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We present a new modification of an endaural incision for access to the temporomandibular joint. This gives excellent posterior, anterior, lateral and inferior exposure, avoids important anatomical structures and provides an almost invisible scar.
Numerous alloplastic materials have been used for partial or total reconstruction of the temporomandibular joint in patients with fibrous or bony ankylosis, severe degenerative joint disease, or traumatic deformity, and for reconstruction following tumor resection and corrective surgery following multiple arthroplasties. We have had initial success with the use of a polyoxymethylene (Delrin) condylar head affixed to a pure titanium mesh for these reconstructive procedures. This versatile prosthesis does not require use of a separate glenoid fossa prosthesis. The surgical technique, as well as a historical perspective on alloplastic total joint prostheses used to date, is described in several patients.
Six partially or fully edentulous rheumatoid patients participated in the study. By comparing the clinical symptoms and tomograms of the temporomandibular joints (TMJS) pre-prosthesis with those post-prosthesis, this report assesses whether dental treatment could provide positive help for TMJS in patients with rheumatoid arthritis (RA). Among the clinical symptoms of TMJ dysfunction, pain from the TMJ region and limitations of movement were improved in all the patients post-prosthesis. Tomographic evidence of desirable remodelling of the condylar heads was observed in two cases.
Whether the result of technical errors or anatomic aberrations, malalignment of osseointegrated implants can create significant difficulty for the restorative dentist who fabricates the final tissue-integrated prosthesis. As a result, the planned prosthesis may defy completion or the implants may have to be left buried. This clinical report illustrates a solution to fabricating a fixed/detachable tissue-integrated prosthesis on malaligned posterior mandibular implants.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Delayed treatment of a patient having micrognathia after surgical correction of gnathopalatoschisis, using a bar joint between the telescopic devices on the remaining teeth, a maxillary cover denture and a supported mandibular model-cast prosthesis.
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The use of preformed vitallium TMJ-prosthesis in combination with a microvascular iliac bone graft is an alternative method for hemimandibular reconstruction. It has several advantages compared with earlier described methods, and we have used it successfully in two cases.
The ideal natural or prosthetic mandibular replacement should be adjustable at the time of surgery, completely stable, free from tissue reaction or rejection, rapidly incorporated into surrounding tissue, and unlimited in lifespan. A brief review of clinically utilized mandibular replacements is discussed in relation to the ideals. At this time the replacement most adequately satisfying these principles is autogenous cancellous bone and marrow supported by a titanium mesh trough. This article describes the details of external mandibular fixation and the reconstructive procedure including preoperative preparation and common postoperative complications. Modifications of the prosthesis and surgical technique are suggested in order to decrease the chances of postoperative exposure, a complication in any type of mandibular reconstruction.
The prosthodontic prognosis in patients with lateral discontinuity defects of the mandible is dependent on a number of complex factors. In some patients only esthetics can be improved, whereas in others mastication and speech improvement can be achieved. Two patients who had undergone the same surgical interventions but presented with different problems are described. The first patient had difficulty with mastication and mandibular movements, which was resolved by building a ramp on a maxillary prosthesis. The second patient had severe speech and swallowing problems, which were corrected with an acrylic, hollow speech prosthesis. In both patients the end result was satisfactory.
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Twenty-three edentulous patients who had been treated with a mandibular fixed complete denture retained by osseointegrated implants were followed over a 10-year period. Nine of these patients had received a maxillary fixed implant-supported complete denture prosthesis after the initial placement of the mandibular restoration, while the remainder still used a conventional maxillary complete denture. The maximal occlusal force or mastication efficiency index of those having fixed implant-supported prostheses in both arches did not differ markedly from those having only a mandibular restoration. However, at the 3-year examination, lower values were recorded for the self-rated masticatory ability, while higher values were given after 10 years. It was concluded that placement of a mandibular fixed implant-supported prosthesis in dissatisfied complete denture wearers led to a dramatic improvement of masticatory function that was quite acceptable for many patients. However, some patients subsequently demanded a maxillary fixed prosthesis to feel satisfactorily rehabilitated.
OBJECTIVE: We analyzed a retrospective series of 30 cases of ameloblastoma operated in the Ivory coast from 1992 to 2000. PATIENTS AND METHODS: The following techniques were used--temporary reconstructions via the endobuccal approach using a Peri prothesis in 27 cases and a resin coated Peri prosthesis in one;-- definitive reconstructions using iliac bone grafts in 3 cases and rib grafts in 14. These reconstructions were performed in a second operation via a cutaneous approach to replace the Peri prosthesis. Thirteen patients were lost to follow-up for this second phase. Mean follow-up ranged from 6 months to 13 months (mean 9.9 months). RESULTS: Satisfactory outcome was acchevied when mouth opening was greater than 10 mm and patients with an acceptable cosmetic result no longer complained of mastication or phonation problems. There were four postoperative infections after bone graft reconstruction (two of them were immediate reconstruction). The resin coated Peri prosthesis led to a skin ulceration. DISCUSSION: This study demonstrated the interest of mandibular reconstruction in undermedicalized countries where indications are dominated by reconstruction after resection for ameloblastoma. The large number of patients lost to follow-up before the second stage bone grafts points out the need for immediate reconstruction using autologous bone. Further study in a larger series would be needed to determine the cause of failure after immediate reconstruction.
The patient described in this case report required removal of several mandibular incisor teeth because of severe periodontal disease. She demanded an immediate replacement for these teeth, but, because of the periodontal conditions, it was not possible to use conventional approaches to fulfill her request. The decision was made to fabricate an immediate indirect-direct, reinforced, bonded composite resin periodontal prosthesis. The patient's extracted mandibular central incisors were used as pontic replacements. The procedure was expedient, inexpensive, and conservative, and the results were esthetic.