Anterior Maxillary Ridge Research Articles

Four locator attachments of mandibular implant-retained overdentures with two different distributions: A 10-year retrospective preliminary study of residual alveolar ridge changes.

There is little information on the long-term function of the four Locator attachment of the mandibular implant retained overdenture (OD), particularly with different distributions. To compare the effect of different four inter-foraminal implant distributions retaining a mandibular OD after 10 years of function on posterior mandibular ridge resorption (PMandRR), anterior maxillary ridge resorption (AMaxRR), and the amount of marginal bone loss (MBL) around all four implants. Twenty-two participants with total edentulism who had worn mandibular OVDs retained by four inter-foraminal implants for 10 years of functional life were selected for this study. They were divided into two groups based on implant distribution: Group I with a quadrilateral distribution (QD) of implants and Group II with a linear distribution (LD) of implants. PMandRR, AMaxRR, and MBL around implants were measured. After 10 years of function, PMandRR was significantly higher in the LD group than in the QD group (p < 0.001*). There was no significant difference in AMaxRR between the QD and LD groups (p = 0.431). The QD group showed a significantly greater amount of MBL around dental implants when compared with the LD group (p = 0.002*). The LD of implants demonstrates more PMandRR compared with the QD. The QD of implants demonstrates a greater amount of MBL around dental implants compared with the LD. Both implant distributions demonstrate the same effect on the AMaxRR. MBL around implants remained within normal accepted values after 10 years of function.

Management of Flabby Maxillary Anterior Ridge: A Case Report

A flabby ridge occurs by replacing bone with connective fibrous tissues and is most commonly found in the anterior maxillary ridge. Flabby tissues present a challenging clinical scenario for the clinician. Making an accurate impression of these tissues is crucial for producing a prosthesis that fits well. In this case report, an open tray approach is used on a patient who has completely edentulous maxillary arch with flabby tissue in anterior region.

Horizontal Ridge Reconstruction of Atrophic Anterior Maxillary Ridges Using Customized Xenograft Bone Shell with a 1:1 Mixture of Autogenous and Xenograft Bone Particulate: A Case Series Study.

To evaluate the efficacy of using a customized xenograft shell with a 1:1 mixture of particulate xenograft and autogenous bone for the reconstruction of horizontally deficient anterior maxillary alveolar ridges. CBCT images of the atrophic maxilla of eight patients were acquired and generated into 3D models. The data were transferred to a 3D printer for fabrication. During the surgery, xenograft blocks were manually sliced and customized on the 3D-printed models into bone shells. Then they were fixed to the atrophic site, and the gap was augmented with a 1:1 mixture of particulate xenograft and autogenous bone. Clinical assessment showed no adverse effects; however, one patient exhibited wound dehiscence. The mean difference between the preoperative and 6-month postoperative CBCTs showed a net average bone gain of 4.06 mm at 2 mm from the crest and 4.34 mm at 5 mm from the crest, which was statistically significant. On the other hand, a statistically significant graft resorption of 1.41 mm at 2 mm from the crest and 2.19 mm at 5 mm from the crest was found when the mean difference between the immediate and 6-month postoperative CBCTs was calculated. Within the limitations of the study, the use of xenograft shells as a barrier for maxillary alveolar ridge reconstruction is a predictable technique; however, further investigations regarding the required time for graft consolidation are required.

Alternative prosthetic approach in the management of flabby edentulous anterior maxilla: A case report and literature review

Abstract A flabby ridge is a condition where excessively mobile and resilient tissue affects the maxillary or mandibular alveolar ridges. This study reviews the flabby anterior maxillary ridges and explores their management. It also included a case report of a 67-year-old male diabetic patient with rare manifestations in the anterior maxilla. The selection of this patient in this study was due to the rare flabby tissue manifestations in the anterior maxilla. These manifestations resulted in denture instability and loss of retention but also caused significant symptoms for the patient, including severe pain, prolonged headaches, and a burning sensation. This study aimed to alleviate pressure on the flabby tissues in the anterior maxilla and enhance the complete denture’s retention, support, and stability. In managing the flabby anterior maxilla described in this study, the prosthetic approach involved utilizing a modified window technique for the secondary impression and a low-viscosity impression material. On the following day till the follow-up period (12 months), the patient showed no complaints of pain, headache, or burning sensation, and the complete denture was in good retention, support, and stability. Prosthodontic management is a reliable alternative to surgery for hypermobile flabby tissues. It improves denture quality, reduces pressure, and enhances comfort and functionality during daily activities.

846 Bone Grafting as an Alternative Approach to Treating Severe Hypodontia in a Child

Abstract Background Severe hypodontia (developmental absence of teeth) can have significant functional and cosmetic impact, causing dietary restrictions, speech delay and bullying. Management in childhood is usually with removable dental prostheses, but retention and stability are often compromised by hypoplastic dento-alveolar bone ridges in the edentulous areas. Presenting problems A 3-year-old child was referred to Paediatric Dentistry with no erupted primary teeth. Radiographs revealed developmental absence of the entire primary dentition. Genetic investigation was negative for changes in genes known to be associated with hypodontia. In the permanent dentition only first molars were radiographically present. The child was struggling with bullying and self-confidence related to his dental appearance and speech. Investigations Plain films and cone beam computed tomography (CBCT) revealed agenesis of all canines and incisors in both jaws, an atrophic edentulous anterior maxilla, and soft tissue communication with the nasal fossa floor. Clinical management Despite provision of a retentive upper removable prosthesis was made impossible by a fleshy anterior maxillary ridge with severe atrophy of the dento-alveolar bone and inadequate sulcus depth. Multiple removable prostheses were fabricated, but retention and stability were poor. He was referred to maxillofacial surgery for excision of redundant fleshy tissue in the anterior maxilla and placement of corticocancellous block graft from the hip with Sonic Weld (KLS Martin) to augment and consolidate the ridge. A successfully retentive prosthesis was subsequently fabricated. Discussion This case presents an unusually invasive, but effective alternative approach to treating severe hypodontia in childhood, where hypoplastic dental ridge and sulcus depth can restrict treatment options.

THE MULTIDISCIPLINARITY IMPORTANCE IN REHABILITATION AFTER THE VERRUCOUS CARCINOMA DIAGNOSIS: A CASE REPORT

Verrucous carcinoma of the oral cavity is low-grade and a rare variant of squamous cell carcinoma. This lesion is described as malignant, exophytic, slowly growing, and locally invasive. The following case aims to report how the lesion localization and tissue healing led to a difficult rehabilitation. An 86-year-old, Caucasian female patient was referred for rehabilitation after having performed partial maxillectomy. Before surgery, a unique lesion with an irregular appearance and with papillary projections was observed. Histologically, it has shown epithelial ridges without significant dysplasia and keratin plugs. Her clinical history was collected and confronted with the anatomopathological exam, confirming verrucous carcinoma in the anterior maxillary ridge. A second surgical intervention, using high-intensity laser therapy, was necessary to improve the maxilla into a better prosthetic bed, increasing retentive areas. A healing guide plate was installed in the immediate post-surgery time to support the tissue before implementing the reparatory prosthesis. Verrucous carcinoma of the oral cavity is low-grade and a rare variant of squamous cell carcinoma. This lesion is described as malignant, exophytic, slowly growing, and locally invasive. The following case aims to report how the lesion localization and tissue healing led to a difficult rehabilitation. An 86-year-old, Caucasian female patient was referred for rehabilitation after having performed partial maxillectomy. Before surgery, a unique lesion with an irregular appearance and with papillary projections was observed. Histologically, it has shown epithelial ridges without significant dysplasia and keratin plugs. Her clinical history was collected and confronted with the anatomopathological exam, confirming verrucous carcinoma in the anterior maxillary ridge. A second surgical intervention, using high-intensity laser therapy, was necessary to improve the maxilla into a better prosthetic bed, increasing retentive areas. A healing guide plate was installed in the immediate post-surgery time to support the tissue before implementing the reparatory prosthesis.

Analysis of Residual Ridge Morphology in a Group of Edentulous Patients Seeking NHS Dental Implant Provision-A Retrospective Observational Lateral Cephalometric Study.

A convenience sample of 154 edentulous patients referred for implant provision at a Regional National Health Service Dental Hospital in the North West of England were identified. The cephalometric radiographs that were taken as part of the patient baseline investigation were assessed. Digital tracing was used to measure the anterior maxillary and mandibular bone height and ridge angle with respect to the maxillary and mandibular planes. The mean height of the bone in the maxilla was found to be 14 mm, and the mean ridge angle for the anterior maxillary residual ridge is 104°. The mean height of bone in the mandible was 18 mm, while the mean ridge angle for the anterior mandibular residual ridge was 77°. Using the Cawood and Howell classification demonstrated that class VI mandibles were the most common. The cross-sectional shape of the mandible varied, with the triangular shape most common. Although there was adequate bone stock for implant placement in these cases, the mandibular residual ridge resorption presents a lingual inclination to the residual bone. The limited residual ridge position and inclination would dictate that conventional implant placement could be challenging.

Prong maxillary complete denture for better facial aesthetic: A case report

Denture teeth and denture flange are two very important aspects of a complete denture. For aesthetic purpose while fabricating the complete denture prosthesis, restoring the labial fullness is a sensitive procedure. There are some clinical situations where the labial flange gives poor facial aesthetics. It is more occur in proclined maxillary anterior ridge or thick labial cortical plate with severe labial undercut. In this article we are presenting a case with thick labial cortical plates and severe labial undercut. So, we have modified the complete denture and delivered a prong (flangeless) denture to give more aesthetic appearance to the patient.

Horizontal maxillary ridge augmentation with ridge split procedure and simultaneous implant placement: A case report

Treatment of edentulous maxillary anterior region with horizontal ridge atrophy presents a clinical situation in which the placement of endosseous implants might be complex or sometimes impossible without a ridge augmentation procedure. This case report presents management of horizontally deficient maxillary anterior ridge with ridge split procedure using piezotome and simultaneous implant placement. In contrast to other ridge augmentation techniques, ridge splitting allows for immediate implant placement following surgery reducing the overall treatment time and eradicates the possible morbidity from a second surgical site.

“HORIZONTAL ALVEOLAR RIDGE AUGMENTATION WITH AUTOGENOUS BLOCK BONE GRAFT A CONE BEAM COMPUTED TOMOGRAPHY EVALUATION CASE SERIES”

Objective: The aim of the present study was to evaluate horizontal alveolar ridge augmentation using autogenous block grafts harvested from mandibular symphysis without barrier membrane in severe maxillary anterior ridge defects. Materials and methods: Six healthy patients with horizontal defects of the maxillary alveolar ridges were selected for alveolar ridge augmentation (class IV atrophy according to Benic and Hammerle classification). These defects were treated by autogenous block onlay grafts harvested from mandibular symphysis protected by anorganic bovine bone particles only. bone width was assessed preoperative, immediately post-operative and after 6 months at re‐entry by cone beam computed tomography. Result: All block grafts sites provided sufficient ridge width for proper implant placement. Mean bone gain was 3.9mm. No soft tissue dehiscence occurred in any of the cases. Conclusion: A combination of autogenous block graft obtained from the symphysis, combined with particulates xenograft alone without barrier membrane is a predictable and successful technique for augmenting maxillary horizontal ridge deficiency.

Does immediate loading of a single implant in the healed anterior maxillary ridge improve the aesthetic outcome compared to conventional loading?

BackgroundImmediate loading is an attractive option for avoiding secondary surgery. However, it is unclear whether it provides a better aesthetic outcome compared to conventional loading with implants placed in healed ridges.AimsTo compare the aesthetic outcomes of immediately and conventionally loaded single implants in healed anterior maxillary ridges.MethodologyA systematic review using PICO was conducted. EMBASE, MEDLINE and DoSS databases were searched. The Cochrane Risk of Bias tool for Randomised Controlled Trials and the Effective Public Health Practice Project tool for other study designs were used for quality appraisal. A narrative synthesis was undertaken.ResultsA total of 622 articles were identified. After screening, a total of five papers were included. Results indicated no statistically significant difference in pink or white aesthetic scores between the immediate and conventional loading groups at 1- and 5-year review and the Papilla Index at the 1-year review.ConclusionWithin the limitations of this review, immediate loading of single implants provides a comparable aesthetic outcome to conventional loading in healed ridges of the anterior maxillary.

Three-Dimensional Maxillary Alveolar Ridge Augmentation Using Three-Dimensional Maxillary Alveolar Ridge Augmentation Using Modified Cortical Shell Technique and Composite Bone Graft

Objective: The present study was performed to assess the 3D alveolar ridge augmentation using the cortical shell from retromolar region and composite bone particulate regarding the width of the residual alveolar ridge. Methods: Thirteen patients with age range 21-40 years old having atrophic anterior maxillary ridge ≤3mm horizontally were included in the study. All patients were subjected to ridge augmentation using composite bone graft and retromolar cortical shell that was fixed in place by two micro-screws. The alveolar ridges were assessed and compared by cone beam computed tomography (CBCT) in the pre-operative, immediate and 4 months post-operative phases by taking linear measurements at the same points after making fusion. The measurements were taken at the crest of the ridge, midway and more apically. The CBCT images were evaluated for the actual gain in width of the alveolar ridge. Statistical analysis was performed to compare CBCT and clinical findings. Results: At the crest of the ridge, midway and more apically the results showed a statistically significant difference between pre-operative and immediate post-operative results (P0.05). The mean increases in crestal bone width, midway and apically at 4 months postoperatively were 3.66mm, 4.01mm and 3.5mm respectively. Conclusion: 3D reconstruction of anterior maxillae with autogenous retromolar cortical shell is a reliable technique with stable outcomes. Two micro- screws Stabilization provides stability and minimal graft resorption. Moreover, the technique allows for implant placement 4 months post-operatively without further re-grafting.

Comprehensive treatment for severe periodontitis with pathologic tooth migration−related bimaxillary protrusion: A case report with 3-year follow-up

Background and OverviewPatients with severe periodontitis often experience pathologic tooth migration (PTM), which impairs esthetics and leads to occlusal disharmony (for example, premature contacts and traumatic occlusion) that can further exacerbate periodontitis. The authors describe a patient who exhibited severe periodontitis with PTM-related bimaxillary protrusion. This report includes 3-year clinical outcomes after periodontal regenerative therapy, implant-anchored orthodontic therapy, and implant prosthodontics intended to achieve both functional and esthetic improvements. Case DescriptionA 63-year-old woman sought treatment with the chief complaint of maxillary anterior tooth mobility. Clinical examination revealed excessive tooth mobility, deep periodontal pockets, and infrabony defects in all teeth. All teeth exhibited PTM; the mandibular anterior teeth exhibited marked protrusion caused by the progression of periodontitis. After initial periodontal therapy, periodontal regenerative therapy was performed in all molar regions. At 6 and 9 months postoperatively, comprehensive orthodontic treatment was initiated for the mandible and maxilla, respectively, using orthodontic anchorage devices to achieve acceptable functional occlusion. After orthodontic treatment, staged guided bone regeneration was performed and dental implants were placed in the severely resorbed maxillary anterior ridge. This comprehensive treatment yielded favorable periodontal conditions, stable occlusion, and good esthetic outcomes. Conclusions and Practical ImplicationsFavorable esthetics, stable occlusion, and highly cleansable periodontal tissues were achieved with well-planned interdisciplinary and comprehensive treatment, although the patient had severe periodontitis and PTM-related bimaxillary protrusion.

The Custom Alveolar Ridge-Splitting (CARS) Technique for Predictable Horizontal Ridge Augmentation in the Atrophic Anterior Maxilla: A Retrospective Case Series Study.

Implant-supported restorations have proven to be a predictable option for replacing missing teeth. In cases of inadequate bone quantity, the bone volume can be increased by bone augmentation procedures. Several factors can affect bone regeneration, including the morphology of the defect at the implant site. A defect surrounded by bony walls (an intraosseous defect) is known to yield a highly successful regeneration. The purpose of this retrospective case series study was to present a new step-by-step surgical procedure known as the Custom Alveolar Ridge-Splitting (CARS) technique for maxillary anterior ridge augmentation. This technique creates an intraosseous defect while splitting and augmenting an atrophic ridge. Sixteen consecutive cases were treated with the CARS procedure. All implants were restored and followed for 12 to 24 months after loading, and all cases were effectively treated with successful implant placement. According to this retrospective study, the CARS procedure is simple, successful, and predictable and may be used as a surgical option for horizontal alveolar ridge augmentation in the anterior maxilla.

Enamel matrix derivative promotes new bone formation in xenograft assisted maxillary anterior ridge preservation-A randomized controlled clinical trial.

To compare the effectiveness of deproteinized bovine bone mineral with 10% collagen alone (DBBMC) or with enamel matrix derivative (DBBMC-EMD) in ridge preservation. 42 maxillary anterior teeth were extracted and received either a DBBMC (control) or DBBMC-EMD (test) treatment protocol. CBCT taken before and 4months after the extraction procedure was used to measure changes in alveolar ridge width (RW), buccal bone height (BH) and palatal bone height (PH). Bone cores were harvested during implant osteotomy preparation, and the samples processed histomorphometrically to assess the fraction of new bone (%NB), residual graft (%RG) and soft tissue matrix (%STM). Overall, both treatment groups showed significant reductions in mean RW from baseline to 4months after extraction, but no significant change in either mean BH or PH over this time. When CBCT measurements were analysed according to the initial thickness of the buccal wall (BT<1mm vs. BT≥1mm), significant reductions in all ridge dimensions (RW, BH and PH) were noted in the <1mm BT group. Histomorphometrically, the DBBMC-EMD test group showed significantly increased new bone formation (%NB): (control=16.5±6.9% cf.; test=45.1±8.8%) with less residual graft (%RG): (control=36.8±8.8% cf.; test=20.3±7.2%) compared to the DBBMC control group. Both DBBMC alone and DBBMC-EMD treated sites 4months after extraction lost RW but showed no significant change in BH or PH. Irrespective of treatment, maxillary anterior teeth with thick initial buccal walls (≥1mm) exhibited less alveolar ridge reduction 4months after treatment. The addition of EMD to DBBMC resulted in more new bone formation in the test group.

EVALUATION OF INTERCHANGEABLE GUIDE IN MINIMALLY INVASIVE RIDGE SPLITTING WITH SIMULTANEOUS IMPLANT PLACEMENT (A PROSPECTIVE CLINICAL STUDY)

Background: The conventional ridge splitting technique offers a feasible and more consistent approach for the challenging narrow alveolar ridge. However, this entails raising of a complete flap to allow an adequate visibility of the osseous defect resulting in disturbance of vascular supply and risk of bone resorption. Stereolithography helps the manufacture of surgical guides using 3D generated models for an accurate placement of implants with minimal invasiveness thus preserving the periosteum. Objectives: To assess the precision of dental implant placement in narrow ridges after ridge splitting minimally invasive technique using an interchangeable guide. Materials and Methods: A prospective study was including 5 patients with anterior maxillary narrow ridge. All patients were selected to suit the proposed inclusion and exclusion criteria. Ridge split procedure was performed for all selected subjects assisted with the surgical guide with simultaneous placement of implants. Patients were evaluated by clinical and radiographical assessments with an average of 6 months follow up. Results: 8 implants were placed. Angular deviations with an average of 2.61 ± 1.46 degrees. The mean values of the horizontal deviation at the coronal and apex sides of the implant were 0.70 ± 0.46 mm and 0.98 ± 0.35 mm. While the Vertical deviations (V) with an average of 0.39 ± 0.29 mm. There were statistically significant differences between preoperative, immediate postoperative and 6 months postoperative values of bone width and density. Conclusions: Alveolar ridge split technique assisted with an interchangeable surgical guide is a feasible and reliable method for placement of dental implants

An in vivo comparative evaluation of graft uptake between chin and ramal graft in the reconstruction of atrophic anterior maxillary edentulous ridges for implant placement

Introduction: The goal of modern dentistry is to restore the patient to normal function, esthetics, comfort, speech and health, which can be brought by caries prevention or replacing of missing teeth. Loss of teeth may be devastating for the patient, both functionally and aesthetically. Complex anatomy, functional and aesthetic demands often make reconstruction very challenging as well as the multitude of complications that can arise during or after treatment. Aim and Objectives: To evaluate the amount of bone resorption of mandibular autogenous block bone graft in reconstruction of atrophic anterior alveolar ridges. Materials and Methods: 5 patients underwent harvesting of corticocancellous bone from Mandibular ramus and 5 patients underwent harvesting of corticocancellous bone from Mandibular chin region for Reconstruction of atrophic alveolar ridge. All patients were reviewed for follow-up for 5 months to evaluate the amount of resorption and acceptance of graft. Results: In a follow up period of 5 months the mean graft resorption in ramal graft is 16.8% and mean graft resorption in symphysis graft is 18%. Conclusion: Minimally invasive approach, ease of application, volume of the graft and least postoperative morbidity are observed in ramal graft. The survival of the graft is better in ramal graft than the graft from the chin as the chin graft shows higher resorption rate. Patient compliance is favorable more towards the ramal graft than the chin graft as the immediate postoperative pain is high in symphysis region. Keywords: Graft, Reconstruction, Implant, Ramus, Symphysis.

A Simplified and Cost-Effective Treatment Approach for Combination Syndrome: A Case Report

Combination syndrome is a dental condition, mostly observed in patients with a completely maxillaryedentulous arch and a partially edentulous mandibular arch persisting only the anterior teeth. Specific oraldestructive changes are often seen in patients. The manifestation of this syndrome consists of resorptionin the anterior maxillary ridge, overgrowth of tuberosities, and supra eruption of mandibular anterior andreduced alveolar ridge height in combination with hypertrophic and atrophic changes in the maxilla andmandible. Complications involved in chewing and mastication are of special apprehension in such a patient.Predictable prognosis can be offered by overdentures. This article attempts to provide a simplified and costeffective approach to this type of treatment modality by a case report.

The long-term stability of soft tissue augmentation in treatment of localized severe maxillary anterior ridge deformities.

Severely deformed edentulous ridges in the esthetic zone (EZ) are very difficult to restore with an esthetic fixed dental prosthesis (FDP). Soft tissue augmentation of these deformed ridges can dramatically improve the esthetics of the restoration. The long-term stability of soft tissue grafting used alone to treat severe localized alveolar ridge deformities will be reported. Three different soft tissue augmentation techniques, connective tissue graft (CTG), keratinized gingival graft (KGG), and pediculated connective tissue graft (PCTG) used to treat severe ridge deformities in the maxillary anterior region in five patients will be described. The stability of the augmentation will be shown at follow-up periods ranging from 5-30 years. All three soft tissue grafting techniques demonstrated long-term stability following the six-month post-treatment result. Edentulous ridges in the esthetic zone, with severe hard and soft tissue deformities, are very difficult to restore esthetically. The development of soft tissue augmentation techniques has allowed clinicians to enhance the esthetics of their fixed dental prostheses (FDP). Restorative clinicians need to be assured that soft tissue shrinkage under the pontics will not occur after the final prosthesis is seated. The stability of these soft tissue augmentations over an extended period of time, will be demonstrated in the presented cases.

COMPARATIVE STUDY BETWEEN TWO DIFFERENT TYPES OF ATTACHMENTS RETAINED IMPLANT MANDIBULAR OVER DENTUREON ON THE ANTERIOR MAXILLARY BONE RESORPTION

This study was conducted to evaluate and compare the effect of using two different types of attachments (Locator and ball); to retain implants mandibular over denture on the anterior maxillary bone resorption. Material and methods: Fourteen completely edentulous male patients with problematic existing mandibular dentures , received two implants in the canine region of the mandible. New maxillary complete dentures and mandibular overdentures were fabricated for all patients, following conventional clinical and laboratory techniques. Patients were divided randomly by closed envelops into two groups; Group I: Patients received implant retained overdenture by locator attachment, while Group II : patients received implant retained overdenture by ball attachment, four months after implant placement. Traced rotational tomograms were used for measurements of maxillary alveolar bone loss. The proportional value between bone areas and reference areas was expressed as a ratio R. Change in R for all patients were evaluated immediately before insertion overdenture (T0), and after two years (T2) later, and calculated for anterior maxillary area. Results: During the two years; the follow up period showed a significant decreasing change in R in the anterior maxillary area. group II (ball attachment) showed a significant change in R more anterior maxillary ridge resorption than group I (locator attachment) (P = 0.011). Conclusion : Within the limitation of this study and consideration of the small sample size, it could be concluded that; Ball attachments for implant retained mandibular overdentures are associated with more maxillary ridge resorption than locator attachments.