Long-term evaluation of three-dimensional volumetric changes of augmented severely atrophic maxilla by anterior iliac crest bone grafting.

PURPOSE: The purpose of this study was to evaluate long-term three-dimensional graft resorption following reconstruction of the severely atrophic maxilla with anterior iliac crest bone grafting. METHODS: Twenty-two patients (13 males), who underwent autogenous bone grafting and implant placement to their severely atrophic maxillary alveolar ridges were identified and included in the study. Pre- and postoperative cone-beam computed tomography (CBCT) scans of 40 recipient grafting sites were evaluated to calculate volumetric changes over time. CBCT scans were performed preoperatively (V0) and one week (V1), three months (V2), one year (V3), and three years (V4) following the augmentation operation. RESULTS: The average graft resorption from V1 to V2, V1 to V3, and V1 to V4 was 31.42%, 33.96%, and 37.96%, respectively. Initial graft volume reduction within the first three months was statistically higher compared to other postoperative periods (P<0.013). The rate of resorption reduced slightly from the third month of the surgery (V2) (P>0.013). There was no statistical difference between resorption volume and gender, type of prosthesis, the presence of vestibuloplasty, or patient age (P>0.05). CONCLUSION: The overall success rate of the iliac bone block grafts was found to be high. The volumetric resorption rates associated with the graft were favourable for the reconstruction of the maxilla and for permitting the placement of dental implants three months after augmentation. The highest graft resorption was found at the third postoperative month. Placement and loading of the implants reduced the resorption rate slightly over time.

The use of reconstruction plates to treat benign mandibular pathological lesions: A retrospective clinical study.

INTRODUCTION: The purpose of this retrospective clinical study was to evaluate the indications for and the utility of reconstruction plates in the management of benign mandibular pathological lesions. The complications associated with plate use were also assessed. PATIENTS AND METHODS: The clinical and radiological data of 23 patients (16 males, 7 females) with large, benign mandibular pathologies were evaluated. During operations, reconstruction plates were used to prevent mandibular fracture or to allow for bone reconstruction after segmental or disarticulation resection. The mean follow-up time was 11.2months. RESULTS: Condylar sag was observed in one patient who had undergone disarticulation resection. A reconstruction plate was removed from one patient because of pain. A plate became exposed in one patient who had undergone a disarticulation resection. Two patients reported slight paraesthesia. Screw-loosening was observed in one patient who had received a non-locking plate. CONCLUSION: Reconstruction plates can be safely used to manage benign mandibular lesions. Preoperative bending of the plates on individualised models is useful for reducing the time required for plate adaptation during operation. Locking reconstruction plates are preferable for preventing screw-loosening. All complications can be managed with careful follow up.

Complications associated with surgically assisted rapid palatal expansion without pterygomaxillary separation.

INTRODUCTION: The purpose of this retrospective clinical study was to evaluate the surgical complications associated with the surgically assisted rapid palatal expansion (SARPE) which does not involve pterygomaxillary separation (PMS). PATIENTS AND METHODS: A total of 40 (25 females, 15 males) skeletally mature patients, who had the diagnosis of maxillary transverse maxillary deficiency (TMD), were treated surgically under local or general anesthesia. The mean follow-up time was 6 months. RESULTS: Recorded perioperative and postoperative complications were discussed within the current literature. No serious complications were observed intraoperatively. Eight patients (20%) showed postoperative complications including neurosensory deficits, maxillary sinus infection, epistaxis, fistula formation and incisional dehiscence. DISCUSSION: Neurosensory deficits were the most common findings. The present findings suggest that minor complications were observed associated with SARPE without PMS. The technique may be performed safely also under local anesthesia.