Application of a surgical navigation system for implant surgery in a deficient alveolar ridge postexcision of an odontogenic myxoma.

PURPOSE: The study's purpose was to describe the application of a surgical navigation system for the treatment-planning and subsequent precise placement of dental implants in a patient, 2 years postexcision of a mandibular odontogenic myxoma. PATIENTS AND METHODS: A 25-year-old male patient presented for rehabilitation of a deficient edentulous ridge at the right mandible following excision of an odontogenic myxoma. The patient was imaged by dental computed tomography while wearing an individually fitted interfacing acrylic splint. Thereafter, computed tomography data were imported to the Image-Guided Implantology system (IGI; DenX Advanced Dental Systems Ltd, Moshav Ora, Israel), and a precise 3-dimensional implant treatment plan was contemplated considering the compromised anatomy and the anticipated prosthesis. RESULTS: Three dental implants were placed using a surgical navigation approach with precise coordination to the presurgical treatment plan and subsequently were restored with a screw-retained fixed prosthesis. At the 1-year follow-up, the implants were osseointegrated and the fixed prosthesis was fully functional. CONCLUSIONS: Computerized navigation is indicated for dental implant surgery in patients with deficient alveolar ridge where coordination of the positioning of the implants to the final prosthesis is difficult.     

Rehabilitation of a Bilateral Maxillectomy Patient with a Free Fibula Osteocutaneous Flap and with an Implant‐Retained Obturator: A Clinical Report

A 47‐year‐old man underwent surgical resection and reconstruction with a fibula osteocutaneous flap. After the surgery, a surgical obturator was placed and adjusted. After flap healing, a conventional obturator was fabricated with polymethyl methacrylate resin and retained by the anatomical undercuts around the reconstructed fibula bone flap and the posterior part of the defect. As the defect shape changed with time, a second conventional obturator was fabricated and fitted. No further recurrence of myoepithelioma was observed for 2 years, and the patient was satisfied with the obturator during mastication and speech; however, despite having no major complaints, the patient found it difficult to chew on the right side, and the obturator was displaced slightly downward when the mouth was opened wide and shifted when chewing hard and sticky food. Thus, an implant‐retained obturator was suggested to provide better retention and stability. Four dental implants were therefore placed into the fibula bone, although one did not osseointegrate because either primary stability was insufficient or overload was affected in the nonloaded implant environment and was replaced. After fitting custom abutments with a magnet, an implant‐retained obturator was placed, and the patient was satisfied with the outcome. During 3 years of follow‐up, no issues were noted with the implant bodies, abutments, obturator, or reconstructed site. The conventional obturator was displaced slightly downward when the patient opened his mouth wide, and it shifted when chewing hard and sticky food because there was limited fibula bone at the reconstruction site and more available posteriorly. For better retention and stability, the implant‐retained obturator was fabricated with a custom abutment and magnetic retention. The patient was satisfied with the results, as improved implant retention increased the stability of the prosthesis. This clinical report describes the rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap and an implant‐retained obturator. The patient's oral functions were improved when the prosthesis was stabilized by means of dental implants and custom abutments.     

Fabrication of a hollow obturator as a single unit for management of bilateral subtotal maxillectomy

Prosthetic rehabilitation with an obturator for a total or subtotal maxillectomy patient is a challenging task, as there are little or no residual maxillary structures to depend on for support, retention, and stability of the prosthesis. This clinical report describes the prosthodontic management of a patient operated on for a bilateral subtotal maxillectomy secondary to ameloblastoma of the palate with a closed hollow obturator. The processing technique described in this article to fabricate the hollow obturator is a variation of other well-known techniques. The variation comprises the use of a wax bolus to maintain a predictable internal dimension for a hollow obturator. This technique allows fabrication of a complete hollow obturator prosthesis as a single unit in heat-polymerized acrylic resin using a single-step flasking procedure.     

The use of dental implants to retain thumb prostheses: a short-term evaluation of 2 cases

This article presents the use of dental implants for the retention of thumb prostheses. Two patients with traumatic amputation of the thumb were rehabilitated with implant-supported digital prostheses. A dental implant was placed in the residual bone of the thumb. After a 3-month osseointegration period, retentive attachment and silicone prostheses were fabricated. Osseointegration of the implant, peri-implant skin health, and prosthesis function were assessed every 6 months. The follow-up period was 18 months for patient 1 and 21 months for patient 2. Osseointegration was achieved, and there were no skin problems. Some degree of tactile sensation was observed, and the patients were satisfied with the esthetic result.     

A two-part prosthesis for edentulous patients following maxillectomy

Conventional dentures constructed for edentulous patients who have undergone maxillectomy have serious deficiencies, not the least being the lack of employable support and retention. This paper describes a method for the construction of a prosthesis which incorporates a removable flexible obturator. This technique overcomes the anatomical problems which limit conventional restorations, and provides dentures which are retentive and stable in function and comfortable for the patient to wear.     

Zygoma implant-supported prosthetic rehabilitation after partial maxillectomy using surgical navigation: a clinical report

The rehabilitation of patients with acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. In most patients these goals are met by means of prosthetic rehabilitation with an obturator prosthesis. If the remaining dentition does not offer sufficient retention and support, the placement of zygoma implants can enhance the stability of the prosthesis. Due to the anatomic intricacies of the zygomatic bone and the implant length, computer-supported navigated implant placement can be advantageous. In the following clinical report, a diabetic patient with a status of posthemimaxillectomy secondary to aspergillusis infection is presented, in whom a zygoma implant was placed using a CT scan-based navigation system. A special retentive anchoring abutment was used to integrate the zygoma implant into a telescopic crown-retained denture on the residual dentition. This tooth-implant-supported obturator prosthesis restored function and phonetics, as well as esthetics, for this young patient.     

Implants for fixed and removable prostheses.

For those individuals whose oral anatomy contraindicates the use of endosteal implants, there still remains a viable alternative to conventional removable dentures. Both maxillary and mandibular implant dentures of a subperiosteal design will provide a stable implant and a retentive restorative prosthesis. The patient is free from the oral gymnastics required to manipulate such appliances and in the maxilla the dentist is able to eliminate all palatal coverage without compromising the retention of the bridge. The lower subperiosteal implant and the pterygoid extension implant discussed both obtain their stability from accurate fit of the implant substructure to the bone. The implant first becomes more retentive when the periosteum tenaciously reattaches itself to the bone and in turn secures the implant in position (Fig. 13). The restorative procedures follow sound prosthetic prinicples with particular attention on avoiding any impingement of the underlying tissue areas. Implant dentures have truly provided patients a means of exploring alternative treatment modalities other than conventional removable dentures. Literally thousands of patients today are living testimony to the accomplishments of oral implantology when pursued as an exacting science prescribed by colleagues experienced in this revolutionary dental discipline.     

A custom made extraoral aid for retaining interim obturator in edentulous patients with bilateral maxillectomy: A report of four patients

It is a considerable challenge for a prosthodontist to rehabilitate and sustain the prosthesis in edentulous patients with bilateral maxillectomy. Compelling evidence is lacking with respect to the treatment outcome when the maxillary defects are closed surgically in comparison to their prosthetic rehabilitation. Four edentulous male patients, with bilateral maxillectomy defects were referred for prosthodontic intervention to meet their nutritional and speech issues. In the absence of intra oral supporting and retentive structures, it was decided to retain the obturator utilizing extraoral aid to address their functional needs. Customized headgear face‐bow retained obturators were adequately retentive and did serve its purpose well in all four patients. It also gave the liberty to alter retention and refine the prosthesis at will, provided access to the operated site for a quick evaluation of disease recurrence, and was economical to the patients. Considering the encouraging outcome experienced in this special category of individuals, it would be reasonable to believe that the headgear face‐bow assembly has an immense potential to function as a valuable, prudent, and a viable retentive aid for a non‐implant retained obturator in edentulous patients with extensive maxillary defect.     

A Novel Method for Retention of an Orbital Prosthesis in a Case with Continuous Maxillary and Orbital Defect

Exenteration of the orbital contents as well as removal of a part of maxilla with an ablative surgery for the removal of a malignant tumor can severely affect a person in terms of function, esthetics and psychological trauma. A well-retained, user-friendly, removable maxillofacial prosthesis is the key to successful prosthetic rehabilitation in such cases. Various retentive techniques include using spectacle frame, conformers, adhesives, osseointegrated implants, magnets or buttons. This paper describes a novel technique for retention of silicone orbital prosthesis using acrylic resin base attached to maxillary obturator with the help of pin and socket of an electric plug wherein the latter is attached to the eye prosthesis with the help of a mechanical undercut. This helps in better retention of both the prostheses.     

Rehabilitation of Partial Maxillectomy Defect with Implant Retained Hollow Bulb Obturator Prosthesis: A Case Report

Tissue integrated oral implants have initiated a new perspective in oral rehabilitation of tumor patients who have had undergone surgical resection procedure. The present case demonstrated a simple and predictable approach to rehabilitate a patient who had partial maxillectomy using dental implants. The use of an implant in conjunction with hollow bulb obturator shared remarkable improvement in retention and stability of the existing complete denture prosthesis.     

Framework night guards for implant-retained auricular prostheses

Prosthetic ear rehabilitation with osseointegrated implants involves using a cast or preformed framework (bar) constructed to fit the implant abutments. Retention of the prosthesis is obtained through clips or magnets. Because the prosthetic ear is not worn during sleep, the ends of the retention bar are left exposed. These projections may become entangled with the linen or hair. To prevent this problem a night guard constructed of soft mouth-guard material is worn over the retentive bar while the patient is sleeping.     

Surgical and prosthetic reconsiderations in patients with maxillectomy

Summary The purpose of this study was to establish and evaluate new possibilities for rehabilitation of patients with obturator prosthesis who had undergone partial or total maxillectomy because of tumour ablation surgery. Eleven patients with maxillary defects were reconstructed with a computer‐aided design/computer‐aided manufacturing designed prosthesis. Missing retention was gained by inserting implants in the remaining bone, so that an expansion of the surgical defect to gain further retention could be avoided. All patients were treated successfully according to the previously described treatment plan. The Obturator Functioning Scale (OFS) of the Memorial Sloan‐Kettering Cancer Centre was applied to evaluate the functional quality of the obturator prosthesis and patient’s satisfaction. It showed good results in all fields of functional outcome and social acceptance.     

Oral rehabilitation with dental implants after cancer treatment

Background: Patients who undergo surgical management of oral cancer may greatly benefit from an implant‐supported prosthesis. This study reports on the clinical experience of dental implant placement in patients following resection of oral cancer over a 15‐year period. Controversies including the use of dental implants in irradiated tissues, and hyperbaric oxygen treatment will also be discussed. Methods: Thirty‐one patients who had dental implants placed as part of their oral rehabilitation between 1992 and 2007 were investigated. Demographic data and factors including implant survival, type of prosthesis provided, radiotherapy and the hyperbaric oxygen therapy were analysed. Results: In this retrospective study, there was a retention rate of 110 implants from a total of 115 implants placed. A high rate of implant retention was found, with 5 implant failures from a total of 115 implants placed. The 5 failed implants occurred in free flap bone that had been irradiated. Conclusions: Dental implants provide an important role in the oral rehabilitation of oral cancer patients. There may be an increased risk of implant failure in free flap bone that has been irradiated.     

种植体与杆卡式附着体用于义耳修复

将３只骨融合式螺旋种植体植入耳缺损区，采用杆卡式附着体作为种植上的部结构和义耳的固体装置，解决义耳固位，这种固位方式具有固位可靠，取戴方便，便于自洁，利于局部组织健康等优点，特别是在对抗侧向力方面具明显的优越性，是目前义耳修复最佳的固位方式。     

Dental implants in geriatric patients: a retrospective study of 47 cases

PURPOSE: To determine the overall success of dental implants placed in geriatric patients. PATIENTS: Dental implants were placed in 47 geriatric patients who were 79 or more years of age at the time of the procedure. The study group was composed of 27 men and 20 women, with a median age of 89 years and a range of 79 to 99 years of age at the time of implant surgery. A total of 73 dental implants were placed in the maxilla and 87 dental implants placed in the mandible. All implants were restored with fixed implant-supported prostheses or removable implant-supported prostheses. Eleven of the patients underwent maxillary sinus augmentation with porous hydroxyapatite and platelet-rich plasma. Seven patients had their implants immediately loaded. RESULTS: A total of 160 dental implants were placed in the 47 geriatric patients. One hundred fifty-nine integrated successfully. In the case of the failed implant, the site was grafted and another implant was placed 5 months subsequent to the initial failure. This replacement implant integrated and has been in function for 6 months. The survival rate for dental implants placed in the maxilla was 99% and in the mandible was 100% in our geriatric population. CONCLUSION: Treatment with dental implants can be predictable and safe for the rapidly growing geriatric population. Geriatric patients who are medically stable are suitable candidates for osseointegrated implant surgery, which facilitates oral function, comfort, and quality of life. A review of the 47 geriatric patients treated supports the conclusion that dental implants can be successfully placed and restored with fixed implant-supported or removable implant-supported prostheses.     

Reconstruction of a maxillectomy patient with an osteocutaneous flap and implant-retained fixed dental prosthesis: a clinical report

This clinical report describes a multidisciplinary approach in the implant rehabilitation of a 53-year-old white male diagnosed with chondrosarcoma. Following a maxillectomy and insertion of a surgical obturator, the patient was unable to adapt physically and psychologically to the removable prosthesis. The patient underwent a microvascular free tissue transfer using an osteocutaneous free fibula flap to reconstruct a right/left infrastructure maxillectomy defect, a soft tissue modification of the skin component using an implant retained stent, and placement of maxillary dental implants to retain a fixed prosthesis. Prosthodontic planning and treatment considerations are discussed.     

Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations: a 7-year retrospective study

PURPOSE: Placement of small-diameter implants often provides a solution to space-related problems in implant restoration. This 7-year retrospective study presents results from 192 small-diameter implants placed in 165 patients from 1992 to 1996. MATERIALS AND METHODS: The dental records of each patient were reviewed. The implants, which were either 2.9 mm or 3.25 mm in diameter, were placed by 2 different surgeons. All prosthetic appliances were fabricated by the same prosthodontist. Ninety-four implants supported single-tooth cemented restorations; the remaining 98 implants supported cemented or screw-retained partial prostheses. RESULTS: The total implant survival rate was 95.3%. Four implants were lost at second-stage surgery, and 5 more were lost after loading. DISCUSSION: Small-diameter implants demonstrated a survival rate similar to those reported in previous studies of standard-size implants. CONCLUSIONS: The results suggest that small-diameter implants can be successfully included in implant treatment. They may be preferable in cases where space is limited.     

Implant Retained Auricular Prosthesis with a Modified Hader Bar: A Case Report

Auricular prostheses for defects of external ear are retained either by mechanical means or implants. All implant retained prostheses are retained by various means such as bar and clip, magnetic attachments or a combination of bar, clip and magnets. The commonest problem encountered with the bar and clip system is loosening of the clip after 3–4 months. When magnets are used as retaining component they tend to corrode over a period of time. So various alternative retention methods which possess good retentive qualities, ease of reparability and patient friendly were tried. In the present case a newly modified Hader bar design which can act as an additional retentive feature apart from the clip is employed to increase retention. The major advantages in the modified Hader bar system were that only two implants were employed, the additional loops in the Hader bar prevented micro movements and the retentive acrylic locks were easy to repair if broken. The modified Hader bar has anti-rotational slots which prevents the sliding or rotation of the prosthesis which gave new confidence to the patient who was otherwise worried of inadvertent displacement of the ear prosthesis while playing.     

Overdenture retention of four resilient liners over an implant bar

STATEMENT OF PROBLEM: Resilient denture liners offer an alternative method of designing implant-retained overdentures. Space is provided in the overdenture to envelop the implant bar with a resilient liner to be applied chairside or processed in the laboratory. The degree of retention may vary and these materials change over time. PURPOSE: This study evaluated the retention on an implant/bar prosthesis with overdentures lined with 4 resilient denture lining materials, after cyclic insertion and removal over a simulated 1.5-year period. MATERIAL AND METHODS: Four implants were placed in a mandibular edentulous cast and a gold bar superstructure was made. Overdentures were processed in Lucitone-199 and Tokuyama, Luci-Sof, Molloplast-B, and PermaSoft (with and without sealer) lining materials, cured according to manufacturers' instructions. Each of 5 overdentures contained each liner and were cycled 2740 times (simulating 1.5 years of service at 5 insertions daily) in 37 degrees C water in an Instron at 20 cm/min. Insertion and retention force were measured. RESULTS: The 3 silicone rubber liners were 3 to 5 times more retentive than the plasticized acrylic liner initially. After cycling, Tokuyama soft liner (autopolymerized silicone) gained 14% retention, Luci-Sof (heat-cured silicone) gained 8%, Molloplast-B (heat-cured silicone) lost 12%, whereas PermaSoft (autopolymerized plasticized acrylic) with sealer lost 43%, and without sealer lost 60%. PermaSoft lining material also chafed and crumbled after cycling and was significantly less retentive in most statistical comparisons. CONCLUSIONS: All the silicone-based resilient liners retained the overdentures well. The plasticized acrylic was less retentive initially, and lost significant retention after 2740 cycles, compared with silicone-based resilient liners.     

Prosthetic rehabilitation of the edentulous patient requiring a partial maxillectomy.

A variety of problems faces the prosthodontist attempting reconstruction of maxillary defects. This article reviews developments in materials and techniques of obturator prosthesis design for patients experiencing maxillectomy. The size of the maxillectomy defect is one of the main factors governing the prognosis for treatment. Many patients require special prosthodontic techniques. However, routine attention to extension of the prosthesis and balanced occlusion is essential. Obtaining satisfactory retention and stability in the definitive obturator prosthesis can be elusive. Resilient denture base materials are extremely useful in retaining the prosthesis, which obturates small defects. However, the flexibility of these materials makes them unsuitable in large maxillectomy cavities because of the deformation that occurs during mastication. Alternative forms of retention, eg., osseointegrated implants and sectional prostheses retained by magnets, are discussed.