• Archives of Plastic Surgery
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• 제44권3호
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• pp.188-193
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• 2017

Alveolar cleft is a tornado-shaped bone defect in the maxillary arch. The treatment goals for alveolar cleft are stabilization and provision of bone continuity to the maxillary arch, permitting support for tooth eruption, eliminating oronasal fistulas, providing an improved esthetic result, and improving speech. Treatment protocols vary in terms of the operative time, surgical techniques, and graft materials. Early approaches including boneless bone grafting (gingivoperiosteoplasty) and primary bone graft fell into disfavor because they impaired facial growth, and they remain controversial. Secondary bone graft (SBG) is not the most perfect method, but long-term follow-up has shown that the graft is absorbed to a lesser extent, does not impede facial growth, and supports other teeth. Accordingly, SBG in the mixed dentition phase (6-11 years) has become the preferred method of treatment. The most commonly used graft material is cancellous bone from the iliac crest. Recently, many researchers have investigated the use of allogeneic bone, artificial bone, and recombinant human bone morphogenetic protein, along with growth factors because of their ability to decrease donor-site morbidity. Further investigations of bone substitutes and additives will continue to be needed to increase their effectiveness and to reduce complications.

• 대한두개안면성형외과학회지
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• 제16권2호
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• pp.49-52
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• 2015

The alveolar cleft has not received as much attention as labial or palatal clefts, and the management of this cleft remains controversial. The management of alveolar cleft is varied, according to the timing of operation, surgical approach, and the choice of graft material. Gingivoperiosteoplasty does not yet have a clear concensus among surgeons. Primary bone graft is associated with maxillary retrusion, and because of this, secondary bone graft is the most widely adopted. However, a number of surgeons employ presurgical palatal appliance prior to primary alveolar bone graft and have found ways to minimize flap dissection, which is reported to decrease the rate of facial growth attenuation and crossbite. In this article, the authors wish to review the literature regarding various advantages and disadvantages of these approaches.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권5호
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• pp.224-229
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• 2014

The maxillary posterior area is the most challenging site for the dental implant. Although the sinus graft is a predictable and successful technique for rehabilitation of atrophic and pneumatized posterior maxilla, when there is severe destruction of alveolar bone, a very long crown length remains challenging after successful dental implants installation with sinus graft. We performed vertical augmentation of the maxillary posterior alveolar ridge using the allogenic block bone graft with a simultaneous sinus graft using allogenic and heterogenic bone chips. After about six months, we installed the dental implant. After this procedure, we achieved a more favorable crown-implant fixture ratio and better results clinically and biomechanically. This is a preliminary report of vertical augmentation of maxillary posterior alveolar ridge using allogenic block bone graft and simultaneous maxillary sinus graft. Further research requires longer observation and more patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권2호
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• pp.85-93
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• 2022

Objectives: The aim of this study was to compare morbidities and duration of surgery, as well as bone formation in alveolar defects reconstructed with symphysis bone combined with allograft and iliac crest bone graft in patients with cleft palate. Patients and Methods: This randomized clinical trial was performed with 22 patients with unilateral alveolar cleft with a follow-up period of 12 months. In 12 patients, alveolar defects were reconstructed with chin bone graft plus allograft (Group A), while for the other 10 patients, iliac bone crest was used as donor site (Group B). Duration of surgery as well as occurrence of morbidities and complications were recorded. In addition, cone-beam computed tomographic (CBCT) scans were performed before surgery and 12 months after surgical procedures in order to compare bone formation between the two groups. Results: Postoperative CBCT demonstrated a mean bone fill percentage of 76.9% of the alveolar defect in Group A, compared with 77.0% in Group B. Paresthesia in the lower lip or chin did not occur in any patients of Group A. The mean duration of the surgical process was significantly shorter for Group A (40 minutes vs 76 minutes, P<0.001). In addition, patients in Group A regained normal gait faster than patients in Group B (1 day vs 9.5 days). Conclusion: Mandibular symphysis bone graft in combination with allograft results in favorable outcomes in patients with unilateral alveolar clefts.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.542-545
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• 2013

Background The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft. Methods Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT. Results Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001). Conclusions An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.8.1-8.6
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• 2015

Background: This study aimed to evaluate the clinical usefulness of autogenous fresh demineralized tooth (auto-FDT) graft prepared at the chairside for alveolar bone grafting during dental implant surgery. Methods: In total, 38 patients requiring both tooth extraction (for endodontic or periodontal reasons or third molar extraction) and alveolar bone regeneration for dental implant placement were included. Within 2 h after clean extraction, the teeth were prepared at the chairside to serve as bone graft material. In the same sitting, blocks or chips of this graft material were used to reconstruct defects at the osteotomy site simultaneously with or before implant placement. Twelve months after prosthesis fabrication and placement, the clinical findings and implant success rates were evaluated. Histological studies were randomly conducted for selected cases. Results: Clinical evaluation showed favorable wound healing with minimal complications and good bone support for the implants. No implant was lost after 12 months of function following prosthetic rehabilitation. Histological examination revealed new bone formation induced by the graft material. Conclusions: Chairside preparation of autogenous fresh demineralized teeth after extraction can be a useful alternative to the use of autogenous bone or other graft materials for the immediate reconstruction of alveolar bone defects to facilitate subsequent implant placement.

• Journal of Periodontal and Implant Science
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• 제52권1호
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• pp.3-27
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• 2022

Purpose: This study was conducted to evaluate and compare the effects of different graft materials used in alveolar ridge preservation on dimensional hard tissue changes of the alveolar ridge, assessed using cone-beam computed tomography (CBCT) scans. Methods: A systematic electronic search of MEDLINE and the Cochrane Central Register of Controlled Trials and a manual search were conducted from November 2019 until January 2020. Randomized controlled trials were included if they assessed at least 1 variable related to vertical or horizontal hard tissue changes measured using CBCT scans. After a qualitative analysis of the included studies, subgroups were formed according to the graft material used, and a quantitative analysis was performed for 5 outcome variables: changes in vertical alveolar bone height at 2 points (midbuccal and midpalatal/midlingual) and changes in horizontal (buccolingual) alveolar bone width at 3 different levels from the initial crest height (1, 3, and 5 mm). Results: The search resulted in 1,582 studies, and after an independent 3-stage screening, 16 studies were selected for qualitative analysis and 9 for quantitative analysis. The metaanalysis showed a significantly (P<0.05) lower reduction of alveolar ridge dimensions for the xenogenic subgroup than in the allogenic subgroup, both vertically at the midbuccal aspect (weighted mean difference [WMD]=-0.20; standard error [SE]=0.26 vs. WMD=-0.90; SE=0.22) as well as horizontally at 1 mm (WMD=-1.32; SE=0.07 vs. WMD=-2.99; SE=0.96) and 3 mm (WMD=-0.78; SE=0.11 vs. WMD=-1.63; SE=0.40) from the initial crest height. No statistical analysis could be performed for the autogenic subgroup because it was not reported in sufficient numbers. Conclusions: Less vertical and horizontal bone reduction was observed when xenogenic graft materials were used than when allogenic graft materials were used; however, the loss of alveolar ridge dimensions could not be completely prevented by any graft material.

• 구강회복응용과학지
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• 제22권2호
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• pp.161-171
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• 2006

Endosseous implants have restored normal function and dental health to many patients. When implants were introduced as an effective treatment modality, their efficacy was limited by the amount of available bone. Today, various grafting procedures can surgically create bone width and volume. Implants can be placed in more ideal locations for successful prosthetic reconstruction. The use of autogenous bone grafts represents the "gold standard" for bone augmentation procedures. Either intraoral or extraoral sites may be considered for donor sites. Alveolar ridge augmentation using autogenous bone block, can be done during implant placement or staged with implant placement, after bone graft healing. In the staged technique, a better implant positioning and the use of wide diameter implants are possible. Alveolar ridge augmentation using autogenous block graft is a predictable way of treatment, for the atrophic alveolar ridge before implant placement. The cases presented in this article clinically demonstrate the efficacy of using a autogenous block graft in generating effective new bone fill for dental implant placement.

• 대한치과의사협회지
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• 제57권12호
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• pp.768-777
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• 2019

Alveolar bone resorption are unpredictable and always occur after tooth extraction. Such bone resorption causes insufficient alveolar ridge which make implant placement difficult. There are many techniques to increase the alveolar ridge. Representative procedures include ridge split, guided bone regeneration, bone graft using autogenous block bone, and alveolar distraction. In each procedure, there are indications and complications. Depending on the shape and the width of bone defects, we can choose procedures for horizontal bone augmentation and vertical bone augmentation.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.445-449
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• 2009

Purpose: A successful surgical treatment for a wide alveolar cleft with bone graft is difficult to achieve due to several factors such as the limitation of gingivoperiosteal flap, the presence of large scar tissues, and the poor blood circulation. To overcome these problems, alveolar distraction osteogenesis using Liou alveolar distraction device was applied. We analyzed the consequences of this surgical treatment. Method: Between 2006 January and 2007 August, we have conducted analysis on the methods and consequences of Liou alveolar distraction osteogenesis for 6 patients. The age of patients was 12 years and 6 months in average. The follow up period was 19 months in average. The Reverse L osteotomy followed by the placement of the Liou alveolar distraction device was performed. After serial distraction, the distractor was removed after 5 months of the process of osteogenesis, and the result was analyzed using the computed tomography and the x-ray films of the alveolar bone and the teeth. Results: The alveolar cleft with 12.5 mm in average width was filled with 8.5 mm of newly formed bone tissue in average width after 5 months of osteogenesis. Among the 6 cases, 5 required the additional bone graft and 1 case only required the gingivoperioplasty. The newly formed bone tissues did not show any signs of bone resorption. However, a considerable degree of teeth displacement was shown. Conclusion: For the alveolar cleft too wide to be reconstructed by a general bone graft, it is strongly recommended to perform the reverse L osteotomy of the cleft side with Liou alveolar distraction device to initiate the alveolar osteogenesis. However, the migrated teeth showed some degree of relapse, thus, the orthodontic treatment is essential following the distraction osteogenesis treatment.