The Palatal Approach to Distraction Osteogenesis of the Anterior Maxillary Alveolus.

PURPOSE: This report describes the palatal approach to gain access for osteodistraction of the anterior maxilla to improve the vector of force during distraction. PATIENT AND METHODS: This case report illustrates a novel approach to anterior maxillary osteodistraction. The palatal approach allows the maxillary segment to be moved anteriorly and inferiorly. This is in contrast to the buccal approach, in which the palatal tissue creates a vector of force toward the palate. The vascular pedicle for the transport segment is the labial mucosa and musculature. RESULTS: In the present case, the alveolar segment was advanced 3.6 mm anteriorly and 12.2 mm inferiorly as measured by pre- and postoperative computed tomograms. This patient with a large vertical alveolar defect and high smile line had successful restoration with dental implants. The result has been stable for 14 months. CONCLUSION: In this case, the palatal approach to the anterior maxillary osteotomy was shown to be an effective method of reconstructing a large vertical anterior defect.

Immediate restoration of NobelActive implants placed into fresh extraction sites in the anterior maxilla.

The aim of this study is to compare the success rates of immediately placed and loaded NobelActive implants with the success rate of immediately placed implants that were allowed to osseointigrate prior to loading. The charts of all patients in a private oral surgery office receiving single-unit dental implants in the maxillary anterior region in fresh extraction sites from 2008-2011 were evaluated. All patients receiving NobelActive implants and immediate restorations were included in the study group, while those receiving implants with delayed restorations were included in the control group. Patient records were evaluated for variables such as age, gender, torque values at time of implant placement, smoking habits, use of bisphosphonates, and other significant diseases such as diabetes. The success rate of the study group was 92.9%, whereas the success rate of the control group was 97.6%. This was not statistically significant. Torque values of the failed implants of the study group were similar to those of successful implants in the study group. All implants placed in patients scheduled for immediate loading achieved high torque values and were able to be restored immediately. NobelActive implants were able to obtain high torque values for predictable immediate restoration in fresh extraction sites. Acceptable success rates with excellent soft tissue healing were achieved.

Palatal approach to the anterior maxillary sandwich osteotomy.

PURPOSE: This report describes a technique used to increase vertical height and anterior prominence of the anterior maxilla. PATIENTS AND METHODS: Two cases illustrate the palatal approach to segmental osteotomy with interpositional bone grafting (sandwich osteotomy) of the anterior maxilla. The palatal approach allows the segment to be moved anteriorly and inferiorly. This is in contrast to the buccal approach, in which the tight palatal tissue creates a vector of force toward the palate. The vascular pedicle for the segmental bone flap using the palatal approach is the labial mucosa and musculature. RESULTS: The maxillary alveolar ridge in case 1 was advanced 4 mm anteriorly and 5 mm inferiorly. In case 2, the ridge was moved 4 mm anteriorly and 6 mm inferiorly. Cases 1 and 2 were later successfully restored with dental implants. CONCLUSION: The palatal approach to the anterior maxillary osteotomy was found to be effective in 2 cases that required anterior and inferior repositioning of the anterior maxilla.

The immediate placement of dental implants into extraction sites with periapical lesions: a retrospective chart review.

PURPOSE: The purpose of this study was to evaluate the success of dental implants placed immediately into extraction sites in the presence of chronic periapical pathology. MATERIALS AND METHODS: The charts of 655 patients who had implants immediately placed into fresh extraction sites were reviewed for the presence or absence of periapical radiolucencies. A total of 922 implants were included. Of the 922 implants, 285 were immediately placed into sockets that had chronic periapical infections. The remaining 637 implants, without signs of periapical pathology, were used as the control group. Success of the implants was defined as successful osseointegration, successful restoration, and absence of evidence of bone loss or peri-implantitis. Other variables such as age, gender, smoking, diabetes, bisphosphonate use, lucencies of adjacent teeth, and implant stability at the time of placement were also evaluated. RESULTS: Of the 922 implants, 285 were placed into sockets with periapical radiolucencies. The success rate of implants placed in the study group was 97.5%, whereas the success rate of the control group was 98.7%. The difference was not found to be statistically significant. The mean follow-up was 19.75 months, with a maximum of 93 months and a minimum of 3 months. A statistically higher failure rate was found for implants placed adjacent to retained teeth with periapical pathology. CONCLUSIONS: The placement of implants in sockets affected by chronic periapical pathology can be considered a safe and viable treatment option. There is a risk of implant failure when placing implants adjacent to teeth with periapical radiolucencies.