The Dermis-Prelaminated Scapula Flap for Reconstructions of the Hard Palate and the Alveolar Ridge: A Clinical and Histologic Evaluation
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Schlenz, Ingrid M.D.; Korak, Klaus J. M.D.; Kunstfeld, Rainer M.D.; Vinzenz, Kurt M.D.; Plenk, Hanns Jr., M.D.; Holle, Jürgen M.D. Author InformationKeywords:
Alveolar ridge
Ridge splitting and ridge expansion have been used to expand narrow alveolar ridges. Piezosurgical ridge splitting involves separating the atrophic crests with piezosurgical inserts. Ridge expansion with motor-driven expanders was proposed to achieve the cortical dilation. The purpose of this study was to evaluate the efficacy of ridge gain by ridge expansion or ridge splitting. Eighteen (36 ramus) swine cadaver jaws were first divided into two groups- ridge expansion with a motor-driven expander or ridge splitting with the piezosurgical system. Then, either an active-tapping implant or nonactivetapping cylinder-type implant was inserted. The crestal ridge diameter change was measured with a Boley gauge. The area of bony perforation, which includes fenestrations and dehiscences, was measured with a prefabricated reference grid. The results showed that there was no statistically significant difference in crestal width gain between groups. However, the combination of the motor-driven ridge expansion technique and the active-tapping implant could be beneficial in significantly decreasing the bony perforation area.
Alveolar ridge
Perforation
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Chondrogenesis
Forelimb
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To analyse and compare the dimensional changes of unassisted extraction sockets with alveolar ridge preservation (ARP) techniques and investigate any factors that impact the resorption of the alveolar bone.A systematic search was conducted to identify randomised clinical trials (RCTs). All data were extracted, and a meta-analysis was performed for the changes in all buccolingual ridge width, midbuccal and midlingual ridge height, and mesial and distal ridge height, and horizontal width at reference points apical to the crestal area.Based on 14 RCTs, the effectiveness of ARP in reducing the dimensions of the postextraction alveolar socket was confirmed. The clinical magnitude of this effect was 1.95 mm in the buccolingual ridge width, 1.62 mm in the midbuccal ridge height, and 1.26 mm on the midlingual ridge height. Additionally, 0.45 mm and 0.34 mm for mesial and distal ridge height, and 1.21 mm, and 0.76 mm for ridge width changes at points 3 and 5 mm apical to the crest were noted. Meta-regression analyses revealed that the reflection of flaps and primary wound coverage during ARP may have detrimental effects on bone remodelling, while no statistical significance was observed for any of the bone graft substitutes or the percentage of molar sockets.Regardless of the protocol, ARP can only minimise ridge resorption. ARP is most effective on horizontal ridge width, providing the most benefit coronally (approximating the crest), followed by the midbuccal ridge height.
Alveolar ridge
Crest
Alveolar crest
Alveolar process
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Anatomical variations often present a challenge in the placement of an implant in its optimal location. A ridge split procedure, which had been recommended for narrow alveolar ridges, has recently undergone a number of modifications, making the procedure simpler and providing more predictable outcomes. This article reports the 3-year follow-up of 2 implants placed using a ridge split procedure with a piezoelectric surgical unit for the rehabilitation of the mandibular posterior ridge.
Alveolar ridge
Mandible (arthropod mouthpart)
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Purpose To analyse and compare the dimensional changes of unassisted extraction sockets with alveolar ridge preservation (ARP) techniques and investigate any factors that impact the resorption of the alveolar bone. Materials and methods A systematic search was conducted to identify randomised clinical trials (RCTs). All data were extracted, and a meta-analysis was performed for the changes in all buccolingual ridge width, midbuccal and midlingual ridge height, and mesial and distal ridge height, and horizontal width at reference points apical to the crestal area. Results Based on 14 RCTs, the effectiveness of ARP in reducing the dimensions of the postextraction alveolar socket was confirmed. The clinical magnitude of this effect was 1.95 mm in the buccolingual ridge width, 1.62 mm in the midbuccal ridge height, and 1.26 mm on the midlingual ridge height. Additionally, 0.45 mm and 0.34 mm for mesial and distal ridge height, and 1.21 mm, and 0.76 mm for ridge width changes at points 3 and 5 mm apical to the crest were noted. Meta-regression analyses revealed that the reflection of flaps and primary wound coverage during ARP may have detrimental effects on bone remodelling, while no statistical significance was observed for any of the bone graft substitutes or the percentage of molar sockets. Conclusions Regardless of the protocol, ARP can only minimise ridge resorption. ARP is most effective on horizontal ridge width, providing the most benefit coronally (approximating the crest), followed by the midbuccal ridge height.
Alveolar ridge
Crest
Alveolar crest
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Introduction : Among many techniques advocated for the horizontally deficient alveolar ridges, ridge split technique has many advantages. Materials and Methods : Here, the main treatment management strategy of the horizontally collapsed ridges, the ridge split approach, is discussed in detail according to our new ridge width classification, with the goal of assisting an operator in choosing the proper bone augmentation technique. Results : Success rate was more than 97 percent with using our protocol in treatment of cases in this study. Conclusion : Choice of the technique is dependent ultimately on operator experience and surgical comfort. The ridge split has many advantages, including lack of donor site morbidity and graft stability over time. Key words : Ridge-split, Alveolar ridge.
Alveolar ridge
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Biomechanics
Thorax (insect anatomy)
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Among the late consequences of obstetrical brachial plexus palsy is winging of the scapula, a functional and aesthetic deformity. This article introduces a novel surgical procedure for the dynamic correction of this clinical entity that involves the dynamic transfer of the contralateral trapezius muscle and/or rhomboid muscles and anchoring to the affected scapula. In more severe cases of scapula winging, the contralateral latissimus dorsi muscle may also need to be transferred to achieve dynamic scapula stabilization. The outcomes of this novel surgical procedure were analyzed in relation to the effect on abduction, external rotation, growth of the scapula, and distance of the scapula from the posterior midline. The results were analyzed in 26 patients who underwent this procedure and had adequate follow-up. The mean patient age was 6.39 years. Fourteen (54 percent) had a diagnosis of Erb palsy, and 12 (46 percent) had a diagnosis of global paralysis. All 26 patients had an additional secondary procedure performed prior to or simultaneously with the scapula stabilization procedure. In 19 patients, the contralateral trapezius was transferred and anchored to the medial border of the winged scapula alone, but in seven cases the underlying rhomboid major was transferred along with the trapezius muscle to provide sufficient scapula stabilization. In five cases in which the scapula winging was severe, the contralateral latissimus dorsi muscle was transferred at a second stage. After this procedure, all patients demonstrated improved scapula symmetry. The mean increase in abduction was 18 degrees (p < 0.001), the mean increase in external rotation was 19 degrees (p < 0.001), and the mean increase in anterior flexion was 12 degrees (p = 0.015). The improvement of the relative position of the winged scapula on the posterior thorax was analyzed by measuring the distance of the inferior angle of both scapulae from the midline, then calculating the difference between normal and affected sides and comparing this value before and after the scapula stabilization procedure. This value preoperatively was 3.24 cm; postoperatively it decreased to 0.36 cm (p < 0.001), demonstrating a statistically significant improvement.
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