Maxillofacial Unit

Crotone, Italy

Maxillofacial Unit

Crotone, Italy
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Johansson L.-A.,Maxillofacial Unit | Johansson L.-A.,Gothenburg University | Isaksson S.,Maxillofacial Unit | Sennerby L.,Gothenburg University
Clinical Oral Implants Research | Year: 2012

Background: Survival rates of implants placed in transalveolar sinus floor augmentation sites are comparable with those placed in non-augmented sites. Flapless implant surgery can minimize postoperative morbidity, alveolar bone resorption and crestal bone loss. The use of cone beam computerized tomography (CBCT) provides 3D presentations with reduced dose exposure. Objectives: To evaluate a flapless, CBCT-guided transalveolar sinus floor elevation technique with simultaneous implant installation. Material and methods: Fourteen consecutive patients in need of maxillary sinus floor augmentation were enrolled in this study. Preoperative CBCT with a titanium screwpost as an indicator at the intended implant position was used to visually guide the flapless surgical procedure. Twenty one implants all with a length of 10mm and a diameter of 4.1 and 4.8mm were inserted and followed clinically and with CBCT for 3, 6 and 12 months postoperatively. Intraoral radiographs were taken for comparison. All patients were provided with permanent prosthetic constructions 8-12 weeks after implant surgery. Results: Ten (47.6%) implants were inserted in residual bone of 2.6-4.9mm and 11 (52.3%) implants were inserted in residual bone of 5-8.9mm. No implants were lost after surgery and follow-up. There was no marginal bone loss during the follow-up verified by CBCT. The implants penetrated on average 4.4mm (SD 2.1mm) into the sinus cavity and the mean bone gain was 3mm (SD 2.1mm). Conclusion: Flapless transalveolar sinus lift procedures visually guided by preoperative CBCT can successfully be used to enable placement, successful healing and loading of one to three implants in residual bone height of 2.6-8.9mm. There was no marginal bone loss during the 3-12 months follow-up. © 2011 John Wiley & Sons A/S.


Johansson L.-A.,Maxillofacial Unit | Johansson L.-A.,Gothenburg University | Isaksson S.,Maxillofacial Unit | Isaksson S.,Malmö University | And 3 more authors.
Clinical Implant Dentistry and Related Research | Year: 2012

Background: The mere lifting of the maxillary sinus membrane by implants protruding into the sinus cavity allows the establishment of a void space for blood clot and new bone formation. Purpose: To evaluate bone formation by using a spherical, hollow, and perforated hydroxyapatite space-maintaining device (HSMD) in a two-stage sinus lift procedure where residual alveolar bone height was ≤2mm. Material and Methods: Spherical, hollow, and perforated HSMDs with a diameter of 12mm were manufactured for this pilot study. Three patients with a residual bone height of 1-2mm, as verified clinically and radiographically, and in need of a sinus augmentation procedure prior to implant installation were selected for the study. The HSMD and bone formation was evaluated by cone beam computerized tomography (CBCT) 6months after augmentation procedure. Implants were installed 6 to 9 months after augmentation. The implant sites were prepared by a trephine drill to obtain a specimen of HSMD and bone for histological evaluation. After implant installation, the condition of the sinus membrane adjacent to the HSMD was evaluated endoscopically. After an additional 8weeks, fixed partial prostheses were fabricated. Results: Bone formation verified by CBCT was found around and inside the device in all three patients after 6months. Despite the fact that residual bone before augmentation was ≤2mm, 12-mm-long implants with diameter of 4.8mm could be inserted with preservation of an intact and healthy sinus membrane verified endoscopically. Bone formation inside HSMDs was noted histologically in two out of three HSMDs. Implants were stable and without any marginal bone loss after 1year of prosthetic loading. Conclusion: A spherical, hollow, and perforated HSMD used in sinus lift procedures can produce a void space for blood clot and new bone formation and subsequent implant installation. © 2010 Wiley Periodicals, Inc.


Abrahamsson P.,Maxillofacial Unit | Abrahamsson P.,Malmö University | Isaksson S.,Maxillofacial Unit | Isaksson S.,Malmö University | Andersson G.,Malmö University
Clinical Oral Implants Research | Year: 2011

Objectives: To evaluate the space-maintaining capacity of titanium mesh covered by a collagen membrane after soft tissue expansion on the lateral border of the mandible in rabbits, and to assess bone quantity and quality using autogenous particulate bone or bone-substitute (Bio-Oss ®), and if soft tissue ingrowth can be avoided by covering the mesh with a collagen membrane. Material and methods: In 11 rabbits, a self-inflatable soft tissue expander was placed under the lateral mandibular periosteum via an extra-oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft and deproteinized bovine bone mineral (DBBM) (Bio-Oss ®) were placed in the expanded area and covered by a titanium mesh. The bone and DBBM were separated in two compartments under the mesh with a collagen membrane in between. The mesh was then covered with a collagen membrane. After 3 months, the animals were sacrificed and specimens were collected for histology. Results: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, no soft tissue dehiscence was recorded. The mean bone fill was 58.1±18% in the bone grafted area and 56.9±13.7% in the DBBM area. There was no significant difference between the autologous bone graft and the DDBM under the titanium mesh with regard to the total bone area or the mineralized bone area. Scanning electron microscopy showed that new bone was growing in direct contact with the DBBM particles and the titanium mesh. There is a soft tissue ingrowth even after soft tissue expansion and protection of the titanium mesh with a collagen membrane. Conclusion: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue, and that new bone can subsequently be generated under a titanium mesh with the use of an autologous bone graft or DBBM. © 2011 John Wiley & Sons A/S.


Idle M.R.,Royal Shrewsbury Hospital | Lowe D.,University of Liverpool | Rogers S.N.,University of Liverpool | Sidebottom A.J.,Maxillofacial Unit | And 2 more authors.
British Journal of Oral and Maxillofacial Surgery | Year: 2014

Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually. We report on 402 patients (332 (83%) female and 70 (17%) male) who had 577 joints inserted between 1994 and 2012. The main diagnoses that resulted in total joint replacement were osteoarthritis, failed operation, ankylosis, and seronegative arthritis. Preoperatively, the median (IQR) maximal incisal opening was 20 (15-26) mm (mean 20) and the median pain scores on the visual analogue scale (VAS 0-10) were 8 for both joints. The median (IQR) baseline dietary score (liquid 0 - solid 10) was 4 (3-6). A total of 173 (43%) patients had had one or more open procedure(s) before total replacement, 177 (44%) had not had open operation, and 52 (13%) had no data entered. The 3 primary systems used were the TMJ Concepts System (Ventura, USA), the Biomet System (Biomet/Lorenz Microfixation, Jacksonville, USA), and the Christensen System (TMJ Implants, Golden, USA). The median (IQR) duration of inpatient stay was 3 (2-4) days (mean 3). Follow-up data will be collected to assess patient recorded outcome measures (PROM) and objective measurements of total joint replacements in the UK from 1994 onwards. © 2013 The British Association of Oral and Maxillofacial Surgeons.


PubMed | Maxillofacial Unit, Imperial College London, Brunel University, Medical Research Council Biostatistics Unit and 2 more.
Type: Journal Article | Journal: Health technology assessment (Winchester, England) | Year: 2014

Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease.(1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH.A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1 (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2 (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrookes Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p<0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p<0.001), with SP2 and bMAD significantly better than SP1. All MADs improved disease-specific QoL. Compliance was lower for SP1, which was unpopular at trial exit. At 4 weeks, all devices were cost-effective at 20,000/quality-adjusted life-year (QALY), with SP2 the best value below 39,800/QALY.A MEDLINE, EMBASE and Science Citation Index search updating two existing systematic reviews (one from November 2006 and the other from June 2008) to August 2013 identified 77 RCTs in adult OSAH patients comparing MAD with conservative management (CM), MADs with CPAP or CPAP with CM. MADs and CPAP significantly improved AHI [MAD -9.3/hour (p<0.001); CPAP -25.4/hour (p<0.001)]. Effect difference between CPAP and MADs was 7.0/hour (p<0.001), favouring CPAP. No trials compared CPAP with MADs in mild OSAH. MAD and CPAP reduced the ESS score similarly [MAD 1.6 (p<0.001); CPAP 1.6 (p<0.001)].An existing model assessed lifetime cost-utility of MAD and CPAP in mild to moderate OSAH, using the revised meta-analysis to update input values. The TOMADO provided utility estimates, mapping ESS score to European Quality of Life-5 Dimensions three-level version for device cost-utility. Using SP2 as the standard device, MADs produced higher mean costs and mean QALYs than CM [incremental cost-effectiveness ratio (ICER) 6687/QALY]. From a willingness to pay (WTP) of 15,367/QALY, CPAP is cost-effective, although the likelihood of MADs (p=0.48) and CPAP (p=0.49) being cost-effective is very similar. Both were better than CM, but there was much uncertainty in the choice between CPAP and MAD (at a WTP 20,000/QALY, the probability of being the most cost-effective was 47% for MAD and 52% for CPAP). When SP2 lifespan increased to 18 months, the ICER for CPAP compared with MAD became 44,066. The ICER for SP1 compared with CM was 1552, and for bMAD compared with CM the ICER was 13,836. The ICER for CPAP compared with SP1 was 89,182, but CPAP produced lower mean costs and higher mean QALYs than bMAD. Differential compliance rates for CPAP reduces cost-effectiveness so MADs become less costly and more clinically effective with CPAP compliance 90% of SP2.Mandibular advancement devices are clinically effective and cost-effective in mild to moderate OSAH. A semi-bespoke MAD is the appropriate first choice in most patients in the short term. Future work should explore whether or not adjustable MADs give additional clinical and cost benefits. Further data on longer-term cardiovascular risk and its risk factors would reduce uncertainty in the health economic model and improve precision of effectiveness estimates.This trial is registered as ISRCTN02309506.This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 67. See the NIHR Journals Library website for further project information.


Tatullo M.,Tecnologica Research Institute | Marrelli M.,Maxillofacial Unit | Shakesheff K.M.,University of Nottingham | White L.J.,University of Nottingham
Journal of Tissue Engineering and Regenerative Medicine | Year: 2015

Dental pulp stem cells (DPSCs) are a promising source of cells for numerous and varied regenerative medicine applications. Their natural function in the production of odontoblasts to create reparative dentin support applications in dentistry in the regeneration of tooth structures. However, they are also being investigated for the repair of tissues outside of the tooth. The ease of isolation of DPSCs from discarded or removed teeth offers a promising source of autologous cells, and their similarities with bone marrow stromal cells (BMSCs) suggest applications in musculoskeletal regenerative medicine. DPSCs are derived from the neural crest and, therefore, have a different developmental origin to BMSCs. These differences from BMSCs in origin and phenotype are being exploited in neurological and other applications. This review briefly highlights the source and functions of DPSCs and then focuses on in vivo applications across the breadth of regenerative medicine. © 2014 The Authors.


Johansson L.-A.,Maxillofacial Unit | Isaksson S.,Maxillofacial Unit | Lindh C.,Malmö University | Becktor J.P.,Maxillofacial Unit | Sennerby L.,Gothenburg University
Journal of Oral and Maxillofacial Surgery | Year: 2010

Purpose: The aim of this study was to prospectively evaluate the status of implants, marginal bone loss, and outcome of maxillary sinus floor augmentation in patients undergoing maxillary sinus lift and simultaneous implant placement with the use of bone grafts harvested adjacent to the actual surgical site. Materials and Methods: Patients in need of maxillary sinus floor augmentation to enable implant placement were enrolled in 2 different groups. In group A, a "bone trap" was used to harvest bone debris during implant preparation with additional bone collected by further drilling adjacent to the implant sites. In group B, a "bone scraper" was used to harvest cortical bone chips from the zygomatic buttress and from the lateral sinus wall before opening of a bony window. All patients were provided a fixed partial denture after a healing period of 3 to 6 months. A total of 61 patients with 81 Straumann implants (Institut Straumann AG, Basel, Switzerland) were assessed, with 17 patients (20 implants) in group A and 44 patients (61 implants) in group B. Results: One implant was lost (in group B) before loading. The survival rate after a follow-up of 12 to 60 months was 98.8%. There was no significant difference in marginal bone loss on the mesial and distal sides of the implant when baseline to 1-year registration was compared with baseline to final registration. During the same time, graft height decreased significantly on the distal apical side of the implants. Conclusions: Bone grafts can be locally harvested at the site of the maxillary sinus augmentation procedure to enable placement, successful healing, and loading of 1 to 3 implants. © 2010 American Association of Oral and Maxillofacial Surgeons.


Abrahamsson P.,Maxillofacial Unit | Abrahamsson P.,Malmö University | Walivaara D.-A.,Maxillofacial Unit | Isaksson S.,Maxillofacial Unit | And 2 more authors.
Journal of Oral and Maxillofacial Surgery | Year: 2012

Purpose: To evaluate the outcome of intraoral soft tissue expansion by measuring the profile change using objective 3D metering equipment and to evaluate localized bone grafting after soft tissue expansion with regard to gain of bone and complications. Materials and Methods: Using a prospective study design, we asked patients with an osseous and soft tissue defect on the buccal aspect of the alveolar process to participate in this study. In 10 patients (experimental group) a self-inflatable soft tissue expander was placed under the periosteum. After 2 weeks, the expander was removed and a particulated onlay bone graft was placed in the expanded area, protected by a titanium mesh covered with a collagen membrane. Ten patients (reference group) were treated with a mandibular ramus bone block graft. The soft tissue profile was registered before each surgical procedure. The vertical and lateral dimensions of the bone grafts were noted at the grafting procedure and at the implant installation. P <.05 was considered significant. Results: The mean soft tissue profile change was 2.9 ± 1.1 mm after soft tissue expansion and 2.3 ± 2.1 mm at implant placement in the experimental group compared with 1.5 ± 1.4 mm at implant placement in the reference group (P =.065). Two patients had minor perforations of the soft tissue expander. In the experimental group, the mean lateral bone augmentation after soft tissue expansion was 4.5 ± 1.3 mm, and after healing, it decreased to 3.9 ± 1.4 mm (P =.063). The mean vertical augmentation was 4.1 ± 1.7 mm and had decreased at implant placement to 3.0 ± 1.4 mm (P =.041). In the reference group, the mean lateral augmentation was 3.8 ± 0.8 mm, and after healing, it reduced to 2.7 ± 0.8 mm (P =.024). The mean vertical augmentation was 2.9 ± 0.9 mm, and after healing of the bone graft at implant placement, it was reduced to 1.6 ± 0.8 mm (P =.01). When smokers were excluded, there was significantly less resorption of the bone grafts in both lateral (P =.049) and vertical (P =.012) dimensions in the experimental group compared with the reference group. Conclusion: Hydrogel expansion of the periosteum is an applicable method to achieve a surplus of soft tissue to cover bone grafts. More refinements to the technique may be required to minimize complications, especially in smoking patients. © 2012 American Association of Oral and Maxillofacial Surgeons.


Puthussery F.J.,Maxillofacial Unit | Shekar K.,Maxillofacial Unit | Gulati A.,Maxillofacial Unit | Downie I.P.,Maxillofacial Unit
British Journal of Oral and Maxillofacial Surgery | Year: 2011

We prospectively studied 21 cases of attachment of the lingual frenulum treated with laser excision, and report the results of a questionnaire survey of patients in the immediate postoperative phase. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.


Weedon S.,Maxillofacial Unit | Ahmed N.,Maxillofacial Unit | Sidebottom A.J.,Maxillofacial Unit
British Journal of Oral and Maxillofacial Surgery | Year: 2013

Temporomandibular disorder (TMD) is a common cause of chronic facial pain that is often treated successfully without operation, but when no improvement is seen arthroscopy may be considered as a therapeutic and diagnostic tool. We prospectively assessed the outcome of 115 arthroscopic procedures to assess the effectiveness and reliability of a 1.2 mm disposable arthroscope (OnPoint™, Biomet Microfixation, Jacksonville, USA). All patients included had not improved after standard conservative management. Discharge from clinic was classed as a successful outcome. Measurements taken before, during, and after operation included mouth opening and lateral deviations (mm). Pain was assessed before and after operation using a 10 cm visual analogue scale. Mean improvement in pain scores was 69% and in mouth opening was 19%, and overall success was 76%. Compared with a previous study using a 1.9 mm scope there were fewer complications after arthroscopy with the small diameter scope. © 2013 The British Association of Oral and Maxillofacial Surgeons.

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