Intraoral Sites Research Articles

Bronchogenic Cyst of the Tongue in an Infant

Bronchogenic cysts are rare congenital lesions and represent the most common primary cysts of the mediastinum. However, extra thoracic bronchogenic cysts are uncommon occurrences and very few bronchogenic cysts in intraoral sites have been reported. Lingual bronchogenic cysts are rare and are considered by many authors to be choristomas. Although the aethiopathogenesis is not known with certainty, it has been suggested that the cysts may arise from undifferentiated embryonic rests of primitive foregut that are misplaced or entrapped between parts of the developing tongue. This case report discussed the case of a large lingual bronchogenic cyst of the tongue in 31 day old infant that enucleation of cyst done without recurrence 12 months after treatment.

Pleomorphic Adenoma of Upper Lip: A Rare Case Presentation.

Pleomorphic adenoma is the most common neoplasm of the salivary glands and is most commonly located in the parotid followed by the submandibular glands. The most common intraoral site includes hard and soft palate. This case report describes a rare and unusual lesion found in a 21years old female, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed and firm mass, about 3cm in diameter, almost protruding below the nose. Complete excision was performed by intraoral route and the histo-pathologic analysis showed pleomorphic adenoma. The tumor did not recur.

Comprehensive measurements of salivary pellicle thickness formed at different intraoral sites on Si wafers and bovine enamel.

The salivary pellicle is a thin acellular film formed on orally exposed surfaces by adsorption of macromolecules from the oral fluids and serves as a protective layer in the maintenance of oral health. Pellicle thickness measurements are a central tool helping to understand how exogenous manipulations may influence pellicle formation. This is of particular importance for the investigation of new preventive and therapeutic approaches. In the present study we determined the kinetics of the in situ pellicle thickness formation at different intraoral sites and investigated how pellicle formation occurs in different individuals. To address the kinetic aspect, the thickness of the in situ pellicle was determined after formation periods of 3 min, 30 min and 120 min. The thickness of the pellicle was either measured on silicon wafers by ellipsometry or on bovine enamel by transmission electron microscopy. We found a physiologically important rapid pellicle formation phase within the first minutes and a slow pellicle formation phase between 30 min and 120 min. Furthermore, our results identify significant inter-individual differences both for the pellicle thickness and for the formation kinetics, indicating the consideration of individual-specific differences of the pellicle layer as an important aspect for future studies.

Clinical Outcome of Implants Placed in Staged Maxillary Sinus Augmentation Using Bovine Bone Mineral Mixed with Autogenous Bone at Three Different Ratios: A 5-Year Prospective Follow-up Study.

To evaluate the 5-year clinical outcomes for implants placed in a staged sinus floor elevation (SFE) procedure and to compare three patient groups with sinus grafts with three different ratios of bovine bone mineral (BBM) and autogenous bone (AB) mixture. A 5-year prospective cohort study was conducted on 81 patients with 119 staged SFEs non-randomly distributed to three groups based on the origin of the AB and the mixture ratio with BBM: group 1 (locally harvested AB [LHB] from osteotomy sites + BBM, ratio: 1:10), 31 patients, 37 SFEs; group 2: (LHB + intraorally harvested peripheral AB [IHPB] from retromolar/chin region + BBM, ratio: 1:4), 22 patients, 29 SFEs; and group 3 (LHB + extraorally harvested peripheral AB [EHPB] from iliac crest/tibia + BBM, ratio 1:1), 28 patients, 53 SFEs. After graft healing (5 to 7 months), 284 dental implants (group 1: 76, group 2: 61, group 3: 147 [overall: 2.3 implants/sinus]) were placed. After an additional healing period (5 to 7 months), all implants placed were functionally loaded and prospectively followed by clinical and radiographic evaluations assessing implant survival/success rate as well as peri-implant marginal bone level (MBL) alteration at 1, 3, and 5 years postloading. A total of 76/81 patients with 267/284 implants were followed for up to 5 years (dropouts: 5 patients/15 implants; implant loss = 2). The 5-year implant survival and implant success rate (group 1: 100%/98.6%; group 2: 98.3%/96.6%; group 3: 99.3%/95.7%) did not differ between the three graft mixture groups. The peri-implant marginal bone alteration (reduction) averaged over all 5 years was 1.40 ± 0.29 mm for group 1, 1.41 ± 0.22 mm for group 2, and 1.46 ± 0.46 mm for group 3 (P = .187). However, over time, a continual and significant MBL reduction (P = .045) was noted for all groups presenting peri-implant MBL changes between 1 year and 5 years of -0.17 mm (group 1), -0.12 mm (group 2), and -0.24 mm (group 3), respectively. According to the clinical results obtained, dental implants inserted in grafted (staged) SFE using a mixture of BBM with a minimal amount of AB harvested from local sites provide for similarly high 5-year implant/augmentation success rates as graft mixtures with AB harvested from peripheral intraoral or extraoral donor sites, confirming no need for additional bone harvesting.

Location, intensity, and experience of pain after intra-oral versus extra-oral bone graft harvesting for dental implants

ObjectivesThe reconstruction of extended and complex defects of the alveolar bone is a frequent requirement prior to implant placement. The aim of this study was to assess and compare location, intensity, and experience of pain after bone graft harvesting for dental implants with respect to the donor site. MethodsIn this prospective non-randomized intervention study, a consecutive sample of 23 patients who received autologous bone grafts from intra-oral (IO; N = 8) or extra-oral (EO; N = 15) donor sites prior to insertion of dental implants for fixed dental prostheses were recruited. All patients completed a self-administered questionnaire regarding pain location, intensity, and experience at baseline (B; before surgery), at the first follow-up (F1; 3 days after surgery), and at the second follow-up (F2; 4 weeks after surgery). Relative Risk Ratios (RRR) were determined for pain locations. For pain intensity and pain experience, 95% confidence intervals were evaluated using percentiles of a bootstrap with 1000 replications to assess statistical significance. ResultsBoth patient groups did perceive pain in the mouth/face after the intervention, but patients in the EO donor site group had additional pain at the hip, felt their pain longer and of higher intensity, and had more negative pain experiences than patients with IO donor sites (all p < 0.05). ConclusionsWhile both IO and EO bone graft harvesting are procedures that are associated with pain in a large proportion of patients, an EO donor site is expected to lead to more pain-related burdens than an IO donor site. Clinical significancePrior to bone graft harvesting, surgeons can now provide patients with tailored information regarding pain perceptions to be expected. This will help the patients with making an informed decision, and on whether or not to agree with surgery.

Scapula pre-augmentation in sheep with polycaprolactone tricalcium phosphate scaffolds

A scapula free flap is a commonly used method to reconstruct intraoral defects of the mandible and maxilla. Despite its clear advantages, it shows some deficiencies concerning the amount and shape of the available bone, especially with respect to later implant placement. To overcome these limitations, we pre-augmented the scapula prior to a potential flap-raising procedure with polycaprolactone (PCL) tricalcium phosphate (TCP) scaffolds in a sheep model. In our study, the scapula angle was augmented with a block of PCL-TCP in three adult sheep. After 6 months, the amount of newly formed bone and scaffold degradation were evaluated using cone-beam computed tomography scans and histomorphometric analysis. All animals survived the study and showed no problems in the augmented regions. The scaffolds were attached firmly to the scapula and showed a bonelike consistency. A fair amount of the scaffold material was degraded and replaced by vital bone. Our method seems to be a valid approach to pre-augment the scapula in sheep. In further experiments, it will be interesting to determine whether it is possible to transplant a modified scapula flap to an intraoral defect site.

Long-term stability of autologous bone graft of intraoral origin after lateral sinus floor elevation with simultaneous implant placement.

Lateral approach to maxillary sinus floor elevation (LSFE) with autologous bone grafts and simultaneous implant insertion is a widespread technique for prosthetic rehabilitation of the atrophic maxilla. To analyze implant survival and autologous bone graft resorption after LSFE, in patients with at least 5 years follow-up. Thirty-three patients (mean age 56 years, range 46-68 years) who had undergone LSFE with intraoral autologous bone graft from mandibular ramus and simultaneous implant insertion were included. A minimum of 5 years of follow-up was required. The total peri-implant bone height was measured at mesial and distal aspects of the implants immediately after surgery (T0) and after a period ranging from 5 to 11.5 years after surgery (mean 7.65 ± 1.80 years) (T1) on digital panoramic and periapical radiographs. Wilcoxon matched-pairs signed rank test was used to compare bone graft height at T0 and T1. The influence of patient-, surgery-, and implant-related factors on the outcomes was investigated. Of the 58 implants placed, no one was lost. All prostheses were in function, and no biological or mechanical complications occurred. The residual ridge height at the involved sites averaged 6.48 ± 1.72 mm. The mean bone height at grafted regions was 12.05 ± 2.47 mm at T0 and 12.13 ± 2.39 mm at T1 (not statistically significant). Marginal bone level change at T1 averaged -1.22 ± 1.60 mm. None of the evaluated factors significantly affected the results. Autologous bone grafts from intraoral donor sites display excellent volume stability over time that may contribute to optimal outcomes of the procedure.

Oral Cancer: An Evaluation of Knowledge and Awareness in Undergraduate Dental Students and the General Public.

To evaluate the knowledge of signs, symptoms and risk factors associated with oral cancer amongst undergraduate dental students and members of the general public. This study was open for a period of six months (Jan-June, 2013) to all undergraduate dental students in the 4th and 5th year of the dental science programme and dental patients attending the School of Dentistry, Griffith University, Australia. The survey evaluated the knowledge and awareness of clinical signs and symptoms and risk factors of oral cancers. A total of 100 undergraduate students and 150 patients provided informed consent and participated in this survey study. Both patients and dental students were aware of the importance of early detection of oral cancer. With the exception of smoking and persistent ulceration, this study indicated that the knowledge about oral cancer, its signs, symptoms and risk factors was limited amongst participants. This study highlights the need to raise awareness and knowledge pertaining to oral cancer, not only in the general community but also amongst those in the dental field. Specific points of concern were the common intraoral sites for oral cancer, erythroplakia as a risk factor, the synergistic action of smoking and alcohol, and HPV (human papilloma virus) as risk factors for oral cancer.

CLINICAL AND RADIOGRAPHIC EVALUATION OF THE USE OF ANTERO-LATERAL WALL OF MAXILLARY SINUS FOR RECONSTRUCTION OF ORBITAL FLOOR DEFECT

INTRODUCTION: The orbital floor fracture results in disruption of bony continuity, enophtalmos, diplopia and herniation of orbital content which lead to a restriction in eye movement. Auotogenous bone graft remains as the gold standard for reconstruction of orbital floor defects, the anterolateral wall of maxillary sinus is considered as one of the donor site used in the reconstruction of the orbital floor defects, which has many advantages such as biocompatibility, strength, vascularization and has no immune reaction. In addition, its contour fits exactly the orbital floor defect, a simple harvesting technique from an intraoral donor site which minimizes its morbidity. OBJECTIVE: We aimed in the present study to evaluate the use of anterolateral wall of maxillary sinus clinically and radiographically in the reconstruction of orbital floor defects in ten patients. MATERIALS AND METHODS: All operated patients had more or less one or more signs and symptoms of orbital floor fracture as diplopia, enophthalmos, limitation of eye movements and progressive infraorbital nerve hypoesthesia. The graft harvested with peizosurgery from contralateral side of the fracture, the donor site is covered by a collagen membrane to prevent soft tissue infiltration. The harvested bone graft is adapted to the defect with no other means of fixation. The follow-up schedule was 3 days postoperatively then once weekly for two weeks and then monthly for 3 months. RESULTS: All patients with preoperative diplopia had significant improvement postoperatively. 8 patients out of 9 with preoperative ocular restriction had improvement in the postoperative follow up visits. 6 patients with preoperative enophthalmos showed improvement in the postoperative follow up visits. 7 patients with infra orbital nerve paresthesia preoperatively, all of them showed improvement in the follow up visits. CONCLUSION: The study concluded that the anterolateral wall of the maxillary sinus is a suitable material for orbital floor reconstruction, especially in cases of small to medium defects (< 3 cm2).

Extra-Alveolar Bone Screws for Conservative Correction of Severe Malocclusion Without Extractions or Orthognathic Surgery.

Evaluate management of challenging malocclusions conservatively (no extractions or orthognathic surgery). Most malocclusions have a predominately environmental etiology. Optimal esthetics and function are restored by aligning the dentition over the apical base of bone at the appropriate vertical dimension of occlusion (VDO). Extra-alveolar (E-A) anchorage is achieved at three intraoral sites: mandibular buccal shelf (MBS), infrazygomatic crest (IZC), and anterior ramus. MBS and IZC bone screws effectively anchor the conservative correction of severe dental and skeletal malocclusions. All bone screw sites are effective for anchoring lever arms to recover impacted teeth. Rather than extracting teeth, E-A anchorage corrects crowding by retracting the posterior segments to increase arch length. Skeletal malocclusion is corrected by aligning teeth over the apical base of bone and restoring the VDO by retracting and posteriorly rotating the dental arches as segments. Challenging dental and skeletal malocclusions can be treated routinely via determinate mechanics anchored with E-A bone screws.

Baseline Biomechanical Properties of Epithelia prior to Tissue Expansion in Dogs.

Background:Soft-tissue deficiencies pose a challenge in a variety of disease processes when the end result is exposure of underlying tissue. Although multiple surgical techniques exist, the transposition of tissue from one location to another can cause donor-site morbidity, long incisions prone to dehiscence, and poor patient outcomes as a result. Use of tissue expansion prior to grafting procedures has been shown to have success in increasing available soft tissue to aid in repairing wounds. However, the current tissue expanders have biomechanical limits to the extent and rate of expansion that usually exceeds the tissue capacity, leading to incisional dehiscence or expander extrusion. Understanding the baseline biomechanical properties of the tissue to be expanded would provide useful information regarding surgical protocol employed for a given anatomical location. Therefore, the aim of this study was to test and compare the baseline (preexpansion) biomechanical properties of different common expansion sites in dogs.Methods:Four samples measuring approximately 20 × 15 × 1 mm were harvested from 8 dogs. The samples were collected from the hard palate, alveolar mucosa, scalp, and chest of the animal and analyzed for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength using a Texture Technologies TA.XT texture analyzer with corresponding biomechanical measurement software. Samples were compared as to their baseline biomechanical properties prior to any soft-tissue expansion. Histological sections of the samples were analyzed using hematoxylin eosin in an attempt to correlate the histological description to the biomechanical properties seen during testing. Summary statistics (mean, standard deviation, standard error, range) are reported for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength and for the histological parameters by intraoral site. Analysis of variance was used to compare the biomechanical and histological parameters among the 4 locations while accounting for multiple measurements from each dog.Results:The scalp had significantly higher maximum stress (σmax) than chest, mucosa, and palate (P < 0.0001), with no differences among the other 3 locations (P > 0.63). Scalp site also had significantly higher maximum tangential modulus (ε) than chest, mucosa, and palate (P < 0.006), with no differences among the other 3 locations (P > 0.17). The locations did not have significantly different maximum tangential stiffness (k; P = 0.72). Histologically, 2 separate patterns of collagen disruption were evident.Conclusion:Although different results were obtained than theorized, this study showed that the scalp had the greatest resiliency to expand prior to tearing, and the highest tangential modulus, with all sites having statistically similar modulus of elasticity. Based on this study, the scalp could be expanded more aggressively compared with the other sites.

EVALUATION OF THE ZYGOMATIC BUTTRESS AS A DONOR SITE FOR RIDGE AUGMENTATION PRIOR TO IMPLANT INSERTION IN THE ESTHETIC ZONE

INTRODUCTION: Traumatic loss of teeth in the esthetic zone commonly results in significant loss of buccal bone. This leads to reducedesthetics, problems with phonetics and reduction in function. Single tooth replacement has become an indication for implant-based restoration.In case of lack of bone volume the need of surgical reconstruction of the alveolar ridge is warranted. Several bone grafting techniques havebeen described to ensure sufficient bone volume for implantation.OBJECTIVES: Evaluation of using the zygomatic buttress as an intraoral bone harvesting donor site for pre-implant grafting.MATERIALS AND METHODS: Twelve patients were selected with limited alveolar ridge defect in the esthetic zone that needs bone graftingprocedure prior to dental implants. Patients were treated using a 2-stage technique where bone blocks harvested from the zygomatic buttressregion were placed as onlay grafts and fixed with osteosynthesis micro screws. After 4 months of healing, screws were removed for implantplacementRESULTS: Harvesting of 12 bone blocks were performed for all patients indicating a success rate of 100% for the zygomatic buttress area asa donor site. Final rehabilitation with dental implants was possible in 11 of 12 patients, yielding a success rate of 91.6%. Three patients (25%)had postoperative complications at the donor site and one patient (8.3%) at the recipient site. The mean value of bone width pre-operativelywas 3.64 ± .48 mm which increased to 5.47 ± .57 mm post-operatively, the increase in mean value of bone width was statistically significant(p < 0.001).CONCLUSIONS: Harvesting of intraoral bone blocks from the zygomatic buttress region is an effective and safe method to treat localizedalveolar ridge defect before implant placement.KEYWORDS: Zygomatic buttress, autogenous bone graft, dental implant, esthetic zone.

Complications of a poly-L-lactic acid and polyglycolic acid osteosynthesis device for internal fixation in maxillofacial surgery.

The purpose of this study was to retrospectively evaluate and examine the incidence of complications using poly-L-lactic acid and polyglycolic acid (PLLA/PGA) copolymer plate system in maxillofacial osteosynthesis. The retrospective study included 87 patients (50 men, 37 women), who needed maxillofacial surgery. We examined the proportion of complications and their factors from clinical data. A comparison was also made for plate decomposition using the molecular weight of the plate without plate exposure and complications. Osteosynthesis sites healed in all patients. Ten cases (11.5%) showed plate exposure-related complications, with all occurring at intraoral surgical sites. There was no significant difference in molecular weight changes of plates in resorbable process. Statistical analysis of study variables between patients with and without exposed plates showed that the plate thickness was significantly associated with the risk of exposed plates (p<0.05). The commercially available PLLA/PGA device could be a useful rapid resorbable material for maxillofacial osteosynthesis. When thick plates are used on the intraoral site, it may be necessary to pay attention to the complication of plate exposure. Even if exposure-related complications have occurred, resorption and degradation of this material proceeds, suggesting the ease of appropriate risk management.

A radiographic analysis of anatomical variation at the mandibular sites of intraoral bone harvesting

AbstractObjectivesIntraoral bone grafting is an important component of implant treatment, but also a source of intra‐ and post‐operative complications. This study sought to determine the relationship of bone surface to underlying nerves and vasculature, at the two most commonly employed intraoral sites for bone harvesting.Materials and MethodsData were collected by direct measurement of 103 potential graft sites (50 retromolar sites: 53 symphyseal sites) of patients undergoing CT scanning for implant surgery assessment.ResultsSymphyseal analysis included 26 female and 27 male patients. Data recorded were as follows: maximal width of the mandible between lower central incisor root tips (mean: 13.7 mm; range: 11.3–16.4 mm), maximal width of the mandible below the canine tip (mean: 11.5 mm; range: 7.7–14.9 mm), tip of canine to mandibular incisive nerve (mean: 4.3 mm; range: 1.2–8.9 mm), canine root tip to outer labial cortex (mean: 4.0 mm; range: 1.9–7.3 mm) and midline distance from the incisive nerve to outer labial cortex (mean: 3.0 mm; range: 1.0–6.9 mm). Retromolar analysis comprised of 33 female and 17 male patients. Data recorded included distance from inferior dental canal to the outer buccal cortex (mean: 3.2 mm; range: 1.0–7.9 mm), the most buccal point of the lower second molar roots to the outer buccal cortex (mean: 3.3 mm; range: 1.0–6.5 mm) and thickness of the mandibular crest at the lower second molar (mean: 13.8; range: 10.2–18.2 mm).ConclusionsThe proximity of underlying vital structures may be easily overlooked in routine examination of implant patients and may be related to patient characteristics.

Stability of Grafted Implant Placement Sites After Sinus Floor Elevation Using a Layering Technique: 10-Year Clinical and Radiographic Results.

To evaluate long-term survival rates and radiographic stability of sinus floor elevations carried out using a two-layer grafting technique. Records were analyzed for patients treated with sinus floor elevations using a modified technique. Phycogenic hydroxyapatite (Algipore, Dentsply Sirona Implants) and autogenous bone particles harvested from intraoral sites were grafted in two distinct layers after elevation of the sinus mucosae. In this approach, the basal part of the sinus floor is grafted with autogenous bone, while the cranial part is grafted with the phycogenic hydroxyapatite. In some cases, implants were placed simultaneously, such that the entire surface of each implant was covered by autogenous bone particles. A titanium membrane was used to close the sinus window, and the implants were loaded 3 months later. In two-stage approaches, the implants were inserted 3 to 4 months after the grafting and loaded after 3 additional months. Panoramic radiographs were taken after the grafting procedure, after implant insertion, after the prosthetic restoration, and then annually for 10 years. These radiographs were used to measure the height between the implant shoulders and the top of the graft. Of the 214 sinus floor elevations performed on 129 patients using the bilayering technique, 198 procedures in 118 patients were included in the study (136 one-stage and 62 two-stage). Membrane perforations during surgery occurred in 17.9% of the procedures and were sutured and sealed with fibrin glue. A total of 487 implants were placed in the grafted areas. No severe postoperative complications occurred, but three implants were lost throughout the 10-year follow-up period. A small decrease of vertical height was observed between the grafting surgery and the stage-two surgery (mean: 1.8 mm). After that, no bone height was lost over the 10 years. The layer grafting technique in combination with sinus floor elevation resulted in radiographically stable vertical bone height for 10 years. This technique enabled early placement and loading of implants in the grafted areas. The survival rate obtained with this procedure is similar to that expected for implants placed in nongrafted areas.

INTRAORAL DIFFUSE LARGE B-CELL LYMPHOMA: CASE REPORT

About 40% of non-Hodgkin’s lymphomas presents extranodal, including gastrointestinal tract, Waldeyer’s ring, spleen, salivary gland and, rarely, the oral cavity. Diffuse large B-cell lymphoma is the most common type, characterized by diffuse proliferation of large neoplastic B lymphoid cell. The most common intraoral sites are palate, buccal mucosa, and tongue. Frequently it affects male patients in the seventh decade of life. It presents clinically as a rapidly enlarging mass, generally painful. A white female patient, 74 years old, attended the Oral Medicine clinic presentingwith 2 painless lesions in the maxillary gingiva bilateral, with 1 month of evolution. The lesions were nodular, with firm consistency, 2.5 cm and 4.5 cm, respectively. The diagnostic hypothesis was lymphoma. An incisional biopsy was performed and microscopic exam showed diffuse large B-cell lymphoma. Immunohistochemistry was positive to CD-20, Ki-67, and MUM-1, and negative to CD-10, confirming the diagnosis. The patient underwent chemotherapy and the lesions regressed.

Autogenous bone grafts in oral implantology\u2014is it still a \u201cgold standard\u201d? A consecutive review of 279 patients with 456 clinical procedures

BackgroundThis study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts.MethodsA consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the years of 2009 until 2011 with autologous bone transplantation prior to secondary implant insertion. Intraoral donor sites (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, and anterior sinus wall) and extraoral donor site (iliac crest) were used. A total of 279 patients underwent after a healing period of 3–5 months routinely computer tomography scans followed by virtual implant planning. The implants were inserted using guided oral implantation as described by Naziri et al. All records of all the consecutive patients were reviewed according to patient age, history of periodontitis, smoking status, jaw area and dental situation, augmentation method, intra- and postoperative surgical complications, and surgeon’s qualifications. Evaluated was the augmentation surgical outcome regarding bone graft loss and early implant loss postoperatively at the time of prosthodontic restauration as well a follow-up period of 2 years after loading.ResultsA total of 279 patients underwent 456 autologous augmentation procedures in 546 edentulous areas. One hundred thirteen crista zygomatico-alveolaris grafts, 104 ramus mandible grafts, 11 symphysis grafts, 116 grafts from the anterior superior iliac crest, and 112 sinus lift augmentations with bone scrapes from the anterior facial wall had been performed. There was no drop out or loss of follow-up of any case that had been treated in our clinical center in this 3-year period. Four hundred thirty-six (95.6%) of the bone grafts healed successfully, and 20 grafts (4.4%) in 20 patients had been lost. Fourteen out of 20 patients with total graft failure were secondarily re-augmented, and six patients wished no further harvesting procedure. In the six patients, a partial graft resorption was detected at the time of implantation and additional simultaneous augmentation during implant insertion was necessary. No long-term nerve injury occurred. Five hundred twenty-five out of 546 initially planned implants in 259 patients could be inserted into successfully augmented areas, whereas 21 implants in 20 patients due to graft loss could not be inserted. A final rehabilitation as preplanned with dental implants was possible in 273 of the 279 patients. The early implant failure rate was 0.38% concerning two out of the 525 inserted implants which had to be removed before the prosthodontic restoration. Two implants after iliac crest augmentation were lost within a period of 2 years after loading, concerning a total implant survival rate after 2 years of occlusal loading rate of 99.6% after autologous bone augmentation prior to implant insertion.ConclusionsThis review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standard” in alveolar ridge augmentation prior to oral implantation.

Clinical Profile of Lymphatic Malformation from One Oral and Maxillofacial Center in Sudan

Background: Lymphatic malformations are developmental defects of the lymphatic system. They are frequently present at birth and are most commonly found in the head and neck regions. The aim of the study was to investigate the clinical presentation of head and neck Lymphatic malformations in relation to, age, gender, color and site of distribution. Methods: This is a retrospective descriptive study, where the record of the patient diagnosed as lymphatic malformation at the Department of Oral and Maxillofacial Surgery at Khartoum Teaching Dental Hospital, during the period of 2005 to 2008 where retrieved and analysed. Result: A cervicofacial lymphatic malformation was found more common in females than in males with a ratio of 11:9. The mean age was 14 ± 10 years, with lip and tongue being the most common sites, followed by the buccal mucosa in the intraoral site and neck in the posterior triangle was the most common site for extraoral site (30%). It was found that the bluish color was the commonest presenting color in oral lymphangioma followed by red pink color. Conclusion: Females are more affected than males, while infants and children were more affected than other age groups. The bulks of the patients were presented with soft swelling, blue to normal colour in the lip, neck and in the tongue. Further prospective studies are needed to evaluate the clinic picture and treatment outcome.

Non-Hodgkin's lymphoma of the maxilla: A rare case report and review

Non-Hodgkin's lymphomas (NHLs) embody a diverse group of malignancies that originate from the lymphoid system. NHL often exhibit in an extranodal pattern, pertaining to the head and neck region. Intraoral sites are much less frequent, accounting for approximately 3.5% of all oral malignancies. Although the exact cause of NHL still remains inconspicuous, however, research has focused on some factors that may contribute to the development of lymphoma, including genetic factors, impaired immune system and viruses, such as HIV or EBV. Clinically, the bony lesion may present as localized or diffuse swelling, with low-grade pain, sweating, unexplained weight loss, fever, etc. Radiographically, these lesions resemble osteomyelitis or other malignancies creating a diagnostic dilemma. Microscopically, diffused lymphomas consist of large tumor cells with large nuclei that are more than twice the size of lymphocytes which may either exhibit centroblastic or immunoblastic features. Here, we report a rare case of NHL affecting the jaws of a 60-year-old male patient.

Alternative intraoral donor sites to the chin and mandibular body-ramus.

BackgroundProvide a review of alternative intraoral donor sites to the chin and body-ramus of the mandible that bring fewer complications and that may be used to regenerate small and medium defects.Material and MethodsA review was conducted using the search engine PUBMED and looking manually into scientific journals.ResultsFrom the 35 articles included, 6 corresponded to the coronoids, 3 corresponded to the zygomatic body, 5 corresponded to the anterior maxillary sinus wall, 3 corresponded to the zygomatic alveolar process, 2 corresponded to the incisive fossa, 2 corresponded to the anterior nasal spine, 2 corresponded to the palatal region, 5 corresponded to the tuberosity, and 7 corresponded to the palatal and mandibular tori.ConclusionsAlthough there are few complications described when using alternative intraoral donor sites, the main problem with these types of grafts is their scarce bone volume, with only the zygomatic body, anterior sinus wall, and palate sites being able to be used in medium defects. More clinical trials are necessary in order to evaluate the behavior of the alternative donor sites over time. Key words:Grafting, autologous bone, autografts, mandible, maxilla, palate hard, zygoma.