Oral findings in a group of newborn Swedish children

Oral examinations were performed of 1021 newborn Swedish children, of whom 101 were re-examined after 2-3 or 4-5 months. The most common findings, registered in 74.9% of the children, were of oral mucosal cysts situated either palatally or on the alveolar ridges. The majority of the palatal cysts disappeared shortly after birth, and some alveolar cysts appeared after birth. Ankyloglossia was found in 2.5% of the children, and Fordyce spots in 1.0%. No natal teeth were found. The upper labial frenum was attached to the crest of the alveolar ridge in 76.7% of the children, palatally in 16.7% and buccally in 6.7%. The relationship of the alveolar ridges was recorded: the anterior segment of the mandibular ridge was distal to the maxillary in 99% of cases, and, posteriorly, the mandibular ridges were lingual to the maxillary in 97.6%. An open bite was found in 39.8% of the children.     

Guided bone regeneration around dental implants in the atrophic alveolar ridge using a bioresorbable barrier. An experimental study in the monkey

The aim of this study was to evaluate guided bone regeneration (GBR) around dental implants placed in atrophic alveolar ridges using an experimental, nonporous bioresorbable barrier. In 8 Rhesus monkeys, the maxillary canines and lateral incisors were extracted bilaterally and the remaining alveoli were reduced to create atrophic ridges. After a healing period of 3 months, soft tissue expansion was performed using a subperiosteal tissue expander. After 1 month of tissue expansion, and IMZ implant was placed in the atrophic ridge on each side in such a way that its coronal 4 mm to 5 mm remained circumferentially exposed above the bone level. The test implants were covered with a bioresorbable barrier made of poly (D,L-lactid-co-trimethylencarbonate) in a 70/30 ratio, whereas the control implants were covered with a nonresorbable expanded polytetrafluoroethylene (e-PTFE) barrier. The e-PTFE barriers were stabilized with titanium minipins while the bioresorbable barriers were analogously fixed using bioresorbable minipins made of poly (L-lactid-co-D,L-lactid) 70/30. Clinical healing progressed uneventfully in both groups and no soft tissue dehiscences occurred. Histometric and histomorphometric analyses were performed 5 months post surgery. Both test and control implants exhibited direct bone-to-implant contact to variable extents. The mean direct mineralized bone-to-implant contact length fraction was 32% of the total implant length in the test sites and 58% in the control sites. Control sites exhibited significantly greater bone fill compared to the experimental sites (P < 0.001). Histologic observations of test specimens demonstrated a moderate inflammatory reaction related to the degradation and resorption products of the barrier. In conclusion, the nonresorbable e-PTFE GBR barrier was found to be superior to the bioresorbable barriers tested in the present investigation.     

Reconstruction of residual alveolar cleft defects with one-stage mandibular bone grafts and osseointegrated implants

PURPOSE: This study evaluates a treatment regimen for reconstruction of residual maxillary alveolar cleft defects consisting of mandibular bone grafting and immediate implant installation. PATIENTS AND METHODS: Sixteen cleft patients (five female and 11 male) had residual cleft defects of the alveolar ridge reconstructed with bone grafts from the mandibular symphyseal region. The bone graft was pretapped at the donor site before fixation in the residual ridge with Br?nemark implants. Twenty implants were installed according to this concept. The period of observation ranged from 36 to 69 months, with a mean of 48 months after implant installation. RESULTS: Five patients developed wound dehiscenses that resulted in total or partial bone graft sequestration. Two implants were lost, one due to sequestration and the other due to mobility at the abutment procedure; 18 implants were still well functioning at the end of the observation period. However, all patients showed significant periimplant bone resorption after this one-stage treatment. CONCLUSION: Because of the observed complication rate, the one-stage procedure may not be optimal for reconstructing residual cleft defects.     

Rat mandibular distraction osteogenesis: Part I. Histologic and radiographic analysis

The application of distraction osteogenesis to craniofacial surgery has altered the approach and treatment of congenital and acquired craniofacial defects. Although the histologic and ultrastructural changes associated with distraction osteogenesis have been described extensively, relatively little is known about the molecular regulation of this process. The elucidation of the molecular mechanisms of distraction osteogenesis has important clinical implications because it may facilitate the use of recombinant proteins or gene therapy to accelerate bone regeneration. Molecular analysis of distraction osteogenesis has been hindered by the use of large animal models in which only limited genetic information is available. In this study, a rat model of mandibular distraction osteogenesis is described. This report includes a pilot study (n = 50) to develop an appropriate distraction device and to determine the optimal placement of the osteotomy. The study subsequently included 80 animals, 35 of which were distracted at a rate of 0.25 mm per day for 6 days (1.5 mm total) and 35 that were distracted at a rate of 0.25 mm twice per day (3.0 mm total). These animals were killed at various time points (after latency and during the distraction and consolidation periods) and displayed histologic and radiographic findings of membranous bone distraction osteogenesis that were consistent with those in large ,animal and clinical models. In addition, five animals each were acutely lengthened 1.5 mm and 3.0 mm and demonstrated a fibrous nonunion. Furthermore, the utility of this model is demonstrated in the analysis of the molecular mechanisms of distraction osteogenesis by applying the polymerase chain reaction to total cellular RNA isolated from normal and distracted rat mandibles. In conclusion, it is believed that the rat model of distraction osteogenesis has significant advantages over traditional models, including decreased costs and facilitation of molecular analysis.     

Interpositional bone grafting technique to widen narrow maxillary ridge

A narrow edentulous alveolar ridge, less than 6 mm in the buccopalatal aspect, can prevent restoration by means of endosseous implants. A widening technique using alveolar ridge splitting and interpositional autogenous bone grafting is described. Accurate imaging of the alveolar bone shape and size was assessed with computerized tomography in a 1:1 scale. Following 6 months of healing, osseointegrated Br?nemark implants were placed in the grafted sites.     

Maxillary sinus augmentation using different grafting materials and dental implants in monkeys. Part I. Evaluation of anorganic bovine-derived bone matrix

The aim of this study was to evaluate clinically, histologically and histometrically the use of anorganic bovine bone matrix (i.e. Bio-oss) as a grafting material for maxillary sinus augmentation procedures. In 4 adult male rhesus monkeys (i.e. Macaca mulatta) the 1st, 2nd and 3rd maxillary molars on one side of the jaws were extracted. The remaining bone between the alveolar crest and the bottom of the sinus was then reduced to 3-4 mm. After 3 months, maxillary sinus augmentation procedures were performed on one side of the jaws in each monkey and the sinuses were grafted with the bovine bone matrix. At that time, 2 IMZ pure titanium plasma coated implants were immediately placed into the augmented sinuses (i.e. simultaneous implants-loaded group). After 4 months, 2 additional similar implants were placed into these previously augmented sinuses (i.e. delayed implants-loaded group). Four months later, the abutment connection was performed and all 4 implants were loaded with a gold-alloy bridge for 6 months (i.e. until sacrifice of the animals). The contralateral side of each monkey received the same treatment with the exception that the extractions were performed 7 months after those in the opposite side and that the implants in this side were not loaded. Thus, 2 additional study groups (i.e. simultaneous implants-unloaded group and delayed implants-unloaded group) were obtained. Clinically, all loaded implants were stable at the day of sacrifice. Histologically, the grafted sinuses exhibited significant bone formation with integration of the bovine bone matrix particles to the new bone. Direct mineralized bone-to-implant contact was greater for the delayed implant placement groups than for the implants installed simultaneously with the sinus augmentation. Furthermore, the percentage of direct mineralized bone-to-implant contact was greater in the residual bone than in the augmented area. It was concluded that the anorganic bovine bone matrix facilitated bone formation and implant osseointegration in the augmented sinuses and that the delayed implant placement in combination with the sinus augmentation procedure seemed to be preferable.     

Appropriate laboratory testing in rheumatic diseases

Single-tooth implants were used to replace congenitally absent maxillary lateral incisors in a 17-year-old patient. The inclination of the alveolar process caused a severe discrepancy between the axes of the planned implant and the crown. To avoid the need for a labial screw opening in the crown or labial overcontouring, a CeraOne abutment of the Br?nemark system was modified by selective grinding in the dental laboratory. Individual all-ceramic crowns were fabricated with the Celay In-Ceram system.     

Reconstruction of alveolar defects before implant placement

Guided bone regeneration and bone grafting have been used to reconstruct defective alveolar ridges in preparation for implant placement. This phase of implant treatment is critical to a successful overall result. Remarkable advances that have occurred in techniques and materials enable us to place and restore implants in cases where previously it was not feasible. Three case reports are presented to illustrate successful management of different alveolar defects.     

Preservation of alveolar bone in extraction sockets using bioabsorbable membranes

The purpose of this study was to evaluate the clinical effectiveness of a bioabsorbable membrane made of glycolide and lactide polymers in preserving alveolar ridges following tooth extraction using a surgical technique based on the principles of guided bone regeneration. Sixteen patients requiring extractions of 2 anterior teeth or bicuspids participated in the study (split-mouth design). Following elevation of buccal and lingual full-thickness flaps and extraction of teeth, experimental sites were covered with bioabsorbable membranes; control sites did not receive any membrane. Titanium pins served as fixed reference points for measurements. Flaps were advanced in order to achieve primary closure of the surgical wound. No membrane became exposed in the course of healing. Reentry surgeries were performed at 6 months. Results showed that experimental sites presented with significantly less loss of alveolar bone height, more internal socket bone fill, and less horizontal resorption of the alveolar bone ridge. This study suggests that treatment of extraction sockets with membranes made of glycolide and lactide polymers is valuable in preserving alveolar bone in extraction sockets and preventing alveolar ridge defects.     

Available bone is the foremost criterion in the insertion of endosteal implants

The foremost criterion in the insertion of endosteal implants is bone availability. Implant dentists should consider first the amount of available bone of the edentulous ridge where the endosteal implant will be inserted. A common error and cause of many implant failures is the dentist's use of an implant modality which is not indicated for the density and morphology of the available bone in the edentulous ridge. Implant modality/system is not the primary criterion in the insertion of endosteal implants. Before the dentist inserts an endosteal implant, he should gauge or measure the amount of bone where the implant is intended to be placed. It should be measured in width, height, length, trajectory, and implant-crown ratio. After recording the measurements of the available bone, these should be placed in different categories to serve as guides in implant selection. If there is not enough bone for the endosteal implant, bone modification should be performed. This can be done either by osteoplasty or ridge augmentation with the use of bone grafting materials. Aside from the amount of available bone in the edentulous ridge, another very, very important thing that should be considered is the quality or its density. Any biocompatible implant demonstrates some osseointegrated surfaces depending upon the bone type into which it is placed and the loads placed upon it. Implant body must exhibit a macrogeometry suitable for acceptable levels of force transfer to the surrounding tissues as well as for implantation into a bony site of a particular anatomic size.     

Distraction osteogenesis for lengthening of the hard palate: Part I. A possible new treatment concept for velopharyngeal incompetence. Experimental study in dogs

Many procedures have been described to correct velopharyngeal incompetence. Significant complications can occur, and the results may not be satisfactory. If the short soft palate has satisfactory muscle function and if it could be moved toward the posterior pharyngeal wall by distraction osteogenesis of the hard palate, an entirely new concept of treatment for velopharyngeal incompetence would be available. The object of the present study was to explore the possibility of osteogenesis occurring in the hard palate in dogs after gradual distraction (callus distraction). Six adult, mix-bred dogs were anesthetized, and the palatal mucosa was elevated. A midpalatal transverse osteotomy and two lateral osteotomies were performed. Tantalum bone markers for cephalometric analysis were placed, and an individually fabricated, orthodontic-like distraction device with an expansion screw in the sagittal direction was inserted. The device was stabilized on the premolars and fixed to the palatal bone with titanium miniscrews. Gradual distraction began after a latency period of 10 to 18 days. The rate of the distraction varied from 0.25 to 0.75 mm per day. The device was left in place for 6 to 8 weeks after expansion to allow for bony consolidation. Assessment was by direct examination, cephalograms, computed tomography, and histology with bone labeling. Impressions of the jaws were taken preoperatively and after device removal to examine plaster cast changes in the dental occlusion. Cephalometric and computed tomographic scan analysis demonstrated a distraction of up to 8 mm. All gaps were filled with de novo osteogenesis. Comparison of the plaster casts revealed no change in the occlusion. At 1 month after distraction, the computed tomographic scan showed the first signs of ossification of the experimental gap from the anterior and posterior bone ends. After 4.5 months ossification was almost complete with a small translucent zone in the middle of the experimental gap. After 7 months ossification was complete.     

An in vitro and in vivo study of cytokines in the acute-phase response associated with bisphosphonates

The aim of this investigation was to evaluate clinically and histologically a new custom-made, root analogue titanium implant placed into extraction sockets in monkeys (Macaca fascicularis). Three adult monkeys were used in this investigation. After raising full thickness flaps on the buccal and lingual side, the upper central and lateral incisors were extracted. Each tooth root was machine copied to 1 titanium analogue using a new CAD/CAM-system. The implants were installed in the respective extraction sockets and the flaps sutured back. After 6 months of healing biopsies were taken and processed according to the cutting-grinding technique. The percentage of mineralized bone-to-implant contact was measured as a fraction of the rough implant surface using computer-assisted analysis. The main clinical problem that occurred during implant placement was the fracture of the buccal alveolar wall. The histometric evaluation showed a mean mineralized bone-to-implant contact of 41.2 +/- 20.6%. In this investigation it could be shown that implants fabricated by laser copying will osseointegrate. The presented data encourage the performance of clinical and experimental trials evaluating the new system utilizing improved second generation CAD/CAM equipment. Such studies are currently underway.     

Effects of guided bone regeneration around commercially pure titanium and hydroxyapatite-coated dental implants. II. Histologic analysis

The purpose of this study was to determine which treatment of a large osseous defect adjacent to an endosseous dental implant would produce the greatest regeneration of bone and degree of osseointegration: barrier membrane therapy plus demineralized freeze-dried bone allograft (DFDBA), membrane therapy alone, or no treatment. The current study histologically assessed changes in bone within the healed peri-implant osseous defect. In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth, and 9.525 mm in diameter. An implant site was then prepared in the center of each defect to a depth of 5 mm beyond the apical extent of the defect. One mandibular quadrant received three commercially pure titanium (Ti) screw implants (3.75 x 10 mm), while the contralateral side received three hydroxyapatite (HA) coated root-form implants (3.3 x 10 mm). Consequently, the coronal 5 mm of each implant was surrounded by a circumferential defect approximately 3 mm wide and 5 mm deep. The three dental implants in each quadrant received either DFDBA (canine source) and an expanded polytetrafluoroethylene membrane (ePTFE), ePTFE membrane alone, or no treatment which served as the control. Clinically, the greatest increase in ridge height and width was seen with DFDBA/ePTFE. Histologically, statistically significant differences in defect osseointegration were seen between treatment groups (P < 0.0001: DFDBA/ePTFE > ePTFE alone > control). HA-coated implants had significantly greater osseointegration within the defect than Ti implants (P < 0.0001). Average trabeculation of newly formed bone in the defect after healing was significantly greater for HA-coated implants than for titanium (P < 0.0001), while the effect on trabeculation between treatments was not significantly different (P = 0.14). Finally, there were significantly less residual allograft particles in defect areas adjacent to HA-coated implants than Ti implants (P = 0.0355). The use of HA-coated implants in large size defects with DFDBA and ePTFE membranes produced significantly more osseointegration histologically than other treatment options and more than Ti implants with the same treatment combinations. The results of this study indicate that, although the implants appeared osseointegrated clinically after 4 months of healing, histologic data suggest that selection of both the implant type and the treatment modality is important in obtaining optimum osseointegration in large size defects.     

Clinical assessment of olfactory dysfunction in Parkinson''s disease

The possibility of placing endosseous implants in the edentulous maxilla is frequently reduced by inadequate bone volume of the residual ridge. In totally edentulous maxillae with knife-edge conformation, insufficient thickness is frequently associated with insufficient height of the residual ridge in the posterior maxilla because of pneumatization of the maxillary sinuses. This surgical method combines grafting of the maxillary sinuses, onlay grafts on the buccal side of maxillary posterior segments, and sagittal osteotomy of the anterior maxilla with interpositional bone grafts. Five to six months after maxillary reconstruction, Br?nemark implants were placed and, after osseointegration occurred, implant-supported dental prostheses were fabricated. Three patients have been treated with this method and 22 implants have been placed. The mean follow-up after final prosthetic rehabilitation has been 16 months; survival rate has been 100%. Despite the small number of patients and the short follow-up, preliminary results have shown very promising results.     

Nasal lavage as tool for health effect assessment of photochemical air pollution

In order to achieve esthetically more satisfying results, it has been proposed to place ITI implants with their border between the rough and smooth surfaces below the level of the alveolar crest, thereby obtaining a submucosally located implant shoulder following healing. The aim of the present experimental study was to clinically and radiographically evaluate the tissue response to the placement of one-stage transmucosal implants with the border between the rough and the smooth surfaces sunk by 1 mm into a subcrestal location. 11 patients underwent comprehensive dental care including the placement of 2 implants of the ITI Dental Implant System in the same quadrant (test and control). Randomly assigned control implants were placed according to the manufacturer's instructions, i.e. the border between the rough titanium plasma-sprayed and the smooth polished surfaces precisely at the alveolar crest. At the test implant the apical border of the polished surface was placed approximately 1 mm below the alveolar crest. Probing bone levels were assessed at implant placement (baseline), 4 and 12 months later. Modified plaque and modified gingival indices were recorded at 1, 2, 3, 4 and 12 months. Clinical probing depth and "attachment" levels were measured at 4 and 12 months. All parameters were assessed at 6 sites around each implant. The mean for each implant was calculated and used for analysis. The Wilcoxon matched pairs signed rank test and the Student t-test were applied to detect differences over time and between the test and control implants. At baseline, a mean difference in probing bone level of -0.86 mm (SD 0.43 mm, p < 0.05) was found between test and control implants with the test implants being placed more deeply. Both test and control implants lost a significant amount of clinical bone height during the first 4 months (test 1.16 mm, p < 0.05; control 0.58 mm, p < 0.05). However, only the test implants significantly lost clinical bone height from 4-12 months (test 1.04 mm, p < 0.05; control 0.45 mm, p = 0.08). Overall, the test implants lost 2.26 mm and the control implants 1.02 mm of bone height during the first year of service. On the average, the test implants demonstrated a bone level of 0.38 mm lower than the controls at 12 months. Except for the modified gingival index at 4 months (mean difference 0.21, SD 0.19, p < 0.05), no clinical parameters yielded significant differences between test and control implants at any time. It is concluded that in addition to the crestal bone resorption occurring at implants placed under standard conditions, the bone adjacent to the polished surface of more deeply placed ITI implants is also lost over time. From a biological point of view, the placement of the border between the rough and the smooth surfaces into a subcrestal location should not be recommended.     

The use of osteotomes for sinus augmentation at the time of implant placement

The placement of endosseous dental implants is often hampered by the loss of alveolar bone. In the posterior maxilla, the presence of the maxillary sinus and less-dense bone present additional obstacles to successful implant placement. Existing methods of subantral augmentation require extensive surgical manipulation, often including a second surgical site for harvesting autogenous bone. The development of surgical osteotomes has facilitated the placement of implants in areas of minimal alveolar bone height in the posterior maxilla. This article describes the osteotome technique for sinus augmentation at the time of implant placement and presents a short-term evaluation of 34 implants placed in 18 patients.     

Clinical evaluations of a porous-surfaced endosseous implant system

Clinical evaluations of a new porous-surfaced implant concept (Endopore) in a large population of fully and partially edentulous patients are reported, and a technique of spreading buccal and lingual plates with osteotomes to place these implants in proximity to the sinus of the posterior maxilla is described. Three-dimensional, interconnecting pores on this implant's bone interface surface give a great surface area for bone engagement. When the maxilla is prepared by this spreading procedure, these implants can be successfully placed in areas having limited available bone. Our success rates are 97.0% for implants stabilizing a mandibular overdenture and 94.8% for implants placed in partially edentulous patients. Many times, sinus lift or other augmentation procedures can be avoided in the maxilla and mandible, allowing for less patient morbidity and for an implant reconstruction that is more affordable for the patient.     

Rat mandibular distraction osteogenesis: II. Molecular analysis of transforming growth factor beta-1 and osteocalcin gene expression

Distraction osteogenesis is a powerful technique capable of generating viable osseous tissue by the gradual separation of osteotomized bone edges. Although the histologic and ultrastructural changes associated with this process have been extensively delineated, the molecular events governing these changes remain essentially unknown. We have devised a rat model of mandibular distraction osteogenesis that facilitates molecular analysis of this process. Such information has significant clinical implications because it may enable targeted therapeutic manipulations designed to accelerate osseous regeneration. In this study, we have evaluated the expression of transforming growth factor beta-1, a major regulator of osteogenesis during endochondral bone formation and development, and osteocalcin, an abundant noncollagenous extracellular matrix protein implicated in the regulation of mineralization and bone turnover. The right hemimandible of 36 adult male rats was osteotomized, and a customized distraction device was applied. Animals were allowed to recover and, after a 3-day latency period, were distracted at a rate of 0.25 mm twice daily for 6 days followed by a 2- or 4-week consolidation period. Distraction regenerate was harvested after the latency period, days 2, 4, or 6 of distraction, and after 2 or 4 weeks of consolidation and processed for Northern analysis (n = 4 at each time point) and immunohistochemical localization of TGF-beta1 (n = 2 at each time point). Six sham-operated animals (i.e., skin incision without osteotomy) were also killed (immediately postoperatively), and the mandibles were harvested and prepared in a similar fashion. Equal loading and transfer of RNA for Northern analysis was ensured by stripping and probing membranes with a probe against GAPDH (a housekeeping gene). Our results demonstrate that the spatial and temporal patterns of TGF-beta1 mRNA expression and protein production coincide with osteoblast migration, differentiation, and extracellular matrix synthesis. In addition, we demonstrate that TGF-beta1 production may be an important regulator of vasculogenesis during mandibular distraction osteogenesis. Finally, we have shown that osteocalcin gene expression coincides temporally with mineralization during rat mandibular distraction osteogenesis.     

The dark side of dioxygen biochemistry

The aim of this study was to evaluate the clinical function and long-term prognosis of overdentures retained by a small number of implants in the maxilla and mandible using one of two different attachment systems. Included in the study were all patients referred to specialty clinics in J?nk?ping and Link?ping, Sweden, during the treatment period who needed an overdenture and could be provided with a minimum number of two bilaterally-placed implants. Excluded were patients with bone-grafted jaws, irradiated cancer patients, heavy bruxers, and patients who had lost a fixed prosthesis because of implant losses. The patients were randomly assigned to receive one retentive system, either a round 2-mm-diameter bar with clips or ball attachments (Nobel Biocare). Eighteen overdentures were placed in maxillae and 32 in mandibles, supported by a total of 115 Br?nemark implants. Of the implants placed, 86.1% were continuously osseointegrated. The cumulative implant survival rates after 7 years of loading were 75.4% in the maxillae and 100% in the mandibles. There was no difference in implant survival rate between the attachment systems. Patients with implant losses were characterized by severely resorbed maxillary ridges and inferior bone quality, together with unfavorable loading circumstances such as short implants combined with long leverages. Complications and prosthetic adjustments were mostly resolved early and easily.     

The effects of metformin on glycemic control and serum lipids in insulin-treated NIDDM patients with suboptimal metabolic control

The edentulous ridge expansion has been introduced in recent years to reestablish an appropriate alveolar ridge width. This technique consists of the placement of implants in the space formed after the dislocation of the buccal plate in a labial direction. In guided bone regeneration, the quantity of bone regenerated under the membranes has been demonstrated to be directly related to the amount of the space under the membranes. This space can diminish as a result of membrane collapse. To avoid this problem, a new technique of edentulous ridge expansion, which involved the use of a titanium mesh barrier to protect the regenerating tissues and to achieve a rigid fixation of the bone segments, was used in association with autologous bone in 25 patients. At second-stage surgery in all patients, it was possible to see tissue, under the mesh, that had the macroscopic characteristics of mature bone and was superficially covered by a thin soft tissue layer. The microscopic examination showed that all autologous bone particles were embedded in newly formed bone. The use of a rigid mesh can assist bone regeneration in non-space-making defects, since it probably does not interfere with the blood flow to the underlying tissues because of the presence of microholes within the mesh.