Use of homologous bone for alveolar crest reconstruction in 483 patients with 5 years' outcomes post implantation.

PURPOSE: The purpose of this study was to evaluate the clinical course of bone reconstruction of the alveolar crest using homologous fresh-frozen bone harvested from deceased donors. METHODS: A retrospective survey was based on the Castelfranco Veneto Hospital database, in which 3264 clinical records with a primary or secondary diagnosis of alveolar atrophy were collected over a 10-year period. A random sample of 483 patients with at least 5 years' follow-up was included in the survey. Patients were contacted by telephone and administered a questionnaire with specific questions to build a significant sample. RESULTS: Of the patients, 449 (93% of the sample) had an uneventful follow-up after surgery and 93.2% received at least one implant, with a mean of 3.4 implants per patient. At the time of the survey, 93% of the patients were wearing a dental prosthesis, 86.9% had not lost any implants, and 6.7% had lost at least one implant, while 6.4% still had implants but presented some clinical problems. Finally, patients were asked to provide an index score (1-10 points) on the therapy as a whole, i.e., bone graft, implants, and prostheses. A score of insufficient (up to 5 points) was given by 5.3% of patients, of sufficient (6 to 7 points) by 6.1%, and of good/very good (over 7) by 88.6%. CONCLUSIONS: Homologous bone for alveolar crest reconstruction can be a valid alternative to autologous grafting if specific tissue limitations are considered when planning therapy. Creeping substitution is partial and slower than in autologous grafts, especially in cases where cortical bone is thick or volume graft is very large. The quality of soft tissue coverage and mucosa lining is also important, possibly due to slower tissue revascularization, so future implants should predictably be positioned primarily within the original host bone.

Surgical and orthodontic treatment of skeletal Class III featuring severe transversal and sagittal discrepancy.

AIMS: Anterior cross-bite is a difficult malocclusion to treat in adult patients, especially if compounded by skeletal discrepancy. The present study describes a dentoskeletal Class III case and aims to provide the clinician with rational guidelines for presurgical orthodontic preparation and postsurgical finishing. PATIENT AND METHODS: In this case, a 20-year-old male patient, R.M, was treated for severe dental and skeletal Class III malocclusion on both the transversal and anteroposterior planes via combined orthodontics and surgery. Initially, the treatment involved surgically-assisted expansion of the upper jaw (total 1 month), followed by a fixed-orthodontics phase to decompensate for the malocclusion in preparation for movement of the osseous bases with the aim of achieving maximum coordination of the dental arches. After 19 months of orthodontic preparation, the patient underwent combined orthognathic surgery (upper and lower jaws). In the subsequent 4 months, orthodontic stabilization and finishing were performed, and debonding was carried out 24 months after the start of active treatment. RESULTS: The combined orthodontic and surgical treatment adequately corrected the severe Class III over a period of 2 years, leading to a satisfactory occlusal, functional and aesthetic result. CONCLUSIONS: Thorough diagnosis and close communication between the orthodontist and maxillofacial surgeon, operating as an interdisciplinary team, ensures good outcomes, even in complex orthodontic and surgical cases.

Imaging of facial soft tissues in multislice computerized tomography: a new geometric method of analysis and its statistical validation.

OBJECTIVE: The main purpose of this preliminary study was to propose an original analysis of facial soft tissues' depth to detect their topographic variability, which causes are intrinsic (depth) and extrinsic (bone shape and reciprocal correlations with soft tissues themselves). To check the utility and accuracy of the method in recognizing measures' differences, other aims were comparison of two different groups of people and statistical validation. STUDY DESIGN: The study sample was composed of 100 consecutive patients (56 females and 44 males) undergoing a routine CT scanning. The images, obtained through the reference plane of the palate, were post-processed on a PC workstation. A goniometer construction was superimposed and centered on the posterior nasal spine, where a grid of eighteen rays was developed to calculate the superficial soft tissues' depths of the face. To test the validity of the method, three of the rays were measured twice, by the same as by another observer. Step-by-step procedures were attained to get maximum standard in measures' reliability. RESULTS: Superficial soft tissues' depths were obtained and sex differences were analyzed (Student's t and Wilcoxon rank-sum test). The statistical reliability was proven with Bland-Altman statistics and the upper 95% limit of agreement was 1.459 mm for intraobserver repeatability and 1.886 mm for interobserver reproducibility. Validation of the method was proven by intraclass correlation coefficient (0.99 both for repeatability and reproducibility) and mean differences (respectively 0.6% and 0.4%). CONCLUSION: The method appeared easy to be applied, reliable and not observer dependent, so suitable for study single as multiple patients with CT images. Future analyses shall be possible.

Bisphosphonate-associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology.

OBJECTIVES: Recently, jawbone osteonecrosis has been reported as a potential adverse effect of bisphosphonates administration. This paper considers and highlights histopathologic and radiologic features of this condition. STUDY DESIGN: Eleven patients, owing to unresponsiveness to conservative treatment and uncontrollable pain, underwent surgical resection of diseased jawbone after extensive hyperbaric oxygen therapy. A thorough clinical, laboratory, and imaging study was performed. Surgical specimens underwent histopathologic and immunohistochemical evaluation. RESULTS: Computerized tomography (CT) scans showed increased bone density, periosteal reaction, and bone sequestration in advanced stages. With magnetic resonance imaging (MRI), exposed areas showed a low signal in T1- and T2-weighted and inversion recovery images, which suggests low water content and is histopathologically correlated with paucity in cells and vessels (osteonecrotic pattern). Unexposed diseased bone was characterized by T1 hypointensity and T2 and IR hyperintensity, which suggests high water content and inflammation, associated with hypercellularity, osteogenesis, and hypervascularity (osteomyelitic pattern). CONCLUSIONS: Diseased bone extends beyond the limits of the bone exposed in the oral cavity. Histopathologic examination correlated well with CT and MRI, which are the choice for the evaluation of bisphosphonate-associated jawbone osteonecrosis.