Showing papers by "Arjan Vissink published in 2001"

Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months.

Abstract: Insertion of endosseous implants in the atrophic maxilla is often complicated because of lack of supporting bone. Augmentation of the floor of the maxillary sinus with autogenous bone graft has been proven to be a reliable treatment modality, at least in the short term. The long-term clinical and radiographic outcome with regard to the grafts, the implants and satisfaction of the patients with their implant-supported overdenture was studied in 99 patients. The sinus floor was augmented with bone grafts derived from the iliac crest (83 subjects, 162 sinuses, 353 implants), the mandibular symphysis (14, 18, 37), or the maxillary tuberosity (2, 2, 2). Before implant installation, the width and height of the alveolar crest were increased in a first stage procedure in 74 patients, while in the other 25 patients augmentation and implant installation could be performed simultaneously (width and height of the alveolar crest >5 mm). Perforation of the sinus membrane occurred in 47 cases, which did not predispose to the development of sinusitis. Loss of bone particles and sequestration were observed in one (diabetic) patient only, in whom a dehiscence of the oral mucosa occurred. A second augmentation procedure was successful in this patient. Symptoms of transient sinusitis were observed in 3 patients. These symptoms were successfully treated with decongestants and antibiotics. 2 other patients developed a purulent sinusitis which resolved after a nasal antrostomy. In all cases, the bone volume was sufficient for implant insertion. 32 of 392 inserted Branemark implants (8.2%) were lost during the follow-up. After the healing period of the bone grafts, no sinus pathology was observed. The patients received implant-supported overdentures (72 patients) or fixed bridges (27 patients). Overall, the patients were very satisfied with the prosthetic construction. We conclude that bone grafting of the floor of the maxillary sinus floor with autogenous bone for the insertion of implants is a reliable treatment modality with good long-term results.

Morbidity of chin bone harvesting.

Abstract: The chin is a very common donor site for autogenous bone grafts. The aim of this retrospective study was to evaluate long-term morbidity of the donor site following chin bone graft harvesting. One to three years after grafting of local bone defects of the anterior maxilla with chin bone, 21 patients were recalled for objective assessment of any residual morbidity at the harvesting area. Morbidity as well as satisfaction of the patients were evaluated by a survey of the medical record, a mail-in questionnaire, and a standardized physical examination. The outcome of this study showed that there was good acceptance of the chin bone harvesting procedure. The objective morbidity was low, but subjectively almost half of the patients reported a changed (decreased) sensibility in the harvesting area. This subjective change in sensibility did not result in noteworthy complaints or discomfort by the patients, however. Although bone harvesting from the chin is generally considered as a good option for reconstruction of local bony defects, the patients should be informed about the potential hazard of a changed sensibility in the chin region.

Treatment outcome of bone-anchored craniofacial prostheses after tumor surgery

Abstract: BACKGROUND Percutaneous endosseous implants have acquired an important place in the prosthetic rehabilitation of patients with craniofacial defects. The objective of this study was to evaluate the clinical outcome of the use of endosseous implants in the orbital and auricular region as well as to assess the satisfaction of patients with implant-retained craniofacial prostheses after tumor surgery. METHODS The clinical outcome and patient satisfaction of implant-retained prostheses in the auricular and orbital region were evaluated in a group of 26 patients with facial defects after tumor surgery by using standardized questionnaires and a clinical assessment. Twelve patients (n = 31 implants) received the implants during ablative tumor surgery, from which 7 patients (n = 20 implants) were treated with radiation therapy after surgery (mean, 65 grays [Gy]). Fourteen patients (n = 44 implants) received the implants after the tumor surgery, from which 5 patients (n = 21 implants) were irradiated after ablative surgery (mean, 54.4 Gy), but before implant placement. RESULTS No implants were lost in patients who had not undergone irradiation (100%), whereas 5 implants were lost in the irradiated group (87.8%). The overall implant survival rate was 93.3%. The peri-implant tissues had a healthy appearance, and no cases of osteoradionecrosis occurred. When compared with patients treated with conventional adhesive retained facial prostheses, satisfaction was higher in patients treated with implant-retained facial prostheses. CONCLUSIONS From this study, it is concluded that implant-retained facial prostheses are better tolerated than adhesive retained prostheses and offer an improvement in the quality of life. Radiotherapy is not a contraindication for the use of osseointegrated implants in the maxillofacial region, but the loss of implants is higher than in nonirradiated sites. Cancer 2001;92:3045–50. © 2001 American Cancer Society.

Sialometry and sialochemistry: diagnostic tools for Sjögren's syndrome

Abstract: Background-The common occurrence of xerostomia in Sjogren's syndrome (SS) as well as the easy accessibility of saliva supports the use of sialometry and sialochemistry in the diagnosis of SS. Collection and analysis of whole saliva (oral fluid) is currently the routine technique for sialometry, despite the fact that it is rather inaccurate and impure. Objective-To assess the value of glandular sialometry and sialochemistry as diagnostic instruments in SS. Methods-In a group of 100 consecutive patients referred for diagnosis of SS, glandular secretory flow rates and a spectrum of salivary components (sodium, potassium, chloride, calcium, phosphate, urea, amylase, total protein) were assessed. The patients were classified as positive or negative for SS according to the revised European classification criteria. Results-Patients with SS differed clearly from those who tested negative for SS, showing lower submandibular/sublingual (SM/SL) flow rates and an appreciably changed salivary composition of parotid and SM/SL saliva. Besides changes in salivary flow rate and composition, distinct sialometric profiles were observed, characteristic of either early or late salivary manifestation of SS, or of the xerogenic side effects of medication. Conclusions-Glandular sialometry and sialochemistry are not only useful tools for differentiating SS from other salivary gland disease in clinical practice, but they also have great potential as diagnostic criteria for SS, showing distinct sialometric and sialochemical changes as well as profiles. Being simple, safe (non-invasive), and sensitive (early disease detection), they have three major advantages over other oral tests for SS.

Morbidity from parotid sialography.

Abstract: Objective: Sialography is commonly used for the diagnosis of Sjogren's syndrome, although its invasive nature is often regarded as a serious drawback for routine usage. The aim of this study was to evaluate the morbidity and acceptability of parotid sialography using oil-based contrast fluid. Study Design: Twenty-four consecutive sialographic procedures were evaluated in terms of morbidity and the patient's acceptance of the procedure, assessed with a standardized questionnaire. Information was also obtained by recording relevant physical parameters during the procedure. Results: There was good acceptance of the sialographic procedure, and the morbidity was low. No signs of overfilling or false route were observed in any of the sialograms. On average, 0.74 mL of contrast fluid was infused with a velocity of 0.01 mL/s. The whole procedure was completed within 12 minutes. Conclusions: Parotid sialography appears less invasive than is often thought. It had a low morbidity rate and was well accepted by the patients. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:572-5)

Disorders of taste and smell

Abstract: Disorders of taste and smell not only are uncomfortable to the person involved, e.g. because of an impaired hedonic and sensory experience of food or the continuous presence of a nasty taste, but can also result in loss of body weight and may have a negative influence on the quality of life. In this article both the physiology of chemosensory function and dysfunction of taste and smell are discussed as well as some clinical consequences and their treatment.

Vesiculobullous lesions of the oral mucosa

Abstract: In general practice, the dentist can be confronted with a vesiculobullous lesion of the oral mucosa. In many cases the lesion can be classified as recurrent herpes labialis, but many other causes can induce a vesiculobullous lesion of the oral mucosa and perioral skin as well. This article gives an overview of the various vesiculous and bullous lesions of the oral mucous membranes. Special attention is given to the possible causes and their treatment.