Novel Techniques in Dentoalveolar and Implant Surgery

The topics of this chapter can help manage or prevent several common intraoperative problems facing clinicians during dentoalveolar and implant surgery. Three novel techniques are presented: (1) a technique for the stabilization of mucoperiosteal flaps following exposure of an impacted tooth requiring the apical repositioning of the gingival flap to allow for bonding of an orthodontic bracket, (2) a technique for the management of bone loss after tooth extraction and immediate dental implant placement, and (3) a technique to repair maxillary sinus membrane perforations during sinus lifting for implant placement

Soft tissue distraction in hand surgery: the “pentagonal frame” technique

Soft tissue distraction (STD) is an increasingly accepted operation in all fields of hand surgery from elbow contracture release to PIP joint release. Current techniques reported lack the ability to distract the joints of the fingers or the hand, maintain the length of released contractures, and hold them in a position while active and passive physiotherapy is possible. We describe a technique by which STD of the hand and fingers is done with no joint or tendon involvement overcoming the aforementioned drawbacks. Thirty-three patients with hand contractures were treated. In this method, a thin 1–1.5-mm Kirschner wire was passed horizontally at the proximal head of the distal phalanx and bent like a frame around the finger, forming a pentagonal shape for anchorage. The distal distraction was exerted at the distal phalanx. Various forms of external fixation were then used to distract a finger, several fingers, or the hand by placing tension on this frame; the distraction was either static (with a wire exerting pressure) or dynamic (using a rubber band to adjust the tension). After obtaining the desired result, the wire or rubber band was temporarily freed to commence active and passive physiotherapy. We maintained the frame for 3–6 weeks. All 33 patients were successfully treated. No major complications were encountered during the follow-up period (3–5 years). The pentagonal frame allows for effective distraction of soft tissues and joint ligaments and maintains the space needed for healing of fractures of the metacarpals and phalanges