Interpositional Bone Graft Research Articles

Le Fort I Osteotomy, Bilateral Sinus Lift, and Inlay Bone-Grafting for Reconstruction in the Severely Atrophic Maxilla: A New Vision of the Sandwich Technique, Using Bone Scrapers and Piezosurgery

Severe atrophy of the edentulous maxilla and progressive pneumatisation of the maxillary sinus can compromise the insertion of dental implants. In this context, ideal implant positioning is limited by inadequate height, width, and quality of the bone. Le Fort I osteotomy and interpositional bone graft is an excellent treatment concept for the dental rehabilitation of patients with atrophied maxilla and reversed intermaxillary relationship. In this report, we indicate the transcendent aspect of elevation and preservation of maxillary sinus and nasal mucosa, modifying the sandwich technique by the useful of bone scrapers and piezosurgery. The procedure is described including a 1-stage approach using cortico-cancellous bone blocks through which implants are placed. In the extremely atrophied alveolar process of the maxilla, this technique provides the desired gain of bone, allows for the ideal placement of dental implants, and improves any discrepancy between the upper and lower arches.

Clinical Tip: Interpositional Bone Graft for First MP Fusion

Clinical Tip: Interpositional Bone Graft for First MP Fusion

Clinical Tip: Interpositional Bone Graft for First MP Fusion

Clinical Tip: Interpositional Bone Graft for First MP Fusion

The Treatment of Nonunion of the Scaphoid with a Horse-Shoe Bone Graft and Fixation with Two Screws

Purpose: Three dimensional anatomical reconstruction of an old scaphoid nonunion injury with a humpback deformity is not an easy procedure. The single interpositional bone graft technique has its limitation for accurate anatomic reconstruction. We report here on the effect of a cortical interpositional horse-shoe graft using two screws and a volar cancellous chip bone graft for the treatment of scaphoid nonunion with a humpback deformity or a miss-match fracture surface in scaphoid nonunion. Materials and Methods: We retrospectively reviewed nineteen patients who were treated for scaphoid nonunion using a cancellous chip bone graft and a cortical interpositional horse-shoe graft with 2 screws (a Herbert's screw and a mini screw). The mean follow up period was 24 months (range: 14-36 months). The mean age was 30.5 years (range: 17-52 years) and 18 patients were male and 1 patient was female. The mean period between injury and operation was 6.7 years (range: 1 to 30 years). The nonunion sites were located in the waist in 15 wrists and in the distal third in 4 wrists. The volar approach was used in 18 cases and the dorsal approach was used in 1 case. In 2 cases, one additional kirschner's wire was used due to the instability of fixation. The clinical results were assessed by the criteria of Maudesley and Chen at the last follow-up. Results: Bony union was obtained in 18 (95%) cases. The average time for union was 13 weeks. There were improvements in the scapholunate angle (from 65.2 degrees to 49.5 degrees) and the intrascaphoid angle (from 43.5 degrees to 29.6 degrees). There are 3 cases with excellent results, 10 cases with good results and 6 cases with fair results. There was one complication. In 1 case, a nonunion gap was seen at 7 months after operation, but there were no clinical symptoms. Conclusion: A cortical interpositional horse-shoe graft using two screws and a cancellous chip bone graft for treating scaphoid nonunion with a humpback deformity or a large defect seems to be an encouraging procedure for regaining the normal anatomy of the scaphoid.

Bone Reformation: Contemporary Bone Augmentation Procedures in Oral and Maxillofacial Implant Surgery

Bone Reformation: Contemporary Bone Augmentation Procedures in Oral and Maxillofacial Implant Surgery

Reconstruction of the atrophic maxilla with interpositional bone grafting/Le Fort I osteotomy and endosteal implants: A 11–16 year follow-up

A Le Fort I osteotomy and interpositional bone graft in combination with implants was used in the reconstruction of patients with extreme atrophy in their maxillae. Surgery was performed in a two-stage procedure. The patients in this study had conditions with reversed intermaxillary relationships with or without increased vertical intermaxillary distance. The aim of the study was to investigate treatment outcome for patients in a prospective, long-term, follow-up with a mean of 13 years (range 11–16 years), concerning implant survival rate and marginal bone loss adjacent to the surfaces of the implant. The impact of gender and smoking was also investigated . Twenty-six patients were included in the study. Of 167 implants, 24 failed. The implant estimated survival rate was 85% at the end of the follow-up. There was no significant difference between smokers and non-smokers or genders concerning implant survival. Marginal bone loss was 2.5, 2.9, 3.0 and 3.1 mm from the implant-abutment junction, after 1, 2, 5 and 10 years, respectively. The bone level stabilised after 2 years. This technique results in good facial morphology, good oral function and aesthetics. All patients are still wearing their original fixed bridges.

Second toe proximal phalanx interposition bone graft to correct a failed Keller's arthroplasty. A new technique

We present a case report of a novel salvage technique for a failed Keller's arthroplasty using nonvascularised phalanx transfer from the second toe to the hallux on the same foot. The technique restores length, function and relieves pain.

Extra-Osseous Ewing’s Sarcoma of the Thumb

The hand is an uncommon location for Ewing's tumour of the bone. This paper details the presentation, pathology and management of an extra-osseous Ewing's sarcoma of the thumb in an adult woman. The management entailed a combination of neo-adjuvant chemotherapy and surgical excision, followed by reconstruction with an interposition bone graft from the subcutaneous surface of the ulna.

O.425 Use of local bone grafts in orthognathic surgery

Implanto-orthognathic reconstructive surgery (IORS) entails a combination of three different types of surgical involvement for the reconstruction of the atrophic mandibular or maxillary alveolar ridge. The surgery combines an orthognathic procedure with interpositional bone grafts and placement of osseointegrated implants by means of a transmucoperiosteal technique. The above-mentioned modified orthognathic technique includes three maxillary and two mandibular procedures. The osseointegrated compression screw implant (OCSI) is particularly suitable for this type of implanto-orthognathic reconstructive surgery as it may be placed transmucoperiosteally during this pre-prosthodontic reconstructive technique, thereby eliminating a second stage intervention.

O.187 Gender-speciflc patient satisfaction after free flbula flaps

The lack of bone mass associated with relatively high muscle attachments and insufficient vestibular depth complicates the prosthetic restoration of the atrophic mandibular alveolar ridge. Alloplasts and autogenous bone grafts have been used to augment the atrophic alveolar ridge with variable results. Onlay bone grafts tend to resorb while alloplastics may become infected and resorb underlying bone. The concept of interpositional bone grafting has certain theoretical advantages. It has been postulated that preservation of the integrity of the mucosa-periosteum-cortex relationship of the repositioned bone and maintenance of its morphological form and osseous architecture will minimize resorption of the transposed basal bone. An animal study was designed to test the validity of this concept. The vascularization, revascularization, and bone healing associated with interpositional autogenous bone grafts and implants of coralline hydroxyapatite were investigated in nine adult mongrel dogs. The mandibular posterior teeth were extracted and an enbloc resection of the alveolar bone which encased the extracted teeth was accomplished to simulate mandibular atrophy. Eight weeks later through an intraoral approach an autogenous cortico-cancellous iliac bone graft was placed in the edentulous area; a 2 cm. × 1 cm. × 1 cm. hydroxyapatite implant was placed on the contralateral side. The animals were sacrificed immediately, at 3 days, and 1, 2, 4, 12, 24, 28, and 40 weeks. Radiographic, microangiographic, and histological studies indicated that the lingual mucoperiosteum in the mandible provided an adequate vascular pedicle for superior repositioning of mandibular basal bone in a single stage. There was early consolidation and remodelling of the grafted bone and implant with minimal alteration of the morphological form and architecture of the repositioned bone. The results of this animal study support the concept of interpositional bone grafting to augment the atrophic mandibular alveolar ridge. The promise of coralline hydroxyapatite was favourable and awaits further ongoing comparative studies with bone grafts.

Glenotemporal osteotomy and bone grafting in the management of chronic recurrent dislocation and hypermobility of the temporomandibular joint

Chronic recurrent dislocation of the temporomandibular joint (TMJ) is rare and has many causes. Although it is possible to start treating it conservatively, these treatments are usually unsuccessful. Over the years, many operations have been done including operating on the muscles, the articular capsule, the articular meniscus, and the condyle. At present, the most widely accepted techniques are those used on the articular eminence. It may be reduced (eminectomy), favouring free movement of the condyles, or an obstacle may be interposed to prevent excessive movement of the condyles. These later techniques include Norman's (glenotemporal osteotomy with interpositional bone grafting). Other techniques include Dauterey's procedure, on which onlay bone grafts or bone substitutes are inserted in a subperiosteal pocket inferior to the articular eminences. We report a prospective study of 60 patients who had a bilaterally modified glenotemporal osteotomy, 40 who had chronic dislocations of the temporomandibular joints and the other 20 who had severe hypermobility of the joints. Bone grafts, iliac or calvarial, were inserted at the osteotomy between the zygomatic arch and the articular eminence, and fixed either by wires, mini-plates or microplates, and screws. Stable results were obtained and retained during long-term follow up of 1–8 years.

Horizontal and vertical ridge augmentation for implant placement in the aesthetic zone

Lack of sufficient bone to place an implant at the functionally and aesthetically most appropriate position is a common problem, especially in the upper anterior jaw. A surgical technique is proposed to augment the alveolar ridge for vertical and horizontal defects through a localized alveolar osteotomy and interpositional bone graft. Three bone cuts (two vertical and one horizontal) are made in the alveolar bone. This portion of bone is carefully down-fractured. The gap between this bone box and the alveolar bone is filled with an interpositional bone graft. An on-lay bone graft is placed in the buccal side of the defect and fixed with titanium osteosynthesis screws. The aim of this surgical technique is to achieve bone graft healing in a short period of time. The broad vascular pedicle on the palatal side is maintained to ensure a nutritional supply for the down-fractured bone and interposed bone graft. The on-lay bone graft augments the palatal-buccal dimension and the interposed graft guarantees vertical augmentation.

Evolution of Operative Techniques for the Treatment of Single-Suture Metopic Synostosis

Primary orbitocranioplasty for metopic craniosynostosis encompasses a variety of techniques, with variable long-term success. The authors present a series illustrating the evolution of surgical techniques and its impact on surgical outcomes. All patients with single-suture metopic synostosis treated at the Children's Hospital of Philadelphia from 1975-2004 were included. Demographic information, preoperative clinical findings, operative technique, postoperative complications, postoperative clinical findings, and length of follow-up were all recorded. Five techniques are presented, reflecting a transition from mere reshaping with metallic fixation to the increased use of primary bone grafting and resorbable fixation to expand the frontal region. Preoperative covariates and technique type were analyzed for effect on outcomes. Eighty-six patients were identified. Mean follow-up was 50 months. In terms of esthetic outcome, patients with preoperative frontal irregularities had a higher incidence of postoperative deformities (P = 0.026). Patients with preoperative mean intercanthal distance <20 had a higher incidence of postoperative frontal irregularities (P = 0.045). Maximal expansion of the supraorbital bar via interpositional bone graft and stabilization of the construct with strategic bone grafting and resorbable fixation resulted in a lower incidence of postoperative temporal hollowing (P = 0.029). Patients with expansion and lateral reinforcement of the expanded bar had a lower incidence of reoperation (P = 0.026). Undercorrection of metopic craniosynostosis is not an uncommon finding. To prevent long-term relapse, aggressive anterolateral expansion of the supraorbital bar via primary bone grafting and resorbable fixation with the overall goal of overcorrection may provide the best esthetic outcome.

Beveled Osteotomy With Lateral Wall Advancement and Interpositional Bone Grafting for Severe Thyroid Orbitopathy

To present a new technique for orbital decompressions for patients with severe thyroid orbitopathy that minimizes complications while maximizing the amount of decompression. This method involves advancing the lateral orbital wall in such a way as to promote osseous union and minimize cosmetic deformities. This paper represents a case series (42 eyes from 26 patients) of orbital decompressions for severe thyroid related orbitopathy. All patients were treated via a graded balanced orbital decompression with advancement of the lateral orbital wall with interpositional bone grafts. Preoperative and postoperative measurements were tabulated and statistically analyzed. All patients demonstrated significant improvement in proptosis with an average Hertel exophthalmometry reduction of 8 mm. In addition, 22 patient orbits with preoperative elevation of intraocular pressure demonstrated an average 7 mm Hg improvement in postoperative intraocular pressure. Seven patients required strabismus surgery postoperatively and no patient developed new onset strabismus after surgery. Of all patients, 54% demonstrated improvement of visual acuity of greater than 1 line and no patient experienced a decrease in visual acuity. Postoperative computed tomography scan demonstrated osseous union of the lateral wall after advancement with this new technique. No patient complained of a palpable deformity of the lateral orbital wall. The graded balanced orbital decompression with interpositional bone grafts effectively decompressed the orbit with significant improvement in final visual acuity, exophthalmometry measurements, and final intraocular pressure. In addition, this technique promotes osseous union with minimal cosmetic deformities.

Le Fort I osteotomy with interpositional bone grafts and delayed oral implants for the rehabilitation of extremely atrophied maxillae: a 1–9‐year clinical follow‐up study on humans

The purpose of this clinical follow-up study was to report the clinical outcome of osseointegrated implants placed in extremely atrophied edentulous maxillae after Le Fort I osteotomy and interpositional autogenous iliac bone grafts. In a 10-year period (1995-2004), 39 patients, 18 males and 21 females, aged from 32 to 76 years, presenting with severely atrophied edentulous maxillae were treated with Le Fort I osteotomy and interpositional iliac bone grafts. Four to 8 months after the reconstructive procedure, 281 osseointegrated implants were placed in the reconstructed maxillae. Four to 8 months afterwards, abutments were connected and the prosthetic rehabilitation started. The mean follow-up period of implants after the start of prosthetic loading was 45.9 months (range: 12-108 months). The reconstructive procedure was successful in 38 of 39 patients. In one patient, partial loss of the inlay graft occurred before implant placement. Six patients (42 implants) dropped out of the study. Fifteen implants were removed during the follow-up period, due to loss of integration. Thirty-two implants, although integrated, presented with peri-implant bone-level changes higher than those proposed for successful implants. Cumulative survival and success rates of implants were 94.5% and 82.9%, respectively. Results from this study showed that Le Fort I osteotomy with interpositional bone grafts followed by delayed implant placement is an acceptable means to rehabilitate edentulous patients affected by extremely atrophied edentulous maxillae. Survival rates of implants are consistent with those related to implants placed in native, non-reconstructed bone. Conversely, the success rate of implants resulted to be lower as compared with those obtained for implants placed in native bone.

Alveolar Segmental “Sandwich” Osteotomies for Posterior Edentulous Mandibular Sites for Dental Implants

The purpose of this retrospective study was to evaluate crestal stability of alveolar augmentation using an interpositional bone graft for dental implant restorations. Eight patients with 10 graft sites were followed from 1 to 4 years with panographic evaluation to determine if dimension changes of the alveolar graft sites had occurred. Ten graft sites showed stability and maintenance of alveolar form and osseointegration of restored dental implants. Very little loss of crestal height was observed; 20 of 22 implants placed remained stable at follow-up. The interpositional alveolar bone graft appears to be a viable alternative to block grafting or guided bone regeneration.

Alveolar Segmental Sandwich Osteotomy for Anterior Maxillary Vertical Augmentation Prior to Implant Placement

Over a 5-year period, 10 partially edentulous patients with anterior vertical maxillary deficiency were treated consecutively with segmental osteotomy and interpositional bone grafting prior to dental implant placement. Alveolar vertical projection and papillary form proved to be stable in all patients up to 5 years postsurgery. Implant aesthetic results were judged to be satisfactory. The technique is an alternative to alveolar distraction osteogenesis but is limited to a vertical increase of about 5 mm in the anterior maxilla.

A Retrospective 5-Year Follow-Up Study of Two Different Titanium Implant Surfaces Used after Interpositional Bone Grafting for Reconstruction of the Atrophic Edentulous Maxilla

Long-term comparative follow-up studies of dental implants placed in augmented bone are rare. Variations in design and surface roughness have been found to be important for bone integration of implants. However, there is no clinical evidence that such variations lead to an improved clinical outcome. To compare two different implant systems used after interpositional bone grafting of the severely resorbed maxilla with a modified augmentation technique using fibrin glue. Twenty-two consecutive patients presenting with severe maxillary atrophy underwent reconstruction with Le Fort I osteotomies and interpositional bone grafting. Before placement of bone blocks, the floors of the maxillary sinuses were packed with bone chips mixed with a fibrin glue, to stabilize the graft. After 6 months of graft healing, the first 11 consecutive patients received Brånemark System implants with a turned surface (Nobel Biocare AB, Göteborg, Sweden). The following 11 consecutive patients were treated with Astra Tech implants with a blasted titanium surface (Astra Tech AB, Mölndal, Sweden). All patients received fixed prostheses. Marginal bone resorption and donor and recipient site morbidity were evaluated. All patients were clinically and radiographically observed throughout 5 years of functional loading. In the Brånemark group, 11 (13%) of 84 placed implants were lost, compared to 4 (5.5%) of 72 placed implants in the Astra Tech group. The difference was not significant. All patients retained fixed constructions after 5 years of loading. The mean marginal bone loss was 2.3+/-0.8 mm (range, 0-5.0 mm) in the Brånemark group and 2.4+/-1.4 mm (range, 0-7.0 mm) in the Astra Tech group although again no statistical difference was found. A larger number of implants in the Astra Tech group had a marginal bone resorption of>or=3 mm, and implant success in that group was lower than in the Brånemark group (52% vs 70%). In this study, reconstruction of the severely resorbed maxilla with Le Fort I osteotomy, interpositional bone grafting, and delayed placement of dental implants was found to be a predictable long-term procedure. Although more implants with a turned surface were lost during the follow-up period, there were no statistically significant differences between turned and titanium blasted implants.

Stability of combined Le Fort I maxillary advancement and mandibular reduction

Abstract Background: There have been reports that correction of severe Class III abnormality by single jaw surgery may invite relapse in the long-term. The purpose of this study was to retrospectively evaluate the stability of combined Le Fort I maxillary advancement and bilateral sagittal split osteotomies for mandibular reduction. Methods: Thirty patients with a skeletal Class III malocclusion underwent bimaxillary surgery using rigid fixation and inter-positional bone grafting of the maxilla. The average age was 24.4 years, and the mean follow-up period was 20 months (Range: 12–63 months). Post-operative changes were measured on lateral cephalometric radiographs using an anatomical best-fit technique. Results: The maxilla was advanced, on average, 6.1 mm (SD: 1.8 mm) and repositioned superiorly at PNS 1.9 mm (SD: 2.1 mm). The mandible was repositioned posteriorly 5.6 mm (SD: 4.2 mm) at menton, which also auto-rotated superiorly. At follow-up, the maxilla relapsed horizontally 0.6 mm (SD: 1.1 mm, p &lt; 0.01) with no significant vertical change. The maxillary central incisors were proclined and the interincisal angle was reduced. Menton relapsed anteriorly 1.4 mm (SD: 2.7 mm, p &lt; 0.01), and gonion rotated superiorly 1.5 mm (SD: 2.3 mm, p &lt; 0.001). In 67 per cent of cases menton moved anteriorly less than 2.5 mm. The overjet and overbite did not change significantly. Conclusions: The data show that 12-months post-operatively, maxillary advancement combined with mandibular setback was relatively stable in the horizontal and vertical planes.

The management of brachymetatarsia

We treated 35 brachymetatarsal rays of 18 feet in 12 patients by one-stage lengthening with interpositional bone grafts or by gradual lengthening with callotasis combined with shortening of the adjacent metatarsals and phalanges. Definition of the two parabolas which connect the metatarsal heads and the tips of the toes, and recognition of three patterns of metatarsal length, were helpful guides in treatment. In total, 36 excisions of the phalanges and/or the metatarsals were undertaken. The mean shortening was 8 mm. The radiological results were satisfactory. The mean values were as follows: one-stage lengthening, length gain, 1.3 cm; healing index, 1.3 months/cm; percentage increase, 30%; gradual lengthening, length gain, 2.0 cm; healing index, 2.0 months/cm; percentage increase, 50%. Associated shortening of an adjacent bone can avoid the disadvantages of one-stage lengthening which may not achieve target length and can result in neurovascular complications. Reduction of the target length enables the surgeon to carry out one-stage instead of gradual lengthening. It also shortens the length of treatment in the group undergoing callotasis and improves cosmesis.