BACKGROUND: Cleft lip and palate CLP is a frequent congenital malformation that manifests in several varieties including unilateral or bilateral anomalies due to either genetic or acquired causes. Alveolar cleft graft ACG remains controversial as regard timing, grafting materials and surgical techniques. The primary goal of alveolar cleft grafting in ACG patients is to provide an intact bony ridge at the cleft site to allow maxillary continuity for teeth eruption, proper orthodontic treatment for dental arch alignment, oronasal fistula closure and providing alar support for nasal symmetry. AIM: This study aims to compare different grafting techniques to treat the alveolar cleft defect. METHODS: This study included 24 cases divided into three groups of patients: Group A was treated with autogenous iliac crest bone; Group B was treated with nano calcium hydroxyapatite with collagen membrane and Group C was treated with tissue engineering method using bone marrow stem cells extract and PRF membrane. RESULTS: According to clinical and radiographic examination measuring bone density in the CT preoperatively compared to six months postoperatively. Group C with bone marrow stem cells extract showed superior results among all followed by group B, while group A with autogenous iliac crest showed resorption in some cases and gave the least values, in addition to its drawbacks as regard donor site affection with pain & scar formation. CONCLUSION: Bone substitutes as Nano calcium hydroxyapatite and bone marrow stem cells extract showed to be reliable methods for bone grafting than autogenous iliac crest.
BACKGROUND: Cleft lip and palate (CLP) is one of the most common congenital deformities involving intervention in several sub-specialties. AIM: The present study was conducted to investigate the amount of maxillary advancement obtained by three different methods. METHODS: A retrospective comparative study was conducted on 24 CLP patients who were treated with three surgical maxillary advancement techniques: Group A was treated with Le Fort I (LFI) orthognathic surgery with bone grafting and rigid fixation (LFI). Group B was treated with intraoral maxillary bone distraction (MIDO). Group C was treated with orthodontic traction by facemask (orthodontic facemasks [OFM]) plus corticotomy. All pre-operative data were collected, which included intraoral and extraoral clinical photos and dental casts. Pre-operative radiographic assessment was compared with post-operative values using digital panorama, multi-slice computed tomography and lateral cephalometric X-ray measuring Sella-nasion-A point; point A-nasion-point B points, with a follow-up period of 6 months. RESULTS: All approaches showed statistically significant success in maxillary advancement with p < 0.01. LFI has produced the highest advancement obtained with regard to the pre-operative advancement required (8.6 ± 1.4) and post-operative advancement achieved (7.8 ± 0.8). MIDO technique is an alternative method to LFI, but it gives less achieved post-operative maxillary advancement (6.25 ± 0.8) and is indicated for moderate cases. OFM gave the least advancement results; however, it has been the most convenient less-invasive method and was more suitable for unsevere cases. CONCLUSIONS: The three approaches produced satisfactory results in rehabilitating deficient maxilla in cleft patients, although each technique has limitations and indications. Future research is recommended to assess the technique’s long-term stability.
Purpose: to evaluate the effect of using two treatment modalities on the alveolar bone height in flat ridge cases. Materials and methods: Ten completely edentulous male patients were selected. Age of the patients ranged from 55-65 years old. All patients had resorbed lower ridges. The patients were divided into two groups, five patients each. All group (A) Patients received conventional flexible denture while, all group (B) patients received overdenture supported by single sympheseal implant. Mandibular bone height was measured by Cone Beam Computerized Tomography (CBCT) for both groups using stent containing radio-opaque stainless steel wires at posterior region corresponding to (5, 6,7) denture teeth at the time of flexible denture/overdenture delivery and 6, 9, 12 month after. Results: Regarding intergroup comparison of the change in bone height (%) group (A) had a higher mean value of bone height changes than group (B) which was found statistically not significant. Regarding frequency and percentage values for patient satisfaction questionnaire answers there were no significant differences in the answers of both groups. Conclusion: Within the limitation of this study, it could be concluded that, there was no significant difference between flexible complete denture group and single implant flexible overdenture group regarding posterior mandibular bone resorption and patient satisfaction.
Purpose: To compare the outcomes after rigid intermaxillary fixation (IMF) versus functional therapy (FT) in patients with mandibular condylar fractures (CFs). Patients and Methods: A prospective comparative study with 3 follow-ups (FU) at 1, 3 and 6 months was undertaken in 2 groups, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from Group1 (GI) received IMF for 10 days, followed by physiotherapy, whereas those in Group2 (GII) had undergone FT for 21 days via guiding elastics. In both groups, all concomitant fractures (if present) were treated by open reduction and internal fixation (ORIF). Patients with unilateral CFs, with or without concomitant mandibular fractures showing one or more of the following conditions were included: adult patients (>18 years of age) indicated for closed treatment, and sufficient dentition for arch bars application. Previous history of tempromandibular joint (TMJ) dysfunction, severe pre-traumatic skeletal dysgnathia, and mid face fractures was excluded. Results: 12 patients (6 in GI and 6 in GII) were included. The clinical TMJ Dysfunction Index of Helkimo (CTDI-H) was equal in both groups at 1 month FU, it became worse in GI than in the GII at 3 month FU, corresponding to better function on the short-term. At the 6 month FU, there were better values in the GII. The Magnetic Resonance Imaging (MRI) scans revealed that the trauma caused disc displacement for 33.3% of GI and 66.7 % of GII. At 6 months FU, 33.3% of GI had improvement in the degree of the disc displacement, but they still had internal derangement with reduction. In GII, 2 out of 4 retained the normal position of the disc and the others had improvement in the disc displacement degree only. Conclusion: Both treatment options may yield acceptable results, however, FT seems to be the appropriate treatment for rapid recovery of range of mandibular motion (ROMM), relief of pain during palpation of masticatory muscles, and recovery of disc position during FU. Its success depends on the passive maneuver of physiotherapy if there is no restricted maximum interincisal opening (MIO) and it should be in a forcible manner in case of restricted MIO.
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