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A reabilitação do paciente com reabsorção severa do rebordo mandibular é uma questão desafiadora na prática cirúrgica devido aos problemas presentes em relação a retenção e estabilidade da prótese. Como consequência apresenta um vestíbulo lingual e vestibular raso, inserções musculares mais próximas ou no nível da crista do rebordo juntamente com a falta de mucosa aderida queratinizada, cujo são considerados fatores de risco para o sucesso em longo prazo dos implantes dentários. Para a eliminação dessas interferências é indicado a cirurgia, o objetivo deste estudo é descrever uma abordagem cirúrgica modificada de enxerto de mucosa palatina acompanhada de uma vestibuloplastia e sulcoplastia lingual simultâneo ao reposicionamento dos ductos das glândulas sublinguais, para aumentar a profundidade do vestíbulo lingual/bucal raso, corrigindo o posicionamento dos ductos das glândulas sublinguais e ganho de tecido queratinizado ao redor dos implantes dentários previamente instalados. Para tanto, a metodologia adotada foi uma revisão da literatura pertinente atualizada e descrição de um relato de caso clínico de uma paciente do sexo feminino, de 60 anos de idade, que se submeteu a cirurgia de enxerto de mucosa palatina, seguida de uma vestibuloplastia e sulcoplastia lingual simultaneamente ao reposicionamento dos ductos das glândulas sublinguais, com ancoragem externa em região interforaminal em mandíbula. Finalizando o tratamento com a entrega das próteses sobre os implantes do tipo protocolo em região inferior e nova prótese total removível superior. Concluiu-se ser o enxerto de mucosa palatina com ancoragem externa em região interforaminal, simultâneos a vestibuloplastia e sulcoplastia lingual se mostra como uma abordagem efetiva para aumentar a profundidade vestibular e lingual, com ganho de tecido queratinizado ao redor dos implantes, em rebordo mandibular gravemente reabsorvido. Além disso, proporciona o reposicionamento dos ductos das glândulas sublinguais.

The rehabilitation of the patient with severe resorption of the mandibular ridge is a challenging issue in surgical practice due to the present problems regarding retention and stability of the prosthesis. As it consequently presents a shallow lingual and buccal vestibule, muscle insertions closer to or at the level of the crest of the ridge together with the lack of adherent keratinized mucosa, which are considered risk factors for the long-term success of dental implants. For the elimination of these interferences, surgery is indicated, the objective of this study is to describe a modified surgical approach of grafting of the palatal mucosa accompanied by a vestibuloplasty and lingual sulcoplasty simultaneously with the repositioning of the ducts of the sublingual glands, to increase the depth of the lingual/buccal vestibule shallow, correcting the positioning of the ducts of the sublingual glands and gain of keratinized tissue around the previously installed dental implants. To this end, the methodology adopted was a review of the relevant updated literature and description of a clinical case report of a female patient, 60 years old, who underwent palatine mucosal graft surgery, followed by a vestibuloplasty and lingual sulcoplasty simultaneously with the repositioning of the ducts of the sublingual glands, with external anchorage in the interforaminal region of the mandible. Finishing the treatment with the delivery of the prostheses on the protocol-type implants in the lower region and a new upper removable total prosthesis. It was concluded that the graft of the palatal mucosa with external anchorage in the interforaminal region, simultaneous to vestibuloplasty and lingual sulcoplasty, is an effective approach to increase buccal and lingual depth, with gain of keratinized tissue around the implants, in severely affected mandibular ridges. reabsorbed. In addition, it provides repositioning of the ducts of the sublingual glands.

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Distraction osteogenesis for the augmentation of severe alveolar bone deficiency has gained popularity during the past two decades. In cases where the vertical bone height is not sufficient to create a stable transport segment, performing alveolar distraction osteogenesis (ADO) is not possible. In these severe cases, a two-stage treatment protocol is suggested: onlay bone grafting followed by ADO. An iliac crest onlay bone graft followed by ADO was performed in 13 patients: seven in the mandible and six in the maxilla. Following ADO, endosseous implants and prosthetic restorations were placed. In all cases, the onlay bone graft resulted in inadequate height for implant placement, but allowed ADO to be performed. ADO was performed to a mean total vertical augmentation of 13.7mm. Fifty-two endosseous implants were placed. During a mean follow-up of 4.85 years, two implants failed, both during the first 6 months; the survival rate was 96.15%. In severe cases lacking the required bone for ADO, using an onlay bone graft as a first stage treatment increases the bone height thus allowing ADO to be performed. This article describes a safe and stable two-stage treatment modality for severely atrophic cases, resulting in sufficient bone for implant placement and correction of the inter-maxillary vertical relationship.

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Pre-prosthetic surgery helps to overcome the challenge of prosthetic rehabilitation of the patient including restoration of the best masticatory function possible, combined with restoration or improvement of dental and facial esthetics. Maxillary denture prosthesis fabrication should include thorough examination of the soft palate and palatoglossal arch anatomy. This case report emphasizes on high palatoglossal arch as a rare and new cause of loss of posterior palatal seal and thereby retention of maxillary denture with rational, treated by pre-prosthetic surgery, ever reported in literature.

RESUMEN

INTRODUCTION: Good alveolar ridge is a prerequisite for successful conventional/ implant supported partial/complete denture. Extensively resorbed ridges with shallow vestibule and high insertion of muscles in to the ridge crest, leads to failure of prosthesis. Success of prosthesis depends on surgical repositioning of mucosa and muscle insertions, which increases the depth of vestibule and denture flange area for retention. So, the study was planned to provide good attached gingiva with adequate vestibular depth using Modified Kazanjian Vestibuloplasty (MKV). AIM: To evaluate efficacy of MKV technique for increasing vestibular depth in anterior mandible so that successful prosthesis can be delivered. Efficacy of the technique was evaluated through operating time required, vestibular depth achieved, scarring or relapse and any postoperative complications associated with the healing. MATERIALS AND METHODS: Total of 10 patients were included in the study, who had minimum 20mm of bone height and less than 5mm of vestibular depth for MKV procedure. The results were tabulated and statistical analysis was carried out to assess vestibular depth achieved i.e. from crest of the ridge to junction of attached mucosa both pre and postoperatively. The study results were compared with existing literature. RESULTS: Healing of raw surface was uneventful with satisfactory achievement of vestibular depth. The average gain in vestibular depth was 11 mm. The patients had good satisfaction index for prosthesis. CONCLUSION: Even in the era of implant prosthesis Modified Kazanjian technique is worth to practice to achieve good results and overcorrection is not required as that of standard Kazanjian technique. It provides adequate attached gingiva for successful prosthesis. Extension of vestibular depth enables fabrication of better denture flange with improved oral hygiene. This technique does not require hospitalization and additional surgery for grafts.

RESUMEN

The objective of this study was to evaluate the outcomes of mandibular vertical defect reconstruction with autologous bone and the use of a sub-periosteal tunnel approach in preparation for dental implant insertion. Forty-three consecutive patients with an atrophic posterior mandible were reconstructed using this method. Two thin laminae of cortical bone, obtained by splitting blocks harvested from the retromolar area, were fixed in a box-like framework containing cancellous and particulate bone. The goal was to achieve an alveolar ridge width of ≥5.5mm and an effective bone height (EBH) of ≥10.5mm for dental implant insertion (≥3.4mm diameter, ≥9.5mm length). Fifty reconstruction procedures were performed. The mean EBH was 7.1±1.3mm pre-treatment and 12.3±1.1mm post-treatment (mean increase 5.2±1.4mm). Complete graft loss was recorded in two cases; the remaining complications were minor. After a mean consolidation period of 3.5 months, 96 dental implants were placed. No failure of osseointegration was observed at follow-up (mean 32.9 months). The average bone height reduction was 0.9mm (graft vertical resorption 17.4%). Reconstruction of posterior mandibular vertical defects using two autogenous cortical bone blocks with particulate bone between them, combined with a tunnelling technique, provided good healing with no wound dehiscence and minimum resorption of the grafted bone, favouring a substantial vertical bone gain.

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Calvarial bone grafts are used for reconstruction of the maxilla or mandible to enable implant placement. The aim of this study was to assess the morbidity resulting from the use of calvarial bone grafts to reconstruct the maxilla and mandible. Thirty-six consecutive patients were included in this prospective study (14 men and 22 women; mean age 59 ± 8.2 years). Perioperative and postoperative complications related to harvesting of the calvarial bone were scored, as well as the occurrence of intraoral complications (average follow-up 25 ± 12 months). Perioperative exposure of the dura occurred in four patients and the graft broke during harvesting in five patients. With a change in the technique, these complications no longer occurred. Postoperative pain levels at the calvarial donor site were low (visual analogue scale (VAS) 1.9 ± 2.0 on day 1) and of short duration (5.2 ± 4.7 days to becoming pain-free). In all cases sufficient bone could be harvested to enable the placement of implants. The exposure of the dura and the intraoral complications were of no clinical consequence. Therefore, calvarial bone grafts appear to be promising for use in pre-implant intraoral reconstructions.

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Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form. This is concerned with surgical modification of the alveolar process and its surrounding structures to enable the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges.

RESUMEN

La distracción osteogénica alveolar, como proceso biológico de neoformación de hueso alveolar, nos motivó a la realización de la presente revisión bibliográfica, con el objetivo enfatizar en el análisis de las variables: antecedentes históricos en Cuba, clasificación de los distractores, fases de la distracción (latencia, distracción y consolidación), indicaciones, contraindicaciones, ventajas, desventajas y complicaciones. Se realizó una revisión bibliográfica mediante la consulta de bases de datos de los sistemas referativos, como MEDLINE y PubMed con la utilización de descriptores alveolar distraction y osteogenic distraction. Se consultaron las fuentes bibliográficas publicadas fundamentalmente en los últimos 5 años, lo que reveló que esta técnica es una excelente alternativa para la formación de huesos y tejidos blandos en zonas de atrofia alveolar, que consta de tres etapas: latencia, distracción y consolidación; un método previsible y con bajas tasas de reabsorción ósea en comparación con otras técnicas de aumento del reborde alveolar. Tiene su principal indicación en la terapia de implantes al proveer volumen óseo. Debemos individualizar cada caso y usar el método más adecuado según las características clínicas y personales del paciente. Una adecuada selección de los casos y una mejor comprensión de la técnica son los puntales para lograr exitosos resultados mediante la distracción osteogénica alveolar. En Cuba se ha aplicado poco la distracción alveolar, por lo que ha sido necesario ampliar los estudios sobre esta temática(AU)

The alveolar osteogenic distraction, as a biological process of alveolar bone neoformation, motivates us to make the bibliographic review whose objective was to emphasize in analysis the following variables: historical backgrounds in Cuba, distraction classification, distraction phases (latency, distraction and consolidation), indications, contraindications, advantages, disadvantages and complications. A bibliographic review was made by database search of reference systems as MEDLINE and PubliMed using the descriptors alveolar distraction o osteogenic distraction. The published bibliographic sources mainly over 5 years concluding that this technique is an excellent alternative for the bone and soft tissues formation in zones of alveolar atrophy including three stages: latency, distraction and consolidation; being a foreseeable method and with low rates of bone reabsorption compared to other techniques of increase of alveolar ridge. It has its main indication in implant therapy to provide bone volume. We must to individualize each case and to use the more appropriate method according the clinical and personal features of patient. A proper case selection and a better understand of technique are essential to achieve successful results by alveolar osteogenic distraction. In Cuba the alveolar distraction has been not much applied being necessary to expand the studies on this subject matter(AU)

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La distracción osteogénica alveolar, como proceso biológico de neoformación de hueso alveolar, nos motivó a la realización de la presente revisión bibliográfica, con el objetivo enfatizar en el análisis de las variables: antecedentes históricos en Cuba, clasificación de los distractores, fases de la distracción (latencia, distracción y consolidación), indicaciones, contraindicaciones, ventajas, desventajas y complicaciones. Se realizó una revisión bibliográfica mediante la consulta de bases de datos de los sistemas referativos, como MEDLINE y PubMed con la utilización de descriptores alveolar distraction y osteogenic distraction. Se consultaron las fuentes bibliográficas publicadas fundamentalmente en los últimos 5 años, lo que reveló que esta técnica es una excelente alternativa para la formación de huesos y tejidos blandos en zonas de atrofia alveolar, que consta de tres etapas: latencia, distracción y consolidación; un método previsible y con bajas tasas de reabsorción ósea en comparación con otras técnicas de aumento del reborde alveolar. Tiene su principal indicación en la terapia de implantes al proveer volumen óseo. Debemos individualizar cada caso y usar el método más adecuado según las características clínicas y personales del paciente. Una adecuada selección de los casos y una mejor comprensión de la técnica son los puntales para lograr exitosos resultados mediante la distracción osteogénica alveolar. En Cuba se ha aplicado poco la distracción alveolar, por lo que ha sido necesario ampliar los estudios sobre esta temática(AU)

The alveolar osteogenic distraction, as a biological process of alveolar bone neoformation, motivates us to make the bibliographic review whose objective was to emphasize in analysis the following variables: historical backgrounds in Cuba, distraction classification, distraction phases (latency, distraction and consolidation), indications, contraindications, advantages, disadvantages and complications. A bibliographic review was made by database search of reference systems as MEDLINE and PubliMed using the descriptors alveolar distraction o osteogenic distraction. The published bibliographic sources mainly over 5 years concluding that this technique is an excellent alternative for the bone and soft tissues formation in zones of alveolar atrophy including three stages: latency, distraction and consolidation; being a foreseeable method and with low rates of bone reabsorption compared to other techniques of increase of alveolar ridge. It has its main indication in implant therapy to provide bone volume. We must to individualize each case and to use the more appropriate method according the clinical and personal features of patient. A proper case selection and a better understand of technique are essential to achieve successful results by alveolar osteogenic distraction. In Cuba the alveolar distraction has been not much applied being necessary to expand the studies on this subject matter(AU)

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Introducción: el objetivo fue determinar radiográficamente el porcentaje de estabilidad de la altura del reborde alveolar del maxilar superior e inferior en pacientes sometidos a cirugía preprotésica de aumento de reborde con implante de HA no reabsorbible. Métodos: el estudio se realizó en quince pacientes, en quienes se determinaron mediciones reproducibles. Para el maxilar superior: (A) desde espina nasal anterior; (B derecha-izquierda) desde el borde más inferior de las fosas nasales; (C derecha- izquierda) desde el borde más inferior de la órbita. Para el maxilar inferior: (E) desde el borde inferior de la mandíbula y pasando por la sínfisis; (F derecha-izquierda) pasando por el agujero mentoniano; (G derecha-izquierda) pasando 5 mm. atrás del agujero mentoniano; (H derecha-izquierda) pasando 10 mm posterior al agujero mentoniano. Todas las mediciones se realizaron en el prequirúrgico, en el posquirúrgico inmediato, y a los nueve meses. Resultados: se promediaron los diferentes puntos del maxilar superior (PPMXS) y se observó una pérdida de altura entre el 6,29 y un 33,6% con promedio del 17,36 %. En el maxilar inferior (PPMXI) se observó una variación desde ganancia del 6,31% hasta una disminución del 18,87%, con promedio del 2,54%. Conclusiones: el implante de HA permite restablecer adecuada altura del reborde alveolar. La altura del reborde alveolar obtenida inicialmente presenta un porcentaje de disminución de su altura en el maxilar superior del 17,36%, y en el maxilar inferior del 2,54 durante el seguimiento a nueve meses.

Introduction: the purpose of this study was to determine radiographically the percentage of stability of alveolar ridge height in the maxilla and the mandible in patients subjected to pre prosthetic surgery of ridge augmentation with non resorbable HA implants. Methods: the study was performed in 15 patients in whom reproducible measurements were taken. For the maxilla: (A) From Anterior Nasal Spine; (B right and left) from the lowest border of the nasal fossae; (C right and left) from the lowest border of the orbit. For the mandible: (E) from the lowest border of the mandible passing through symphysis; (F right and left) passing through the mental foramen; (G right and left) passing 5 mm posterior to the mental foramen; (H right and left) passing 10 mm posterior to mental foramen. All measurements were performed before surgery, immediately after and nine months after surgery. Results: the different points of the maxilla were averaged (PPMXS) and a height loss between 6.29% and 33.6% was observed, with an average of 17.36%. For the mandible (PPMXL) variations ranging from 6.31% of augmentation to 18.8% loss were observed, with an average of 2.54%. Conclusions: HA implants allow reestablishment of adequate alveolar ridge height. The alveolar ridge height initially obtained presents a decrease percentage in height for the maxilla of 17.36% and 2.54% for the mandible after nine months follow up.

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La colocación de implantes dentales osteointegrados y la retención de las prótesis estomatológicas convencionales de acrílico es un grave problema en pacientes con reborde alveolar atrófico. La distracción osteogénica ofrece en la actualidad una solución potencial ante la severa pérdida de tejido óseo alveolar. Este estudio tuvo el propósito de evaluar en nuestro medio la Efectividad y Estabilidad de la osteogénesis alveolar. Se realizó un ensayo clínico Fase II. Fueron tratados 5 pacientes con atrofia del reborde alveolar mandibular o maxilar con distractores alveolares intraorales producidos por Walter Lorenz Surgical, Inc, (ROTT-NELSON-1713-06-04) para inducir osteogénesis. Los pacientes fueron atendidos de forma ambulatoria. El período de latencia fue de 5 días, la tasa de distracción de 1mm diario y el período de contención de 4 semanas . La efectividad de la distracción aplicada fue 76.3% y la estabilidad de 92.0 %. La media de la distracción total obtenida fue 7,25 mm. La Distracción osteogénica resultó ser un método eficaz para lograr incremento de la cresta alveolar en pacientes que presentaron atrofias previas.

The bone integrated dental implants placement and the conventional acrylic estomatological prosthesis is a serious problem in patients with an atrophic alveolar edge. Ostheogenic distraction currently offers a potential solution to the severe loss of alveolar bone tissue. This study had the purpose of evaluate the effectiveness and stability of alveolar ostheogenesis. A Clinical Trial Phase II was conducted. Five patients with an atrophy of the jaw bone or maxillary alveolar edges were treated with intraoral alveolar distracters produced by Walter Lorenz Surgical Inc.(Rott-Nelson-1703-06-04) to induce ostheogenesis. They were all out patients. The latency period was of 1 mm/day and the contention period of 4 weeks. The effectiveness of the applied distraction was of a 76.3% and the stability of a 92.0%. The average of the total distraction obtained was of 7,25 mm. Ostheogenic distraction was an efficacious method to achieve the alveolar dent in patients with previous atrophy.