A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Management of bone defects with Bio-oss

Introduction: The defects in the alveolar bone might appear as a result of congenital malformations, traumatic injuries, periodontal disease, surgical traumas, chronic periapical changes and tumors from benign or malignant origin. The aim of this study was to provide solid and healthy area with application of Bio-Oss in the defect. Materials and methods: Based on the clinical diagnosisestablished by previously taken history, clinical examination and radiographic images oral-surgery interventions was made. To realize the aim of this work, augmentative material was implicated in the bone defects made in the patients after removal of follicular cyst, chronic periapical lesion, and parodontopathia. During the first and seventh day of the interventions, the patients have been followed through from aspect of possible development of local and general complications after the oral-surgery intervention. After period of one, three and six mount control x-ray was made. Results: Obtained results confirmed that: volume of the socket and defect of the bone was kept, fast revascularization was achieved, bone formation and slow resorption of the augmentative material was achieved, and period of normal healing without infection was also achieved. Conclusions: The augmentative materials used for treatment of bone defects besides their basic chemical and physical characteristics referring to their solubility in the body fluids, the transformation, modulation and resorption must be completely safe or secure, i.e. not to bring any risk of infection, immunological risk, physiological intolerance or inhibition of the process of restitutio ad integrum. In our study Bio-Oss was confirmed as augmentative material who had this characteristics. Keywords: bone defect, resorption of the bone, augmentative material, Bio-Os

Evaluation of Survival Rate of Zygomatic Implants Placed using Immediate Loading Protocol in Atrophic Maxillaa: A Clinical study

BACKGROUND: Zygoma implants are evidence –based surgical and prosthetic solution for rehabilitation of atrophic posterior maxilla with both classical two stage and immediate loading protocols. Zygoma implants avoid grafting and sinus lift procedures and therefore contribute to a shorter and more comfortable treatment. Zygoma bone is superior to that of the posterior maxilla in providing anchorage and success of zygomatic implant is due to Quad cortical stabilization, that he implant body engages four cortical bones: 1. Maxillary Lingual Plate, 2. Maxillary sinus floor, 3. Maxillary sinus roof, 4. Lateral cortex of the body of zygomatic bone. Immediate loading decreases the time of treatment and increases the acceptance of the treatment by the patient. AIMS AND OBJECTIVES: To evaluate the survival rate of immediately loaded zygomatic implant based on clinical criteria. MATERIALS AND METHODS: 5 patients with completely edentulous atrophic posterior maxilla fulfilling the criteria were selected. Nobel Biocare zygomatic implants were placed in the posterior region of completely edentulous maxilla and anterior conventional implants in selected subjects. The patients were assessed pre operatively and post operatively 1 week, 3 months 6, 9 and 12 months to assess clinical parameters like pain, infect ion, implant stability quotient, Lund – Mackay rhino sinusitis analysis, Ainamo and Bay gingival bleeding index and evaluation of position of apical third of zygomatic implant. The data collected was analyzed statistically. RESULTS: The zygomatic implants and the anterior conventional implants were immediately loaded and a survival rate of 100% was obtained in both zygoma and conventional implants in the current study. The mean ISQ achieved on the right side was 68.80 ± 4.14 and on the left side 65.6 intra operatively which was suggestive of good primary stability. Post operatively after a period of one year follow up the mean ISQ o the right and left side was 71 which indicate secondary stability. CONCLUS ION: Completely edentulous atrophic maxilla rehabilitated with immediate loaded zygomatic implants in combination with anterior conventional implants revealed a survival rate of 100% in one year follow up in current study. There were no potential complications encountered during the follow up period