Maxillary Bone Graft Research Articles

Occlusal Reconstruction by Maxillary Bone Grafting, Dental Implants and Orthognathic Surgery After Facial Trauma.

Occlusal Reconstruction by Maxillary Bone Grafting, Dental Implants and Orthognathic Surgery After Facial Trauma.

Research Progress of Maxillary Sinus Cyst and Maxillary Posterior Dental Region Implantation

The loss of single or multiple teeth in the maxillary posterior region usually leads to alveolar bone resorption, atrophy, and maxillary sinus cavity gasification, resulting in insufficient vertical bone height of the maxillary posterior alveolar bone, which brings great difficulties to tooth implantation. Maxillary sinus floor lifting is an important method to solve the posterior maxillary bone mass deficiency, which can be divided into internal lifting and external lifting. In order to avoid the occurrence of complications such as maxillary sinus mucosa perforation and facilitate the selection of surgical methods, it is particularly important to accurately understand the anatomical characteristics of maxillary sinus before surgery. Maxillary sinus cyst is the most common benign disease of maxillary sinus. It has always been considered as an absolute contraindication for maxillary sinus floor elevation bone grafting, which seriously restricts the possibility of maxillary sinus bone increment. This article reviews the research progress of maxillary sinus cyst and maxillary posterior dental implantation at home and abroad.

Association Between Maxillary Segmentation and Perioperative Complications in Le Fort I Osteotomy.

The Le Fort I osteotomy is used to reposition the maxilla to correct numerous maxillofacial and occlusal deformities. The aim of this study was to delineate perioperative complication rates associated with Le Fort I osteotomy and determine whether the number of maxillary segments or bone grafting yielded increased complication rates. Patients undergoing Le Fort I osteotomy from 2012 to 2019 were identified from the multi-institution "National Surgical Quality Improvement Program" database using Current Procedure Terminology codes. The predictor variables of interest included maxillary segmentation defined as 1, 2, or 2 pieces and the presence or absence of bone graft. Perioperative complications were collected as the primary outcome variable, including superficial and deep space infections, wound dehiscence, airway complication, peripheral nerve injury, and hemorrhage. The secondary outcome variables included readmission and reoperation rate within the 30-day postoperative period. Complication rates were compared using multivariate analysis across groups stratified by the number of maxillary segments and inclusion of bone grafting. Of the 532 patients that met the inclusion criteria, 333 (63%) underwent 1-piece, 114 (21%) 2-piece, and 85 (16%) 2-piece Le Fort I osteotomy procedures. A total of 48 patients exhibited complications (9%), with hemorrhage (2.3%) being the most common complication observed. The number of maxillary segments was not a significant predictor of perioperative complications ( P = 0.948) nor was the use of bone grafting ( P = 0.279).

Rapid Maxillary Expansion Treatment in Patients with Cleft Lip and Palate: A Survey on Clinical Experience in the European Cleft Centers.

Cleft lip and palate patients require complex interdisciplinary treatment, including maxillary expansion and secondary alveolar bone grafting. However, the evidence on these treatment procedures and outcomes is lacking. Therefore, this study aimed to survey the subjective observations of European maxillofacial surgeons and orthodontists on the maxillary expansion and bone grafting treatment protocols and the associated complications. An online questionnaire was sent to 131 centers. The questions assessed the participants' demographic data, maxillary expansion and alveolar bone grafting protocols, and the associated complications. Descriptive statistics and a t-test were used to analyze the data. The response rate was 40.5%. The average age for maxillary expansion was 9-10 years. The secondary alveolar bone grafting was planned 5-10 months after the expansion. The most common complications were asymmetric expansion, relapse, and fistula formation. The protocols and materials used vary widely among centers. Anatomical alterations and developmental processes, like tooth eruption adjacent to the cleft, should be seriously considered for treatment planning. This survey showed that there is still a lack of consensus on these treatment procedures. Further clinical trials should focus on long-term outcome evaluation to identify treatment components for optimal alveolar bone substitution and transversal maxillary expansion treatment in patients with clefts.

Platelet-rich fibrin in combination with mandibular or maxillary non-vascularized bone graft: a systematic review

Platelet-rich fibrin in combination with mandibular or maxillary non-vascularized bone graft: a systematic review

Bone vitality and vascularization of mandibular and maxillary bone grafts in maxillary sinus floor elevation: A retrospective cohort study.

Mandibular retromolar (predominantly cortical) and maxillary tuberosity (predominantly cancellous) bone grafts are used in patients undergoing maxillary sinus floor elevation (MSFE) for dental implant placement. The aim of this retrospective cohort study was to investigate whether differences exist in bone formation and vascularization after grafting with either bone source in patients undergoing MSFE. Fifteen patients undergoing MSFE were treated with retromolar (n= 9) or tuberosity (n= 6) bone grafts. Biopsies were taken 4months postoperatively prior to dental implant placement, and histomorphometrically analyzed to quantify bone and osteoid area, number of total, apoptotic, and receptor activator of nuclear factor-κB ligand (RANKL)-positive osteocytes, small and large-sized blood vessels, and osteoclasts. The grafted area was divided in three regions (caudal-cranial): RI, RII, and RIII. Bone volume was 40% (RII, RIII) higher and osteoid volume 10% (RII) lower in retromolar compared to tuberosity-grafted areas. Total osteocyte number and number of RANKL-positive osteocytes were 23% (RII) and 90% (RI, RII) lower, but osteoclast number was higher (retromolar: 12, tuberosity: 0) in retromolar-grafted areas. The total number of blood vessels was 80% (RI) to 60% (RIII) lower, while the percentage of large-sized blood vessels was 86% (RI) to 25% (RIII) higher in retromolar-grafted areas. Number of osteocyte lacunae and apoptotic osteocytes were similar in both bone grafts used. Compared to the retromolar bone, tuberosity bone showed increased bone vitality and vascularization in patients undergoing MSFE, likely due to faster bone remodeling or earlier start of new bone formation. Therefore, tuberosity bone grafts might perform better in enhancing bone regeneration.

Assessing the feasibility of using autogenous maxillary bone graft to repair isolated orbital floor fractures: A pilot study using CT measurements

AbstractIntroductionOrbital floor fractures are a common injury managed by oral maxillofacial surgeons. They can result in significant bony defects that increase the orbital volume and necessitate surgical repair to avoid the development of enophthalmos. A variety of materials have been used in the reconstruction of orbits including alloplastic materials and autogenous bone grafts. The use of the anterior maxillary antral wall as a bone graft offers the advantage of being readily accessible, naturally thin and has less donor site morbidity than other bone graft sites. There is a paucity of literature in regards to how and when to use an anterior maxillary antral wall graft.Materials and MethodsWe performed a retrospective review of computerized tomography head scans for patients presenting with isolated orbital floor fractures over a 5‐year period. 25 patients were included in the study and manual measurements were recorded for the orbital floor defect and the dimensions of the ipsilateral and contralateral anterior maxillary wall.ResultsIt was found that 92% of fractures could have been repaired using a contralateral anterior maxillary wall bone graft (p < 0.05).ConclusionUse of the anterior wall of the maxillary antrum is a feasible alternative to traditional alloplastic materials. Further study using three‐dimensional bio‐modelling could help developing more accurate guidelines for using this technique in orbital fracture repair.

Modified Le Fort I interpositional grafting of the severe atrophied maxilla-a retrospective study of 106 patients over 10 years.

The objective of this study was to evaluate a modified Le Fort I interpositional grafting followed by dental implants for the rehabilitation of edentulous atrophied maxillae (Cawood classes IV and V). The surgical modification was a bilateral sinus floor augmentation prior to the osteotomy. This generated a closed recipient bed which allowed the use of particulated bone grafts (xenogenic bone mineral) and a reduced amount of autologous iliac bone grafts. A total of 106 patients with maxillary interpositional bone grafts were included in this retrospective analysis between 2006 and 2020. The panoramic radiographs and lateral cephalograms were analyzed to assess the gain and stability of the maxillary bone and the peri-implant bone loss. In addition, the observational period of up to 14years implant survival and success was evaluated. A stable vertical bone height with mean 0.63±1.41mm resorption over 5years after implant loading was observed. A mean of 0.20±0.37mm marginal bone loss was noted after 5years. The implant survival was 96.4% after 5years and implant success can be rated 91.7% in a mean follow-up period of 93months and 168months maximal observation time. Perioperative complications included sinus membrane perforation (59.43%), wound healing disturbances (25.47%), and transient primary complications (13.78%). All receded apart from two subtotal graft losses (1.8%). The modified Le Fort I osteotomy with interpositional bone grafts is a predictable procedure in terms of bone and implant stability. Patients with atrophic maxillae who are fit for surgery should be informed about risks and benefits of this treatment alternative.

Comparison of piezosurgery and conventional rotary instruments in schneider's membrane sinus lifting: A pilot randomized trial.

BackgroundThe present study aimed to evaluate and compare the postoperative effects of the piezoelectric device and conventional rotary instruments in Schneider’s membrane sinus lifting procedure. Material and MethodsTwenty patients requiring bilateral maxillary bone graft augmentation in the posterior maxillary region were selected. Piezoelectric surgery was performed on one side and conventional surgery with a rotary diamond bur on the other. Postoperative pain, swelling, edema, and mouth opening were evaluated at one hour and two and seven days after the procedures. All variables were submitted to Friedman or Wilcoxon tests at a 5% significance level. ResultsThe comparison between groups showed that postoperative pain after one hour and two days was significantly lower (p< 0.05) in the piezoelectric device group. Regarding the edema, the results of both techniques were similar at all times assessed (p> 0.05). Piezosurgery was statistically associated (p< 0.05) with greater mouth opening only at the 48-hour evaluation. ConclusionsOsteotomy with a piezoelectric device causes less pain and greater mouth opening postoperatively compared with the conventional technique. Key words:Piezosurgery, sinus lift, edema, pain, rotative instruments.

Technical Modifications Specific to the Cleft Le Fort I Osteotomy.

To discuss technical modifications specific to the cleft Le Fort I osteotomy that improve mobilization and demonstrate the stability of the maxilla at the Le Fort I level in a cohort of patients with cleft palate (with or without cleft lip) who underwent traditional maxillary advancement. This was a retrospective evaluation of patients with cleft palate (+/- cleft lip) who underwent orthognathic surgery for management of skeletal malocclusions. All study subjects had a Le Fort I osteotomy +/- bilateral mandibular sagittal split osteotomies. The cleft Le Fort I osteotomy technique is modified to extensively release fibrous tissue and scar from the posterior maxilla, including around the tuberosity, along the posterior maxillary sinus wall, and circumferentially around the descending palatine canal. Maxillary position was assessed using angular and linear measurements pre-operatively (T0), immediately post-operatively (T1), and at 1-year post-operatively (T2). Descriptive and bivariate statistics were computed; a P < 0.05 was considered significant. Twenty-eight patients with cleft palate (with or without cleft lip) were included. The sample's mean age was 18.9 ± 1.4 years and included 11 females. The majority of subjects (64.3%) underwent bimaxillary surgery; eight subjects (28.6%) had segmental maxillary surgery and 14 subjects (50%) had simultaneous maxillary interpositional bone grafting. The mean maxillary sagittal advancement was 6.1 mm (range: 0-10 mm). At 1-year post-operatively, the absolute change in SNA was 0.7 ± 0.9 degrees; the absolute change in maxillary sagittal position was 0.8 ± 0.6 mm. There was no association between the magnitude of advancement and the magnitude of position change (P = 0.86). Stability was not influenced by segmental surgery, bone grafting, or bimaxillary surgery (P > 0.33). Using a modified technique with extensive release of posterior scar and graduated intra-operative traction, maxillary advancement of up to 10 mm can be performed in patients with cleft palate (± cleft lip) with sagittal relapse of < 1 mm at 1-year post-operatively.

An Overview of Timeline of Interventions in the Continuum of Cleft Lip and Palate Care.

This article provides an overview of timeline of interventions and the critical role different providers have in the continuum of cleft lip and palate care. The earliest intervention is the presurgical infant orthopedic treatment, which is initiated in the first few weeks of life. This is followed by several interventions done in a phased manner. These include: lip repair, palate repair, velopharyngeal surgery, maxillary expansion, maxillary bone grafting, limited phase of orthodontic treatment, comprehensive phase of orthodontic treatment (with/without orthognathic surgery), and restorative dentistry.

Is alteration of the occlusal plane stable with isolated nasomaxillary fixation of the Le Fort I osteotomy?

The purpose of this work was to evaluate the stability of maxillary position in the setting of occlusal plane rotations in bimaxillary surgery with rigid fixation of the mandible and bilateral nasomaxillary fixation at the Le Fort I level. This was a retrospective assessment of patients undergoing bimaxillary surgery for the correction of dentofacial deformities with occlusal plane alterations. Demographic measures assessed included age, sex, history of craniofacial anomaly, segmental maxillary osteotomy, and maxillary bone grafting. Cephalometric measures assessed included occlusal plane rotation (clockwise (CWR) or counterclockwise (CCWR)), angular measurements of maxillary and mandibular position (SNA, SNB, and ANB), and occlusal plane angle (occlusal plane to corrected Frankfort horizontal); these were assessed preoperatively (T0) and immediately (T1), 6 weeks (T2), and 1year postoperative (T3). Descriptive and bivariate statistics were computed; P≤0.05 was considered significant. Thirty-six patients were included as study subjects (mean age 18.6±1.8 years; 17 (47.2%) female); 27 (75%) had a primary diagnosis of craniofacial anomaly. Eleven patients (30.6%) had segmental maxillary osteotomies; 10 patients (27.8%) had simultaneous maxillary bone grafting. Twelve patients underwent CCWR; 24 patients underwent CWR. No patient required repeat surgery for malocclusion or relapse; there were no malunions or non-unions during follow-up. For CCWR patients, the mean occlusal plane change from preoperative to postoperative was 5.8±2.8°, remaining stable at 1 year postoperative (ΔT3–T1 1.6±1.0°, P>0.05). For CWR patients, the mean occlusal plane rotation was 4.5 ± 2.2°, remaining stable at 1 year postoperative (ΔT3–T1 1.1±0.9°, P>0.05). In patients undergoing bimaxillary surgery for occlusal plane rotation, two-point fixation of the Le Fort I osteotomy resulted in a stable maxillary position at 1 year postoperative.

Multiple failing maxillary implants in full arch rehabilitation‐ results of retreatment

Background Current implant research is shifting from survival to success, but failure is still an important topic to consider. When implants fail, there is often no fixed prosthetic alternative and retreatment is proposed. Current research on retreatment is predominantly based on single, early failures with survival rates varying between 71.0 and 94.6%. Retreatment of late and multiple failure is rarely described, despite the increasing incidence of failure due to peri-implantitis. Aim/Hypothesis The aim of this study was to assess implant retreatment in a group of patients with multiple failing implants after full maxillary rehabilitation, by implant removal, maxillary augmentation and placement of an overdenture supported by four to six implants. Material and Methods All consecutive patients (n = 16) referred for multiple late implant failures in rehabilitated maxillae between 2008 and 2018 were included in the study. The study was approved by the Medical Ethical Committee of UMCG. All patients were treated by removal of the failing implants combined with vertical and horizontal augmentation of the maxilla using the iliac, calvarial or maxillary tuberosity bone grafts. After four months of healing, four to six implants were placed in the maxilla. Four months later, a bar-retained overdenture was made. At time of last evaluation implant survival, complications, clinical parameters, change in peri-implant bone and patient-related outcome measures were recorded. Results 76 implants were placed in 16 patients. One patient with six implants was lost to follow-up due to severe illness. Therefore, 70 implants in 15 patients were evaluated at 3.3 ± 2.5 years (range 1.1–8.6 years) after loading. Common complications were antrum perforation after implant removal (n = 4; 26.6%) and wound dehiscence after augmentation (n = 4; 26.6%). Complications did not interfere with successive implant placement. In all cases, enough bone volume was present to insert the implants. Overall implant survival was 95.7%. Three implant failures occurred within the first year of function. Peri-implant bone loss was 0.32 ± 0.46 mm, pocket probing depth was 4.55 ± 1.59 mm. Plaque, calculus, inflammation and bleeding were hardly seen (median 0). Patients scored high on satisfaction of their overdentures (mean overall score 8.7 ± 1.2, max. 10). Chewing soft and tough foods were scored as ëgoodí, hard foods were scored as ëmoderateí. Oral Health Impact Profile Score was 29.5 ± 33.3. Conclusion and Clinical Implications Removing multiple failing implants and immediate reconstruction of the maxilla with bone grafts is a safe and predictable treatment procedure when applied for an implant supported overdenture. Complications did not interfere with retreatment.

A review of complications of maxillary sinus augmentation and available treatment methods.

Maxillary sinus grafting is a dependable procedure that has been in use for a long time. However, clinical complications often arise. To prevent complications of maxillary sinus grafting, it is necessary to know the contra-indications, both for general implantation and for maxillary bone grafting. In addition, presence of various complications requires careful consideration of treatment method; therefore, dentists should be familiar with the treatment protocols. Complications can be divided into postoperative, immediate postoperative, and delayed postoperative complications. Particularly for the outpatient, it is necessary to quickly distinguish between treatable cases and cases for which transfer is required. The purpose of this review is to discuss the contra-indications, complications, and treatment options for complications of maxillary sinus graft.

Lipoatrophy Associated With Maxillary Bone Graft for the Purpose of Dental Implants and Correction by Fat Grafting: A Case Report

Lipoatrophy could be a manifestation of a metabolic disorder, pharmacological therapy, or as the result of an immune reaction in adipose tissue. Localized lipoatrophy after a dental intervention is a finding rarely described in scientific literature of head and neck pathology. A 56-year-old woman reported experiencing tissue loss on the right cheek. A maxillary bone graft for the purpose of dental implants had been performed 10 months prior to the first signs. Medical imaging showed no signs of any lytic bone lesions. A fat graft harvested from the abdomen was used to fill the deficit. For a clinician, lipoatrophy even if extremely rare should be considered among the inflammatory complications after a dento-alveolar bone graft. Especially because of its rarity, any coincidental systemic disorder should be excluded during the assessment of the condition.

Dentoskeletal effects of facemask therapy in skeletal Class III cleft patients with or without bone graft

The association between maxillary protraction and bone graft in patients with cleft lip and palate remains unclear. The purpose of this study was to investigate whether a secondary alveolar bone graft influences dentoskeletal effects of facemask therapy in unilateral cleft lip and palate patients with a skeletal Class III relationship. In this prospective nonrandomized clinical trial, 61 consecutive boys with unilateral cleft lip and palate and skeletal Class III malocclusion were divided into 3 groups: grafted facemask group (n=21), ungrafted facemask group (n=20), and untreated control group (n=20). Sixteen dentoskeletal measurements on lateral cephalometric radiographs were compared before and after therapy or observation with 1-way analysis of variance or the Mann-Whitney U test. After facemask therapy, the grafted group showed a statistically significantly greater advancement of Point A (S-Vert-A, 4.18±1.94mm; SNA, 3.51°±2.21°) than did the ungrafted group (S-Vert-A, 2.64±1.58mm; SNA, 1.92°±1.05°). Furthermore, significant SNB changes were found in the grafted group when compared with those in the ungrafted group (-0.38°±1.77° vs -1.69°±1.34°; P<0.05). The changes in the mandibular plane angle (MP-SN, MP-FH) in the grafted group were less pronounced than in the ungrafted group by approximately 2° (P<0.05). Flaring of the maxillary incisors was more pronounced in treated subjects than in untreated subjects. The mandibular incisors proclined in both grafted (1.54°±4.21°) and control (0.97°±3.71°) patients, and were retroclined in the ungrafted group (-2.13°±3.68°). Facemask therapy performed after an alveolar bone graftproduced more anterior maxillary migration (90%) and less pronounced mandibular clockwise rotation (10%) than those in the ungrafted group (50%, 50%, respectively).

Migrarea implanturilor dentare în sinusurile maxilare – un posibil risc de aspergiloză sinuzală

Sometimes the maxillary endosseous implants may migrate into the maxillary sinus, a quarter of them being recorded in maxillary sinus bone grafts. Less frequent it occurs after the occlusal loading or during the prosthetic abutment insertion. The displacement and retention of a dental implant in maxillary sinus causes a chronic sinusitis. One of such infection might be aspergillosis. Clinically the aspergillosis of maxillary sinus may be non-invasive, invasive or allergic. The treatment of non-invasive aspergillosis in immunocompetent individuals consists in surgical removal of infected fungal mass without a systemic antifungal medication. The invasive aspergillosis which is affecting immunocompromised persons has to be treated both by surgical and long-term systemic antifungal therapy. In allergic form the surgical removal of nasal polyp and recreation of the patency of the maxillary ostium are recommended.

Treatment of class II furcation defects with autogenous bone graft associated with Bichat’s fat pad: case report

The periodontal treatment of teeth with furcation defect is clinically challenging. In cases of class II furcation defects, the regenerative surgery shows low morbidity and good prognosis when correctly indicated. The aim of the presentstudy is to report a treatment option for class II furcation defect through autogenous bone graft associated with the Bichat’s fat pad. Case report: A 59-year-old female patient was diagnosed with class II furcation defect in the left mandibular first molar. The treatment comprised surgical reconstruction of the defect with a combination of maxillary tuberosity bone graft and Bichat’s fat pad. The clinical and radiographic follow-up of 180 days showed bone formation inthe furcation area and absence of probing depth. Conclusion: An association of autogenous graft form the maxillary tuberosity with a Bichat’s fat pad proved to be a safe, low cost, and effective therapy for the regenerative treatment of class II furcation.

EFFECT OF PLATELET RICH PLASMA (PRP) TO AUTOGENOUS BONE GRAFT

Bone graft use in maxillofacial surgery is currently developing, though some problems still persist. One of promising solutions to the problems is application of platelet rich plasma which may accelerate soft tissue healing and bone formation. This study aims to provide basic understanding to the development of PRP application in bone healing where bone graft is applied on human maxillae. Bone defects were made on maxillae of albino rabbits, with an application of bone graft in control group and bone graft plus PRP in treatment group. Histopathological analysis was performed in both groups to assess osteoblast density and collagen tissue area. On day 21st, more osteoblast density and collagen area in treatment group are significantly observed (p&lt;0.05, 95% confidence interval). Observations were made on hard callus formation. In conclusions, platelet rich plasma may increase density of osteoblast in rabbit maxillary bone graft.

Treatment of class II furcation defects with autogenous bone graft associated with Bichat’s fat pad: case report

The periodontal treatment of teeth with furcation defect is clinically challenging. In cases of class II furcation defects, the regenerative surgery shows low morbidity and good prognosis when correctly indicated. The aim of the present study is to report a treatment option for class II furcation defect through autogenous bone graft associated with the Bichat’s fat pad. Case report: A 59-year-old female patient was diagnosed with class II furcation defect in the left mandibular first molar. The treatment comprised surgical reconstruction of the defect with a combination of maxillary tuberosity bone graft and Bichat’s fat pad. The clinical and radiographic follow-up of 180 days showed bone formation in the furcation area and absence of probing depth. Conclusion: An association of autogenous graft form the maxillary tuberosity with a Bichat’s fat pad proved to be a safe, low cost, and effective therapy for the regenerative treatment of class II furcation.