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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2011. Vol. 16, no. 1
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- Comparison of the retention strengths of three complete denture adhesives : an in vivo study(2011) Mañes Ferrer, José Félix; Selva Otaolaurruchi, Eduardo José; Barutell Castillo, Alfonso de; Bouazza Juanes, KheiraStatement of problem: One of the main problems posed by complete dentures is retention and stability. In order to solve this problem, dentists and the dental industry for a long time have attempted to improve denture adhesion by developing a range of ?glues? of highly varied composition and efficacy. Purpouse: The present in vivo clinical study evaluates whether the adhesives used to improve complete denture retention are truly effective and able to increase denture adhesion to the mucosa covering the edentulous alveolar ridge of the mandibular dentures. Material and Methods: An in vivo clinical study is made of 30 patients with complete mandibular dentures to evaluate the retention afforded by three commercial complete denture adhesives (Benfix®, Fittydent® and Supercorega®). A spring scale was used to measure retention strength (in grams). The purpose was to determine whether the use of complete denture adhesives is effective, and to establish which commercial brands offer the highest retention strengths. Results and Conclusion:The results obtained indicate that retention is enhanced by the use of such adhesives, and that Fittydent® offers the best retention performance, followed by Benfix® and Supercorega®. Clinical implications: the study of denture adhesives and his efficiency are necessary to improve the edentulous patient satisfaction. More in vivo investigations are necessary in dental literature
- The use of hydrogels in bone-tissue engineering(2011) Park, Jun-BeomMany different types of scaffold materials have been used for tissue engineering applications, and hydrogels form one group of materials that have been used in a wide variety of applications. Hydrogels are hydrophilic polymer networks and they represent an important class of biomaterials in biotechnology and medicine because many hydrogels exhibit excellent biocompatibility with minimal inflammatory responses and tissue damage. Many studies have demonstrated the use of hydrogels in bone-tissue engineering applications. In this report, the summary was conducted on various kinds of polymers and different modification methods of hydrogels to enhance bone formation. The results revealed that hydrogels are applied for bone regeneration and that the modification of hydrogels with bioactive molecules or cell-based approaches resulted in significant increases in new bone formation. This suggests that the use of hydrogels with modification may offer an option for bone-tissue engineering, and further research is needed to identify the biological and physical properties of hydrogels.
- Biomechanical behavior of cavity configuration on micropush-out test : a finite-element-study(2011) Cekic Nagas, Isil; Shinya, Akikazu; Ergün, Gülfem; Vallittu, Pekka K.; Lassila, Lippo V.J.Objective: The objective of this study was to simulate the micropush-out bond strength test from a biomechanical point of view. For this purpose, stress analysis using finite element (FE) method was performed. Study design: Three different occlusal cavity shapes were simulated in disc specimens (model A: 1.5 mm cervical, 2 mm occlusal diameter; model B: 1.5 mm cervical, 1.75 mm occlusal diameter; model C: 1.5 mm cervical, 1.5 mm occlusal diameter). Quarter sizes of 3D FE specimen models of 4.0×4.0×1.25 mm3 were constructed. In order to avoid quantitative differences in the stress value in the models, models were derived from a single mapping mesh pattern that generated 47.182 elements and 66.853 nodes. The materials that were used were resin composite (Filtek Z250, 3M ESPE), bonding agent (Adper Scotchbond Multi-Purpose, 3M ESPE) and dentin as an isotropic material. Loading conditions consisted of subjecting a press of 4 MPa to the top of the resin composite discs. The postprocessing files allowed the calculation of the maximum principal stress, minimum principal stress and displacement within the disc specimens and stresses at the bonding layer. FE model construction and analysis were performed on PC workstation (Precision Work Station 670, Dell Inc.) using FE analysis program (ANSYS 10 Sp, ANSYS Inc.). Results: Compressive stress concentrations were observed equally in the bottom interface edge of dentin. Tensile stresses were observed on the top area of dentin and at the half of lower side of composite under the loading point in all of the FE models. Conclusions: The FE model revealed differences in displacement and stress between different cavity shaped disc specimens. As the slope of the cavity was increased, the maximum displacement, compressive and tensile stresses also increased.
- Identification of the nuclear factor kappa-beta (NF-kB) in cortical of mice Wistar using Technovit 7200 VCR(2011) Salles, Marcos B.; Konig Jr, Bruno; Allegrini Junior, Sergio; Yoshimoto, Marcelo; Martins, Marília T.; Coelho, Paulo G.Objective: this study aimed to develop a nondecalcified bone sample processing technique enabling immunohistochemical labeling of proteins by kappa-beta nuclear factor (NF-kB) utilizing the Technovit 7200 VCR® in adult male Wistar rats. Study Method: A 1.8 mm diameter defect was performed 0.5mm from the femur proximal joint by means of a round bur. Experimental groups were divided according to fixing solution prior to histologic processing: Group 1- ethanol 70%; Group 2-10% buffered formalin; and Group 3- Glycerol diluted in 70% ethanol at a 70/30 ratio + 10% buffered formalin. The post-surgical periods ranged from 01 to 24 hours. Control groups included a nonsurgical procedure group (NSPG) and surgical procedures where bone exposure was performed (SPBE) without drilling. Prostate carcinoma was the positive control (PC) and samples subjected to incomplete immunohistochemistry protocol were the negative control (NC). Following euthanization, all samples were kept at 4o C for 7 days, and were dehydrated in a series of alcohols at -20o C. The polymer embedding procedure was performed at ethanol/polymer ratios of 70%-30%, 50%-50%, 30%-70%, 100%, and 100% for 72 hours at -20o C. Polymerization followed the manufacturer?s recommendation. The samples were grounded and polished to 10-15?m thickness, and were deacrylated. The sections were rehydrated and were submitted to the primary polyclonal antibody antiNF-kB on a 1:75 dilution for 12 hours at room temperature. Results: Microscopy showed that the Group 2 presented positive reaction to NF-kB, diffuse reactions for NSPG and SPBE, and no reaction for the NC group. Conclusion: The results obtained support the feasibility of the developed immunohistochemistry technique.
- Lateral pterygoid muscle dystonia. A new technique for treatment with botulinum toxin guided by electromyography and arthroscopy(2011) Martos, Pedro L.; Rodríguez Campo, Francisco José; Bances del Castillo, Raquel; Altura Guillén, Oscar Miguel; Cho Lee, Gui-Youn; Mancha de la Plata, María; Escorial Hernandez, VeronicaLateral pterygoid muscle dystonia is characterized by mandibular displacement towards the opposite side of the affected muscle. It may be associated with functional disorders affecting speech, swallowing, chewing and facial symmetry. Injection with botulinum toxin is recognized as the most effective treatment. Locating the lower head of the lateral pterygoid muscle for the injection is not difficult using electromyographic guidance; however, location of the upper head is more complicated, even with electromyography. We report a case of lateral pterygoid muscle dystonia in which precise injection of the upper head was achieved with the aid of arthroscopy.
- Effect of three prophylaxis methods on surface roughness of giomer(2011) Kimyai, Soodabeh; Savadi Oskoee, Siavash; Ajami, Amir Ahmad; Sadr, Alireza; Asdagh, SaeedehObjectives: Plaque and stains are removed by prophylaxis methods from tooth surfaces. Since prophylaxis methods can have a detrimental effect on the surface finish of restorations, the aim of this in vitro study was to investigate the effect of three prophylaxis methods, including pumice with rubber cup, pumice with brush, and air-powder polishing device (APD) on the surface roughness of giomer. Study design: Sixty four cylindrical giomer (Beautifil II, Shofu) samples with a diameter of 6 mm and a height of 2 mm were used. Subsequent to a 3-month period of storage in distilled water at 37ºC, the samples were randomly divided into four groups of 16. In group 1 (control), no prophylaxis procedure was carried out. In groups 2 to 4 the samples were exposed to pumice with rubber cup, pumice with brush, and APD prophylaxis methods, respectively. The surface roughness of the samples was measured using a profilometer and the effect of different prophylaxis methods on surface topography was characterized by atomic force microscopy (AFM). All data were analyzed by one-way ANOVA and Duncan?s post hoc test at a significance level of P < 0.05. Results: There were statistically significant differences in surface roughness among the groups (P < 0.0005). Furthermore, in pairwise comparisons there were statistically significant differences between all the groups (P < 0.05). The roughest surfaces, in descending order, were observed with the use of APD, pumice with brush, and pumice with rubber cup. Conclusions: The use of different prophylaxis methods resulted in an increased surface roughness of giomer compared with the control group. APD prophylaxis exerted the most detrimental effects on the surface of giomer.
- Altered passive eruption (APE) : a little-known clinical situation(2011) Alpiste Illueca, Francisco M.Gummy smile constitutes a relatively frequent aesthetic alteration characterized by excessive exhibition of the gums during smiling movements of the upper lip. It is the result of an inadequate relation between the lower edge of the upper lip, the positioning of the anterosuperior teeth, the location of the upper jaw, and the gingival margin position with respect to the dental crown. Altered Passive Eruption (APE) is a clinical situation produced by excessive gum overlapping over the enamel limits, resulting in a short clinical crown appearance, that gives the sensation of hidden teeth. The term itself suggests the causal mechanism, i.e., failure in the passive phase of dental eruption, though there is no scientific evidence to support this. While there are some authors who consider APE to be a risk situation for periodontal health, its clearest clinical implication refers to oral esthetics. APE is a factor that frequently contributes to the presence of a gummy or gingival smile, and it can easily be corrected by periodontal surgery. Nevertheless, it is essential to establish a correct differential diagnosis and good treatment plan. A literature review is presented of the dental eruption process, etiological hypotheses of APE, its morphologic classification, and its clinical relevance.
- Intraorifice sealing ability of different materials in endodontically treated teeth(2011) Bailón Sánchez, Mª Estela; González Castillo, Silvia; González Rodríguez, Mª Paloma; Poyatos Martínez, Rafael; Ferrer Luque, Carmen MaríaObjectives: To evaluate Cavit? G, ProRoot? MTA and Tetric® EvoFlow as intraorifice barriers to prevent coronal microleakage in root canal treatment. Study Design: Forty-two human single rooted teeth were divided randomly in three experimental groups of 10 specimens each and two control groups. The experimental groups were prepared with hand instrumentation and cold lateral condensed technique of the gutta-percha. Four millimetres of coronal gutta-percha were removed and replaced by one of the following filling materials: Cavit? G, Tetric® EvoFlow or ProRoot? MTA. In the experimental groups, leakage was measured by the concentration of leaked glucose in the apical reservoir at 1, 7, 30, and 45 days, using the enzymatic glucose oxidase method. Data were analyzed by means of Mann-Whitney U and Kruskal-Wallis tests at ?=0.05. Results: The glucose penetration results of three experimental groups increased gradually over time. No significant differences were found among groups at 24 hours and 1 week. At thirty and forty-five days, Cavit? and Tetric® EvoFlow values were significantly different (p=0.007 and p=0.023, respectively). Conclusions: The sealing ability of the Cavit? G, ProRoot? MTA and Tetric® EvoFlow used as intraorifice materials tends to be similar over time.
- Periodontal health and esthetic results in impacted teeth exposed by apically positioned flap technique(2011) Cercadillo Ibarguren, Iñaki; Gargallo Albiol, Jordi; Abad Sánchez, D.; Echeverría García, José Javier; Berini Aytés, Leonardo; Gay Escoda, CosmeObjectives: This study evaluates the periodontal health status and the esthetic results of teeth subjected to orthodontic traction, after their exposure by an apically positioned flap. Study design: Fifteen patients were included in the study, ages between 11 and 28 years old. The fenestrated teeth and their homologous contralateral normally erupted teeth, used as control, were evaluated. Results: Statistically significant differences were found in the position of the gingival margin (p = 0.005), with an average distance between cemento-enamel junction (CEJ) and gingival margin of 2.47 mm (SD 1.19) in control teeth and of 1 mm (SD 1.31) in the operated teeth, and in the depth of palatal probing (p = 0.031), with 2.1 mm (SD 0.9) for the experimental teeth and 1.7 mm (SD 0.8) for the control teeth. The gingival index, the bleeding during probing and the probing depth did not show statistically significant differences. The patient?s subjective esthetic evaluation was more favorable for the control teeth in most of the cases. Conclusions: The surgical approach for the impacted teeth by means of the apically positioned flap resulted to be a predictable technique allowing the maintenance of the periodontal health on a long-term basis.
- Vertical distraction osteogenesis of a free vascularized fibula flap in a reconstructed hemimandible for mandibular reconstruction and optimization of the implant prosthetic rehabilitation. Report of a case(2011) Cho Lee, Gui-Youn; Naval Gias, Luis; Martos, Pedro L.; González García, R.; Rodríguez Campo, Francisco JoséFree vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects (over 6 centimeters) resulting from trauma, infections or tumor resections. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it does not offer sufficient bone height to restore the alveolar arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical. We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible after resection of an odontogenic myxoma, for optimization of the implant prosthetic rehabilitation. The distraction device was applied intraorally. After 10 days of latency period, distraction protocol was performed at a distraction rate of 0.5 mm per day. A consolidation period of 3 months followed. Afterwards the distraction device was removed and 3 osseointegrated dental implants were placed in the distracted area. As a result, the vertical discrepancy between the fibula and the native hemimandible was corrected. The amount of vertical height achieved after distraction was 17 milimeters. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. In conclusion, we consider that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation, after mandibular reconstruction following tumor surgery
- The influence of local anesthetic solutions storage on tissue inflammatory reaction(2011) Berto, Luciana Aranha; Groppo, Francisco Carlos; Ramacciato, Juliana Cama; Tofoli, Giovana; Volpato, Maria Cristina; Ranali, José; Novaes, Pedro Duarte; Motta, Rogério Heládio LopesObjective: This study aimed to analyze the influence of storage conditions of local anesthetic solutions in the inflammatory reaction after injection in rats. Study design: Twenty-four rats received in their oral mucosa the injection of 2% lidocaine with epinephrine 1:100.000 solutions (LA) submitted to the following storage conditions during a twelve-month period: G1 - inside the original packaging, in refrigerator (5±1°C); G2 - inside the original box, under light shelter, at room temperature; G3 - outside the original box at room temperature (exposed to artificial light for 12 hours/day) and G4 - brand new solution. For the controls tests, 0.9% sodium chloride solution was injected in the opposite side. After 6 and 24 hours, three animals of each group were sacrificed and their maxilla along with the soft tissue were removed and submitted to histological analysis (HE). Results: The pH of LA was measured before and after the storage period and no statistically differences were observed between G1 and G4, but both were different from G2 and G3. All the scores of the testing solutions were higher than their respective negative controls, except for G1 at 6 hours. The order of the scores of inflammation after 6 hours was G3>G4>G2=G1. After 24 hours the order was G3>G2>G1>G4. Conclusion: The study showed that the method of storage can influence the pH and the level of inflammatory reaction after the injection of 2% lidocaine with epinephrine 1:100.000.
- A novel trephine design for sinus lift lateral approach. Case report(2011) Farré Pagés, Núria; Augé Castro, Mª Luisa; Alaejos Algarra, Fernando; Mareque Bueno, Javier; Ferrés Padró, Eduard; Hernández-Alfaro, FedericoVarious techniques are described in the literature, either by crestal or lateral approach. Sinus augmentation has a high percentage of success, but presents a number of intraoperative and postoperative complications. The most frequent complication is the Schneiderian membrane perforation with a percentage of perforations between 11% and 56% according to authors. The aim of this study is to describe another membrane approach technique for the sinus lateral wall osteotomy that minimizes the risk of Schneiderian membrane perforation. We present a case of a 50 year old patient attended the University Dental Clinic (UDC) of International University of Catalonia for implant and crown treatment due to the loss of a right maxillary first molar. To insert an implant in position 1.6 a computerized tomography (CT) was requested to determine with greater accuracy the quantity of residual crestal bone. It showed a height of 5 mm and width of 8 mm. The lateral osteotomy was performed with a (SLA KIT® -Neobiotech) trephine mounted in the same implant handpiece with which the field for the implant and the implant itself were prepared. It can be concluded that in the case described, the use of trephine drills of the SLA system mounted in a handpiece allows better access to lateral approach due to its perpendicular position relative to the sinus wall minimizing the membrane perforation risk.
- Validation of a computer-assisted system on classifying lower third molars(2011) Cortell Ballester, Isidoro; Almendros Marqués, Nieves; Berini Aytés, Leonardo; Gay Escoda, CosmeObjectives: The present study evaluates the reliability of the Radio Memory® software (Radio Memory; Belo Horizonte, Brasil.) on classifying lower third molars, analyzing intra- and interexaminer agreement of the results. Study Design: An observational, descriptive study of 280 lower third molars was made. The corresponding orthopantomographs were analyzed by two examiners using the Radio Memory® software. The exam was repeated 30 days after the first observation by each examiner. Both intra- and interexaminer agreement were determined using the SPSS v 12.0 software package for Windows (SPSS; Chicago, USA). Results: Intra- and interexaminer agreement was shown for both the Pell and Gregory and the Winter classifications, p<0.01, with 99% significant correlation between variables in all the cases. Conclusions: The use of Radio Memory® software for the classification of lower third molars is shown to be a valid alternative to the conventional method (direct evaluation on the orthopantomograph), for both clinical and investigational applications.
- Incidence of impacted and supernumerary teeth-a radiographicStudy in a North Greek population(2011) Fardi, Anastasia; Kondylidou-Sidira, Athena; Bachour, Zaki; Parisis, Nikolaos A.; Tsirlis, Anastasios T.Objectives: The aim of the present study was to investigate the prevalence of impacted and supernumerary teeth, apart from third molars. Study design: This was a retrospective study of 1.239 panoramic radiographs taken of patients who presented to the Department of Dentoalveolar Surgery, Implantology and Radiology at the School of Dentistry of the Aristotle University of Thessaloniki, Greece between 1991 and 1999. The panoramic radiographs and dental records were reviewed in order to determine whether there were impacted or supernumerary teeth. Observations were also made on the space in dentition, corresponding to the position of each impacted tooth, the lack of space for tooth eruption, transmigration, retained primary teeth or prosthetic restoration. Results: A total of 170 (13.7%) patients presented with at least one impacted tooth. None of them had an impacted incisor. Impacted canines were the most prevalent dental anomaly (8.8%), followed by impacted premolars (2.2%). Supernumerary teeth (1.8%) and impacted molars (1%) were the least common anomalies. Among the 225 impacted teeth, the most frequently affected teeth were the canines (59.6%), followed by premolars (19.1%), and supernumerary teeth (15.1%), while the incidence of impacted molars was substantially lower (6.2%). Conclusions: The most frequently impacted teeth were the maxillary canine, the second mandibular premolar and the second mandibular molar. The majority of the supernumerary teeth consisted of mesiodens. There was space in the dentition of each impacted tooth in 29.3% of the cases examined; there was a retained primary tooth in 25.1%, and a prosthetic restoration had been constructed in 24%. Insufficient space for the eruption of the impacted tooth and transmigration was observed in 17.3% and 4.2% of the cases, respectively.
- Relation between bone density and primary implant stability(2011) Farré Pagés, Núria; Augé Castro, Mª Luisa; Alaejos Algarra, Fernando; Mareque Bueno, Javier; Ferrés Padró, Eduard; Hernández-Alfaro, FedericoAims: This study aims to relate bone density in Hounsfield units (Hu) with the primary implant stability measured by insertion torque (Ncm) and resonance frequency analysis (ISQ). Materials and Methods: Ten patients were included in this study. A total of 54 implant sites were provided from 10 computerized tomography scans. The computerized tomography scan was used for the preoperative evaluation of bone density for each patient. The bone mean density around planned implants was determined with Physioplanet TM software. Bone quality according resistance to drilling, insertion torque and resonance frequency measurements were recorded. Results: A statistically significant relationship was observed between bone quality density and location with ISQ values. Conclusions: This research demonstrates a strong relationship between the bone density values from computerized tomography and the location in the maxillaries. A correlation exists between bone quality, according to the Lekholm and Zarb classification, and Hu computerized tomography values. The primary implant stability measured with resonance frequency analysis depends on bone density values, bone quality and implant location.
- Zirconia implant abutments : a review(2011) Gomes, Ana Luisa; Montero Martín, JavierObjectives: An increasing aesthetic demand within developed populations conducted to the fabrication of metalfree restorations and to a wide use of ceramic materials, due to its excellent characteristics of biocompatibility and aesthetics. With the incessant increase of commercial labels involved in this technological advance, a review is imposed on ceramic abutments, specifically on zirconia. We made a search of articles of peer-reviewed Journals in PubMed/ Medline, crossing the terms ?Dental Abutments?, ?Dental Porcelain? and ?Zirconia?. The review was divided by subtopics: zirconia physical and mechanical properties, precision fit in the implant-abutment interface, zirconia abutments strength and, finally, bacterial adherence and tissues response. Several studies demonstrate that zirconia abutments offer good results at all the levels but relevant issues need further studies and evaluation. One of the most important is the clinical long term success of zirconia abutments on implants, given that in the literature there are no sufficient in vivo studies that prove it.
- Oral findings in Rett syndrome : a systematic review of the dental literature(2011) Fuertes González, María Cristina; Silvestre Donat, Francisco Javier; Almerich Silla, José ManuelRett syndrome (RS) is a chromosome X-linked genetic neurological disorder characterized by developmental regression, particularly in relation to expressive language and use of the hands, together with profound mental retardation, that almost exclusively affects females. The present review describes the 35 cases of RS Publisher in the indexed literature (Medline) ? the first corresponding to 1985 and the last to the year 2007. Certain oral manifestations of the disease are derived from the drug treatment prescribed to control the disease, while others are common to other clinical conditions characterized by convulsion activity, difficulties for correct oral hygiene, walking problems and/or an excess of oral / digital-manual habits. In any case, bruxism is the oral habit most frequently associated with RS ? the treatment of which remains the subject of controversy.
- Salivary levels of Tumour Necrosis Factor-alpha in patients with recurrent aphthous stomatitis(2011) Eguía Del Valle, Asier; Martínez-Conde Llamosas, Rafael; López Vicente, José; Uribarri Etxebarria, Agurne; Aguirre Urízar, José ManuelObjetives: Recurrent aphthous stomatitis (RAS) is a common pathology of the oral mucosa with a complex and multifactorial etiology. Tumour Necrosis Factor-alpha (TNF?) is a cytokine with an important but not well-known role in the development of new lesions in RAS patients. Modifications of salivary levels of TNF? in RAS patients during the active periods of the disease have been measured in this work. The possible implication of TNF? in RAS etiology is also discussed. Study design: The study group was composed of 20 patients previously diagnosed with RAS and randomly selected. As a control group 10 healthy patients were also randomly selected. In both groups a TNF? assessment was carried out in non stimulated saliva. All the patients in the study group presented active lesions at the moment of the salivary sample collection. Values oscillating between 0 and 8.1 pg/ml were considered as normal. Results: Salivary TNF? levels are 2 to 5 times higher in RAS patients than those of healthy patients. Conclusions: TNF? has a possible implication in the RAS etiology and it may also have an important role in the search of new treatments for this disease.
- Implant failure : etiology and complications(2011) Sakka, Salah; Coulthard, PaulThe possible occurrence of implant failure is a major concern for implantologists and knowledge in such unavoidable fact is clinically essential. Periimplantitis is an inflammatory response in which there is a loss of the bony support of the implant. Diagnosis is based on the clinical signs of infection such as hyperplastic soft tissues, suppuration, colour changes of the marginal peri-implant tissues and gradual bone loss. This site-specific infection may have many features in common with chronic adult periodontitis. Surgical trauma, micromotion and overload are also considered to be associated with implant failures. The lack of osseointegration is generally distinguished by implant mobility and radiological radiolucency. Here, the implant is considered to be failed . Progressive marginal bone loss without marked mobility is referring to a failing implant. The purpose of this concise review was to discuss the implant complications and failure by highlighting the major etiologic factors as well as the parameters used for evaluating such failure.
- Envelope approach for onlay bone grafting : preliminary surgical and prosthetic results(2011) Hernández-Alfaro, Federico; Salvan Garcia, Eva; Mareque Bueno, Javier; Ferrés Padró, EduardMinimally invasive surgery principles have been applied to preprosthetic-implant surgery, and an adequate presurgical planning reduces morbidity in both harvesting and stabilization of the bone grafts. Objective: A new ?envelope? approach for onlay bone grafting at the alveolar process is presented, this avoids releasing incisions yet allowing adequate reconstruction of the defective site. Study design: To be included in the study the patient had to have an antero-posterior defect of the alveolar crest. Patient age and sex, location of the defect, type and size of graft, and complications appeared during follow up were recorded. Results: Ten consecutive patients (4 men and 6 women) have been succesfully treated with this technique between June/2006 and February/2008. Eight defects were located at the anterior maxilla (between canines), and the remaining two at the anterior mandible (between canines). Four patients received bone grafts harvested from the chin, and the remaining six patients received bone grafts from the mandibular body. Mean size of the graft was: width 11,5mm (range 8 to 17), height 14,7mm (range 9 to 18), depth 4,3mm (range 3 to 6). Conclusion: This technique improves vascularization of the mucoperiosteal flap and avoidance of releasing incisions which has an aesthetic impact in patients with gingival smile.
