ABSTRACT
Loss of mandibular continuity and functionality in cancer patients undergoing extensive mandible resections is challenging. In these situations, the gold standard treatment is fibula free flap reconstruction. The major challenge occurs when there is a failure of the transplanted fibula. Here we report the case of a patient who underwent right hemimandibulectomy with disarticulation and immediate mandibular reconstruction with a fibula free flap. Subsequently, the flap viability was lost, and there was necrosis of the transplanted bone segment in the short-term follow-up. Considering the best form of rehabilitation for the patient, minimizing the risks of loss and optimizing the reconstructive quality, we opted to install a customized prosthesis including a condylecavity joint component associated with a new free flap and subsequent rehabilitation of the dental occlusion with an implant-supported fixed prosthesis.
ABSTRACT
Objective:To investigate the method of determining oral implantation sites based on an anatomical model of mandibular premolar area of a Beagle dog.Methods:This study was performed in the Second Affiliated Hospital of Zhejiang Chinese Medical University between January 2019 and October 2020. Mandibular anatomical structure and measurement data were compared between before and after removal of premolar teeth to determine safe implantation areas and oral implantation sites.Results:Among all mandibular premolars, the roots of the 1 st to 4 th premolars (P1-P4) gradually increased. The diameter of the mesial roots of the double root teeth P2, P3, and P4 was (2.72 ± 0.45) mm, (3.22 ± 0.32) mm, (4.16 ± 0.34) mm, respectively, which was significantly shorter than those in the distal roots [P2: (2.98 ± 0.29) mm, P3: (3.48 ± 0.27) mm, P4: (4.58 ± 0.22) mm]. The length of distal roots P2, P3 and P4 was (8.79 ± 0.41) mm, (9.21 ± 0.31) mm, (10.12 ± 0.36) mm), respectively, which was significantly shorter than that of mesial root [P2: (8.91 ± 0.69) mm, P3: (9.48 ± 0.27) mm, P4: (11.58 ± 0.24) mm]. Among all mandibles, the distance (H) from the mental foramen to the first molar and the width (W) of the alveolar crest increased successively [H1: (7.24 ± 0.49) mm, H2: (8.28 ± 0.71) mm, H3: (9.52 ± 0.37) mm, W1: (5.71 ± 0.81) mm, W2: (5.82 ± 0.28) mm, W3: (6.72 ± 0.54) mm]. Conclusion:The mental foramen and the distal part outside the canine apical area are safe implantation areas. In the safe implantation area, the length and diameter of the implant prosthesis do not exceed the root length in the implantation area and the maximum diameter in the buccal lingual direction.
ABSTRACT
Mandibular defects lead to severe deformation and functional deficiency. Vascularized osteocutaneous tissue has been widely used to reconstruct the mandible. However, it is technically challenging to shape this type of grafts in such a manner that they resemble the configuration of the mandible. A 48-year-old female patient who underwent anterolateral thigh (ALT) flap coverage after a tongue cancer excision was diagnosed with a tumor recurrence during the follow-up. A wide excision mandibulectomy and mandibular reconstruction with an ALT flap and a titanium implant were performed. The prefabricated titanium implant was fixed to the condyle. Then, an ALT flap was harvested from the ipsilateral thigh and anastomosed. After confirming that the circulation of the flap was intact, the implant was fixed to the parasymphysis. On the radiograph taken after the surgery, the prosthesis was well positioned and overall facial shape was acceptable. There was no postoperative complication during the follow-up period, 1 year and 2 months. The prefabricated implant allows the restoration of facial symmetry without harvesting autologous bone and it is a safe and effective surgical option for mandibular reconstruction.
Subject(s)
Female , Humans , Middle Aged , Follow-Up Studies , Mandible , Mandibular Prosthesis Implantation , Mandibular Reconstruction , Postoperative Complications , Prostheses and Implants , Recurrence , Thigh , Titanium , Tongue Neoplasms , TransplantsABSTRACT
As próteses totais convencionais inferiores são as mais difíceis de adaptar, devido à perda óssea ser maior e consequentemente à baixa estabilidade e pouca retenção. Entretanto, com o aparecimento dos implantes osse-ointegráveis surgiram os tratamentos com próteses do tipo overdenture, as quais oferecem melhor estabilidade e retenção. O objetivo deste trabalho foi comparar os três principais tipos de sistemas de retenção para a pró¬tese overdenture encontrada na literatura. Para isso, foram realizadas pesquisas com os termos "overdenture"; "attachment", "implant-supported", "dental prosthesis", "denture" e "oral rehabilitation" nas bases de dados PubMed, Science Direct e Scielo. Os sistemas barra-clipe e esférico apresentaram semelhanças estatísticas quanto à retenção e estabilidade. Já o sistema magnético apresentou pouca retenção e baixa estabilidade
The conventional lower total prosthesis is the most difficult dental prosthesis to adapt in the patients mouth, due to bone loss be greater in this region, which consequently decreases stability and retention of the prosthe¬sis. However, the appearance of osseointegrated implants gave rise to treatments with overdenture prostheses, which offer better stability and retention to the prostheses. The aim of this study was to compare the three main types of overdenture prosthesis restraint systems found in the literature. For this research, we used the terms: "overdenture"; "attachment", "implant-supported", "dental prosthesis", "denture" and "oral rehabilitation" in the databases of PubMed, Science Direct and Scielo. The clip bar and spherical systems presented statistical similarities regarding retention and stability. Already, the magnetic system presented little retention and low stability
Subject(s)
Mandibular Prosthesis Implantation , Prosthesis Implantation , Denture, Overlay , Denture Precision Attachment , Mouth RehabilitationABSTRACT
Objective This study was conducted to measure the mandibular incisive canal (MIC) by cone beam computed tomography(CBCT)and to assess 3?dimensional structure, course and adjacent structure of the MIC , in order to ensure safe region for surgery of the mandibular interforaminal area. Methods A total of the CBCT images from 83 patients were studied and measured. The detection rates of MIC were calculated The diameter of the MIC and the distances from MIC to the labial and lingual cortices and the inferior border of the mandible and tooth tips were measured at canines and lateral incisors. Results MIC was found in 67.8%of the patients. In the position of canine, the diameter of MIC, the mean distance of the MIC to the tips of the teeth, to the buccal border of the mandible , to the lingual border of the mandible and the inferior border of the mandible were (1.3±0.4), (8.9±2.9), (4.3±0.9), (5.2±1.1) and (8.6± 1.5) mm, respectively. In the position of the incisor, the distance of MIC, the mean distance of the MIC to the tips of the teeth, to the buccal border of the mandible , to the lingual border of the mandible and the inferior border of the mandible were (1.0 ± 0.3), (13.3 ± 4.0), (4.2 ± 0.9), (5.9 ± 0.9) and (8.9 ± 1.8) mm, respectively. Conclusion CBCT clearly show three dimensional structure, course and adjacent structure of the MIC. Preoperative CBCT can provide vital information for surgery of the mandibular interforaminal area.
ABSTRACT
O tratamento reabilitador que utiliza próteses fixas implantossuportadas soluciona as deficiências dentárias maxilomandibulares com real sucesso. O tratamento proposto inicialmente por Branemark em dois estágios cirúrgicos está sofrendo sucessivas modificações e aperfeiçoamentos, no intuito de diminuir o tempo de instalação das próteses sobre implantes, existindo, em alguns casos, a possibilidade de se reabilitar pacientes imediatamente após a instalação dos implantes. Nesse sentido, vários estudos sobre a carga imediata têm sido frequentemente realizados, e devidamente documentados na literatura, para a solução dos casos envolvendo próteses totais fixas sobre implantes osseointegráveis. Em decorrência da reabsorção do rebordo alveolar maxilomandibular pós-extração, a utilização de componentes protéticos angulados é uma opção para a correção da posição de implantes vestibularizados. Este trabalho tem como objetivo apresentar um caso clínico de implantes do tipo Cone-Morse, imediatos, instalados em região anterior de mandíbula, com a confecção de uma prótese total inferior com carga imediata, utilizando-se um sistema de fixação tipo tubo-parafuso como forma de substituição aos pilares angulados.
The rehabilitative treatment that uses fixed prosthesis with dental implants addresses the dental maxillomandibular deficiencies with real success. The treatment initially proposed by Branemark in two surgical stages is undergoing successive modifications and improvements in order to reduce the installation time of the prostheses on implants, in some cases there is an opportunity to rehabilitate the patient immediately after implant placement. Accordingly, several studies on immediate loading have been frequently performed and documented in the literature for the solution of cases involving fixed prostheses on osseointegrated implants. As a result of resorption of the alveolar maxillomandibular post-extraction, the use of angulated abutments is an option for the correction of the position of implants. This paper aims to present a case report of immediate implants with Cone-Morse platform. placed in the anterior mandible and making a mandibular fixed prosthesis with immediate loading in which was used a fixed screw-type tube as a way to replace angled abutments.
Subject(s)
Humans , Male , Dental Prosthesis Retention , Dental Prosthesis, Implant-Supported , Denture, Complete, Lower , Immediate Dental Implant Loading , MandibleABSTRACT
Microgenia is that the mental protuberance is small state because of symphysis did not developed properly while occlusion and size of mandible are normal. One or two-step sliding advancement genioplasty is mainly performed to make good aesthetic harmony with face, but in slight or moderate degree of microgenia patients who do not want general anesthesia or osteotomy, the multiporous high-density polyethylene(Medpor(R)) can be used. It is easy to carve and bend, and has a variety of size and shape to fit the contour of the chin anatomy. Under the local anesthesia. a vertical incision which can preserve mentalis muscle is made about 2 cm at inferior labial sulcus along inferior frenulum in the jaw midline. Subperiosteal dissection is performed to make a pocket. Seperated Medpor(R)s are inserted in each side and reassembled into one in the midline. To minimize bone erosion, implant has to be placed on the inferior side of mandible edge and fixed with screw. Bandage compression was applied for 3 days and antibiotics was treated for 7 days postoperatively. This technique has a small incision, easy procedure and faster recovery. During the follow-up period, there were no specific complications and patients were all satisfied to their result.