On Implant Prosthodontics: One Narrative, Twelve Voices - 8 (original) (raw)
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Journal of Oral and Maxillofacial Surgery, 1997
Purpose: A new method of reconstruction of the atrophic maxilla by combining a bilateral sinus floor elevation and cancellous bone graft with buccal and labial onlay graft using L-shaped corticocancellous blocks from the posterior iliac crest is presented. Patients and Methods: Seventeen patients were treated with this procedure. One hundred one IMZ implants were placed in 14 patients, and 22 Branemark implants were placed in three patients. Patients were observed for 6 months after prosthetic rehabilitation. Results: All patients were fully rehabilitated with fixed bridges except one, who prefered an overdenture. Only two implants were lost at the time of the abutment connection. Some bone resorption was seen around six implants. The success rate with this procedure was 92.7% 6 months after prosthetic rehabilitation if implants with bone resorption were considered failures. Conclusions: These preliminary results indicate that this surgical procedure is suitable for reconstruction of most atrophic maxillas.
Maxillary reconstruction to enable implant insertion: a retrospective study of 181 patients
Head & Face Medicine, 2008
Background: The purpose of the present study was to evaluate different types of maxillary preprosthetic surgery using autogenous bone graft and suggest a guideline for maxillary reconstruction to place implant. Methods: 181 patients (125 females and 56 males), age range from 16 to 76 years old, were operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri). Different techniques were used, but always with autogenous bone grafting. 21 patients underwent a Lefort 1 procedure, 139 underwent sinus graft with or without vestibular onlay graft and 21 underwent onlay graft. This surgical procedure was made to allow the insertion of 685 implants. Results: The patients were evaluated by clinical and radiological assessment. In the cases of Lefort 1, the rate of successful osteointegration was higher when the implants were placed in the second part of a two stages procedure: 92%, against 81% for one stage. In cases of sinus lift procedure, the rate of implant success was 98%. The infection rate was 3.5%. There was no significant resorption and the type of prosthesis used was a denture retained by a bar or fixed bridge. In cases of onlay graft, the implant insertion success was 97% and there was no infection. The amount of resorption was more significant in the pre-maxilla than in the other areas and the type of prosthesis used was fixed dentures. Conclusion: These observations demonstrate that: the aetiology of the bone defect indicate the type and number of the surgical procedures to re-established good jaws relationship and give the bone conditions to implant insertion successful. Clinical Relevance: A guideline for surgical decision in the maxillary reconstruction for oral rehabilitation by implants may help to prevent failures of osseous resorption disorders and to foresee the investment of the bone in quality and necessary quantity.
International Journal of Oral and Maxillofacial Surgery, 1997
This study presents the results from 20 consecutive patients treated with an autogenous bone graft from the iliac crest. In ten patients the graft was placed in the maxillary sinuses and the floor of the nose (inlay group). Ten patients, in addition to the inlay graft, had a corticocancellous bone block secured with mini-screws to the anterior maxillary ridge (inlay/onlay group). Endosteal implants (BNnemark | were placed six months after surgery. A total of 136 implants were placed, of which eight failed to integrate during the six-month healing period. A further 15 implants were lost during the follow-up period. For the inlay group the average follow-up period was 22 months and for the inlay/ onlay group 19 months. Donor site morbidity was significantly less when iliac bone was harvested with a trephine (inlay group) than in patients treated with our routine procedure for bone harvesting (inlay/onlay group). Surgical technique, donor site morbidity, implant survival and patient acceptance are presented.
Methods to Treat the Edentulous Posterior Maxilla: Implants With Sinus Grafting
Journal of Oral and Maxillofacial Surgery, 2009
Prosthetic rehabilitation of the edentulous posterior maxilla with implant-supported prostheses frequently presents a challenge for the oral surgeon because of the lack of bone due to alveolar ridge resorption or maxillary sinus pneumatization. To overcome these problems, different solutions were proposed over the years, such as the use of short implants or tilted implants (including zygoma implants), with the aim of avoiding maxillary sinus floor elevation. Both of these techniques have advantages and disadvantages that should be evaluated carefully to choose the most appropriate treatment. Zygoma implants or short/tilted implants are not a panacea for the treatment of patients with inadequate posterior maxillary bone stock. Instead, treatment should be based on the characterization of resorption patterns of the posterior maxilla, and may include the need for sinus grafting or other grafting procedures to reestablish not only adequate bone volume for implant placement, but also a favorable intermaxillary relationship, to optimize the functional and esthetic outcome of the final prosthetic rehabilitation. The authors discuss the indications, advantages, and disadvantages of sinus-grafting procedures in association with or without other reconstructive procedures.
Nasal Floor Augmentation for the Reconstruction of the Atrophic Maxilla: A Case Series
Journal of Oral and Maxillofacial Surgery, 2012
The severely atrophic edentulous maxilla imposes a challenge for dental implant rehabilitation. Nasal floor augmentation (NFA) is a method of augmenting bone height in the anterior maxilla. Autogenous bone has been commonly used as a graft material. Because of variations in results and lack of insufficient studies reporting the use of bone substitutes to graft the nasal floor, this study aims to evaluate the survival and success of dental implants placed in nasally grafted maxillae with osteoconductive bone substitutes. Materials and Methods: Six patients with completely edentulous maxillae and inadequate height in the anterior to support implants underwent NFA. The nasal floor was exposed through an intraoral approach and grafted with osteoconductive bone graft substitutes. Twenty-four dental implants were placed, restored with a bar-retained implant-supported overdenture after a traditional healing period, and followed up after prosthetic loading. Patient satisfaction was evaluated with a questionnaire, and responses were expressed on a visual analog scale from 1 to 10. Bone levels were quantified radiographically based on a score ranging from 1 to 3, where 3 represented the highest bone support. Implants were evaluated for thread exposure and soft tissue health and were considered successful if the following criteria were met: absence of mobility; lack of symptoms; bone score of 3; and healthy peri-implant soft tissue without thread exposure. Results: The age of patients ranged from 48 to 84 years, with a mean of 71.2 years. Three patients underwent NFA and simultaneous implant placement, whereas the other 3 had a mean healing period of 6.5 months before implant placement. Post-loading follow-up ranged from 4 to 29 months, with a mean of 14.2 months. The implant survival rate was 100%, with no complications. Ninety-three percent of the responses to the treatment satisfaction questionnaire had a score of 7 or greater. Bone scores ranged from 2 to 3, with 87.5% of implants having a score of 3 and 12.5% having a score of 2. None of the implants had a bone score of 1. Conclusions: The use of osteoconductive bone substitutes for NFA, as shown in this small case series, is a reliable method for reconstruction of the anterior atrophic maxilla for implant-supported overdentures.
Maxillofacial Plastic and Reconstructive Surgery
Total mandible and bilateral TMJ reconstruction combining a customized jaw implant with a free fibular flap: a case report and literature review, 2023
Background The need for whole mandibular bone reconstruction and bilateral joint replacement is fortunately rare, but it is an extremely challenging topic in maxillofacial surgery, due to its functional implications. CAD-CAM techniques development has opened new broad horizons in the surgical planning of complex maxillofacial reconstructions, in terms of accuracy, predictability, and functional cosmetic results. The review of the literature has revealed a small number of scientific reports on total mandibulectomy including the condyles, with only eleven cases from 1980. Most of the works describe reconstructions secondary to dysplastic or inflammatory diseases affecting the lower jaw. The aim of this work, reporting a rare case of massive fibrous dysplasia of the whole mandible, is to share our experience in the management of extended mandibular and bilateral joint reconstruction, using porous titanium patientspecific implants. Case presentation The authors present a 20-year-old male patient suffering from massive bone fibrous dysplasia of the mandible. The mandibular body and both the rami and the condylar processes had been involved, causing severe functional impairment, tooth loss, and facial deformation. The young patient, after repeated ineffective conservative surgical treatments, has required a biarticular mandibular replacement. Using virtual surgical planning (VSP) software, the authors, in collaboration with medical engineers, have created a custom-made original titanium porous mandibular implant, suspended from a bilateral artificial temporomandibular joint. The mandibular titanium implant body has been specifically designed to support soft tissues and to fix, in the alveolar region, a free fibular bone graft, for delayed dental implant prosthetic rehabilitation. Conclusion The surgical and technical details, as well as the new trends in mandibular reconstructions using porous titanium implants, are reported, and discussed, reviewing literature reports on this topic. Satisfactory functional and cosmetic restorative results have been obtained, and no major complications have occurred. The patient, currently in the 18 th month clinical and radiological follow-up, has recently completed the functional restoration program by an implant-supported full-arch dental prosthesis.