Use of buccal fat pads to prevent vestibular gingival recession of zygomatic implants.

Zygomatic implants can be used for dental rehabilitation in atrophic maxillae. This allows for maxillary grafts to be avoided while also permitting immediate functional use. Initially, the implants had a palatal emergence. The surgical technique has undergone continuous development and the implants are now sometimes extra-maxillary in order to better match with the prosthetic space. The main risk is vestibular exposure of the implant as a gingival recession caused by mucositis or peri-implantitis. When the first patients exhibited this problem, the authors sought a solution in order to prevent this complication from occurring. The authors here describe a technique for covering the implants with the buccal fat pad. The dissection and the suture of the fat pad around the implants provide a thick gingiva and mucosa on the vestibular side. The authors have used this technique for the past four years. Twenty-five patients had coverage of the implants. Nineteen had Hybrid Zygoma and six had Quad Zygoma All-on-Four implants. Not a single patient had a gingival recession upon follow-up examination. This technique allows a considerable amount of thick gingiva around the implants to be retained. It also prevents long-term exposure of the implants on the vestibular side.

[Morbidity of autologous bone harvesting in implantology: Literature review from 1990 to 2015]. / Morbidité des prélèvements osseux autogènes en implantologie : revue de littérature de 1990 à 2015.

INTRODUCTION: Autogenous bone is commonly used in pre-implant bone reconstructions. Five harvesting sites are frequently used: mandibular symphysis and ramus, iliac crest, calvaria and tibia. One of the deciding criterions among these sites is the donor site morbidity. The purpose of our work was to analyze the intra- and postoperative complications that may occur on the different donor sites. MATERIAL AND METHODS: An automatic and manual search on Medline covering the period 1990-2015 was made. Human studies, in English or French language, detailing the complications linked to bone harvest done for pre-implant surgery were included. RESULTS: Eighty-three clinical trials or case reports were analyzed. Iliac crest, mandibular symphysis and ramus donor sites were afflicted with the highest pain scores and sensory disturbances. Iliac and tibial bone harvests were complicated by walk disturbances in the first weeks. Some rare neurological complications have been reported after calvarial bone harvest. DISCUSSION: Although commonly used, iliac crest bone harvest is responsible for significant morbidity. Calvarial harvest is related to the lowest morbidity. It has to be performed by an experienced team in order to reduce the risk of neurologic injury. Regarding intraoral donor sites, mandibular symphysis becomes less popular. Mandibular ramus harvest has the lowest complication rate and is well accepted by patients.

[Anterior mandibular bone augmentation techniques. Literature review]. / Les augmentations osseuses mandibulaires antérieures. Revue de la littérature.

INTRODUCTION: Mandibular edentation may lead to major symphyseal resorption making the placement of dental implants impossible. In this situation, bone augmentation techniques are available. The goal of our study was to make a review of the literature of the different techniques in use. METHOD: A bibliographic research was conducted on the Medline, Ovid and Cochrane Library databases with the following keywords: anterior mandible, bone grafting, mandibular symphysis reconstruction. We selected only articles written in English, published from January 1975 to August 2014 and expressly dealing with anterior mandibular bone augmentation techniques. RESULTS: Sixty-nine articles were analyzed. Eight bone augmentation techniques were reported. Bone grafting using iliac or calvarial bone and immediate or delayed implantation was the most popular technique. The main complications were infection, exposure or resorption of the graft, and chin and lip hypo- or anesthesia. The other reported techniques (osteotomies, distraction osteogenesis, transmandibular implants, mandibular reconstruction plates, fibula free flaps) were more confidential or had specific indications. There was no indication for biomaterials excepted if combined with autologous bone.

[Anterior mandibular bone grafts by sub-mental approach]. / Greffes osseuses mandibulaires antérieures par voie sous-mentonnière.

INTRODUCTION: Some cases of totally edentulous mandibles are associated with extreme osseous resorption which do not allow the placement of dental implants, even in the symphysis area. We present a bone graft technique performed by mean of a submental approach. TECHNICAL NOTE: The reconstruction is performed under general anesthesia by mean of calvarial bone bone grafts affixed on the superior face and occasionally on the inferior face of the mandibular symphysis, between the mental foramens. The approach is a conventional sub-mental approach that exposes the entire symphysal region. Four patients (aged 61 to 81) have been operated according to this technic. There was no postoperative complication. Mean bone increase was 9.3mm. Nineteen implants were inserted (4.75 implants per patient). No implant have been lost. The scare was inconspicuous. DISCUSSION: This technique is indicated for cases with extreme bone resorption. It allows the reconstruction of the mandibular symphysis, without an intraoral approach and thus with minimized risk of bone graft exposure. Postoperative courses are uneventful. This technique is therefore indicated for elderly patients who complain about ill-fitting dentures.

[Le Fort I osteotomies combined with post-operative bone grafts]. / Greffes osseuses réalisées à partir des résidus peropératoires lors des ostéotomies de Le Fort I.

INTRODUCTION: We present and assess a surgical technique for maxillary auto-bone grafting concomitantly with Le Fort I osteotomy. The graft has 2 main objectives: to fill in the space between the 2 advanced segments of the maxilla to help bone consolidation, and to increase the volume of the malar, para-nasal spaces to improve post-operative esthetic results. TECHNICAL NOTE: Bone fragments, removed during the Le Fort I osteotomy, are stored and wrapped in a Surgicel(®) sheet, then grafted in the space left by the osteotomy, or on the anterior maxilla in the para-nasal area or on the malar bone. One hundred and twenty-three patient records, operated from 2007 to 2012, were collected to assess the post-operative course retrospectively. The post-operative course was uneventful in 93.5% of cases. About 8.4% of patients (7 cases) presented with a persistent post-operative maxillary edema. 1 patient (1.2%) presented with a sinus infection without any determined etiology. The grafts were all osteointegrated at the end of follow-up. DISCUSSION: The technique is simple and quickly performed; it improves bone healing and cosmetic results, without increasing morbidity or surgical time. It is a good alternative to bone grafts from a secondary sample site. It can be applied to all Le Fort I osteotomies.

[Reconstruction of the atrophic edentulous maxilla for implant placement]. / Reconstruction pré-implantaire du maxillaire atrophique.

INTRODUCTION: Extreme maxillary atrophy results from partial or total maxillary bone defect, affecting the alveolar and basal segments. The residual bone is only a few millimeters high and does not allow retention of dental prostheses (complete edentulation), or placing implants. Bone reconstruction with cranial bone grafts usually allows obtaining enough bone volume in a single step to place implants for prosthetic rehabilitation, 3 months later. TECHNICAL NOTE: Reconstruction begins by inserting bone grafts on the sinus floor. The pre-maxilla is then rebuilt with bone grafts placed on the nose floor then on the palate and vestibule. The premolar and molar sectors are rebuilt last with vestibular and palatine bone grafts assembled and stabilized by screws, or steel wire rings, and reinforced on their deep portion with diploe sheets. DISCUSSION: Extreme maxillary atrophy reconstruction with cranial bone grafts is a reliable technique with reproducible results and few complications (sinusitis, bone sequester). Nevertheless, it requires strong experience to adequately perform harvesting and reconstruction.

[Pre-implant posterior mandibular reconstruction]. / Reconstruction pré-implantaire du secteur mandibulaire postérieur.

INTRODUCTION: We present a literature reviewed of pre-implant posterior mandible reconstruction, and report our experience with 107 patients exclusively reconstructed with cranial bone grafts. MATERIAL AND METHODS: Over a period of 15 years, 167 patients presenting with sometimes extremely severe bone resorption were grafted using various techniques depending on the type of resorption. RESULTS: The mean bone augmentation was 7.83 mm vertically and 7.16 mm horizontally respectively for patients with vertical and horizontal resorption. It was 6.66 mm vertically and 8.11 mm horizontally for patients with combined horizontal and vertical resorption. The postoperative complications were: mental nerve dysesthesia in 6.5% of patients, graft exposure in 1.8%, and ± complete graft resorption in 4.2%. Implant placement was possible 3 months after reconstruction and bridge placement 6 months after reconstruction. DISCUSSION: The posterior mandible is the most difficult area to reconstruct, according to our experience. The vertical expansion technique, called "sandwich" osteotomy, frequently cannot be used. Alveolar distraction has a lot of drawbacks: patient constraints, uncertain outcome, and high risk of complications. Guided bone regeneration is restricted to small deficits. The onlay graft technique is poorly documented although it has many assets as demonstrated by our study. It may be used in any situation, even the most severe cases, except for rare cases of reduced occlusal space.