Publications

Circummandibular Wires for Treatment of
Dentoalveolar Fractures Adjacent to Edentulous
Areas: A Report of Two Cases

Craniomaxillofacial Trauma and Reconstruction Vol. 8 No. 3/2015 – Karl Maloney, DDS

In general, dentoalveolar fractures are a common injury seen in emergency departments, dental offices, and oral and maxillofacial surgery practices.

These injuries can be the result of direct trauma or indirect trauma.

Direct trauma more often causes trauma to the maxillary dentition due to the exposure of the maxillary anterior teeth.

Indirect trauma is usually the result of forced occlusion secondary to a blow to the chin or from a
whiplash injury.

Falls are the most common mechanism of injury seen in the pediatric group. In adolescents, many of these fractures are sustained during sporting activities.

However, the use of mouth guards and other protective equipment has decreased this number.

Most adult injuries are caused by motor vehicle accidents, contact sports, falls, bicycles, interpersonal violence, medical/dental mishaps, and industrial accidents.

Early intervention to reduce and stabilize the fracture is required to establish a bony union and ensure correct function. 

Most dentoalveolar fractures have bilateral stable adjacent dentition and are treated with a closed technique utilizing an acid-etch/resin splint followed by splint removal at 4 weeks.

Other inferior stabilization treatments used are arch bars and other wiring techniques. It is widely accepted that semirigid stabilization techniques, such as an acid-etch/resin splint or wiring procedures, are adequate to treat
dentoalveolar fractures.

This is in contrast to the treatment of mandible fractures where AO principles of rigid fixation are often followed. Fractures that are unable to be reduced sometimes necessitate an open reduction followed by internal fixation, sometimes using a secondary splint for mobile teeth.

In those rare cases when there are not stable adjacent teeth bilaterally other modalities must be considered. In the present report, two cases are presented where circummandibular wires were used to treat fractured mandibular dentoalveolar segments adjacent to edentulous areas.

To read & download the entire Craniomaxillofac Trauma Reconstruction publication, click here.


Autogenous Block Grafts for Maxillary Reconstruction Prior to Implant Placement

Implant News & Views Volume 15 No. 6 – Karl Maloney, DDS

Alveolar defects of the anterior maxilla are commonly encountered when treatment planning for dental implants.

Frequent causes for these defects are infection, trauma or congenitally missing teeth. There are currently many different techniques available to the implant surgeon for reconstructing the alveolar ridge for placement of dental implants.

Among those are autogenous bone grafts, guided tissue regeneration using particulate grafts and barrier membranes, ridge osteotomies and rhBMP-2.

The author has had success reconstructing the anterior maxilla using autogenous block grafts harvested transorally from the mandibular symphysis and ramus.

Three cases are presented where block grafts were used successfully to reconstruct the anterior maxilla prior to dental implant placement. The cases are presented with an emphasis on the bony reconstruction prior to implant placement.

Case 1

A healthy 16 year-old female was referred for implant evaluation of the upper right lateral incisor site.

She reported a history of congenitally missing maxillary lateral incisors. She had prosthetic lateral incisors held in place by an orthodontic arch wire.

In examination she had healthy, adequate keratinized gingiva at the site, with a horizontally deficient ridge [Fig. 1].

Panoramic and Cone Beam CT (CBCT) studies were Fig. 1 Fig. 2 performed. The panoramic radiograph revealed unerupted, developing teeth numbers 1,16,17 and 32 [Fig. 2].

The CBCT showed a ridge width of approximately 3.52 mm at the #7 site [Fig. 3].

The treatment plan was to perform extraction of tooth #32 in conjunction with a block graft harvest from the right ramus, under general anesthesia in the office.

To read & download the results of Case 1, click here.

Case 2

A 45 year-old healthy male, non-smoker, was referred for replacement of teeth #’s 8 and 9 with dental implants.

Tooth #8 was lost many years ago due to infection. Tooth #9 was discolored, necrotic and non-restorable.

A CBCT (Panoramic and Cone Beam CT) was obtained which showed a horizontally deficient ridge at the #8 site [Fig. 13].

The treatment plan was to reconstruct the #8 site with an autogenous symphysis block graft and extraction of tooth #9 with socket grafting using allograft, under general anesthesia.

A crestal/sulcular incision was used exposing the defect [Fig. 14]. After the defect was evaluated

and measured, the wound was packed during the harvesting of the graft.

To read & download the results of Case 2, click here.

 

Case 3

This is a 40 year-old healthy female, non-smoker who had an implant placed outside of the country, which failed and was removed by a colleague.

The patient was later referred to me for implant evaluation at the #10 site. Periapical radiographs were provided which showed the implant and site just prior to and after implant removal [Fig. 21].

On examination the width of the ridge was severely deficient. A CBCT (Panoramic and Cone Beam CT) was obtained which showed minimal alveolar bone present in the area [Fig. 22].

A symphysis block graft was harvested and fixated to the site as described in the previous cases.

At six months a CBCT was taken and showed more than 7mm of width of bone [Fig. 23]. The area was approached using a crestal incision and the graft was found to be bleeding, with minimal resorption [Fig. 24].

The fixation was removed and the graft was integrated and stable.

An implant was placed with excellent stability and the site was closed with a 3-0 chromic gut suture [Figs.

25-26].

The implant was restored 4 months after placement.

To read & download the results of Case 3, click here.


NON-DISPLACED PEDIATRIC ORBITAL FRACTURE WITH DISPLACEMENT OF THE INFERIOR RECTUS MUSCLE INTO THE MAXILLARY SINUS: A CASE REPORT & REVIEW OF THE LITERATURE

K Maloney: Int. J. Oral Maxillofac. Surg. 2014; 43: 29–31. # 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Orbital fractures occur less frequently in the pediatric population than in the adult population.

Due to the elasticity of the bones that comprise the orbital floor it is not uncommon for the orbital floor to fracture and immediately self-reduce.

This puts the muscles and soft tissues of the orbital floor at an increased risk of entrapment.

There is no exact agreement in the literature as to the ideal timing of surgical intervention for these types of injuries.

However, there are many surgeons who advise early intervention in the first few days of the injury.

This article describes a case of a non-displaced orbital fracture with displacement of the inferior rectus into the maxillary sinus that was treated in the first 24 h and resulted in an excellent outcome.

Introduction

Pediatric facial fractures are less common than in the adult population, accounting for 3–6% of all facial fractures.1

Orbital floor fractures make up 15% of all pediatric facial fractures, and pediatric cases make up 22% of all orbital fractures requiring surgery.2

There are few facial fractures that require urgent surgical intervention.

Pediatric orbital fractures can be one of them.3,4 These fractures can differ from adult orbital fractures in signs and symptoms, fracture pattern, and urgency.1–3,5

In children, due to the elasticity of the bone, the fractured floor has the tendency to return to the original anatomic position.

When this occurs there can be minimal displacement of the floor with entrapment of muscle and soft tissues within the fracture site.1,3,4

Clinically this can result in decreased motility, nausea and vomiting, and diplopia.1,3–7

Most facial trauma surgeons advocate early surgical intervention for these types of injuries to prevent ischemia to the inferior rectus muscle.1,3,5,7

Few cases exist in the literature specifically referring to the inferior rectus muscle being completely displaced into the maxillary sinus after a trapdoor fracture.6

This report describes a case of a non-displaced orbital fracture with the inferior rectus displaced into the maxillary sinus that was treated immediately, resulting in an excellent outcome.

To read & download the entire Non-Displaced Pediatric Orbital Fracture With Displacement Of The Inferior Rectus Muscle Into The Maxillary Sinus: A Case Report And Review Of The Literature publication, click here.


CONE BEAM COMPUTED TOMOGRAPHY AND SIMPLANT MATERIALIZE DENTAL SOFTWARE VERSUS DIRECT MEASUREMENT OF THE WIDTH AND HEIGHT OF THE POSTERIOR MANDIBLE: AN ANATOMIC STUDY

Karl Maloney, DDS,* Jairo Bastidas, DMD,† Katherine Freeman, DrPH,‡ Todd R. Olson, PhD,§ and Richard A. Kraut, DDS | J Oral Maxillofac Surg 69:1923-1929, 2011

Cone beam computed tomography (CBCT) has  proved to be a useful tool in many aspects of oral and maxillofacial surgery and in implant dentistry.1-4

In addition to implant dentistry, CBCT has been valuable in dentoalveolar surgery, temporomandibular joint evaluation, orthodontics, orthognathic surgery, clefts, trauma, and benign and malignant pathologic processes of the maxillofacial region.5-17

The purpose of this study was to investigate the accuracy of measurements of mandibular height and width of bone using a CBCT machine (I-CAT) and a dental implant planning software (SimPlant) compared with direct digital caliper measurements on cadaveric mandibles (anatomic).

With the emergence of CBCT and its applications for placement of endosteal implants, there is a need to determine the accuracy of CBCT in determining the height and width of the mandibular alveolar bone above the inferior alveolar nerve (IAN).

In 2000, the American Academy of Oral and Maxillofacial Radiology issued a position paper recommending crosssectional imaging for treatment planning of implant cases.18

CBCT patients would undergo medical-grade spiral CT for 3-dimensional analysis of the bone before implant placement when 3-dimensional imaging was indicated.

With CBCT surgeons can attain 3-dimensional imaging of patients for implant treatment planning and lower the dose of radiation, as low as 20% of conventional CT or comparable to a full-mouth series of periapical radiographs.18-20

CBCT has also been shown to provide superior and more accurate detail of teeth and supporting hard tissues at a more cost-efficient price compared with conventional CT.13,21

As CBCT machines and software using data from CBCT are becoming more accessible to practitioners for treatment planning of implant cases, these are being used more to determine the amount of bone available for placement of dental implants.

This study tested the hypothesis that vertical and horizontal measurements using CBCT and SimPlant in the posterior cadaveric mandible are accurate compared with direct digital caliper measurements.

To read & download the entire Cone Beam Computed Tomography And Simplant Materialize Dental Software Versus Direct Measurement Of The Width And Height Of The Posterior Mandible: An Anatomic Study publication, click here.