• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권4호
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• pp.301-307
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• 2004

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

• 대한치과보철학회지
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• 제45권1호
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• pp.34-47
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• 2007

Statement of problem: Conventional mandibular complete denture lacks in support and stability for edentulous patients to use. Purpose: To enhance support and stability of mandibular complete denture, 2 implants were inserted on the inter-mental foramina space of edentulous patients. With 2 magnetic attachments on the inner side of the overdenture, we gave immediate loads and evaluated the stability of the implants, the responses of the supporting tissues, and the satisfaction of the patients. Material & methods: 6 edentulous patients (5 male, 1 female) each recieved 2 SLA implants in the inter-mental foramina region and implants were immediately loaded with overdenture with magnet attachments. To evaluate the implants stability and the peri-implant tissues, clinical exams, RFA tests and radiographic exams were preformed at the 1 week, 2wks, 6wks, 12wks, and 24wks. post- surgery. Results: The mean surgery time was $45.7{\pm}7.7mins$., while the denture delivery time was $45.5{\pm}12.6mins$. Only 2 of 14 implants were failed. Survived implants that remained were clincally and radiographically stable. Mean ISQ values were relatively stable, showing $69.71{\pm}5.55$, $69.00{\pm}9.48$, $67.92{\pm}7.86$, $67.92{\pm}9.58$, $70.08{\pm}7.61$, $71.92{\pm}6.43$ at the 1 wk, 2 wks, 6 wks, 12 wks, 24 wks. follow up check. Crestal bone changes were $-1.18mm{\pm}0.68mm$, $-1.35{\pm}0.69mm$, $-1.47{\pm}0.68mm$ at the 6wks, 12wks, 24wks. follow up check. Bleeding on probing(BOP index) was not significant. Conclusion: Mandibular ovedentures with 2 magnetic attachments over two interforaminal implants on edentulous patients for immediate function is a recommendable novel treatment for edentulous patients which shows stability on the implants and supporting tissue.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.531-537
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• 2009

Purpose: Alveolar bone grafting has become an essential process in the treatmemt of alveolar cleft patient for stabilization of the maxillary arch, elimination of oronasal fistula, the reconstruction of the soft tissue nasal base support, and creation of bony support for tooth eruption for implant. The use of Autologous iliac cancellous bone is preferable because of the adequate quantity and high osteoinductive potential. However, even with iliac bone, insufficient osteoregeneration and absorption occur due to several factors such as the patient's age, cleft width, functional stress, and others. In order to increase osteoregeneration where the iliac bone is placed, the present study is associated with bone marrow aspirate (BMA). The experimental study evaluated the efficacy of osteoregeneration in normal cleft rabbits when alveolar bone grafting was performed with autologous iliac corticocancellous bone. Methods: Twenty - four New Zealand White rabbits were divided randomly into 2 groups (BMA, control). All animals underwent harvesting of corticocancellous bone graft from the right posterior iliac crest via standard surgical technique. $1m{\ell}$ of BMA were obtained by scraping the needle and aspirate with $10m{\ell}$ syringe from the contralateral iliac bone wall. The muco - periosteal flap on the palate was elevated. A mixture of Equal bone's volumes with BMA and saline as its control was inserted into the cleft. Animals were sacrificed at 2, 4, and 8 weeks and maxilla was harvested for dental peri - apical X-ray, bone matrix density (BMD),and histologic analysis. Result: BMD of regenerated bone to the cleft in the rabbits was higher than that of the control rabbits. X-ray, histologic analysis showed that increased osteoregeneration and low absorption rate were observed in the BMA group. Conclusion: Our experimental study showed BMA enhanced the osteoregeneration and survival rate of alveolar bone grafting. BMA is easy to extract & cost - time effective. So it can be an effective enhancers for bone grafting mixtures.