Rehabilitation of Atrophic Maxilla Using the Combination of Autogenous and Allogeneic Bone Grafts Followed by Protocol-Type Prosthesis

Currently, there are several techniques for the rehabilitation of atrophic maxillary ridges in literature. The grafting procedure using autogenous bone is considered ideal by many researchers, as it shows osteogenic capability and causes no antigenic reaction. However, this type of bone graft has some shortcomings, mainly the restricted availability of donor sites. In recent years, several alternatives have been investigated to supply the disadvantages of autogenous bone grafts. In such studies, allogeneic bone grafts, which are obtained from individuals with different genetic load, but from the same species, have been extensively used. They can be indicated in cases of arthroplasty, surgical knee reconstruction, large bone defects, and in oral and maxillofacial reconstruction. Besides showing great applicability and biocompatibility, this type of bone is available in unlimited quantities. on the other hand, allogeneic bone may have the disadvantage of transmitting infectious diseases. Atrophic maxillae can be treated with bone grafts followed by osseointegrated implants to obtain aesthetic and functional oral rehabilitation. This study aimed to show the viability of allogeneic bone grafting in an atrophic maxilla, followed by oral rehabilitation with dental implant and protocol-type prosthesis within a 3-year follow-up period by means of a clinical case report.

Use of 4 Immediately Loaded Zygomatic Fixtures for Retreatment of Atrophic Edentulous Maxilla After Complications of Maxillary Reconstruction

This article reports the 20-month clinical outcome of the use of 4 zygomatic implants with immediate occlusal loading and reverse planning for the retreatment of atrophic edentulous maxilla after failed rehabilitation with autogenous bone graft reconstruction and maxillary implants. The intraoral clinical examination revealed mispositioned and loosened implants underneath a maxillary complete denture. The panoramic radiograph showed 6 maxillary implants. One implant was displaced into the right maxillary sinus, and the implant anchored in the region of tooth 21 was fractured. The other implants presented peri-implant bone loss. The implants anchored in the regions of teeth 21 to 23 and 11 to 13 were first removed. After 2 months, the reverse planning started with placement of 4 zygomatic fixtures, removal of the implants migrated into the sinus cavity and anchored in the region of tooth 17, and installation of a fixed denture. After 20 months of follow-up, no painful symptoms, peri-implant inflammation or infection, implant instability, or bone resorption was observed. The outcomes of this case confirm that the zygoma can offer a predictable anchorage and support function for a fixed denture in severely resorbed maxillae.

Ameloblastic carcinoma of the maxilla: A case report

This study aims to present the clinical features and treatment of a case of maxillary ameloblastic carcinoma. A meloblastic carcinoma is a rare malignant odontogenic carcinoma that has metastatic potential. Due to its rare incidence, there are few studies focusing on its radiological characteristics. When ameloblastic carcinoma demonstrates an aggressive appearance, it may be diagnosed as a malignant tumor; however, in cases showing a non-aggressive appearance, it is difficult to distinguish ameloblastic carcinoma from ameloblastoma. We report a case of ameloblastic carcinoma of the maxilla in a 59-year-old male patient, including the clinical signs, radiological images and pathological features. A partial area was surgically excised under local anesthesia and the material was sent to the Laboratory of Oral Pathology. The histological sections revealed a fragmented odontogenic tumor of epithelial origin, consisting of solid parenchyma and also revealed basal cells resembling ameloblasts, occasionally arranged in palisades. Certain parts of the architecture resembled that of an ameloblastoma; however, the cytology of other areas confirmed the diagnosis of ameloblastic carcinoma of the maxilla. The patient was scheduled for definitive surgery, including a right maxillectomy and radiotherapy. The patient was followed up every 3 months. After 2 years follow-up, there were no clinical or radiological signs of recurrence.

Analysis of mechanical behavior of implant-supported prostheses in the anterior maxilla: analysis by speckle pattern interferometry

The use of implants to rehabilitation of total edentulous, partial edentulous or single tooth is increasing, it is due to the high rate of success that this type of treatment present. The objective of this study was to analyze the mechanical behavior of different positions of two dental implants in a rehabilitation of 4 teeth in the region of maxilla anterior. The groups studied were divided according the positioning of the implants. The Group 1: Internal Hexagonal implant in position of lateral incisors and pontic in region of central incisors; Group 2: Internal Hexagonal implant in position of central incisors and cantilever of the lateral incisors and Group3 - : Internal Hexagonal implants alternate with suspended elements. The Electronic Speckle Pattern Interferometry (ESPI) technique was selected for the mechanical evaluation of the 3 groups performance. The results are shown in interferometric phase maps representing the displacement field of the prosthetic structure.

Conservative Management of a Large Keratocystic Odontogenic Tumor in the Maxilla

Keratocystic odontogenic tumor is characterized by high recurrence rates. Conservative or aggressive management has been suggested as a method of treatment. Decompression is a conservative treatment that has been used in the treatment of large odontogenic cysts. The authors report a case of a 14-year-old patient with a keratocystic odontogenic tumor located in the right maxilla, which was treated by decompression followed by enucleation with curettage. The lesion did not recur on follow-up for 3 years after the enucleation surgery.

B-cell lymphoblastic lymphoma in the maxilla of a child: A rare case report

Lymphoblastic lymphoma is a malignant neoplasia that originates from B or T lymphocyte precursors and rarely occurs in the mouth. The authors report a rare case of B-cell lymphoblastic lymphoma in the maxilla of a child. Clinical examination revealed facial asymmetry with a swelling of the right maxilla, covered by healthy mucosa and painful to palpation. Radiographic examination revealed a poorly defined radiolucent lesion. Based on the hypothesis of malignant neoplasia of hematopoietic origin, an incisional biopsy was performed. Histological examination revealed malignant neoplasia with proliferation of monomorphic, lymphoid cells. Immunohistochemical staining was positive for leucocyte common antigen (LCA), CD 10, CD20, CD79, and terminal deoxynucleotidyl transferase (TdT). After the diagnosis of B-cell lymphoblastic lymphoma, the patient underwent chemotherapy, but died of leukoencephalopathy and demyelinization caused by high doses of methotrexate.

Osteoblasts engulf apoptotic bodies during alveolar bone formation in the rat maxilla

During bone formation, as in other tissues and organs, intense cellular proliferation and differentiation are usually observed. It has been described that programmed cell death, i.e., apoptosis, takes place in the control of the cellular population by removing of the excessive and damaged cells. Although it is generally accepted that apoptotic bodies are engulfed by professional phagocytes, the neighboring cells can also take part in the removal of apoptotic bodies. In the present study, regions of initial alveolar bone formation of rat molars were examined with the aim to verify whether osteoblasts are capable of engulfing apoptotic bodies, such as professional phagocytes. Rats aged 11-19 days were sacrificed and the maxillary fragments containing the first molar were removed and immersed in the fixative solution. The specimens fixed in glutaraldehyde-formaldehyde were processed for light microscopy and transmission electron microscopy. For the detection of apoptosis, the specimens were fixed in formaldehyde, embedded in paraffin, and submitted to the TUNEL method. The results revealed round/ovoid structures containing dense bodies on the bone surface in close contact to osteoblasts and in conspicuous osteoblast vacuoles. These round/ovoid structures showed also positivity to the TUNEL method, indicating that bone cells on the bone surface are undergoing apoptosis. Ultrathin sections showed images of apoptotic bodies being engulfed by osteoblasts. Occasionally, the osteoblasts exhibited large vacuoles containing blocks of condensed chromatin and remnants of organelles. Thus, these images suggest that osteoblasts are able to engulf and degrade apoptotic bodies. (c) 2005 Wiley-Liss, Inc.

All-on-four concept and immediate loading for simultaneous rehabilitation of the atrophic maxilla and mandible with conventional and zygomatic implants

We report the simultaneous rehabilitation of an edentulous patient with a hybrid (zygomatic and conventional implants) all-on-four implant-supported prosthesis for the maxilla and a standard (conventional implants) all-on-four implant-supported prosthesis for the mandible. The transfer impression was made with a multifunctional guide and the upper and lower prostheses were placed 24 h postoperatively. Clinical and radiographic examinations showed no infection or bony resorption 2 years later. Simultaneous maxillary and mandibular rehabilitation with all-on-four immediate loading is a viable, fast and effective option for edentulous patients. (C) 2009 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.

Rehabilitation with zygomatic implants: a treatment option for the atrophic edentulous maxilla--9-year follow-up.

This article reports the 9-year clinical outcome of the two-stage surgical rehabilitation of a severely atrophic edentulous maxilla with a metal-resin fixed denture supported by implants anchored in the zygomatic bone and the maxilla. After clinical and radiographic examination, zygomatic implants were inserted bilaterally and four standard implants were placed in the anterior region of the maxilla. Six months later, the implants were loaded with a provisional acrylic resin denture, and the definitive implant-supported metal-resin fixed denture was provided 1 year after implant placement. After 9 years of follow-up, no painful symptoms, peri-implant inflammation or infection, implant instability, or bone resorption was observed. In the present case, the rehabilitation of severe maxillary atrophy using the zygomatic bone as a site for implant anchorage provided good long-term functional and esthetic results. Therefore, with proper case selection, correct indication, and knowledge of the surgical technique, the use of zygomatic implants associated with standard implants offers advantages in the rehabilitation of severely resorbed maxillae, especially in areas with inadequate bone quality and volume, without needing an additional bone grafting surgery, thereby shortening or avoiding hospital stay and reducing surgical morbidity.

Tilted implants and prototyping: A security option for improving the anchorage in atrophic maxilla

Rehabilitating atrophic maxilla poses many challenges. Reconstructive techniques that require sinus grafting are viable and acceptable; however, these techniques also are considered to be expensive, invasive, and time-consuming. Tilted implants anchored in distal areas using available bone have been reported as a less invasive and highly predictable treatment option. This article presents a case involving implant anchorage via tilted implants as an alternative technique to bone grafting procedures. Copyright © 2013 by the Academy of General Dentistry.

Tilted and Short Implants Supporting Fixed Prosthesis in an Atrophic Maxilla: A 3D-FEA Biomechanical Evaluation

Purpose: This study compared the biomechanical behavior of tilted long implant and vertical short implants to support fixed prosthesis in an atrophic maxilla. Materials and Methods: The maxilla model was built based on a tomographic image of the patient. Implant models were based on micro-computer tomography imaging of implants. The different configurations considered were M4S, four vertical anterior implants; M4T, two mesial vertical implants and two distal tilted (45°) implants in the anterior region of the maxilla; and M6S, four vertical anterior implants and two vertical posterior implants. Numerical simulation was carried out under bilateral 150N loads applied in the cantilever region in axial (L1) and oblique (45°) (L2) direction. Bone was analyzed using the maximum and minimum principal stress (σmax and σmin), and von Mises stress (σvM) assessments. Implants were analyzed using the σvM. Results: The higher σmax was observed at: M4T, followed by M6S/L1, M6S/L2, M4S/L2, and M4S/L1 and the higher σvM: M4T/L1, M4T/L2 and M4S/L2, M6S/L2, M4S/L1, and M6S/L1. Conclusions: The presence of distal tilted (all-on-four) and distal short implants (all-on-six) resulted in higher stresses in both situations in the maxillary bone in comparison to the presence of vertical implants (all-on-four). © 2013 Wiley Periodicals, Inc.

Horizontal ridge augmentation of the atrophic anterior maxilla using rhBMP-2/ACS or autogenous bone grafts: A proof-of-concept randomized clinical trial

Aim To compare the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge carrier (ACS) with autogenous bone graft for augmentation of the edentulous atrophic anterior maxilla. Methods Twenty-four subjects were enrolled in a randomized, controlled, parallel-group, open-label clinical trial. Subjects either received rhBMP-2/ACS (1.5 mg/ml) or particulated autogenous bone harvested from the mandibular retromolar region. A titanium-mesh was used to provide space and wound stability. A guide was used to standardize clinical recordings using an analogue caliper. Alveolar ridge width was also assessed using cone-beam computed tomography. Results rhBMP-2/ACS yielded significantly greater radiographic horizontal bone gain compared with autogenous bone graft at immediate subcrestal levels (1.5 ± 0.7 versus 0.5 ± 0.9 mm; p = 0.01); non-significant differences were observed at mid- (2.9 ± 0.8 versus 2.9 ± 0.9 mm; p = 0.98) and apical (1.7 ± 0.9 versus 1.8 ± 1.1 mm; p = 0.85) crestal levels. No significant differences in clinical horizontal bone gain were observed at 6 months between rhBMP-2/ACS and autogenous bone graft (3.2 ± 0.9 mm versus 3.7 ± 1.4 mm; p = 0.31). Sixty-two implants were placed after 6 month of healing with no significant differences between groups for number of implants, implant size, primary stability and survival. Conclusions rhBMP-2/ACS appears a realistic alternative for augmentation of the edentulous atrophic anterior maxilla. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Mechanical behavior of dental implants in different positions in the rehabilitation of the anterior maxilla

Statement of problem. In dental rehabilitations that involve implants, the number of implants is sometimes smaller than the number of lost teeth. This fact can affect the biomechanical behavior and success of the implants.Purpose. The purpose of this study was to investigate the mechanical behavior of different implant positions in the rehabilitation of the anterior maxilla.Material and methods. Three-dimensional models of the maxilla were created based on computed tomography images for 3 different anterior prosthetic rehabilitations. In group IL, the implants were placed in the lateral incisor positions with pontics in the central incisor positions; in group IC, the implants were in the central incisor positions with cantilevers in the lateral incisor positions; and, in group ILIC, one implant was in a lateral incisor position and one was in a central incisor position, with a pontic and a cantilever in the remaining positions. A 150 N load was distributed and applied at the center of the palatal surface of each tooth at a 45-degree angle to the long axis of the tooth. The resulting stress-strain distribution was analyzed for each group.Results. The lowest displacement of the prosthetic structure was observed in group IC, although the same group exhibited the largest displacement of the bone tissue. In the bone tissue, the von Mises stress was mainly observed in the cortical bone in all groups. The maximum value of the von Mises stress shown in the cortical tissue was 35 MPa in the implant that neighbors the cantilever in group ILIC. The maximum von Mises stress in the trabecular bone was 3.5 MPa.Conclusion. The prosthetic configuration of group IC limited the displacement of the prosthetic structure but led to greater displacement of the bone structure. The use of a cantilever increased the stress concentration in the implant and in the bone structure adjacent to the cantilever under the conditions studied here.

Synchronous Ossifying Fibromas of Maxilla and Mandible

Ossifying fibroma is a benign neoplasm composed of fibrocellular tissue and mineralized material of varying appearance, which is most commonly seen in the posterior region of the mandible as a solitary lesion. We report an unusual case of synchronous ossifying fibroma of maxilla and mandible. To the best of our knowledge, only 13 similar cases have been previously reported.

Spontaneous osteonecrosis of the jaws in the maxilla of mice on antiresorptive treatment: A novel ONJ mouse model

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)