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Particles versus solid forms of hydroxyapatite as a treatment modality to preserve residual alveolar ridges.

In two separate but related studies, different forms of hydroxyapatite were implanted into the extraction sockets of human teeth to delay alveolar resorption and to form the background for a comparison of the treatment modalities. The significant differences in the treatment modalities and the postoperative sequelae seem to merit this report. The implantation of the particles appears to be clinically, a more expedient procedure than the implantation of cones. The time required to select an appropriate-sized cone, modify the cone as needed to achieve a snug fit into the extraction socket, and seat the cone deeply enough in the extraction socket to assure at least 2 mm of bone above the top of the cone implant was significantly greater than the time required to fit and pack particles into an extraction socket. None of the postimplantation problems encountered with cones was encountered in using the particle implants. The postimplantation problems encountered with cones included submucosal prominence, erosion through the mucosa (dehiscence), migration, loss of the implant, or surgical maintenance or resubmergence. Data from these two studies suggest that the implantation of particles into the extraction sockets of human teeth to delay alveolar ridge resorption is a more prudent, forgiving, considerate, problem-free, and predictable procedure than the implantation of cones.

Adult↗

Using soft vinyl stents to facilitate augmentation of maxillary anterior atrophic ridges with hydroxyapatite.

A technique has been described for fabrication of a surgical template made of soft vinyl mouthguard material. Use of this stent at the time of surgery can be of great value to the oral surgeon and the prosthodontist. The risk of excessive augmentation and migration of the particulate hydroxyapatite to an undesired area will be minimized if the stent is used as a matrix. Uniform results in size and form of the ridge can be obtained from the surgical procedure when the stent is used. The denture-bearing area of the maxillary anterior ridge will improve significantly, enabling the dentist to make a maxillary complete denture.

Alveolar Ridge Augmentation↗

Residual alveolar ridge maintenance with a new endosseous implant material.

In an effort to maintain the height of the residual alveolar ridge, Bioglass cones were placed in fresh sockets after tooth extraction. Today the emphasis is on maintaining the residual alveolar ridge instead of letting it resorb and subsequently resorting to heroic efforts for augmentation. To date, 242 cone implants have been placed in 29 patients. Implant follow-up observation time ranged from 12 to 32 months with an average of 19.9 months. Twenty-seven patients have been fitted with dentures. To date seven implants (2.9%) have been lost. The Bioglass implants appear to be highly biocompatible as evidenced by absence of infection, normal mucosal healing, and radiographic evidence of bone healing around the implants. Evaluation of several implants reexposed surgically revealed new bone in direct contact with the immobile implants circumferentially. The problem of implant dehiscence that started to occur after approximately 10 months in other investigations had not manifested itself in the Bioglass implant patients who have been wearing their dentures for at least 12 months.

Alveolar Process↗

Correction of alveolar ridge deformities with titanium implants.

A technique for the correction of alveolar ridge defects with titanium implants has been described. Custom cast titanium implants enable the dentist to achieve precise, predictable, stable ridge augmentation previously unavailable with other techniques and materials. The extension of this technique for the correction of more complex alveolar defects is logical.

Alveolar Ridge Augmentation↗

Preprosthetic surgery in the elderly.

Preprosthetic surgery is an aspect of dentistry that has a close relationship to prosthodontics and oral and maxillofacial surgery. The main functions of preprosthetic surgery are elimination of pathology in the denture-bearing soft and hard tissues, and ridge improvement. Limited vestibuloplasty is still considered a predictable and cost-effective procedure for patients who are well adapted to removable dentures. The excellent documentation of osseointegrated implants as supportive and retentive devices for prostheses has reduced the need for major ridge-improving surgery. Many clinical conditions, especially in the maxilla, cannot be managed solely with implants. The combination of preprosthetic surgery and implants may solve problems that neither discipline can solve alone.

Aged↗

Reconstruction of the alveolar process by implantation of allogenic demineralized dentin.

Different materials have been used for reconstruction of the alveolar process. None of these, however, is perfect in every respect. Allogenic demineralized dentin has been shown to induce bone formation and to maintain the bone contour. In the present case this material was used to reconstruct a traumatic defect of the alveolar process in the region of the upper left incisors. The result was satisfactory, both esthetically and functionally. Additional cases and a longer period of observation will be necessary to assess the relevance of this finding.

Accidents, Traffic↗

Surgical correction of the atrophic alveolar ridge. A preliminary report on a new concept of treatment.

Inferior repositioning of the atrophic maxillary edentulous alveolar ridge by LeFort I osteotomy and simulataneous bone grafting, and superior repositioning of the atrophic mandibular edentulous ridge by horizontal osteotomy of the mandibular body and simultaneous bone grafting have been accomplished successfully. These two new surgical procedures add a new dimension to treatment of severe atrophy of the alveolar ridges in edentulous or partially edentulous patients.

Adult↗

The use of freeze-dried bone as a biologic crib for ridge augmentation. A preliminary report.

Freeze-dried bank bone has been used as a biologic crib, packed with autogenous cancellous bone from the iliac crest, to augment mandibular and maxillary ridges. This technique entails little morbidity. It has been used in six patients, with good clinical success. Three of the patients who underwent mandibular augmentations began wearing dentures within 3 months after augmentation surgery. One patient had a soft-tissue breakdown overlying a graft to the maxilla and subsequently lost a portion (less than one third) of the graft; the other two patients are currently ungoing denture construction. Secondary procedures, such as vestibuloplasty, have been necessary in only two of the six patients. Long-term follow-up is needed, but clinical and radiographic evidence to date demonstrates good results.

Alveoloplasty↗

Denture stabilization with peralveolar tubing.

Mock dentures were stabilized in six monkeys by means of polyethylene tubings passed through surgically created buccolingual peralveolar channels. Macroscopic, radiographic, and microscopic examinations demonstrated that the dentures were stabilized and the tubings well tolerated throughout the 120-day study period.

Alveolar Process↗

Maxillary osteotomy and vestibuloplasty for the correction of maxillary anterior atrophy: preliminary report.

A one-step procedure has been designed to help the patient with abnormal maxillary anterior alveolar atrophy. The technique combines an anterior maxillary osteotomy with a maxillary vestibuloplasty. Bone grafting and skin grafting are not required, and prosthetic rehabilitation can begin 6 to 8 weeks postoperatively. This is a preliminary report; however, 18-month follow-up examinations show continued stability and minimal regression.

Alveoloplasty↗