Browsing by Author "Gibaly, Amr"

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    Assessment of bone quality using buccal and palatal autogenous cortical shells harvested from two different mandibular donor sites for maxillary alveolar ridge augmentation: a histomorphometric randomized clinical trial
    (Springer, 11/24/2020) Mounir, Mohamed; EL Morsy, Ola Alaa; Amer, Hatem; Mounir, Samy; Gibaly, Amr
    Purpose This study aims to compare the quality of free autogenous bone grafts harvested from two different mandibular donor sites, used as onlay shells to augment horizontally and vertically deficient anterior maxillary alveolar ridges. Methods Fourteen patients with edentulous and atrophic anterior maxillae are randomly allocated into two groups. Seven symphyseal chin (group I) and seven retromolar (group II) mandibular bone grafts were harvested and fashioned to construct buccal and palatal frameworks, fixed in place with mini-screws, followed by compacting the inter-positional gaps with an equal particulate mix of xenograft and autogenous cancellous particulates. Six months later, 42 core biopsies, three from each patient, 21 for each study group, were retrieved before the implants' insertion and subjected to histomorphometric bone area percent analysis. Results The bone area percent of the newly formed bone augmented with the chin shells was 52.53 +/- 1.68% versus 47.97 +/- 1.83% for the retromolar grafts. The mean area percent difference between both groups was statistically significant (p = 0.0004). Conclusion A higher bone quality and more volumetric stability were associated with the symphyseal cortical shells.
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    A COMBINED STAGED NOVEL APPROACH FOR RECONSTRUCTION OF PERSISTING ORO-ANTRAL FISTULAE DEFECTS UTILIZING TRIPLED LAYER CLOSURE AND OPEN SINUS LIFTING
    (EDJ, 2019-10) Gibaly, Amr; Mounir, Mohamed; Mounir, Samy
    This study aimed to assess the clinical outcome of a designated approach purpose to reconstruct large oro-antral fistulae combining tripled layer soft tissue closure along with later sinus lifting and bone grafting. The study constituted of three non-smokers male patients, which were subjected to failed previous surgical closures of large oro-antral fistulae, with a subsequent maxillary sinus infection and morbid vascular bed. After definite eradication of the persisting infection, the large communications were planned to be restored by three soft tissue flaps, the first of which based on utilizing the dense epithelial fistulous sinus tract, which was crafted, instead of being eliminated and adapted to the underlying bony defect to represent a shield that sealed the defect, obliterated the dead space, withstood the postoperative fluid overload and supported the overlying pedicled fat pad and the buccal advancement flap, which represented the second and third layers of closure. Three months later, open sinus lifting and bone grafting of the defects were carried out. Although two patients complained significant postoperative pain, limitation of mouth opening and swelling, all the reconstructed defects healed uneventfully, none of them revealed postoperative infection, wound dehiscence or relapse throughout the investigation period, and the patients neither exhibited any sign of recurrent maxillary sinusitis nor graft failure, furthermore, C.B.C.T. six months postoperatively, demonstrated that the reconstructed defects are well organized to receive proper sized dental implants. The authors recommend implementing this study over a broadened sample size, as this study was restrained by the small number of participants.
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    Full-staged digital and prosthetic guided protocol for the insertion of dental implants in autogenous free bone grafts after reconstruction of segmental mandibular defects
    (Springer, 2020) Mounir, Samy; Mounir, Mohamed; Gibaly, Amr
    Purpose: This study aims to evaluate the clinical and radiographic outcomes of dental implants, inserted in consolidated free bone grafts; postsegmental mandibular resection, after following a fully guided staged protocol, which established a systematic approach that correlates the grafted bone and the enclosed implants to the undisturbed mandibular segments and the maxillary occlusal plane. Methods: Seven patients were enrolled in the study; all were diagnosed for mandibular locally aggressive tumors. All of the patients were subjected to computer-guided segmental mandibular resections, secondary free iliac crest bone graft; aided by computer-guided harvest and prosthetic guidance of the graft positioning and fixation. Finally, the guided bone grafts; after being consolidated, received twenty-nine computer-guided dental implants. Results: By the end of the period of osseointegration, the predetermined criteria of implant success judged the success of twenty-five implants, versus the failure of four implants, with (86.2%) percentage of success. Conclusion: The clinical and radiographic assessments demonstrated sound base bone grafts, which succeeded not only to restore the native mandibular continuity and configuration but also to direct the fair-sized embedded dental implants into favorable coastal locations and axial projections, which influenced a smooth prosthetic rehabilitation. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
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    Primary reconstruction of resected proximal mandibular segments: a novel protocol using patient-specific poly ether-ether ketone (peek) condylar replicas
    (The Egyptian Association of Oral and Maxillofacial Surgeons, 2020-04) El-Hawary, Hesham; Mounir, Mohamed; Mounir, Samy; Gibaly, Amr
    Purpose: This study aims to evaluate the efficiency of computer-aided design and computer-aided manufacturing (CAD/CAM), mirror-imaged Polyetheretherketone (PEEK) assembly that aimed to duplicate both of the exact anatomic position and the configuration of the resected mandibular condyle, post segmental proximal tumor resection. Methods: Five patients were included in the study; diagnosed for mandibular ramus locally aggressive tumors, involving or markedly jeopardizing the mandibular condyles. All of the patients were subjected to a fully guided reconstructive protocol that implements guided resection, guided alignment of a pre-bent reconstruction plate, secured to a (CAD/CAM) fabricated, mirror-imaged (PEEK), looking forward to duplicating both of the anatomic location and the configuration of the amputated mandibular ramus and condyle. Results: Clinical evaluation revealed acceptable recovery of the maximal mouth opening and limited postoperative malocclusion and mandibular deviation. The computed radiographic superimposition between the virtual plane and the one- week postoperative C.T. revealed decreased linear condyle displacement in both the mediolateral and anteroposterior directions versus an increased linear vertical displacement and decreased axial angular rotation versus increased sagittal angular rotation. The replication between the virtually planned condylar location and that surgically duplicated was judged as good to excellent among all the cases. Conclusion: The novel simulation and allocation of the customized (PEEK) assembly represents a simple and efficient modality to reconstruct both of the lost condylar position and configuration. However, the anterior extension of the resected proximal mandibular segment deemed determinant to the success of the identical surgical execution of the virtual preplanned arrangemen