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Three cases of replacement of the condylar process have been presented with their courses and the type of prosthesis that was chosen. Each case has a unique cause with different needs for the use of a prosthesis.
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The Proplast TMJ condylar implant, the glenoid fossa implant, and the TMJ interpositional implants should be singled out as having provided a new and more predictable mode of TMJ reconstruction. The use of these implants in cases of ankylosis, degenerative joint disease, orthognathic deformities, and traumatic injuries has greatly contributed to the success of these reconstructions. These implants represent the state of the art in TMJ reconstruction and increasing data from longer-term follow-up have shown a rate of success much higher than any previous implant used in the TMJ. TMJ reconstruction requires careful surgical planning, meticulous surgical technique, and intelligent perioperative care. Postoperative physical therapy is considered essential in the management of these patients. Complications related to reankylosis have been virtually eliminated, as no postoperative immobilization is required in most cases. Long-term stability of these implants, due to the ingrowth of tissue into Proplast, appears to be assured. Continued experience with the implants and close follow-up of reconstruction patients is necessary in the future to adequately assess the performance of the newer glenoid fossa and TMJ interpositional implants. Certainly, a new era in TMJ reconstruction has begun, resulting in increased benefits to the patients whom we all serve.
Communication between the surgeon and the maxillofacial prosthodontist before, during, and after surgery is the most important aspect to successful prosthetic rehabilitation of the head and neck cancer patient. Surgeons should understand the problems and limitations involved in prosthetic rehabilitation so that the patient is adequately educated during rehabilitation. Osseointegrated implants, although an important advancement in this field, should not take the place of proper defect preparation. The use of implants in the irradiated patient is currently being evaluated by controlled studies. However, if implants are used, then their position and number should be carefully planned in the pretreatment phase. Preparation of the defect by skin grafting and controlling the position of the remaining structures is important to the overall aesthetic and functional result of the prosthesis.
A report of ten-year follow-up examinations of a patient who had a hemimandibulectomy with disarticulation because of fibrous dysplasia and immediate permanent reconstruction of the mandible with a Vitallium custom-cast prosthesis is presented. Careful preoperative planning, operative technique, and postoperative follow-up examinations are essential for successful maintenance of the prosthesis. Autogenic bone grafts are, in general, superior to alloplasts in permanent reconstruction of defects in mandibular continuity after resection. However, there are indications for alloplastic reconstruction when the condyle is disarticulated with the resection.
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Breakage of a segment of an acrylic resin denture base of a mandibular removable prosthesis may result from inadequate retention and support. The runner bar modification can be a solution for this problem, especially where excessive crown length is to be restored in the mandibular anterior region. A technique is described for placement of a 14-gauge (1.7 mm) round wax runner bar that conforms to the anterior arch form on the removable partial denture wax-up. Wax vertical struts are added between the denture base retention and the runner bar. Improved retention and rigidity, without compromising esthetics and function, can be obtained through use of this procedure.
The purpose of this study was to evaluate the long-term functional properties of regenerated bone induced by recombinant human bone morphogenetic protein-2 (rhBMP-2) in segmental bone defects of primate mandibles. The 30-mm defects were created in the mandibles of six young monkeys and the mandibles were fixed with titanium plates. Then 9 mg of rhBMP-2 permeating a poly-D, L-lactic-co-glycolic acid-coated gelatin sponge (PGS) was implanted into the bone defect. Dental implants were placed into the regenerated mandible 20 weeks after surgery, then suprastructures were placed and masticatory force loading was begun 8 weeks after the insertion of the dental implants. Bone formation and the quality of new bone were evaluated radiologically and histologically at 15 and 30 weeks after surgery, and 4 and 24 weeks after masticatory force loading. The resected mandibles were completely regenerated with the rhBMP-2-induced bone. Excellent remodelling and consolidation of new bone were observed after loading. This study demonstrated that the new bone induced by rhBMP-2 in large segmental defects was maintained and functional for at least 1 year. Bone regeneration induced by rhBMP-2 holds promise as a future therapy and may be an effective alternative to autogenous bone grafts for implant dentistry and reconstructive surgery.
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This study used three-dimensional finite element analysis to investigate the effect of three different occlusal surface materials (resin, resin composite, and porcelain) and four different framework materials (gold, silver-palladium, cobalt-chromium, titanium alloys) on the stress distribution in a six-implant-supported mandibular fixed prosthesis and surrounding bone. A total of 172 N vertical load was distributed over the entire occlusal surface of the finite element model. Generated stress values were calculated in the occlusal surface material, framework, prosthesis retaining screws, implants, and surrounding cortical and spongy bones. The results obtained demonstrated that using a prosthesis superstructure material with a lower elastic modulus (1) did not lead to substantial differences in stress patterns nor in values at the cortical and spongy bones surrounding the implants; and (2) concentrated stresses in the retaining screws for the prosthesis and thus increased the potential risk of prosthesis failure. For the single loading condition investigated, the optimal combination of materials was found to be cobalt-chromium for the framework and porcelain for the occlusal surface.
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PURPOSE: The aim of the present article is to review some of the technical treatment options for implant prostheses restoring the edentulous mandible, mainly based on the Brånemark system. MATERIALS AND METHODS: Clinical and technical aspects are discussed for the three established concepts: (1) implant-supported fixed prosthesis, (2) removable implant-supported overdenture, and (3) combined implant-retained and soft tissue-supported overdenture prosthesis. RESULTS: The framework of an implant-supported fixed screw-retained prosthesis can be processed in gold, Co-Cr alloy, or titanium with casting, laser-welding, or milling techniques. To improve the stability and retention of a conventional complete denture, one to four implants are indicated, and unsplinted (single attachments) or splinted designs (bar systems) can be applied. The design of the overdenture prosthesis must be carefully planned according to the requirements to ensure adequate stability and optimal form, contour, and esthetics, and the patient's best comfort. CONCLUSION: A large variety of different treatment modalities exist for both the fixed and removable mandibular implant prosthesis. Clinical and technical aspects should be considered at the beginning of the treatment to: (1) select the optimal implant position, (2) establish an adequate number of functional units, (3) select the appropriate retainers, and (4) apply the best technique for framework processing and veneering.
The results presented show the relative importance of muscle force and occlusal resistance locations and prosthesis/hemimandible interface length. For the prosthesis design used, the addition of muscle function on the prosthesis side has little effect upon bone stress. However, occlusal resistance on the prosthesis side produces much more stress in the bone than other resistance positions. Stress produced by the shorter prosthesis is higher at the areas of bolt/bone interface than for the long prosthesis. However, superimposed inherent stress patterns somewhat obscured the comparison with longer prostheses.
In patients with tumors of the head and neck, ionizing radiation delivered in dosages that will kill cancer cells induces unavoidable changes in normal tissue. Bone cells and vascularity may be irreversibly injured, leaving devitalized bone susceptible to the development of osteoradionecrosis. This clinical report describes the fabrication of an acrylic/rubber prosthesis retained by an orthodontic headgear. The prosthesis was used to improve the mastication, speech, and saliva control of a patient treated for osteoradionecrosis of the mandible.
This report presents the case of a teenager affected by hypohidrotic ectodermal dysplasia and rehabilitated with a fixed maxillary partial prosthesis and mandibular overdenture supported by osseointegrated implants. Treatment had a major impact on patient's self-esteem, function, and esthetics.
The therapy of facial fractures is aimed at an early definitive treatment. Exact repositioning of the fragments is first achieved by setting the right occlusion. Intermaxillary fixation is then performed by interdental arch bars reenforced with acrylic material and intermaxillary rubber bands or wire. The middle third of the face is mainly subjected to static forces. Fractures in this area are therefore set and fixated with interosseous wire ligatures. Craneofacial suspension is carried out by means of a craneofixateur extern. Fractures of the mandible are treated differently. In order to counteract the strong dynamic forces internal fixation is necessary using compression plates in combination with tension bands. Another modality of treatment by a specially designed plate with excentric gliding holes renders the tension bands superfluous since it is capable of applying compression forces also at the dental area. In fractures with osseous defects long plates are used which stabilize the mandibular arch. If the articular prominence is missing these plates may be applied with a capitular end in order to reconstruct the articulation.