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PubMedDate not supplied

Advanced residual ridge resorption: surgical management.

With the introduction of osseointegration by Dr P.-I. Brånemark, reconstruction of advanced residual ridge resorption has become a successful procedure in patients for whom previous methods had been disappointing. For reconstruction of the maxillae an onlay, nasal and/or antral inlay, labial and/or buccal onlay, or interpositional bone graft with osseointegrated implants used to provide support for both the graft and the prosthesis can be used. The maxillary and mandibular onlay bone grafts and the nasal and/or antral inlay bone grafts are discussed.

Alveolar Bone Loss↗
PubMed1992

Restoration of the mandible by full-thickness calvarial bone flap.

Two patients with reconstruction of a massive mandibular defect with vascularized full-thickness calvarial bone flaps are reported. In Patient 1, the mandibular body developed osteomyelitis and once was replaced with a metallic prosthesis. The prosthesis later perforated the skin and was removed. Full-thickness calvarial bone flaps were elevated bilaterally to reconstruct the mandibular body. In Patient 2, the mandible was totally destroyed by invasion of squamous cell carcinoma. The lower one-half of the face was resected and replaced with a large island scalp flap with full-thickness calvarial bone.

Adult↗
PubMedDate not supplied

Prosthetic intervention in the era of microvascular reconstruction of the mandible--a retrospective analysis of functional outcome.

PURPOSE: The purpose of this retrospective study was to compare the functional outcomes of patients who had mandibular resection and reconstruction with and without prosthetic intervention, and to identify predictive factors that may have an impact on functional outcomes. MATERIALS AND METHODS: Two hundred twenty head and neck cancer patients who had undergone mandibular resection and reconstruction with at least 6 months of postoperative convalescence formed the basis of this retrospective review. Patients who did not receive prosthetic intervention formed group I (n = 142); those who received prosthetic intervention formed group II (n = 78). Functional outcomes were measured using four individual assessments (nutritional status, swallowing, masticatory performance, and speech) and one that combined the information from these assessments, the global measure of functional outcome (GMFO). Statistical analyses were used to compare the baseline characteristics and functional outcome between groups I and II and to analyze independent predictors for GMFO. RESULTS: Of the 220 patients reviewed, 78 (35%) had prosthetic intervention; group II patients had better individual functional outcome measures and GMFO. Use of a prosthesis remained associated with GMFO after controlling for other significant predictors; other independent predictors were xerostomia, number of remaining mandibular teeth, number of tooth-to-tooth contacts, type of reconstruction, flap interference, and tongue defect. Patients who had fewer mandibular teeth and received a smaller prosthesis had better overall outcome than patients who received a larger prosthesis. CONCLUSION: Patients who had prosthetic intervention after mandibular reconstruction had significantly better functional outcomes than patients who did not receive prosthetic intervention, even after adjusting for confounding variables.

Adult↗
PubMed2003

Apicoectomy of an endosseous implant to relieve paresthesia: a case report.

Various radiographic and surgical techniques have been recommended to avoid paresthesia following mandibular implant placement. However, nerve impingement is sometimes inevitable, and when lingering numbness is reported, clinicians have a limited number of corrective options. This report describes a technique for cutting-back the apex of the implant, a technique that may be useful when lingering numbness persists after osseointegration has occurred.

Aged↗
PubMed1996

[Indications and complications of free micro-flaps in ORL oncology].

Eighty-three free flaps were used to repair head and neck cancer defects between 1993 and 1995. The flaps used were 37 (44%) radial forearm flaps, 29 (35%) iliac crest flaps, 8 (10%) free jejunum flaps, 4 (5%) fibula flaps, 3 (3%) latissimus dorsi flaps and 2 (2%) rectus abdomini flaps. The indications for each flap are discussed. The flap loss rate was 4.8%, which led to reoperation with a new free flap in 3.6% of the cases. The other complications are discussed. Pre and post operative radiotherapy had no influence on the outcome of the free flaps. The mean duration of hospitalisation was 36 days. 78% of the patients who underwent a mandibular reconstruction were fitted with a fixed dental prosthesis and had normal mastication. 66% of the patients with oropharyngeal reconstruction had normal deglutition and 30% had a mixed diet. The acceptable complication rate, the good esthetic and functional results obtained with free flaps indicate that they should be used as a first choice technique in the reconstruction of head and neck cancer defects.

Adenocarcinoma↗
PubMed1992

Fixture design and overload influence marginal bone loss and fixture success in the Brånemark system.

It has been documented that the long-term clinical outcome of the Brånemark system is very favourable. However, failures do occur before and after loading. This study examined the differences in marginal bone loss between standard and self-tapping fixtures and attempted to explain excessive marginal bone loss or loss of osseointegration during the first 3 years of loading. Marginal bone loss (scored on long cone radiographs) and fixture failure rate were compared for different fixture designs. For standard fixtures, in comparison with self-tapping fixtures, the failure rate was clearly higher before as well as after loading. However, for successful fixtures no difference in marginal bone loss was observed. For the conical fixtures an increased marginal bone loss around the smooth part was observed. The effect of fixture overload, marginal bone height and loss of osseointegration was examined in 69 patients with 1 and 15 patients with 2 fixed full prostheses, and in 9 patients with an overdenture in the upper jaw. Excessive marginal bone loss (more than 1 mm) after the first year of loading and/or fixture loss correlated well with the presence of overload due to a lack of anterior contact, the presence of parafunctional activity and osseointegrated full fixed prostheses in both jaws.

Adolescent↗
PubMed1998

Reconstruction of advanced mandibular resorption with both subperiosteal and root-form implants.

A combination implant reconstruction using both subperiosteal and endosseous root-form implants for advanced mandibular resorption is presented. In theory and practice, physiologic endosseous implant support should prevent further resorption in the mandibular symphysis region. Three patients' post-treatment outcomes demonstrate a complete return of mandibular oral function. The greater risk of mandibular fracture, which is associated with other treatment options (multiple root-form implants or transmandibular implants), is avoided with this treatment approach. With follow-up periods ranging from 6 months to 28 months the three patients are satisfied with comfort, function, and appearance. A long-term follow-up study is planned for future publication.

Aged↗
PubMedDate not supplied

Clinical outcome and prosthodontic compensation of tilted interforaminal implants for mandibular overdentures.

PURPOSE: The aim of this study was to evaluate the sagittal inclination of interforaminal implants, the clinical implant outcome, and the necessary extent of prosthodontic compensation modalities for implant overdentures (IODs). MATERIALS AND METHODS: Lateral cephalometric radiographs of 62 patients, each with a mandibular IOD retained by 2 to 4 implants, were analyzed. The sagittal inclination of the longitudinal implant axis of the most anterior implant was analyzed relative to the mandibular and occlusal planes. The angle needed to compensate for the inclination of the mandibular implant to obtain Angle's class I for the prosthesis (the compensation angle) was measured and compared with respect to skeletal class. Peri-implant structures were measured using the Plaque Index and the Gingival Index. The compensation angle was correlated with the mandibular implant inclination, the degree of mandibular atrophy, and the anterior facial height. RESULTS: The most anterior mandibular implants showed a mean retroinclination of 74.3 +/- 9.3 degrees in relation to the mandibular plane; retroinclination was significantly more pronounced in skeletal class II than skeletal classes I and III (P < .05). The compensation angle (26.9 +/- 10.5 degrees) was more significant for skeletal class II than for skeletal classes I and III (P < .01). Sagittal mandibular implant inclination correlated significantly to the compensation angle (r = -0.46; P < .05), mandibular atrophy (r = 0.32; P < .05) and mandibular facial height (r = -0.45; P < .05). Implant survival rate and peri-implant parameters (bone loss, pocket-depth, Plaque and Gingival Indices) of the interforaminal implants were not shown to be influenced by implant retroinclination. Nine patients (2 skeletal class 1, 7 skeletal class II) reported phonetic problems with the IOD because of narrowing of the lingual space but described significant improvement after a median 4.7 months (range, 3 to 12 months). DISCUSSION AND CONCLUSION: Depending on skeletal class, prosthetic compensatory mechanisms will be operative in the presence of mandibular implant retroinclination for IOD. Knowledge of mandibular inclinations and the compensatory mechanisms may be an essential factor in successful prosthetic rehabilitation and may provide for a homogenous design of the bar construction and easier handling and may also reduce stress on the attachment mechanism.

Cephalometry↗
PubMed2004

Vertical distraction osteogenesis of the mandible applied to an iliac crest graft: report of a case.

OBJECTIVES: This clinical case represents a particular application of vertical distraction osteogenesis of the mandible. The surgical technique was applied to an iliac crest bone graft previously positioned on an anterior mandibular defect with the aim to restore the vertical height after a partial resorption in a trauma patient. CASE REPORT: Distraction osteogenesis was applied because it was necessary to restore the mandibular height in a young male patient who presented with a post-trauma anterior mandibular bony deficiency. Because of the irregularity of the mandibular surface and the depth of the defect, the patient first underwent an iliac crest bone grafting that, after 3 months, showed partial resorption. Vertical distraction osteogenesis was performed on the grafted mandible in order to obtain a satisfactory bony height of the mandibular ridge. Then the patient was successfully rehabilitated by means of an implant-supported prosthesis. CONCLUSION: Vertical distraction osteogenesis appears to be a versatile surgical procedure, which can be applied as a secondary treatment in patients presenting with mandibular trauma sequelae.

Adult↗
PubMed1990

[Relation between articulatory function and prosthesis. II-1. Longitudinal changing aspect of experimental palatal plate on muscular discharge of intrinsic muscles, tongue movement and mandibular movement before pronunciation].

As the first step of evaluating the kinematic function and the coordinative movement among articulatory organs, attention was focused on the palatal form in various factors related to the function of pronunciation on complete denture. After the experimental palatal plate was inserted into 13 natural dentitions in the age ranging from 21-24 years old, muscular discharge of intrinsic muscles, tongue movement and mandibular movement before pronunciation were recorded longitudinally. These data were comparatively evaluated with those before insertion of the experimental palatal plate, and the following conclusion were obtained. It has been made clear in this study that from the change of muscular discharge of intrinsic muscles, tongue movement and mandibular movement before pronunciation between before and after the insertion of the experimental palatal plate, correction aspect of the kinematic function and the coordinative movement among articulatory organs varied with point and method of articulation on each sound. And these facts suggested that it was necessary to diagnose and treat under consideration of the relation between the palatal form and articulatory function of tongue and mandible in removable prosthodontic treatment.

Adult↗
PubMed1990

[A clinical study on occlusal plane in relation with orofacial morphology and stomatognathic function].

Occlusal plane is one of the important and fundamental factors that establish the mandibular position and the form of dental arch and prosthesis. The aim of this study is to investigate the morphological and functional importance of occlusal plane in relation with orofacial morphology and stomatognathic function. Cephalograms were taken and electromyograms of masseter, anterior and posterior temporal muscles were recorded during clenching, tapping and chewing movements in 30 normal young adult subjects. Mandibular movements were simultaneously recorded using Sirognathograph (Siemens, West Germany). A correlation analysis was performed to study the relationship between the occlusal plane and morphological and functional parameters. As a result, the occlusal plane angle showed; 1) close correlations with the mandibular plane angle, Camper's plane angle and palatal plane angle, 2) correlations with the duration of activity of anterior temporal muscles and the sagittal angle of chewing pathway. The results suggest that there is a close relationship between the occlusal plane and orofacial morphology. Furthermore, the morphological parameters closely related to the occlusal plane were found to affect stomatognathic function. It is concluded that the occlusal plane is the important factor which harmonizes morphology and function of the stomatognathic system.

Cephalometry↗