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Bemquerer LM, de Arruda JAA, Costa FPD, Abreu LG, Macari S, Moreno A, Jardilino FDM, Travassos DV, Silva TA. Diagnosis and rehabilitation of an infant with palatal mucormycosis: A clinical report and systematic literature review. J Prosthet Dent 2024:S0022-3913(24)00200-2. [PMID: 38609762 DOI: 10.1016/j.prosdent.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 04/14/2024]
Abstract
STATEMENT OF PROBLEM Oral mucormycosis is uncommon in pediatric patients with hematolymphoid diseases. Prosthetic rehabilitation is challenging, and protocols are scarce in the literature. PURPOSE The purpose of this clinical report and systematic literature review of case reports and case series was to describe the clinicopathologic aspects of oral mucormycosis and the interim prosthetic rehabilitation of an affected infant. MATERIAL AND METHODS The clinical lesions were ulcerative and necrotic with underlying bone exposure that affected the hard palate. The affected area underwent surgical debridement, and histopathologic analysis was performed. A literature search in PubMed/MEDLINE, Embase, Scopus, and Web of Science up to October 2023 was performed. RESULTS The histopathological features were consistent with mucormycosis. Topical and systemic antifungals were prescribed. Tooth eruption was insufficient, and an acetate plate without clasp retention, but still with adequate retention, was fabricated. Articulatory, masticatory, and swallowing functions were restored, preventing the passage of food and fluids into the oroantral cavities. Twenty-five articles describing 26 patients with oral mucormycosis related to hematolymphoid disorders affecting the pediatric population were identified. None of the authors of these articles provided information about oral rehabilitation. CONCLUSIONS Early diagnosis and treatment are essential to increasing the chances of survival for infants affected by oral mucormycosis. Custom-made rehabilitation should be provided to restore oral function and improve the patient's general health.
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Affiliation(s)
- Larissa Marques Bemquerer
- Postgraduate Student, Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - José Alcides Almeida de Arruda
- Postdoctoral Researcher, Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Fernanda Pereira Delgado Costa
- Postgraduate Student, Multiprofessional Integrated Residency in Health, Clinics Hospital, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Lucas Guimarães Abreu
- Adjunct Professor, Department of Child and Adolescent Oral Health, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Soraia Macari
- Adjunct Professor, Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Amália Moreno
- Adjunct Professor, Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Francisca Daniele Moreira Jardilino
- Adjunct Professor, Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Denise Vieira Travassos
- Associate Professor, Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Tarcília Aparecida Silva
- Full Professor, Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.
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2
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Basavaraju RM, Shetty S, Pugazhendhi P, Aradya A. Prosthodontic rehabilitation of patients with a unilateral subtotal maxillectomy using a customised subperiosteal zygomatic implant: a post-COVID-19 mucormycosis. BMJ Case Rep 2024; 17:e258338. [PMID: 38199654 PMCID: PMC10806840 DOI: 10.1136/bcr-2023-258338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Restoring the maxillary resection defect involving the alveolar process, the hard and soft palate and the paranasal sinuses in terms of phonetics, mastication and deglutition is more challenging, especially with young patients with aesthetic concerns.This case report describes the prosthodontic rehabilitation of a young patient with a unilateral subtotal maxillectomy due to post-COVID-19 mucormycosis. A patient-specific subperiosteal implant was planned to rehabilitate the patient's bony defect. Using postsurgical CT, a customised subperiosteal titanium framework was fabricated by the direct metal laser sintering method using grade IV titanium alloy. The fabricated framework was implanted over the patient's zygomatic anatomic contour. Three months later, the patient-specific implant was unveiled to the oral cavity, an open-tray impression was made and the fixed implant prosthesis was fabricated.This case report opens a new realm of rehabilitation for severely compromised maxillary bony defects and impaired oral functioning with no other viable conventional reconstruction options.
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Affiliation(s)
- Ravi Marballi Basavaraju
- Prosthodontics and Crown & Bridge, JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Sujeeth Shetty
- Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, Karnataka, India
| | - Prakash Pugazhendhi
- Prosthodontics and Crown & Bridge, JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Anupama Aradya
- Prosthodontics and Crown & Bridge, JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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3
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Pandya HB, Bhad KM, Patel VR, Diwan SR, Dave HM. Rehabilitation of Acquired Maxillary and Mandibular Defects Secondary to Mucormycosis - A Case Series. Ann Maxillofac Surg 2023; 13:228-231. [PMID: 38405574 PMCID: PMC10883218 DOI: 10.4103/ams.ams_79_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/15/2023] [Accepted: 10/01/2023] [Indexed: 02/27/2024] Open
Abstract
Rationale To suggest a directing algorithm for rehabilitative management of complex soft and hard tissue defects due to mucormycosis. Patient Concerns An utmost need for surgical, reconstructive and rehabilitative options; functional, aesthetic, acceptable to the patient and enduring rehabilitation. Diagnosis Different cases of rhinomaxillary mucormycosis pertaining to the facial skeleton, diagnosed with the help of radiographic as well as fungal cultures. Treatment Thorough medical assessment, and antifungal prescription; followed by surgical resection of the affected areas, rigorous follow-up scheme and later rehabilitation with the help of implants and immediate loading. Outcomes Regular follow-ups for at least one year and successful rehabilitation providing acceptable functional outcomes. Take-away Lessons Unconventional pathologies like rhinomaxillary mucormycosis infecting the jaws require novel, unprecedented and elaborate procedures both surgical and reconstructive based on sound scientific principles. There must be a vision for the rehabilitation of such cases right from the commencement of the surgical treatment.
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Affiliation(s)
- Haren B. Pandya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Science, Dharmsinh Desai University, Nadiad, Gujarat, India
| | - Kaustubh M. Bhad
- Department of Oral and Maxillofacial Surgery, AMC Dental College, Ahmedabad, Gujarat, India
| | - Vimesh R. Patel
- Department of Oral and Maxillofacial Surgery, Karnavati School of Dentistry, Ahmedabad, Gujarat, India
| | - Shaswat R. Diwan
- Department of Oral and Maxillofacial Surgery, Sparshh and Diwasha Maxillofacial Centre, Ahmedabad, Gujarat, India
| | - Harsh Manoj Dave
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Science, Dharmsinh Desai University, Nadiad, Gujarat, India
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4
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Bhargava A, Soni S, Raj K, Gupta M, Deshpande R, Khan MF. Analog and Digital Protocols for Functional Prosthetic Rehabilitation of Post-COVID-19 Rhino-Orbito Cerebral Mucormycosis Maxillofacial Defects: A Case Series. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S1347-S1350. [PMID: 37694062 PMCID: PMC10485534 DOI: 10.4103/jpbs.jpbs_79_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 09/12/2023] Open
Abstract
The current study aims to present our clinical observations and experience gathered during the diagnosis, clinical presentation, medical/surgical treatment, and functional prosthetic rehabilitation of cases of rhino-orbital/cerebral Mucormycosis patients. Mucormycosis is an aggressive, life-threatening invasive fungal infection that occurs in people who are immune-compromised. The rise of ROCM during the second wave of the COVID-19 pandemic in India suggests a more effective association between Mucormycosis and the SARS-CoV-2 delta variant. The treatment strategy for Mucormycosis is an early diagnosis which is critical for a successful outcome. The initial step is to reduce or remove underlying risk factors followed by surgical excision and debridement of the afflicted tissues supplemented with antifungal medication. The first-line antifungal treatment is Liposomal Amphotericin B. Postsurgical resection defects are rehabilitated by either removable partial prosthesis (obturators) or by fixed zygomatic implant/patient-specific implant supported prosthesis. Management of ROCM requires a multidisciplinary approach. This case series highlights detailed medical, surgical, and functional prosthetic management modalities adopted by our team in managing such a dreaded disease which may be used as a tool for the formulation of standardized prevention and management/treatment/rehabilitation protocols in the future so that disease morbidity and mortality be reduced and an endemic outbreak could be averted.
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Affiliation(s)
- Anuj Bhargava
- Department of Dentistry, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Smita Soni
- Department of ENT, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Kavita Raj
- Department of Dentistry, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Mahak Gupta
- Department of Dentistry, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Rohan Deshpande
- Consultant Maxillofacial Surgeon and Implantologist, Kalpvruksha Hospital, Nagpur, Maharashtra, India
| | - Mohd Faisal Khan
- Department of Prosthodontics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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5
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Deepika K, Goel S, Gupta R, Jain RA. Application of Polyvinyl chloride sheet as delayed surgical obturator in maxillectomy defects secondary to mucormycosis- A case series. J Oral Biol Craniofac Res 2023; 13:207-209. [PMID: 36712579 PMCID: PMC9874062 DOI: 10.1016/j.jobcr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/15/2022] [Accepted: 01/05/2023] [Indexed: 01/16/2023] Open
Abstract
It was a great challenge for the prosthodontist to rehabilitate and sustain the prosthesis in patients with bilateral maxillectomy defects due to mucormycosis seen with Covid-19 during second wave in India. In such extensive defects there was difficulty in retaining the obturator due to the absence of soft tissue or anatomical undercuts, condition of existing dentition, retained inferior turbinates and limitation in taking retention from defect side during healing phase. In such extensive maxillectomy defects, retention, stability and support can be enhanced by maximum preservation of hard and soft tissues, skin grafting and removal of inferior turbinates to provide a larger surface area for stress distribution. But here, in this case series, maxillectomy defects with retained inferior turbinates presented a problem in retaining the obturator prosthesis due to limitation in taking retention from the defect side. The conventional method of fabrication of obturator using autopolymerizing acrylic failed in terms of weight of the prosthesis and in gaining retention from the defect side during healing phase. Therefore, thermoplastic vacuum pressed Polyvinyl chloride sheet (PVC) was used for fabrication of delayed surgical obturator due to many merits conferred by it. Its light weight, non porous nature, easy adaptability, patient comfort, efficient undercut engagement, hygienic nature makes it a good treatment option. The main cocern was to close oro-nasal communication to eliminate the need of nasogastric tube and to prevent nasal regurgitation. In all cases, patients were comfortable with the obturator prosthesis in terms of adaptation and function.
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Affiliation(s)
- Kumari Deepika
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shefali Goel
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Rekha Gupta
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Radhika A. Jain
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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6
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Ali IE, Otomaru T, Sumita Y. Refabrication of an implant-retained obturator using the denture duplication technique in a bilateral maxillectomy patient with a free fibula osteocutaneous flap. J Prosthodont Res 2023; 67:157-160. [PMID: 35185083 DOI: 10.2186/jpr.jpr_d_21_00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE We aimed to introduce a simple method for refabrication of an implant-retained obturator using the denture duplication technique while retaining the custom abutments for a patient who underwent bilateral maxillectomy and reconstruction with a free fibula osteocutaneous flap. We have proposed this technique to facilitate the impression-making procedure for this extensive maxillary defect and to avoid lengthy and complicated laboratory procedures. METHODS A custom tray was developed by duplicating the fitting surface of an old obturator using silicone putty. The tray was used for a bite-pressure impression wherein both definitive impression and jaw relation were obtained simultaneously, reducing the time required for the placement of a new obturator. CONCLUSIONS We used the denture duplication technique to refabricate an implant-retained obturator while retaining the custom abutments. Decreased chairside time, fewer visits, the use of easily available materials, and uncomplicated laboratory procedures make this technique more economical and acceptable for patients. Using this approach, the patient was able to use the old prosthesis until the delivery of the new prosthesis. The replacement obturator that was developed using this method maintained an acceptable level of oral function.
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Affiliation(s)
- Islam E Ali
- Department of Maxillofacial Prosthetics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | | | - Yuka Sumita
- Department of Maxillofacial Prosthetics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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7
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Paliwal J, Sharma V, Gurjar B, Nagar R. A Novel Technique for Retention of the Immediate Obturator Following Maxillectomy in Mucormycosis: A Case Report. Cureus 2022; 14:e24687. [PMID: 35663650 PMCID: PMC9162907 DOI: 10.7759/cureus.24687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/05/2022] Open
Abstract
Mucormycosis is an aggressive opportunistic fungal infection that affects blood supply-rich areas such as the maxilla. Because of the compromised immune system caused by coronavirus disease 2019 (COVID-19) infection and diabetes, this infection has spread at a rapid rate. Early detection and treatment can reduce disease mortality and morbidity. However, the difficulties of prosthetic rehabilitation and the lack of multidisciplinary planning negatively influence the quality of life (QOL). This case report uses the novel concept of magnet-retained immediate prosthetic rehabilitation in such a case.
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Affiliation(s)
- Jyoti Paliwal
- Prosthodontics, Rajasthan University of Health Sciences (RUHS) College of Dental Sciences, Jaipur, IND
| | - Vineet Sharma
- Prosthodontics, Rajasthan University of Health Sciences (RUHS) College of Dental Sciences, Jaipur, IND
| | - Balwant Gurjar
- Prosthodontics, Rajasthan University of Health Sciences (RUHS) College of Dental Sciences, Jaipur, IND
| | - Ramawatar Nagar
- Prosthodontics, Rajasthan University of Health Sciences (RUHS) College of Dental Sciences, Jaipur, IND
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8
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Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes. J Fungi (Basel) 2021; 8:jof8010044. [PMID: 35049983 PMCID: PMC8781413 DOI: 10.3390/jof8010044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
It has been nearly two years since the pandemic caused by the novel coronavirus disease (COVID-19) has affected the world. Several innovations and discoveries related to COVID-19 are surfacing every day and new problems associated with the COVID-19 virus are also coming to light. A similar situation is with the emergence of deep invasive fungal infections associated with severe acute respiratory syndrome 2 (SARS-CoV-2). Recent literature reported the cases of pulmonary and rhino-cerebral fungal infections appearing in patients previously infected by COVID-19. Histopathological analysis of these cases has shown that most of such infections are diagnosed as mucormycosis or aspergillosis. Rhino-orbital-cerebral mucormycosis usually affects the maxillary sinus with involvement of maxillary teeth, orbits, and ethmoidal sinuses. Diabetes mellitus is an independent risk factor for both COVID-19 as well as mucormycosis. At this point, there is scanty data on the subject and most of the published literature comprises of either case reports or case series with no long-term data available. The aim of this review paper is to present the characteristics of COVID-19 related mucormycosis and associated clinical features, outcome, diagnostic and management strategies. A prompt diagnosis and aggressive treatment planning can surely benefit these patients.
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9
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Affiliation(s)
- N Gopi Chander
- Editor, The Journal of Indian Prosthodontic Society, Chennai, Tamil Nadu, India
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10
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Pałka Ł, Gaur V. The importance of mucormycosis infections on
example of Rhino Orbital Cerebral Mucormycosis. POSTEP HIG MED DOSW 2021. [DOI: 10.5604/01.3001.0014.8123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mucormycosis is an angioinvasive fungal infection, characterized by high morbidity and mortality
and is strongly dependent on the patient’s general health condition, initial site of infection,
and the time from diagnosis to treatment commencement. It has been reported that the
occurrence of mucormycosis has increased rapidly, also among immunocompetent patients.
Moreover, the rise in number is expected to continue. Among all clinical manifestations of
mucormycosis, the rhino-orbital-cerebral type (ROCM) is the most common. The aim of this
article is to increase the awareness of mucoral infections, especially ROCM, and to describe its
first symptoms, as proper treatment requires immediate surgical and medical intervention.
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Affiliation(s)
| | - Vivek Gaur
- Jaipur Dental College, Maharaj Vinayek Global University, Jaipur, India
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11
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Gaur V, Patel K, Palka L. An implant-supported prosthetic rehabilitation of a patient with a bilateral subtotal maxillectomy defect secondary to rhino-orbital-cerebral mucormycosis: A clinical report of a graftless approach. J Prosthet Dent 2021; 128:101-106. [PMID: 33551135 DOI: 10.1016/j.prosdent.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 11/15/2022]
Abstract
This clinical report presents the rehabilitation of extensive hard and soft tissue defects caused by rhino-orbital-cerebral mucormycosis as a result of untreated diabetes mellitus. The patient underwent subtotal maxillectomy and was rehabilitated with an implant-supported maxillofacial prosthesis with zygomatic and pterygoid implants by following an immediate loading protocol.
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Affiliation(s)
- Vivek Gaur
- PhD Student, Department of Oro-Maxillofacial Surgery, Jaipur Dental College, Jaipur, India.
| | - Kiran Patel
- Professor, Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Manipur-ghuma, Bopal, Ahmedabad, Gujarat, India
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12
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Mani UM, Mohamed K, Krishna Kumar A, Inbarajan A. A modified technique to fabricate a complete hollow obturator for bilateral maxillectomy in a patient with mucormycosis—A technical case report. SPECIAL CARE IN DENTISTRY 2019; 39:610-616. [DOI: 10.1111/scd.12423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/29/2019] [Accepted: 09/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Uma Maheswari Mani
- Department of Prosthodontics,Sri Ramachandra Dental College and HospitalSri Ramachandra Institute of Higher Education and Research (DU) Chennai India
| | - Kasim Mohamed
- Department of Prosthodontics,Sri Ramachandra Dental College and HospitalSri Ramachandra Institute of Higher Education and Research (DU) Chennai India
| | - Arjun Krishna Kumar
- Department of Prosthodontics,Sri Ramachandra Dental College and HospitalSri Ramachandra Institute of Higher Education and Research (DU) Chennai India
| | - Athiban Inbarajan
- Department of Prosthodontics,Sri Ramachandra Dental College and HospitalSri Ramachandra Institute of Higher Education and Research (DU) Chennai India
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13
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Arshad M, Shirani G, Mahmoudi X. Rehabilitation after severe maxillectomy using a magnetic obturator (a case report). Clin Case Rep 2018; 6:2347-2354. [PMID: 30564327 PMCID: PMC6293142 DOI: 10.1002/ccr3.1874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/23/2018] [Accepted: 10/01/2018] [Indexed: 11/08/2022] Open
Abstract
This report presents oral rehabilitation of a maxillectomy patient after cancer surgery by fabricating a prosthesis comprising of a denture and a custom-made magnetic retainer. Herein, we present a case of hemimaxillectomy due to squamous cell carcinoma, which was efficiently rehabilitated with implants. Patient's condition and his profile acceptably improved following rehabilitation.
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Affiliation(s)
- Mahnaz Arshad
- Dental Research Center, Dentistry Research InstituteTehran University of Medical SciencesTehranIran
- Department of Prosthodontics, School of Dentistry, International CampusTehran University of Medical SciencesTehranIran
| | - Gholamreza Shirani
- Dental Research Center, Dentistry Research InstituteTehran University of Medical SciencesTehranIran
- Department of Oral and Maxillofacial Surgery, School of DentistryTehran University of Medical SciencesTehranIran
| | - Xaniar Mahmoudi
- School of Dentistry, International CampusTehran University of Medical SciencesTehranIran
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14
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[Rhino-orbito-cerebral mucormycosis from dental origin: Case report]. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2018; 38:27-31. [PMID: 29668130 DOI: 10.7705/biomedica.v38i0.3383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 04/11/2017] [Indexed: 12/26/2022]
Abstract
Rhino-orbito-cerebral mucormycosis from dental origin is an acute infection caused by opportunistic fungi belonging to the order of Mucorales, which affects mainly diabetic and immunocompromised patients.We report the case of a 63-year old diabetic man who performed a dental extraction on himself by his own means and subsequently developed a rhino-orbito-cerebral mucormycosis with cutaneous and palatal affection. The species isolated in the mycological culture was Rhizopus sp.
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15
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Matheus HR, Ervolino E, Faleiros PL, Novaes VCN, Theodoro LH, Garcia VG, de Almeida JM. Cisplatin chemotherapy impairs the peri-implant bone repair around titanium implants: An in vivo study in rats. J Clin Periodontol 2017; 45:241-252. [PMID: 28965362 DOI: 10.1111/jcpe.12824] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/15/2022]
Abstract
AIM The purpose of this study in animals was to evaluate the peri-implant bone repair against systemic administration of the antineoplastic agent. MATERIAL AND METHODS We used 84 male rats (Rattus norvegicus, albinus, Wistar), divided into two groups: cisplatin (CIS) and saline solution (SS). The titanium implants were inserted into the right tibia at day 0 in all animals from both groups. Group SS received SS intraperitoneally at 15 and 17 days postoperatively. Group CIS received 5 and 2.5 mg/kg of CIS intraperitoneally at 15 and 17 days postoperatively, respectively. Euthanasia was performed at 22, 30 and 60 days postoperatively. Twenty-four undecalcified specimens were prepared for histometric analysis of bone/implant contact (BIC). Sixty specimens were selected to bone area (BA) measurement, histological analysis and immunohistochemical analysis of RUNX-2, osteocalcin (OCN) and tartrate-resistant acid phosphatase (TRAP). BIC and BA were considered to be the primary outcome parameters. RESULTS Group CIS showed lower BIC (11.87 ± 0.97 mm; 19.19 ± 0.8 mm; 17.69 ± 1.05 mm; p ≤ .05) and BA (3.68 ± 1.29 mm2 ; 3.05 ± 0.88 mm2 ; 3.23 ± 0.67 mm2 ; p ≤ .05), as well as decreased number of RUNX-2 (102.8 ± 27.35 cells/mm2 ; 100.04 ± 8.61 cells/mm2 ; 118.82 ± 21.38 cells/mm2 ; p ≤ .05)- and OCN-positive cells (120 ± 24.5 cells/mm2 ; 102 ± 27.73 cells/mm2 ; 100 ± 14.23 cells/mm2 ; p ≤ .05) at 22, 30 and 60 days, respectively. The animals in group CIS also showed increased number of TRAP-positive cells (86.8 ± 6.37 cells/mm2 ; 71.5 ± 4.72 cells/mm2 ; 92.8 ± 9.52 cells/mm2 ; p ≤ .05) and a persistent and exacerbated inflammatory response in all experimental periods. CONCLUSION Within the limits of this study, it was concluded that the chemotherapeutic CIS negatively affects the bone repair at peri-implant areas, jeopardizing the osseointegration of titanium implants.
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Affiliation(s)
- Henrique Rinaldi Matheus
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Edilson Ervolino
- Department of Basic Science, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Paula Lazilha Faleiros
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Vivian Cristina Noronha Novaes
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Leticia Helena Theodoro
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Valdir Gouveia Garcia
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Juliano Milanezi de Almeida
- Department of Surgery and Integrated Clinic-Periodontics Division, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
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Abstract
Osseointegrated implants are regularly used for retention and stability of maxillofacial prosthesis, especially in palatal obturator with large defects and few remaining teeth. In these cases, loads that tissues receive from a prosthesis can cause bone resorption and thus enlarge the defect. Implants may help redistribute the loads on the perimplant bone crest and avoid exacerbating the defect. The authors present a case in which the palatal defect has increased overtime. After placement of a sealing prosthesis with implants, bone and mucosal tissues stability around the defect it is observed during 1 year of follow-up.
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Qu XZ, Wang MY, Ong HS, Zhang CP. Post-operative hemimaxillectomy rehabilitation using prostheses supported by zygoma implants and remaining natural teeth. Clinics (Sao Paulo) 2016; 71:575-579. [PMID: 27759845 PMCID: PMC5054771 DOI: 10.6061/clinics/2016(10)04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES: This study aimed to evaluate the stability of prostheses supported by zygoma implants and remaining teeth for subjects who had undergone hemi-maxillectomy. METHODS: Ten patients were included in the study. Oral rehabilitation was performed using a temporary prosthesis that was supported by remaining teeth for the first three months. Then, a zygoma implant was placed to provide support for a final prosthesis in addition to the remaining teeth. Each prosthesis was tailor-made according to biomechanical three-dimensional finite element analysis results. The patients were assessed using the prosthesis functioning scale of the Memorial Sloan-Kettering Cancer Center. In addition, retention and bite force were recorded for both the temporary prosthesis and the final prosthesis. RESULTS: The mean bite force of the prosthetic first molar was increased to 69.2 N. The mean retentive force increased to 13.5 N after zygoma implant insertion. The bite force on the prosthetic first molar was improved to 229.3 N. CONCLUSION: Bite force increased significantly with the support of a zygoma implant. The use of zygoma implants in the restoration of maxillary defects improved functional outcome and patient satisfaction.
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Affiliation(s)
- Xing Zhou Qu
- Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiao Tong University, Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai, China
| | - Ming Yi Wang
- Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiao Tong University, Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai, China
| | - Hui Shan Ong
- Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiao Tong University, Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai, China
| | - Chen Ping Zhang
- Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiao Tong University, Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai, China
- E-mail:
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Otomaru T, Sumita YI, Aimaijiang Y, Munakata M, Tachikawa N, Kasugai S, Taniguchi H. Rehabilitation of a Bilateral Maxillectomy Patient with a Free Fibula Osteocutaneous Flap and with an Implant-Retained Obturator: A Clinical Report. J Prosthodont 2015. [DOI: 10.1111/jopr.12319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Takafumi Otomaru
- Department of Maxillofacial Prosthetics; Tokyo Medical and Dental University; Tokyo Japan
| | - Yuka I. Sumita
- Department of Maxillofacial Prosthetics; Tokyo Medical and Dental University; Tokyo Japan
| | - Yiliyaer Aimaijiang
- Department of Maxillofacial Prosthetics; Tokyo Medical and Dental University; Tokyo Japan
| | - Motohiro Munakata
- Department of Prosthodontic Dentistry for Function of TMJ and Occlusion; Kanagawa Dental University; Kanagawa Japan
| | - Noriko Tachikawa
- Department of Oral Implantology and Regenerative Dental Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Shohei Kasugai
- Department of Oral Implantology and Regenerative Dental Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Hisashi Taniguchi
- Department of Maxillofacial Prosthetics; Tokyo Medical and Dental University; Tokyo Japan
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Finite element analysis of stability and functional stress with implant-supported maxillary obturator prostheses. J Prosthet Dent 2014; 112:1578-84. [PMID: 25277029 DOI: 10.1016/j.prosdent.2014.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 11/23/2022]
Abstract
STATEMENT OF PROBLEM Maxillary resections jeopardize the stability and functional stress generated by implanted-supported prostheses. PURPOSE The purpose of this study was to evaluate the stability and functional stress caused by implanted-supported obturator prostheses in simulated maxillary resections of an edentulous maxilla corresponding to Okay Classes Ib, II, and III, with no surgical reconstruction. MATERIAL AND METHODS Implants were positioned in the residual maxilla, and bar-clip retention systems were designed for each experimental model. The 3-dimensional models of the maxillary resection and corresponding implanted-supported obturator prosthesis, constructed from a computed tomography scan, were used to develop a finite element mesh. Loads were simultaneously applied to the occlusal (80 N) and anterior (35 N) platforms corresponding to the prosthetic teeth. Qualitative analysis was based on the scale of maximum principal stress; values obtained by means of quantitative analysis were expressed in MPa. RESULTS The implant-supported obturator prostheses tended to rotate toward the surgical resection, the region with no osseous support. Tensile and compressive stresses in the gingival mucosa and in the cortical bone increased as the osseous support and the numbers of implants and clips diminished. CONCLUSIONS All evaluated bar-clip retention systems displayed a tendency toward dislodgment of the obturator prosthesis, increasing as the osseous resection area amplified. The osseous tensile and compressive stresses resulting from the bar-clip retention system for Okay Classes Ib, II, and III maxillectomy may not be favorable to the survival rate of implants.
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Gowda ME, Mohan MS, Verma K, Roy ID. Implant rehabilitation of partial maxillectomy edentulous patient. Contemp Clin Dent 2013; 4:393-6. [PMID: 24124314 PMCID: PMC3793569 DOI: 10.4103/0976-237x.118362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Edentulous patients with maxillectomy defects present a significant challenge for prosthetic rehabilitation and the adaptive capabilities of the patient as retention is highly compromised. Hence, the option of using endosseous implants to increase obturator retention has been used. A patient of mucormycosis of the left maxilla was treated with surgical excision. After satisfactory healing, definitive implant supported magnet retained prosthesis was fabricated for the patient. Implants with magnetic units offer a practical method of improving the retention of obturators provided acceptable prosthetic protocols are followed for the rehabilitation.
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Affiliation(s)
- Mahesh E Gowda
- Division of Prosthodontics, Army Dental Centre (R and R), New Delhi, India
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21
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Bidra AS, May GW, Tharp GE, Chambers MS. Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy Defect. J ORAL IMPLANTOL 2013; 39:91-7. [DOI: 10.1563/aaid-joi-d-10-00181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bilateral maxillectomy is known to have serious esthetic and functional consequences. The retention and support of a maxillary obturator prosthesis in these patients is particularly challenging. Surgical placement of implants is also challenging because of the lack of available bone. Therefore, implant placement into remote sites such as zygoma has been advocated. Very few articles in the literature have discussed the use of pterygoid/pterygomaxillary implants in patients undergoing maxillectomy. This case report describes the maxillofacial rehabilitation of an elderly man who underwent a bilateral subtotal maxillectomy due to basaloid squamous cell carcinoma of the hard palate. After initial healing, the patient had a pterygoid implant placed on each side of the oral cavity. Zygomatic implants were also attempted, but they failed to osseointegrate. Both pterygoid implants showed successful osseointegration. These 2 implants significantly helped to retain a hollow maxillary obturator prosthesis that aided in improved swallowing, speech, and esthetics. To the authors' knowledge, this is the first report in the literature that describes usage of pterygoid implants for rehabilitation of a patient undergoing bilateral maxillectomy.
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Affiliation(s)
- Avinash S. Bidra
- Department of Reconstructive Sciences, University of Connecticut, Farmington, Conn
| | | | | | - Mark S. Chambers
- Section of Dental Oncology, University of Texas, M.D Anderson Cancer Center, Houston, Tex
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22
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Distraction osteogenesis – An overview of principle and its applications. Indian J Dent 2012. [DOI: 10.1016/j.ijd.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Goiato MC, Ribeiro PDP, Pellizzer EP, Pesqueira AA, Haddad MF, dos Santos DM, Moreno A. Photoelastic analysis to compare implant-retained and conventional obturator dentures. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:061203. [PMID: 22734733 DOI: 10.1117/1.jbo.17.6.061203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The use of photoelastic analysis contributes to the rehabilitation of patients with oral-sinus-nasal sequelae, which in turn affect important functions such as chewing, swallowing, and speech. The prosthetic rehabilitation with implant-retained dentures is a suitable treatment option. The purpose of this study was to verify, by using a photoelastic analysis, the stress distribution in implant-retained palatal obturator dentures (relined or not) associated with different attachment systems (O-ring, bar-clip, and bar-clip associated with distally placed O-rings). Two photoelastic models were obtained from an experimental maxillary cast presenting an oral-nasal communication. One model had two 13-mm length implants placed on the left region. A total of eight colorless maxillary obturators were fabricated and subsequently four of them were relined with soft silicone soft, and three had attachment systems associated. The assembly (model/attachment system/prosthesis) was positioned in a circular polariscope and a 100-N load was applied at 10 mm/s. The results showed that the denture relining influenced the distribution and amount of stress on the models. The O-ring group displayed the lowest stress levels, followed by bar-clip system associated with distally placed O-rings and bar-clip groups.
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Affiliation(s)
- Marcelo Coelho Goiato
- UNESP, Araçatuba Dental School, Department of Dental Materials and Prosthodontics, São Paulo 16015-050, Brazil.
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Patil PG, Patil SP. Fabrication of a hollow obturator as a single unit for management of bilateral subtotal maxillectomy. J Prosthodont 2012; 21:194-9. [PMID: 22372720 DOI: 10.1111/j.1532-849x.2011.00799.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Prosthetic rehabilitation with an obturator for a total or subtotal maxillectomy patient is a challenging task, as there are little or no residual maxillary structures to depend on for support, retention, and stability of the prosthesis. This clinical report describes the prosthodontic management of a patient operated on for a bilateral subtotal maxillectomy secondary to ameloblastoma of the palate with a closed hollow obturator. The processing technique described in this article to fabricate the hollow obturator is a variation of other well-known techniques. The variation comprises the use of a wax bolus to maintain a predictable internal dimension for a hollow obturator. This technique allows fabrication of a complete hollow obturator prosthesis as a single unit in heat-polymerized acrylic resin using a single-step flasking procedure.
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Affiliation(s)
- Pravinkumar G Patil
- Department of Prosthodontics, Government Dental College & Hospital, Nagpur, Maharashtra, India.
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26
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Photoelastic Analysis of Implant-Retained and Conventional Obturator Prostheses With Different Attachment Systems and Soft Relining. J Craniofac Surg 2011; 22:797-800. [DOI: 10.1097/scs.0b013e31820f3473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Affiliation(s)
- Samuel R Zwetchkenbaum
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan School of Dentistry, 1011 N University Ave., Ann Arbor, MI 48109-1078, USA.
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Photoelastic Stress Analysis of Different Attachment Systems on Implant-Retained and Conventional Palatal Obturator Prostheses. J Craniofac Surg 2011; 22:523-6. [DOI: 10.1097/scs.0b013e3182085401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bilhan H, Geckili O, Bural C, Sonmez E, Guven E. Prosthetic Rehabilitation of a Patient after Surgical Reconstruction of the Maxilla: A Clinical Report. J Prosthodont 2010; 20:74-8. [DOI: 10.1111/j.1532-849x.2010.00660.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Örtorp A. Three tumor patients with total maxillectomy rehabilitated with implant-supported frameworks and maxillary obturators: a follow-up report. Clin Implant Dent Relat Res 2009; 12:315-23. [PMID: 19438940 DOI: 10.1111/j.1708-8208.2009.00164.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few reports are available on treatment using implant-supported frameworks with maxillary obturators after total maxillectomy on tumor patients. PURPOSE To describe, evaluate, and report the clinical and radiographic performance of implant-supported frameworks and maxillary obturators after maxillectomy during the first years of function. MATERIALS AND METHODS Three patients with cancer in the maxillary region treated by total maxillectomy were rehabilitated. Seventeen dental and two craniofacial implants were installed, and the patients each received implant-supported, screw-retained, three-unit frameworks with a U-shaped bar and obturators retained by four magnetic attachments. Clinical and radiographic data were collected up to 7 years of follow-up. RESULTS The frequency of complications was low. Two craniofacial implants and one dental implant were loose and removed at abutment connection. No implants were lost after framework connection, and the mean marginal bone loss was small. CONCLUSION Within the limitations of this report, dental implants are useful for rehabilitation of total maxillectomy patients, and a three-unit, screw-retained, implant-supported framework with maxillary obturator retained by magnetic attachment is a successful treatment concept for this patient group.
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Affiliation(s)
- Anders Örtorp
- Department of Prosthetic Dentistry/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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