This research article compares graft uptake and resorption between chin and ramal bone grafts used to reconstruct atrophic maxillary ridges for dental implant placement. 5 patients received chin grafts and 5 received ramal grafts. Cone beam CT scans after 5 months found mean resorption of 16.8% for ramal grafts and 18% for chin grafts. Ramal grafts had advantages of a minimally invasive approach, more graft volume, and less postoperative morbidity compared to chin grafts. Patient compliance was also better with ramal grafts due to less immediate postoperative pain. The survival of ramal grafts was better than chin grafts due to the higher resorption rate of chin grafts.
Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–...Dr Ripunjay Tripathi
journal club Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–Supported Crowns: A 1-Year Retrospective Study
Kniha at el , J Periodontol 2016;87:511-518.
Abstract: Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. Corticotomy facilitated orthodontics have been employed in various forms over speed up orthodontic treatment It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects. Keywords: Corticotomy, decortication, review, orthodontic treatment
Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–...Dr Ripunjay Tripathi
journal club Evaluation of Hard and Soft Tissue Dimensions Around Zirconium Oxide Implant–Supported Crowns: A 1-Year Retrospective Study
Kniha at el , J Periodontol 2016;87:511-518.
Abstract: Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. Corticotomy facilitated orthodontics have been employed in various forms over speed up orthodontic treatment It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects. Keywords: Corticotomy, decortication, review, orthodontic treatment
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
The malocclusion mostly come from:
Incisor protrusion
Jaw protrusion
Both of them
Author: https://www.linkedin.com/in/drdunghanquoc/
Facebook: https://www.facebook.com/drdunghanquoc
Abstract: Immediate implant placement has been the acceptable procedure for the past two decades. Perhaps
the most important aspect of any implant surgery in accordance with the successful procedure is implant
surgery and bone to implant contact.The aim of this article is to describe a clinical case in which a fractured
maxillary canine was replaced by an immediately loaded postextraction implant using a simplified technique,
which permits a reduction of the number of implant components and consequently a lower cost of treatment,
while at the same time maintaining acceptable aesthetic and functional outcomes.
Key words: Immediate implant placement, Immediate loading, Immediate provisionalisation, Esthetics
An Assessment on the Clinical Performance of Non-carious Cervical Restorationsasclepiuspdfs
Cervical restorations were known as the least durable type of restoration. Therefore, it is important for clinician to identify the contributing factors that may lead to failure of the restorations. Objective: The purpose of this study was to compare the clinical performance in terms of type of restorative materials and the influence of clinical handling technique of non-carious cervical restorations. Materials and Methods: This cross-sectional study was carried out to patients with restorations on non-carious cervical lesions (NCCLs) at Universiti Sains Islam Malaysia dental clinic. The clinical performance of the restorations was evaluated using the ratings of the United States Public Health Service criteria and analyzed using the Pearson Chi-square.
This journal club presents a case of prosthetic
rehabilitation of an amputated thumb. It emphasizes that
prosthetic replacement is a better option for aesthetic and
psychological improvement, particularly in cases where the
victim is unwilling to undergo complicated surgical procedures for reconstruction of thumb or where functioning
of thumb cannot be restored even by multiple surgeries. In
the present case, a 20 years old female patient, with
missing thumb of her right hand was rehabilitated aesthetically by a non-invasive and cost effective prosthetic
procedure by using heat temperature vulcanizing silicone
material. The prosthesis (the thumb) was attached using
medical adhesives. On 3 months recall appointment, no
complications were observed. The prosthesis was in good
shape and required no further intervention. The prosthetic
thumb lacks the sensation of a normal or reconstructed
thumb, although it does not require the multiple procedures
of surgical reconstruction and the accompanying loss of
time for rehabilitation and healing
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
The malocclusion mostly come from:
Incisor protrusion
Jaw protrusion
Both of them
Author: https://www.linkedin.com/in/drdunghanquoc/
Facebook: https://www.facebook.com/drdunghanquoc
Abstract: Immediate implant placement has been the acceptable procedure for the past two decades. Perhaps
the most important aspect of any implant surgery in accordance with the successful procedure is implant
surgery and bone to implant contact.The aim of this article is to describe a clinical case in which a fractured
maxillary canine was replaced by an immediately loaded postextraction implant using a simplified technique,
which permits a reduction of the number of implant components and consequently a lower cost of treatment,
while at the same time maintaining acceptable aesthetic and functional outcomes.
Key words: Immediate implant placement, Immediate loading, Immediate provisionalisation, Esthetics
An Assessment on the Clinical Performance of Non-carious Cervical Restorationsasclepiuspdfs
Cervical restorations were known as the least durable type of restoration. Therefore, it is important for clinician to identify the contributing factors that may lead to failure of the restorations. Objective: The purpose of this study was to compare the clinical performance in terms of type of restorative materials and the influence of clinical handling technique of non-carious cervical restorations. Materials and Methods: This cross-sectional study was carried out to patients with restorations on non-carious cervical lesions (NCCLs) at Universiti Sains Islam Malaysia dental clinic. The clinical performance of the restorations was evaluated using the ratings of the United States Public Health Service criteria and analyzed using the Pearson Chi-square.
This journal club presents a case of prosthetic
rehabilitation of an amputated thumb. It emphasizes that
prosthetic replacement is a better option for aesthetic and
psychological improvement, particularly in cases where the
victim is unwilling to undergo complicated surgical procedures for reconstruction of thumb or where functioning
of thumb cannot be restored even by multiple surgeries. In
the present case, a 20 years old female patient, with
missing thumb of her right hand was rehabilitated aesthetically by a non-invasive and cost effective prosthetic
procedure by using heat temperature vulcanizing silicone
material. The prosthesis (the thumb) was attached using
medical adhesives. On 3 months recall appointment, no
complications were observed. The prosthesis was in good
shape and required no further intervention. The prosthetic
thumb lacks the sensation of a normal or reconstructed
thumb, although it does not require the multiple procedures
of surgical reconstruction and the accompanying loss of
time for rehabilitation and healing
Periodontally Accelerated Osteogenic Orthodontics: A Surgical Technique and C...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Full body is the most of I don't have a lot more then I have been on my phone is a new one number and my heart is a new phone is it possible to be fine and I have a good day of the year and I am a good time with my family and I have to do not know what you do not know how to do with your family is a good day of
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
Immediate Implant Placement And Restoration With Natural Tooth In The Maxilla...Abu-Hussein Muhamad
Anterior tooth loss and restoration in the esthetic zone is a common challenge in dentistry today. The prominent visibility of the area can be especially distressing to the patient and requires a timely and esthetically pleasing solution. Immediate single-tooth implantation followed by immediate provisionalization is becoming an increasingly desirable treatment that offers numerous benefits over conventional delayed loading. Provisionalization for immediately-placed implants using the patient’s existing tooth can enhance the final aesthetic outcome if certain steps are
followed. If the natural tooth is intact and can be used as a provisional, the emergence profile can be very similar to the preoperative condition. This article outlines a technique to use the patient’s natural tooth after extraction to provisionalize an implant.
Root Resection – A Dark Horse in Management Offurcation Involved Maxillary Mo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...Abu-Hussein Muhamad
Piezosurgery has been applied in dentistry for many years. This paper reviews specifically the treatment applications that have been used in surgically assisted orthodontic treatment since the last decade. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease amount of apical root resorption. The aim of this case report is to compare the use of micro-motor and piezoelectric surgery unit during decortication in Periodontally Accelerated Osteogenic Orthodontics technique.
Key words: Piezoelectric surgery, piezosurgery, Periodontal regeneration , accelerated tooth movement
60.Srinivasan S, Velusamy G, Munshi MAI, Radhakrishnan K, Tiwari RVC. Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans. J Contemp Dent Pract. 2020 Dec 1;21(12):1325-1330. PubMed PMID: 33893253.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
Light House Retreats: Plant Medicine Retreat Europe
65th publication jooo - 3rd name
1. Original Research Article DOI: 10.18231/2395-6194.2018.0032
Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology, July-September, 2018;4(3):131-135 131
An in vivo comparative evaluation of graft uptake between chin and ramal graft in
the reconstruction of atrophic anterior maxillary edentulous ridges for implant
placement
Arun Ramaiah1
, Bharti Wasan2
, Rahul Tiwari3,*
, Heena Tiwari4
1
Senior Fellow, Cleft & Craniofacial Centre, St. Thomas Hospital, Malakkara, Pathanamthitta, Chengannur, Kerala, 2
PG Student,
Dept. of OMFS, Guru Nanak Dev Dental College, Sunam, Punjab, 3
FOGS, MDS, Dept. of OMFS & Dentistry, JMMCH & RI,
Thrissur, Kerala, 4
BDS, PGDHHM, Government Dental Surgeon, CHC Makdi, Kondagaon, Chhattisgarh, India
*Corresponding Author: Rahul Tiwari
Email: drrahulvctiwari@gmail.com
Abstract
Introduction: The goal of modern dentistry is to restore the patient to normal function, esthetics, comfort, speech and health,
which can be brought by caries prevention or replacing of missing teeth. Loss of teeth may be devastating for the patient, both
functionally and aesthetically. Complex anatomy, functional and aesthetic demands often make reconstruction very challenging
as well as the multitude of complications that can arise during or after treatment.
Aim and Objectives: To evaluate the amount of bone resorption of mandibular autogenous block bone graft in reconstruction of
atrophic anterior alveolar ridges.
Materials and Methods: 5 patients underwent harvesting of corticocancellous bone from Mandibular ramus and 5 patients
underwent harvesting of corticocancellous bone from Mandibular chin region for Reconstruction of atrophic alveolar ridge. All
patients were reviewed for follow-up for 5 months to evaluate the amount of resorption and acceptance of graft.
Results: In a follow up period of 5 months the mean graft resorption in ramal graft is 16.8% and mean graft resorption in
symphysis graft is 18%.
Conclusion: Minimally invasive approach, ease of application, volume of the graft and least postoperative morbidity are
observed in ramal graft. The survival of the graft is better in ramal graft than the graft from the chin as the chin graft shows
higher resorption rate. Patient compliance is favorable more towards the ramal graft than the chin graft as the immediate
postoperative pain is high in symphysis region.
Keywords: Graft, Reconstruction, Implant, Ramus, Symphysis.
Introduction
Traditionally removable prosthesis or fixed partial
dentures have been the treatment of choice in order to
replace tooth loss permitting restoration of masticatory
function, speech and aesthetics. Alveolar ridge
resorption after tooth loss is a common phenomenon.
After a tooth is extracted the alveolar ridge decreases in
width and height very rapidly, with as much as 50%
loss in width during the first year, two-thirds of which
occurs in the initial 3 months.1
Often in clinical
practice, the loss of a tooth does not coincide with
replacement by a dental implant and there is frequently
a lag of months to years before an edentulous site
presents for therapy. Therefore, it is often required that
we perform hard tissue ridge augmentation to increase
bone volume prior to dental implant placement and
restoration. Frequently, however, there is a lack of
supporting bone in addition to the absent teeth due to
disease, atrophy or trauma. Sufficient amount of
underlying bone is required to stabilize the dental
implant.2
So that implants can be inserted in an ideal
buccolingual and mesio-distal position with good axial
inclination and to reshape the soft tissue contour.
Different types of Bone grafts like Iliac crest, Ribs,
Tibia, Fibula, Exostoses, Chin, Torus, Ramus,
Tuberosity and grafting materials like Allografts,
Alloplasts, Xenografts and are available for use in
augmentation of Atrophic alveolar ridges. The
autogenous bone grafts have been used for many years
for ridge augmentation and are still considered the gold
standard for jaw reconstruction.3
For most localized
alveolar defects, as in reconstruction of atrophic
alveolar ridges for implant placement, block bone grafts
from the Symphysis and Ramus buccal shelf offer
advantages over iliac crest grafts, including close
proximity of donor and recipient sites, convenient
surgical access, decreased donor site morbidity and
decreased cost.4
The cortico-cancellous bone obtained
from these sites facilitate faster vascular in growth,
which results in rapid integration and less potential
resorption during the healing period.5
Another
important fact is that bone blocks harvested from intra
membranous sites revascularize faster than those
obtained from endochondral sites.6
Bone grafting in the
atrophic edentulous alveolar ridge is mandatory for
implant placement. Bone grafts have been obtained
arbitrarily with the help of regular diagnostic protocols
which end up in excess graft harvesting and donor site
morbidity. Hence accurate graft resorption and required
graft harvest can be assessed with advanced diagnostic
aid such as Cone Beam CT and the amount of
resorption determined, helps to obtain an appropriate
sized graft in future for grafting cases.
2. Arun Ramaiah et al. An in vivo comparative evaluation of graft uptake between chin and ramal….
Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology, July-September, 2018;4(3):131-135 132
Aims and Objectives
To evaluate the amount of bone resorption of
mandibular autogenous block bone graft in
reconstruction of atrophic anterior alveolar ridges.
Materials and Methods
We included 11 patients in our study with anterior
atrophic edentulous ridges. We evaluated the graft take
up and amount of resorption in 5 patients (3 male and 2
female) with symphysis graft and 6 patients (3 male and
3 female) with ramal graft who had upper or lower
anterior atrophic edentulous ridges. In symphysis group
3 male patients had upper anterior edentulous ridge and
2 female patients had lower anterior edentulous ridge.
The reasons for bone loss being Periapical pathology in
1 patient, traumatic extraction in 2 patients and
prolonged edentulism in 2 patients. In ramal group 3
male and 3 female had upper anterior edentulous ridge.
The reason for bone loss being periapical pathology in
2 patients, traumatic pathology in 2 patients and
prolonged edentulism in 2 patients. Out of which one
patient was excluded as he was a chronic smoker. The
subjects of this study were patients who visited for
replacement of missing front teeth, 5 patients
underwent harvesting of corticocancellous bone from
Mandibular ramus and 5 patients underwent harvesting
of corticocancellous bone from Mandibular chin region
for Reconstruction of atrophic alveolar ridge. All
patients were reviewed for follow-up, for 5 months to
participate in the study to evaluate the amount of
resorption and acceptance of graft. The patients were
evaluated by the following methods: Clinical
examination, Radiographs – OPG, IOPA, Cone beam
CT, Patient interview. Healthy patients between the age
group of 18 to 60 years, Patients with anterior
edentulism, anterior edentulous patients with vertical or
horizontal bone loss due to trauma, prolonged
edentulism, cystic lesions etc. were included in the
study. Smokers, aged patients, patients with poor oral
hygiene, patients with un controlled diabetes,
immunocompromised patients and patients with
bleeding disorders were excluded.
Results
The harvested grafts were secured with a screw to
ensure graft immobilization. In our study we analyzed
the bone quality and amount of resorption with the help
of Cone beam CT scan. In Symphysis group, patient 1
graft of 4 mm was placed, patient 2 graft of 4.2 mm
placed, patient 3 graft of 5 mm thickness was placed,
patient 4 graft of 4.5 mm was placed and in patient 5
graft of 5 mm was obtained. (Figure & Table 1) In
Ramal group patient 1 graft of 4.7mm was placed,
patient 2 graft of 3.1 mm was placed, patient 3 graft of
1.6 mm was placed, patient 4 graft of 5.2mm was
placed and patient 5 graft of 1.5 mm was placed. Pre-
operative width, immediate post-operative width, 4th
month post-operative width, resorption and resorption
rate were evaluated in both the groups. (Figure & Table
2)
Table 1: Data of patients with ramal graft
Patient Pre-operative
width
Post-operative
width
4th
month post-
operative width
Resorption Resorption%
1 2.8 mm 7.5 mm 6.7 mm 0.8 mm 12%
2 3.6 mm 6.7 mm 5.5 mm 1.2 mm 21.8%
3 2.5 mm 4.1 mm 3.5 mm 0.6 mm 17.1%
4 2.0 mm 7.2 mm 6.3 mm 0.9 mm 14.2%
5 3.5 mm 4.2 mm 4.2 mm 0.8 mm 19%
Table 2: Data of patients with symphysis graft
Patient Pre-operative
width
Post-operative
width
4th
month post-
operative width
Resorption Resorption%
1 2.9 mm 6.9 mm 6.0 mm 0.9 mm 15%
2 3.3 mm 7.1 mm 5.9 mm 1.0 mm 16%
3 2.5 mm 6.5 mm 5.3 mm 1.2 mm 22%
4 3.0 mm 7.5 mm 6.0 mm 1.5 mm 25%
5 2.3 mm 7.3 mm 6.8 mm 0.8 mm 11%
3. Arun Ramaiah et al. An in vivo comparative evaluation of graft uptake between chin and ramal….
Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology, July-September, 2018;4(3):131-135 133
Fig. 1.1: Preoperative CBCT; Fig. 1.2: Preoperative intraoral photograph; Fig. 1.4: Elevation of the flap; Fig
1.5: Removal of the ramal graft; Fig. 1.3: Placement of graft, Fig 1.6: Postoperative CBCT; Fig. 1.7: Implant
placement
Fig. 2.1: Preoperative CBCT; Fig. 2.2: Preoperative intraoral photograph; Fig. 2.3: Elevation of the flap; Fig.
2.4: Removal of the chin graft; Fig. 2.5: Placement of graft; Fig. 2.6: Postoperative CBCT
Discussion
In our study the required volume is comfortable for
implant placement which were obtained from
symphysis or ramus region. Apart from the dimensional
requirement, proximity of the donor site, devoid of
second surgical site and similar osteogenic property of
the graft also enables the surgeon in decision making to
select these donor sites.7,8
Thus, autogenous bone grafts
became popular and they have been used for many
years for ridge augmentation.9
The use of autogenous
bone grafts with Osseo integrated implants originally
was discussed by Branemark and colleagues, who often
used the distant sites like iliac crest, calvarium, rib and
tibia.10
Our study was carried out to determine the
amount of resorption of mandibular symphysis & ramal
block bone graft in anterior atrophic edentulous ridge
for the future implant placement. This includes the
amount of bone resorption in the due course, so that the
exact amount of bone required for the augmentation
alone can be harvested from the donor site in future
which helps to minimize the donor site morbidity.
Mean incidence of resorption of ramal graft is 16.8%
whereas the resorption of symphysis graft is 18%.
Though there is a marginal distinction among the
4. Arun Ramaiah et al. An in vivo comparative evaluation of graft uptake between chin and ramal….
Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology, July-September, 2018;4(3):131-135 134
quantum of resorption, no qualitative significance was
noticed in the bone while the placement of implants.
Alveolar ridge resorption after tooth loss is a common
phenomenon, alveolar ridge decreases in width and
height very rapidly, nearly 50% loss in width within the
first year in which 2/3rd of resorption occurs in the first
3 months.11-13
Most of the patients do not prefer dental
implant treatment as a first choice due to various
causes, primarily due to economic reasons.14
So, the
patients often present to the clinician after a long
edentulous span. In the study 9 patients were using
removable dentures till the ridge augmentation
procedure. The mean average edentulous period being 2
1⁄2 years (2 to 4). As all the patients were having
compromised dental rehabilitation both esthetically as
well as functionally, the surgical augmentation
followed by permanent implant prosthesis were
planned. The age ranges for the patient group falls
between 18 and 45 years, sex predilected to females and
partly edentulous, the option for permanent restoration
with implants gained more scope. Alveolar ridge
augmentation is an inevitable procedure in many cases,
where the qualitative and quantitative bone loss.15
Successful implant placement can be achieved in
atrophic anterior regions by using block autografts.16
Versatility of the harvesting procedure, graft resorption
and donor site morbidity are the main clinical concerns
associated with autogenous grafting procedures.17
Based on such criteria, this prospective study has been
carried out to compare the most commonly used donor
sites like chin and ramus for harvesting the bone.
Membranous grafts have shown less resorption than
endochondral bone grafts, which suggests that intra oral
donor sites may provide an advantage in harvesting
block grafts for augmentation of the alveolar ridge, and
they can be easily assessed in an office setting.18-20
With the aids of advanced imaging techniques such as
Cone beam CT are also an effective diagnostic tool in
the assessment of bone defects, bone resorption and
greatly helpful in treatment.21
As the block bone graft
augmentation in atrophic ridges for implant placement
remains an attractive and simpler option, the procedure
is widely applied by the clinicians rather than preferring
the alloplasts.22-24
In symphysis donor site drawbacks
are morbidity, which includes intra operative
complications such as bleeding, mental nerve injury,
soft tissue injury to the cheeks, lips, and tongue, block
graft fracture, infection, and potential bicortical harvest,
dysesthesia of the anterior mandibular dentition.25-27
Computed axial tomography can be used to determine
osseous architecture without distortion. However, CT
images have 3 major drawbacks, 1. High radiation
dosage, 2. High degree of scattered radiation around
metallic restorations and implants, 3. There is
significant burnout of medullary bone which is directly
proportional to the radiation dose.28
Conclusion
Considering the postoperative complications,
though the symphysis is easier to approach, the
invasion is greater as the muscles of the labial chin are
transected and resutured. On the other hand, medial
ramus can be approached transmucosally without any
viable tissue injury. As the site is approached
intraorally, the resultant defect doesn’t cause any
obvious facial disharmony. 1. Minimally invasive
approach, ease of application, volume of the graft and
least postoperative morbidity are observed in ramal
graft. 2. The survival of the graft is better in ramal graft
than the graft from the chin as the chin graft shows
higher resorption rate. 3. Patient compliance is
favorable more towards the ramal graft than the chin
graft as the immediate postoperative pain is high in chin
region.
Limitations
Periapical or panoramic x- rays have been used to
evaluate the implant sites, there are limitations of these
radiographs like distortion, magnification and missing
3rd dimension bone volume.
Conflict of Interest: None
Source of Funding: None
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