Andreas Thor

Background: Prosthetic treatment of the edentulous maxilla may require bone augmentation to enable placement and integration of dental implants. This constitutes a complex healing situation, and resorption of the grafted bone and failure of the implants often occur. The application of autogenous platelet‐rich plasma (PRP) has been suggested to improve incorporation and preservation of bone grafts. Purpose: The aim of this controlled clinical study was to evaluate whether PRP in conjunction with grafting of particulated autogenous bone to the maxilla could improve the integration and clinical function of dental implants. An additional aim was to compare block bone grafts without PRP with PRP‐treated particulated bone. Material and Methods: Nineteen consecutive patients were included in the study and treated with iliac bone grafts and dental implants in the maxilla according to a split‐mouth design. In the anterior maxilla, particulated bone mixed with PRP (test) was compared with onlay block grafts without additional PRP (control). In the posterior maxilla, particulated bone grafts with (test) or without (control) PRP were placed as sinus inlay grafts. After 6 months of healing, 152 implants (8 implants/patient) (TiOblast™, Astra Tech AB, Molndal, Sweden) were placed. Test (PRP; 76 implants) and non‐PRP (76 implants) sides were evaluated and compared by implant survival rate, marginal bone level, and implant stability using resonance frequency analysis (RFA) during 1 year in function. Results: Two control implants in control sites in two patients were lost at abutment connection. After 1 year in function, no further implants were lost, giving an overall survival rate of 98.7%. The marginal bone level measurements showed no significant differences, although there was a tendency toward less resorption on PRP sides. RFA measurements showed statistically significantly higher implant stability quotient values for PRP sites at abutment connection in the anterior but not in the posterior regions. Conclusions: The present clinical study showed that a high implant survival rate and stable marginal bone conditions can be achieved after 1 year of loading in the maxilla following autogenous bone grafting whether or not PRP is used. RFA measurements revealed differences at abutment connection, which could be explained by the type of graft rather than as an effect of PRP. Although no obvious positive effects of PRP on bone graft healing could be demonstrated, the handling of the particulated bone grafts was improved.

Background: Systemic mastocytosis (mast‐cell proliferation in various organs, including the skeleton) is a rare disease. Reports on mastocytosis that affects facial bones are few. The bone lesions may be osteolytic or sclerotic.Purpose: To describe (for the first time) bone grafting followed by dental implant treatment yielding a good result in a patient with systemic mastocytosis.Materials and Methods: A bone graft was performed on a 60‐year‐old woman with systemic mastocytosis. Dental implant treatment was performed 13 weeks after sclerotic bone of the iliac crest was grafted to the maxillary sinus bilaterally. A microimplant was installed simultaneously with the dental implants and was removed 6 months later for histo‐morphometric evaluation. Bone biopsy specimens from the donor site of the sclerotic iliac crest and later from the remodeled maxillary bone graft were histologically analyzed. A clinical examination of the patient with regard to her mastocytosis was performed by a dermatologist. The patient was followed up after 3 years.Results: Bone grafting and dental implant treatment were successful, and the patient's clinical and radiologic situation was stable after 3 years. Histologic examination of the bone grafted from the iliac crest showed sclerotic lesions in the bone and a dense infiltration of mast cells. The bone graft seemed to remodel initially in a normal way in the maxillary sinus. However, computed tomography 3 years later showed regions of sclerosis in the remodeled maxillary bone. These lesions now had a pattern similar to the adjacent facial bone. Both the microimplant and the dental implants integrated well. Bone‐implant contact measured on the microimplants was 20% higher in this actual case, compared to that of patients previously treated and grafted with the same technique.Conclusions: There are many clinical implications to be considered when treating this group of patients. Bone grafting, remodeling of the bone, and dental implant installation were successful in this patient with systemic mastocytosis and signs of osteosclerosis. Installation of microimplants in patients with pathologic bone conditions may allow successful dental implant treatment.

Treatment principles of paediatric mandibular fractures may differ from the treatment of the adult population in that a conservative approach is in most cases advocated before the use of internal rigid fixation with plates and screws. This is because of a relative high risk of disturbed facial skeletal growth and risk of damaging unerupted teeth. Knowledge of conservative treatment options is essential in order to minimize these risks and one option is presented in this paper. This case report describes a 5-year-old girl that sustained an open fracture of the mandible and who was successfully treated by the means of applying orthodontic brackets and an arch bar combined with ligatures and rubber elastics.