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Implant-based dental rehabilitation in reconstructed mandible – problems and solutions
Abstracts use of autogenous bone graft is limited due to its resulting complications, creation of an additional bone defect and paresthesia of donor site. Due to the lack of osteogenetic properties of allogenic bone, xenograft, and alloplast, a longer period of time is required for the healing process to be completed. This prospective study was designed to qualify the safety and efficacy of Bongros-BMP (Bioalpha, Korea), incorporating the osteoinductive ErhBMP2 (recombinant human bone morphogenic protein) in the osteoconductive hydroxyapatite as a single bone graft material, comparing with bovine xenograft (BioOss® , Geistlich Pharma Ag, Switzerland). Method: Strict inclusion criteria was used for this study, regarding patient’s age (40–70 years old), edentulous site (posterior maxilla), alveolar ridge height (2–6 mm), alveolar bone width (>6 mm), and patient’s medical condition (absence of maxillary sinusitis and bone metabolic disease). During maxillary sinus graft, Bongros-BMP or Bio-Oss, as bone graft materials, was selected and applied randomly in 15 patients. Bone healing was assessed 3 months after the first implant surgery by computerized tomography and bone biopsy. Results: Good bone healing process and implant osteointegration was observed in all patients. Complications, such as maxillary sinusitis and wound dehiscence, were noticed in one case of the Bongros-BMP group, respectively. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.374
112 Implant-based dental rehabilitation in reconstructed mandible – problems and solutions R. Veeraraghavan ∗ , U. Puthalath Oral and Maxillofacial Surgery, Amrita School of Dentistry, Kochi, India
Microvascular free fibula transfer is accepted as the gold standard in jaw reconstruction following ablative surgery. Apart from fibula, other free bone flaps are also used in select situations. With the emphasis shifting to the quality of life in the post-treatment phase, dental rehabilitation has acquired an unprecedented importance. Implant-supported dentures are certainly the best way to achieve this. Implantology in reconstructed jaw is vastly different from the conventional technique. One needs to decide upon many critical issues such as choice of
flap, primary/secondary implant placement, radiotherapy, prioritising between form and function, soft tissue pedicles etc. It is important to make certain that bone tissue of adequate quantity and quality are available at the required site. To ensure this, planning for dental rehabilitation should start in the early stages of treatment planning. At our centre, implant-based dental rehabililitation on free flaps have been practiced over the past several years. In this paper, we shall discuss the issues related to implantology in free fibula flaps, with emphasis on problems and their solutions in the planning phase. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.375
113 Rehabilitation of a patient with complete absence of maxillary alveolar bone F.N. Lima ∗ , C.M.S.d.A. Pinto, R.D. Rêgo, J.F.D. Cunha Filho, C.N.F.D.A.L. Babadopolus, G.D.L. Bezerra Júnior Cirurgia e Traumatologia Buco Maxilo Faciais, Hospital Batista Memorial, Fortaleza, Brazil
The rehabilitation treatment in patients with severely atrophic maxilla has always challenged the skills and expertise of most experienced professionals in dentistry. The physiological process of alveolar bone resorption after the loss of a tooth, accelerated by the use of muco-supported prosthesis, take extreme proportions in certain individuals, limiting treatment options and greatly reducing the predictability of the treatments. Basically there are two treatment options for rehabilitating patients with atrophic maxilla, bone graft reconstruction for later implant placement, or installation of zygomatic implants. By opting for reconstructive treatment in these situations are generally used autogenous bone grafts obtained from an extra oral donor site, most commonly removed from the iliac crest, calvarium and tibia. But to succeed in the reconstruction with bone graft it is imperative the presence of a good receptor site, because without adequate support and vasculature it is not possible a good integration of the grafted material. Since 1989, there was the option of using longer implants attached to the zygomatic bone, to support the upper prosthesis, where the grafts will probably not succeed. Since then, the zygomatic implants have become a treatment option for the rehabili-
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tation of atrophic jaws alternatively the use of bone grafts. This paper aims to report a case of complete resorption of the maxillary alveolar bone, treated by installing four implants anchored solely in the body of the zygomatic bone, due to scarce receptor site for bone reconstruction. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.376
114 Installation of short implants in severely atrophic mandible using rigid internal fixation: report of 2 cases M. Woltmann 1,2,∗ , F. Lemke 3 , R.B. Oliveira 2 1 Funda¸cão Universidade Regional de Blumenau, Blumenau, Brazil 2 Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil 3 Prosthetics, Funda¸cão Universidade Regional de Blumenau, Blumenau, Brazil
With the loss of teeth begins a process of resorption of the alveolar process already well known by dentists, greatly hampered the rehabilitation of patients with total prostheses or implants. While in that region of the anterior jaw implants is possible to install in most cases, severely atrophic jaws in the installation of dental implants may not be possible, condemning the patient to stay with his dentures. They are described as techniques to facilitate the rehabilitation of these patients bone grafts, distraction osteogenesis and short implants, and reconstruction of the atrophic jaw with bone graft choice of a majority of the authors. The purpose of this report is through the description of two clinical cases a little-known technique, which can be used to rehabilitate severely atrophic mandible using rigid internal fixation using plates 2.0 mm system, installed on mandible associated with short implants to minimize the risk of mandibular fracture and allow the prosthetic rehabilitation of patients. The technique of using rigid internal fixation and short implants in severely atrophic mandibles proved safe and low morbidity in clinical cases in question, if compared with other techniques such as bone grafting or distraction osteogenesis. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.377
112 Implant-based dental rehabilitation in reconstructed mandible – problems and solutions R. Veeraraghavan ∗ , U. Puthalath Oral and Maxillofacial Surgery, Amrita School of Dentistry, Kochi, India
Microvascular free fibula transfer is accepted as the gold standard in jaw reconstruction following ablative surgery. Apart from fibula, other free bone flaps are also used in select situations. With the emphasis shifting to the quality of life in the post-treatment phase, dental rehabilitation has acquired an unprecedented importance. Implant-supported dentures are certainly the best way to achieve this. Implantology in reconstructed jaw is vastly different from the conventional technique. One needs to decide upon many critical issues such as choice of
flap, primary/secondary implant placement, radiotherapy, prioritising between form and function, soft tissue pedicles etc. It is important to make certain that bone tissue of adequate quantity and quality are available at the required site. To ensure this, planning for dental rehabilitation should start in the early stages of treatment planning. At our centre, implant-based dental rehabililitation on free flaps have been practiced over the past several years. In this paper, we shall discuss the issues related to implantology in free fibula flaps, with emphasis on problems and their solutions in the planning phase. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.375
113 Rehabilitation of a patient with complete absence of maxillary alveolar bone F.N. Lima ∗ , C.M.S.d.A. Pinto, R.D. Rêgo, J.F.D. Cunha Filho, C.N.F.D.A.L. Babadopolus, G.D.L. Bezerra Júnior Cirurgia e Traumatologia Buco Maxilo Faciais, Hospital Batista Memorial, Fortaleza, Brazil
The rehabilitation treatment in patients with severely atrophic maxilla has always challenged the skills and expertise of most experienced professionals in dentistry. The physiological process of alveolar bone resorption after the loss of a tooth, accelerated by the use of muco-supported prosthesis, take extreme proportions in certain individuals, limiting treatment options and greatly reducing the predictability of the treatments. Basically there are two treatment options for rehabilitating patients with atrophic maxilla, bone graft reconstruction for later implant placement, or installation of zygomatic implants. By opting for reconstructive treatment in these situations are generally used autogenous bone grafts obtained from an extra oral donor site, most commonly removed from the iliac crest, calvarium and tibia. But to succeed in the reconstruction with bone graft it is imperative the presence of a good receptor site, because without adequate support and vasculature it is not possible a good integration of the grafted material. Since 1989, there was the option of using longer implants attached to the zygomatic bone, to support the upper prosthesis, where the grafts will probably not succeed. Since then, the zygomatic implants have become a treatment option for the rehabili-
1137
tation of atrophic jaws alternatively the use of bone grafts. This paper aims to report a case of complete resorption of the maxillary alveolar bone, treated by installing four implants anchored solely in the body of the zygomatic bone, due to scarce receptor site for bone reconstruction. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.376
114 Installation of short implants in severely atrophic mandible using rigid internal fixation: report of 2 cases M. Woltmann 1,2,∗ , F. Lemke 3 , R.B. Oliveira 2 1 Funda¸cão Universidade Regional de Blumenau, Blumenau, Brazil 2 Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil 3 Prosthetics, Funda¸cão Universidade Regional de Blumenau, Blumenau, Brazil
With the loss of teeth begins a process of resorption of the alveolar process already well known by dentists, greatly hampered the rehabilitation of patients with total prostheses or implants. While in that region of the anterior jaw implants is possible to install in most cases, severely atrophic jaws in the installation of dental implants may not be possible, condemning the patient to stay with his dentures. They are described as techniques to facilitate the rehabilitation of these patients bone grafts, distraction osteogenesis and short implants, and reconstruction of the atrophic jaw with bone graft choice of a majority of the authors. The purpose of this report is through the description of two clinical cases a little-known technique, which can be used to rehabilitate severely atrophic mandible using rigid internal fixation using plates 2.0 mm system, installed on mandible associated with short implants to minimize the risk of mandibular fracture and allow the prosthetic rehabilitation of patients. The technique of using rigid internal fixation and short implants in severely atrophic mandibles proved safe and low morbidity in clinical cases in question, if compared with other techniques such as bone grafting or distraction osteogenesis. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.377