The technique of two-piece bone reconstruction

Date: 31/05/2018 / Author: Mr Hiếu

Implant placement in patients with cleft lip and palate patients 
(Journal of Clinical Medicine 108, No. 2, pp.54-58). Prof. Vo Van Nhan.

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Objectives: To evaluate the results of bone reconstruction after grafting of bone grafts. METHODS: A prospective, randomized, controlled study of 32 patients with cleft lip and palate revealed a total of 23 females and 9 males aged 15 to 29 years. RESULTS: The medial bones of the jaw were restored to an average of 11.4 ± 2.4 mm, with an average external dimension of 6.1 ± 1.0 mm. 90.6% (29/32) of patients with type I demanded implant placement, 9.4% (3/32) with type III bone implant not enough implants implant should be fixed restorations. CONCLUSION: The technique of 2-piece reconstruction of the iliac creped shell contributed a new method, which resulted in bone grafting, bone resurfacing, and implant resurfacing. mouth.

Key words: bone graft, cleft palate, palate.

Objection: To evaluate the outcome of alveolar cleft bone graft. Method: The progressive clinical study performed on 32 patients with unilateral cleft lip and alveolar cleft defect, included 23 female and 9 male in the age of 15 to 29 years. Results: The mean apical-coronal distance of the bone graft was 11.4 ± 2.4mm and the mean buccal-distance was 6.1 ± 1.0 mm. 29 patients (90.6%) were rated type I on Enermark implant, 3 patients (9.4%) type III had insufficient bone for implant placement required fix bridge fixation. Conclusion: The two iliac bone block autograft have contributed a new method that showed good results in the alveolar cleft bone graft for implant placement in palatal cleft lip patients.

Key words: Alveolar cleft bone graft, palatal cleft lip patient.

1. Set the problem

According to the World Health Organization, the proportion of patients with KHM - VM is estimated to be about one in 500 newborn babies. In Vietnam, the percentage of children with disabilities from KHM - VM ranges from 1/709 to 1/1000 [1]. In Vietnam, studies on liposuvial cleft liposuction studies have focused primarily on epidemiological and liposuvial cleft liposuction techniques [2], [1] but no bone resorption studies have been performed. slot for denture implant on the implant for this object. Meanwhile, most lip-palatine patients have never had a bone graft surgery and dental restorations so the need for treatment is huge. Therefore, we conducted a study entitled "Technique of two-piece reshaping of the iliac crest in reclamation of the cleft lip in patients with cleft lip and palate", aiming at evaluating the result of bone reconstruction after bone graft. dentifrice gap

2. Subjects and methods of research

2.1. Research subjects

Selection criteria: Patients aged 15 years or older, good health, had lip-palatine-shaped clefts, unilateral cleft lip and bone graft. Exclusion criteria: There were no cleft lip or cleft palate and patients did not agree to participate in the study.

2.2. Research Methods

Study design: A prospective, randomized, controlled trial to evaluate the results of bone grafting. Sample size: 32 patients.

2.3. Research Process:

- Information gathering: clinical examination, intraoral and oral shots, sample imaging, CT- Cone Beam, Panorex and periosteography.

Orthodontics and general dental treatment before surgery. After that, graft-versus-bone graft surgery follows the technique of grafting two-piece bone-to-bone crest. 4-6 months after implantation. After 6 months of bone implant integration, dental restorations.

- Results of bone graft stability after 15 and 18 months of bone graft.

2.4. Procedure of grafting bone graft surgery with the technique of grafting two pieces of bones of the shell of the iliac crest

Use a 10mm diameter disc to cut the pelvis into two pieces. The first skeleton was about the size of the opening and placed on the nasal mucosa which had been stitched. Then, place the sponge on the bones of the shell until it is nearly full. Finally place the second bones of the skeleton and the spongy bone, which are larger than the slits on the grafted bone and have been fixed with a screw for the purpose of squeezing the bones of the sponge and fixing the bones. . Sewing of the incision: starting with stitches on the jaw to close the crown of the palatine crown with the vestibular seals. After that, the sealing of the outer membranes on the two sides of the cleft from the tip of the jaw to the vestibule. Continuously restore the lining of the gum sac from the openings to the sides.

2.5. Criteria for evaluating results

2.5.1. Evaluation of bone grafts for graft-and-orifice fracture:

Use of the film around the apex of the bone bridge formed in the openings according to the Enermark scale. [6]

- Type I: 75% - 100% recovery compared to normal grave height

- Grade II: 50% - 75% recovery from normal grave height

- Type III: 25% to 50% recovery compared to normal grave height

- Type IV: 0% to 25% recovery compared to normal graft height

Successes include Type I and Type II. Partial failure is type III. Total failure of type IV.

2.5.2. Evaluation of bone graft results on CT Cone Beam

Evaluation of bone resorption in 3 dimensions to conclude that there is sufficient bone for implants to apply the standard of Franck Renouard (1999) with the following content: bone enough to implant the upper bone implant at least 7mm and outer dimensions for a minimum of 4mm [7].

Measurement of bone graft on CT Cone beam:

- After 4 months of bone grafting, CT Cone Beam was taken and the transect was performed with the guide trough of contrast medium.

- The upper dimension is measured from the lowest point and the highest point of the bone on the CT image over the positioning axis. The upper part is d.

- The outer dimension is calculated as follows: on the CT slice through the positioning axis, the bone is divided into 3 equal parts, the inner dimension is the outer outer diameter of the upper third (a), the middle third ( b) and one third below (c) of the bone at the slice through the positioning axis. The outer dimension is denoted r. Formula for equation: outer dimension in r = (a + b + c) / 3

3. Research results

3.1. The results of bone graft gap openings

3.1.1. Successful implant results in bone integration

3.1.2. Results of bone regeneration Enermark

Table 3.1: Enermark bone resorption at 6, 12, 15 and 18 months after bone graft

P = 0.000 
During the follow-up period of 6, 12 and 15 months, 90.6% success rate (type I) was achieved, with 9.4% failure. After 18 months, one case of osteoporosis was transferred from type I to type II, but according to Enermark, type I and II were considered successful. The overall success rate was 90.6%. Bridges in the open area at 18 months were significantly different (p <0.05) between the 6, 12 and 15 months.

3.1.3. Results of bone reconstruction on CT Cone Beam

There were 29 cases (accounting for 90.6%) of sufficient bone to implant according to Franck Renouard's standard [7]. There are 3 cases (9.4%) not enough bone to implant implants so these 3 patients are fixed spherical fixation. Bone grafts for implant placement were significantly higher than for implantable bone implants (p <0.05).

4. Discussion

Trong nghiên cứu của chúng tôi, kết quả ghép xương sau 6, 12, 15 và 18 tháng, ghép xương thành công (cầu xương loại I và II) là 90,6% (29/32), thất bại một phần là 9,4% (3/32). Tỉ lệ này tương tự như nghiên cứu của Abyholm (1981) có tỉ lệ thành công chiếm 91% [3] hay trong nghiên cứu Bergland (1986) tỉ lệ thành công 90% [4]. Mặc dù tỉ lệ thành công trong nghiên cứu của Abyholm và Bergland tương đương với nghiên cứu của chúng tôi nhưng hai nghiên cứu này thực hiện ở hàm răng hỗn hợp vốn là đối tượng có điều kiện thuận lợi hơn đối tượng có hàm răng vĩnh viễn [5]. Do vậy, kết quả của chúng tôi có thể nên được đánh giá khả quan hơn.

In addition, our study showed a higher success rate than Tadashi Mikoya (2010) of 83.3% [9], Grant's (2009) study was 76% [8] . These studies are based on composite teeth which are more advantageous than permanent teeth [5] because, according to Abyholm (1981) [3], the bone marrow proliferation activity is stronger, the volume of the bone next to it The gap is greater in younger patients (composite teeth) than in older patients (permanent teeth). As a result, bone grafting in older patients becomes more complicated and results in less.

In addition, the Dempf study [5] in patients with permanent teeth with an average age of 21.3 was similar to that in our study, but the success rate was 68% Partial failure was 24% and total failure was 8%. This result is lower than our possible results because we have used the following methods: improvement of material handling techniques, application of two-piece technique of bony pelvic bony edema (to limit bone grafts and bone healing); Thanks to the technical coordination of the flaps to the side, the palate and the release of bone membrane to help the ligaments do not stretch, provide enough blood for the grafts; at the same time,

5. Conclusion

Restoration of the jaw bone area: 
• The average downward trend is: 11.4 ± 2.4 mm 
• The outer dimension in the average is: 6.1 ± 1.0 mm

There are 90.6% of the bone in the bridge height is almost normal openings and 90.6% of cases enough bone to implant 
Thus two pieces of bone grafting techniques iliac crust contributed a method New, good results in bone graft surgery gap filling, bone resurfacing to implant implants for patients mouth cleft lip - palate.

1. Phan Quoc Dung (2006), "Congenital malformation of the frog's jaw at Tu Du and Hung Vuong", Thesis of Medicine. 
2. Nguyen Bach Duong, Tran Thu Trung, Lam Hoai Phuong (2010), "Characteristics of cleft palate - frog jaws in 32 southern provinces from 2007 to 2010", Research Projects Medical Publishing, p.81-89. 
3. Stockholm F., Bergland O., Semb G. (1981), "Secondary bone grafting of alveolar clefts", Scandinavian Journal of Plastic and Reconstructive Surgery, 15, pp.127-140. 
4. Bergland O., Semb G. and Abyholm FE (1986), "Elmination of the Residual Alveolar Cleft by Secondary Bone Grafting and Subsequent Orthodontic Treatment," Cleft Palate Journal, 23, pp.175 - 205.
5. Dempf R., Teltzrow T., Kramer FJ (2002), "Alveolar bone grafting in patients with complete clefts: a comparative study between secondary and tertiary bone grafting", Cleft Palate Craniofac J, 39, pp.18-25. 
6. Enemark H., Sindent-Pedersen S., Bundgaard M. (1987), "Long-term Results after Secondary Bone Grafting of Alveolar Clefts", J Oral Maxillocfac Surg, 45, pp.913-919. 
7. Franck Renouard, Bo Rangert (1999), "Treatment of the edentulous maxilla", In: Risk factors in implant dentistry, Quintessence Publishing Co., Inc., pp. 67-109. 
8. Grant T. McIntyre, M. Orth., Mark F. Devlin (2010), "Secondary Alveolar Bone Grafting (CLEFTSiS) 2000-2004", Cleft Palate Craniofac, 47, pp.66-72.
9. Tadashi Mikoya, Nobuo Inoue, Yusuke Matsuzawa (2010), "Monocortical mandibular Bone Grafting for Reconstruction of Alveolar Cleft," Cleft Palate-Craniofacial Journal, 47 (5), pp. 453-468.


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