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Anterior Zygoma Implants as an Alternative for the Adult Alveolar Cleft
OOOOE Volume 110, Number 3 fractures and 37 (7.11%) skull fractures. Intracranial injuries were 155 (29.80%) for the H group and 241(19.85%) for the NH group. Conclusions: The helmeted group demonstrated a significant decrease in the incidence of craniofacial and skull fractures. Coincidentally the helmeted group demonstrated an increase in intracranial injures. Chi square analysis revealed that the number of deaths in non-helmeted was statistically significant. Hospital fatality data may not be the most accurate gauge of the consequences resulting from the changes in the motorcycle helmet law. Pre-hospital fatalities may be a confounding factor for this report.
ANTERIOR ZYGOMA IMPLANTS AS AN ALTERNATIVE FOR THE ADULT ALVEOLAR CLEFT Authors: Cesar A. Guerrero, DDS; Patricia Lopez, DDS; Marianela Gonzalez DDS, Ms, MD; Adriana Sabogal, DDS Purpose: This aim of this study is to introduce the use of anterior zygoma implants to anchorage a dental prosthesis in adult cleft patients. Understanding that alveolar grafts and orthodontics is the ideal treatment of the young patient, this new alternative offers an excellent base for dental prosthesis when there is no bone for regular implants, either after failed treatments or confronting a soft tissue closed wide cleft. Materials and Method: 3 patients, ages 18 through 35 years old (average 27), presented after multiple surgeries (3 to 11) with unilateral complete cleft lip and palate; they were missing several teeth at the alveolar cleft site. 3 were under orthodontics treatment and were referred for orthognathic surgery. After completion of the bi-maxillary surgery, the soft tissue clefts were closed, but the bony separation was wide, fibrosis was present and no implant placement possibility existed. Either 1 zygoma and a standard implant or 2 zygomas were inserted, through the piriform rim up to the infraorbital rim in either side of the cleft. The implants were very stable and were loaded immediately with a provisional prosthesis, to maintain the orthognathic surgery stability and the orthodontist was able to place brackets and use them for anchorage as well. The older patient in the group was not in orthodontic therapy and temporary prosthesis was indicated immediately. Pre- and post-operative orthodontics records were taken and meticulous periodontal and prosthetic care was instituted. Results: All implants were immediately loaded and provisional prosthesis was fabricated. Esthetics and function were obtained at once and minimal morbidity was reported. Patients’ satisfaction and improved mastication and phonation were recorded. Conclusions: Anterior zygoma implants are an excellent alternative for the adult cleft patient, where removable or long fixed bridges had performed poorly in the past. All patients underwent several attempts to obtain a bone reconstruction and presented with wide bony cleft, even though the soft tissue had no fistulas or communications. The temporary prosthesis anchoraged in the zygoma implants were esthetic and functional and help the orthodontist in stability and finishing the treatment.
STRYKER NAVIGATION SYSTEM PROTOCOL FOR CRANIOFACIAL RECONSTRUCTION PLANNING Authors: Michael Ding, DDS, MD; Marianela Gonzalez, DDS, MS; Suzanne Verma, MAMS Purpose: Craniofacial reconstruction can be a challenging situation for both the patient and surgeon. Patients with cranio-
317 facial anomalies, post-traumatic injuries and the post-surgical cancer patient with combined soft tissue and osseous defects necessitate a team approach to their rehabilitation. The oral and maxillofacial surgeon can be invaluable to a number of these patients during the reconstructive phase of treatment. With the assistance of the Stryker Navigation System, osteointegrated implants may be utilized in the reconstructive phase of treatment to assist in the retention of facial prosthesis. This is a review of the Stryker Navigation System protocol, with case reports including the pre-operative planning, surgical phase of reconstruction and final prosthetic results fabricated by the anaplastologist. Methods: Multiple patients with both soft tissue and osseous defects, who were treated by our institutional oral and maxillofacial surgeons and anaplastologist, are presented, including the preoperative evaluation for the Stryker Navigation System protocol to assist in the placement of osteointegrated implants for retention of facial prostheses. Results: With the assistance of the Stryker Navigation System, osteointegrated implants may be placed in compromised osseous anatomic areas that lead to the best predictable cosmetic result with minimal complications. The placement of these implants can assist in the retention of facial prostheses during the final reconstructive phase for many of the patients that are treated by the oral and maxillofacial surgeon. Conclusions: Implant supported facial prostheses are an alternative form of treatment in the reconstructive phase of many patients with craniofacial anomalies, post-traumatic injuries or post-cancer resections. Using the Stryker Navigation System, osteointegrated implants can be placed in areas of the craniofacial skeleton with predictable results and few complications. With the final implant retained prosthesis fabricated by an anaplastologist, many of our patients may be rehabilitated to a more normal appearance.
SURGICALLY-ASSISTED RAPID CANINE ORTHODONTIC DISTRACTION Author: Pushkar Mehra, BDs, DMD; Elif Kesar, DMD; Mariana Velazquez, DDS Purpose: Treatment of dental crowding includes extraction of premolar teeth and retraction of anterior ones including the canines. Time required for canine distalization using traditional orthodontic techniques varies between 6 to 9 months. “Dental distraction” with combined surgical and rapid postoperative orthodontic treatment can possibly shorten the treatment time required for canine distalization. Method: Patients with dental crowding and malocclusion were included in the study. Criteria for inclusion were: 1) Anterior dental crowding with any dental or skeletal malocclusion, 2) Extraction of first premolar teeth and surgical alveolar bone preparation, 3) Rapid distalization of canines into the extraction spaces. Regular x-rays were obtained and orthodontic bands were placed on the canines and brackets bonded to the incisors. Periodontal charting, including pocket probing depths, was completed. After premolar extraction, the interseptal bone distal to the canine was undermined with a surgical bur. Vertical grooves were made along the buccal and lingual extraction socket margins and extended obliquely toward the base of the interseptal bone to weaken it. The aim is to reduce the volume of alveolar bone on the distal aspect of the canine root to facilitate subsequent orthodontic movement of the canines by decreasing resistance. The distraction device is placed immediately after the surgical procedure. Activation was started on the first postoper-
ANTERIOR ZYGOMA IMPLANTS AS AN ALTERNATIVE FOR THE ADULT ALVEOLAR CLEFT Authors: Cesar A. Guerrero, DDS; Patricia Lopez, DDS; Marianela Gonzalez DDS, Ms, MD; Adriana Sabogal, DDS Purpose: This aim of this study is to introduce the use of anterior zygoma implants to anchorage a dental prosthesis in adult cleft patients. Understanding that alveolar grafts and orthodontics is the ideal treatment of the young patient, this new alternative offers an excellent base for dental prosthesis when there is no bone for regular implants, either after failed treatments or confronting a soft tissue closed wide cleft. Materials and Method: 3 patients, ages 18 through 35 years old (average 27), presented after multiple surgeries (3 to 11) with unilateral complete cleft lip and palate; they were missing several teeth at the alveolar cleft site. 3 were under orthodontics treatment and were referred for orthognathic surgery. After completion of the bi-maxillary surgery, the soft tissue clefts were closed, but the bony separation was wide, fibrosis was present and no implant placement possibility existed. Either 1 zygoma and a standard implant or 2 zygomas were inserted, through the piriform rim up to the infraorbital rim in either side of the cleft. The implants were very stable and were loaded immediately with a provisional prosthesis, to maintain the orthognathic surgery stability and the orthodontist was able to place brackets and use them for anchorage as well. The older patient in the group was not in orthodontic therapy and temporary prosthesis was indicated immediately. Pre- and post-operative orthodontics records were taken and meticulous periodontal and prosthetic care was instituted. Results: All implants were immediately loaded and provisional prosthesis was fabricated. Esthetics and function were obtained at once and minimal morbidity was reported. Patients’ satisfaction and improved mastication and phonation were recorded. Conclusions: Anterior zygoma implants are an excellent alternative for the adult cleft patient, where removable or long fixed bridges had performed poorly in the past. All patients underwent several attempts to obtain a bone reconstruction and presented with wide bony cleft, even though the soft tissue had no fistulas or communications. The temporary prosthesis anchoraged in the zygoma implants were esthetic and functional and help the orthodontist in stability and finishing the treatment.
STRYKER NAVIGATION SYSTEM PROTOCOL FOR CRANIOFACIAL RECONSTRUCTION PLANNING Authors: Michael Ding, DDS, MD; Marianela Gonzalez, DDS, MS; Suzanne Verma, MAMS Purpose: Craniofacial reconstruction can be a challenging situation for both the patient and surgeon. Patients with cranio-
317 facial anomalies, post-traumatic injuries and the post-surgical cancer patient with combined soft tissue and osseous defects necessitate a team approach to their rehabilitation. The oral and maxillofacial surgeon can be invaluable to a number of these patients during the reconstructive phase of treatment. With the assistance of the Stryker Navigation System, osteointegrated implants may be utilized in the reconstructive phase of treatment to assist in the retention of facial prosthesis. This is a review of the Stryker Navigation System protocol, with case reports including the pre-operative planning, surgical phase of reconstruction and final prosthetic results fabricated by the anaplastologist. Methods: Multiple patients with both soft tissue and osseous defects, who were treated by our institutional oral and maxillofacial surgeons and anaplastologist, are presented, including the preoperative evaluation for the Stryker Navigation System protocol to assist in the placement of osteointegrated implants for retention of facial prostheses. Results: With the assistance of the Stryker Navigation System, osteointegrated implants may be placed in compromised osseous anatomic areas that lead to the best predictable cosmetic result with minimal complications. The placement of these implants can assist in the retention of facial prostheses during the final reconstructive phase for many of the patients that are treated by the oral and maxillofacial surgeon. Conclusions: Implant supported facial prostheses are an alternative form of treatment in the reconstructive phase of many patients with craniofacial anomalies, post-traumatic injuries or post-cancer resections. Using the Stryker Navigation System, osteointegrated implants can be placed in areas of the craniofacial skeleton with predictable results and few complications. With the final implant retained prosthesis fabricated by an anaplastologist, many of our patients may be rehabilitated to a more normal appearance.
SURGICALLY-ASSISTED RAPID CANINE ORTHODONTIC DISTRACTION Author: Pushkar Mehra, BDs, DMD; Elif Kesar, DMD; Mariana Velazquez, DDS Purpose: Treatment of dental crowding includes extraction of premolar teeth and retraction of anterior ones including the canines. Time required for canine distalization using traditional orthodontic techniques varies between 6 to 9 months. “Dental distraction” with combined surgical and rapid postoperative orthodontic treatment can possibly shorten the treatment time required for canine distalization. Method: Patients with dental crowding and malocclusion were included in the study. Criteria for inclusion were: 1) Anterior dental crowding with any dental or skeletal malocclusion, 2) Extraction of first premolar teeth and surgical alveolar bone preparation, 3) Rapid distalization of canines into the extraction spaces. Regular x-rays were obtained and orthodontic bands were placed on the canines and brackets bonded to the incisors. Periodontal charting, including pocket probing depths, was completed. After premolar extraction, the interseptal bone distal to the canine was undermined with a surgical bur. Vertical grooves were made along the buccal and lingual extraction socket margins and extended obliquely toward the base of the interseptal bone to weaken it. The aim is to reduce the volume of alveolar bone on the distal aspect of the canine root to facilitate subsequent orthodontic movement of the canines by decreasing resistance. The distraction device is placed immediately after the surgical procedure. Activation was started on the first postoper-