Mandibular Symphysis Bone Research Articles

Radiographic Assessment of Different Autogenous Bone Grafts in the Alveolar Cleft: A Retrospective Longitudinal Study.

To assess feasibility and maintenance of bone after alveolar cleft reconstructions using graft from iliac crest and mandibular symphysis. 51 alveolar clefts grafted with iliac crest and 51 ones grafted with mandibular symphysis bones were selected from patients aged between 7 and 12years. At three (T1) and 12months (T2) after surgeries, periapical radiographs were performed to measure the height of the grafted bone based on the modified Bergland scale. Chi-square and Mann-Whitney-Wilcoxon tests compared differences between T1 and T2 according to each bone graft. From the clefts grafted with mandibular symphysis bone, 47 were classified as type I (92.5%) and 04 as type II (7.84%) at T1. At T2, 36 were classified as type II (25.49%) and 02 as type III (3.92%). In the analysis of the clefts grafted with iliac crest at T1, 48 were classified as type I (94.11%) and three as type II (5.88%). At T2, 37 classifieds as type I (72.54%), 12 as type II (23.52%) and two as type III (3.92%). There was no statistically significant difference between treatments. It was concluded that iliac crest and mandibular symphysis are adequate areas from which bone grafts can be obtained for reconstruction of alveolar cleft.

Postoperative Daycare as a Safe and Cost-Effective Option for Secondary Alveolar Bone Graft (SABG) Surgery: A Retrospective Comparative Cohort Study.

To evaluate the outcomes of Secondary Alveolar Bone Grafting (SABG) in patients treated either in daycare or with multiple day hospitalization (MDH) in relation to costs and complication rates. Retrospective comparative cohort study. The data was collected from two settings: Postoperative daycare or MDH after oral cleft surgery in an Academic Medical Center in The Netherlands. Data of 137 patients with unilateral Cleft lip, alveolus, and palate (CLAP) treated between 2006-2018 were evaluated. Registered clinical variables: age, gender, cleft subtype, bone donor site, type of hospitalization, length of stay, additional surgery, complications, surgeons, and costs. Closure of the alveolar cleft with/without closure of the anterior palate. Univariate analyses. Of the 137 patients, 46.7% were treated in MDH, and 53.3% in daycare. Total costs for daycare were significantly lower (P < .001). All patients treated in daycare received mandibular symphysis bone, whereas in MDH, 46.9% received iliac crest bone instead. Bone donor site was associated with postoperative care type. Complication rates were slightly but not significantly higher in daycare (26%) vs. MDH (14.1%) (P = .09). Most were Grade I (minor) according to Clavien Dindo classification. Daycare after alveolar cleft surgery is about as safe as MDH, but significantly cheaper.

Anterior Dental Implant in Grafted Cleft Alveolus: A Clinical Comparison Between Intramembranous and Endochondral Bone Graft.

Alveolar bone graft is usually performed during the early mixed dentition phase, at the chronological age of 6 to 8 years old, to reconstruct the cleft alveolus. As the appropriate time for implant placement is after completion of full growth, it can result in a likelihood of resorption. The aim of this study is to compare the clinical outcomes of anterior dental implants with delayed bone grafting using iliac crest (endochondral) and mandibular ramus or symphysis (intramembranous) bone in adolescents to adulthood patients with cleft alveolus. This study included 10 patients with cleft alveolus who underwent delayed bone grafting with autogenous block bone and particulate cancellous bone and marrow (PCBM) from the mandibular ramus and symphysis with dental implant placement, and iliac crest. The success of the treatment was evaluated through clinical and radiographic examination including marginal bone loss measurement of the implants. All patients underwent delayed bone grafting between the ages of 11 and 21.1 years (mean age: 15.1±4.3y). The implant diameters ranged from 3.8 to 4.5mm and the lengths ranged from 8.0 to 11.5mm. All of the implants were integrated successfully and survived during the 3-year follow-up period. Delayed bone grafting followed by implant placement showed long-term stability with satisfactory esthetic and functional rehabilitation. One of the main advantages of delayed bone grafting is to achieve adequate bone support for future dental implant placements with less bone resorption compared with those of primary, early secondary, and secondary bone grafting.

Cone-beam computed tomographic comparison of chin symphysis bone particles and allograft versus iliac crest bone graft alone for reconstruction of alveolar bone defects in cleft patients.

ObjectivesThe aim of this study was to compare morbidities and duration of surgery, as well as bone formation in alveolar defects reconstructed with symphysis bone combined with allograft and iliac crest bone graft in patients with cleft palate.Patients and Methods This randomized clinical trial was performed with 22 patients with unilateral alveolar cleft with a follow-up period of 12 months. In 12 patients, alveolar defects were reconstructed with chin bone graft plus allograft (Group A), while for the other 10 patients, iliac bone crest was used as donor site (Group B). Duration of surgery as well as occurrence of morbidities and complications were recorded. In addition, cone-beam computed tomographic (CBCT) scans were performed before surgery and 12 months after surgical procedures in order to compare bone formation between the two groups.ResultsPostoperative CBCT demonstrated a mean bone fill percentage of 76.9% of the alveolar defect in Group A, compared with 77.0% in Group B. Paresthesia in the lower lip or chin did not occur in any patients of Group A. The mean duration of the surgical process was significantly shorter for Group A (40 minutes vs 76 minutes, P<0.001). In addition, patients in Group A regained normal gait faster than patients in Group B (1 day vs 9.5 days).ConclusionMandibular symphysis bone graft in combination with allograft results in favorable outcomes in patients with unilateral alveolar clefts.

Day Care Surgery for Unilateral Alveolar Bone Grafting of Residual Clefts With Mandibular Symphyseal Bone-A Prospective Questionnaire Study.

To evaluate patients' experiences of shortened hospitalization in relation to bone grafting of unilateral alveolar clefts with mandibular symphyseal bone grafts. Prospective cohort questionnaire study. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark. Thirty-nine (male n = 26, female n = 13) patients with unilateral residual clefts after primary reconstruction, mean age 10.4 years. All patients underwent a standardized procedure with closure of the alveolar defect using mandibular symphyseal bone grafts. Patients were discharged within a day after surgery. Within 24 hours after discharge from surgery, patients and their parents filled in a 14-item psychometric questionnaire assessing the quality of their recovery. For all questions, a visual analogue scale (VAS) (0-10) was used. Patients' experience of shortened hospitalization in relation to secondary bone grafting of alveolar defects. Factors influencing the overall experience were measured using a VAS scale. A significant correlation between "Information from the hospital" and feeling worried and anxious was found (P = .04). Additionally, the ability to sleep correlated with pain (P = .003) and with nausea (P = .001). Although this study included a limited number of patients, the findings suggest that treatment of alveolar residual cleft with bone grafting from the mandibular symphyseal region in a day care surgery setting is characterized by very high patient satisfaction.

A new mandibular deformation index predicts amount of bone deformation in edentulous patients treated with an implant-supported fixed prosthesis.

The present study was performed to examine the mandibular deformation during mouth opening in edentulous patients, treated with an implant-supported fixed prosthesis using strain gauges, and identify factors affecting deformation. Twenty patients with a fully edentulous mandible who received either 4 or ≥6 implants were included. The distal-most implants were placed mesial to the mental foramen (premolar region) in patients with 4 implants and distal to the mental foramen (molar region) in patients with ≥6 implants. Mandibular deformation during mouth opening was measured using strain gauges in two directions: anteroposterior direction and lateral direction between the distal-most implants on the left and right sides (arch width). The mandibular anatomy was evaluated using computed tomography. Arch width reduction between the left and right implants during mouth opening ranged from 47.38 to 512.80 µm; the range of deformation was 0.12 to 15.14 µm in the anteroposterior direction. Furthermore, a significant positive correlation was noted between arch width reduction in the premolar region and the ratio between the symphyseal bone height and width (P = 0.0003, r = 0.72). The reduction in arch width was higher in the molar region than in the premolar region during mouth opening. Moreover, the reduction could be high in the mandibular symphyseal bone because of its greater height and lesser width. The ratio between the symphyseal bone height and width is defined as the mandibular deformation index (MDI) and is used to predict the rate of mandibular bone deformation.

A Retrospective CBCT Study of the Relationship between Mandibular Symphysis Bone Density and Mandibular Growth Direction

The objective of this retrospective study was to investigate the relationship between mandibular symphysis bone density (BD) and mandibular growth direction in adolescent patients by facilitating the measurement of cortical and cancellous BDs at the mandibular symphysis using cone beam computed tomography (CBCT). 224 adolescent patients (98 males and 126 females) were categorized by sex, age, and mandibular growth direction. Cortical and cancellous BDs were measured along with a sagittal slice at multiple locations. Females exhibited higher cortical BD than males at menton (Me, P =0.002). Patients with a posterior growth direction exhibited a higher cortical BD than those with anterior and normal growth direction at Me (P <0.021, P <0.001, respectively), pogonion (Pog, P =0.037, P =0.037, respectively) and genion (Ge, P =0.007, P =0.008, respectively). Patients with a posterior growth direction exhibited a higher cortical BD than those with anterior growth direction at B point (P =0.009). Significant differences in BD were identified across anthropometric categories. These findings may be useful in determining mandibular growth direction in adolescents.

Evaluating mandibular symphysis bone density according to various skeletal patterns with CBCT.

The aim of this retrospective study was to evaluate the bone density (BD) at the mandibular symphysis according to horizontal and vertical patterns using cone-beam computed tomography (CBCT). Three hundred nineteen untreated adults with a mean age of 24years. CBCT images were converted into the lateral cephalometric images, and tracings were performed for categorizing the patients based on skeletal features. Cortical BDs at B point, pogonion (Pog), genion (Ge) and menton (Me), and cancellous BDs of the mandibular symphysis were measured using CBCT images. Statistical analyses were performed to evaluate the effects of horizontal and vertical skeletal patterns on BDs. Females exhibited higher BD than males at the Me, Pog, Ge (P<.001). Hyperdivergent skeletal pattern showed significantly higher cortical BD than normovergent and hypodivergent skeletal patterns at Me (P<.001). Normovergent skeletal pattern showed significantly higher cortical BD than hypodivergent skeletal patterns at Me (P=.001). Class II skeletal pattern showed significantly higher cortical BD than Class I and III skeletal patterns at Me (P<.001) and Ge (P<.05). Class I skeletal pattern showed significantly higher mean cortical BD than Class III skeletal pattern at B point (P=.025). Cancellous BD was higher in Class III and hypodivergent skeletal patterns than others but showed no statistical significance. Significant differences were identified across various skeletal patterns. Several mandibular symphyseal landmarks showed statistically significant differences in BD at Me, B point and Ge, with Me having the most statistically significant findings.

Volumetric Assessment of Mandibular Symphyseal Bone graft for Secondary Reconstruction of Unilateral Alveolar Clefts

Purpose: To evaluate the volume of bone graft that can be harvested from the mandibular symphysis and compare it with the bone volume needed for secondary grafting unilateral alveolar clefts using a computer-aided design (CAD) software program based on 3 Dimensional Cone Beam CT Scans. In addition, to study the bone fill of the mandibular symphysis graft in the alveolar cleft.Subjects & Methods: The subjects were 12 patients with unilateral alveolar clefts who underwent Cone Beam CT Scans 1 week prior to procedure. Using a 3D Analysis Software, the available bone that can be harvested from the mandibular symphysis area was determined using CBCT. Also, the volume of the Alveolar cleft defect was calculated preoperatively to assess the sufficiency of the symphyseal bone graft. All patients underwent secondary alveolar cleft grafting with mandibular symphysis bone. Six months postoperatively, CBCT was used to evaluate the amount of bone fill of the alveolar cleft.Results: The mean harvestable symphysis bone volume including the lingual cortex was 2.4 cm3 (range: 1.4–4.3 cm3). The actual harvested particulate symphyseal bone graft volume was calculated during surgery and was 2.62 cm3 (range: 1.6–4.0 cm3). The preoperative mean volume of the unilateral alveolar cleft defects was 1.9 cm3 (range: 1.1- 2.85 cm3). The mean postoperative bone fill ratio of the unilateral alveolar cleft was 79% (range 54% to 96%) 6 months postoperatively.Conclusion: This Study showed that the mandibular symphysis provided sufficient bone volume for secondary unilateral alveolar cleft grafting. Also, the mandibular symphyseal bone graft provided adequate bone fill of the alveolar cleft 6 months postoperatively..

Volumetric Cleft Changes in Treatment With Bone Morphogenic Protein/β-Tricalcium Phosphate Versus Grafts From the Iliac Crest or Symphysis

To compare the volumetric changes in successfully treated clefts with secondary alveolar grafting using recombinant human bone morphogenic protein-2 (rhBMP-2) delivered in β-tricalcium phosphate (βTCP) scaffold versus autogenous grafts obtained from the iliac crest and mandibular symphysis. We performed a retrospective cohort study of cone-beam computed tomography scans of 25 subjects with unilateral or bilateral clefts. Of the 25 patients, 7 received an iliac crest bone graft, 9 received a mandibular symphyseal bone graft, and 9 subjects received the rhBMP-2/βTCP bone substitute. Volumetric rendering software was used to calculate the amount of new bone formation and residual bone defect present in the cleft area. The data were analyzed using Wilcoxon and Kruskal-Wallis tests and Pearson's correlation coefficient. The mean percentage of new bone formation for the iliac crest, symphysis, and rhBMP-2/βTCP was 85.47, 80.56, and 81.22%, respectively (P=.0854). The initial cleft volume had a weak positive correlation with the percentage of new bone formation (r=0.18), but the postoperative residual cleft volume had a strong negative correlation (r=0.71). rhBMP2 delivered in a βTCP scaffold in alveolar cleft patients can be a viable alternative to autogenous iliac crest and symphysis grafts, eliminating donor site morbidity.

Quantitation of Mandibular Symphysis Bone as Source of Bone Grafting: Description in Class I and Class III Skeletal Conditions.

The aim of this study was to quantify the cortical and cancellous bone in the mandibular symphysis and relate it to the teeth and to the skeletal class. A descriptive study was conducted using cone beam computerized tomography (CBCT). Class I and class III subjects were included, defined according to dental occlusion and cephalogram results. Linear measurements were taken on the CBCT of the mandibular canines, lateral incisors, and central incisors, where the analysis was related to the axial and apical axes considering the bone in relation to the dental area. With previous definitions, an observer took 2 measurements of the height of the mandibular symphysis, cortical bone of the buccal and lower region, and thickness of cancellous bone at different levels; the correlation coefficient between the first and second measurement was 0.99 and presented P = .001. The results were analyzed with analysis of variance and Tukey's honest significant difference test, with P < .05 being statistically significant. The symphysis height was significantly greater in class III subjects. The cortical bone was an average 1.67 ± 0.44 mm in vertical distance in the skeletal class I group and 1.74 ± 0.47 mm in the class III group. The cancellous bone had an average width of 5.03 ± 1.94 mm in the skeletal class I group and 4.74 ± 2.05 mm in the class III group. It was observed that cancellous bone was significantly thicker at the incisor level than at the canine level. There were anatomical differences between skeletal class I and class III subjects, although the clinical significance may be questionable. With the values from these analyses, it may be concluded that there are no significant differences in quantitation of the cortical and cancellous bone in the anterior mandibular symphysis.

An Analysis of Mandibular Symphyseal Graft Sufficiency for Alveolar Cleft Bone Grafting.

The purpose of this study was to evaluate the sufficiency of the mandibular symphysis as a donor site for unilateral and bilateral alveolar grafting, measuring both the alveolar cleft volume and maximum bone graft volume that can be harvested from the mandibular symphysis using 3-dimensional computed tomography (CT) and software in children and adults. Computed tomography data obtained from 20 unilateral and bilateral cleft lip palates patients in the preoperative period were used in this study. The patients were divided into 2 groups: children (female, n = 5; male, n = 5) and adults (female, n = 5; male, n = 5). The required bone graft volume for grafting and the maximum bone graft volume that can be harvested from the mandibular symphysis were measured based on cone beam CT data and software. The average required bone graft volume (cleft volume) for unilateral alveolar grafting was 963.51 ± 172.31 mm in the children and 1001.21 ± 268.16 mm in the adults. The average required bone graft volume for bilateral alveolar grafting was 1457.82 ± 148.18 mm in the children and 2189.59 ± 600.97 mm in the adults. The average the mandibular symphysis bone graft volume was 819.29 ± 330.85 mm in the children and 2164.9 ± 1095.86 mm in the adults. The results demonstrated that the mandibular symphysis region provided an adequate bone volume for alveolar grafting in adults with unilateral alveolar clefts. However, it is difficult to standardize these results, due to cleft volume and graft volume that could be harvested from the mandibular symphysis are highly variable among individuals.

A case of mandible hypoplasia treated with autologous bone graft from mandibular symphysis: Expression of VEGF and receptors in bone regeneration

The vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) system plays an important role in angiogenesis and osteogenesis during both skeletal development and postnatal bone growth and repair. Indeed, protein expression changes of this system could contribute to craniofacial defects commonly associated with a variety of congenital syndromes. Similarly to other craniofacial bones, mandible arises from neural crest cells of the neuroectodermal germ layer, and undergoes membranous ossification. Here, we report a case of left mandibular hypoplasia in a 42-year-old man treated with autologous bone graft from mandibular symphysis. After 3 months from surgical reconstruction, the protein expression of VEGF and receptors (VEGFR-1, -2 and -3) in regenerated bone tissue was evaluated by immunohistochemistry. At variance with the mandibular symphysis bone harvested for graft surgery, we observed de novo expression of VEGF and VEGFRs in osteoblasts and osteocytes from post-graft regenerating mandible bone tissue. In particular, while VEGFR-1 and VEGFR-3 immunopositivity was widespread in osteoblasts, that of VEGFR-2 was scattered. Among the three receptors, VEGFR-3 was the more intensively expressed both in osteoblasts and osteocytes. These findings suggest that VEGFR-2 might be produced during the early period of regeneration, while VEGFR-1 might participate in bone cell maintenance during the middle or late consolidation period. VEGFR-3 might, instead, represent a specific signal for ectomesenchymal lineage differentiation during bone regeneration. Modulation of VEGF/VEGFR signaling could contribute to graft integration and new bone formation during mandibular regeneration.

Mandibular Symphyseal Bone Graft for Reconstruction of Alveolar Cleft Defects: Volumetric Assessment With Cone Beam Computed Tomography 1-Year Postsurgery.

The aims of this retrospective study were to evaluate the volumetric outcome of mandibular symphyseal bone graft in patients with unilateral cleft lip and palate by estimating the bone fill 1-year postoperatively on cone beam computed tomography. The outcome was assessed in relation to the (1) root development stage of the cleft side canine, (2) presence/absence of a cleft side lateral incisor, and (3) volume size of the preoperative cleft defect. The alveolar bone defect volume of 32 consecutive unilateral cleft lip and palate patients aged 8 years 1 month to 11 years 11 months was evaluated using a recently defined and standardized protocol. The outcome was calculated as the percentage of bone fill using the formula (VOLpre - VOLpost) / VOLpre) × 100. The preoperative mean alveolar cleft volume was 934 mm(3), and the average percentage bone fill was 87%. There was no significant difference between bone fill and root developmental stage of the cleft-side canine (P = .882) nor presence/absence of the cleft side lateral incisor (P = .803). The size of the cleft defect did not correlate with the bone fill (r = .03, P = .84). Secondary alveolar bone grafting with mandibular symphyseal bone graft in patients with unilateral cleft lip and palate is an attractive procedure assessed from the volumetric outcome using cone beam computed tomography. The 1-year average bone fill of 87% was not significantly influenced by root development stage of the cleft-side canine, presence or the absence of a cleft side lateral incisor, or size of the alveolar defect.

Deproteinized Bovine Bone Graft in Maxillary Alveolar Cleft Reconstruction

Though alveolar grafting continues to be a viable treatment regimen, its associated protocols and techniques are many and varied. The present study was conducted to evaluate the use of deproteinized bovine bone xenograft mixed with autogenous mandibular symphyseal bone graft in secondary maxillary alveolar cleft reconstruction compared to the gold standard anterior iliac crest autogenous graft. 10 patients (mean age 9.3years 1.33) with unilateral maxillary alveolar cleft defect requiring secondary alveolar cleft grafting were included in this study. Patients were selected from the outpatient clinic, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University. The study was conducted from June 2012 till February 2013. Patients were divided randomly into 2 equal groups. Group A received the gold standard anterior iliac crest graft. Group B received mandibular symphyseal bone mixed with deproteinized bovine bone in a 1:1 ratio. For each patient, 3 CBCT scans were ordered: preoperatively, immediately postoperatively and 6 months postoperatively. Volumetric and densitometric measurements were made using the Mimics[1] software. Data were collected and statistical analysis was performed using SPSS (Statistical package for the social sciences)[2]. Data were represented as mean standard deviation. Paired sample student t-test was used to compare each pair of the studied variables within the studied group of patients. Independent sample t test was used to compare variables between the two studied groups. The test result was considered statistically significant if the Pvalue was equal to or less than 0.05. Results showed the percentage of defect filling immediately postoperatively to be 90.8 9.2% for Group A and 94.2 4.3% for Group B, while percentage of defect filling 6 months postoperatively was 86.6 10.0% for Group A and 88.4 2.8% for Group B. Comparison of the 2 groups regarding the percentage of defect filling by the graft immediately postoperatively and at 6 months showed no statistical significant difference with a P-value of 0.483 and 0.736 respectively. Comparison of the percentage of graft resorption between the 2 groups also showed no statistical significant difference. (P-value 0.704) Similarly, comparison of graft density between Group A and Group B immediately postoperatively (P-value 0.52) and after 6 months (P-value 0.81) showed no statistical significant

Functional and morphological correlates of mandibular symphyseal form in a living human sample

Variation in recent human mandibular form is often thought to reflect differences in masticatory behavior associated with variation in food preparation and subsistence strategies. Nevertheless, while mandibular variation in some human comparisons appear to reflect differences in functional loading, other comparisons indicate that this relationship is not universal. This suggests that morphological variation in the mandible is influenced by other factors that may obscure the effects of loading on mandibular form. It is likely that highly strained mandibular regions, including the corpus, are influenced by well-established patterns of lower facial skeletal integration. As such, it is unclear to what degree mandibular form reflects localized stresses incurred during mastication vs. a larger set of correlated features that may influence bone distribution patterns. In this study, we examine the relationship between mandibular symphyseal bone distribution (i.e., second moments of area, cortical bone area) and masticatory force production (i.e., in vivo maximal bite force magnitude and estimated symphyseal bending forces) along with lower facial shape variation in a sample of n = 20 living human male subjects. Our results indicate that while some aspects of symphyseal form (e.g., wishboning resistance) are significantly correlated with estimates of symphyseal bending force magnitude, others (i.e., vertical bending resistance) are more closely tied to variation in lower facial shape. This suggests that while the symphysis reflects variation in some variables related to functional loading, the complex and multifactorial influences on symphyseal form underscores the importance of exercising caution when inferring function from the mandible especially in narrow taxonomic comparisons.

Donor site morbidity after reconstruction of alveolar bone defects with mandibular symphyseal bone grafts in cleft patients—111 consecutive patients

The aim of this study was to assess the objective and subjective morbidity after reconstruction of alveolar bone defects with mandibular symphyseal bone grafts in patients with cleft lip and palate. One hundred and eleven patients born between 1995 and 1999, who had undergone chin bone harvesting for alveolar cleft reconstruction in the period from 2000 through 2011, were included. A survey of medical records was conducted. Subjective morbidity after reconstruction was assessed using a questionnaire. Medical records revealed few postoperative incidents; 5.6% reported persistent sensory disturbances in the donor area. Postoperative pain averaged 3.6±2.1 (scale 0–10). The overall satisfaction with the surgical result was 8.7±1.7 (scale 0–10). This study revealed that chin bone harvesting for reconstruction of alveolar defects in patients with cleft lip and palate is a safe and predictable procedure, highly appreciated by the patients, and characterized by only minor postoperative incidents. Patients must be informed of the risk of sensory disturbances in the donor area.

Secondary Closure of Alveolar Clefts with Mandibular Symphyseal Bone Grafts and with Platelet-Rich Fibrin Under Local Anesthesia: Three Case Reports

Secondary alveolar bone grafting is a method that enables an excellent oral rehabilitation of the patients having cleft palate. Many types of bone grafts have been used for reconstruction of the cleft, including autogenous bone and bone substitutes. Platelet-rich fibrin (PRF) has been shown to be effective in grafting the defect. The aim of this presentation is to report the closure of an alveolar cleft with the use of symphyseal bone grafts harvested with platelet rich fibrin under local anesthesia. PRF may be a good treatment choice depending on the early radiographical view of the defect and uneventfull healing.

Intraosseous territory of the facial artery in the maxilla and anterior mandible: Implications for allotransplantation

Aim The aim of this anatomical study was to define the intraosseous vascular territory of the facial artery. The clinical issue is whether ipsilateral facial artery anastomosis will guarantee blood supply to the ipsi- and contralateral mandibular symphyses and maxillae in allotransplantation. Material and methods Of 10 human cadaveric heads, the left facial artery was injected with a positive contrast agent. The maxillae and mandibular symphyses were investigated with cone-beam computed tomography (CBCT). Results Each ipsilateral maxilla and mandibular bone segment showed contrast medium in the intraosseous vessels. In 50% of cases, this was also the case on the contralateral side of the maxilla and anterior mandible. Conclusions The maxillae and the mandibular symphyses receive ipsilateral blood supply from the facial artery and, in 50% of cases, also from the contralateral facial artery. Internal maxillary artery anastomosis is not required for a vascularized maxillary bone flap. Additionally, involvement of the submental artery is not needed for a mandibular symphyseal bone flap.

Simulation of sinus floor augmentation with symphysis bone graft using three-dimensional computerized tomography

The objective of this study was to evaluate the maximum amount of harvestable bone graft in the mandibular symphysis and the augmentation volume needed for different sinus lift levels (from 10 to 18 mm), in addition to calculating which sinus lift level can be acquired using the individual's symphysis bone graft volume with three-dimensional computerized tomography (3D CT) and software. Data from 15 CT scans was obtained from 15 adult patients (10 males, five females). The CT data, in DICOM format, was read into Mimics software from Materialize (Leuven, Belgium), with a slice thickness of 0.5 mm. The mandibular symphysis bone graft volumes and different levels of sinus lift augmentation volumes were calculated on the 3D images using Mimics software. It was determined that the average symphysis bone volume (3491.08+/-772.12 mm(3)) could provide approximately 14 mm of sinus lift height (3167.84+/-1067.65). 3D CT techniques and software can be used to calculate the required graft volume for sinus floor augmentation and symphysis bone graft volume, and the mandibular symphysis region can provide adequate bone volume for sinus lift augmentation.