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Moraschini V, Louro RS, Son A, Calasans-Maia MD, Sartoretto SC, Shibli JA. Long-term survival and success rate of dental implants placed in reconstructed areas with extraoral autogenous bone grafts: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2024; 26:469-481. [PMID: 38450931 DOI: 10.1111/cid.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To evaluate the long-term survival and success rates of implants placed in reconstructed areas using microvascularized or non-microvascularized extraoral bone grafts. MATERIALS AND METHODS An electronic search was performed in five databases and in gray literature for articles published until June, 2023. The eligibility criteria comprised observational studies (prospective or retrospective) and clinical trials, reporting survival and success rates of implants placed in extraoral bone grafts. A meta-analysis (implant failure) was categorized into subgroups based on the type of bone graft used. The risk of bias within studies was assessed using the Newcastle-Ottawa Scale. RESULTS Thirty-one studies met the inclusion criteria. The mean follow-up time was 92 months. The summary estimate of survival rate at the implant level were 94.9% (CI: 90.1%-97.4%) for non-vascularized iliac graft, 96.5% (CI: 91.4%-98.6%) for non-vascularized calvaria graft, and 92.3% (CI: 89.1%-94.6%) for vascularized fibula graft. The mean success rate and marginal bone loss (MBL) were 83.2%; 2.25 mm, 92.2%; 0.93 mm, and 87.6%; 1.49 mm, respectively. CONCLUSIONS Implants placed in areas reconstructed using extraoral autogenous bone graft have high long-term survival rates and low long-term MBLs. The data did not demonstrate clinically relevant differences in the survival, success, or MBL of grafts from different donor areas or with different vascularization. This systematic review was registered in INPLASY under number INPLASY202390004.
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Affiliation(s)
- Vittorio Moraschini
- Department of Periodontology, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Rafael Seabra Louro
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Andrea Son
- Department of Implant Dentistry, School of Dentistry, Guarulhos University, São Paulo, Brazil
| | | | | | - Jamil Awad Shibli
- Department of Implant Dentistry, School of Dentistry, Guarulhos University, São Paulo, Brazil
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Kaiser M, Burg S, Speth U, Cotter ML, Smeets R, Gosau M, König D. Outcomes and influencing factors of dental implants in fibula, iliac crest, and scapula free flaps: a retrospective case-control study. Int J Implant Dent 2024; 10:8. [PMID: 38334913 PMCID: PMC10858007 DOI: 10.1186/s40729-024-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Reconstruction with vascularized bone grafts after ablative surgery and subsequent dental rehabilitation with implants is often challenging; however, it helps improve the patient's quality of life. This retrospective case-control study aimed to determine the implant survival/success rates in different vascularized bone grafts and potential risk factors. METHODS Only patients who received implants in free vascularized bone grafts between 2012 and 2020 were included. The free flap donor sites were the fibula, iliac crest, and scapula. The prosthetic restoration had to be completed, and the observation period had to be over one year after implantation. Implant success was defined according to the Health Scale for Dental Implants criteria. RESULTS Sixty-two patients with 227 implants were included. The implant survival rate was 86.3% after an average of 48.7 months. The causes of implant loss were peri-implantitis (n = 24), insufficient osseointegration (n = 1), removal due to tumor recurrence (n = 1), and osteoradionecrosis (n = 5). Of all implants, 52.4% were classified as successful, 19.8% as compromised, and 27.8% as failed. Removal of osteosynthesis material prior to or concurrent with implant placement resulted in significantly better implant success than material not removed (p = 0.035). Localization of the graft in the mandibular region was associated with a significantly better implant survival (p = 0.034) and success (p = 0.002), also a higher Karnofsky Performance Status Scale score with better implant survival (p = 0.014). CONCLUSION Implants placed in vascularized grafts showed acceptable survival rates despite the potential risk factors often present in these patient groups. However, peri-implantitis remains a challenge.
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Affiliation(s)
- Marina Kaiser
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Simon Burg
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ulrike Speth
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marie-Luise Cotter
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Daniela König
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Lombardo G, D'Agostino A, Nocini PF, Signoriello A, Zangani A, Pardo A, Lonardi F, Trevisiol L. Clinical outcomes and periodontal conditions of dental implants placed in free fibula flaps (FFF): a retrospective study with a mean follow-up of 6 years. Clin Oral Investig 2023; 27:7737-7751. [PMID: 37917356 PMCID: PMC10713700 DOI: 10.1007/s00784-023-05364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Up-to-date literature regarding long-term success of implant rehabilitations after microvascular reconstructions with free fibula flap (FFF) is still very scarce. This study aimed to evaluate clinical outcomes, especially related to oral hygiene conditions, of patients rehabilitated with this technique. MATERIALS AND METHODS A total of 25 patients who underwent maxillofacial reconstructive surgery with FFF were retrospectively evaluated for soft tissues conditions, oral hygiene habits, and implant survival and success, assessed with a mean follow-up of 6 (range 2-15) years after loading. RESULTS Fourteen patients received full-arch fixed prostheses and 11 removable bar-supported overdentures. At the follow-up evaluation, 52% of prostheses did not allow proper accessibility for oral hygiene. Overall prosthetic survival was 100%, and implant survival and success were respectively 93.6% and 72%. Prevalence of peri-implantitis was 29% at implant level and that at patient level 96%. CONCLUSIONS Six-year clinical outcomes of this study reveal that poor oral hygiene practices and compliance by patients who underwent maxillofacial reconstruction with FFF are significantly associated with peri-implant disease. CLINICAL RELEVANCE Findings of the present study underline the need by clinicians for a careful assessment, in reference to a specific implant therapy, of patient's prosthetic accessibility for oral hygiene procedures.
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Affiliation(s)
- Giorgio Lombardo
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Antonio D'Agostino
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Pier Francesco Nocini
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Annarita Signoriello
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Alessandro Zangani
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Alessia Pardo
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Fabio Lonardi
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Lorenzo Trevisiol
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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Yang ZY, Kang YF, Lv XM, LiuFu JF, Zhang L, Shan XF, Cai ZG. Iliac crest towards alveolar processes or mandibular inferior margin in mandibular reconstruction with a vascularized iliac bone flap: which is better? Clin Oral Investig 2023; 27:751-758. [PMID: 36571588 DOI: 10.1007/s00784-022-04823-0] [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] [Received: 02/13/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The study aims to compare differences among iliac bone flaps with different iliac crest orientations for the repair of mandibular defects with an aim to analyze their advantages, disadvantages, and effects. MATERIAL AND METHODS Clinical data and computed tomography scans of all patients who underwent iliac bone flap repair of the mandible in Peking University School and Hospital of Stomatology from January 2016 to April 2021 were collected. Patients were divided into the iliac crest towards alveolar process (Group A) and the iliac crest towards mandibular inferior margin (Group B). Software was used to measure corresponding indicators. The results obtained for the groups were statistically analyzed. RESULTS The study included 78 patients (25 and 53 in groups A and B, respectively). The symmetry of the LC-type defect was better in group A (p < 0.05). The all-bone width of the alveolar process side in group A was greater than 6 mm; in 15 cases of group B, the width was less than 6 mm (p < 0.05). The intermaxillary distance of two sites were higher in group B (p < 0.05). The bone cortical thickness was significantly thicker in group A (p < 0.05). CONCLUSION One year after the mandibular body defect was reconstructed with a vascularized iliac bone flap, the iliac crest towards alveolar process group showed better bone symmetry, width, intermaxillary distance, and cortical thickness to meet the planting requirements. CLINICAL RELEVANCE The use of an iliac crest towards alveolar process may be a better approach for mandible reconstruction.
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Affiliation(s)
- Zong-Yan Yang
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Jian-Feng LiuFu
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
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Comparison of the Effect of Four Different Abutment Screw Torques on Screw Loosening in Single Implant-Supported Prosthesis after the Application of Mechanical Loading. Int J Dent 2021; 2021:3595064. [PMID: 34335769 PMCID: PMC8315865 DOI: 10.1155/2021/3595064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background The complications of implant-supported prostheses can be classified into mechanical and biological ones, one part of which is associated with screw loosening. This study was aimed to compare the effect of four different abutment screw torque techniques on screw loosening in single implant-supported prostheses following the application of mechanical loading. Materials and Methods In this experimental study, a total of 40 implants in acrylic blocks (6 × 10 × 20 mm) were mounted perpendicular to the surface. They were then randomly divided into four groups: (1) torquing once with 30 Ncm, (2) torquing three times with 30 Ncm and 5-minute intervals, (3) torquing once with 30 Ncm, opening the screw, and retorquing with 30 Ncm, and (4) torquing once with 35 Ncm. The torque values were confirmed by using a digital torque meter. Then, the samples underwent a force (2 cps, 0.453-11.793 kg) for three hours before the measurement of detorque values. The screw loosening force (torque) was then measured and recorded. The obtained data were analyzed by SPSS (version 22) software using one-way ANOVA and Tukey post hoc test at a 5% error level. Results The maximum mean detorque values of the abutment screws in single implant-supported prostheses were reported for groups 4 (27.8 ± 1.3), 1 (26.8 ± 1.3), and 3 (25.1 ± 1.3), and the minimum mean detorque value was found in group 2 (24.9 ± 1.2). Moreover, no significant difference was observed between groups 2 and 3 (p > 0.05), but a significant difference was found between groups 1 and 3 and other groups (p < 0.05). Conclusion The increase in the torque value increased the torque loss. However, the detorque value in group 4 showed the least difference with the value recommended by the manufacturer (30 Ncm).
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Wolf F, Spoerl S, Gottsauner M, Klingelhöffer C, Spanier G, Kolbeck C, Reichert TE, Hautmann MG, Ettl T. Significance of site-specific radiation dose and technique for success of implant-based prosthetic rehabilitation in irradiated head and neck cancer patients-A cohort study. Clin Implant Dent Relat Res 2021; 23:444-455. [PMID: 33949108 DOI: 10.1111/cid.13005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiotherapy aggravates implant-based prosthetic rehabilitation in patients with head and neck cancer. PURPOSE To evaluate the impact of radiation dose at implant and parotid gland site for prosthetic rehabilitation. MATERIAL AND METHODS The retrospective study includes 121 irradiated head and neck cancer patients with 751 inserted implants. Radiation doses on implant bed and parotid gland site were recorded by 3-dimensional modulated radiation plans. Implant success was clinically and radiographically evaluated according to modified Albrektsson criteria and compared to treatment- and patient-specific data. RESULTS Implant overall survival after 5 years was 92.4% with an implant success rate of 74.9%. Main reasons for implant failure were marginal bone resorption (20.9%), implant not in situ or unloaded (9.6%) and peri-implantitis (7.5%). A mean radiation dose of 62.6 Gy was applied with a mean parotid dose of 35 Gy. Modulating radiation techniques went along with lower grades of xerostomia (p < 0.001). At implant site mean doses of 57.5, 42.0, and 32.3 Gy were recorded for oral, oropharyngeal, and hypopharyngeal/laryngeal carcinoma, respectively. Implant success inversely correlated to radiation dose at implant site. Strong predictors for implant failure in uni- and multivariate analysis were implant-specific dose >50 Gy (HR 7.9), parotid dose >30 Gy (HR 2.3), bone (HR 14.5) and soft tissue (HR 4.5) transplants, bad oral hygiene (HR 3.8), nonmodulated radiation treatment planning (HR 14.5), and nontelescopic prosthetics (HR 5.2). CONCLUSION Radiotherapy impedes implant success in a dose-dependent manner at implant site. Modern radiation techniques effectively reduce xerostomia favoring implant-based prosthetic rehabilitation. Implantation in bone grafts is more critical and telescopic-retained overdentures should be preferred.
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Affiliation(s)
- Franziska Wolf
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Steffen Spoerl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Maximilian Gottsauner
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Klingelhöffer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Gerrit Spanier
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Carola Kolbeck
- Department of Prosthodontics, University Hospital Regensburg, Regensburg, Germany
| | - Torsten E Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Matthias G Hautmann
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
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Lee SKY, Salinas TJ, Wiens JP. The Effect of Patient Specific Factors on Occlusal Forces Generated: Best Evidence Consensus Statement. J Prosthodont 2021; 30:52-60. [PMID: 33474770 DOI: 10.1111/jopr.13334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The purpose of this Best Evidence Consensus Statement was to search the literature to determine if there is a relationship between patient specific factors and occlusal force. MATERIALS AND METHODS A literature review was conducted in the following databases: Evidence-Based Medicine Reviews (EBMR), Cochrane Database of Systematic Reviews, Embase, and Ovid MEDLINE(R) and Epub Ahead of Print. Articles on patient factors and occlusal force were compiled by using a combination of the key words: "bite force," "occlusal force," "partial and complete edentulism," "bruxism," and "orthognathic class." Inclusion criteria included meta-analyses, systematic reviews, randomized controlled trials, case series, and journal articles. Exclusion criteria were case reports, studies in children, animals, and bench studies. RESULTS Of the 1502 articles that met the initial search criteria, 97 related to patient-specific factors affecting occlusal forces. These articles were evaluated, rated, and organized into appropriate categories addressing questions of foci. CONCLUSIONS The range of occlusal force is highly variable among subjects correlated to patient specific factors such as age, gender, partial and complete edentulism, the presence of a maxillofacial defect, location of edentulous area, orthognathic profile, and magnitude of occlusal vertical dimension. Tooth replacement therapies targeted at increasing occlusal contact seem to have a positive effect on increasing occlusal force. Bruxism does not necessarily demonstrate higher occlusal powering but may have greater tooth contact time. Occlusal force is not clearly affected by the type of dental restoration or restorative material used. The clinical significance of the changes in occlusal forces is yet to be determined.
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Affiliation(s)
| | | | - Jonathan P Wiens
- Department of Restorative Dentistry, University of Detroit Mercy School of Dentistry, Detroit, MI
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D'Agostino A, Lombardo G, Favero V, Signoriello A, Bressan A, Lonardi F, Nocini R, Trevisiol L. Complications related to zygomatic implants placement: A retrospective evaluation with 5 years follow-up. J Craniomaxillofac Surg 2021; 49:620-627. [PMID: 33581959 DOI: 10.1016/j.jcms.2021.01.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/03/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022] Open
Abstract
This retrospective study assessed zygoma implants in patients treated for upper maxilla extreme atrophy, trauma, cleft palate, or failed reconstruction. The implants were placed using Quad (4 zygoma implants) or mixed (zygoma and conventional implants in premaxilla) surgical technique, with intra-sinus or extra-sinus approach, followed by immediate or deferred loading. Clinical and radiographic evaluations were carried out at 5-year follow-up from loading. Implant survival, symptoms and signs of sinusitis, radiological alterations in terms of mucosal thickening or obliteration of the maxillary sinuses, oroantral communications, and peri-implant soft tissues were examined. A total of 42 patients, with 116 zygoma implants, were included in the study. The cumulative survival rate was 97.41%. One zygomatic bone fracture was assessed. Eight patients reported sinusitis, and two showed oro-antral communications. A comparison between mean pre- and post-operative Lund-Mackay scores showed a statistically significant increase of sino-nasal disease in the post-operative scores (p = 0.0019). Mucositis and gingival recession was observed in 21 and 8 implants respectively. Average recession was 2.52 ± 2.35 mm. According to our results, placement of zygoma implants has proved to be a predictable procedure, with a lower rate of severe complications compared to other treatment options in extreme upper jaw atrophy.
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Affiliation(s)
- Antonio D'Agostino
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Giorgio Lombardo
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Vittorio Favero
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
| | - Annarita Signoriello
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Anna Bressan
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Fabio Lonardi
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Riccardo Nocini
- Unit of Otolaryngology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Lorenzo Trevisiol
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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Bulat S, Butsan S, Salikhov K, Abramian S, Arsenidze A. Free fibula flap for reconstruction of the severely atrophic mandible: a retrospective study. Int J Oral Maxillofac Surg 2020; 50:546-554. [PMID: 32893080 DOI: 10.1016/j.ijom.2020.08.005] [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: 01/28/2020] [Revised: 06/06/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this retrospective study was to assess the feasibility of using a free fibula flap (FFF) for reconstruction of the alveolar region of the severely atrophic mandible, by determining bone stability after dental implant insertion and prosthetic rehabilitation in a series of eight female patients aged 36-65 years. Dental implant insertion was performed 3-4 months after reconstruction. Prosthetic loading was performed 3-4 months after implant insertion. The height of the reconstructed mandible after surgery was 21.20±1.87mm, with an increase of 8.80±1.71mm from the preoperative height. The height of the FFF immediately after reconstruction was 11.24±1.10mm; this showed a vertical loss of 0.99±0.52mm (8.79%) and maintenance of 91.21% of the initial height at a mean 14 months post-reconstruction. Applying the Wical and Swoope formula to estimate the original mandibular body height, it was found that the difference between this calculated height (21.17±3.76mm) and the reconstructed height (21.20±1.87mm) was only 0.03±3.17mm (0.14%). An overall insignificant decrease of 0.46±1.14 cm3 in FFF volume had occurred at 3-4 months after dental implant functional loading, while in two cases an increase in volume was found (1.22cm3 and 1.71cm3). The good and stable results obtained show that the FFF may be used to reconstruct the whole mandibular alveolar region, with the best possible outcomes.
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Affiliation(s)
- S Bulat
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.
| | - S Butsan
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - K Salikhov
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - S Abramian
- Department of Prosthetic Dentistry and Implantology, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A Arsenidze
- Department of Prosthetic Dentistry and Implantology, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Khadembaschi D, Brierly GI, Chatfield MD, Beech N, Batstone MD. Systematic review and pooled analysis of survival rates, success, and outcomes of osseointegrated implants in a variety of composite free flaps. Head Neck 2020; 42:2669-2686. [PMID: 32400954 DOI: 10.1002/hed.26238] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 09/19/2023] Open
Abstract
The aim of this review was to provide an update on survival rates of osseointegrated implants into common composite free flaps used for maxillary and mandibular reconstructions and identify factors affecting outcomes. PubMed, Medline, Embase, and Cochrane databases were searched. Included studies reported implant survival by flap type. Results were pooled and survival was estimated with the Kaplan-Meier method. Variables affecting survival were assessed using Cox regression. Thirty-two of the 2631 articles retrieved were included, totaling 2626 implants placed into fibula, iliac crest, scapula, and radial forearm free flaps. Pooled survival showed 94% 5-year survival of implants in fibula and iliac crest with no difference between groups (P = .3). Factors effecting survival included radiotherapy (HR 2.3, 95% CI 1.2-4.6, P = .027) and malignant disease (HR 2.2, 95%CI 1.6-3.1, P < .001). Implant survival appears adequate across common flap types; however, there are limited numbers reported in less common flaps.
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Affiliation(s)
- Darius Khadembaschi
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Gary I Brierly
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Mark D Chatfield
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Nicholas Beech
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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11
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Pelissier E, Desoutter A, Chaux-Bodard AG. Peri implant bone resorption on microvascular free fibula flap: a radiographic retrospective study. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: As the vascularization of the microvascular free fibula flap enables to maintain an osteogenic potential, osseointegrated implants have a 86% to 99% success rate. Thus, only few studies consider peri-implant bone resorption (PIBR). The aim of the study was to radiologically evaluate PIBR on fibula flaps. Materials and methods: Data were retrospectively collected. Gender, age, reason for interruptive mandibulectomy, previous radiotherapy, number of implants placed on the reconstruction, length and number of segments of the reconstruction, height of resorption were collected for each patient. Measurements were made on panoramic radiograph. Results: 85 clinical reports were reviewed for 39 retained. Peri-implant bone resorption was observed in 21 (53.9%) patients. The average age of the resorption group was 55.4 . All of the 5 patients with 4 or 5 implants on their reconstruction did not developed PIBR. 59.1% of patients with 1 segment reconstruction developed PIBR, 54.6% with 2 segments and 33.3% with 3 segments. Discussion: Age and poor oral hygiene appeared to be clearly more related to PIBR. An important number of implant (4 or 5) and a reconstruction with more than 1 segment seemed to decrease PIBR. Further studies are required to confirm these hypotheses.
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12
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Ettl T, Junold N, Zeman F, Hautmann M, Hahnel S, Kolbeck C, Müller S, Klingelhöffer C, Reichert TE, Meier JK. Implant survival or implant success? Evaluation of implant-based prosthetic rehabilitation in head and neck cancer patients—a prospective observational study. Clin Oral Investig 2019; 24:3039-3047. [DOI: 10.1007/s00784-019-03172-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 12/04/2019] [Indexed: 12/11/2022]
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13
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Huang Y, Wang J. Mechanism of and factors associated with the loosening of the implant abutment screw: A review. J ESTHET RESTOR DENT 2019; 31:338-345. [PMID: 31150572 DOI: 10.1111/jerd.12494] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yiqing Huang
- Department of ProsthodonticsHubei‐MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University Wuhan China
- Department of StomatologyThe Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
| | - Jiawei Wang
- Department of ProsthodonticsHubei‐MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University Wuhan China
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14
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Patel SY, Kim DD, Ghali GE. Maxillofacial Reconstruction Using Vascularized Fibula Free Flaps and Endosseous Implants. Oral Maxillofac Surg Clin North Am 2019; 31:259-284. [DOI: 10.1016/j.coms.2018.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Bagegni A, Abou-Ayash S, Rücker G, Algarny A, Att W. The influence of prosthetic material on implant and prosthetic survival of implant-supported fixed complete dentures: a systematic review and meta-analysis. J Prosthodont Res 2019; 63:251-265. [PMID: 30871937 DOI: 10.1016/j.jpor.2019.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/20/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Evaluating the impact of the prosthetic material on implant- and prosthetic survival of implant-supported fixed complete dentures. STUDY SELECTION Electronic and hand searches were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify clinical studies including at least 10 patients restored with implant-supported dentures. The primary outcome was to evaluate the implant survival rate according to the applied restorative materials. The prosthetic survival rate was evaluated as secondary outcomes. RESULTS Forty-one of 2254 studies were finally selected. A statistically significant difference (p = 0.0337) was found between implant survival rates in the main restorative groups (metal-ceramic:97%(95%CI [0.96;0.98]), all-ceramic:99%(95%CI [0.98;1.00]), metal-resin:97%(95%CI [0.96;0.98])). Prosthetic survival rates were: (metal-ceramic:95%(95%CI [0.89;0.97]), all-ceramic:97%(95%CI [0.92;0.99]), metal-resin:97%(95%CI [0.95;0.98]), with no statistically significant difference (p = 0.3796) between the groups. Chipping incidence rates were as follows: metal-ceramic:8%(95%CI[0.03;0.20]), all-ceramic:15%(95%CI [0.06;0.32]), and metal-resin:22%(95%CI [0.13;0.33]). Five types of exact restorative materials were identified (porcelain-fused-to-non-precious alloy, porcelain-fused-to-zirconia, precious-metal-acrylic-resin, non-precious-metal-acrylic resin, and PMMA). Again, implant survival rates were statistically significantly influenced by the applied restorative materials (p = 0.0126), whereas, no significant differences were reported regarding prosthetic survival rate. CONCLUSIONS Prosthetic material selection seems to have no clinically relevant influence on implant- and prosthetic survival rate in implant-supported fixed complete dentures. Due to the high chipping rate, quantifying prosthetic survival alone does not seem to be a reliable tool for evaluating the outcome of the restorations and providing recommendations. These results, along with the obvious lack of evidence, suggest that clinicians must exercise caution whenever porcelain-fused-to-zirconia or metal-resin restorations are considered.
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Affiliation(s)
- Aimen Bagegni
- Department of Prosthodontics, School of Dentistry, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Samir Abou-Ayash
- Department of Reconstructive Dentistry And Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Gerta Rücker
- Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ahmad Algarny
- Department of Prosthodontics, School of Dentistry, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wael Att
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, MA, United States.
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16
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Bottini GB, Brandtner C, Steiner C, Wittig J, Hartig F, List C, Gaggl A. Microvascular reconstruction and dental rehabilitation of benign severely atrophic jaws and defects of the alveolar ridge: our philosophy in 2019. Br J Oral Maxillofac Surg 2019; 57:151-156. [DOI: 10.1016/j.bjoms.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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17
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Treatment of a mandibular discontinuity defect by using a fibula free flap and an implant-supported fixed complete denture fabricated with a PEKK framework: A clinical report. J Prosthet Dent 2018; 119:1021-1024. [DOI: 10.1016/j.prosdent.2017.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 12/31/2022]
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18
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Mandibular kinematics and maximum voluntary bite force following segmental resection of the mandible without or with reconstruction. Clin Oral Investig 2017; 22:1707-1716. [DOI: 10.1007/s00784-017-2263-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/23/2017] [Indexed: 11/25/2022]
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19
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Ozen J, Erol B, Dikicier S, Alp G. Rehabilitation With an Implant-Supported Metal-Acrylic Fixed Prosthesis After Ameloblastoma Resection in Mandible: Clinical Case Letter. J ORAL IMPLANTOL 2017; 43:365-369. [PMID: 28841384 DOI: 10.1563/aaid-joi-d-17-00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Julide Ozen
- 1 Department of Prosthodontics, Istanbul Aydin University, Faculty of Dentistry, Istanbul, Turkey
| | - Behcet Erol
- 2 Department of Oral and Maxillofacial Surgery, Istanbul Aydin University, Faculty of Dentistry, Istanbul, Turkey
| | - Sibel Dikicier
- 3 Department of Prosthodontics, University of Health Sciences, Faculty of Dentistry, Istanbul, Turkey
| | - Gulce Alp
- 4 Department of Prosthodontics, Okan University, Faculty of Dentistry, Istanbul, Turkey
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20
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Preventing Early-Stage Graft Bone Resorption by Simultaneous Innervation. Plast Reconstr Surg 2017; 139:1152e-1161e. [DOI: 10.1097/prs.0000000000003263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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21
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Maroulakos G, Nagy WW, Ahmed A, Artopoulou II. Prosthetic rehabilitation following lateral resection of the mandible with a long cantilever implant-supported fixed prosthesis: A 3-year clinical report. J Prosthet Dent 2017; 118:678-685. [PMID: 28461046 DOI: 10.1016/j.prosdent.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
This clinical report describes the prosthetic management of the surgical reconstruction of a patient after mandibular resection. Complete oral rehabilitation was achieved with a maxillary complete denture and a mandibular implant-supported fixed prosthesis with a custom titanium framework and a long unilateral cantilever.
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Affiliation(s)
- Georgios Maroulakos
- Assistant Professor, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis.
| | - William W Nagy
- Professor and Director, Graduate Prosthodontics, Department of Restorative Sciences, Texas A&M University College of Dentistry, Dallas, Texas
| | - Ayman Ahmed
- Clinical Assistant Professor, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis
| | - Ioli I Artopoulou
- Lecturer, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
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22
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Kniha K, Möhlhenrich SC, Foldenauer AC, Peters F, Ayoub N, Goloborodko E, Hölzle F, Modabber A. Evaluation of bone resorption in fibula and deep circumflex iliac artery flaps following dental implantation: A three-year follow-up study. J Craniomaxillofac Surg 2017; 45:474-478. [PMID: 28258918 DOI: 10.1016/j.jcms.2017.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/13/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
Long-term results of dental implant treatment in fibula free and deep circumflex iliac artery (DCIA) free flaps are scarce. The purpose of this study was to assess and compare peri-implant bone resorption of vascularized bone flaps treated with dental implants. A total of 28 patients, 14 fibula and 14 DCIA flaps, respectively, underwent reconstruction of the lower and upper jaw by the use of vascularized bone flaps and were treated with dental implants. Peri-implant bone resorption was measured using digital panographs up to 3 years. Radiographic pictures were taken immediately after implant surgery before prosthetic rehabilitation (T0), the second after 6-12 months (T1), the third after 13-24 months (T2), and the fourth after 25-36 months (T3). Over a period of 3 years, implant resorption changed significantly over time (pD1 = 0.0113, pD2 = 0.0232, pD3 = 0.0143). However, a significant difference in overall resorption between implants with fibula flaps and DCIA could not be detected for the patient average or within the implant-level analysis. Flaps presented minimal resorption from beneath (mean resorption DCIA 0.65, fibula = 0.26). Strong peri-implant bone resorption changed significantly over time. However, no significant difference was observed between fibula and DCIA flaps.
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Affiliation(s)
- Kristian Kniha
- Department of Oral and Cranio-Maxillofacial Surgery (Head & Chairman Univ.: Prof. Dr. med. Dr. med. dent. F. Hölzle), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany.
| | - Stephan Christian Möhlhenrich
- Department of Oral and Cranio-Maxillofacial Surgery (Head & Chairman Univ.: Prof. Dr. med. Dr. med. dent. F. Hölzle), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany; Department of Orthodontics (Head & Chairman Univ.: Prof. Dr. med. dent. U. Fritz), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany
| | - Ann Christina Foldenauer
- Department of Medical Statistics (Head & Chairman Univ.: Prof. Dr. rer. nat. R.-D. Hilgers), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany
| | - Florian Peters
- Department of Oral and Cranio-Maxillofacial Surgery (Head & Chairman Univ.: Prof. Dr. med. Dr. med. dent. F. Hölzle), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany
| | - Nassim Ayoub
- Department of Oral and Cranio-Maxillofacial Surgery (Head & Chairman Univ.: Prof. Dr. med. Dr. med. dent. F. Hölzle), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany
| | - Evgeny Goloborodko
- Department of Oral and Cranio-Maxillofacial Surgery (Head & Chairman Univ.: Prof. Dr. med. Dr. med. dent. F. Hölzle), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Cranio-Maxillofacial Surgery (Head & Chairman Univ.: Prof. Dr. med. Dr. med. dent. F. Hölzle), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Cranio-Maxillofacial Surgery (Head & Chairman Univ.: Prof. Dr. med. Dr. med. dent. F. Hölzle), University Hospital Aachen, Pauwelstraße 30, 52074, Aachen, Germany
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23
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Möhlhenrich SC, Kniha K, Elvers D, Ayoub N, Goloborodko E, Hölzle F, Modabber A. Intraosseous stability of dental implants in free revascularized fibula and iliac crest bone flaps. J Craniomaxillofac Surg 2016; 44:1935-1939. [DOI: 10.1016/j.jcms.2016.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/08/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022] Open
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24
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Keestra JAJ, Barry O, Jong LD, Wahl G. Long-term effects of vertical bone augmentation: a systematic review. J Appl Oral Sci 2016; 24:3-17. [PMID: 27008252 PMCID: PMC4775004 DOI: 10.1590/1678-775720150357] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/22/2015] [Indexed: 11/21/2022] Open
Abstract
Extraction, periodontitis, or trauma can cause a reduction on the alveolar ridge. This could result in an insufficient alveolar bone width and height. Different techniques of vertical bone augmentation are described in literature. However, nowadays there is not enough evidence against lateral augmentation procedures to verify if these techniques are stable over a long period of time.
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Affiliation(s)
| | - Obada Barry
- Mund- und Kieferheilkunde, Poliklinik für Chirurgische Zahn-, Universität Bonn, Bonn, Germany
| | | | - Gerhard Wahl
- Mund- und Kieferheilkunde, Poliklinik für Chirurgische Zahn-, Universität Bonn, Bonn, Germany
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25
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Wang Y, Zhang H, Fan S, Zhang D, Huang Z, Chen W, Ye J, Li J. Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery. Int J Oral Maxillofac Surg 2016; 45:1400-1405. [DOI: 10.1016/j.ijom.2016.06.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/22/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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26
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Nocini PF, Trevisiol L, D'Agostino A, Zanette G, Favero V, Procacci P. Quadruple zygomatic implants supported rehabilitation in failed maxillary bone reconstruction. Oral Maxillofac Surg 2016; 20:303-308. [PMID: 26911802 DOI: 10.1007/s10006-016-0552-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
Extreme atrophy of the jaws constitutes a challenge for maxillofacial surgeons. The technique involving Le Fort I osteotomy, bone grafting, and endosseous implants remains the gold standard treatment for class V and class VI atrophy of the maxilla. As severe maxillary atrophy is associated to impaired microvascularization of overlying soft tissues, reconstruction using vascularized free fibula flaps together with endosseous implants is one of the possible treatment plans. When this approach fails, however, retreating these patients using traditional techniques often proves unsatisfactory. This study outlines our clinical experience with full-arch zygoma implant-supported prosthetic rehabilitation to treat severe atrophic maxilla following failure of strategies including multiple Le Fort I procedures or vascularized free fibular flaps.
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Affiliation(s)
- Pier Francesco Nocini
- Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
- Department of Surgery, Section of Dentistry and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy
| | - Lorenzo Trevisiol
- Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
- Department of Surgery, Section of Dentistry and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy
| | - Antonio D'Agostino
- Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
- Department of Surgery, Section of Dentistry and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy.
| | - Giovanni Zanette
- Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
- Department of Surgery, Section of Dentistry and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy
| | - Vittorio Favero
- Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
- Department of Surgery, Section of Dentistry and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy
| | - Pasquale Procacci
- Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
- Department of Surgery, Section of Dentistry and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy
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27
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Impact of radiotherapy on implant-based prosthetic rehabilitation in patients with head and neck cancer: A prospective observational study on implant survival and quality of life—Preliminary results. J Craniomaxillofac Surg 2016; 44:1453-62. [DOI: 10.1016/j.jcms.2016.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/13/2016] [Accepted: 07/15/2016] [Indexed: 11/19/2022] Open
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28
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Virtual Surgical Planning in Precise Maxillary Reconstruction With Vascularized Fibular Graft After Tumor Ablation. J Oral Maxillofac Surg 2016; 74:1255-64. [DOI: 10.1016/j.joms.2016.01.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 11/23/2022]
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29
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Kim A, Kar K, Nowzari H, Cha HS, Ahn KM. Immediate free iliac bone graft after nonsegmental mandibular resection and delayed implant placement: a case series. IMPLANT DENT 2015; 22:438-43. [PMID: 24013392 DOI: 10.1097/id.0b013e31829f1ed0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resection of mandibular tumors without proper reconstruction may lead to unfavorable esthetic and function results. The purpose of this case series was to describe clinical results and a technique to prevent tissue loss using nonvascular iliac grafts immediately following tumor resection and long-term stability of the implants. MATERIALS AND METHODS Three female patients presented with oral neoplasms (2 ameloblastoma and 1 ossifying fibroma). The mandibular reconstruction was performed with nonvascularized iliac grafts simultaneous with tumor removal. Subsequently, 10 dental implants were placed 6 to 9 months after reconstruction and restored. Survival and success of the implants were evaluated. RESULTS Marginal mandibulectomy in 1 patient and buccal bone resection in 2 patients was performed; the resection sites were reconstructed with an immediate nonvascularized iliac graft. All implants survived and were successful during follow-up periods between 44 and 105 months. Mean marginal bone loss of 10 implants was 0.09 mm. CONCLUSIONS Immediate reconstruction with nonvascularized iliac grafts following tumor resection may be a viable treatment option for nonsegmental inlay osseous defects. In these case series, the resorption of the iliac bone was minimal after 6 to 9 months consolidation periods.
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Affiliation(s)
- Andrew Kim
- *Resident, Department of Advanced Periodontology, University of Southern California, Los Angeles, CA. †Associate Professor, Department of Advanced Periodontology, University of Southern California, Los Angeles, CA. ‡Private Practice, Department of Periodontics, Beverly Hills, CA. §Associate Professor, Department of Prosthodontics, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea. ‖Associate Professor, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
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30
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Asa'ad F, Rasperini G, Pagni G, Rios HF, Giannì AB. Pre-augmentation soft tissue expansion: an overview. Clin Oral Implants Res 2015; 27:505-22. [PMID: 26037472 DOI: 10.1111/clr.12617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to explore the development of soft tissue expanders, their different types and their potential applications prior to bone augmentation and implant placement. MATERIAL AND METHODS A review of pertinent literature was performed using PubMed to comprehend the dynamics of soft tissue expanders and determine the current position of their pre-augmentation applications. RESULTS There is promising, albeit preliminary information regarding the benefits of pre-augmentation soft tissue expansion. Findings cannot be generalised due to relatively small sample size. CONCLUSIONS Further clinical trials with larger sample sizes and long-term follow-up are needed before soft tissue expanders can be confidently applied in everyday clinical practice.
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Affiliation(s)
- Farah Asa'ad
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Giorgio Pagni
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Hector F Rios
- Department of Periodontics and Oral Medicine, Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Aldo B Giannì
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
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31
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Rodella LF, Cocchi MA, Rezzani R, Procacci P, Hirtler L, Nocini P, Albanese M. Fresh frozen bone in oral and maxillofacial surgery. J Dent Sci 2015. [DOI: 10.1016/j.jds.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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32
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Mandibular reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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33
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Assessment of functional improvement with implant-supported prosthetic rehabilitation after mandibular reconstruction with a microvascular free fibula flap: A study of 25 patients. J Prosthet Dent 2015; 113:140-5. [DOI: 10.1016/j.prosdent.2014.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/22/2022]
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Quiles JC, Souza FA, Bassi APF, Garcia IR, França MT, Carvalho PSP. Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study. Int J Oral Maxillofac Surg 2014; 44:239-44. [PMID: 25457821 DOI: 10.1016/j.ijom.2014.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 08/04/2014] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the clinical survival rate of osseointegrated implants placed in the atrophic maxilla that has been reconstructed by means of autogenous bone grafts harvested from a cranial calvarial site. Further, we sought to analyse the level of peri-implant bone after prosthetic rehabilitation and to determine subjective patient satisfaction with the treatment performed. This study conformed to the STROBE guidelines regarding retrospective studies. Twenty-five patients who had received osseointegrated implants with late loading in the reconstructed atrophic maxilla were included in the study. The survival rate and level of peri-implant bone loss were evaluated. A questionnaire related to the surgical and prosthetic procedures was completed. The observed implant survival rate was 92.35%. The mean bone loss recorded was 1.76mm in the maxilla and 1.54mm in the mandible. The results of the questionnaire indicated a high level of patient satisfaction, little surgical discomfort, and that the patients would recommend the procedure and would undergo the treatment again. From the results obtained, it is concluded that the cranial calvarial site is an excellent donor area; calvarial grafts provided stability and maintenance of bone volume over the course of up to 11 years.
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Affiliation(s)
- J C Quiles
- São Leopoldo Mandic School of Dentistry and Research Center, Campinas, Brazil
| | - F A Souza
- Department of Surgery and Integrated Clinic, Araçatuba Dental of School, Universidade Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
| | - A P F Bassi
- Department of Surgery and Integrated Clinic, Araçatuba Dental of School, Universidade Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - I R Garcia
- Department of Surgery and Integrated Clinic, Araçatuba Dental of School, Universidade Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - M T França
- Private Practice Clinic, Araçatuba, Brazil
| | - P S P Carvalho
- São Leopoldo Mandic School of Dentistry and Research Center, Campinas, Brazil; Department of Surgery and Integrated Clinic, Araçatuba Dental of School, Universidade Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
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Li BH, Byun SH, Kim SM, Lee JH. The Clinical Outcome of Dental Implants Placed through Skin Flaps. Otolaryngol Head Neck Surg 2014; 151:945-51. [DOI: 10.1177/0194599814552061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective and Study Design The incidence of peri-implantitis, marginal bone loss, implant success, and survival rates of 52 dental implants placed through the skin paddle and 23 implants through the neighboring gingiva were investigated. Mixed linear model was adopted to analyze the influence of radiation and skin paddle on marginal bone loss and peri-implantitis. Results The incidence of peri-implantitis in implants placed through the skin flaps was higher (32.7%) than that of implants placed through the oral mucosa (8.7%). According to the mixed linear analysis, no significant difference in the amount of marginal bone loss was observed between the 2 groups: implants placed through the skin graft had marginal bone loss of 0.39 ± 0.14 mm at 1 year and 0.50 ± 0.23 mm at 5 years, and implants placed through the oral mucosa had marginal bone loss of 0.32 ± 0.12 mm and 0.52 ± 0.21 mm at the same time intervals. The 1-year and 2- to 5-year cumulative survival rates of the implants placed through the skin were 100% and 98%, respectively, and those of implants placed through the oral mucosa were both 95.65%. The 1-year and 2- to 5-year cumulative success rates of the implants placed through the skin were 92.30% and 79.38%, respectively, and those of implants placed through the oral mucosa were 91.30% and 82.59%, respectively. Conclusion Implants can be successfully placed and maintained in lining defects covered with a skin paddle; hence, this treatment modality may be considered reasonable and reliable for the functional and aesthetic rehabilitation of patients with oromaxillofacial reconstructions.
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Affiliation(s)
- Bo-Han Li
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
- Bin Zhou Medical College, School of Stomatology, Yantai, China
| | - Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
- Oral Cancer Center and Clinical Trial Center, Seoul National University Dental Hospital, Seoul, Korea
| | - Soung-Min Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
- Dental Research Institute, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
- Oral Cancer Center and Clinical Trial Center, Seoul National University Dental Hospital, Seoul, Korea
- Dental Research Institute, Seoul National University, Seoul, Korea
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Abstract
The LeFort I osteotomy is one of the most commonly used procedures to correct midface deformities. It allows for correction in three dimensions including advancement, retrusion, elongation, and shortening. It is indicated, often in conjunction with mandibular surgery, for class II and III malocclusion, facial asymmetry, obstructive sleep apnea, and maxillary atrophy. Before surgery, proper orthodontics and surgical planning should be undertaken to ensure adequate outcomes. Overall, the surgery is widely used due to its low complication profile and reliable long-term results.
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Affiliation(s)
- Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Charles H Hyman
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Hakim SG, Kimmerle H, Trenkle T, Sieg P, Jacobsen HC. Masticatory rehabilitation following upper and lower jaw reconstruction using vascularised free fibula flap and enossal implants—19 years of experience with a comprehensive concept. Clin Oral Investig 2014; 19:525-34. [DOI: 10.1007/s00784-014-1247-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
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[Reconstruction of the atrophic edentulous maxilla for implant placement]. ACTA ACUST UNITED AC 2014; 115:164-8. [PMID: 24534647 DOI: 10.1016/j.revsto.2014.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/22/2013] [Accepted: 01/09/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Extreme maxillary atrophy results from partial or total maxillary bone defect, affecting the alveolar and basal segments. The residual bone is only a few millimeters high and does not allow retention of dental prostheses (complete edentulation), or placing implants. Bone reconstruction with cranial bone grafts usually allows obtaining enough bone volume in a single step to place implants for prosthetic rehabilitation, 3 months later. TECHNICAL NOTE Reconstruction begins by inserting bone grafts on the sinus floor. The pre-maxilla is then rebuilt with bone grafts placed on the nose floor then on the palate and vestibule. The premolar and molar sectors are rebuilt last with vestibular and palatine bone grafts assembled and stabilized by screws, or steel wire rings, and reinforced on their deep portion with diploe sheets. DISCUSSION Extreme maxillary atrophy reconstruction with cranial bone grafts is a reliable technique with reproducible results and few complications (sinusitis, bone sequester). Nevertheless, it requires strong experience to adequately perform harvesting and reconstruction.
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Early bone resorption of free microvascular reanastomized bone grafts for mandibular reconstruction--a comparison of iliac crest and fibula grafts. J Craniomaxillofac Surg 2013; 42:e217-23. [PMID: 24269641 DOI: 10.1016/j.jcms.2013.08.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/01/2013] [Accepted: 08/23/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Patients with continuous bone defects of the mandible after ablative tumor surgery need bony reconstruction for proper function and aesthetics. Free microvascular reanastomized bone grafts provide a clinically proven option for such patients, yet the optimal source of donor tissue has not yet been established. The aim of this study was to evaluate and compare the bone volume stability of vascularized bone grafts, particularly in the early highly resorptive phase, from the iliac crest (DCIA) and the fibula and to assess the implantologic rehabilitations. MATERIALS AND METHODS Thirty-six patients with mandibular continuity defects due to tumor resection were reconstructed by the use of vascularized bone grafts; 21 patients received DCIA flaps and 15 patients received a composite free fibular flap, depending on the size and location of the defect. Bone resorption was assessed using digital panographs. Radiographs were taken immediately after bone reconstruction, 6 months postoperatively, prior to implant surgery, and at prosthetic loading. RESULTS After a mean observation period of 6 months, vertical bone resorption was 6.79% for the patients of the iliac crest group (DCIA), 10.20% after 11 months, and 12.58% after 17 months. Fibular grafts showed a bone resorption of 5.30% after a mean observation time of 6 months, 8.26% after 11 months, and 16.95% after 17 months. Eighteen patients received 71 implants for implant-retained dental reconstructions. CONCLUSIONS Microvascular reanastomized bone grafts represent a reliable treatment option for reconstruction in cases of large defects of the mandible, with low graft resorption in the early healing phase. Additionally, the compared grafts provide sufficient bone volume to permit implant rehabilitation.
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Mertens C, Thiele O, Engel M, Seeberger R, Hoffmann J, Freier K. The Use of Self-Inflating Soft Tissue Expanders Prior to Bone Augmentation of Atrophied Alveolar Ridges. Clin Implant Dent Relat Res 2013; 17:44-51. [DOI: 10.1111/cid.12093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christian Mertens
- Department of Oral and Maxillofacial Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Oliver Thiele
- Department of Oral and Maxillofacial Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Robin Seeberger
- Department of Oral and Maxillofacial Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Kolja Freier
- Department of Oral and Maxillofacial Surgery; University Hospital Heidelberg; Heidelberg Germany
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Zheng GS, Su YX, Liao GQ, Chen ZF, Wang L, Jiao PF, Liu HC, Zhong YQ, Zhang TH, Liang YJ. Mandible reconstruction assisted by preoperative virtual surgical simulation. Oral Surg Oral Med Oral Pathol Oral Radiol 2011; 113:604-11. [PMID: 22676986 DOI: 10.1016/j.tripleo.2011.05.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/27/2011] [Accepted: 05/13/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In this study, we evaluated the clinical efficacy of mandible reconstruction with preoperative virtual planning, which focused on esthetics and occlusion. STUDY DESIGN A series of 9 patients were enrolled prospectively to undergo mandibulectomy and simultaneous reconstruction. Preoperative spiral CT scans of the maxillofacial region and the fibula region were performed. Virtual surgery of tumor resection and fibula reconstruction was performed in the Mimics platform. The reconstructed mandible models were fabricated with CAD/CAM technique. The reconstruction plate and the positioning template were accommodated to the stereolithographic model as the surgical template. RESULTS Surgery was performed accurately according to the templates. All the fibula flaps survived. The appearance and occlusion of the patients were satisfactory. CONCLUSIONS With preoperative virtual planning, the spatial relationship of the mandible and the fibula graft can be planned individually, which helps achieve optimum appearance and occlusion relationship.
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Affiliation(s)
- Guang-sen Zheng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
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