Primary Failure of Dental Eruption Due to Variants Parathyroid Hormone Receptor 1: Retrospective Study and Proposal of Guidelines Treatment.

OBJECTIVE: Primary failure of eruption is characterized by a nonsyndromic defect in tooth eruption in the absence of mechanical obstruction. It is correlated to rare heterozygous variants in the parathyroid hormone receptor 1 gene. The management of primary failure of eruption is complex because many therapies are ineffective. The present study aimed to compare the clinical outcomes of our patients with the findings reported in the literature, and to propose a treatment guideline based on the literature and our experience. METHODS: Retrospective study of patients affected by primary dental eruption failure in the department and analyse of the results and compare with those of the litterature. RESULTS: Twelve patients belonging to 5 families (9 males, 3 females; 13-52 y old) diagnosed and treated in the maxillofacial surgery and stomatology department of the Lille University Hospital were included. All patients showed posterior tooth involvement, and most patients showed bilateral defects. None of the affected teeth had coronal alveolar bone, whereas 6 patients showed root resorption in the affected teeth. Genetic analyses, performed on 11 patients, identified a parathyroid hormone receptor 1 disease-causing variant in 7 of them (63%). Multidisciplinary treatment was required to rehabilitate these patients. Orthodontic interventions, even at an early age, are difficult in affected teeth, which are often blocked or have internal resorption. Moreover, retention of these affected teeth during growth leads to dentoskeletal malocclusions, requiring difficult surgical management in the long term. Therefore, early extraction of these teeth is frequently recommended once the diagnosis has been confirmed. An implant-borne prosthetic rehabilitation can then be achieved at the end of growth after correction of the jaw discrepancy. In case of a late diagnosis, other surgical or noninvasive techniques may be used depending on the clinical situation. Distraction osteogenesis or segmental osteotomy could be discussed for patients with mild phenotypes. CONCLUSIONS: Early diagnosis of primary eruption defects is crucial to offer appropriate management as early as possible, and so to avoid late complicated treatments.

Pre-implant surgery complexity for achieving implant-supported prosthetic rehabilitation in oligodontia patients: a retrospective study.

INTRODUCTION: Oligodontia is a rare dental developmental pathology that requires prolonged, complex and multidisciplinary treatment. Although bone augmentation is frequently required during a complete implant treatment of oligodontia. Therefore, we evaluated the ability to predict pre-implant surgery complexity based on age, number of missing teeth, and number of implants required to achieve implant-supported prosthetic rehabilitation. MATERIAL AND METHODS: This retrospectively registered study included all patients who underwent surgical treatment for oligodontia in our Oral and Maxillofacial Surgery Department between January 2012 and May 2023. Demographic data, number and location of missing teeth, pre- and per-implant surgical procedures, and the number of planned implants were recorded. A quantitative variable called "complexity score of pre-implant surgery" was created. This 10-point score was calculated by adding one point for each preimplant surgical procedure registered. A simple linear regression was calculated to explain the number of targeted implants based on number of missing teeth. A multiple linear regression model was used to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants. RESULTS: 119 oligodontia patients were included in the study. The median number of tooth agenesis was 10. A total of 825 implants were placed, 14 (1.7%) of which failed. A significant regression equation was used (F(1,118) = 1098,338; p < 0.0001) to explain the number of targeted implants based on number of missing teeth, with a R2 of 0.903. A significant regression equation was found (F(3,116) = 107,229; p < 0.0001) to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants, with a R2 of 0.735. DISCUSSION: These results based on patient data indicate that age, number of missing teeth and number of targeted implants could reliably explain the complexity of pre-implant surgery.

Surgical Management of Craniomaxillofacial Features in the Otopalatodigital Spectrum Disorders.

ABSTRACT: Otopalatodigital syndrome spectrum disorders are caused by Filamin A (FLNA) gene mutations. Otopalatodigital syndrome spectrum disorders are a group of rare congenital skeletal dysplasia, with specific craniomaxillofacial features including otopalatodigital syndrome type 1 and type 2, Melnick-Needles syndrome, frontometaphyseal dysplasia, terminal osseous dysplasia with pigmentary defects. The authors describe cases of a young girl with Melnick-Needles syndrome and a young boy with frontometaphyseal dysplasia treated in the Oral and Maxillofacial Surgery Department. Both patients had FLNA gene mutation confirmed with molecular genetic analysis. The authors proposed a 4 step treatment of the malformations with good outcomes both aesthetically and functionally, without complication.

Secondary Care of Cleft Lip and Palate: Analysis of Dentofacial Orthopedic and Orthognathic Treatments.

INTRODUCTION: Orthodontic and orthognathic management of cleft lip and/or palate (CLP) is a highly controversial subject. We present herein a retrospective study of 214 secondary cases followed over 22 years in order to assess the factors of successful management. MATERIAL AND METHODS: The study focuses on the results of gingivoperiosteoplasty, and occlusal stability. Nine subgroups were identified, taking into account the age of the patients, the history of surgery on the alveolar region, and the presence or absence of skeletal discrepancy. RESULTS: Results clearly demonstrate a higher rate of poor outcomes and failures in the multioperated population. The success rate of the graft is 80.82% in the multioperated population versus 100% non-multioperated population. Periodontitis problem or orthodontic difficulties affect 19.17% of the patient in the multioperated groups versus 12% in the other groups. Relapse, particularly the transversal dimension, is also found mostly in the multi-operated population: 17.8% versus 6% in the non-multioperated population. DISCUSSION: Several factors are involved in the success of orthodontics, dentofacial orthopedics, and orthognathic surgery of CLP patients. Our study shows that previous surgeries, especially when they are multiple with repeated failures, jeopardize the chances of success of secondary treatments. This is explained by the secondary fibrosis of the tissues around the cleft. Finally, major palatal surgeries performed early, have adverse effects on maxillary growth. Many other factors play an important role in the stability of the success that are linked with orofacial functions. These data must be taken into account in the treatment of CLP patients.

Augmented reality in implantology: Virtual surgical checklist and augmented implant placement.

OBJECTIVES: Aim of the present study was to create a pedagogical checklist for implant surgical protocol with an augmented reality (AR) guided freehand surgery to inexperienced surgeons using a head mounted display (HMD) with tracking. METHODS: The anatomical model of a patient with two missing mandibular teeth requiring conventional single-tooth implants was selected. The computed tomography (CT) scans were extracted and imported into segmentation and implant planning software. A Patient-specific dental splint through an intermediate strut, supported 3D-printed QR code. A checklist was generated to guide surgical procedure. After tracking, the AR-HMD projects the virtual pre-surgical plan (inferior alveolar nerve (IAN), implant axis, implant location) onto the real 3D-printed anatomical models. The entire drilling sequence was based on the manufacturer's recommendations, on 3D-printed anatomical models. After the implant surgical procedure, CT of the 3D-printed models was performed to compare the actual and simulated implant placements. All procedures in the study were performed in accordance with the Declaration of Helsinki. RESULTS: In total, two implants were placed in a 3D-printed anatomical model of a female patient who required implant rehabilitation for dental agenesis at the second mandibular premolar positions (#35 and #45). Superimposition of the actual and simulated implants showed high concordance between them. CONCLUSION: AR in education offers crucial surgical information for novice surgeons in real time. However, the benefits provided by AR in clinical and educational implantology must be demonstrated in other studies involving a larger number of patients, surgeons and apprentices.

Surgical bone augmentation procedures for oral rehabilitation of patients with oligodontia: A review with a systematic approach.

Oligodontia is a developmental dental anomaly defined by the absence of 6 or more permanent teeth, excluding the third molars. We performed a review with a systematic approach and proposed a guideline for the choice of the bone augmentation surgery. The different bone augmentation technique terms were searched in the PubMed and Science Direct database. Clinical studies were eligible if they reported on pre-implant surgery in patients with oligodontia. The database search yielded 400 studies after duplicates removed. Thirty studies were finally included, involving 410 patients. Sixty-three sinus lifts were performed in 37 patients with no failure. Thirteen out of 33 patients with iliac bone transplantation and two out of 24 with parietal bone transplantation had resorption, one out of 4 patients who received allogeneic bone block had complete failure. Seventy-eight patients underwent guided bone regeneration, none had bone loss. No failure was found with the alveolar distraction osteogenesis technique. Four out of thirteen patients developed permanent hypoesthesia after inferior alveolar nerve transposition. The cumulative implant survival rate was 94.4% after bone augmentation procedures. Extensive edentulous areas should be grafted with parietal bone, as iliac grafts present a greater risk of resorption. Smaller edentulous areas should be treated by endobuccal harvesting or guided bone regeneration. Osteogenesis distraction and nerve transposition are effective surgeries for medium-to-large mandibular edentulous spaces. The implant survival rate is not significantly different between implants placed in grafted and nongrafted bone, the appropriate choice of bone augmentation technique can reduce the risk of peri­implant bone resorption.

Pre-implant and implant management of oligodontia patients: A 10-year retrospective study.

INTRODUCTION: the aim of this study was to report and assess the management and implant rehabilitation of oligodontia patients since its recognition in 2012 by french authorities in the nomenclature. MATERIAL AND METHODS: we conducted a retrospective study in the Maxillofacial Surgery and Stomatology Department of the Lille University Hospital between January 2012 and May 2022. Patients had to present an oligodontia recognized under the ALD31 in adulthood, and to have benefited from a pre-implant/implant surgical treatment in the unit. RESULTS: a total of 106 patients were included in the study. The mean number of agenesis was 12 per patient. The most missing teeth are the ones at the end of the series. After a pre-implant surgery phase including orthognathic surgery and/or bone grafting, 97 patients benefited from implant placements. The mean age for this phase was 19.38. A total of 688 implants were placed. The median number of implants placed was 6 per patient and 5 patients presented implant failures after or during the osseointegration phase (16 implants lost). The implant success rate was 97.6%. 78 patients benefited from rehabilitations by fixed implant-supported prostheses and 3 by implant-supported mandibular removable prostheses. DISCUSSION: The described care pathway seems to us adapted to the patients followed in our department, with good functional and esthetic results. It would be necessary to evaluate on a national scale to adapt the management process.

Implant repositioning with segmental osteotomy.

INTRODUCTION: The aim of this study is to assess a pioneering technique for atrophic premaxilla restoration. The objective is to reposition an implant reconstruction zone into a position both anatomically and physiologically suitable for occlusal function. Indeed, unlike the other few articles published on the correctional osteotomy of the implant in an inadequate situation, we have planned here an initially «unsuitable¼ insertion in order to benefit of the available bone mass. MATERIAL AND METHOD: 3 patients aged 14-20 years old (1 woman and 2 men) were operated on at the maxillo-facial department of Lille 2 University Hospital for partial implant-prosthetic rehabilitation on atrophic maxillary and/or mandibular sector. 13 implants were seated (85% in the maxilla) in the native bone then moved subsequently by segmental osteotomy. RESULTS: The patients were assessed both clinically and radiologically according to the functional and aesthetic criteria of implant-prosthetic restoration. Functionally, a biomechanically favourable implant/number of teeth ratio (80%) was achieved, with consistent occlusal relationships (centric positioning of the midline point and absence of crossbite) in 100% of cases. Aesthetically, the screw access hole is systematically non-apparent (100%) but has a prosthetically substituted reduced gingivo-alveolar architecture. DISCUSSION: These observations suggest that implant repositioning with segmental osteotomy allows for atrophic premaxilla restoration in implanted bone volume whatever the initial angulation. Peri-implant aesthetic difficulties are not specific to the technique suggested here but are quite common to all premaxilla reconstruction techniques. Lastly, this group of three patients is not enough to be conclusive, and a larger group would be necessary to validate this type of management.

Autogenous bone grafting with conventional implants vs zygomatic implants for atrophic maxillae: a retrospective study of the oral health-related quality of life.

INTRODUCTION: Autogenous bone grafting (ABG)-combined or not with Le Fort I osteotomy (LFIO)-and zygomatic implants (ZI) are two reliable techniques for the fixed rehabilitation of atrophic maxillae. ZI allow a reduced treatment duration with no need to graft, immediate loading and in principle less morbidity. The aim of this retrospective study was to compare these two protocols on oral health-related quality of life (OHRQoL). We also discussed implant and prosthetic survival rates, and biological complications. MATERIAL AND METHODS: All patients who benefited from ZI or ABG with conventional implants (CI) for a fixed maxillary rehabilitation, from November 2011 to April 2019, were included: 21 patients in the ABG group and 22 in the ZI group. OHRQoL was evaluated postoperatively by OHIP-14 questionnaire. RESULTS: OHIP-14 median scores were respectively 6.5 (interquartile range [IQR] 2.0-13.0) and 6.0 (IQR 3.0-10.0) without significant difference (p = 0.97). Implant/prosthetic survival rates were 97.9%/100% and 97.1%/95.5%. Biological complications rates were 33.3% and 36.4% without significant difference (p = 0.83). DISCUSSION: The type of surgery or prosthesis does not seem to affect final OHRQoL, implant and prosthetic survival rates or biological complications rates.

The inception of a hospital-based dental emergency department in a precarious region decreases the incidence of severe cellulitis of odontogenic origin.

INTRODUCTION: Although most localized odontogenic infections can be managed successfully without complications, some can cause extensive morbidity through the onset of cervicofacial cellulitis. The management of these more severe infections generally requires emergency treatment, including surgical treatment under general anesthesia, and prolonged length of hospital stay. MATERIAL & METHODS: In this work, we assessed the impact of the provision of a hospital-based dental emergency department on the regional incidence of severe odontogenic cellulitis in a socioeconomically precarious region. Monthly case rates of odontogenic cellulitis treated between January 2010 and December 2019 at the hospital-based dental emergency department of Lille Medical University Hospital were collected. RESULTS: The mean number of monthly severe odontogenic cellulitis cases treated under general anesthesia was significantly higher before than after the inception of the hospital-based dental emergency service [14.07 (5.83) vs 8.79 (4.42); p<0.0001]. Conversely, the monthly mean number of collected odontogenic cellulitis cases treated under local anesthesia was significantly lower before the emergency service was set up [22.42 (12.73) vs 43.32 (23.41); p<0.0001]. CONCLUSION: The provision of a hospital-based dental emergency department resulted in a decrease in severe dental infections in a region with high indices of socioeconomic precarity, morbidity and mortality. Greater accessibility to dental care allows for the rationalization of care through more precocious and fewer burdensome procedures.

Biological factors predicting the length of hospital stay in odontogenic cellulitis.

OBJECTIVE: The purpose of this study was to assess whether common biological factors are correlated with a longer hospital stay. STUDY DESIGN: All patients having odontogenic cellulitis, treated from January 2019 to December 2019 at Lille University Hospital, and requiring surgical drainage under general anesthesia, were included, retrospectively. Data, such as length of hospital stay and biological factors, namely, C-reactive protein (CRP) level, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, and bacterial samples were collected. RESULTS: Significant moderate-strong correlations were found between postoperative length of stay and patients' LRINEC score (rs = 0.556) and presurgical CRP level (rs = 0.579). There was a significant moderate correlation between postoperative length of stay and presurgical procalcitonin level (rs = 0.451), and a weak correlation between postoperative length of stay and presurgical white blood cell count (rs = 0.282). Linear regression verified CRP as an independent predictor of length of hospital stay, showing a significant linear relationship between them (p < 0.0001). A significant regression equation was found (F(1,65) = 27.089; p = 0.0001), with an R2 of 0.294. CONCLUSION: In this study, CRP was the key biological predictor of length of hospital stay. STATEMENT OF CLINICAL RELEVANCE: The ability to predict length of hospital stay and identify patients requiring intensive care management, using simple and inexpensive biological parameters (such as CRP), will enable more cost-effective care and efficient hospital bed management.

Microsurgical reconstruction of the jaw with fibular grafts and implants.

Reconstructive treatments for jaw defects are complex procedures that can combine multiple techniques including fibula free flap (FFF) grafting. The purpose of this retrospective study was to document and share our experience on mandibular and maxillar reconstruction with FFF followed by secondary dental rehabilitation using implant insertion.We reviewed 198 patients treated by FFF grafting for mandibular and/or maxillary defects in our department during the past 11 years (1996-2007). A selection of 30 patients (18 males and 12 females, mean age of 46 y) with adequate criteria (hygiene, motivation, and prognosis) received secondary placement of osseointegrated implants. The implant success was clinically and radiographically evaluated.A total of 105 osseointegrated implants were placed in the grafted fibulas 5 months to 3 years after the reconstruction surgery. Only 4 implants were lost because of peri-implantitis (3 patients) and fibular fracture (1 patient); this corresponds to a 96.2% implant success rate.During the mean follow-up of 76 months, patient's satisfaction and functional and aesthetic results were evaluated. Radiologic findings indicated a low crest resorption around the implants despite an unfavorable crown-to-root ratio.The main difficulties in the reconstructions were lack of FFF height, absence of a vestibular groove, limitation of mouth opening, skin paddle thickness, and the reconstruction of surrounding tissues including the lip. Our management strategy is discussed.Prosthetic choice is fundamental to achieving patient-specific solutions. The prostheses used included sealed or screwed bridge, resin-bonded bridge, tooled bar, implant-borne denture, or implant-stabilized dentures. Dental implants may be used even in situations involving an unfavorable crown-to-root ratio and implant position by using milled bar and overdenture. The FFF provides a consistent bone graft that allows a reliable and predictable restoration with dental implants, leading to a satisfactory functional and aesthetic restoration.

The use of onlay bone grafting for implant restoration in the extremely atrophic anterior maxilla. A case series

Functional and aesthetic treatments are challenging when ensuring maintain long-term successful prosthetic rehabilitation after alveolar ridge resorption of the anterior maxilla. The goal of this case series was to evaluate implant success rate, prosthetic stability and patient satisfaction in patients treated by onlay bone grafting in atrophic premaxilla. Nineteen patients treated for severe atrophic anterior maxilla by reconstruction using onlay bone grafting and implant restoration between 2002 and 2012 were examined. The surgical procedure was designed to allow the insertion of 49 endosseous implants in the grafted anterior maxillae. Bone resorption and implant success rate were retrospectively evaluated after a follow-up period of 5 years (from 5 to 15 years) subsequent to reconstruction. A questionnaire was the medium used to evaluate patient satisfaction and highlight functional and aesthetic outcomes. The bone grafting success rate was 74%. None of the grafted bones were reported to be infected. Four implants were removed. Implant survival rate was 91.8% after 8.9 years. The permanent reconstruction was fixed in 74% of the cases and removable in 26%. The level of patient satisfaction reported was 6.5/7. In conclusion, his study suggests that onlay bone grafting can be considered a predictable technique for rehabilitation in atrophic premaxilla. The procedure has a high implant survival rate, acceptable bone resorption over time, and promotes graft stability for longterm prosthetic fixation, thereby increasing patient satisfaction.

Zygomatic implants in our daily practice. Part I: Treatment Plan and Surgical Technique / L'implant zygomatique dans notre pratique quotidienne. Partie I: Plan de traitement et technique chirurgicale

Prosthetic rehabilitation of the atrophic edentulous maxilla is a challenge for which zygomatic implants (ZI) stand out from traditional techniques (aiming to increase bone volume) with reduced treatment duration and immediate loading. The aim of this study was to review the ZI treatment plan and its surgical technique based on a series of nine edentulous atrophic maxillary cases. Implant survival rate and postoperative follow-up were reported as well as those described in the literature. The advantages and disadvantages of ZI versus traditional methods of rehabilitation in our daily work were also discussed. Implant survival rate was 100% over follow-up periods varying from 5 to 47 months. During postoperative follow-up, two patients presented with slight palate inflammation. The results obtained with zygomatic implants are satisfactory in terms of reproducibility and speed of rehabilitation of the maxillary. When the patient wishes a fixed prosthetic rehabilitation, the solution provided by the ZI becomes more common in the daily practice of the clinician.

La réhabilitation prothétique du maxillaire atro­phique édenté constitue un défi pour lequel l'im­plant zygomatique (IZ) se démarque des tech­niques traditionnelles (visant à augmenter le volume osseux) par une durée de traitement réduite et une mise en charge immédiate. L'ob­jectif de cette étude était de faire le point sur le plan de traitement par IZ et sur sa technique chirurgicale en se basant sur une série de neuf cas maxillaires atrophiques édentés. Les taux de survie implantaire et toutes les suites opératoires ont été présentés ainsi que ceux décrits dans la littérature. Les avantages et les inconvénients des IZ ont également été discutés par rapport aux méthodes traditionnelles de réhabilitation dans notre pratique quotidienne. Le taux de survie était de 100% pour une durée de suivi variant de 5 à 47 mois. Les patients avaient présenté deux inflammations palatines légères postopératoires. L'ancrage zygomatique a montré des résultats satisfaisants par sa fiabilité et sa rapidité à réha­biliter l'étage maxillaire. Dans le cas où le patient souhaite une réhabilitation prothétique fixe, la solution apportée par l'IZ tend à se démocratiser dans le travail quotidien du praticien.

Zygomatic implants in our daily practice. Part II: Prosthetic rehabilitation and effect on quality of life / L'implant zygomatique dans notre pratique quotidienne. Partie II: Réhabilitation prothétique et influence sur la qualité de vie

Effect of prosthesis and dental implants on quality of life related to the patient's oral health can guide the clinician in providing best services. The zygomatic implant (ZI) is a partial or complete alternative technique to so-called traditional rehabilitation techniques (aiming to increase bone volume) of edentulous atrophic maxillae. The objective of this study was to evaluate the impact of fixed prosthetic rehabilitation by ZI on patients' quality of life. This study highlighted the level of satisfaction of nine patients treated with ZI via their pre-therapeutic and post-therapeutic scores on the Oral Health Impact Profile (OHIP)-14 scale. Effect of ZI on quality of life in reference literature was also discussed. The mean pre-therapeutic and post-therapeutic OHIP scores were 29.1 and 5.8, respectively. Results about the quality of life of our patients was very satisfying. In accordance with literature, fixed prosthetic rehabilitation on ZI brought satisfaction in both its functional and aesthetic dimensions. This option of therapeutic arsenal for advanced atrophy of the edentulous maxillary is becoming more and more interesting in our daily practice.

L'influence des prothèses et des implants dentaires sur la qualité de vie liée à la santé bucco-dentaire du patient peut guider le praticien dans la prestation des meilleurs services. L'implant zygomatique (IZ) constitue une technique alternative partielle ou complète aux techniques de réhabilitation dites «traditionnelles¼ (visant à augmenter le volume osseux) des maxillaires atrophiques édentés. L'objectif de cette étude était d'appréhender l'impact de la réhabilitation prothétique fixe par IZ sur la qualité de vie des patients. Cette étude mettait en évidence le degré de satisfaction d'une série de neuf patients traités par IZ à travers leurs scores au questionnaire Oral Health Impact Profile OHIP-14 préthérapeutiques et post-thérapeutiques. L'influence des IZ sur la qualité de vie est discutée par rapport à la littérature de référence. Le score OHIP préthérapeutique moyen était de 29,1. Le score OHIP post-thérapeutique moyen était de 5,8. Le ressenti sur la qualité de vie des patients était très satisfaisant. Conformément à la littérature, la réhabilitation prothétique fixe sur IZ apportait une satisfaction tant dans sa dimension fonctionnelle qu'esthétique. Cette option de l'arsenal thérapeutique du maxillaire atrophique édenté se montre de plus en plus intéressante dans notre pratique quotidienne.

Temporomandibular joint arthritis: Clinical, orthodontic, orthopaedic and surgical approaches.

Rheumatic diseases (RD) of the temporomandibular joints (TMJs) are increasingly frequent affections and unfortunately often confused with "classic" manducatory dysfunctions (disk dislocation, myofascial pain syndroms). Their diagnosis is mandatory, given the major subsequent craniofacial disorders, which may occur (mandibular condylar hypoplasia, facial hyperdivergence, remodelling of the condylar unit, ankylosis), although the clinical implementation remains unspecific. The delayed diagnosis may be explained by the embryologic, anatomical and physiological characteristics of this joint. Magnetic resonance imaging (MRI), scans and more recently cone-beam computed tomography (CBCT) allow to diagnose its early signs (alteration of the disc-ligament complex, intra-articular effusion, osteochondral lesions). The treatment of TMJ rheumatic diseases (RD) is not consensual, and often includes a non surgical phase (hygiene and dietary rules, non-steroid anti-inflammatory drugs (NSAI), occlusal splints, and/or a surgical phase for the advanced stages (joint washing, orthognathic surgery, or joint surgery), and non responding patients to the medical treatment of inflammatory rheumatism. Orthodontics will be useful to correct dento-alveolar compensations, while monitoring, however, the impact on joint function.

Condylar resorptions and orthodontic-surgical treatment: State of the art.

Resorption of the mandibular condyle [RMC] is a disease of the temporomandibular joints, with multifactorial origins. The clinical manifestations take the form essentially of joint pain and occlusal disorders, depending on the rate at which the condyle is affected. X-ray imaging shows that the condyle is reduced in volume, flattened and displaced backwards, with loss of cortical substance in advanced forms. The aim of this article is to recall some pathophysiological features and then to review all the diagnostic and etiological factors and discuss possible modes of management.

Retrospective evaluation of 211 patients with maxillofacial reconstruction using parietal bone graft for implants insertion.

PURPOSE: For a century, autologous bone grafts have been used in maxillofacial reconstruction. The ideal bone harvest site and grafting procedure remains a point of contention in regards to obtaining optimal long-term results with sufficient bone quantity and density without serious complications. More recently, confronted with growing patient requests and biomaterials development, maxillofacial surgeons and dentists have been considering these issues as they relate to pre-implant surgery. This study sought to evaluate implant success rate and complications following pre-implant surgery with parietal bone grafting. MATERIALS AND METHODS: A retrospective study was carried out on patients who underwent maxillofacial reconstruction of different sites (symphysis, mandibular corpus, maxillary sinus and premaxilla) for the purpose of implant insertion. RESULTS: 311 procedures in 211 patients were included. The implant osseointegration rate was around 95%. Clinical follow-up ranged from 10 months to 11 years. A secondary procedure was performed in 6.1% of cases and we noted no serious complications at the harvest site. DISCUSSION: With good revascularization and osseointegration of the graft, the use of parietal bone leads to an implant success rate similar to that seen in the literature. Moreover, the use of this material results in few infections and low bone resorption provided there is strict immobilization of the graft and no tension on the soft tissue sutures. CONCLUSION: Parietal bone grafts technique possess the required qualities for the success of implant surgery, offering results at least as interesting as others using autogenous bone and with no serious complications on donor site.