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OBJECTIVES: Our goal was to determine whether the radiographic fractal dimension of the maxillary and mandibular alveolar processes is related to bone density of the alveolar processes, spine, hip, and radius in healthy women. STUDY DESIGN: Thirty-seven dentate healthy white women aged 20 to 78 years underwent assessment of systemic and alveolar process bone. After a periodontal examination, D-speed vertical bite-wing and periapical radiographs with aluminum step wedges and a density correction algorithm were used to make alveolar process fractal dimension and density calculations within regions of interest that avoided crestal bone and intrabony defects. Anteroposterior (L1-L4) and lateral (L2-L4) lumbar spine, total hip, and total wrist densities were determined by means of dual energy x-ray absorptiometry. RESULTS: Correlation analysis revealed significant relationships between maxillary alveolar process fractal dimension and maxillary alveolar process density (r = 0.47, P < or =.01), mandibular alveolar process density (r = 0.48, P < or =.01), and mandibular alveolar process fractal dimension (r = 0.44, P < or =.05); and between mandibular alveolar process fractal dimension and maxillary alveolar process density (r = 0.54, P < or =.01) and mandibular alveolar process density (r = 0.58, P < or =.001). No significant relationships were found between the maxillary alveolar process or the mandibular alveolar process fractal dimension and the density of any postcranial regions. CONCLUSIONS: In healthy women, the alveolar process radiographic fractal dimension is significantly related to the alveolar process density but is not related to the density of the spine, hip, or radius.
The existence of the alveolar process depends on the development of teeth. In edentulous maxillae, the alveolar process disappears in general in the region of incisives, canines and eventually premolars, but it persists in over 80% of cases in the region of molars. The persistence of the alveolar process correlates with the pneumatisation of the alveolar process by the alveolar recess of the maxillary sinus. The sinus may invade the whole alveolar process or only part of it so that in its lower part a thicker bone layer persists. Very rarely the alveolar process disappears completely with the loss of teeth. The deepest recess of the maxillary sinus corresponds to the level of the zygomatic process i.e. to the region of the first and second molar teeth.
OBJECTIVE: To study a new method of simultaneous repair of alveolar cleft and the deformity of the nose and lip. METHODS: 42 patients with cleft of alveolar process were included in this study. We filled the cleft of alveolar process with iliac cancellous bone and covered the depression of piriform aperture and the nasal side with iliac cartilage. Simultaneously, we corrected the nasal deformity using V-Y plasty of a mucosa-cartilage compound flap at the nasal vestibule. RESULTS: In the patients aged 9 approximately 11 years, the mean height of the repaired alveolar process was 86.7%; the mean thickness was 89.6%; the contour and function of the alveolar process was grade I or II. The canine erupted at the place of bone grafting. The depression of the piriform aperture and alae nasi was repaired. The contour of the nares was symmetrical. In the patients over 12 years, the mean height of the alveolar process was 70.1%; the mean thickness was 71.7%; the contour and function of the alveolar process was grade II or III. The deflexion of nasal dorsum and nasal dome was not ameliorated in 2 patients of 18 years old. CONCLUSIONS: The application of iliac cancellous and chondral bone to simultaneously repair cleft of alveolar process and the nasal deformity is an ideal plastic method. It can recover the height of alveolar process and the continuity of dental arch, ameliorate the nasal deformity, and redress the deflexion of nasal dorsum and nasal end. It can also eliminate the psychological obstacle of the patients at an early stage.
Skeletal mass declines in all populations with age, and the literature suggests that changes in oral bone may be linked to the status of the post-cranial (systemic) skeleton. However, there is a lack of information defining the relationship between alveolar process bone and the post-cranial skeleton in healthy individuals. The purpose of this study was to determine: (1) if the bone densities of the maxillary and mandibular alveolar processes are related to the bone density of the spine, hip, or radius in healthy women; and (2) if the alveolar process densities decline with age. Forty-one dentate Caucasian women aged 20 to 78 years underwent assessment of post-cranial (systemic) and alveolar process bone. D-speed vertical bitewing and periapical radiographs incorporating aluminum stepwedges, controlled exposure and processing conditions, and a density correction algorithm were used to make alveolar process density assessments with regions of interest (ROIs) apical to crestal bone and intrabony defects. Anteroposterior lumbar (L1 to L4) and lateral lumbar (L2 to L4) spine, total hip (and subregions), and radius bone densities were determined by dual-energy x-ray absorptiometry (DEXA). Correlation analysis revealed significant relationships between maxillary alveolar process bone density and the density of the mandibular alveolar process (r = 0.57, p < or = 0.001), anteroposterior lumbar spine (r = 0.53, p < or = 0.001), lateral lumbar spine (r = 0.52, p < or = 0.001), total hip (r = 0.39, p = 0.01), total radius (r = 0.39, p = 0.01), and age (r = -0.38, p = 0.01). A two-tailed t test comparison revealed significantly greater maxillary alveolar process bone density in women younger than 50 years of age than in those 50 and older (p < or = 0.01). We conclude that the density of maxillary alveolar process bone is significantly related to the density of the mandibular alveolar process, lumbar spine, hip, and radius in healthy women and that maxillary alveolar process bone density declines with age.
In the absence of symptoms indicative of pathological processes in the region of clinically edentulous alveolar processes, primary radiographic examination is sometimes omitted. For this reason, the authors report the results from the evaluation of the radiographs of 2177 patients with clinically edentulous alveolar processes. 320 (14.7%) positive findings were obtained from 278 patients. The great number of positive findings justifies the demand for careful radiographic examination also in case of clinically edentulous alveolar processes prior to the planning of any stomatological treatment.
The influence of the anatomical characters of the alveolar processes on the morphology of bone destruction during the development of periodontitis seemed to be very important in Man. The purpose of the present study is to check such an association in hamster, experimental model used in periodontal research. A macroscopic study of mandibular alveolar processes of hamsters with periodontal diseases has shown that the destruction aspects of the alveolar processes had constant features, despite variability in the importance of bone destruction aspects of the alveolar processes had constant features, despite variability in the importance of bone destruction between animals: -- the lingual zone of m1 was most affected, -- the alveolar bone destruction was more important on the lingual face than on the buccal face, -- intra-bony lesions developed along a buccal gutter extending from the distal root of m1 to the mesial root of m3. The morphology of these bone destructions corresponded to anatomical features, the most striking being: -- the bone wall surrounding the mesial root of m1, where a dehiscence was present, was extremely thin,-- the lingual bone plate was uniformly this despite localized reliefs which thickened it in places, -- the buccal bone plate was widened by a cervical gutter. It appeared therefore that the localisation and morphology of the periodontal bone lesions in the hamster are related to the anatomy of the alveolar processes.
Bone turnover rates can be altered by metabolic and mechanical demands. Due to the difference in the pattern of loading, we hypothesized that there are differences in bone remodeling rates between the maxillary and mandibular alveolar processes. Furthermore, in a canine model, the alveolar process of teeth that lack contact (e.g., second premolars) would have a different turnover rate than bone supporting teeth with functional contact (e.g., first molars). Six skeletally mature male dogs were given a pair of calcein labels. After sacrifice, specimens representing the anterior and posterior locations of both jaws were prepared for examination by histomorphometric methods to evaluate the bone volume/total volume (BV/TV; %), bone volume (mm2), mineral apposition rate (MAR; microm/day), and bone formation rate (BFR; %/year) in the alveolar process. There were no significant differences (P>0.05) in the BV/TV within the jaws. The bone volume within the alveolar process of the mandible was 2.8-fold greater than in the maxilla. The MAR was not significantly different between the jaws and anteroposterior locations. However, the BFR was significantly (P<0.0001) greater in the mandible than in the maxilla. The anterior location had higher (P=0.002) remodeling than the posterior location in the maxilla but not in the mandible. While there was a greater bone mass and increased remodeling in the mandible, no remodeling gradient in the coronal-apical direction was apparent in the alveolar process. Bone adaptation probably involves a complex interplay of bone turnover, mass, and architecture.
Extraction of teeth from the lower jaw often results in atrophy of the alveolar process and mandibular body, and sometimes the atrophy progresses so severely as to seriously affect the fitness of the denture, especially the full denture. If the alveolar ridge is markedly resorbed, patients are not satisfied, unless the alveolar process is surgically heightened and the fitness of the denture is regained. Plastic operation of the alveolar process by visor osteotomy and grafting of the iliac bone was performed on a 54-year-old woman who presented at our Department with a complaint of unfitness of the full denture because of marked atrophy of the mandibular alveolar process. As a result of this operation, a functionally well-fitting denture could be fitted to the satisfaction of this patient. This paper describes the outline of the surgical procedure.
A system of nomenclature for deformities of the alveolar process is presented. Descriptive, familiar topographic terms are used (crater, trench, moat, ramp and plane), and specific criteria are given for each term. Two hundred randomly selected osseous deformities in dry skulls were classified by two examiners at independent sessions using the proposed system. One hundred ninety of these defects were given identical descriptions. The nomenclature system is proposed to facilitate communication among practitioners concerning osseous deformities of the alveolar process, as well as to permit comparison of the effectiveness of various therapeutic modalities directed toward bone regeneration in periodontics.
This article describes the treatment of a boy with Class II deep bite and hypoplasia of the alveolar process due to agenesis of the canines and premolars. At first, the occlusion has been adjusted by advancement of the mandible and opening of the bite after bilateral sagittal split osteotomy. Later, under local anaesthesia, a segmental osteotomy of the hypoplastic alveolar process has been performed. Distraction of the hypoplastic alveolar process has been achieved by orthodontic traction on the residual dentition in the segments. After sufficient augmentation of the alveolar process, 6 implants for two bridges have been placed.
A modification of Hofer's (1942) osteotomy of the alveolar process of the lower jaw is described. Under certain circumstances it is possible to cut the alveolar process sagittally. Thereby a gap in the alveolar process is avoided and there is no need for bone grafting normal alveolar ridge height being maintained nevertheless.
After tooth extraction there is a great interindividual variation in the remodelling pattern of the alveolar process in edentulous areas, with some individuals losing little bone and others undergoing extensive resorption. However, little is known about possible longitudinal changes in the dentate region of the alveolar process of adults and if these are related to alterations in the skeletal bone mineral density (BMD). In a prospective study, on two occasions, 5-yr apart, the BMD of 117 women was determined in the distal forearm by using dual-energy X-ray absorptiometry, and the bucco-lingual thickness of the mandibular alveolar process was measured on dental casts by using a dial calliper. A decrease in the mean alveolar thickness, exceeding a cut-off value of 0.1 mm, was found in 60% of the women and an increase was found in 3% of the individuals. This decrease was 0.22 +/- 0.20 mm in the posterior region and 0.16 +/- 0.19 mm in the anterior region. The changes in alveolar thickness in the posterior region were significantly correlated to the BMD changes both on the mid-crestal level site and on the cervical level site. We conclude that the bucco-lingual thickness decreases with age in the dentate alveolar process, possibly owing to periosteal resorption related to skeletal bone loss.
OBJECTIVES: This in vitro study examined radiographic fractal dimension changes in alveolar process bone during simulated osteoporosis. STUDY DESIGN: Ten specimens of human maxillary alveolar process bone were progressively decalcified, and the percentage of calcium lost at each decalcification stage was quantified. Four radiographs of each specimen, together with an aluminum step-wedge, were exposed at 70 kVp at each stage. The test set of 560 radiographs was digitized, identical bony regions of interest were selected from the density-corrected images of each specimen, the regions were digitally filtered to reduce film-grain noise, and fractal dimension was computed on a line-to-line basis. Correlation analysis quantified the relationship between calcium loss and fractal dimension change. Analysis of variance and Duncan's multiple range test determined whether a difference existed in fractal dimension computed from images at x-ray beam angulations of -5, 0, and +5 degrees. RESULTS: A strong correlation (average r = -0.94, p < or = 0.0037) was found between generalized demineralization and decreasing fractal dimension. In every bone sample fractal dimension changed significantly (p < or = 0.0189) with angular change. CONCLUSIONS: Radiographic fractal dimension holds promise for detecting simulated osteoporosis in the maxilla under ideal conditions, but the sensitivity of fractal dimension to small x-ray beam angular change renders its clinical application questionable.
OBJECTIVE: To improve safety and viability of one-time operation in the therapy of cleft lip and palate and cleft alveolar process. METHODS: Under the air-vein anesthesia, one-time operations were performed in 42 patients with complete cleft lip and palate plus cleft alveolar process. After rehabilitation in ICU, all patients were put into wards, and left hospital 4-7 days after operation. RESULTS: The situation during anesthesia and operation was good. There were no statistically significant changes in blood pressure, oxygen saturation of blood, heart rate and cardiac rhythm before, during and after operation. No anesthetic accident and no complication happened. The loss of blood was about 42.7 +/- 6.5 ml and the duration of operation was about 139.2 +/- 18.6 minutes. The rehabilitation was successful after operations. First intention took place in almost all patients' incisions, and palatal fistulas appeared in only 2 cases. CONCLUSION: Under the control of provisioned pediatric anesthesia and rehabilitation, one-time complete cleft lip and palate plus cleft alveolar process closure is safe and viable.
PURPOSE: Loss of ridge width and height typically occur after tooth extraction. This study aimed to investigate whether smoking would effect alveolar ridge remodeling after tooth extraction. MATERIALS AND METHODS: Twenty-one individuals (11 nonsmokers, 10 smokers) requiring a nonmolar extraction in the upper jaw were selected. Radiographs were taken 7 and 180 days after surgery, and the following parameters obtained: alveolar process height (AH), alveolar process width (AW), radiographic bone density in the postextraction socket (BDS), and in the pre-existing bone apically (BDPB). RESULTS: Six months after surgery, intragroup analysis showed that both groups presented a significant reduction in AH, while only smokers had a significant reduction in AW, BDS, and BDPB (P < .05). Furthermore, intergroup analysis showed that smokers presented lower BDS (91.45 pixels +/- 26.62 and 59.53 pixels +/- 19.99, for nonsmokers and smokers, respectively; P = .006) and continued to present lower BDPB (129.34 pixels +/- 42.10 and 89.29 pixels +/- 29.96, for nonsmokers and smokers, respectively; P = .023). Additionally, smokers presented a tendency for lower AH and AW than nonsmokers, but this was not statistically significant. CONCLUSION: Within the limits of the present study, smoking may lead to a more significant dimensional reduction of the residual alveolar ridge and postpone postextraction socket healing.
MATERIAL AND METHODS: The aim of this study was to assess the effects of atrophy of the alveolar process and subsequent orthodontic treatment on the transplantation results of developing third molars. The material consisted of 35 teeth transplanted to an atrophied alveolar process. 19 of these teeth were treated orthodontically subsequent to transplantation. The control group consisted of 61 developing molars transplanted to a new extraction socket. The transplanted teeth were followed up clinically and radiographically for a mean period of 3.2 years. RESULTS: The success rate was 85% for transplants to new extraction sockets and 84% for transplants to atrophied jaw sections with subsequent orthodontic treatment. In contrast, transplants to atrophied jaw sections without subsequent orthodontic treatment showed a significantly (p < or = 0.001) lower success rate of only 37.5%. These poorer results were due to persistent infraocclusion and ankylosis. CONCLUSIONS: Even in cases with atrophy of the alveolar process, a transplantation with subsequent orthodontic treatment represents a promising treatment concept, whereas teeth without subsequent orthodontic treatment showed a lower success rate. Orthodontic tooth movement had no negative effect on the healing rates of transplanted developing third molars.
Specific features of the disposition of root apexes of premolars and molars in the alveolar process of the upper jaw were studied in 148 skulls and 67 tooth-jaw cuts. The least thickness of the alveolar process was found to be at the level of the first premolar (10,41 +/- 0,33 mm), and the greatest--at the level of the first molar (14,075 +/- +/- 0,456 mm). Strong correlation of the alveolar process was established between the levels of the premolars and the last two molars. The distance from the apexes of cheek roots of the first molar to the bottom of the maxillary sinus is 2,05--2,92 mm, and the palatal roots -- 2,02 mm. On roentgenograms the molar roots are often projected on the sinus bottom.