Remoção de pré-maxila em paciente com fissura labiopalatina: relato de caso / Removal of the premaxilla in patient with cleft lip and palate: case report

Diversas anomalias craniofaciais acometem os seres humanos, dentre estas podem ser citadas as fissuras labiopalatinas. Ocorrem devido à mal formações congênitas e comprometem o desenvolvimento orofacial e maxilo-mandibular, gerando complicações estéticas e funcionais. O momento para abordagem cirúrgica em pacientes com deformidade deste tipo é crucial para atingir o melhor resultado. Entretanto, muitos deles não procuram atendimento ou não tem acesso aos centros especializados. A pré-maxila em portadores de fissura labiopalatina transforame bilateral, não submetidos a tratamento cirúrgico na infância, é comumente protruída, impedindo o desenvolvimento e função adequada da musculatura perioral/ Ainda, pode causar dificuldades alimentares,de fonação e, principalmente, estético. O objetivo do presente trabalho é relatar o caso de uma paciente acompanhada no serviço de cirurgia bucomaxilofacial OSID/UFBA, portadora de fissura labiopalatina, submetida à remoção de pré-maxila em idade adulta. O fechamento da fenda palatina não foi possível devido a idade da paciente e o grau de desenvolvimento do palato, tendo indicado tratamento com uso de prótese obturadora. Considera-se que quanto mais precoce e associado a uma boa técnica cirúrgica forem realizadas as intervenções primárias, menores serão as sequelas. Consequentemente, os resultados estéticos e funcionais serão mais prováveis, sendo desnecessária a remoção cirúrgica da pre-maxila(AU)

Several craniofacial anomalies affect humans and, among these, it can be cited the cleft lip and palate. These occur due to congenital malformations and compromise the orofacial and maxillo-mandibular development, causing aesthetic and functional complications. The moment of the surgical approach in patients with this type of deformities is crucial to achieve the best outcome, however, many of them do not seek care or have no access to specialized centers. The premaxilla in carries of bilateral cleft lip and palate when they are not submitted to a surgical treatment in childhood, is commonly protruding, impeding the development and function of the perioral musculature, besides difficult feeding, phonation and mainly aesthetic. The aim of this article is to report the case of a patient accompained with the Bucomaxillofacial Surgery Service from OSID / UFBA, with cleft lip and palate, submitted to pre-maxilla removal, in adulthood. The cleft palate closure was not possible due to the age of the patient and degree of development of the palate, indicating treatment with obturator prosthesis. It is considered that, the sooner and associated with a good surgical technique, primary interventions are performed, the fewer the sequelae and consequently the aesthetic and functional results, where, in most cases, surgical removal of the premaxilla will be unnecessary(AU)

Comparing intra-oral wound healing after alveoloplasty using silk sutures and n-butyl-2-cyanoacrylate

OBJECTIVES: The need for proper wound closure is of paramount importance after any intra-oral surgery. Various wound closure techniques have been described in literature using traditional non-absorbable suture materials. These include like synthetic absorbable sutures, surgical staples and tissue adhesives. Cyanoacrylates are among the most commonly used biocompatible tissue adhesives. To evaluate and compare intraoral wound healing using 3-0 silk sutures and n-butyl-2-cyanoacrylate after alveoloplasty.MATERIALS AND METHODS: A total of 20 patients requiring bilateral alveoloplasty in the same arch (upper or lower) were included in this study. Patients with any pre-existing pathology or systemic disease were excluded. After alveoloplasty was performed, the wound was closed using 3-0 braided silk sutures on one side, and using n-butyl-2-cyanoacrylate bio adhesive on the other side. Patients were evaluated based on the following parameters: time required to achieve wound closure; the incidence of immediate and postoperative hemostasis; the time to the use of the first rescue medication; the side where pain first arises; and the side where wound healing begins first.RESULTS: Compared to 3-0 silk sutures, cyanoacrylate demonstrated better hemostatic properties, reduced operative time, reduced postoperative pain and better wound healing.CONCLUSION: These data suggest that cyanoacrylate glue is an adequate alternative to conventional sutures to close the surgical wound after alveoloplasty, and better than are 3-0 silk sutures.

Análise das exodontias realizadas na atenção primária da Região Metropolitana de Belo Horizonte / Analysis of tooth extractions performed in the primary health care of the Belo Horizonte metropolitan region

Objetivo: Analisar as exodontias de dentes permanentes (exodontia de dente permanente e múltipla com alveoloplastia por sextante) realizadas na atenção primária da Região Metropolitana de Belo Horizonte (RMBH). Métodos:Para a coleta de dados, foi utilizado o banco de dados da produtividade da atenção primária, da RMBH, ano de 2017, disponibilizado pelo Departamento de Informática do Sistema Único de Saúde (SUS). A variável dependente foi o indicador nº 21 do SUS, que corresponde ao percentual de exodontias realizadas dentre os procedimentos da atenção primária, cujo parâmetro deve ser ≤ 8% (≤ 8% e > 8%). As variáveis independentes foram: dados sociodemográficos (localização, população, Índice de Desenvolvimento Humano ­ IDH e Índice de Gini) e de saúde (cobertura de Estratégia de Saúde da Família ­ ESF e Equipes de Saúde Bucal ­ ESB e presença de Centro de Especialidades Odontológicas ­ CEO). Associações foram avaliadas por meio dos testes do Qui-Quadrado de Pearson e Exato de Fisher (p < 0,05), utilizando o programa SPSS 22.0. Resultados:Foram analisados 49 municípios, sendo 67,3% do núcleo metropolitano. A mediana populacional foi de 25.537 habitantes, com IDH médio de 0,707 e Índice de Gini mediano de 0,464. As medianas de cobertura da ESF e ESB foram, respectivamente, 96,7% e 52,7%. Apenas 32,7% dos municípios apresentaram CEO. O indicador nº 21 do SUS apresentou uma mediana de 6,7%. Não houve associação entre o indicador nº 21 do SUS e as variáveis sociodemográficas e de saúde (p > 0,05). Conclusão:A RMBH apresentou valores satisfatórios em relação ao percentual de exodontias realizadas, provavelmente devido aos bons indicadores socioeconômicos e de saúde bucal apresentados.

Aim: To analyze the extractions of permanent teeth (extraction of permanent teeth and extraction of multiple teeth with alveoloplasty per sextant), performed in a primary health care unit of the Metropolitan Region of Belo Horizonte (MRBH). Methods:For data collection, the primary care productivity database of 2017 from MRBH, provided by the Department of Information Technology of the Brazilian Unified Health System (SUS in Portuguese), was used. The dependent variable was the SUS indicator number 21, which corresponds to the percentage of extractions performed among primary dental care procedures, whose parameter must be ≤ 8% ( ≤ 8% and > 8%). The independent variables were: sociodemographic data (location, population, Human Development Index (HDI), and Gini Index) and health (coverage of Family Health Strategy (FHS) and Oral Health Teams (OHT), as well as the presence of Dental Specialty Centers (DCS). Associations were evaluated using the Pearson's Chi-square and Fisher's Exact tests (p < 0.05), using the SPSS 22.0 program. Results: This study analyzed 49 municipalities, 67.3% of which were metropolitan areas. The median population was 25,537 inhabitants, with a mean HDI of 0.707 and a median Gini index of 0.464. The median coverage of ESF and ESB were 96.7% and 52.7%, respectively. Only 32.7% of the municipalities presented CEO. The SUS indicator number 21 presented a median of 6.7%. No association was found between the SUS indicator number 21 and the sociodemographic and health variables (p > 0.05). Conclusion: The MRBH presented satisfactory values in relation to the percentage of tooth extractions, most likely due to the good socioeconomic and oral health indicators presented.

Implant treatment on anterior cross-bite of a patient who had orthognathic surgery 20 years ago / 대한치과보철학회지

Orthognathic surgery of skeletal Class III malocclusion improves oral function and facial appearance. The greater amount of skeletal discrepancy, the greater amount of teeth movement required for decompensation, and this often causes pathological changes in periodontal tissue especially in lower anterior dentition. We made a Top-Down treatment plan with personalized analysis using Face Hunter, Plane System and ARCUS Digma II, in order to resolve severe mobility and cross-bite of lower anterior teeth for 49-year-old female patient who had undergone orthognathic surgery 20 years ago due to skeletal Class III malocclusion and mandibular prognathism. Lower anterior teeth were extracted and alveoloplasty was done. After healing of the wound, immediate loading was conducted immediately after implant placement. Final restorations were fabricated Zirconia using CAD/CAM, and inserted intraorally screw-retained type. During 6-month follow-up, no abnormal episodes of restorations were observed, and obtained satisfactorily both of functional and esthetic outcomes.

Fabrication of immediate complete denture using Campagna tray technique / 대한치과보철학회지

An immediate complete denture is considered as restoration for lost natural teeth, which is fabricated following the extraction of the remaining teeth. Current esthetics and function can be retained by using immediate denture without edentulous period. However, the major disadvantages of immediate denture relate to the difficulties associated with taking accurate definitive impression and predicting the results of immediate denture. In this case report, the Campagna tray technique was used to take the final impression in a 49-year-old male patient presented with all remaining teeth diagnosed as hopeless teeth. Surgical templates were used for alveoloplasty after extraction. The immediate complete dentures were then delivered. The clinical assessments of immediate dentures showed good esthetic and functional outcomes. The patient showed high level of satisfaction.

Management of traumatic neuralgia in a patient with the extracted teeth and alveoloplasty: a case report

A majority of patients who sustain injuries to the peripheral sensory nerves of the face and jaws experience a slow but gradual return of sensation that is functional and tolerable, if not the same as before the injuries. However, long-term effects of such injuries are aggravating for many patients, and a few patients experience significant suffering. In some of these patients, posttraumatic symptoms become pathological and are painful. The predominant painful components are (1) numbing anesthesia dolorosa pain, (2) triggered neuralgiaform pain, (3) burning and aching causalgiaform pain, and (4) phantom pain. This is a case report of conservative management of traumatic neuralgia and neuritis as part of posttraumatic pain syndromes in geriatric patients who have undergone the teeth extraction and alveoloplasty.

Alveoloplastia interseptal: una renovada técnica de cierre de las comunicaciones y fístulas bucoantrales / Interseptal alveoloplasty: a renewed technique for closing communications and oral-antral fistula

Se realizó un estudio descriptivo, prospectivo y de intervención terapéutica en 11 pacientes con comunicación y/o fístula bucoantral, tratados con la técnica de alveoloplastia interseptal en el Servicio de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, en el período 2010-2012, con vistas a describir los resultados obtenidos con este método terapéutico. Entre las variables analizadas figuraron: edad, sexo, causa, diente afectado, condición del seno maxilar, tratamiento preoperatorio, dimensión de la complicación, tiempo de evolución, complicaciones quirúrgicas y evolución posoperatoria. En la serie predominaron los resultados excelentes en comunicaciones y fístulas bucoantrales, con dimensiones entre 3 y 5 mm, localizadas en áreas edentes o con un solo diente adyacente, ubicadas en el reborde alveolar, sin afectación de las paredes bucal o palatina o ambas y con reborde alveolar con trofismo adecuado. Esta técnica proporciona una base ósea con pedículo de tejido blando, lo cual facilita una cicatrización más rápida, con menor riesgo de complicaciones posoperatorias.

A descriptive, prospective and therapeutic intervention in 11 patients with communication and/or oral-antral fistula, treated with the interseptal alveoloplasty technique was carried out in the Maxillofacial Surgery Service from "Saturnino Lora Torres" Clinical Surgical Teaching Provincial Hospital in Santiago from Cuba in the period 2010-2012, aimed at describing the obtained results with this therapeutic method. Among the analyzed variables there were: age, sex, cause, affected tooth, condition of the maxillary sinus, preoperative treatment, magnitude of the complication, duration of the clinical course, surgical complications and postoperative clinical course. In the series the excellent results prevailed in communications and oral-antral fistula, with dimensions between 3 and 5 mm, located in edentulous areas or with a single adjacent tooth, located in the alveolar edge, without damaging the oral or palatine walls or both, and with alveolar edge with adequate trophism. This technique provides a bony base with pedicle of soft tissue, which facilitates a faster scaring, with lower risk of postoperative complications.

Nostril Base Augmentation Effect of Alveolar Bone Graft

BACKGROUND: The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft. METHODS: Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT. RESULTS: Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001). CONCLUSIONS: An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - part 3: Oral and Maxillofacial Surgery

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

Influence of the Alveolar Cleft Type on Preoperative Estimation Using 3D CT Assessment for Alveolar Cleft

BACKGROUND: The bone graft for the alveolar cleft has been accepted as one of the essential treatments for cleft lip patients. Precise preoperative measurement of the architecture and size of the bone defect in alveolar cleft has been considered helpful for increasing the success rate of bone grafting because those features may vary with the cleft type. Recently, some studies have reported on the usefulness of three-dimensional (3D) computed tomography (CT) assessment of alveolar bone defect; however, no study on the possible implication of the cleft type on the difference between the presumed and actual value has been conducted yet. We aimed to evaluate the clinical predictability of such measurement using 3D CT assessment according to the cleft type. METHODS: The study consisted of 47 pediatric patients. The subjects were divided according to the cleft type. CT was performed before the graft operation and assessed using image analysis software. The statistical significance of the difference between the preoperative estimation and intraoperative measurement was analyzed. RESULTS: The difference between the preoperative and intraoperative values were -0.1+/-0.3 cm3 (P=0.084). There was no significant intergroup difference, but the groups with a cleft palate showed a significant difference of -0.2+/-0.3 cm3 (P<0.05). CONCLUSIONS: Assessment of the alveolar cleft volume using 3D CT scan data and image analysis software can help in selecting the optimal graft procedure and extracting the correct volume of cancellous bone for grafting. Considering the cleft type, it would be helpful to extract an additional volume of 0.2 cm3 in the presence of a cleft palate.

The Reharvesting of Iliac Crest Cancellous Bone for the Repair of the Alveolar Cleft

PURPOSE: The anterior iliac crest is a common source for autologous cancellous bone graft. For patients who have previously received cancellous bone grafts from bilateral anterior iliac crests, there may be concerns of whether a sufficient quantity of autologous cancellous bone remains for additional grafts without harvesting it from other sites, such as the posterior iliac crest. METHODS: We experienced 3 cases of reharvesting in 2 patients. The diagnosis of the first patient was bilateral facial cleft number 3. This patient received bilateral side cleft alveoloplasty with corticocancellous bone graft from the both anterior iliac crest respectively by a previous surgeon. This patient then needed reharvesting of the anterior iliac crest cancellous bone to correct an ongoing skeletal problem for the bilateral cleft. The other patient had bilateral incomplete cleft of the primary palate. This patient received left side cleft alveoloplasty with cancellous bone graft from the right anterior iliac crest. Before the patient could receive the alveoloplasty on the other side, a radial head osteotomy and cancellous bone graft was performed by orthopedic surgeons who then used the remaining left iliac crest in order to treat a pulled elbow. For the completion of the right side cleft alveoplasty, the anterior iliac crest cancellous bone needed to be reharvested. Prior to the reharvesting, a preoperative computed tomography scan of the pelvis was obtained to assess the maturity of the donor site regeneration. The grafts were then taken from site where a greater amount of regeneration was evident. RESULTS: Long term follow ups showed that the grafts were successfully taken. This sufficient volume was obtainable 14 months after the first harvest. CONCLUSION: Satisfactory results were achieved after the reharvesting of iliac cancellous bone. Thus, it appears that the reharvesting of the iliac bone is a possible alternative to multiple site grafting, use of allograft or bone substitute materials.

One Stage Correction of the Severe Secondary Cleft Lip Nasal Deformities in Foreigners

PURPOSE: It is accepted universally that correction of the cleft lip nasal deformity requires multiple stages of surgery. Following primary lip repair in infancy or early childhood, secondary surgery to improve the deformity of the lip and nose is frequently necessary. A suitable surgical procedure to correct the accompanying deformity, such as cleft palate and alveolus, must be carried out at an appropriate age. In developing countries, it is common for patients with cleft lip nasal deformity to present severe secondary deformities in adolescence, because of poor follow-up and inappropriate surgery. METHODS: The first patient was a 12 year old Mongolian boy. He presented prominent lip scar, short lip, wide columella, asymmetric nostril, palatal fistula, cleft alveolus, and velopharyngeal incompetence. He underwent cheilorhinoplasty, transpositional flap, alveoloplasty by iliac bone graft, and sphincter pharyngoplasty. On follow-up, a bilateral maxillary hypoplasia and a class III malocclusion developed. He underwent LeFort I osteotomy and maxillary advancement at the age of 16 years. The second patient was an 18 year old Eastern Russian girl. She presented with a deviated nose, right alar base depression, short lip, protrusion on vermilion, large palatal fistula, and severe VPI due to short palate. She underwent the combined procedure of cheilorhinoplasty, corrective rhinoplasty, tongue flap for palatal fistula, and superiorly based pharyngeal flap. And the tongue flap was detached at postoperative 3 weeks. RESULTS: The overall results have been extremely pleasing and satisfactory to patients. There were no postoperative complications. CONCLUSION: We discovered the one stage operation for radical correction was sufficient procedure to provide excellent clinical outcomes in patients with severe cleft lip nose deformity.

Cleft palate habilitation.

Presurgical Orthopaedics is any treatment that alters the position of the segments of cleft maxilla in infancy prior to lip and palate reconstruction. There are different approaches, with different mechanics, seeking and achieving different end results. This article describes PNAM, a current approach to the traditional method of presurgical infant orthopaedics for patients with unilateral and bilateral clefts of lip and palate. The goal of PNAM is to align and approximate the alveolar cleft segments while at the same time achieving correction of nasal cartilage and soft tissue deformity.

Analysis of Oral State of Hansen's Patients and Denture fabrication for Pre-Prothodontic Oro-maxillofacial minor surgury / 나학회지

The purposes of this study were to investigate the oral health care conditions of patients who have Leprous disease, which is an infectious disease(Dental caries: DMF rate and DMFT rate, and Periodontal conditions: CPITN0, CPITN1 CPITN2 CPITN3 ) and the satisfaction of use of denture fabrication related to general, functional and esthetic factors among dental patients for pre-Prothodontic Oro-maxillofacial minor surgury in National sorokdo hospital. The objects for this study were 754patients(male: 453, female: 301, 60-69ages: 340, 70-79ages: 414)treated in the oral health center among Leprous disease patients with gingivitis and periodontal disease, residents in the Sorokdo from 2003, January to 2005, September. 1. The results of Dental caries investigated that the number of 60-80year-old patients group that DMF rate was 99.2% of them, DMFT rate 59.2% 2. The results of periodontal conditios investigated that the number of 60-69year-old patients group were Community Periodontal treatment need index(CPITN)0: 15, CPITN1: 2, CPITN2: 66, CPITN3: 257, and 70-79year-old patients group were CPITN0: 27, CPITN1: 1, CPITN2: 116, CPITN3: 271 (Community Periodontal treatment need index(CPITN)0 of patients who have Leprous disease means anodontia states) 3. Dental fabrication patients for pre-Prothodontic Oro-maxillofacial minor surgury have operated Lower lip reconstruction, Hypergingivotomy, Flap, Alveoloplasty, Tours ostotomy and Apicoectomny

An investigation of restoration of alveolar cleft with engineered bone / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate restoration of alveolar cleft with engineered bone constructed by sponge collagen protein combined bone mesenchymal stem cells (BMSC).</p><p><b>METHODS</b>Twelve dogs were divided into 4 groups, the third incisor and alveolar bone with periosteum in bilateral maxilla were removed to form alveolar cleft model. The BMSCs were isolated from dog bone marrow. After being cultured and induced, the BMSCs were seeded in sponge collagen protein and cultured for 48 hours. The composites of BMSCs and collagen were implanted into the defect of alveolar cleft. After 12 weeks' feeding, those dogs were sacrificed. Three-dimensional CT and histological examination were used to observe the progress of bone formation.</p><p><b>RESULTS</b>The defects healed at 12 weeks after being implant BMSCs-collagen composites, the width of engineered bone is resembled with positive control, but the height is less than positive control.</p><p><b>CONCLUSIONS</b>The engineered bone can restore the defect of alveolar bone effectively, it can be used clinically to treat alveolar cleft.</p>

Secondary bone grafting in cleft lip and palate with eruption of tooth into the graft: a case report.

Secondary bone grafting in cleft lip and palate patients is performed preferably before the eruption of permanent canine in order to provide adequate periodontal support for eruption and preservation of the teeth adjacent to the cleft. Presented here with is a case of unilateral cleft lip and palate, which was followed up from birth to 15 years of age. The role of an orthodontist in the team approach for management of such anomalies is described. Also discussed in detail is the entire range of treatment procedures the child underwent, especially the role of secondary bone grafting.

Mid-premaxillary sutural distraction osteogenesis for repair of alveolus cleft: an experimental study in dogs / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a new technique for repair of alveolar cleft by sutural distraction osteogenesis.</p><p><b>METHODS</b>Nine 8-weeks mongrel dogs were used in this study, three being in the control group, six in the experimental group. Alveolar cleft model was created surgically in all animals. Two weeks later, a U-shaped distractor made of Ni-Ti memory alloy wire was insterted into the premaxilla to distract the mid-premaxillary suture. When the premaxilla of the cleft side approached the ipsilateral maxilla, periosteoplasty of the alveolar cleft was performed. The distractor was removed at two weeks after periosteoplasty. The results were evaluated clinically, radiographically, morphologically and histologically.</p><p><b>RESULTS</b>The cleft model in dogs was stable and similar to the human alveolar cleft. In experimental dogs, the premaxilla was moved gradually toward the maxilla so that the cleft was closed. The distracted mid-premaxillary suture showed a gradually widened traingle, with its tip being posterior. The density of the distracted traingle suture was increased gradually. Bony repair was achieved completely at the cleft three months post-periosteoplasy. The morphology of the mid-premaxillary suture was restored.</p><p><b>CONCLUSION</b>The alveolar cleft could be repaired by the technique of mid-premaxilla suture distraction.</p>

Secondary Alveoloplasty Using Iliac Cancellous Bone Graft in the Cleft Lip and Palate Patients

Maxillar bone of the patients with complete cleft lip and palate showed delayed growth pattern due to defect of bone formation and bony defect of cleft site, maxillary retrusion and defect and displacement of lateral incisor and canine. In the patients with bilateral cleft lip and palate, there are more severe bony defect and hypoplasia which leads to premaxillar instability and maxillary retrusion and makes the Type III malocclusion. In these patients, the reason for secondary bone graft to alveolar cleft after surgery of cleft lip and palate is to provide the stability of maxillary arch, to create bony matrix through which the teeth can erupt and to construct the plateform of the alar base for improving nasal and upper lip symmetry. There are many arguement about preferred timing of bone graft and donor site of bone graft, but we performed secondary bone graft for 16 alveolar cleft patients who is between the ages of 7 to 10 years, and we have followed up during 1 to 5 years. We harvested cancellous bone from iliac bone for donor, performed cancellous bone graft to alveolar cleft, and then sutured gingival flap water tightly, and applied Coe-pak on the operation site for protecting graft site after bone graft. As a result of radiograph for the quality of graft "take", there were little of bony absorption in 70% of cases, partial bony absorption in 30% of cases. By alveoloplasty with bone graft, there were improvement and harmony in nose, upper lip and alveolar arch. The patients with remnant alveolar fistula also were repaired, and permanent teeth were erupted with good shape. Results were satisfactory in the almost patients

Effects of Osseointegration According to Implant Placement Timing in the Distracted Alveolar Bone of Dogs

The present study was aimed to investigate the effect of osseointegration according to implant placement timing in the distracted alveolar bone using intraoral distraction device. Six adult mongrel dogs of either sex, weighing about 15kg, were used. The animals were divided into 4-week and 8-week groups according to the timing of implant installation. The left upper and lower premolars and first molars were extracted and an alveoloplasty was performed to simulate an atrophic ridge. After 12 weeks of healing, a segmental osteotomy was made and an intraoral distraction device which was designed for augmentation of vertical height of the edentulous ridge was applied. Latency period was allowed for 5 days and then distraction was made at a rate of 1.2mm/day for 8 days. Four or eight weeks after distraction, implants were installed. Twelve weeks after implant installation, the animals were sacrificed. Macroscopic, radiographic, and histologic examinations of distracted alveolar ridge were performed. No significant abnormalities such as infection and dehiscence of overlying soft tissue were observed. Radiographically, there was slight bone resorption around the medial and distal edges of the alveolar bone segment, and a new bone deposition was observed in the neighboring alveolar crest area in the both groups. The satisfactory osseointegration was achieved in the distracted gap of the both groups, but fibrous tissue appeared on the buccal side of implant in the distracted gap in 4-week group. These results suggest that proper timing of implant installation is 8 weeks rather than 4 weeks after distraction when dental implant is to be placed onto the distracted bone.

Polyostotic Fibrous Dysplasia of Cranio-Maxillofacial Area / 대한구강악안면방사선학회지

Fibrous dysplasia is believed to be a hamartomatous developmental lesion of unknown origin. This disease is divided into monostotic and polyostotic fibrous dysplasia. Polyostotic type can be divided into craniofacial type, Lichtenstein-Jaffe type, and McCune-Albright syndrome. In this case, a 31-year-old female presented spontaneous loss of right mandibular teeth before 5 years and has shown continuous expansion of right mandibular alveolus. Through the radiographic view, the coarse pattern of the mixed radiopaque-lucent lesion was seen on the right mandibular body, and there was diffuse pattern of the mixed radiopaque-lucent lesion with ill-defined margin in the left mandibular body. In the right calvarium, the lesion had cotton-wool appearance. Partial excision for contouring, multiple extraction, and alveoloplasty were accomplished under general anesthesia for supportive treatment. Finally we could conclude this case was polyostotic fibrous dysplasia of cranio-maxillofacial area based on the clinical, radiologic finding, and histopathologic examination.