Electromagnetic navigated condylar positioning after high oblique sagittal split osteotomy of the mandible: a guided method to attain pristine temporomandibular joint conditions.

OBJECTIVES: Reproduction of the exact preoperative proximal-mandible position after osteotomy in orthognathic surgery is difficult to achieve. This clinical pilot study evaluated an electromagnetic (EM) navigation system for condylar positioning after high-oblique sagittal split osteotomy (HSSO). STUDY DESIGN: After HSSO as part of 2-jaw surgery, the position of 10 condyles was intraoperatively guided by an EM navigation system. As controls, 10 proximal segments were positioned by standard manual replacement. Accuracy was measured by pre- and postoperative cone beam computed tomography imaging. RESULTS: Overall, EM condyle repositioning was equally accurate compared with manual repositioning (P > .05). Subdivided into 3 axes, significant differences could be identified (P < .05). Nevertheless, no significantly and clinically relevant dislocations of the proximal segment of either the EM or the manual repositioning method could be shown (P > .05). CONCLUSIONS: This pilot study introduces a guided method for proximal segment positioning after HSSO by applying the intraoperative EM system. The data demonstrate the high accuracy of EM navigation, although manual replacement of the condyles could not be surpassed. However, EM navigation can avoid clinically hidden, severe malpositioning of the condyles.

Short- and long-term changes of the pharyngeal airway after surgical mandibular advancement in Class II patients-a three-dimensional retrospective study.

PURPOSE: To evaluate the short- and long-term impact of mandibular-only advancement on pharyngeal airway space (PAS) changes by using cone-beam computed tomography (CBCT) and a new segmentation software. Furthermore, to determine whether a correlation exists between forward movement and PAS gain. MATERIALS AND METHODS: A retrospective evaluation of a homogeneous cohort of Class II patients who had undergone mandibular-only advancement was performed. Pre- (T0), post- (T1), and 1-year post-operative (T2) CBCT scans were obtained in each case, and the changes in PAS parameters (volume and smallest cross-sectional area) were compared with new segmentation software. Mandibular advancement was measured and correlated with PAS parameters. RESULTS: A significant postoperative gain in all airway parameters compared with baseline was shown for T1 (p = 0.02), with an additional increase for T2 (p < 0.001). No significant linear association between the movement of the measurement points and any other PAS parameters could be discerned (p > 0.05). CONCLUSION: Our findings indicate that bilateral mandibular-only advancement surgery results in a significant widening of the PAS in Class II patients. Long-term adaption of the PAS also occurs after surgery implying an additional gain of PAS over time. Sicat Air® software seems to be a sufficient and promising tool for PAS evaluation.

Can electromagnetic-navigated maxillary positioning replace occlusional splints in orthognathic surgery? A clinical pilot study.

INTRODUCTION: Because of the inaccuracy of intermaxillary splints in orthognathic surgery, intraoperative guidance via a real time navigation system might represent a suitable method for enhancing the precision of maxillary positioning. Therefore, in this clinical trial, maxillary repositioning after Le Fort I osteotomy was guided splintless by an electromagnetic navigation system. MATERIALS AND METHODS: Conservatively planned maxillary reposition in each of 5 patients was transferred to a novel software module of the electromagnetic navigation system. Intraoperatively, after Le Fort I osteotomy, the software guided the maxilla to the targeted position. Accuracy was evaluated by pre- and postoperative cone beam computer tomography imaging (the vectorial distance of the incisal marker points was measured in three dimensions) and compared with that of a splint transposed control group. RESULTS: The repositioning of the maxilla guided by the electromagnetic navigation system was intuitive and simple to accomplish. The achieved maxillary position with a deviation of 0.7 mm on average to the planned position was equally accurate compared with that of the splint transposed control group of 0.5 mm (p > 0.05). DISCUSSION: The data of this clinical study display good accuracy for splintless electromagnetic-navigated maxillary positioning. Nevertheless, this method does not surpass the splint-encoded gold standard with regard to accuracy. Future investigations will be necessary to show the full potential of electromagnetic navigation in orthognathic surgery.

Surgery-first approach in orthognathic surgery: Psychological and biological aspects - A prospective cohort study.

INTRODUCTION: The aim of this pilot study was to investigate psychological and biological changes after application of a surgery-first orthognathic treatment approach. METHODS: A prospective cohort study of 9 patients (6 women and 3 men; mean age 26.7 years) suffering from skeletal Class II and III deformities was conducted. Skeletal changes from pre-to post-treatment were analyzed based on data acquired by use of cone-beam computed tomography (CBCT). Psychological changes were analyzed using the orthognathic quality of life (OQLQ) questionnaire, Sense of Coherence 29-item scale (SOC-29) and longitudinal day-to-day questionnaire. For biological evaluation, concentrations of IL-1 ß, IL-6, TGF ß 1-3, MMP-2 and VEGF were assessed in crevicular fluid by bead-based multiplex assays at one preoperative and various postoperative time points. RESULTS: A significant improvement (P = 0.015) in quality of life, as measured with the OQLQ, was observed between baseline and 3 months post-surgery. The most affected dimensions were: facial aesthetics (p = 0.022), oral function (p = 0.051) and social aspects (p = 0.057). Sense of coherence (SOC) significantly improved after treatment by 9 points (P = 0.029). Despite the significant improvement in OQLQ and SOC during the course of the study, the personal experience of appearance varied distinctly in course and intensity. In accordance with the temporal pattern of fracture healing, the analysis of crevicular fluid revealed an increase in pro-resorptive factors (IL-1 ß, IL-6 and MMP-2) at early postoperative time points, while remodeling factors (members of the TGF-ß superfamily) were detected at later postoperative time points. CONCLUSIONS: Orthognathic treatment using the surgery-first approach has a positive impact on patient's psychosocial status. Accelerated tooth movement after surgery might, to a certain extent, be due to elevated levels of bone remodeling factors with overlapping functions during fracture healing and tooth movement.

Effect of occlusal plane correction on lip cant in two-jaw orthognathic surgery - A three-dimensional analysis.

INTRODUCTION: The aim of the present study was to evaluate the impact of canting correction in occlusal plane (OP) on the change of lip cant (LC) using three-dimensional (3D) photogrammetry in combination with cone-beam computed tomographic (CBCT) scans in class III asymmetric patients. MATERIALS AND METHODS: Fourteen asymmetric patients with exclusively skeletal class III malocclusion undergoing two-jaw surgery were included. All patients received 3D-photogrammetry and CBCT scans before (T1) and after orthognathic surgery (T2). After image fusion of the CBCT scans, angular correction of the occlusal plane (COP) between T1 and T2 was measured. Accordingly, angular correction of the lip cant (CLC) was analyzed after matching the preoperative 3D-photogrammetric scan to the postoperative. RESULTS: At the T1 stage, the canting of the OP was higher compared to the LC (4.95° vs. 3.77°). During T1 to T2, a significant angular cant correction was observed: COP (2.64°, p = 0.004) and CLC (1.76°, p = 0.01). In addition, a linear relationship between COP and CLC was revealed with a correlation coefficient for angular change of 0.47. For the linear regression COP turned out to be a predictor for CLC (B = 0.372, t (13) = 1.848, p = 0.089). Hence a correction of the OP of 1° resulted in a correction of the LC of only 0.372°. DISCUSSION: The use of CBCT scans in combination with 3D-photogrammetry are valuable tools to accurate analyze canting corrections of the OP and the LC during orthognathic surgery.

Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome.

BACKGROUND: The aim of the study was to analyse intraoral neurophysiological changes in patients with unilateral lingual nerve lesions as well as patients with Burning Mouth Syndrome (BMS) by applying a standardized Quantitative Sensory Testing (QST) protocol. METHODS: The study included patients suffering from a peripheral lesion of the lingual nerve (n = 4), from BMS (n = 5) and healthy controls (n = 8). Neurophysiological tests were performed in the innervation areas of the tongue bilaterally. For BMS patients the dorsal foot area was used as reference. RESULTS: For patients with peripheral lesion of the lingual nerve the affected side of the tongue showed increased thresholds for thermal (p < 0.05-0.001) and mechanical (p < 0.01-0.001) QST parameters, indicating a hypoesthesia and thermal hypofunction. In BMS patients, a pinprick hypoalgesia (p < 0.001), a cold hyperalgesia (p < 0.01) and cold/warmth hypoesthesia (p < 0.01) could be detected. CONCLUSIONS: The results of this study verified the lingual nerve lesion in our patients as a peripheral dysfunction. The profile showed a loss of sensory function for small and large fibre mediated stimuli. A more differentiated classification of the lingual nerve injury was possible with QST, regarding profile, type and severity of the neurologic lesion. BMS could be seen as neuropathy with variable central and peripheral contributions among individuals resulting in chronic pain.

Electromagnetic navigated positioning of the maxilla after Le Fort I osteotomy in preclinical orthognathic surgery cases.

OBJECTIVES: Inaccuracies in orthognathic surgery can be caused during face-bow registration, model surgery on plaster models, and intermaxillary splint manufacturing. Electromagnetic (EM) navigation is a promising method for splintless digitized maxillary positioning. STUDY DESIGN: After performing Le Fort I osteotomy on 10 plastic skulls, the target position of the maxilla was guided by an EM navigation system. Specially implemented software illustrated the target position by real-time multistage colored three-dimensional imaging. Accuracy was determined by using pre- and postoperative cone beam computed tomography. RESULTS: The high accuracy of the EM system was underlined by the fact that it had a navigated maxilla position discrepancy of only 0.4 mm, which was verified by postoperative cone beam computed tomography. CONCLUSIONS: This preclinical study demonstrates a precise digitized approach for splintless maxillary repositioning after Le Fort I osteotomy. The accuracy and intuitive illustration of the introduced EM navigation system is promising for potential daily use in orthognathic surgery.

Occurrence of cervical lymph node metastasis of maxillary squamous cell carcinoma - A monocentric study of 171 patients.

INTRODUCTION: Fewer than 5% of oral squamous cell carcinomas (SCC) are presented in the maxilla. The absence of cervical lymph node metastasis (LNM) is one of the main positive prognostic factors. This single-centre study analysed the cervical lymph node metastasis behaviour in patients with oral SCC of the upper jaw and serves as a basis for a cervical lymph node treatment suggestion. MATERIAL AND METHODS: The retrospective study includes 171 patients with isolated SCC of the maxilla. In addition to tumour resection, 83% of the patients underwent a selective neck dissection (ND). The data of cervical metastasis, TNM-status, tumour grade, tumour location as well as nicotine and alcohol behaviour were statistically analysed. RESULTS: The average rate of cervical metastasis was 44% in total. Tumour stage significantly affected risk for cervical metastasis (T1 = 6%, T2 = 41%, T3 = 60% and T4 = 60%) (p < 0.01). Development of cervical LNM was seemingly influenced by male gender. DISCUSSION: This study postulates a high rate of cervical metastasis of maxillary SCC. Risk for metastasis is mainly determined by the tumour stage. Alcohol and nicotine abuse have a negative impact on cervical LNM. CONCLUSION: Reviewing recent literature underlined by the illustrated data, we put up for discussion the treatment of SCC of the maxilla as similar to therapy protocols for SCC of the oral cavity. This would include an ipsilateral ND even in low tumour stage and in T4 staged tumours on both sides. However, prospective multicentre studies are needed to verify and recommend these therapy assumptions.

Approach to intraoperative electromagnetic navigation in orthognathic surgery: A phantom skull based trial.

INTRODUCTION: Intraoperative guidance using electromagnetic navigation is an upcoming method in maxillofacial surgery. However, due to their unwieldy structures, especially the line-of-sight problem, optical navigation devices are not used for daily orthognathic surgery. Therefore, orthognathic surgery was simulated on study phantom skulls, evaluating the accuracy and handling of a new electromagnetic tracking system. MATERIAL AND METHODS: Le-Fort I osteotomies were performed on 10 plastic skulls. Orthognathic surgical planning was done in the conventional way using plaster models. Accuracy of the gold standard, splint-based model surgery versus an electromagnetic tracking system was evaluated by measuring the actual maxillary deviation using bimaxillary splints and preoperative and postoperative cone beam computer tomography imaging. The distance of five anatomical marker points were compared pre- and postoperatively. RESULTS: The electromagnetic tracking system was significantly more accurate in all measured parameters compared with the gold standard using bimaxillary splints (p < 0.01). The data shows a discrepancy between the model surgical plans and the actual correction of the upper jaw of 0.8 mm. Using the electromagnetic tracking, we could reduce the discrepancy of the maxillary transposition between the planned and actual orthognathic surgery to 0.3 mm on average. DISCUSSION: The data of this preliminary study shows a high level of accuracy in surgical orthognathic performance using electromagnetic navigation, and may offer greater precision than the conventional plaster model surgery with bimaxillary splints. CONCLUSION: This preliminary work shows great potential for the establishment of an intraoperative electromagnetic navigation system for maxillofacial surgery.

One-stage tooth-borne distraction versus two stage bone-borne distraction in surgically assisted maxillary expansion (SARME).

OBJECTIVE: To evaluate and compare the effects of tooth-borne and bone-borne distraction devices in surgically assisted maxillary expansion (SARME) on dental and skeletal structures. STUDY DESIGN: A sample of 33 skeletally mature patients with transverse maxillary deficiencies was examined with cone beam computed tomography (CBCT) before and 3 months after surgery. Fourteen patients were treated with tooth-borne devices and 19 patients with bone-borne devices. RESULTS: Dental crown expansion in the first premolars did not differ significantly between the two groups, and median expansion was 5.55 mm (interquartile range [IQR] 5.23) in the tooth-borne device group and 4.6 mm (IQR 3.4) in the bone-borne device group. In the first molars, crown expansion and lateral tipping were significantly greater in the tooth-borne device group (P ≤ .02). The median skeletal nasal isthmus increase was significantly more in the bone-borne device group at 3.0 mm than in the tooth-borne device group at 0.98 mm (P ≤ .02). CONCLUSIONS: Both tooth-borne and bone-borne devices are effective treatment modalities to correct maxillary transverse deficiencies. Bone-borne devices produced greater widening of the skeletal nasal floor and fewer dental side effects in the first molars.

Surgical management of cross-bites in orthognathic surgery: Surgically assisted rapid maxillary expansion (SARME) versus two-piece maxilla.

PURPOSE: The surgical treatment of cross-bites includes surgically-assisted maxillary expansion (SARME) or maxillary-bipartition during bimaxillary surgery. This study evaluates and compares the changes in the teeth and lower nasal passage, as well as the stability of the expansion. PATIENTS AND METHODS: The measurements were performed on the cone-beam computed tomography (CBCT) scans of 32 patients with transverse (width) deficiencies of the maxilla. To expand the maxilla, 12 patients underwent the two-piece maxilla method, while 20 patients received SARME. RESULTS: The mean distraction width for SARME was 6.8 mm (SD 3.7), while that for the two-piece maxilla was 4.1 mm (SD 1.6). The expansion with SARME was over the entire length of the maxilla, from anterior to posterior, whereas the expansion of the two-piece patient group was only in the posterior part of the maxilla. The segments of the maxilla opened nearly parallel in SARME, while they were reverse V-shaped in the two-piece maxilla, from anterior to posterior. CONCLUSION: A key point in the planning of combined orthodontic-orthognathic therapy with surgical correction of a cross-bite is the precise determination of the area where the width needs to be increased, and the amount of correction needed to treat the patient using minimal surgical procedures.

The use of self-inflating soft tissue expanders prior to bone augmentation of atrophied alveolar ridges.

BACKGROUND: Extensive bone augmentation procedures are frequently performed prior to implant surgery. To achieve tension-free wound closure at the grafted site and thus avoid dehiscence and exposure or total loss of the bone graft, extensive soft tissue mobilization is required. In vitro studies have shown the potential of self-filling osmotic tissue expanders to optimize the amount of resulting soft tissue and vascularization of the recipient site. PURPOSE: The purpose of this prospective clinical study was to evaluate the application and complication rate of osmotic hydrogel expanders inserted subperiosteally prior to bone grafting. METHODS: In this prospective observational study, eight patients were implanted with 11 intraoral osmotic hydrogel expanders prior to bone augmentation procedures. All expanders were placed in subperiosteal positions using the tunnel technique. The occurrence of soft tissue-related complications such as necrosis, perforation, infection, or wound dehiscence leading to expander loss was defined as the primary parameter for analysis and evaluation. Further clinical parameters were soft tissue quality and quantity as well as expansion duration. RESULTS: The expansion time depended upon defect size and expander dimensions. Complications, that is, perforation of the expanders through the oral mucosa, occurred in two patients (3 expanders) who suffered from extreme preoperative scarring in the treated areas owing to prior trauma in one patient and cleft surgery in the other. Patients were grafted with autologous (n = 7) or synthetic (n = 1) block grafts. The expanders were removed during bone grafting surgery. No further dehiscence occurred during the observation period, and all patients were treated successfully with dental implants and subsequent prosthetic reconstruction. CONCLUSIONS: Within the limits of this observational clinical study, hydrogel expanders may help to generate additional soft tissue, and they might contribute to the overall improvement of the bone augmentation process by reducing the risk of complications related to the lack of soft tissue. Further randomized controlled studies are necessary.

A system for context-aware intraoperative augmented reality in dental implant surgery.

PURPOSE: Large volumes of information in the OR are ignored by surgeons when the amount outpaces human mental processing abilities. We developed an augmented reality (AR) system for dental implant surgery that acts as an automatic information filter, selectively displaying only relevant information. The purpose is to reduce information overflow and offer intuitive image guidance. The system was evaluated in a pig cadaver experiment. METHODS: Information filtering is implemented via rule-based situation interpretation with description logics. The interpretation is based on intraoperative distances measurement between anatomical structures and the dental drill with optical tracking. For AR, a head-mounted display is used, which was calibrated with a novel method based on SPAAM. To adapt to surgeon specific preferences, we offer two alternative display formats: one with static and another with contact analog AR. RESULTS: The system made the surgery easier and showed ergonomical benefits, as assessed by a questionnaire. All relevant phases were recognized reliably. The new calibration showed significant improvements, while the deviation of the realized implants was <2.5 mm. CONCLUSION: The system allowed the surgeon to fully concentrate on the surgery itself. It offered greater flexibility since the surgeon received all relevant information, but was free to deviate from it. Accuracy of the realized implants remains an open issue and part of future work.

Development of the clinical use of distant flaps for head and neck reconstruction.

The reconstruction of hard and soft tissue defects, mainly after ablative oncologic surgery in the head and neck area, is an evolving field. The use of free flaps for reconstruction of the head and neck is considered to be the surgical standard. In our analysis of more than 1000 free flaps we give an overview of the development of the use of different types of free tissue transfer to the head and neck area over the last 25 years. We show that the evolving field of head and neck reconstruction raises new possibilities with new types of flaps, whereas other types of flaps disappear in the everyday clinical use. The spectrum of reconstruction possibilities broadens with the number of different flap types available to the head and neck surgeon.

Biocompatibility of gold and stainless steel chains used for forced eruption of impacted teeth - an in vitro investigation.

OBJECTIVE: Surgical approaches for the mobilization of impacted teeth involve the use of gold chains to connect the impacted tooth with the orthodontic appliance. In this study we have compared the local effects gold plated stainless steel with stainless steel specimen using an in vitro model of the gingival mucosa and monolayer cultures of cells of the alveolus. STUDY DESIGN: Local effects on differentiation, proliferation, and apoptosis and inflammatory response were tested using organotypic cultures of gingival cells. Cytotoxicity was measured by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assays with monolayer cultures of human periodontal cells. RESULTS: The data obtained in this study could not reveal any differences in favor of using gold plated chains during the mobilization of impacted teeth. CONCLUSION: For patients not suffering from allergies against nickel there might be no rationale to favor gold plated chains, as there are no functional aspects to favor gold plated chains over stainless steel chains.

Proximal segment positioning with high oblique sagittal split osteotomy: indications and limits of intraoperative mobile cone-beam computerized tomography.

OBJECTIVE: The purpose of this study was to evaluate the indications and limits for intraoperative proximal segment positioning control by mobile cone-beam computerized tomography (CBCT). STUDY DESIGN: For mandible osteotomy in orthognathic surgery, the high oblique sagittal split osteotomy (HSSO) is our standard procedure. In 22 patients, positioning control of the proximal segment was performed during and after surgery to check this alternative osteotomy technique. RESULTS: The mean intercondylar distance increased 0.31 mm in all patients. No significant change of the condyle positions was found in the axial and coronal planes. In the sagittal plane a significant change was found. In 1 case, revision was required because of a lateral shifting of the condyles. CONCLUSIONS: Intraoperative positioning control with CBCT is an effective and reliable method to avoid condyle malpositions. Only minor position changes occur when using HSSO in orthognathic surgery, without compromising temporomandibular joint function postoperatively.

Neurosensory alterations and function of the temporomandibular joint after high oblique sagittal split osteotomy: an alternative technique in orthognathic surgery.

The current most common technique for repositioning of the mandible, bilateral sagittal split osteotomy (BSSO), was first described by Obwegeser and Dal Pont in the early1960s, and has since been modified several times. However, there is always a risk of damaging the inferior alveolar nerve. We have studied 50 consecutive patients who had high oblique sagittal split osteotomy (HSSO) as an alternative to avoid damage to the nerve. The patients were evaluated for sensory alterations and function of the temporomandibular joint (TMJ). Healing of both wound and bone were complete and uneventful in all 50 patients. Mean (SD) sagittal movement of the mandible was 6.6 (2.9)mm and length of the osteotomy line was 11.0 (3.1)mm. No patient had either temporary or permanent alteration in sensitivity. Pinprick tests showed no significant changes between the preoperative and postoperative readings (p>0.16) or in the chronological results (p>0.23). No disorders of the TMJ developed. Mean (SD) mouth opening 6months postoperatively was 41.6 (8.6)mm. The lateral excursion increased postoperatively by 1.86mm to the left and by 0.76mm to the right. Protrusion increased by 0.66mm. HSSO is therefore a suitable alternative to BSSO as it avoids injury to the inferior alveolar nerve without compromising the TMJ. Ossification was uneventful though bony attachment was less than with the classic BSSO.

Early bone resorption after vertical bone augmentation--a comparison of calvarial and iliac grafts.

OBJECTIVE AND AIM: Severe cases of bone atrophy in the maxilla or mandible are often reconstructed using bone from extraoral donor sides. Most commonly, grafts from the iliac crest are used for augmentation, however, frequently associated with bone resorption as possible late complication. Calvarial bone grafts, often reported to show less resorption, are an alternative. The aim of this study was to compare the bone stability of vertical bone grafts from the iliac crest and the calvarium. PATIENTS AND METHODS: Twenty-three patients receiving vertical onlay bone grafts were included in this retrospective cohort study. In nine patients alveolar ridge defects were treated with bone from the iliac crest. Fourteen patients were reconstructed using calvarial bone grafts. To quantify bone resorption, the data of digital panographs were evaluated. Radiographs were taken prior to bone grafting, after augmentation surgery, 6 months after bone healing, prior to implant surgery, after implant surgery and at yearly intervals thereafter. RESULTS: Postoperative complications at the recipient site occurred equally in both groups. The complication rate was 35.7% for the calvarial group and 33.3% in the iliac crest group. No donor-site complications were reported in either group. After bone augmentation procedure, a mean vertical bone gain of 8.55 mm (SD 5.96) was measured. Bone grafts from the iliac crest showed a significantly higher bone loss of 24.16% (SD 8.47) than grafts from the calvarium (8.44%, SD 3.64) at the time of implant placement (P = 0.0003). Implant survival was similar in both groups. DISCUSSION: Both bone-grafting approaches are successful and reliable techniques, enabling implant placement in even highly atrophied alveolar ridges and with identical implant survival rates, although bone resorption differs. Within the limitations of this study bone from the calvarium shows higher bone stability in the early healing phase.

Reconstruction of severely atrophied alveolar ridges with calvarial onlay bone grafts and dental implants.

OBJECTIVE: Severely atrophied alveolar ridges are most commonly reconstructed with free autologous bone grafts from the iliac crest. The use of these grafts, however, is frequently associated with bone resorption as possible late complication after implant surgery and prosthetic loading. Other donor sites, especially intraoral donor sites, show limited availability. The aim of this present study was to evaluate the clinical and radiographical outcome of alveolar ridge reconstruction with bone from the calvarium and subsequent implant rehabilitation. PATIENTS AND METHODS: Reconstruction was performed by using calvarial split grafts in case of severe and complex alveolar ridge defects induced by trauma or bone atrophy. Fifteen patients were treated at 19 different intraoral recipient sites (15 sites in the maxilla, four in the mandible). Autologous block grafts were used for combined vertical and horizontal grafting. After a 3-month healing period, patients received dental implants. A total of 99 dental implants (OsseoSpeed™, Astra Tech AB, Mölndal, Sweden) were inserted and left to heal in a submerged position for 3 months before the prosthetic implant-based rehabilitation was performed. RESULTS: No donor site complications occurred during or after surgery. At the intraoral recipient sites two infections occurred, leading to partial loss of the grafts. Implant placement, however, was possible in all cases. Two of 99 implants were lost in two patients prior to prosthetic loading. Patients were followed up clinically and radiographically for an average observation period of 28 months. Implant survival rate and success rates were 97.85 and 95.7%, respectively, and a minimal marginal bone loss was documented. DISCUSSION: The low morbidity at the donor sites and the good marginal bone stability in the reconstructed regions indicate that calvarial bone grafts represent a viable treatment alternative to grafts from the iliac crest.

Magnetic resonance imaging in isolated sagittal synostosis.

Isolated fusion of the sagittal suture is the most prevalent form of craniosynostosis. Although the typical clinical appearance usually points the way to the right diagnosis, computed tomographic (CT) scans are still recommended as necessary tools for both the diagnosis of scaphocephaly and the preoperative planning. Because CT scans are accompanied by the biological effects of ionizing radiation, some authors have already postulated the use of magnetic resonance imaging (MRI) especially because MRI seems to be valuable for detecting intracranial anomalies compared with CT scans. Hence, we investigated the preoperative MRIs of 42 children with isolated sagittal synostosis to evaluate the frequency of brain anomalies and their therapeutic consequences.In our study, 10 patients (23.8%) showed pathologic MRI findings such as ventricular dilatation and hypoplastic corpus callosum, whereas 32 patients (76.2%) had an unremarkable MRI except a pathognomonic secondary deformation of the brain caused by the abnormally shaped skull, which was present in all patients. Seven patients showed clinically significant symptoms including papilledema or psychomotoric developmental delay; however, the clinical appearance was not predictive for pathologic MRI findings and vice versa.As the detection of brain anomalies had no influence on the surgical procedure or led to any additive therapy in our patients, we conclude that evaluation of possible pathologic brain findings does not legitimate the general use of MRI in clinically normal children with isolated sagittal synostosis.