Effects of Local Low-Dose Alendronate Injections Into the Distraction Gap on New Bone Formation and Distraction Rate on Distraction Osteogenesis.

Bisphosphonates that constrain bone resorption have a direct effect on osteoclast function. In this experimental study, the effects of low-dose local alendronate injections on the distraction gap (DG) in rabbit mandible at 2 different rates were evaluated.The experimental study was conducted on 20 male, New Zealand white rabbits. The animals were divided into 3 experimental groups and 1 control group. Group 1 consisted of animals with distraction at the rate of 1 mm/day, receiving postoperative local low-dose alendronate local injections into the DG. Group 2 consisted of animals with distraction at the rate of 2 mm/day, receiving postoperative 0.75 µg/kg of alendronate local injections into the DG. Group 3 consisted of animals with distraction at the rate of 2 mm/day, receiving postoperative 0.2 mL local saline injections into the DG. Group 4 consisted of animals with distraction at the rate of 1 mm/day, receiving postoperative 0.2 mL local saline injections into the DG. All the injections were performed immediately postoperatively and for all groups at 1, 2, 3, and 4 weeks following surgery. The distraction zones were evaluated using dual-energy X-ray absorptiometry and histological analysis.Histologically, bone healing was found to be significantly accelerated in Groups 1 and 4 compared with Groups 2 and 3 (P < 0.05). Bone healing was superior in Group 1 and the difference was statistically significant compared with Group 4. There was a significant increase in mean bone mineral density in the 1 mm daily rate groups (Groups 1 and 4) compared with the 2 mm daily rate groups (Groups 2 and 3) (P < 0.05).Local low-dose alendronate injections could be an effective way for improving bone formation in distraction osteogenesis. Furthermore, the results of this study did not support the hypothesis that injections of local low-dose alendronate may allow 2 mm/day instead of 1 mm/day of elongation in the rabbit mandible.

Clinical Evaluation of the Use of Tibial Bone Grafting in Dentoalveolar Reconstructive Surgery.

OBJECTIVE: The aim of this study was to evaluate the efficacy of tibial autogenous bone grafting in the treatment of patients with alveolar bone defects. MATERIALS AND METHODS: The study subjects consisted of 12 patients (10 male, 2 female, age: 19-51 years) who underwent reconstructive autogenous bone-grafting procedures. The medial approach to the tibial bone was used to harvest autogenous cancellous bone grafts in all the patients. Clinical parameters (complications at the donor and recipient sites, resorption and volume of the grafts) were evaluated retrospectively. RESULTS: The mean age of the patients was 36.25 ± 0.9 years. Of the 12 patients, 5 (41.7%) received bone grafts for sinus augmentation, 3 (25%) for cyst cavity reconstruction and 4 (33.3%) for alveolar cleft reconstruction procedures. The average follow-up period was 28.4 months (range: 21-40 months). An average of 5.2 cm3 of cancellous bone was harvested for grafting procedures. All the grafting procedures were successful, and there were no surgical complications during the harvesting protocol. In all cases, pain and gait disturbance lasted less than 2 weeks. CONCLUSION: The results of this study suggest that the use of tibial autogenous bone graft harvested using a medial approach was a safe, simple and effective method for grafting various alveolar bone defects where high amounts of cancellous bone grafts were needed with low morbidity.

Piezosurgery versus conventional surgery in radicular cyst enucleation.

OBJECTIVE: This study compared the use of piezosurgery and conventional surgery in radicular cyst enucleation. STUDY DESIGN: The study was conducted with 29 patients who were radiologically and cytologically prediagnosed with radicular cysts in the jaw region. Nineteen patients were treated using piezosurgery, and 10 were treated using conventional surgical procedures. Surgical procedures were evaluated according to the following criteria: hemorrhage, soft-tissue damage, manipulation complexity, major perforation areas on the enucleated cyst tissue, and approximate operation duration. Patients were monitored postoperatively and evaluated for hemorrhaging at 24, 48, and 72 hours following surgery. Follow-up was conducted to check for recurrences and ranged from 5 to 24 months. RESULTS: No complications were observed in any of the 20 patients treated using piezosurgery, although the duration of surgery was longer than expected. Of the 10 patients treated using conventional methods, hemorrhaging that affected the operation occurred in 3 cases, perforation of the cyst epithelium and difficulties in enucleation occurred in 5 cases, postoperative hemorrhage occurred in 2 cases, and recurrence was observed in 2 cases. CONCLUSIONS: Piezosurgery may be considered effective in procedures such as enucleation that require sensitive manipulation, despite the increase in the length of the overall surgical procedure. Given the results of the present study and the current lack of information in the literature regarding postoperative pain, infection, and long-term success rates associated with the use of piezosurgery in cyst enucleation, further study in this area is recommended.

Correction of postsurgical alveolar ridge defect with vertical alveolar distraction of the onlay block graft.

Alveolar bone augmentation for dental implant rehabilitation is one of the greatest challenges for oral and maxillofacial surgeons. Bringing out an inadequate quantity of vertical bone during augmentation compromises correct implant positioning and the resulting prosthetic restoration. Alveolar distraction osteogenesis is now generally used in correcting alveolar ridge atrophy due to trauma, congenital defects, or periodontal defects. Onlay block grafting is a suitable method for restoring the alveolar bony defects. However, it sometimes can become a complicated procedure to repair the horizontal defect accompanying a vertical defect using only bone blocks. This clinical report presents a successful reconstruction of a severe anterior mandibular alveolar bony defect as a result of impacted teeth extraction and periodontal problem in a 50-year-old healthy female patient. The defect was reconstructed with symphysis graft and platelet-rich fibrin in the first step. Vertical alveolar distraction was performed on the grafted site to maintain the suitable bony height 3 months later. Grafted bony segment distraction and the treatment options in similar cases were also discussed in this clinical report among with the literature.