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Maxillofacial reconstruction by bone transport and multiple dental implants
22
Abstracts
The outcome of patients suffering from oral squamous cell carcinoma treated under certified tumour board conditions A. Gröbe
Furthermore, the use of osseointegrated implants allowed functional dental rehabilitation anchorage. http://dx.doi.org/10.1016/j.ijom.2017.02.079
University Medical Center Hamburg, Hamburg, Germany Objectives: The aim of our study was to review the outcome of patients with oral squamous cell carcinoma (OSCC) treated according to the current diagnostic and treatment protocols (“Tumor Board Group” [TBG]) compared to patients diagnosed before the introduction of standardised and certified guidelines (“Conventional Group” [CG]). We also analysed the influence of prognostic factors on overall survival (OS), disease-free survival (DFS) and recurrence free survival (RFS) rates. Methods: A total of 321 patients (TBG 95 patients and CG 226 patients) with histologically confirmed OSCC were included in our study. RFS, DFS and OS rates were analysed by Kaplan-Meier estimates. Cox regression was performed for multivariate analysis of prognostic factors. Results were statistically significant with a P value of <0.05. Results: T, N, American Joint Committee on Cancer (AJCC) stage, age and therapy resulted to be independent risk factors for OS and DFS. We were not able to identify statistically significant prognostic factors for RFS apart from grading. 31.58% of patients from the TBG received postoperative adjuvant treatment compared to 74.78% within the CG. The OS rate was 79.63% at 30 months for patients from the TBG in comparison with 65.54% for patients from the CG. Conclusion: The implementation of standardised guidelines including the establishment of the “Tumor Board Conference” results in a higher percentage of patients receiving surgery as only treatment and in better OS rates. To further support this positive trend, patients shall be followed longer and analysed in future. T, N and M as well as AJCC stage were identified as most important prognostic factors for OS and DFS in our study.
Multiple zygoma implants for severe maxillary atrophy C.A. Guerrero ∗ , M. Gonzalez, R.R. Throndson University of Texas Medical Branch, Galveston, United States Objectives: Demonstrate the feasibility to immediately load a hybrid prosthesis on multiple zygoma implants for severe maxillary atrophy without grafting. Methods: 50 patients were treated with multiple zygoma implants (4, 5 or 6 fixtures) for immediate loading serving as anchorage for a hybrid denture (zirconia, metal-acrylic or metal porcelain prosthesis). We used transmucosal implants into the piriform rim to the infraorbital rim, body of the zygoma or/and tuberosity up to the pterygoid plates. The architectural zygoma implant positioning design was based on: quality and quantity of bone, opposite dentition, age of the patient, masticatory muscles power and type of skeletal malocclusion. 95% of the implants were extrasinus with lateral fat pad coverage when needed and the remaining 5% underwent sinus mucosa medial repositioning. All surgeries were performed under general anaesthesia. Results: All patients were followed up to 10 years (average 5.6 years) the provisional teeth were installed immediately and final prosthesis was fabricated within eight weeks postsurgery. Complications were related to surgery or prosthesis, one implant was exposed into the sinus and needed sinus treatment and eventually was removed (the prosthesis continued to work on four implants), and two implants got exposed laterally, requiring lateral fat pad coverage with success. The provisional teeth phase is fundamental to comply with the patient aesthetics desires and functional-occlusal requirements, through multiple and sequential changes.
http://dx.doi.org/10.1016/j.ijom.2017.02.078 http://dx.doi.org/10.1016/j.ijom.2017.02.080 Maxillofacial reconstruction by bone transport and multiple dental implants
State of the art in intraoral distraction osteogenesis
C.A. Guerrero ∗ , M. Gonzalez, R.R. Throndson
C.A. Guerrero ∗ , M. Gonzalez, R.R. Throndson
University of Texas Medical Branch, Galveston, United States
University of Texas Medical Branch, Galveston, United States
Objective: To reconstruct the maxilla or the mandible using pedicled osteotomised segments for major continuity defects. Methods: 10 patients were treated for maxillofacial continuity defects, ranged from 2 to 16 cm, as a result of tumour resection, gunshot wound or trauma. Utilising local osteotomies and bone transport, the bony segments maintained the soft tissue attachments and were mobilised and fixated in position to a reconstruction plate. For minor defects up to 4 cm local osteotomies and immediate fixation to a reconstructive plate were performed, combined with internal bone transport for major defects. Clinical analysis, photographs and radiographs (panoramic, lateral and P-A cephalic) were used to evaluate the bone continuity, facial aesthetics, occlusion and mandibular function. Results: All patients were adequately reconstructed intraorally with radiographic evidence of bony continuity. No soft tissue dehiscence, infection or necrosis of the segments was observed after 2 years of follow up. Conclusions: All reconstruction were successful, and full bony continuity was obtained, using pedicled osteotomised segments.
Objective: Demonstrate the possibility to develop new bone and soft tissues in a controlled and predictably manner to treat maxillofacial deficiencies. Avoiding the use of bone grafting, decreasing morbidity and costs. Methods: 720 patients underwent intraoral distraction osteogenesis with miniaturised appliances to increase maxillofacial width and/or anteroposterior bone and surrounding soft tissues to correct severe skeletal deficiencies. The distraction devices were completely buried with extension activators or placed transmucosally, to avoid food and saliva contamination and obtain closed chamber for ideal bone formation. The variables included: amount of movement, age of the patient, quality and quantity of bone. Movements were 7 mm (mandibular widening) to 55 mm (bone transport after tumour resection). Strict distraction protocols were reinforced, selection of adequate surgical sites and avoiding complications are the key to success. Results: Bone growth was controlled either by adequate planning or bony fragments repositioned after the activation phase and before consolidation, with the distractors one-end repositioning or rigid fixation. The distraction devices were removed after
Abstracts
The outcome of patients suffering from oral squamous cell carcinoma treated under certified tumour board conditions A. Gröbe
Furthermore, the use of osseointegrated implants allowed functional dental rehabilitation anchorage. http://dx.doi.org/10.1016/j.ijom.2017.02.079
University Medical Center Hamburg, Hamburg, Germany Objectives: The aim of our study was to review the outcome of patients with oral squamous cell carcinoma (OSCC) treated according to the current diagnostic and treatment protocols (“Tumor Board Group” [TBG]) compared to patients diagnosed before the introduction of standardised and certified guidelines (“Conventional Group” [CG]). We also analysed the influence of prognostic factors on overall survival (OS), disease-free survival (DFS) and recurrence free survival (RFS) rates. Methods: A total of 321 patients (TBG 95 patients and CG 226 patients) with histologically confirmed OSCC were included in our study. RFS, DFS and OS rates were analysed by Kaplan-Meier estimates. Cox regression was performed for multivariate analysis of prognostic factors. Results were statistically significant with a P value of <0.05. Results: T, N, American Joint Committee on Cancer (AJCC) stage, age and therapy resulted to be independent risk factors for OS and DFS. We were not able to identify statistically significant prognostic factors for RFS apart from grading. 31.58% of patients from the TBG received postoperative adjuvant treatment compared to 74.78% within the CG. The OS rate was 79.63% at 30 months for patients from the TBG in comparison with 65.54% for patients from the CG. Conclusion: The implementation of standardised guidelines including the establishment of the “Tumor Board Conference” results in a higher percentage of patients receiving surgery as only treatment and in better OS rates. To further support this positive trend, patients shall be followed longer and analysed in future. T, N and M as well as AJCC stage were identified as most important prognostic factors for OS and DFS in our study.
Multiple zygoma implants for severe maxillary atrophy C.A. Guerrero ∗ , M. Gonzalez, R.R. Throndson University of Texas Medical Branch, Galveston, United States Objectives: Demonstrate the feasibility to immediately load a hybrid prosthesis on multiple zygoma implants for severe maxillary atrophy without grafting. Methods: 50 patients were treated with multiple zygoma implants (4, 5 or 6 fixtures) for immediate loading serving as anchorage for a hybrid denture (zirconia, metal-acrylic or metal porcelain prosthesis). We used transmucosal implants into the piriform rim to the infraorbital rim, body of the zygoma or/and tuberosity up to the pterygoid plates. The architectural zygoma implant positioning design was based on: quality and quantity of bone, opposite dentition, age of the patient, masticatory muscles power and type of skeletal malocclusion. 95% of the implants were extrasinus with lateral fat pad coverage when needed and the remaining 5% underwent sinus mucosa medial repositioning. All surgeries were performed under general anaesthesia. Results: All patients were followed up to 10 years (average 5.6 years) the provisional teeth were installed immediately and final prosthesis was fabricated within eight weeks postsurgery. Complications were related to surgery or prosthesis, one implant was exposed into the sinus and needed sinus treatment and eventually was removed (the prosthesis continued to work on four implants), and two implants got exposed laterally, requiring lateral fat pad coverage with success. The provisional teeth phase is fundamental to comply with the patient aesthetics desires and functional-occlusal requirements, through multiple and sequential changes.
http://dx.doi.org/10.1016/j.ijom.2017.02.078 http://dx.doi.org/10.1016/j.ijom.2017.02.080 Maxillofacial reconstruction by bone transport and multiple dental implants
State of the art in intraoral distraction osteogenesis
C.A. Guerrero ∗ , M. Gonzalez, R.R. Throndson
C.A. Guerrero ∗ , M. Gonzalez, R.R. Throndson
University of Texas Medical Branch, Galveston, United States
University of Texas Medical Branch, Galveston, United States
Objective: To reconstruct the maxilla or the mandible using pedicled osteotomised segments for major continuity defects. Methods: 10 patients were treated for maxillofacial continuity defects, ranged from 2 to 16 cm, as a result of tumour resection, gunshot wound or trauma. Utilising local osteotomies and bone transport, the bony segments maintained the soft tissue attachments and were mobilised and fixated in position to a reconstruction plate. For minor defects up to 4 cm local osteotomies and immediate fixation to a reconstructive plate were performed, combined with internal bone transport for major defects. Clinical analysis, photographs and radiographs (panoramic, lateral and P-A cephalic) were used to evaluate the bone continuity, facial aesthetics, occlusion and mandibular function. Results: All patients were adequately reconstructed intraorally with radiographic evidence of bony continuity. No soft tissue dehiscence, infection or necrosis of the segments was observed after 2 years of follow up. Conclusions: All reconstruction were successful, and full bony continuity was obtained, using pedicled osteotomised segments.
Objective: Demonstrate the possibility to develop new bone and soft tissues in a controlled and predictably manner to treat maxillofacial deficiencies. Avoiding the use of bone grafting, decreasing morbidity and costs. Methods: 720 patients underwent intraoral distraction osteogenesis with miniaturised appliances to increase maxillofacial width and/or anteroposterior bone and surrounding soft tissues to correct severe skeletal deficiencies. The distraction devices were completely buried with extension activators or placed transmucosally, to avoid food and saliva contamination and obtain closed chamber for ideal bone formation. The variables included: amount of movement, age of the patient, quality and quantity of bone. Movements were 7 mm (mandibular widening) to 55 mm (bone transport after tumour resection). Strict distraction protocols were reinforced, selection of adequate surgical sites and avoiding complications are the key to success. Results: Bone growth was controlled either by adequate planning or bony fragments repositioned after the activation phase and before consolidation, with the distractors one-end repositioning or rigid fixation. The distraction devices were removed after