title: Bone augmentation of the osteo-odonto alveolar lamina in MOOKP--will it delay laminar resorption?
abstract: OBJECTIVE
  We aimed to describe a new technique and analyse the early outcomes of augmenting the canine tooth using a mandibular bone graft in an attempt to delay or retard the process of laminar resorption following the modified osteo odonto keratoprosthesis (MOOKP) procedure.
  
  
  METHODS
  This was a retrospective case series.
  
  
  METHODS
  Eyes that underwent the bone augmentation procedure between December 2012 and February 2014 were retrospectively analysed. The procedure, performed by the oromaxillofacial surgeon, involved securing a mandibular bone graft beneath the periosteum on the labial aspect of the canine tooth chosen to be harvested for the MOOKP procedure. This procedure was performed simultaneously with the Stage 1 A of the MOOKP. Three months later, the tooth was harvested and fashioned into the osteo-odonto alveolar lamina similar to the method described in the Rome-Vienna Protocol.
  
  
  RESULTS
  The bone augmentation procedure was performed in 11 eyes (five SJS/ six chemical injuries). The mean follow-up after Stage 2 of MOOKP procedure in these eyes was 7.45 months (2 to 20 months). Complications noted were peripheral laminar exposure (three eyes-SJS) and bone graft exposure and necrosis in the mouth (nine-SJS). No evidence of clinical laminar resorption was noted in any of the eyes.
  
  
  CONCLUSIONS
  Laminar resorption in MOOKP can lead to vision and globe threatening complications due to the consequent cylinder instability and chances of extrusion. Augmenting the bone on the labial aspect of the canine tooth might have a role to play in delaying or preventing laminar resorption.
authors.affiliation: CJ Shah Cornea Services/Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, 600006, Tamil Nadu, India, drgeethaiyer@gmail.com.
authors.forename: Geetha
authors.initials: G
authors.lastname: Iyer
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Srinivasan
authors.forename: Shweta
authors.initials: S
authors.lastname: Agarwal
authors.forename: Ekta
authors.initials: E
authors.lastname: Rishi
authors.forename: Pukhraj
authors.initials: P
authors.lastname: Rishi
authors.forename: Gunaseelan
authors.initials: G
authors.lastname: Rajan
authors.forename: Shanmugasundaram
authors.initials: S
authors.lastname: Shanmugasundaram
mesh_terms: D000328:Adult; D000539:Alveolar Process / Q000637:transplantation*; D001705:Bioprosthesis; D001862:Bone Resorption / Q000517:prevention & control*; D016025:Bone Transplantation; D002057:Burns, Chemical / Q000601:surgery; D003316:Corneal Diseases / Q000601:surgery*; D005126:Eye Burns / Q000139:chemically induced; D005260:Female; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000601:surgery; D014092:Tooth Root / Q000637:transplantation*; D014792:Visual Acuity; D055815:Young Adult