrophic mandible using calvarial split bone grafts for implant-supported oral rehabilitation

This article describes reconstruction of the severely atrophic mandible using calvarial bone grafts for implant-supported prosthetic oral rehabilitation. The study aim was to evaluate the efficacy of the treatment by determining implant survival and complication rates, and the extent of the postoperative graft resorption. Ten patients who underwent the treatment were followed clinically and radiologically using panoramic radiographs and CT scans during a mean postoperative period of 30 months. Good bone healing was observable 6 months postoperatively. The height reduction measured on panoramic radiographs was insignificant (mean 0.68 mm). Only minor complications occurred. Implant survival was 95%. Prosthodontic treatment was successfully performed in all cases, resulting in an improvement of oral function. Histological analysis of 1 bone biopsy showed minimal resorptive changes in otherwise very dense bone. Augmentation using calvarial grafts is a promising treatment alternative for the severely atrophic mandible.