[Technical note:simple tools in preimplant surgery]. / Les petits moyens en chirurgie préimplantaire.

Osteotomes, the bone scraper, and the bone trap are simple tools used for preprosthetic surgery. They are not very invasive, present little risks, and they can be used in private surgical practice with local anaesthesia. The osteotome preserves, dilates, and condenses the alveolar bone instead of eliminating it like drilling does. It does not require any motor or irrigation. It increases the width and the height of the alveolar crest. It allows the localized expansion of narrow or misshapen alveolar crest when its width ranges between 3 and 4.5mm. It also allows performing a localized sinus lift, when the sinus floor height ranges between 4 and 8mm. The bone scraper is used to retrieve cortical chips of parietal bone for sinus lift. The bone trap is connected to the suction tube. It is used to collect bone powder after milling or bone drilling. These simple tools should be available for all maxillofacial surgeons in specific indications.

[Pre-implantation apposition grafts for edentuous anterior maxillary. Retrospective study of 36 patients]. / La greffe d'apposition à visée pré-implantaire pour édentation maxillaire antérieure.

INTRODUCTION: Apposition grafting is a method of choice for reconstruction of the anterior maxillary. The purpose of this work was to evaluate the success rate, the degree of bone resorption and the osteointegration of these grafts. MATERIAL AND METHODS: We reviewed retrospectively 36 cases of pre-maxillary bone apposition in patients operated from 1998 to 2002. Autografts were used for all patients. The harvesting site was parietal for 24 patients, intraoral for 8 and iliac for 4. RESULTS: There was two graft failures. The success rate was 94.5%. Partial resorption with effect on implantation was noted in 3 patients. Eighty implants were inserted successfully in 234 grafted sites with on average 2.4 implants per graft. Three implants were removed. Implant survival was 96.2%. DISCUSSION: This study demonstrated that the premaxillary apposition technique using autologous grafts provides sufficient bone volume to enable optimal implant insertion and stability.

[Stability of grafts and implants after bone grafting of the maxillary sinus. Retrospective analysis of 44 patients]. / Stabilité du greffon et des implants après greffe osseuse du sinus maxillaire.

OBJECTIVES: We assessed the reliability of maxillary bone grafting and implant stability, comparing our results with reports in the literature. MATERIAL AND METHODS: This retrospective series included 44 patients who underwent maxillary sinus bone grafting between 1998 and 2002. An analogous graft was used for 31 patients and a combination autologous-bone substitute graft for 13. One hundred twelve dental implants were positioned at the grafting site (2.5 implants per graft). We assessed recipient site morbidity, bone graft integration and stability, and stability of the implants. RESULTS: Bone grafting was successful in 97.8% of patients. There was one failure. Two of the 112 implants failed. DISCUSSION: Our results are comparable with those in the literature. This study demonstrated the reliability of maxillary bone grafting with equivalent results using autologous bone and combination autologous bone-bone substitute.

[Early implant treatment of a child with anhidrotic ectodermal dysplasia. Apropos of a case]. / Traitement implantaire précoce d'un enfant atteint d'une dysplasie ectodermique anhidrotique. A propos d'un cas.

The purpose of this article is to report the clinical course and follow-up of a child with ectodermal dysplasia who was treated with implants surgery very early. Different possibilities for prosthetic restoration in the anodontic child are reviewed. Tolerance was excellent. Good cover of the implant was achieved at four years. We propose early implantation reconstruction surgery for these exceptional cases. A prospective multicentric study of this condition would be useful.

[Dental agenesis. Results of a prospective study of 30 cases]. / Agénésies dentaires. Résultats d'une étude prospective à partir de 30 cas.

OBJECTIVE: We conducted a prospective study to determine the types of bone anomalies observed in different types of dental agenesia. PATIENTS AND METHOD: This prospective series included 30 patients who attended our pluridisciplinary clinic since 1988. There were 22 cases of non syndromal agenesia and 8 cases of syndromal agenesia. Patients consulted for a variety of reasons, no specific sign was found. The diagnosis was based on the panoramic x-ray and confirmed at the genetic consultation. RESULTS: Results were systemized by localization of the agenesia. In all cases, the height of the bone crest was preserved compared with the adjacent teeth. In the anterior part of the maxillary, the bone crest was thin showing a water drop aspect. In the posterior maxillary, there was a decrease in the subsinusal height due to invagination of the floor of the sinus. In the anterior part of the mandible, the crest had a knife blade aspect but no loss of height and in the posterior part, a preserved distance between the residual crest rim and the dental canal. DISCUSSION: In 60% of the solitary agenesias in the anterior part of the maxillary, augmentation was not required. A sinus graft was required in all cases involving the posterior maxillary. Multiple anterior or lateral agenesias were treated with a parietal graft.

[Pre-implantation iliac graft in the sinus. Retrospective study of the complications encountered in 100 cases]. / Greffe sinusienne d'origine iliaque à visée pré-implantaire. Etude rétrospective des complications rencontrées à partir de 100 cas.

MATERIAL AND METHODS: This series included 60 patients operated on between 1996 and 1998. Preoperative work-up included a x-ray study bone quality, preparation of the buccal cavity and assessment of the rhinosinus. We used the surgical technique described by Boynes and Tatum with modifications. The bone graft, mean 16 cm2 was fixed with a stud and clamp assemble or a long screw through the gingival crest, or with a microscrew on the lateral wall of the maxillary sinus. Minimal follow-up was two years. RESULTS: Mean age was 54 years (range 20-80). There were only two minor (hematoma) donor site problems. At the receiver site, there were 30 perforations of the mucosa that had no effect on the graft vitality. During the postoperative period, there were 2 hematomas that resolved spontaneously and 20 cases of dysesthesia in the V2 territory. Mid-term outcome (15 days to 6 months postoperatively) showed: 4 graft infections requiring removal in 3 cases and 6 partial resorptions requiring a new parietal bone graft in 3 cases. DISCUSSION: The iliac bone graft provided abundant cancellous tissue. The mid-term outcome was satisfactory although the postoperative problems resolved more slowly and were more painful than when harvesting a parietal graft. Mucosal perforations were frequent but reparable and did not increase postoperative morbidity. Infection was the most severe complication. Our incidence (3%) was slightly higher than reported in the literature. A possible explanation would be the mean height of the graft (18-20 mm) and the severity of the atrophies treated.

[Microvascular mandibular reconstruction and implantology. A study of the stability of long-term results, apropos of 2 cases followed for 8 years]. / Reconstruction mandibulaire microvascularisée et implantologie. Etude de la stabilité des résultats à long terme, à propos de deux cas suivis à 8 ans.

The objective of this study was to determine the long term stability of implants on mandibles reconstructed by microvascular bone transfer. We present two cases of mandible reconstruction, the first one was performed after tumor resection and the second one after gunshot injury. The reconstructions were performed by iliac crest osseous and osteocutaneous free flaps and the mean follow-up period was 8 years. The implant was an IMZ Titanium and a classic prosthetic system was used. No complication was observed (mucous ulceration, infiltration around the implant), and the feared friction phenomenon between the neo mucosa and the reconstructed bone has not been a problem for long term follow-up.

[Cancer of the breast at the time of diagnosis. A national CANAM study: analysis of 3007 cases]. / Le cancer du sein au moment du diagnostic. Etude nationale de la CANAM: analyse de 3,007 cas.

Between April 1988 and February 1990, 3,007 cases of female breast cancer were recorded among people insured by CANAM*; 118 cancers were bilateral from the start and 2,889 were unilateral. At the time of diagnosis the patients' age ranged from 24 to 101 years (median: 60 years), and 35.6 percent of the tumours were virtually subclinical. Lymph node involvement was clinically absent in 75 percent of the cases and histologically absent in 57 percent. In women under 50 the proportion of small TO-T1 tumours was greater than 40 percent, which pleaded for detection before the age of 50 years. Conversely, in economically weak populations and in women who were followed up for cancerous disease, breast cancer was diagnosed at a later stage. In older (retired) women (median age: 74), who accounted for 44 percent of the whole population, the proportion of advanced tumours was practically doubled (T4: 11 percent versus 6 percent), and the probability of metastases at the time of diagnosis had risen from 4.2 to 6.1 percent. In these patients, clinical examination once a year should contribute to an earlier diagnosis.