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M634: Smile Line Reconstruction With Multiple Dental Implants
Surgical Mini-Lectures
M634 Smile Line Reconstruction With Multiple Dental Implants Lee R. Walker, MD, DDS, Los Gatos, CA Reconstruction of the smile line with implants requires careful case planning to ensure optimum esthetic outcome. An understanding of biologic width principles is essential in determining prosthetic platform size, implant diameter, position of implant placement, and appropriate selection of abutments as well as provisionalization techniques. Scientific rational and theories for established and new esthetic protocols will be reviewed with strategies for optimizing esthetic outcomes from both surgical and restorative speaker input. References Tarnow DP, Cho SC, Wallace SS. The effect of inter–implant distance on the height of inter–implant bone crest. J Periodontol 2000;71:546549 Tarnow DP, Elian N, Fletched P, Froum S, Mager A, Cho SC, Salama M, Salama H, Garber D. Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. J Periodontol 2004;74:1785-1788 Tarnow DP, Magner AQ, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63:995-6 Lazarra RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent 2006;26:9-17 Higginbottom F, Belser U, Jones J, Keith S. Prosthetic Management of Implants in the Esthetic Zone. J Oral Maxillofac Implants 2004; 19(suppl):62-72
M635 Reconstruction of Trauma, Tumor, and Major Pre-Prosthetic Defects Robert E. Marx, DDS, Miami, FL Successful reconstruction and rehabilitation of the jaws, today, requires scientific knowledge and surgical skills of bone and soft tissue transplantation. The common tumor related continuity defects after benign tumor surgery, cancer surgery, and osteoradionecrosis, share the findings of missing soft tissue, as well as bone. Continuity defects of the mandible resultant from benign tumor surgeries, mostly do not require specific soft tissue reconstruction. However, a contamination free and infection free tissue bed is needed for a successful bony reconstruction. Bone grafting is, therefore, best accomplished from a transcutaneous approach that avoids oral communications. Cancellous cellular marrow grafts are the superior graft results today, particularly when enhanced with platelet rich plasma growth factor additions, which accelerate bone regeneration and proAAOMS • 2007
duce a more dense graft. Platelet rich plasma has been shown to contain platelet derived growth factor (PDGF), transforming growth factor– beta1 and beta2 (TGF– b1 and TGF– b2), vascular endothelial growth factors, (VEGF), and epithelial growth factor (FGF). Cancer related defects and those defects associated with osteoradionecrosis often require significant soft tissue reconstruction first. It is common to place soft tissue flaps such as pectoralis major, trapezius, latissimus dorsi, or sternocleidomastoid myocutaneous flaps together with a titanium reconstruction plate in advance of bone grafting. In the maxilla, the temporalis muscle flap is the preferred flap. In addition, several free vascular soft tissue flaps are useful, such as the radial forearm flap, the circumflex scapular flap, and the rectus abdominus flap. Osteoradionecrosis defects also require hyperbaric oxygen prior to any type of reconstruction. The hyperbaric oxygen protocol of 20 sessions at 2.4 ATA for 90 treatment minutes before elective reconstruction, followed by ten sessions afterward, is the standard of care today. References Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR Strauss JE and Georgeff KR: Platelet Rich Plasma – Growth factor enhancement for bone grafts. Oral Surg 85, 638-646, 1998 Marx RE: Mandibular Reconstruction – Advances in Oral and Maxillofacial Surgery, 1943-1993. J Oral Maxillofacial Surg 466-479, 1993 Gray JC, Phil M and Elves MW: Donor cells contribution to osteogenesis in cancellous bone grafts. Clin Orthop 163, 261-269, 1982
M636 Orthognathic Surgery: Treatment Planning and Surgical Techniques Larry M. Wolford, DMD, Dallas, TX Surgical techniques in orthognathic surgery have and will continue to undergo modifications and change in an effort to improve the quality of patient care and outcome. This program will present state– of–the–art surgical techniques and research results substantiating the efficacy of these surgical methods. The following modifications will be discussed: 1. Genioplasty A. Augmentation B. Tenon and mortise osseous genioplasty 2. Anterior mandibular subapical osteotomy 3. Mandibular body osteotomy 4. Mandibular ramus sagittal split osteotomy modifications A. Ramus and inferior border osteotomy B. Rigid fixation 5. Maxillary osteotomy modification A. Maxillary step osteotomy and rigid fixation B. Porous block HA grafting 75
M634 Smile Line Reconstruction With Multiple Dental Implants Lee R. Walker, MD, DDS, Los Gatos, CA Reconstruction of the smile line with implants requires careful case planning to ensure optimum esthetic outcome. An understanding of biologic width principles is essential in determining prosthetic platform size, implant diameter, position of implant placement, and appropriate selection of abutments as well as provisionalization techniques. Scientific rational and theories for established and new esthetic protocols will be reviewed with strategies for optimizing esthetic outcomes from both surgical and restorative speaker input. References Tarnow DP, Cho SC, Wallace SS. The effect of inter–implant distance on the height of inter–implant bone crest. J Periodontol 2000;71:546549 Tarnow DP, Elian N, Fletched P, Froum S, Mager A, Cho SC, Salama M, Salama H, Garber D. Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. J Periodontol 2004;74:1785-1788 Tarnow DP, Magner AQ, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63:995-6 Lazarra RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent 2006;26:9-17 Higginbottom F, Belser U, Jones J, Keith S. Prosthetic Management of Implants in the Esthetic Zone. J Oral Maxillofac Implants 2004; 19(suppl):62-72
M635 Reconstruction of Trauma, Tumor, and Major Pre-Prosthetic Defects Robert E. Marx, DDS, Miami, FL Successful reconstruction and rehabilitation of the jaws, today, requires scientific knowledge and surgical skills of bone and soft tissue transplantation. The common tumor related continuity defects after benign tumor surgery, cancer surgery, and osteoradionecrosis, share the findings of missing soft tissue, as well as bone. Continuity defects of the mandible resultant from benign tumor surgeries, mostly do not require specific soft tissue reconstruction. However, a contamination free and infection free tissue bed is needed for a successful bony reconstruction. Bone grafting is, therefore, best accomplished from a transcutaneous approach that avoids oral communications. Cancellous cellular marrow grafts are the superior graft results today, particularly when enhanced with platelet rich plasma growth factor additions, which accelerate bone regeneration and proAAOMS • 2007
duce a more dense graft. Platelet rich plasma has been shown to contain platelet derived growth factor (PDGF), transforming growth factor– beta1 and beta2 (TGF– b1 and TGF– b2), vascular endothelial growth factors, (VEGF), and epithelial growth factor (FGF). Cancer related defects and those defects associated with osteoradionecrosis often require significant soft tissue reconstruction first. It is common to place soft tissue flaps such as pectoralis major, trapezius, latissimus dorsi, or sternocleidomastoid myocutaneous flaps together with a titanium reconstruction plate in advance of bone grafting. In the maxilla, the temporalis muscle flap is the preferred flap. In addition, several free vascular soft tissue flaps are useful, such as the radial forearm flap, the circumflex scapular flap, and the rectus abdominus flap. Osteoradionecrosis defects also require hyperbaric oxygen prior to any type of reconstruction. The hyperbaric oxygen protocol of 20 sessions at 2.4 ATA for 90 treatment minutes before elective reconstruction, followed by ten sessions afterward, is the standard of care today. References Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR Strauss JE and Georgeff KR: Platelet Rich Plasma – Growth factor enhancement for bone grafts. Oral Surg 85, 638-646, 1998 Marx RE: Mandibular Reconstruction – Advances in Oral and Maxillofacial Surgery, 1943-1993. J Oral Maxillofacial Surg 466-479, 1993 Gray JC, Phil M and Elves MW: Donor cells contribution to osteogenesis in cancellous bone grafts. Clin Orthop 163, 261-269, 1982
M636 Orthognathic Surgery: Treatment Planning and Surgical Techniques Larry M. Wolford, DMD, Dallas, TX Surgical techniques in orthognathic surgery have and will continue to undergo modifications and change in an effort to improve the quality of patient care and outcome. This program will present state– of–the–art surgical techniques and research results substantiating the efficacy of these surgical methods. The following modifications will be discussed: 1. Genioplasty A. Augmentation B. Tenon and mortise osseous genioplasty 2. Anterior mandibular subapical osteotomy 3. Mandibular body osteotomy 4. Mandibular ramus sagittal split osteotomy modifications A. Ramus and inferior border osteotomy B. Rigid fixation 5. Maxillary osteotomy modification A. Maxillary step osteotomy and rigid fixation B. Porous block HA grafting 75