Onlay Augmentation Research Articles

Arthroscopic Repair of Retracted Large and Massive Rotator Cuff Tears With and Without Augmentation With a Bio-Inductive Collagen Implant Reveals Substantial and Comparable Clinical Improvement

PurposeThe study objective was to compare clinical and imaging results following repair of retracted large and massive full thickness rotator cuff tears, including revision repairs, with and without augmentation with a bio-inductive collagen implant. MethodsThe study group comprised 24 patients (17 males) with retracted 2-3 tendon rotator cuff tears undergoing arthroscopic repair followed by on-lay augmentation with a bio-inductive collagen implant. The control group comprised 24 patients (19 males) matched by tear size undergoing repair without augmentation. Mean patient age at repair in both groups was 61 years. Active range of motion (ROM) and patient-reported outcomes (PROs) were recorded pre- and post-operatively. Non-contrast high-field MRI was obtained in 20/24 collagen implant patients and 17/24 control patients at minimum 6 months follow-up to assess tendon healing. ResultsASES scores and SST improved from 35 to 86 and 3.6 to 9.3, respectively, in the collagen implant group and from 39 to 87 and 3.9 to 9.7 in the control group. VAS-pain improved from 6.0 to 0.9 and from 5.9 to 0.9 in the collagen implant and control groups, respectively (p<0.001 for all). Overall improvements in ROM and PROs were similar in both groups. MRI revealed intact repairs in 11/20 (55%) patients in the patch group and 9/17 (53%) in the control group. Two patients in each group were revised to reverse shoulder arthroplasty. ConclusionsArthroscopic repair of retracted large and massive rotator cuff tears, including revision repairs, with and without augmentation using a bio-inductive collagen implant results in substantial and comparable early clinical improvement, although predictable healing remains elusive. Further work is needed to optimize patient selection for massive rotator cuff repair and define more precisely the indications for augmentation of these repairs using the collagen implant.

Onlay patch augmentation in rotator cuff repair for moderate to large tears in elderly patients: clinical and radiologic outcomes.

This study evaluated the clinical and radiologic outcomes of onlay patch augmentation in rotator cuff repair for moderate-to-large tears in elderly patients. We reviewed 24 patients who underwent onlay augmentation with dermal allograft after arthroscopic rotator cuff repair from January 2017 to March 2020. Inclusion criteria were patients aged &gt;65 years with tears &gt;2.5 cm, who were followed for &gt;12 months after surgery, and patients who could raise their arms above 90° preoperatively. American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, pain visual analog scale (VAS), and VAS for satisfaction were used as clinical outcomes. For the evaluation of cuff integrity, magnetic resonance imaging scans were performed every 3 months after surgery. The results were compared before and after surgery in all patients and between the retear and intact groups. The average follow-up period was 16.38 months, and the mean age of patients was 71.05 years. All patients showed significant improvement in ASES score, Constant-Murley score, and pain VAS at the last evaluation. The average value of satisfaction VAS was 7.27/10. The retear rate was 25% (6/24) if Sugaya type 3 was categorized in the retear group, otherwise 16.7% (4/24), if Sugaya type 3 was categorized into the intact group. Irrespective of Sugaya type 3 being included in the retear group, there was no significant difference in outcome variables between the intact and retear groups during follow-up. In moderate-to-large rotator cuff tear in elderly patients, onlay patch augmentation improved clinical outcomes. Retear did not adversely affect clinical outcomes.

Efficacy of urethral reconstruction for urethral stricture associated with hypospadias surgery in adults.

We report our experience with urethral reconstruction for hypospadias surgery-related urethral stricture in terms of surgical and patient-reported outcomes. Twenty-nine adult males who underwent urethral reconstruction for hypospadias surgery-related urethral stricture between August 2008 and January 2022 were retrospectively reviewed. Uroflowmetry and patient-reported outcomes were evaluated at 3, 6, and 12 months, and annually thereafter. Surgical success was defined as the absence of additional procedures. Patients were asked to rate their satisfaction with urethral reconstruction as "very satisfied", "satisfied", "unsatisfied", or "very unsatisfied". The median patient age at referral was 43 years. The median number of previously performed hypospadias surgeries was three, and 18 patients (62.8%) had been treated with repeated transurethral procedures. The median stricture length was 54 mm (interquartile range 36-81). Performed urethral reconstruction included staged urethroplasty in 22 (75.9%), one-stage onlay augmentation in 3 (10.2%), and perineal urethrostomy in 4 (13.8%) cases. Urethral reconstruction was successful in 26 patients (89.7%) over a median postoperative period of 31 months. Patient-reported outcomes were assessed in 25 (86.2%) patients. The mean maximum flow rate, international prostate symptom score total score, international prostate symptom score quality of life score, and EuroQol-5 dimensions index significantly improved postoperatively. Twenty-three patients (92%) were "very satisfied" or "satisfied" with the outcome of their urethral reconstruction. Urethral reconstruction is a highly successful and patient-satisfying treatment for hypospadias surgery-related urethral stricture in adult patients. Perineal urethrostomy is a reasonable alternative for elderly patients and for patients with complicated hypospadias surgery-related urethral strictures.

Urethral meatus preserving ventral onlay augmentation urethroplasty for female urethral stricture: our technique with initial experience

BackgroundFemale urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience.MethodsWe performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up.ResultsThere was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period.ConclusionThe technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.

Surgical and patient-reported outcomes of urethroplasty for bulbar stricture due to a straddle injury.

To report our experience with urethroplasty for bulbar stricture due to a straddle injury based on surgical and patient-reported outcomes. Patients who underwent urethroplasty for bulbar stricture due to a straddle injury between 2010 and 2018 were retrospectively analyzed (N = 132). Successful urethroplasty was defined as the absence of the need for additional treatment. The patients completed the validated Urethral Stricture Surgery Patient-reported Outcome Measure and Sexual Health Inventory for Men (SHIM) questionnaires before (baseline) and 1year after urethroplasty. The median (interquartile range) age was 50 (36-62) years; urethral stricture length estimated from urethrograms, 8.6 (5.1-12.5) mm; and postoperative follow-up, 41 (22-56) months. Urethroplasty was performed through excision with primary anastomosis in 95.5% (n = 126) and onlay augmentation with a buccal mucosa graft in 4.5% (n = 6). Urethroplasty was successful in 98.5% (n = 130). The 2 failures due to periurethral abscess were successfully salvaged with another urethroplasty. Eighty-four patients (63.6%) completed the questionnaires at 1year postoperatively. The mean lower urinary tract (LUT)-specific quality of life, SHIM, and EuroQol-visual analog scale scores all improved significantly from 2.6, 8.5, and 57.5 at baseline to 0.3, 11.6, and 84.6 postoperatively (p < 0.0001, p = 0.004, p < 0.0001, respectively). All patients were either "satisfied" (19/84, 22.6%) or "very satisfied" (65/84, 77.3%). Lower postoperative LUT symptom score was an independent predictor of a "very satisfied" patient (odds ratio 0.81, 95% confidence interval 0.67-0.98, p = 0.002). Urethroplasty for bulbar stricture due to a straddle injury has a high success rate and is beneficial for both subjective and objective symptoms.

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews.

Male anterior urethral stricture is scarring of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen, decreasing the urinary stream. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts or flaps, called substitution urethroplasty, has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty, and lingual mucosa harvested from the underside of the tongue has recently emerged as an alternative material with equivalent outcome. Onlay augmentation of oral mucosa graft on the ventral side (ventral onlay) or dorsal side (dorsal onlay, Barbagli procedure) has been widely used for bulbar urethral stricture with comparable success rates. In bulbar urethral strictures containing obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay (Palminteri technique) or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) are the procedures of choice. Most penile urethral strictures can be repaired in a one-stage procedure either by dorsal inlay with ventral sagittal urethrotomy (Asopa technique) or dorsolateral onlay with one-sided urethral dissection (Kulkarni technique); however, staged urethroplasty remains the procedure of choice for complex strictures, including strictures associated with genital lichen sclerosus or failed hypospadias. This article presents an overview of substitution urethroplasty using oral mucosa graft, and reviews current topics.

Surgical techniques used in the rehabilitation of partially edentulous patients with atrophic posterior mandibles: A systematic review and meta-analysis of randomized controlled clinical trials

PurposeGiven the lack of general consensus in the literature regarding the best method to rehabilitate partially edentulous patients with extended atrophic edentulous sites in the posterior zone of the mandible, and with a residual ridge height less than 8 mm (with or without bone augmentation procedures), the aim of this systematic review was to analyze all the relevant randomized clinical trials (RCT), and, by means of a meta-analysis of the collected data, draw some conclusions regarding the best available treatments for the rehabilitation of posterior edentulism in partially dentate mandible. Materials and methodsAn electronic search was conducted in the MEDLINE and Cochrane Oral Health Group databases for studies published between January 2000 and September 2015 with the use of relevant keywords and hand-searching. All identified publications were screened by the authors according to the Cochrane Data Collection Form for Intervention Reviews. Collected outcomes such as biological complications, vertical ridge changes, implant and prosthetic failure were studied by subgroups analyses. ResultsAn initial search yielded 81 potential articles, of which 12 studies were chosen for inclusion. Short implants seemed to be effective in limiting incidence of the biological complications (RR: 2.822; 95% CI: 1.809–4.403; p < 0.0001) and degree of ridge height reduction (difference in means of 0.052 mm; 95% CI: 0.026–0.079 mm; p < 0.0001) when compared with long implants placed in augmented bone. Implants placed in augmented areas with the use of onlay block grafts seemed to behave worse than implants placed in the augmented sites regardless of the augmentation procedures. However, this difference did not reach statistical significance. ConclusionFindings from subgroup analyses revealed that (1) short implants placed in the posterior atrophic areas of partially edentulous mandibles were associated with superior outcomes compared with long implants in augmented bone, such as lower rate of biological complications and of peri-implant bone loss; whereas (2), there was no evidence that onlay augmentation was inferior to any of the other augmentation techniques employed.

V12-04 ONE-STAGE RECONSTRUCTION OF OBLITERATIVE DISTAL ANTERIOR URETHRAL STRICTURES WITH CIRCULAR BUCCAL MUCOSA GRAFT

You have accessJournal of UrologyReconstruction1 Apr 2015V12-04 ONE-STAGE RECONSTRUCTION OF OBLITERATIVE DISTAL ANTERIOR URETHRAL STRICTURES WITH CIRCULAR BUCCAL MUCOSA GRAFT Fikret Fatih Onol, Sinasi Yavuz Onol, Ahmet Bindayi, Ahmet Tahra, Ugur Boylu, and Eyüp Veli Küçük Fikret Fatih OnolFikret Fatih Onol More articles by this author , Sinasi Yavuz OnolSinasi Yavuz Onol More articles by this author , Ahmet BindayiAhmet Bindayi More articles by this author , Ahmet TahraAhmet Tahra More articles by this author , Ugur BoyluUgur Boylu More articles by this author , and Eyüp Veli KüçükEyüp Veli Küçük More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2774AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Distal urethral strictures are common in adult men due to susceptibility of the distal urethra to trauma, infection, and inflammatory diseases. Reconstruction of distal urethral strictures is a challenge for creating both a functional and a cosmetic outlet. Substitution urethroplasty for obliterative distal urethral strictures generally requires a two-stage approach or a complex urethral plate reconstruction combined with onlay augmentation. We report our experience with one-stage distal urethral reconstruction using circular buccal mucosa graft (cBMG). METHODS The data of 24 men (age: 25-72 years) treated with cBMG urethroplasty between 2001 and 2014 were reviewed. Patients were evaluated with AUA symptom score, uroflowmetry, and retrograde urethrography/voiding cystourethrography. The external meatus was involved and the stricture was confined to distal urethra in all cases. The etiology was iatrogenic in 9 and inflammatory in 15 men. Through a circum-meatal incision, the distal strictured urethra was dissected from the healthy glans tissue, and sectioned at the location of proximal healthy urethra. A rectangular BMG with 4 cm. length and 1 to 3 cm. width (depending on the length of the defect) was harvested. The BMG was rolled on a 24Fr urethral sound with its mucosa facing inward, and its long edge was sutured circumferentially to the healthy proximal urethral mucosa. Neo-meatus was then reconstructed with distal anastomosis of the cBMG circumferentially to the initial circum-meatal incision. Foley catheter was removed after 2 weeks. Postoperative data were recorded during an initial visit 7 days after urethral catheter removal and at 1st, 3rd, 6th months, then yearly thereafter. Preoperative AUA symptom score and Qmax measurements were compared with postoperative values obtained at the last follow-up using Wilcoxon sign test. RESULTS With a median follow-up of 36 months (range: 6 to 96), 19 (79.1%) patients were cured. One patient had early graft loss, 2 patients developed stricture at the proximal anastomotic site and 2 patients had re-stricture at the neo-meatus. Mean Qmax(ml/sec) increased from 6.9±5.2 preoperatively to 21.6±9.2 postoperatively (p=0.01), and mean AUA score decreased from 26.1±3.7 preoperatively to 7.8±3.6 postoperatively (p=0.002). CONCLUSIONS Our results suggest cBMG as a feasible alternative in one-stage reconstruction of obliterative distal urethral strictures urethra, since glans penis has a good blood supply that provides an efficient circumferential graft take. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e977-e978 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fikret Fatih Onol More articles by this author Sinasi Yavuz Onol More articles by this author Ahmet Bindayi More articles by this author Ahmet Tahra More articles by this author Ugur Boylu More articles by this author Eyüp Veli Küçük More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Volumetric analysis of implanted biphasic calcium phosphate/collagen composite by three-dimensional cone beam computed tomography head model superimposition

Facial onlay augmentation is often performed as an ancillary procedure simultaneously with orthognathic surgery to improve facial appearance, with hydroxyapatite (HAp) and HAp-based composites often used as the materials of choice. The ability to apply HAp in a granular rather than solid shape form may be responsible for its comparatively reduced rate of complications. However, a known complication of HAp and HAp composites is reduction of implant volume over time associated with resorption of the material. Evaluation of the volumetric changes of implanted biphasic calcium phosphate (HAp/β-TCP)/collagen composite in the malar areas from baseline to 4 months, 9–12 months, and 18–24 months after surgery using cone beam computed tomography (CBCT) surface superimposition and volumetric subtraction was done. The average decrease of volume of implanted HAp/β-TCP 4 months after surgery was 18.6%. Further volumetric decreases were negligible and a mean total volume loss of 21.65% was found at 18–24 months postoperatively.

Clover-Shaped Advancement Flap for Correction of Short and Broad Columella in a Patient with Frontorhiny

This report describes a recessively inherited frontonasal malformation termed "frontorhiny" in recent literature. The authors developed a modified open rhinoplasty incision for correction of a broad, swollen columella due to frontorhiny. The clover-shaped flap was composed of a central V–Y advancement flap and bilateral folding flaps. This report relates the case of an 8-year-old girl with a broad columella and poor nasal tip development treated by a clover-shaped flap with dorsal onlay augmentation using autologous rib cartilage. This clover-shaped flap technique may be useful not only in frontorhiny cases but also in other cases of a short and broad columella. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Comparison of calcium phosphate preparations for onlay cranial augmentation in a murine model

Calcium phosphate preparations are often employed for a variety of reconstructive tasks. The majority of existing data regarding these preparations relates to their use as an inlay implant. The present study aims to evaluate calcium phosphate preparations and their tissue characteristics related to onlay augmentation. Thirty-six research mice were divided into three groups of 12. Each animal underwent onlay augmentation with a calcium phosphate preparation. Group 1 members were subjected to hydroxyapatite (HA) paste while group 2 was treated with beta-tricalcium phosphate granules alone (TCP). Finally, group 3 was treated with a combined mixture of both substances (HA-TCP). The animals were harvested for histological analysis and data collection. Groups 2 (TCP) and 3 (HA-TCP) developed greater osteoneogenesis and tissue integration compared to Group 1 (HA). The results were found to be statistically significant (p < 0.01). Calcium phosphate preparations including TCP alone or in combination with HA undergo greater osteoneogenesis and soft tissue integration compared with hydroxapatite alone when used as an onlay implant in the animal model. Therapeutic study — Level II.

Regarding “Application-Specific Selection of Biomaterials for Pediatric Craniofacial Reconstruction: Developing a Rational Approach to Guide Clinical Use”

Background Biomaterials provide an invaluable alternative to autogenous bone graft for pediatric craniofacial reconstruction. However, there is no uniform agreement on the choice of biomaterial for different reconstructive needs. Methods Patients who had reconstruction of the craniofacial skeleton with alloplastic materials from 1994 to 2006 by a single surgeon were reviewed. Biomaterials used consisted of three classes: cement pastes, biomaterials designed to be replaced by bone, and prefabricated polymers. The study included 25 patients with a mean age of 5.5 years and a mean follow-up of 3.3 years. Results Cement pastes used for onlay augmentation to the cranial skeleton in eight patients consisted of hydroxyapatite (n = 5) and calcium phosphate (n = 3). One patient had a postoperative infection that resolved with partial implant removal and antibiotics. Biomaterials designed to be replaced by bone consisted of bioactive glass (n = 3) and demineralized bone (n = 8), which were used for inlay reconstruction of full-thickness calvarial defects in 11 patients. Computed tomographic scanning showed adequate bone mineralization in nine patients; two of the three patients with calvarial defects greater than 5 cm in diameter demonstrated variable mineralization. Prefabricated porous polyethylene was used in six patients for either onlay malar augmentation (n = 3) or inlay calvarial reconstruction (n = 3). One patient had a peri-implant infection that resolved with aspiration, irrigation, and intravenous antibiotics. Conclusions The authors developed an algorithm to guide use of biomaterials in craniofacial reconstruction based on whether (1) growth of the underlying craniofacial skeleton is nearly complete (>90 percent); (2) onlay or inlay reconstruction is to be performed; and (3) the reconstruction is performed in a load-bearing or non-load-bearing area.

Application-Specific Selection of Biomaterials for Pediatric Craniofacial Reconstruction: Developing a Rational Approach to Guide Clinical Use

Biomaterials provide an invaluable alternative to autogenous bone graft for pediatric craniofacial reconstruction. However, there is no uniform agreement on the choice of biomaterial for different reconstructive needs. Patients who had reconstruction of the craniofacial skeleton with alloplastic materials from 1994 to 2006 by a single surgeon were reviewed. Biomaterials used consisted of three classes: cement pastes, biomaterials designed to be replaced by bone, and prefabricated polymers. The study included 25 patients with a mean age of 5.5 years and a mean follow-up of 3.3 years. Cement pastes used for onlay augmentation to the cranial skeleton in eight patients consisted of hydroxyapatite (n = 5) and calcium phosphate (n = 3). One patient had a postoperative infection that resolved with partial implant removal and antibiotics. Biomaterials designed to be replaced by bone consisted of bioactive glass (n = 3) and demineralized bone (n = 8), which were used for inlay reconstruction of full-thickness calvarial defects in 11 patients. Computed tomographic scanning showed adequate bone mineralization in nine patients; two of the three patients with calvarial defects greater than 5 cm in diameter demonstrated variable mineralization. Prefabricated porous polyethylene was used in six patients for either onlay malar augmentation (n = 3) or inlay calvarial reconstruction (n = 3). One patient had a peri-implant infection that resolved with aspiration, irrigation, and intravenous antibiotics. The authors developed an algorithm to guide use of biomaterials in craniofacial reconstruction based on whether (1) growth of the underlying craniofacial skeleton is nearly complete (>90 percent); (2) onlay or inlay reconstruction is to be performed; and (3) the reconstruction is performed in a load-bearing or non-load-bearing area.

Dentin dysplasia type I: a challenge for treatment with dental implants

BackgroundDentin dysplasia type I is characterized by a defect of dentin development with clinical normal appearance of the permanent teeth but no or only rudimentary root formation. Early loss of all teeth and concomitant underdevelopment of the jaws are challenging for successful treatment with dental implants.MethodsA combination of sinus lifting and onlay bone augmentation based on treatment planning using stereolithographic templates was used in a patient with dentin dysplasia type I to rehabilitate the masticatory function.Results(i) a predisposition for an increased and accelerated bone resorption was observed in our patient, (ii) bone augmentation was successful using a mixture of allogenic graft material with autogenous bone preventing fast bone resorption, (iii) surgical planning, based on stereolithographic models and surgical templates, facilitated the accurate placement of dental implants.ConclusionBony augmentation and elaborate treatment planning is helpful for oral rehabilitation of patients with dentin dysplasia type I.

Bone Reconstruction of the Maxillary Alveolus for Subsequent Insertion of a Dental Implant in Patients With Cleft Lip and Palate

Bone grafting of maxillary alveolus cleft defect followed by insertion of dental implant may be a good alternative to conventional prosthetic treatment. The principle is the formation of stable alveolar crest with a sufficient three-dimensional volume. The problems are lack and quality of mucoperiosteum for the reconstruction of shell and bone gap characteristics for bone graft intake. The procedure was carried out by a single surgeon (MD) in 45 patients between 29 August 2001 and 30 June 2006, with an 86.7% success rate. The success was defined as completed process with dental implant insertion and its loading by a prosthetic suprastructure without a failure for at least 15 months from that last step. The success rate mainly depends on 1) good alveolar arch flow of maxilla segments in both horizontal and vertical planes; 2) the height of osseous poles of at least 12 mm and onlay augmentation of built-up section does not work; 3) adequate volume of cancellous bone graft, 3.7 cm on average. On the basis of histologic verification and clinical findings, the bone graft is matured enough to ensure a primary stability of a fixture in 12.5 weeks after reconstruction. Early load may prevent bone resorption. Prediction of complications are as follows: 1) graft resorption increases according to gap size and low possibility of revascularization; 2) a higher number of complications are linked to presence of oronasal fistula and to scarring of soft tissues; 3) because of more gracile skeleton and female metabolism, the risk is higher in women.

Dorsal onlay augmentation urethroplasty with small intestinal submucosa: Modified Barbagli technique for strictures of the bulbar urethra

To present the results from one clinic's experience of using small intestinal submucosa (SIS) in augmentation urethroplasty for management of strictures of the bulbar urethra. Urethral surgery was performed in nine men with strictures 4-6 cm. All of the patients were evaluated by history, physical examination, retrograde urethrogram, and uroflowmetry. Four layers of SIS were soaked in saline or Ringer's solution for 15 minutes at 37 degrees C, and the inner surface of the patch was gently fenestrated with a thin scalpel. The patch was spread-fixed onto the tunica albuginea. The mucosa was sutured to the submucosal graft first at 2-3 mm inwards from the SIS margins, then the spongiosum tissue was attached to the margins with interrupted absorbable sutures. Of the nine patients who underwent augmentation urethroplasty using SIS, only one had re-stricture at 6 months due to urethral infection. At 18 months after the surgery the uroflowmetry of the other eight patients was 20-21 mL/s. In terms of complications, six patients reported having post-micturition dribbling, and seven patients reported lack of morning erections for 35-69 days after surgery. Using SIS is a safe procedure; however, long-term follow-up is needed to substantiate the good short-term results.

Onlay augmentation versus sinuslift procedure in the treatment of the severely resorbed maxilla: a 5-year comparative longitudinal study

Augmentation procedures in the severely resorbed maxilla are standard techniques in preprosthetic surgery. Aim of the present study was to compare onlay bone grafting and sinus floor elevation with autogenous bone grafts in edentulous patients in terms of bone resorption of the posterior alveolar crest and implant survival in a 5-year longitudinal study. A total of 100 patients (53 female and 47 male patients) requiring augmentation using autogenous bone due to a severely resorbed maxillae were evaluated. The degree of resorption and bone quality were preoperatively estimated in panoramic radiographs according to Lekholm and Zarb. The overall 5-year success rate of implants placed after augmentation procedures in the posterior maxilla was 93.1%. Following onlay augmentations 215 out of 235 implant insertions were successful, i.e. a success rate of 91.5% was achieved. In the sinuslift group, 330 out 349 implants remained successful, i.e. a success rate of 94.6% was found. The difference between both groups was statistically significant at the end of the evaluation period. Bone resorption, measured as loss of total bone height in panoramic radiographs, was initially more pronounced following onlay augmentations (>20% after 12 months of observation). The degree of resorption decreased in the further course of the study. Lower resorption rates and a higher overall success rate were demonstrated for the sinus lift group.

Oculoplastic and orbital applications of porous high-density polyethylene implants.

Porous high-density polyethylene implants have become well accepted for the repair of orbital wall fractures, delayed orbital reconstruction, orbital rim and malar bony onlay augmentation, and volume replacement as orbital spherical implants for the treatment of anophthalmos. Medpor (Porex Surgical, Inc. College Park, GA) is a commercially available porous high-density polyethylene product available in sheets, blocks, Flexblocks, several onlay contour shapes, spheres, and custom implants. Recently, the motility coupling post was introduced to provide an integrated Medpor spherical implant with enhanced prosthetic motility. Medpor implants possess several advantages over hydroxyapatite implants.

Interposed bone grafts to accommodate endosteal implants for retaining mandibular overdentures A 1–7 year follow-up study

The results are reported on 34 edentulous patients, who underwent interposed autogenous bone graft augmentation in the symphysis of the mandible, combined with bone-hydroxylapatite onlay augmentation of the area posterior to the mental foramina. Two to four implants were placed in the grafted symphysis after 3–5 months. An overdenture was constructed three months later. The follow-up period ranged from one to seven years. Ninety-five percent of the implants were functioning adequately at follow up. An average loss of mandibular bone height of 10–13% was observed. The data provided no evidence of a further time-dependent resorption from two-and-a-half to seven years.

Iliac apophyseal cartilage augmentation of the deficient piriform rim and maxilla in alveolar cleft grafting

This article presents a new approach to cleft lip and cleft palate repair, where the retained bulk of alveolar cleft grafts is augmented by simultaneous cartilage augmentation of the deficient maxilla. Nine patients who provided 10 cleft sites underwent secondary bone grafting of the clefted alveolus by this technique. This study evaluates the following: (1) the postoperative esthetic results, (2) the quantity of bone in the grafted area, and (3) the provision of bone support for unerupted teeth, for teeth adjacent to the cleft, and for orthodontic tooth movement when the secondary bone grafting of the cleft is integrated with the onlay augmentation of the deficient maxilla. Photographic and radiographic investigations were undertaken. The photographic evaluation showed that all patients exhibited improved facial esthetics in the area of the cleft, particularly in the paranasal area of the maxilla; improved alar base support, symmetry of the columella, and less deviation of the tip of the nose were seen. The radiographic evaluation indicated the following: (1) the average percentage of the alveolar bone height of the grafted area was equal to 76% of the normal side; (2) nine canines erupted or were erupting through the grafted area; there were no adequate records to evaluate the fate of the remaining canine; (3) no teeth involved in the cleft area were ankylosed, because of inadequate records, so evaluators could not determine the status of one tooth; (4) all patients had adequate quantity of bone for orthodontic tooth movement through the grafted area; and (5) the periodontal support of the teeth involved in the cleft was adequate.