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Prosthodontic rehabilitation after traumatic tooth and bone loss: A clinical report
Prosthodontic rehabilitation after traumatic tooth and bone loss: A clinical report Buket Akalin Evren, DDS,a Selcuk Basa, DDS, PhD,b Yasar Ozkan, DDS, PhD,c Hakki Tanyeri, DDS, PhD,d and Yasemin Kulak Ozkan, DDS, PhDe University of Marmara, Faculty of Dentistry, Istanbul, Turkey; University of Istanbul, Faculty of Dentistry, Istanbul, Turkey Traumatic injuries from motor vehicle accidents may cause anatomic deficiencies in soft and hard tissues. Successful treatment of patients with such deficiences may include preprosthetic surgery using osseointegrated implants to increase prosthesis retention and stability. This article describes the treatment of a motor vehicle accident victim whose anterior teeth and supporting tissues were lost. (J Prosthet Dent 2006;95:22-5.)
A
n interdisciplinary approach is often indicated in the planning and treatment of patients who have severe maxillofacial trauma.1 Traumatic injuries are generally caused by mechanical, electrical, and chemical agents, radiation, and heat. Motor vehicle accidents, firearms, and falls are examples of trauma that result from mechanical types of injuries. Head trauma usually results in anterior tooth loss.2 The patient with maxillofacial defects resulting from motor vehicle accidents may have numerous soft- and hard-tissue injuries ranging from neurologic involvement to fractures and/or avulsions of the temporomandibular joint, maxilla, mandible, teeth, and supporting structures.3 These defects often result in the loss of attached mucosa and alveolar processes, reducing potential prosthesis support and requiring bone and skin grafting.4,5 Patients with traumatic defects present with moveable tissue beds and lack of sufficient tooth and bone support, which limit prosthesis retention. A stable and retentive prosthesis contributes to the patient’s psychological well-being.1,6,7 The loss of prosthodontic support may result in the tendency to use a removable prosthesis supported by both teeth and soft tissues. The placement of osseointegrated implants offers an opportunity to enhance the prosthodontic support with different restorative designs.4 The treatment of patients with prostheses supported by endosseous dental implants has become a more frequent restorative option.8 Removable implant-supported prostheses have numerous advantages, including increased retention, stability, patient satisfaction, and the preservation of existing hard and soft tissues.9 This clinical report describes the treatment of a a
Research Assistant, Department of Prosthodontics, University of Marmara. b Professor, Department of Oral and Maxillofacial Surgery, University of Marmara. c Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Marmara. d Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University. e Professor, Department of Prosthodontics, University of Marmara.
22 THE JOURNAL OF PROSTHETIC DENTISTRY
partially edentulous patient with a traumatic injury as a result of an automobile accident. The prosthetic rehabilitation was completed by fabricating a maxillary implant-supported removable prosthesis and a mandibular prosthesis with intracoronal attachments.
CLINICAL REPORT A 28-year-old woman was referred to Marmara University Dentistry Faculty for dental rehabilitation. The patient’s history included an automobile accident that had resulted in multiple facial fractures and extensive soft-tissue wounds. The traumatological urgent rehabilitation was performed in the Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery. Cranial radiographs confirmed the presence of multiple facial bone fractures located in the zygomatic arch, orbital and maxillary sinus walls, and in the mandibular body. Mini plates and screws were observed in the cranial radiographs, which had been used to approximate and reduce the facial fractures (Fig. 1). According to previous medical reports, no intracranial pathologic condition was observed; however, both of the optic nerves were avulsed. Vision was completely lost as a result of the accident and could not be restored. The patient’s chief concerns were relative to speech, mastication, and esthetics. Extraoral examination revealed facial scar tissues involving the nose and lips. Intraoral examination revealed that several teeth were lost along with the associated alveolar ridge as a result of the traumatic injury and periodontal disease (Fig. 2). The patient’s oral hygiene was poor. Subluxated, displaced, and periodontally compromised teeth were extracted. The traumatic lacerations resulted in scar bands on the hard and soft palate and in the vestibular region of the lost teeth. The patient had an Angle Class I occlusion with an acceptable vertical and horizontal overlap prior to the accident. Due to the fractures in the maxilla and mandible, the patient had limited opening, with reduced interarch space and mandibular deviation. The temporomandibular joints were asymptomatic, and associated muscles were not painful. The VOLUME 95 NUMBER 1
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THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 2. Intraoral view of patient before treatment, with missing maxillary and mandibular teeth and alveolar ridges.
Fig. 1. Cranial radiograph showing mini plates and screws used for fixing fractured zygomatic arch, orbital, and maxillary sinus walls.
remaining dentition included 6 maxillary teeth (right second molar, left canine, left first and second premolars, and left first and second molars) and 3 mandibular teeth (right canine, right second premolar, and right second molar). After completion of the medical and dental history and clinical and radiographic examination, the patient received periodontal treatment to improve the periodontal condition of the remaining teeth. Several different restorative options were discussed with the patient, ranging from maintaining the existing dentition to extraction of the remaining maxillary teeth. The patient expressed a desire to keep as many of the remaining teeth as possible, for as long as possible. In the mandibular arch, the use of a fixed partial denture (FPD) was contraindicated because of extensive tooth and bone loss. As a result, a removable partial denture (RPD) with intracoronal attachments was selected for esthetics, function, and ease of oral hygiene maintenence. Esthetically, the elimination of facial clasps with intracoronal attachments would provide a more esthetic appearance for the replacement of the missing teeth. JANUARY 2006
Fig. 3. Metal-ceramic FPD with intracoronal attachment placed on left maxillary canine.
Functionally, the intracoronal attachments in the complete crown restorations would allow the abutment teeth to be loaded along the long axes.2 The maxillary arch was primarily affected by the trauma with the presence of scar tissue, nonmucous soft tissue, and the absence of alveolar ridge and adequate vestibule. For these reasons, the placement of a conventional removable prosthesis was assessed as being unfavorable.10,11 Therefore, to provide retention and meet the esthetic requirements, an implant-supported removable maxillary prosthesis with intracoronal attachments was suggested, and the patient accepted the suggested treatment plan. Two implants (ITI; Straumann, Waldenburg, Switzerland), one in the anterior (3.3 mm wide, 14 mm long) and the other in the posterior region (4.1 mm wide, 14 mm long), were placed using a 2-stage surgical protocol.12 The patient was referred for prosthetic rehabilitation after a 6-month time period to allow for osseointegration and full maturation of the soft tissue. Diagnostic casts and record bases were fabricated and then mounted in an articulator (Artex; Girrbach Dental GmbH, Pforzheim, Germany). The traumatic 23
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Fig. 4. Metal-ceramic FPD with intracoronal attachment placed on right mandibular first premolar.
Fig. 5. Ball attachments to connect implants to removable prosthesis.
Fig. 6. Intraoral view of definitive removable prosthesis.
Fig. 7. Extraoral view of definitive removable prosthesis.
dislocation of the facial bones and teeth resulted in supraerupted teeth, causing deflective occlusal contacts and the inability to achieve maximal intercuspation. Therefore, the abutment teeth were prepared for complete coverage crowns, with shoulder finish lines, to provide support for the prosthesis and to restore the occlusion. The left maxillary first and second molars were intact and were not needed as abutments. After making the impressions (Speedex; Coltene/ Whaledent Inc, Cuyohoga Falls, Ohio), centric relation was recorded (Impression Compound; Kerr Dental, Orange, Calif) and a facebow transfer was made (Artex Rotofix Facebow; Girrbach Dental GmbH). In the maxilla, metal-ceramic FPDs connecting the left canine, left first premolar, and left second premolar (VMK95 Metall Keramik; Vita Zahnfabrik, Bad Sackingen, Germany) were fabricated, with an intracoronal attachment (AP-Piccolino; Servo-Dental, Hagen, Germany) placed on the mesial aspect of the left maxillary canine (Fig. 3). The incorporation of an attachment
intracoronally on the mesial surface or in pontics between the FPD retainers was used in the fabrication of the prosthesis. Attachments in the interabutment FPD pontics are well suited for retaining the major connectors of unilateral distal-extension RPDs.13 In the mandible, the right mandibular canine, second premolar, and second molar were connected with a metal-ceramic FPD, with an intracoronal attachment on the right first premolar and a prefabricated bar (Metalordental, Oensingen, Switzerland) connecting the right second premolar to the right second molar to provide a splinting effect (Fig. 4). Mandibular teeth were splinted to improve the prognosis, since their surrounding bone quality was not optimal. The bar was attached to the crowns of the abutment teeth in such a way that the marginal gingiva would not be traumatized and would be accessible for cleaning. The bar was rectangular in the cross-section, whereas the gingival surface was rounded and passively contacted the mucosa. A milled lingualrest design with a cervical shoulder was used for the
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metal-ceramic FPDs for ease of placement, bracing, and for stability in the fully seated position.13 After the adjustment of the metal-ceramic FPDs, the impressions (Speedex; Coltene/Whaledent Inc) for the removable prostheses were made with custom impression trays. After trial evaluation of the metal frameworks with the attachments, the artificial teeth (Vitapan; Vita Zahnfabrik) were arranged, and the occlusion was established to provide harmony with the metal-ceramic FPDs. The wax trial dentures were then evaluated intraorally. The removable prosthesis was connected to the implants with ball attachments (ITI; Straumann AG) (Fig. 5). A satisfactory esthetic and functional result was achieved after several postinsertion denture evaluations and adjustments (Figs. 6 and 7). The patient was educated in the proper insertion and removal of the prosthesis and was able to manage insertion and removal after practicing. Information was also provided to family members concerning oral hygiene and placement of the prosthesis. The patient experienced no functional difficulties over a 12-month observation period.
DISCUSSION Large maxillary defects seen after traumatic injuries can result in functional impairment of speech, mastication, swallowing, and esthetics. The cosmetic deformity may have a significant psychological impact. Although an acceptable cosmetic result may be obtained, prosthesis stability is more difficult to achieve due to the avulsion of anatomic structures, alterations in the buccal sulcus, and/or the presence of scar tissue.7 The presence of scar tissue, nonmucous soft tissue, and the absence of alveolar ridge and adequate vestibule limit prosthetic retention and stability.7 In addition, limited interarch space restricts operative procedures and the ability to replace artificial teeth. For these reasons, the placement of a conventional removable or fixed prosthesis in trauma patients is very difficult.10 There are both esthetic and functional advantages to using a prosthesis with intracoronal attachments. The use of osseointegrated implants may provide reliable prosthesis retention in addition to the retention gained by the removable prosthesis with intracoronal attachments.11 Implants provide an excellent means of stabilizing the prosthesis in a manner that may restore the patient to a preaccident level of function, which has a dramatic impact on patient acceptance.2 The patient’s ability to maintain oral hygiene, keep recall appointments, and develop adequate manual dexterity for the placement and care of the prosthesis are beneficial, as is the presence of family support for the patient.3,4
JANUARY 2006
THE JOURNAL OF PROSTHETIC DENTISTRY
SUMMARY Traumatic injuries to the mouth and oral cavity may be treated in a variety of ways. The patient situation described in this clinical report illustrates traumatic injuries that may occur and potential treatment options. The optimal treatment for patients with traumatic tooth loss and hard- and soft-tissue malformations may include the use of osseointegrated implants to provide increased prosthesis support and stability.
REFERENCES 1. Morton D, Fridrich K, Aquilino SA, Fridrich TA. Interdiciplinary treatment of severe maxillofacial trauma: a clinical report. J Prosthet Dent 2000;84: 133-5. 2. Balshi TJ. Oral prosthodontic rehabilitation for traumatic sports injuries. Dent Clin North Am 1991;35:771-96. 3. Wiens JP. Acquired maxillofacial defects from motor vehicle accidents: statistics and prosthodontic considerations. J Prosthet Dent 1990;63: 172-81. 4. Wiens JP. The use of osseointegrated implants in the treatment of patients with trauma. J Prosthet Dent 1992;67:670-8. 5. Tipton PA. Esthetic restoration of the traumatized and surgically reconstructed anterior maxilla. J Esthet Restor Dent 2002;14:267-74. 6. Sykes LM, Essop RM. Combination intraoral and extraoral prosthesis used for rehabilitation of a patient treated for cancrum oris: a clinical report. J Prosthet Dent 2000;83:613-6. 7. Mou SH, Chai T, Shiau YY, Wang JS. Fabrication of conventional complete dentures for a left segmental mandibulectomy patient: a clinical report. J Prosthet Dent 2001;86:582-5. 8. Meraw SJ, Eckert SE, Yacyshyn CE, Wollan PE. Retrospective review of grafting techniques utilized in conjunction with endosseous implant placement. Int J Oral Maxillofac Implants 1999;14:744-7. 9. McAndrew R. Prosthodontic rehabilitation with a swing-lock removable partial denture and a single osseointegrated implant: a clinical report. J Prosthet Dent 2002;88:128-31. 10. Brogniez V, Lejuste P, Pecheur A, Reychler H. Dental prosthetic reconstruction of osseointegrated implants placed in irradiated bone. Int J Oral Maxillofac Implants 1998;13:506-12. 11. Brignoni R, Dominici JT. An intraoral-extraoral combination prosthesis using an intermediate framework and magnets: a clinical report. J Prosthet Dent 2001;85:7-11. 12. Sutter F, Schroeder A, Buser D. The new concept of ITI hollow-cylinder and hollow-screw implants: Part 2: clinical aspects, indications and early clinical results. Int J Oral Maxillofac Implants 1988;3:173-81. 13. Graber G, Rateitschak KH. Color atlas of dental medicine, volume 2: removable partial dentures. New Tork: Thieme Medical Publishers; 1988. p. 20, 35. Reprint requests to: DR BUKET AKALIN EVREN UN_IVERS_ITY OF MARMARA FACULTY OF DENT_ISTRY DEPARTMENT OF PROSTHODONT_ICS _ SOK. NO: 6 80200 GU¨ZELBAHCxE BU¨YU¨KCx_IFLIK N_ISANTASI, ISTANBUL TURKEY FAX: 90-0-212-246 52 47 E-MAIL: [email protected] 0022-3913/$32.00 Copyright Ó 2006 by The Editorial Council of The Journal of Prosthetic Dentistry.
doi:10.1016/j.prosdent.2005.11.002
25
A
n interdisciplinary approach is often indicated in the planning and treatment of patients who have severe maxillofacial trauma.1 Traumatic injuries are generally caused by mechanical, electrical, and chemical agents, radiation, and heat. Motor vehicle accidents, firearms, and falls are examples of trauma that result from mechanical types of injuries. Head trauma usually results in anterior tooth loss.2 The patient with maxillofacial defects resulting from motor vehicle accidents may have numerous soft- and hard-tissue injuries ranging from neurologic involvement to fractures and/or avulsions of the temporomandibular joint, maxilla, mandible, teeth, and supporting structures.3 These defects often result in the loss of attached mucosa and alveolar processes, reducing potential prosthesis support and requiring bone and skin grafting.4,5 Patients with traumatic defects present with moveable tissue beds and lack of sufficient tooth and bone support, which limit prosthesis retention. A stable and retentive prosthesis contributes to the patient’s psychological well-being.1,6,7 The loss of prosthodontic support may result in the tendency to use a removable prosthesis supported by both teeth and soft tissues. The placement of osseointegrated implants offers an opportunity to enhance the prosthodontic support with different restorative designs.4 The treatment of patients with prostheses supported by endosseous dental implants has become a more frequent restorative option.8 Removable implant-supported prostheses have numerous advantages, including increased retention, stability, patient satisfaction, and the preservation of existing hard and soft tissues.9 This clinical report describes the treatment of a a
Research Assistant, Department of Prosthodontics, University of Marmara. b Professor, Department of Oral and Maxillofacial Surgery, University of Marmara. c Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Marmara. d Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University. e Professor, Department of Prosthodontics, University of Marmara.
22 THE JOURNAL OF PROSTHETIC DENTISTRY
partially edentulous patient with a traumatic injury as a result of an automobile accident. The prosthetic rehabilitation was completed by fabricating a maxillary implant-supported removable prosthesis and a mandibular prosthesis with intracoronal attachments.
CLINICAL REPORT A 28-year-old woman was referred to Marmara University Dentistry Faculty for dental rehabilitation. The patient’s history included an automobile accident that had resulted in multiple facial fractures and extensive soft-tissue wounds. The traumatological urgent rehabilitation was performed in the Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery. Cranial radiographs confirmed the presence of multiple facial bone fractures located in the zygomatic arch, orbital and maxillary sinus walls, and in the mandibular body. Mini plates and screws were observed in the cranial radiographs, which had been used to approximate and reduce the facial fractures (Fig. 1). According to previous medical reports, no intracranial pathologic condition was observed; however, both of the optic nerves were avulsed. Vision was completely lost as a result of the accident and could not be restored. The patient’s chief concerns were relative to speech, mastication, and esthetics. Extraoral examination revealed facial scar tissues involving the nose and lips. Intraoral examination revealed that several teeth were lost along with the associated alveolar ridge as a result of the traumatic injury and periodontal disease (Fig. 2). The patient’s oral hygiene was poor. Subluxated, displaced, and periodontally compromised teeth were extracted. The traumatic lacerations resulted in scar bands on the hard and soft palate and in the vestibular region of the lost teeth. The patient had an Angle Class I occlusion with an acceptable vertical and horizontal overlap prior to the accident. Due to the fractures in the maxilla and mandible, the patient had limited opening, with reduced interarch space and mandibular deviation. The temporomandibular joints were asymptomatic, and associated muscles were not painful. The VOLUME 95 NUMBER 1
EVREN ET AL
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 2. Intraoral view of patient before treatment, with missing maxillary and mandibular teeth and alveolar ridges.
Fig. 1. Cranial radiograph showing mini plates and screws used for fixing fractured zygomatic arch, orbital, and maxillary sinus walls.
remaining dentition included 6 maxillary teeth (right second molar, left canine, left first and second premolars, and left first and second molars) and 3 mandibular teeth (right canine, right second premolar, and right second molar). After completion of the medical and dental history and clinical and radiographic examination, the patient received periodontal treatment to improve the periodontal condition of the remaining teeth. Several different restorative options were discussed with the patient, ranging from maintaining the existing dentition to extraction of the remaining maxillary teeth. The patient expressed a desire to keep as many of the remaining teeth as possible, for as long as possible. In the mandibular arch, the use of a fixed partial denture (FPD) was contraindicated because of extensive tooth and bone loss. As a result, a removable partial denture (RPD) with intracoronal attachments was selected for esthetics, function, and ease of oral hygiene maintenence. Esthetically, the elimination of facial clasps with intracoronal attachments would provide a more esthetic appearance for the replacement of the missing teeth. JANUARY 2006
Fig. 3. Metal-ceramic FPD with intracoronal attachment placed on left maxillary canine.
Functionally, the intracoronal attachments in the complete crown restorations would allow the abutment teeth to be loaded along the long axes.2 The maxillary arch was primarily affected by the trauma with the presence of scar tissue, nonmucous soft tissue, and the absence of alveolar ridge and adequate vestibule. For these reasons, the placement of a conventional removable prosthesis was assessed as being unfavorable.10,11 Therefore, to provide retention and meet the esthetic requirements, an implant-supported removable maxillary prosthesis with intracoronal attachments was suggested, and the patient accepted the suggested treatment plan. Two implants (ITI; Straumann, Waldenburg, Switzerland), one in the anterior (3.3 mm wide, 14 mm long) and the other in the posterior region (4.1 mm wide, 14 mm long), were placed using a 2-stage surgical protocol.12 The patient was referred for prosthetic rehabilitation after a 6-month time period to allow for osseointegration and full maturation of the soft tissue. Diagnostic casts and record bases were fabricated and then mounted in an articulator (Artex; Girrbach Dental GmbH, Pforzheim, Germany). The traumatic 23
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EVREN ET AL
Fig. 4. Metal-ceramic FPD with intracoronal attachment placed on right mandibular first premolar.
Fig. 5. Ball attachments to connect implants to removable prosthesis.
Fig. 6. Intraoral view of definitive removable prosthesis.
Fig. 7. Extraoral view of definitive removable prosthesis.
dislocation of the facial bones and teeth resulted in supraerupted teeth, causing deflective occlusal contacts and the inability to achieve maximal intercuspation. Therefore, the abutment teeth were prepared for complete coverage crowns, with shoulder finish lines, to provide support for the prosthesis and to restore the occlusion. The left maxillary first and second molars were intact and were not needed as abutments. After making the impressions (Speedex; Coltene/ Whaledent Inc, Cuyohoga Falls, Ohio), centric relation was recorded (Impression Compound; Kerr Dental, Orange, Calif) and a facebow transfer was made (Artex Rotofix Facebow; Girrbach Dental GmbH). In the maxilla, metal-ceramic FPDs connecting the left canine, left first premolar, and left second premolar (VMK95 Metall Keramik; Vita Zahnfabrik, Bad Sackingen, Germany) were fabricated, with an intracoronal attachment (AP-Piccolino; Servo-Dental, Hagen, Germany) placed on the mesial aspect of the left maxillary canine (Fig. 3). The incorporation of an attachment
intracoronally on the mesial surface or in pontics between the FPD retainers was used in the fabrication of the prosthesis. Attachments in the interabutment FPD pontics are well suited for retaining the major connectors of unilateral distal-extension RPDs.13 In the mandible, the right mandibular canine, second premolar, and second molar were connected with a metal-ceramic FPD, with an intracoronal attachment on the right first premolar and a prefabricated bar (Metalordental, Oensingen, Switzerland) connecting the right second premolar to the right second molar to provide a splinting effect (Fig. 4). Mandibular teeth were splinted to improve the prognosis, since their surrounding bone quality was not optimal. The bar was attached to the crowns of the abutment teeth in such a way that the marginal gingiva would not be traumatized and would be accessible for cleaning. The bar was rectangular in the cross-section, whereas the gingival surface was rounded and passively contacted the mucosa. A milled lingualrest design with a cervical shoulder was used for the
24
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EVREN ET AL
metal-ceramic FPDs for ease of placement, bracing, and for stability in the fully seated position.13 After the adjustment of the metal-ceramic FPDs, the impressions (Speedex; Coltene/Whaledent Inc) for the removable prostheses were made with custom impression trays. After trial evaluation of the metal frameworks with the attachments, the artificial teeth (Vitapan; Vita Zahnfabrik) were arranged, and the occlusion was established to provide harmony with the metal-ceramic FPDs. The wax trial dentures were then evaluated intraorally. The removable prosthesis was connected to the implants with ball attachments (ITI; Straumann AG) (Fig. 5). A satisfactory esthetic and functional result was achieved after several postinsertion denture evaluations and adjustments (Figs. 6 and 7). The patient was educated in the proper insertion and removal of the prosthesis and was able to manage insertion and removal after practicing. Information was also provided to family members concerning oral hygiene and placement of the prosthesis. The patient experienced no functional difficulties over a 12-month observation period.
DISCUSSION Large maxillary defects seen after traumatic injuries can result in functional impairment of speech, mastication, swallowing, and esthetics. The cosmetic deformity may have a significant psychological impact. Although an acceptable cosmetic result may be obtained, prosthesis stability is more difficult to achieve due to the avulsion of anatomic structures, alterations in the buccal sulcus, and/or the presence of scar tissue.7 The presence of scar tissue, nonmucous soft tissue, and the absence of alveolar ridge and adequate vestibule limit prosthetic retention and stability.7 In addition, limited interarch space restricts operative procedures and the ability to replace artificial teeth. For these reasons, the placement of a conventional removable or fixed prosthesis in trauma patients is very difficult.10 There are both esthetic and functional advantages to using a prosthesis with intracoronal attachments. The use of osseointegrated implants may provide reliable prosthesis retention in addition to the retention gained by the removable prosthesis with intracoronal attachments.11 Implants provide an excellent means of stabilizing the prosthesis in a manner that may restore the patient to a preaccident level of function, which has a dramatic impact on patient acceptance.2 The patient’s ability to maintain oral hygiene, keep recall appointments, and develop adequate manual dexterity for the placement and care of the prosthesis are beneficial, as is the presence of family support for the patient.3,4
JANUARY 2006
THE JOURNAL OF PROSTHETIC DENTISTRY
SUMMARY Traumatic injuries to the mouth and oral cavity may be treated in a variety of ways. The patient situation described in this clinical report illustrates traumatic injuries that may occur and potential treatment options. The optimal treatment for patients with traumatic tooth loss and hard- and soft-tissue malformations may include the use of osseointegrated implants to provide increased prosthesis support and stability.
REFERENCES 1. Morton D, Fridrich K, Aquilino SA, Fridrich TA. Interdiciplinary treatment of severe maxillofacial trauma: a clinical report. J Prosthet Dent 2000;84: 133-5. 2. Balshi TJ. Oral prosthodontic rehabilitation for traumatic sports injuries. Dent Clin North Am 1991;35:771-96. 3. Wiens JP. Acquired maxillofacial defects from motor vehicle accidents: statistics and prosthodontic considerations. J Prosthet Dent 1990;63: 172-81. 4. Wiens JP. The use of osseointegrated implants in the treatment of patients with trauma. J Prosthet Dent 1992;67:670-8. 5. Tipton PA. Esthetic restoration of the traumatized and surgically reconstructed anterior maxilla. J Esthet Restor Dent 2002;14:267-74. 6. Sykes LM, Essop RM. Combination intraoral and extraoral prosthesis used for rehabilitation of a patient treated for cancrum oris: a clinical report. J Prosthet Dent 2000;83:613-6. 7. Mou SH, Chai T, Shiau YY, Wang JS. Fabrication of conventional complete dentures for a left segmental mandibulectomy patient: a clinical report. J Prosthet Dent 2001;86:582-5. 8. Meraw SJ, Eckert SE, Yacyshyn CE, Wollan PE. Retrospective review of grafting techniques utilized in conjunction with endosseous implant placement. Int J Oral Maxillofac Implants 1999;14:744-7. 9. McAndrew R. Prosthodontic rehabilitation with a swing-lock removable partial denture and a single osseointegrated implant: a clinical report. J Prosthet Dent 2002;88:128-31. 10. Brogniez V, Lejuste P, Pecheur A, Reychler H. Dental prosthetic reconstruction of osseointegrated implants placed in irradiated bone. Int J Oral Maxillofac Implants 1998;13:506-12. 11. Brignoni R, Dominici JT. An intraoral-extraoral combination prosthesis using an intermediate framework and magnets: a clinical report. J Prosthet Dent 2001;85:7-11. 12. Sutter F, Schroeder A, Buser D. The new concept of ITI hollow-cylinder and hollow-screw implants: Part 2: clinical aspects, indications and early clinical results. Int J Oral Maxillofac Implants 1988;3:173-81. 13. Graber G, Rateitschak KH. Color atlas of dental medicine, volume 2: removable partial dentures. New Tork: Thieme Medical Publishers; 1988. p. 20, 35. Reprint requests to: DR BUKET AKALIN EVREN UN_IVERS_ITY OF MARMARA FACULTY OF DENT_ISTRY DEPARTMENT OF PROSTHODONT_ICS _ SOK. NO: 6 80200 GU¨ZELBAHCxE BU¨YU¨KCx_IFLIK N_ISANTASI, ISTANBUL TURKEY FAX: 90-0-212-246 52 47 E-MAIL: [email protected] 0022-3913/$32.00 Copyright Ó 2006 by The Editorial Council of The Journal of Prosthetic Dentistry.
doi:10.1016/j.prosdent.2005.11.002
25