Pedicled buccal fat pad flap for upper lip augmentation in orthognathic surgery patients.

PURPOSE: In this article, a new method of upper lip augmentation using a bilateral buccal fat pad flap is reported. This prospective study evaluated the changes in the upper lip that occur after maxillary surgery with concomitant mobilization of the bilateral buccal fat to improve upper lip projection. MATERIALS AND METHODS: A bilateral pedicled buccal fat pad flap to fill the premaxilla, paranasal, and upper lip areas, in association with a Le Fort I osteotomy for maxillary advancement, was performed in 11 orthognathic surgical patients with a thin upper lip. Minimum follow-up was 12 months. Cone-beam computed tomograms from an i-CAT device (Imaging Sciences International, Hatfield, PA) were taken pre- and postoperatively and loaded into Dolphin software (Dolphin Imaging and Management Solutions, Chatsworth, CA) for analysis. Changes at the right upper incisor tip, upper lip anterior, upper inside, stomion superior, and subnasale were measured in each patient immediately before and 6 months after surgery. Dimensional changes of the upper lip were measured using lip length (from the subnasale to the stomion superior) and lip thickness (from the upper inside to the upper lip anterior). RESULTS: The average maxillary advancement was 4.81 ± 2.47 mm, and the average vertical movement was 1.00 ± 1.75 mm; both were measured at the upper incisor tip. Upper lip movement, measured at the upper lip anterior, was 5.98 ± 2.46 mm (124.32% of maxillary advancement, mean data). Lip thickness increased 0.9 ± 0.19 mm, and lip length increased 0.77 ± 0.32 mm. The new upper lip contour was considered good to excellent in all cases. CONCLUSIONS: The technique described was useful to increase the projection, volume, and contour of the premaxilla, paranasal, and upper lip areas in orthognathic surgical patients. Moreover, it appeared to be useful to control the length shortening of the upper lip in all cases.

5-year clinical experience with BTI dental implants: risk factors for implant failure.

OBJECTIVES: The aims of this study were to identify with appropriate statistical tests the risk factors associated with implant failure and to evaluate the long-term survival of dental implants using implant loss as an outcome variable and performing an implant-, surgery- and patient-based analysis of failures. MATERIAL AND METHODS: A retrospective cohort study design was used. One thousand sixty patients received 5787 BTI implants during the years of 2001-2005 in Vitoria, Spain. The potential influence of demographic items, clinical items, surgery-dependent items and prosthetic variables on implant survival was studied. Implant survival was analysed using a life-table analysis. Cox proportional hazards regression was used to identify risk factors related to implant failure. RESULTS: Smoking habits, implant position, implant staging (two-stage implants) and the implementation of special techniques were statistically correlated with lower implant survival rates. Two risk factors associated with implant failure were detected in this study: implant staging (two-stage implants) and the use of special techniques. Additionally, the overall survival rates of BTI implants were 99.2%, 96.4% and 96% for the implant-, surgery- and patient-based analysis, respectively. Totally, 28 out from 5787 implants (0.48%) were lost during the observation period. Most of the patients with implant failure (69.6%) presented chronic or aggressive periodontitis. CONCLUSIONS: Implant staging and the use of special techniques are risk factors for implant failure.

Autologous platelets as a source of proteins for healing and tissue regeneration.

Platelets are known for their role in haemostasis where they help prevent blood loss at sites of vascular injury. To do this, they adhere, aggregate and form a procoagulant surface leading to thrombin generation and fibrin formation. Platelets also release substances that promote tissue repair and influence the reactivity of vascular and other blood cells in angiogenesis and inflammation. They contain storage pools of growth factors including PDGF, TGF-beta?and VEGF as well as cytokines including proteins such as PF4 and CD40L. Chemokines and newly synthesised active metabolites are also released. The fact that platelets secrete growth factors and active metabolites means that their applied use can have a positive influence in clinical situations requiring rapid healing and tissue regeneration. Their administration in fibrin clot or fibrin glue provides an adhesive support that can confine secretion to a chosen site. Additionally,the presentation of growth factors attached to platelets and/or fibrin may result in enhanced activity over recombinant proteins. Dental implant surgery with guided bone regeneration is one situation where an autologous platelet-rich clot clearly accelerates ossification after tooth extraction and/or around titanium implants. The end result is both marked reductions in the time required for implant stabilisation and an improved success rate. Orthopaedic surgery, muscle and/or tendon repair, reversal of skin ulcers, hole repair in eye surgery and cosmetic surgery are other situations where autologous plate-lets accelerate healing. Our aim is to review these advances and discuss the ways in which platelets may provide such unexpected beneficial therapeutic effects.