PubMed · 3277724
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R A James, J L Lozada, P H Truitt, B E Foust, S A Jovanovic. 1988. Subperiosteal implants.. https://pubmed.ncbi.nlm.nih.gov/3277724/
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Microvascular iliac crest and scapula transplants have been used in reconstruction of the lower jaw following tumor surgery. It has only been with the insertion of dental implants that a satisfactory prosthetic rehabilitation of the patient has been achieved. For this study, a follow-up of 38 patients with lower jaw tumors was carried out. The patients had been treated with partial resection of the lower jaw and neck dissection with microvascular iliac crest transplants (n = 20) or microvascular scapula transplants (n = 18); this was followed with dental implants (n = 143) in the region of the transplants or the local lower jaw. One hundred thirty-nine of the 143 dental implants were loaded by prosthetic superstructures. In all patients, the implant situation was evaluated on average 2 years 5 months after implantation. Periotest values, periimplant probing depths, and contact bleeding were registered, and the extent of periimplant bone loss was defined radiographically. The clinical situation in the region of the implant was compared for both types of implants and also with the nonresected lower jaw. The average Periotest values were within the normal range for all groups. In one scapula implant, however, a better average of Periotesting, -3.3, was found compared with implants of the iliac crest with Periotest values of -0.7. A measurement of -2.1 was found for the local lower jaw, similar to that of scapula implants. Pathologic probing depths were found for all three compared groups. The radiographically determined vertical loss of bone was the same for all three groups, on average 1 mm at 27 months postoperatively. The highest incidence of sulcus bleeding was found in the scapula implant group. Thus, it can be stated that the scapula transplants provide a similar transplant site to local lower jaw bone, whereas implants in iliac crest transplants show lesser bony stability. Periimplant soft-tissue conditions are worse for both types of transplants compared with local tissue of the lower jaw.
Reconstruction of segmental mandibular defects resulting from trauma, infection, or tumor resection still remains difficult. Although cosmetic improvement was seen in patients who had immediate reconstruction of the mandibular continuity, normal mastication and deglutition could not be achieved by conventional removable dentures. Since 1988, the treatment protocol has been modified to use endosseous root-form implants to support dental prostheses instead of the conventional removable prostheses in these patients. There are 2 types of prostheses that can be constructed over dental implants: (1) a removable implant overdenture and (2) a fixed detachable prosthesis. Although the latter better meets in patients' psychological needs, it may present problems such as phonetic discrepancies, food impaction, difficult home care, and poor esthetics if the patient has a high lip line. In addition, it is not easy to fabricate accurately in the laboratory. To overcome these problems, a case is presented to illustrate the use of another fixed-type prosthesis, a double-coping technique, for fabricating dentures so that any discrepancy between the inner and outer copings can be filled by cement. The technique not only improves the shortcomings of fixed detachable prostheses but also satisfactorily meets patients' desire for normal mastication and deglutition. Follow-up after 4 years showed no significant changes around the implants by clinical and radiographic examinations.
The use of CT-based intraoperative navigation has greatly improved controlled surgery in many specialties. In this study the precision of the SMN system (Zeiss, Oberkochen, Germany) for navigated drilling and following implantation in the maxilla is evaluated. This study should prove the suitability of navigation systems for computer-assisted implantation in the maxilla to avoid perforation to the maxillary sinus. Therefore 60 target drills were carried out on 10 standardized polyurethane milling models after CT-scanning. The models were produced with cranial open maxillary sinuses. The CT-scans were performed with a slice distance of 1 mm. Then the CT-data were transferred to the workstation of the SMN system (Zeiss, Oberkochen, Germany) and a referenciation of the fiducials for superposition of the native and CT model were done. Referenciation of the model was performed with the aid of a drilling tool. This drilling tool was used for later navigation-assisted drilling into the upper jaw. The target of drilling was the maxillary sinus floor. The aim was to come as near as possible without perforation. The distance of the bottom of the drilling holes to the maxillary sinus floor were measured after section of the model. An average drilling depth of 6.97 mm (s=0.4) and a mean distance to sinus floor of 0.11 mm (s=0.2) was found. In 13 cases the lower board of sinus was perforated.In conclusion a high precision of CT-based navigation for controlled preimplantological drilling was seen.