Preprosthetic Surgery Research Articles

Rehabilitation of patients that present impacted teeth: avoiding preprosthetic surgical procedures

Rehabilitation of patients that present impacted teeth: avoiding preprosthetic surgical procedures

WITHDRAWN: Interventions for replacing missing teeth: preprosthetic surgery versus dental implants.

WITHDRAWN: Interventions for replacing missing teeth: preprosthetic surgery versus dental implants.

Maxillary Segmental Micro Osteotomy: A Human Cadaver Study on the Efficacy of the Technique.

Ultrasonic bone cutting was recently introduced as a feasible alternative to the conventional tools of cranio-maxillofacial surgery because it offers improved precision and safety.This study examined the feasibility of minimally invasive orthodontic or preprosthetic surgery using a piezosurgery device for latero-posterior maxillary segmental osteotomy. Four fresh cadaveric heads were obtained for this study. Maxillary posterior osteotomy was performed using piezoelectric surgery. To preserve the vascular supply, only 1 vestibular incision was made during surgery. The Mectron Piezosurgery unit is a multipurpose device that uses micrometric ultrasonic piezoelectric vibrations with a variable frequency and cutting energy. The strategy for maxillary osteotomy included 1 horizontal osteotomy, 2 vertical osteotomies, and 1 palatal osteotomy performed transantrally without incision of the mucoperiosteum. The osteotomies were performed using a piezodevice (OT7-type inserts: 0.55 and 0.35 mm). In total, 1 horizontal cut (3 mm above the roots of the teeth), 2 vertical bone cuts, and 1 palatal osteotomy were made without incision of the palatal mucoperiosteum.Gentle dissection of the buccal fat pad was used to promote the healing of hard and soft tissues in the osteotomized zone. No damage to soft tissues, including the palatal mucosa, occurred. The buccal fat pad was mobilized easily without requiring an additional incision. The osteotomic sites were linear and clean in the palatal aspect. The integrity of the vascular network was maintained because of the lack of damage to the palatal mucosa. No chisels were used during the osteotomies. This cadaveric study shows the feasibility of using piezosurgery for segmental maxillary osteotomy. This report outlines a new and simple application of segmental maxillary micro-osteotomy.

Piezoelectric surgery vs rotary instruments for lateral maxillary sinus floor elevation: a systematic review and meta-analysis of intra- and postoperative complications.

Lateral maxillary sinus floor elevation (LMSFE) is a predictable preprosthetic surgical procedure that is used to overcome the limitations of the atrophied alveolar ridge for the placement of oral implants. Techniques using piezoelectric devices (PEDs) and conventional rotary instruments have been described for LMSFE in the literature, with little information regarding their efficiency in terms of membrane perforation, operating time, and implant outcomes. The aim of this systematic review was to examine the intra- and postoperative events associated with the use of PEDs and conventional rotary instruments for LMSFE. This systematic review was prepared according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature was searched for studies comparing the use of PEDs with conventional rotary instruments for LMSFE. The Cochrane Collaboration risk of bias tool was used to assess the studies selected, and meta-analyses were performed using statistical software. A total of 124 citations were identified. Of these, four studies with 178 LMSFEs in 120 participants were included. The pooled estimates for the risk of sinus membrane perforation did not show any significant difference between the two surgical techniques (risk ratio, 0.87; 95% confidence interval, 0.40-1.91; P = .73). Similarly, no significant difference in implant failure was found after 1 year of functional loading. The overall meta-analysis showed a statistically significant difference in the operating time between the two techniques with more time required for PED. The intra- and postoperative events associated with the use of PEDs and conventional rotary instruments for LMSFE are comparable.

EVALUATION OF PLATELET RICH FIBRIN IN SINUS LIFTING WITH SIMULTANEOUS IMPLANT PLACEMENT

Introduction: Rehabilitation of the edentulous posterior maxilla with dental implants is challenging. The deficient alveolar ridge interferes with implant insertion of adequate length placed in the correct position and with the accurate inclination. The maxillary sinus elevation procedure has become an important preprosthetic surgical procedure for bone creation in the posterior maxilla prior to implant placement. The use of PRF during sinus-lift procedures has been advocated for many years. Objectives: This study was designed to evaluate the use of platelet rich fibrin (PRF) following sinus lifting with piezosurgery and simultaneous implant placement. Materials and methods: 7 patients were selected to perform sinus lifting with simultaneous implant placement using PRF as a sole agent and piezosurgery device. Results: Cone beam computerized tomography 6 months postoperatively showed statistically significant increase in bone height and density. The mean of the newly formed bone height was (6.55 ± 1.14 mm). The mean postoperative bone height measured from the floor of the maxillary sinus and alveolar crest was (11.35 ± 0.56 mm). The mean of the newly formed bone density was 507 HU. The mean of the postoperative bone density around the implants after 6 months was (547.71 ± 188.42 HU). The mean marginal bone loss was (0.82 ± 0.25 mm). Conclusion: PRF could be successfully used as a sole agent for bone regeneration in lateral sinus lifting with simultaneous implant placement.

Clopidogrel is not associated with increased bleeding complications after full-mouth extraction: A retrospective study

BackgroundTo the authors' knowledge, the effect of clopidogrel on bleeding complications during full-mouth extraction has not been studied. The authors aimed to determine the safety of continued use of clopidogrel during full-mouth extraction. MethodsThe authors performed a retrospective study of consecutive patients undergoing full-mouth extraction who were taking aspirin, clopidogrel, a combination of aspirin and clopidogrel, or neither. The main study outcomes in the 4 study groups were estimated blood loss, transfusion requirements, and complications. The authors also examined the correlation between the number of teeth extracted and estimated blood loss in various groups. ResultsSeventy-one patients underwent full-mouth extraction with removal of an average of 19 teeth. The authors excluded 3 patients owing to lack of data regarding blood loss. Of the remaining 68 patients, 25 were using aspirin, 12 were using clopidogrel, 9 were using both aspirin and clopidogrel, and 22 had discontinued the use of antiplatelets. There was no significant difference in the number of teeth extracted (P = .283) and estimated blood loss (P = .111) among the 4 groups. The authors found a significant moderate correlation between the number of teeth extracted and estimated blood loss in the group using aspirin (r = 0.537; P = .006) and in the group using clopidogrel, whether alone or in combination with aspirin (r = 0.535; P = .012), but not in the group who discontinued the use of antiplatelets. There was no need for blood transfusion in any patient. ConclusionsThe results of this study provide limited evidence to suggest that continuation of clopidogrel during full-mouth extraction and preprosthetic surgery may be safe and does not appear to be associated with a significant risk of bleeding. Practical ImplicationsClopidogrel therapy during full-mouth extraction is not associated with significant bleeding complications and may be continued in patients who have a high risk of experiencing a cardiac event.

An unusual clinical manifestation of ossified styloid complex: Diagnosis and treatment

The stylohyoid complex (SC) connects the temporal bone to the hyoid bone and may suffer anatomical variations that are represented by an increase in length of the styloid process or ossification of the stylohyoid ligament. Reported here is a case of a 58-year-old asymptomatic patient who presented an unusual clinical manifestation on the floor of the mouth, which precluded the installation and adaptation of dental prostheses. The first diagnostic hypothesis was sialolithiasis. Panoramic radiography and cone-beam computed tomography revealed a massive ossified SC. Preprosthetic surgery was performed. The present case report highlights that the styloid complex may present unusual anatomical variations which can be clinically and radiographically detectable.

Panoramic study of mandibular basal bone height

Aims and Objectives: To provide information regarding the changes of mandibular basal bone height using panoramic radiography, in relation to age, sex, and the state of dentulousness, which could be utilized in clinical practice, especially in implantology and pre-prosthetic surgery. Materials and Methods: A total of 200 subjects, who were categorized according to age, sex, and state of dentulousness, were subjected to vertical measurements of mandibular basal bone in panoramic radiographs. Two measurements were made, D 1 and D 2 . The distance measured between the lower border of mental foramen to the lower border of the mandible was termed as D 1 . The distance between the lowest point of mandibular canal to the lower border of the mandible was termed as D 2 . These measurements were compared between males/females and dentulous/edentulous, which were further subjected to statistical analysis with Student's t -test. Results: Males had higher D 1 and D 2 values compared to females and edentulous groups had higher D 1 and D 2 values compared to dentulous subjects. Conclusions: Men have higher values of mandibular basal bone height compared to females and also that there exists some potential for mandibular basal bone to increase in height as the age progresses.

Customizing guidance flange prosthesis for management of segmental mandibulectomy

Treatment of benign and malignant tumors may involve surgical resection of the mandible, which may be segmental or hemisectioned. The prosthetic rehabilitation of resected mandible becomes difficult when preprosthetic planning is not considered. Preprosthetic plastic surgery and/or implant assisted overdenture may enhance the prosthetic rehabilitation of edentulous patients who have undergone resection of the mandible. Due to medical conditions, unwillingness for additional surgery or economical restraints, the treatment is limited to guidance flange prosthesis. The guidance flange prosthesis helps in directing the deviating mandible to improve form and function. This case report describes a procedure for fabricating customized guiding flange prosthesis to rehabilitate edentulous segmental mandibulectomy.

Piezosurgery in Periodontics

ABSTRACT Piezosurgery is a new and innovative method that uses piezoelectric ultrasonic vibrations to perform precise and safe osteotomies. It was first invented by Tomaso Vercelotti to overcome the limitations of traditional instruments in oral bone surgery. Its use was first reported in the field of preprosthetic surgery alveolar crest expansion and sinus grafting. It provides substantial improvement dental/implant surgery, benefiting the surgeon by ease of use and the patient by minimizing surgical trauma and promoting rapid healing. Manual is used to remove small amounts of bone in areas with relatively less dense mineralization. The manual instruments are difficult to control in cortical bone, particularly where precise osteotomies are essential. They are mostly applied for gross cutting of large bone segments. Motor Driven instruments are often used when bone is very dense. Motor driven instruments transform electric or pneumatic energy into mechanical cutting action using the sharpened edge of burs or saw blades. These instruments generate a significant amount of heat in the cutting zone that must be minimized by water irrigation overheating of adjacent tissue may alter or delay the healing response. The reduced rotational speed decreases not only frictional heat but also cutting efficiency. Motorized cutting tools also decrease tactile sensitivity, slower rotational speed necessitates increased manual pressure which increases the macro-vibration of the cutting tool and further diminishes sensitivity. This article discusses about the wide range of application of piezoelectric technique. How to cite this article Devi S, Swaminathan M, Karthikeyan I, Anitha K. Piezosurgery in Periodontics. Int J Prosthodont Restor Dent 2015;5(2):51-55

Mandibular Anterior Immediate Denture Using Visible Light Cure Acrylic

Management of a 51-year-old female of Afro Trinidadian descent required removal mandibular incisors. This patient’s periodontal condition and her inability to afford pre-prosthetic surgery, bone grafting or even a fixed partial denture for replacement of the proposed units after extraction necessitated alternative treatment options to implants. Her profession required interaction with the public and as such an immediate replacement was essential. Impressions were taken and an immediate partial denture fabricated using a visible light cure acrylic. The mobile teeth were extracted and the denture delivered to the patient with minimal adjustments. The patient was monitored for three months while healing of the extraction site occurred and her periodontal condition was treated. Inability to afford definitive treatment for one year required the denture be maintained for that period. Follow up showed that the aesthetics, function and structural integrity of the denture had not been compromised.

Vestibuloplastia con láser. Reporte de caso

One of the greatest challenges when rehabilitating fully edentulous patients, is to manufacture a denture to be placed on an alveolar ridge with advanced bone resorption. This requires performing preprosthetic surgery and prepare groundwork bone and surrounding soft tissues to receive a tissue-borne prosthesis, as well as providing suitable retention and support. This will elicit lesser trauma and thus allow prompt tissue healing. The case here presented is that of a 56 year old female, with non-contributory medical history. The patient had been wearing dentures for the last 14 years; her dentures were ill-adapted. Intra-oral clinical examination revealed collapsed and re-absorbed ridges. Due to a lack of retention in the lower ridges, a laser surgery was performed to deepen the vestibule. 18 days after surgery tissues were completely healed, the vestibule had recovered 6mm depth in the anterior section and 4mm in the posterior section. Rehabilitation was completed with the manufacture of full bimaxillary dentures. It was thus concluded that laser vestibuloplasty confers depth to the vestibule and offers the advantages of laser incision, which decreases hemorrhage, provides better operating field and reduces post-operative inflammation and pain.

In vivo comparative model of oxygen plasma and nanocomposite particles on PLGA membranes for guided bone regeneration processes to be applied in pre-prosthetic surgery: A pilot study

ObjectivesTo evaluate the bone regeneration potential of a new membrane fabricated with polyglycolide acid (PLGA) after being treated with oxygen plasma (PO2), and/or being functionalized with silicon dioxide (SiO2) or titanium dioxide (TiO2) nanoparticles. MethodsBone defects (5mm×3mm) were produced on the top of 3 experimentation rabbits’ skulls and were covered with variously modified PLGA scaffolds. After the animals were sacrificed, neoformed bone (%), mineralized bone (mm), bone resorption (%), osteoclasts/mm2, and intensity of osteosynthetic activity, were assessed under microscope. ResultsThe following groups were formed depending on the type of membrane: PLGA (control); PLGA/PO2; PLGA/SiO2; PLGA/TiO2; PLGA/PO2/SiO2; and PLGA/PO2/TiO2. The histological sections showed bone layers in advanced stages of formation. The highest percentages of neoformed bone corresponded to PLGA/PO2/SiO2 membranes (59.07%; p=0.31) followed by PLGA/PO2 barriers (50.27%). The controls showed the lowest mineralization (13.89mm; p=0.24). PLGA/TiO2 scaffolds exhibited the least bone resorption (4.45%; p=0.77) and osteoclasts/mm2 (1.58; p=0.86). PLGA/SiO2 and PLGA/TiO2 membranes stimulated the maximum osteosynthetic activity. ConclusionsThe treatment of PLGA barriers with PO2 increased bone regeneration in rabbits. When comparing the effect of PO2/SiO2 and PO2/TiO2, higher percentages of neoformed bone were encountered after silicon-dioxide coating. Clinical significanceThe incorporation of SiO2 nanoparticles onto PO2-treated PLGA membranes was the most promising technique out of those investigated to promote bone formation in rabbits. The addition of SiO2 or TiO2 layers to PLGA substrates may stimulate the osteosynthetic activity, which might be useful to restore bone dimensions in preparation for naturally appearing dental prostheses.

Clinical application of CO2laser in dentistry: A case series

Surgical lasers have been well accepted by all disciplines of healing arts as useful adjunct to care of patients. The attitude toward their use has changed from one of gee-whiz appreciation for modern technology to that of acceptance of lasers as standard surgical instruments. The applications of Laser technology in dentistry and medicine have now entered the age of sophisticated and rational treatment. This presentation is an attempt to distil our experience with the patients in various periodontal soft and hard tissue procedures such as biopsies, frenectomies, white lesions, vesicullobulous lesions, preprosthetic surgery and dentinal hypersensitivity with the use of Carbon dioxide laser. Laser device used for all intra oral procedures in the presentation is LASERSAT TM Carbon dioxide Laser Manufactured by SATELAC R . Dental Laser safety and protection protocol was strictly followed. All patients responded well to Laser treatment with complete healing of lesions with no post operative complications. No recurrence of any lesion was reported at follow up visits. Lasers have become an integral part of periodontal surgeons' armamentarium. They have proved to be useful as adjunct to conventional treatment modalities in various soft and hard tissue intraoral procedures with better patient acceptance.

Complications and medicolegal problems.

Oral and maxillofacial surgery deals with a wide variety of treatment areas. In detail, it includes minor oral surgeries such as extractions, pre-prosthetic surgery, implant surgery, traumatology, oncology, reconstructive surgery, dentofacial deformities, temporomandibular disorders, infections, salivary gland surgery, orofacial pain, esthetic surgery, and surgery on medically compromised patients. Therefore, to become a specialist, continuous study to acquire a wide range of medical knowledge and hard training is required. In carrying out professional treatments of oral and maxillofacial surgery, complications related to surgical treatment are unavoidable. Surgeons are bound to experience complications and medical disputes, great and small. Although minor and known complications are easily settled, unexpected and/or unusual complications occur continuously. In rare cases the complications of infectious diseases can be worsened and bring about fatal results, and severe systemic complications can occur after surgical treatment for medically compromised patients. For example, the occurrence of facial nerve paralysis after orthognathic surgery or progressive lipodystrophy and auditory changes after implant surgery and orthognathic surgery, respectively, perplex surgeons1,2,3. Patients may think the operation went wrong and the medical team may claim that the complication has nothing to do with the operation and thus they have no responsibility for it. In these situations, the occurrence of a medical dispute between the two parties is unavoidable. All responsibility for the occurrence of complications does not rest with the medical team. If a medical team is well aware of the presumed cause and treatment of complications, and offers detailed explanations to patients during the course of treatment, most complications can be settled without big problems, and medical disputes can be minimized. Even if any fatal complication occurs, performing an appropriate treatment with best efforts will not put the medical team at a disadvantage in a medical dispute. The number of medical disputes has been rapidly increasing recently, and is expected to keep increasing. The major cause of medical disputes is a lack of communication with the patient and complications that occur after treatment. Complications can occur even when normal treatment has been performed. Oral and maxillofacial surgeons should be well aware of the problems and various complications related to surgical treatments, explain them well to patients, and actively cope with them. Patients are not totally ignorant in respect to medicine, and both their interest in their own health and their medical common sense have noticeably increased. Also, patients request the investigation of causes and want detailed explanations when inappropriate results are brought about; if a medical team does not cope with this appropriately, it can lead to medical disputes, and in many cases a judge will decide against the medical team and hospital. To conclude, I would like to emphasize the following. Medical teams should pay attention to various problems and complications related to surgical treatment and actively cope with them. When a complication occurs, the medical team should explain it to the patient in detail and do their best to settle it. The most important way to minimize medical disputes is for a medical team to have close relationships with patients.

Maxillary sinus perforation with presence of an antral pseudocyst, repaired with platelet rich fibrin

The maxillary sinus lifting procedure is an important preprosthetic surgical procedure for the creation of adequate bone volume in the edentulous posterior maxilla for the placement of dental implants. The presence of a maxillary sinus cyst has been considered a contraindication for this operation. Perforation of the membrane and hence the elongation of the healing time for implant placement is the most common complication in this type of procedure. The purpose of the case is to show the safely repair of the large sinus perforation during the sinus lifting with presence of the antral pseudocyst. In this case, we present a patient who had a maxillary sinus lifting procedure in the presence of antral pseudocysts. No complications were seen during follow-up periods and all implants are functioning successfully. Platelet-rich fibrin may be used safely when large perforation occurs during the sinus lifting with the presence of an antral pseudocyst.

Repositioning of the Mental Nerve in Case of Severe Mandibular Atrophy: A Case Series

ABSTRACT Following tooth extraction, cortical bone suffers greater resorption on the vestibular area and patients typically present narrow and low alveolar crests. In case of moderate to severe mandibular atrophy; the bone height between alveolar crest and mental nerve is too narrow and patients may feel pain under pressure. Repositioning of the mental nerve is an effective preprosthetic surgery procedure in patients with hyperesthesia caused by dental prosthesis. As well as this surgical repositioning of the mental nerve facilitates the placement of implants can prevent pain, in overdenture prosthesis and fixed dentures. In this report, mental nerve repositioning, implant placement in the interforaminal region of the mandible and prosthetic rehabilitation of two cases with hyperesthesia due to severe mandibular atrophy is presented. Nerve repositioning may constitute a treatment alternative in patients with a consequent risk of mental nerve damage during the placement of dental implants. How to cite this article Kadioglu MN, Senturk MF, Oncul AMT, Cambazoglu M. Repositioning of the Mental Nerve in Case of Severe Mandibular Atrophy: A Case Series. Int J Experiment Dent Sci 2014;3(1):41-43.

Options to avoid the second surgical site: a review of literature

As esthetics gain importance, periodontal plastic surgical procedures involving soft tissue grafts are becoming commoner both around natural teeth as well as around implants. Periodontal soft tissue grafts are primarily used for the purpose of root coverage and in pre-prosthetic surgery to thicken a gingival site or to improve the crestal volume. Soft tissue grafts are usually harvested from the palate. Periodontal plastic surgical procedures involving soft tissue grafts harvested from the palate have two surgical sites; a recipient site and another donor site. Many patients are apprehensive about the soft tissue graft procedures, especially the creation of the second/donor surgical site in the palate. In the past decade, newer techniques and products have emerged which provide an option for the periodontist/patient to avoid the second surgical site. MucoMatrixX, Alloderm(®), Platelet rich fibrin, Puros(®) Dermis and Mucograft(®) are the various options available to the practicing periodontist to avoid the second surgical site. Use of these soft tissue allografts in an apprehensive patient would decrease patient morbidity and increase patient's acceptance towards periodontal plastic surgical procedures.

Modern Therapy for Severe Alveolar Ridge Atrophy

This clinical report illustrates a modern method for oral rehabilitation of severe edentulous atrophic ridge. Shallow vestibule and small denture-bearing area of the maxilla provide insufficient retention, and only the symphyseal region of the mandible has obvious alveolar ridge. The surgery of deepening vestibule of the maxilla ridge was done by using tentative miniscrew combined with old denture and soft liner. The osseointegrated dental implants were installed over symphyseal region of the mandible to act as retentive devices for prostheses. In addition, functional reline with rebase material to build buccal-tongue contact over the retromolar area after denture delivery obtained high satisfaction from the patient. Many clinical conditions cannot be managed solely with implants or preprosthetic surgery alone, whereas a combination of the 2 can achieve successful outcome.

Incidence of osteoradionecrosis following oral and maxillofacial surgery in irradiated head and neck cancer patients

Aim The aim of this study was to investigate the incidence of osteoradionecrosis following various surgical procedures, including tooth extraction, periodontal surgery, pre-prosthetic surgery, removal of bone spicules and removal of bone reconstruction/osteosynthesis plates. Material and methods The charts of 68 patients who had undergone post-radiotherapy surgical procedures were reviewed. The following information was obtained: gender, age, radiotherapy dose and field, type of surgical procedure and time between the end of radiotherapy and the surgical procedure. Results Osteoradionecrosis developed in 14 patients and did not statistically correlate with gender, radiotherapy dose and field or time between the end of radiotherapy and the surgical procedure. Removal of bone spicules was significantly associated with osteoradionecrosis (P = 0.033), compared with tooth extraction, pre-prosthetic surgery, removal of reconstruction/osteosynthesis plates and periodontal surgery. Conclusions Our findings show removal of bone spicules is a significant risk factor for the development of osteoradionecrosis, suggesting that careful evaluation and management of spicules in previously irradiated patients is particularly important in the prevention of osteoradionecrosis.