Fogorvosi szemle, 2006 (99. évfolyam, 1-6. szám)

2006-04-01 / 2. szám

82

FOGORVOSI SZEMLE ■ 99. évf. 2. sz. 2006.

interface. The mode of insertion and the location of placement have also outstanding importance not only in non-loss of implants but also in their load ability, however these are not fully discussed.

Method: On wire marked skulls, the highest bony demarcation of the palatal bony complex in the middle and distal thirds of the hard palate was at least 2 mm higher vertically than seen on lateral cephalograms. A safety margin of at least 2 mm is recommended when planning treatment on basis of lateral cephalograms to avoid potential nasal perforation. On the other hand, ossification of the midpalatal suture starts distally becomes increasingly tortuous and interdigited with increasing age in adolescence. 10 representative cases of PI (Orthosystem® Strauman, Switzerland) are discussed. These were placed afore to the sutura transversa palatinea and had a specially fixed 3 months healing period, tolerating force lead on jiggling of PI in the maxillary posterior region.

Results: Palatal distal bone structures (suture & septum) are also able to support the stability of the PI, being resistant to orthodontic as well as to non-axial direct loading, and the intermittent orthopedic traction forces do not resulted in jiggling and looseness of any implant. It was shown that PI anchor makes possible to move groups of 4-6 teeth (with the respective 6-12 roots) simultaneously within the processus of alveolar bone. The explantation is safe, compared to the premaxillary integrated implants.

Discussion: A new concept and a new insertion method of PI are suggested to the application for direct loading, either with heavy continuous or massy intermittent force in difficult cases. The reported endosseous insertion procedure creates a valid bone-anchorage not merely for simple teeth stabilization, but for dynamic treatment elements as well.

Conclusion: The suggested non-traumatic application results in a predictable treatment outcome, is comfortable to the patient and practical to the orthodontist to prevent any complications in adolescents.

DR. P. WINDISCH,1 DR. D. SZENDRŐI-KISS,1 DR. A. HORVÁTH,1 DR. I. GERA,1 DR. A. SCULEAN1 2

1 Semmelweis University of Medicine, Budapest, Hungary;

2 University Nijmegen, The Netherlands

VERTICAL ALVEOLAR RIDGE AUGMENTATION AROUND PERIODONTALLY COMPROMISED TEETH

Aim: To evaluate a surgical protocol for vertical and horizontal ridge augmentation around periodontally compromised teeth using a natural bone mineral [NBM (Bio-Oss®, Geistlich, Wolhusen, Switzerland)] a bioresorbable membrane [GTR (Bio- Gide®, Geistlich, Wolhusen, Switzerland)] and free connective tissue graft.

Methods: 13 systemically healthy patients (aged 30 to 57 years) with inadequate dental alveolar ridge width and height around teeth presenting anatomically complicated intrabony

defects were included in the study. All patients completed initial therapy, which included scaling, root planing, and oral hygiene instructions. Open-flap surgery was performed to expose the defect. After debridement, the defect was filled and overfilled with the NBM, and subsequently covered with the GTR barrier. Before wound closure, subepithelial connective tissue graft with an epithelial collar was harvested from the palate and sutured to the oral flap. After a mean interval of 13.5 (9-18) months, endosseous implants were successfully placed. No implant was lost. During implant placement, biopsies were retrieved from the augmented areas and submitted for histological examination.

Results: The histological evaluation revealed formation of new bone and residual particles in each grafted site at the time of implant placement. Histomorphometric analysis revealed a range of new bone from 41.2 percent to 72.1 percent with a mean of 48.6 percent.

Conclusion: The present findings indicate that sites grafted with NBM + GTR + free connective tissue grafts may represent a new technique for the augmentation of deficient alveolar ridges prior to implant placement and to simultaneously enhance periodontal regeneration at adjacent teeth.

DR. K. ZOLTÁN, DR. GY. SZABÓ, DR. L. CZIRJÁK, DR. I. SZÁNTÓ

University of Pécs, Faculty of Medicine, Dental School

DIFFICULTIES OF TREATMENT IN PATIENT WITH SYSTEMIC SCLEROSIS - A PILOT STUDY

Introduction: The symptoms of systemic sclerosis which directly affect the dentists’ work is microstomia, buccal rigidity, salivary hypofunction, increased frequency of caries and periodontal diseases, osteal resorption and Raynaud-phenomenon. These patients need special treatment and individual prosthesis.

Materials and methods: A 50-year-old woman with systemic sclerosis was referred to our clinic. Her disease is at an advanced stage, therefore she has all the listed symptoms. The right upper canine used by overdenture, the right upper second molar was extracted because of parodontitis chronica. We have to consider the patient’s microstomia and Raynaudphenomenon during the preparation of removable denture. During the examination it became obvious that the extention of the base plate to the tuber maxillae would greatly obstruct the insertion of the denture. Furthermore the impression is just possible with sectioned tray.

So an acrylic complete denture with shortened arch was made for the patient.

Results: The denture works aesthetically and functionally well. During the five months’ observation time the denture provided excellent function and despite the reduced salivation the prosthesis stabilizator material proved to be effective. Furthermore some special mouth exercises were recommend to the patient.