The Use of Cortical Bone Wedges from the Mandibular Ramus “Wedge Technique” for 3-Dimensional Bone Augmentation of the Atrophic Ridges

Autogenous bone is still considered the gold standard in bone augmentation for implant insertion in atrophic ridges. However, augmentation of multiple edentulous atrophic segments usually necessitates the use of extraoral donor sites. This chapter introduces the Wedge Technique, as a new bone augmentation method that can augment multiple edentulous ridges with intraoral cortical bone grafts. Patients with moderate to severe ridge atrophy in different regions of the jaws were treated with the wedge technique (WT). Patients received a panoramic radiograph immediately after the surgery, and they were examined clinically and radiographically (periapical radiograph) every 2 weeks. At four months, CBCT was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the new bone volume and quality and to insert implants. The follow-up period ranged from 30 to 120 months. The healing process was uneventful, with minimal morbidity. The success rate was 95%, the bone gain average was 3–6 mm vertically and 3–9 mm horizontally. The wedge technique can augment multiple segments of atrophic ridges with a small amount of autogenous graft. The achieved bone volume was satisfying, especially that the majority of the augmented areas were at posterior mandibular defects.

Acetabular ventroversion using the sacroiliac wedge, with or without pelvic osteotomies in dogs: an ex vivo study

ABSTRACT: Canine hip dysplasia (CHD) is a common condition observed in the surgical clinics for small animals. Among the surgical techniques for management of CHD, triple pelvic osteotomy and sacroiliac wedge promote acetabular lateral axial rotation (ventroversion), increasing acetabular coverage and joint stability. The present study aimed to evaluate radiographically, by measuring the Norberg angle (NA) and the acetabular coverage percentage (ACP), the acetabular ventroversion induced by the sacroiliac wedge technique, with or without pelvic osteotomies; we also checked the feasibility of wedges made of polyamide with an angulation of 20° and 30°. The software used to measure NA and ACP was AutoCAD® 2009. Pelves from 10 canine corpses were evaluated radiographically at four time-points: M0 (Control Group), M1 (wedges of 20° and 30°), M2 and M3 (wedges associated with bilateral pubis and ischium osteotomies, respectively). There was no significant increase in the acetabular ventroversion at M1, M2, and M3. The polyamide sacroiliac wedge technique proved to be feasible, stable, and easy to apply. Further, the software proved to be efficient and easy to use for NA and ACP measurements. In the present study, even in the cases of non-dysplasic adult canine corpses, it was concluded that the sacroiliac wedge technique does not require to be accompanied by pubis and ischial osteotomies because they did not significantly increase the NA and ACP.

Insertion of percutaneous endoscopic gastrostomy tubes with jejunal extensions using the “wedge” technique: a novel method to prevent retrograde tube migration into the stomach

Background and study aim In percutaneous endoscopic gastrostomy (PEG) with jejunal extension (PEGJ) procedures, retrograde migration of the jejunal extension tube into the stomach during endoscope withdrawal is a frustrating problem. We describe the novel “wedge” technique for inserting the jejunal extension tube, utilizing single-balloon enteroscopy to anchor it in place. Patients and methods Prospective 1-year study of consecutive patients undergoing PEGJ insertion at a single tertiary care center. The primary outcome was number of pyloric intubations required to place the jejunal extension tube. Secondary outcomes included success rate, time, and complications related to jejunal extension tube insertion. Results 17 patients underwent the procedure. The jejunal extension tube was inserted at the first attempt in 15 patients (88.2 %) and 2 required another pyloric intubation. Abdominal X-ray showed that all PEGJ tubes were successfully seated in the proximal jejunum. The mean (SD) time required for jejunal extension insertion was 16.9 (8.6) minutes. Two adverse events occurred due to PEG insertion although none were related to the jejunal extension insertion itself. Conclusions: The “wedge” technique is an effective and easy method for inserting a jejunal extension tube after PEG insertion.