Alveolar ridge preservation and reconstruction.
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Biomedical subjects
Publications and source records attributed to J S Seibert.
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Esthetic reconstruction of large-volume Class III ridge deformities where bone and soft tissue have been lost buccolingually as well as apicocoronally continues to offer a major challenge in therapy to periodontists and to those engaged in advanced reconstructive dentistry. No single procedure is well suited for solving all problems in reconstructive surgery. A series of staged surgical procedures is frequently necessary to augment the ridge to its former dimensions. The authors have devised a combination onlay-interpositional graft procedure that appears to offer promise in solving many of the problems encountered in gaining predictable soft tissue ridge augmentation in Class III ridge defects.
A conscious effort should be made at the time of tooth extraction to eliminate or lessen the creation of a defect within the residual alveolar ridge. This objective can be achieved if teeth are extracted in an atraumatic manner and appropriate implant materials are placed into the sockets to prevent the eventual collapse of the ridge. Guided tissue regeneration procedures also may be used to prevent collapse within the ridge or augment an existing defect. In many instances, deformed ridges can be augmented to their former dimensions by the use of pouch, interpositional, or onlay graft procedures. Case reports are presented to show the effectiveness of these procedures.
There are a number of periodontal plastic surgery procedures that can be used to reconstruct deformed, partially edentulous ridges in order to enhance dentofacial esthetics in fixed prosthetic treatment. The preprosthetic-presurgical phase of treatment planning is critical to a successful overall result. The information gained at this stage of treatment governs the techniques that should be used and the integration and staging of events in therapy. Four case reports are presented to illustrate successful management of different types of esthetic and prosthetic problems.
This article has presented many of the newer concepts and techniques that have been developed to treat a problem that has been of major concern to the prosthodontist: the problem of favorable periodontal support and poor or deformed edentulous ridges. In the past, dentists were not aware, or did not believe, that it was possible to reconstruct ridge deformities, and they resorted to prosthetic solutions to solve the problems of tissue reconstruction, function, and aesthetics. New procedures and concepts permit us to extend the range of therapy and hope we are able to offer our patients. It is probably true that prosthodontists are more sensitive to the emotional concerns and needs of patients that have sustained ridge-jaw deformities. These patients bear deep emotional scars. They feel cast apart from "normal" society. Successful treatment for these patients not only restores their deformed ridge and dentition, it helps to erase the mental scars and emotional trauma these patients have had to accept. These procedures enable us to restore their sense of self-confidence and dignity.
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1. Thirty free autogenous gingival grafts were placed on bone and 30 were placed on a periosteal bed. The distribution into the groups was random. All 60 grafts survived, showing that both procedures were predictable. 2. Over one-half (17 of 30) of those on periosteum demonstrated mobility by 6 months postoperatively. No mobility was observed in the group placed directly on bone. 3. Osseous placed grafts demonstrated less swelling and better hemostasis than did the periosteally placed grafts. 4. A healing lag was observed in the grafts placed on bone which lasted only for the first two postoperative visits, approximately 2 weeks. 5. No infections or sequestrations were noted in any case.
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Five patients manifested cutaneous changes indistinguishable from those noted in some porphyric disorders, consisting of fragility, denudation, and blister formation of sun-exposed skin. Microscopical examination showed subepidermal bulla formation and the desposition of PAS-positive, diastase-resistant material and IgG in or around the upper dermal blood vessel walls. There was also electron microscopical evidence of vascular basal lamina reduplication and the deposition of a fine fibrillar material in and around these vessels. However, no abnormal porphyrin formation was noted. All five patients had been receiving 250 mg of tetracycline hydrochloride twice a day for at least six months and had had extensive sun exposure prior to the onset of the condition. For four patients, discontinuing the medication led to complete remission, despite subsequent sun exposure; the fifth patient was much improved, but her skin was still somewhat fragile seven months later. We concluded that these cutaneous changes resulted from a low-grade photosensitization by tetracycline hydrochloride.
A study was undertaken in 24 human volunteer subjects to determine the possible effects of selected commercially available dentifrices on clinically normal masticatory mucosa. An acrylic stent was fabricated which was designed to hold four test dentifrices in close apposition to the palatal tissues for 1 hour. Evaluation approximately 8 hours later revealed pathologic responses which were evident clinically and histologically. 1. Clinically, palatal tissues exposed to Crest were not distinguishable from control areas, while Colgate (mfp), MacCleans, and Ultra Brite produced erythematous changes which were statistically significant when compared with adjacent control sites. 2. Histologically, epithelial changes were seen within the test sites which ranged from a parakeratin-like surface layer to necrosis and intraepithelial abcess formation. Control sites consisted of normal orthokeratinized palatal mucosa in all cases. 3. The more severe microscopic reactions were noted with MacCleans and Ultra Brite, while the milder reactions were associated with Colgate (MFP). Crest infrequently produced a parakeratin-like response. The response was not statistically significant when compared with controls. 4. The clinical and histologic reactions were generalized throughout the test population, suggesting that the responses were not due to individual hypersensitivity but due to irritation from one or more of the dentifrice components. Although the clinical significance of these findings could not be readily assessed, the potential for irritation of human palatal mucosa by selected dentifrices has been demonstrated. These findings support the suggestion by the World Workshop in Periodontics (1966)20 that efforts should be directed to the development of dentifrice materials less harsh to the oral tissues.
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