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Biomedical subjects

P J W Stoelinga

Publications and source records attributed to P J W Stoelinga.

At least 19 recordsLinked to original sources
PubMed2006

Reconstruction of the mandible after ablative surgery for the treatment of aggressive, benign odontogenic tumours in Tanzania: a preliminary study.

This study presents results on 11 patients suffering from ameloblastoma who had ablative surgery followed by reconstruction of the mandible in a single operative procedure in Tanzania. The procedure included the use of autogenous particulate bone from the anterior or posterior iliac crest. In 6 of the patients, the tumour was removed from the cortical scaffold, which was then irradiated with 50 Gy. Perforations were made on the scaffold and it was then placed back to fit the defect and was held in place by custom-made titanium plates, fixed on both ends with screws. The particulate bone chips were mixed with autogenous platelet rich plasma (PRP) and Tissue Col. In 5 of the patients, the cortical scaffold was not used but rather a mixture of bone and PRP was packed into the defect under the titanium plates. Four patients had some complications varying from fracture of the scaffolds to infection. None from the group reconstructed without scaffolds suffered any complications. A quality of life (QOL) assessment of the 7 successful cases showed that these patients were satisfied and had a good QOL. These results imply that this immediate means of reconstruction is feasible and thus, offers a big advantage to the patients.

Adolescent↗
PubMed2005

Reconstruction of the mandible with an autogenous irradiated cortical scaffold, autogenous corticocancellous bone-graft and autogenous platelet-rich-plasma: an animal experiment.

This paper reports on an experimental animal study evaluating a method of mandibular reconstruction using irradiated cortical scaffolds. Twelve goats underwent a continuity resection at the mandibular angle. Primary reconstruction was carried out using specially designed osteosynthesis plates and screws. The defect was bridged by the original, irradiated cortical scaffold, which was filled with an autogenous particulate bone graft from the anterior iliac crest. To accelerate bone healing, platelet rich plasma (PRP) was mixed with the particulate bone graft. The hypothesis of this study was that bone healing in segmental reconstruction of the goat mandible by means of an irradiated cortical scaffold, filled with a particulate cancellous bone graft mixed with PRP, would be as successful as when using a non-irradiated scaffold. All goats had an uneventful healing. The osteosynthesis plates and screws withstood immediate loading for periods varying from three to six weeks. The radiologic and histologic results were less favourable with regard to bone remodelling than the results obtained in similar experiments with non-irradiated cortical bone scaffolds.

Animals↗
PubMed2005

Stabilisation of sagittal split set-back osteotomies with miniplates: a prospective, multicentre study with 2-year follow-up.

The aim of this study was to assess post-operative stability of bilateral sagittal split set-back osteotomies using two miniplates and clinical parameters including nerve function, TMJ function, occlusal relapse and patient satisfaction. The stability was measured on cephalometric radiographs and possible condylar alterations on orthopantomograms. This prospective study implied a 2-year follow-up on a group of 24 patients. The same protocol was used at six participating institutions at which the patients were treated. A stable occlusion without appreciable relapse was seen in 91% after 2-year follow-up. Only two patients in this study had mild occlusal relapse. The mean skeletal horizontal relapse at pogonion of the whole group, after 2 years was 1.1mm and appeared to be directed backwards. At occlusal level, however, the mean relapse was 1.2mm forwards. The function of the inferior alveolar nerve 2 years post-operatively was reported to be normal in approximately 70% of the patients, yet 80% had no complaints about nerve dysaesthesia. In approximately 21% of the patients, signs and symptoms of TMJ dysfunction had disappeared. Another group (10%), however, without pre-operative signs and symptoms of TMJ dysfunction developed these signs or symptoms post-operatively. No condylar remodelling or resorption was seen in this group of patients. The sagittal split set-back osteotomy fixed with miniplates appeared to be a relatively save and reliable procedure giving rise to adequate results and a high degree of patients satisfaction.

Adolescent↗
PubMed2005

Evaluation of quality of life among patients after extirpation of mandibular ameloblastoma.

OBJECTIVE: To evaluate the quality of life (QOL) based on the functional, aesthetic and personal satisfaction among patients with ameloblastoma who underwent either partial or total mandibulectomy without reconstruction. DESIGN: Cross-sectional study. SETTING: The Department of Oral Surgery and Oral Pathology, School of Dentistry; Muhimbili University College of Health Sciences, Tanzania. SUBJECTS: Patients surgically treated for ameloblastoma without reconstruction. RESULTS. The postoperative problems were mostly associated with eating of solid foods, appearance and speech. All patients treated by total mandibulectomy had moderately severe problems with eating of solid foods and were dissatisfied with their appearance. CONCLUSION: The relatively small tumours resulted in a much better QOL. Public awareness programmes to avoid late referral and treatment is the most effective way to reduce the number of patients who after treatment suffer a poor QOL.

Adolescent↗
PubMed2005

[Use of bone grafts from the mandibular body in pre-implant surgery].

Thirteen patients with resorption of the alveolar process in the upper or lower jaw were treated with augmentation using autogenous bone from the mandibular body. The objective and subjective results were retrospectively assessed. The morbidity of the donorsite was considered mild. 3 Patients experienced temporary sensory disturbance of the inferior alveolar nerve. In 1 patient spontaneous sequestration of a part of the transplant occured. In all patients the bonevolume at time of implantation was sufficient to insert the planned amount of implants. In total 46 implants were inserted. One implant was lost during follow-up and replaced. From this study it is concluded that the mandibular body can be considered as a good donor site for autogenous bone for pre-implant reconstruction of the alveolar process.

Adult↗
PubMed2004

Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Part II. Radiographic parameters.

This prospective study implied a two-year follow-up on a group of patients that underwent a Bilateral Sagittal Split Osteotomy (BSSO) for advancement (n=222) of the mandible that were treated in seven institutions following the same treatment protocol. The aim of Part II of this study was to correlate the clinical findings on stability and relapse as reported in Part I (clinical parameters) of this series of articles with the cephalometric findings. The mean skeletal relapse at pogonion of the whole group after two years was 0.9 mm. The clinically stable group, however, had only 0.4 mm relapse, whereas the clinical relapse group showed a mean relapse of 3.3 mm. The findings underline a relationship between the amount of advancement and relapse. The tendency for both, horizontal and vertical movement is the same, i.e., the larger the surgery effect, the larger the relapse. The angle post plane/mandibular plane showed the highest explained variance 9%. Patients with a high mandibular plane angle may be more prone to relapse. The explained variance of all considered prognostic factors together, however, is small (13%). The findings of this study express that patients with a clinical stable occlusion after a BSSO advancement, stabilised with miniplates, have a minimal to no skeletal relapse as measured on the cephalometric radiograms. The clinically non-stable group, however, appeared to have considerable skeletal relapse.

Bone Plates↗
PubMed2004

Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Part III--condylar remodelling and resorption.

This prospective study implied a two-year follow-up in a group of patients that underwent a Bilateral Sagittal Split Osteotomy (BSSO) for advancement of the mandible that were treated in seven institutions following the same treatment protocol (using two miniplates). The aim of Part III of this study was to define a Condylar Morphology Scale (CMS) and to analyse radiological changes in the TMJ after BSSO in relation to postoperative relapse and to determine the incidence of morphologic changes and its risk factors. It was concluded that the used 3-point CMS served its purpose well. In eight patients (4%) resorption of the condyle developed postoperatively. The value of preoperative cephalograms to predict condylar alterations appeared to be limited (12% explained variance). Patients treated at a relative low age (< or = 14 years) appeared to be at risk for the occurrence of condylar alterations including resorption. A steep mandibular plane angle and the low facial height ratio (post:ant) were also significantly related to the occurrence of condylar alteration, but the multi variance regression showed that these parameters had only limited value. The occurrence of pain and TMJ sounds in the first few months postoperatively are highly suspicious for condylar changes to occur in the next months.

Adolescent↗
PubMed2004

Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Part I. Clinical parameters.

The principal aim of this study was to assess the postoperative stability of bilateral sagittal split osteotomies (BSSO) using two miniplates. Part I reports on the clinical results including treatment characteristics, nerve functions, TMJ function, occlusional relapse and patient satisfaction. This prospective study evaluated a group of 222 patients who underwent a BSSO for mandibular advancement. The same treatment protocol was used at seven participating institutions at which the patients were treated. A stable occlusion without appreciable relapse was seen in 84% after 2 years of follow-up. A considerable minority (16%) had occlusal relapse. There were no clinical parameters that pointed towards a high risk for relapse except age. The mean operation age of the relapse group was 20.7 years (SD 6.7) and in the stable group 26.1 years (SD 8.2). The function of the inferior alveolar nerve 2 years postoperatively was reported to be normal in approximately 88% of the patients, while 94% had no complaints about nerve dysaesthesia. In approximately 56% of the patients with pre-existing TMJ-dysfunction these signs and symptoms had disappeared. Another group of patients, however, without TMJ-dysfunction preoperatively (22%) developed signs or symptoms of TMJ-dysfunction postoperatively. The sagittal split osteotomy fixed with miniplates appeared to be a relatively safe and reliable procedure giving rise to a high degree of patient satisfaction, despite the fact that some occlusal relapse was seen.

Adolescent↗
PubMed2004

Reconstruction of the mandible using preshaped 2.3 mm titanium plates, autogenous particulate cortico-cancellous bone grafts and platelet rich plasma: a report on eight patients.

The results are presented of eight patients who had partial mandibulectomies for malignant tumours and were secondarily reconstructed with pre-shaped 2.3 mm titanium plates, autogenous particulate cortico-cancellous bone grafts and platelet rich plasma. Healing was uneventful in all cases and when prosthodontically needed, implants were inserted after approximately 6 months, whilst biopsies were taken. The histology showed bone remodelling in six cases, whilst in one case after 6 months the bone was largely replaced by abundant fibrous tissue. In this case the implants were lost after 9 months. In one case a new carcinoma developed after 6 months with subsequent death of the patient. Thus, in six patients adequate results were achieved with adequate functional and aesthetic outcome, given the poor conditions of the surrounding tissues. This method provides three-dimensional reconstruction with sufficient bone height and volume to facilitate prosthodontic treatment.

Aged↗
PubMed2004

Mandibular reconstruction: a histological and histomorphometric study on the use of autogenous scaffolds, particulate cortico-cancellous bone grafts and platelet rich plasma in goats.

Twenty-eight goats underwent a continuity resection of the mandibular angle. In all goats primary reconstruction was carried out using specially designed pre-shaped osteosynthesis plates and monocortical screws. The original cortical scaffold was used to bridge the defect, filled with an autogenous particulate bone graft in 14 goats, whereas platelet-rich-plasma (PRP) was added in another 14 goats. Both groups were divided in three subgroups that were sacrificed after 3, 6 and 12 weeks. Histological and histomorphometric evaluation revealed that the use of PRP enhanced the bone healing considerably. This effect was statistically significant and particularly visible in the 6 and 12 weeks' groups

Animals↗
PubMed2003

Assessment of the value of anorganic bone additives in sinus floor augmentation: a review of clinical reports.

In order to objectively assess the value of anorganic bone additives in sinus floor augmentation, a review of the English literature till May 2002 was carried out. The studies or parts of studies had to include at the least two patients, with a follow-up of at least 3 months, whilst histomorphometric data ought to be available of biopsies taken from the core of the graft. Only 12 studies fulfilled these criteria. Firm conclusions could not be drawn because there were substantial differences in histomorphometric techniques, healing periods and ratio autogenous bone anorganic additives, but it seemed that autogenous bone without anorganic additives resulted in the highest amount of bone after a 4-6 months healing period, while hydroxyapatite and bovine bone mineral, used as a bone substitute, gave the lowest amount of bone. No correlation between bone volume and time of graft healing could be found. The consequences, however, for implant placement and survival are at present, not fully understood. A plea is made for systematic prospective clinical and experimental studies to assess the various bone additives and ratios of autogenous bone to bone additives in composite grafts analysed with an adequate histomorphometric technique. Part of this study was presented at the 15th ICOMS, Durban, South Africa, 19-24 May 2001.

Alveolar Ridge Augmentation↗
PubMed2002

Mandibular reconstruction: a clinical and radiographic animal study on the use of autogenous scaffolds and platelet-rich plasma.

This paper reports on an experimental animal study evaluating a method of mandibular reconstruction. After a successful pilot study, 28 goats underwent a continuity resection of the mandibular angle. Primary reconstruction was carried out using specially designed osteosynthesis plates and screws. The defect was bridged by the original cortical scaffold, filled with an autogenous bone graft from the iliac crest. To accelerate bone healing, platelet-rich plasma (PRP) was mixed with the particulate bone graft in 14 goats. All goats had uneventful healing. The osteosynthesis plates and screws withstood immediate loading for periods varying from 3 weeks to 3 months. The use of PRP appeared to enhance bone healing considerably.

Animals↗
PubMed2002

[Orthodontic-surgical treatment of patients with mandibular hypoplasia].

A combined orthodontic-surgical treatment strategy for patients with mandibular hypoplasia is presented. The importance of a proper diagnosis on which the treatment should be based is emphasised. The principles of the orthodontic pre and postoperative treatment and the surgery are explained. The possibility to use the curve of Spee to gain vertical chin height is emphasised. This can be achieved by levelling of this curve postoperatively. Possible unfavourable side effects are mentioned. It is concluded that highly predictable results can be achieved using the described techniques.

Female↗
PubMed2002

[Surgically assisted rapid maxillary expansion: a retrospective study].

Transverse maxillary hypoplasia, in adolescents and adults, may be corrected by means of a 'surgically assisted rapid maxillary expansion' (SARME). The results of 7 patients who were treated by means of a SARME, are presented. Attention is paid to the technique, the type of expansion, and the stability of the expansion of the maxilla 1-1.5 years after SARME. The mean expansion between the cuspids was 4.7 mm (sd 1.7) and between the first molars 5.6 mm (sd 3.2). The SARME technique appeared to give rise to a predictable result and a sufficient amount of expansion, although the sample is small and the follow-up period relatively short. All patients had a satisfactory result without complications.

Adolescent↗