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  • 1
    ISSN: 1600-0501
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: In a prospective study, 20 patients who underwent harvesting of chin grafts as outpatients, were followed up for 12 months (3 further patients with incomplete follow-up data were excluded from the study). Preoperatively and 7 days, 1, 3, 6 and 12 months postoperatively, follow-up data were assessed. Evaluation of the superficial sensory function of the inferior alveolar nerve was determined by the Pointed-Blunt Test and the Two-Point-Discrimination Test. Sensory disturbances were objectively assessed by testing thermal sensitivity with the “Pain and Thermal Sensitivity” Test (PATH Test). In addition, evaluation of the pulp sensitivity of teeth 35–45 was carried out by cold vitality testing. One week postoperatively, 8 patients were affected by superficial sensory impairment. 8 nerve territories showed hypoaesthetic reactions and 5 showed hyperaesthetic reactions. After 12 months, two patients still suffered from hypoaesthesia of one side of the chin. There was a statistically significant sensitivity impairment of the chin for all patients comparing the preoperative data of the Two-Point-Discrimination Test (left/right median: 8.17/8.17 mm, interquartile range (IQR) 1.00/2.00 mm) with the first postoperative measurement (left/right median 9.00/8.33 mm, IQR 1.67/2.66 mm). Comparing the latter to the last postoperative measurement there was significant tendency for regeneration of a nerve function (left/right median 8.00/7.84 mm, IQR 0.66/2.00 mm). In the PATH Test all hypoaesthetic areas could be identified by a reduction of thermal sensitivity. After the first postoperative examination 21.6% (n=38/176) of the examined teeth had lost their pulp sensitivity. After 12 postoperative months 11.4% (n=20/176) still did not react sensitively. Many of these were canines (n=8/20). Comparing the preoperative to the first postoperative examination, there was a significant reduction of pulp sensitivity. However, statistically significant recovery until the last postoperative follow-up could not be detected. The assessed data show that patients have to be informed extensively about disturbances of the inferior alveolar nerve function lasting longer than 12 months. Moreover, the loss of pulp sensitivity is a very frequent event which has always to be taken into account. Considering the high rate of complications with harvesting of chin grafts, more prospective trials should be done to find out whether there are other donor sites for autogenous bone which put less strain on patients.
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  • 2
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Dysgnathiechirurgie ; Operationssimulation ; Weichgewebesimulation ; Computersimulation ; Keywords ; Orthognathic surgery ; Preoperative planning ; Soft tissue simulation ; Computer-aided simulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Background In addition to standard X-rays, photographic documentation, cephalometric and model analysis, a computer-aided, three-dimensional (3D) simulation system has been developed in close cooperation with the Institute of Communications of the Friedrich-Alexander-Universität Erlangen-Nürnberg. With this simulation system a photorealistic prediction of the expected soft tissue changes can be made. Prerequisites are a 3D reconstruction of the facial skeleton and a 3D laser scan of the face. After data reduction, the two data sets can be matched. Cutting planes enable the transposition of bony segments. The laser scan of the facial surface is combined with the underlying bone via a five-layered soft tissue model to convert bone movements on the soft tissue cover realistically. Conclusion Further research is necessary to replace the virtual subcutaneous soft tissue model by correct, topographic tissue anatomy.
    Notes: Hintergrund Im Rahmen eines Sonderforschungsbereichs der Deutschen Forschungsgemeinschaft (SFB 603) wurde in Zusammenarbeit mit dem Lehrstuhl für Nachrichtentechnik der Universität Erlangen-Nürnberg ein computergestütztes Simulationssystem zur dreidimensionalen, fotorealistischen Vorhersage von Weichgewebeveränderungen nach orthognathen Eingriffen entwickelt. Voraussetzung sind 3D-CT-Datensätze des Gesichtsschädels sowie eine ebenfalls dreidimensionale Laserabtastung der Gesichtsoberfläche. Beide Datensätze können nach Datenreduktion über ein mathematisches Verfahren so miteinander verknüpft werden, dass mit Hilfe so genannter “cutting planes” Verlagerungen von Knochensegmenten auf das bedeckende Weichgewebe realitätsnah übertragen werden können. Schlussfolgerung Es bedarf weiterer Forschungsanstrengungen, um auch die subkutanen Weichgewebelagen so in das Simulationsmodell zu integrieren, dass noch bestehende Abweichungen korrigiert werden können.
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  • 3
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Rekonstruktion ; Implantate ; Tumorresektion ; Knochentransplantate ; Key words Reconstruction ; Implants ; Oncologic surgery ; Bone grafting
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A total of 409 implants was inserted into 83 consecutive patients, who had tumor-related intraoral resections of soft tissue and bone. A life table analysis was used to determine the survival rate of the implants placed over a period of 13 years. Log rank tests and a Cox regression analysis were employed to identify relevant effects of surgical parameters on implant survival. A total of 38 implant failures were encountered. Most of the losses (n = 16) occurred during the first year of functional loading. The cumulative, overall survival rate of implants was 56.5%. Previous radiation therapy, insertion into grafted bone or original jaw bone, and insertion into microsurgically revascularized grafts did not significantly affect the survival rates. In the Cox regression, only the timing of implant placement was significantly related to the survival rate in the group of patients with bone grafts (P = 0.0197), with a lower survival rate of 36.2% of primary inserted implants and 67.1% survival in the group with secondary implant placement.
    Notes: Zusammenfassung Fragestellung: Ziel der vorliegenden Untersuchung war die Analyse der Langzeitergebnisse enossaler Implantate bei Tumorpatienten. Material und Methode: 409 Implantate, die in 83 konsekutiven Patienten nach tumorbedingten intraoralen Resektionen zur Wiederherstellung der Kaufunktion in den Jahren von 1983–1996 inseriert worden waren, wurden in die Untersuchung einbezogen. Die Langzeiterfolgsrate wurde mit Hilfe einer Verweildaueranalyse nach Kaplan u. Meier berechnet. Ergebnisse: 38 Implantate gingen im Beobachtungszeitraum verloren, 16 davon im ersten Jahr nach funktioneller Belastung. Die Gesamtverweilwahrscheinlichkeit betrug 56,5%. Vorangegangene Radiatio, die Verwendung von Knochentransplantaten allgemein und der Einsatz revaskularisierter Transplantate hatten keinen signifikanten Einfluß auf die Überlebenszeit. In der Gruppe der Patienten mit Knochentransplantaten hatten die Implantate in Kombination mit Auflagerungsosteoplastiken die geringste Verweilwahrscheinlichkeit (32,2%), während avaskuläre und revaskularisierte Transplantate zur Kontinuitätsüberbrückung höhere Erfolgsraten aufwiesen (70,0% bzw. 74,5%). Die niedrigere Erfolgsrate primärer Implantatinsertionen in Kombination mit Osteoplastiken erwies sich in der Cox-Analyse als signifikant.
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  • 4
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Kraniofaziale Syndrome ; Unterkieferhypoplasie ; Osteotomien ; Distraktionsosteogenese ; Key words ; Craniofacial syndromal disease ; Mandibular hypoplasia ; Osteotomy ; Distraction osteogenesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: In recent years, lengthening the human mandible by distraction osteogenesis has become an accepted treatment to correct severe mandibular hypoplasia. Using intraoral unidirectional and extraoral bidirectional distraction devices we report about our experiences and results in the application of the bone distraction technique in four selected cases of syndromal disease, including various forms of mandibular hypoplastic malformations. The patients involved were a boy with Pierre Robin syndrome, a girl with unilateral facial hypoplasia in Goldenhar’s syndrome, a case with Nager’s syndrome, and a rare case of midline deficiency caused by partial deletion of chromosome 18 (18p-syndrome). The distraction period lasted from 6 to 30 days and new bone formation, ranging from 6 to 28 mm, was achieved.
    Notes: In den letzten Jahren hat sich die Distraktionsosteogenese zu einem etablierten Behandlungsverfahren zur Korrektur hypoplastischer Unterkiefer entwickelt. Wir berichten über unsere Erfahrungen mit uni- und bidirektionalen Distraktoren sowohl in der intra- als auch extraoralen Applikation bei 4 ausgewählten Patienten mit Unterkieferhypoplasien im Rahmen syndromaler Krankheitsbilder. Dabei handelte es sich um 1 Knaben mit Pierre-Robin-Syndrom, 1 Mädchen mit einer einseitigen Unterkieferhypoplasie bei Goldenhar-Syndrom, 1 Säugling mit Nager-Syndrom sowie 1 seltenen Fall eines Mittelliniendefekts bei 18p-Syndrom. Die Distraktionsdauer reichte von 6–30 Tagen, wobei ein Knochengewinn von 6–28 mm erzielt werden konnte.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    ISSN: 1434-3940
    Keywords: Schlüsselwörter ; Implantatmaterialien ; Implantationsverfahren ; Membrangestützte Knochenregeneration ; Knochendistraktion ; Knochentransplantation ; Knochenersatzmaterialien ; Defektprothese ; Epithese ; Key words ; Implant materials ; Implant procedures ; Membrane-supported bone regeneration ; Bone distraction ; Bone grafting ; Bone substitutes ; Defect prostheses ; Epitheses
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Endosseous osseointegrated implants have become an integral part of the treatment scheme for the prosthetic reconstruction and rehabilitation of masticatory function following scientific studies of the reactions between implant and soft and hard tissues. Furthermore, implants offer good chances for prosthetic rehabilitation in the insufficient bone site, if the extremely atrophic jaw is to be reconstructed by grafting procedures with avascular and vascular grafts, by guided bone regeneration, by distraction osteogenesis, by bone substitutes and in the future by osteoinductive proteins in order to prepare the conditions for implant insertion. Those reconstruction procedures combined with implants become often necessary, if complicated hard and soft tissue defects of the skull have to be reconstructed to create the prerequisites for the stabilisation of epitheses or to insert implant-supported devices.
    Notes: Zusammenfassung Enossale osteointegrierte Implantate sind nach wissenschaftlicher Erarbeitung der Reaktionsweisen zwischen dem Fremdkörperimplantat und den Hart- und Weichgeweben integriertes Behandlungskonzept zur Wiederherstellung der Kaufunktion mit Zahnersatz geworden. Darüber hinaus bieten sie auch im unzulänglichen Knochenlager Möglichkeiten für die Versorgung mit Zahnersatz, wenn wie bei einer extremen Kieferatrophie durch osteoplastische Rekonstruktionsverfahren mit avaskulären und vaskulären Knochentransplantaten, durch die gesteuerte Geweberegeneration, durch die Distraktionsosteogenese, durch Knochenersatzmaterialien und in der Zukunft durch osteoinduktive Proteine die Voraussetzungen für eine Versorgung mit Implantaten geschaffen werden. Diese Rekonstruktionsverfahren in Kombination mit Implantaten werden daneben häufig erforderlich, wenn es um den Aufbau komplexer Hart- und Weichgewebedefekte des Gesichtsschädels geht als Voraussetzung für die Stabilisierung von Defektprothesen oder zum implantatgestützten epithetischen Ersatz.
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  • 6
    ISSN: 1600-0501
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The aim of the present study was to determine the degree of osseointegration of fixtures in different onlay grafting materials. Hydroxylapatite blocks of 2 different pore sizes and free monocortical bone grafts from the iliac crest were inserted in Gijttingen minipigs and fixed with 2 titanium fixtures. The extent of the bone/implant interface area on the fixture surface was determined from histological specimens by morphometric measurements and related to the total thread surface of the fixtures. Fixtures inserted into bone grafts showed the most complete degree of osseointegration, whereas the smallest bone/implant interface area was found with fixtures inserted into those HA blocks with the smaller pore size. There was a significant decrease in the degree of osseointegration between the host bone site and the augmentation material only with the fixtures inserted into the HA blocks of smaller pore size.
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