Implant-Supported Rehabilitation Using GBR Combined with Bone Graft on a Reconstructed Maxilla with the Fibula Free Flap.

Alveolar ridge augmentation procedures allow restoring jaw defects due to teeth extractions, periodontal diseases, trauma, or outcomes from a previous surgery. This case report describes a patient suffering from Fibrous Dysplasia of the right upper maxilla surgically reconstructed by fibula free flap. In 2003, four dental implants were placed in the 1.2, 1.3, 1.5, and 1.6 areas. Twelve years later, the onset of peri-implantitis led to the failure of osseointegration with consequent thinning of the fibula flap. To avoid the risk of fracture and to restore the bone volumes necessary for a new implant-prosthetic rehabilitation, we used heterologous biomaterials in combination with a non-reabsorbable membrane, according to the Guided Bone Regeneration (GBR) technique. GBR was performed using the Equimatrix® natural bone mineral matrix, Cytoplast™ Ti-150, a non-reabsorbable titanium-reinforced membrane, and four fastening screws to pin the membrane. After six months, the membrane was removed and two Zimmer® implants 3.7 × 13 mm were placed in the 1.1 and 1.2 areas. A fixed implant-supported prosthesis with a custom-milled titanium bar screwed to the implants was made. Computed tomography (CT) six months after GBR showed a good bone regeneration of 1.5 cm mesiodistal (MD), 1.8 cm buccopalatal (BP), and 2.8 cm in height. The main difficulty of this clinical case concerns the low predictability of success of GBR on a maxillary reconstructed area with a free fibula flap: there is no previous evidence in the literature. Clinical and radiographic exams nowadays show that there is no macroscopic bone reabsorption; however, further research is needed to obtain more information.

Timing for implant placement in patients treated with radiotherapy of head and neck.

BACKGROUND: Aim of this retrospective study was to evaluate the most appropriate timing for the implant placement in oral cancer patients treated with radiation therapy. MATERIALS AND METHODS: We collected data for 17 subjects (10 females, 7 males; mean age: 51 ± 19) with malignant oral tumors who had been treated with ablative surgery and radiation therapy of head and neck. The radiotherapy was set in accordance with the NCCN guidelines. Every patient received dental implant rehabilitation between 2014 and 2016. A total of 84 titanium implants were placed, at a minimum interval of 12 months, in irradiated residual bone. Every patient underwent a minimum follow-up of 12 months. RESULT: Implant loss was dependent on the position and location of the implants (P = 0.05-0.1). Moreover, implant survival was dependent on the total dose of radiation and, mostly, on the timing of implant insertion after the end of the radiation therapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determining survival. We observed significantly better outcomes when the implant was placed at least after 14 months and not loaded until at least 6 months after placement. CONCLUSION: Although the retrospective design of this study could be affected by selection and information biases, we conclude that a delayed implant placement after the end of the radiation therapy and a delayed loading protocol will give the best chance of implant osseointegration, stability and, ultimately, effective dental rehabilitation.

Aesthetic satisfaction in lip and palate clefts: a comparative study between secondary and tertiary bone grafting.

Lip and palate cleft represent one of the most frequently occurring congenital deformity, which includes dental anomalies, such as variation in tooth number and position. In case of hypodontia implant-prosthetic rehabilitation offers significant advantages in terms of function, aesthetics and quality of life and bone graft is usually needed. Secondary bone grafting, generally performed in the mixed dentition phase (years 8-11) seems to be the most successful method to allow for rehabilitation. It's often necessary to perform a tertiary bone grafting in adult age in order to achieve better bone quantity and quality before implant placement. Aim of this retrospective study was to evaluate the aesthetic perception that patients had of themselves comparing dental implants placed in tertiary grafted alveolar cleft sites with a previous secondary grafting to only secondary grafting. Between 2009 and 2012, fourteen alveolar cleft were treated with implant rehabilitation and eleven of them received tertiary bone grafting six months prior to implant placement. All patients were questioned to give a score from 1 to 10 their aesthetic satisfaction of their smile before and after implant rehabilitation and during pre-surgery provisional rehabilitation. At the end of their prosthesis rehabilitation patients who received tertiary bone grafting resulted more satisfied than those who had secondary bone grafting only (9.5 vs 8).

Prosthetic rehabilitation involving the use of implants following a fibula free flap reconstruction in the treatment of Osteosarcoma of the maxilla: a case report.

INTRODUCTION: Osteosarcoma is an aggressive primary bone tumor composed of connective tissue cells directly producing osteoid and bone. Prosthetic rehabilitations in post-oncological patients after bone reconstruction are not substantially different than those of patients affected by severe atrophy of upper or lower jaw after bone reconstruction. The treatment for patients with a malignant neoplasia of the oral cavity requires multidisciplinary approach by a team of different specialists that follow the patient through the phases of diagnosis, therapy and oral rehabilitation. Reconstructive surgery of jaws using vascularized free flap allows a significant gain of tissues that enables a successful final prosthetic rehabilitation. In fact main prosthetics difficulties result from lack of hard and soft tissues in affected area. Reconstructed patients have a greater ease of care management. CASE PRESENTATION: A 25-year-old Caucasian male was diagnosed with chondroblastic osteosarcoma of the pre-maxilla. The patient initially noticed the displacement of his maxillary incisors with progression into a definite swelling of the pre-maxillary a month later. Computerized Tomographic Scan and Radionuclide Bone Scan revealed the absence of both distant metastasis and regional nodal involvement. A biopsy and subsequent histopathology examination confirmed the lesion as being a chondroblastic type of osteosarcoma. The case study directed us to rehabilitate the patient by implant supported prosthesis consisting 3 different components: a titanium base screwed on implants, a titanium structure (primary structure) assembled on the base and a composite coatedstructure (secondary structure) that reproduced teeth and gum. At surgery, we proceeded placing 6 dental implants in 1.4, 1.3 1.2, 2.1, 2.2 and 2.4 positions. Contextually was performed a bone graft using particulate bone and collagen membranes. CONCLUSIONS: Prosthetic rehabilitation in Maxillofacial Osteosarcoma treatment is an hard challenge for prosthodontist due to anatomic conditions of this kind of patients. Dental implants play a crucialrole in the therapy of patients affected by malignancies in the head-and-neck region. The goal of implant rehabilitationis to improve the quality of life of these patients by allowing proper retention of removable prostheses and a reduction in the load placed on vulnerable soft tissues. Today prosthetically guided rehabilitation represents the main rehabilitation protocol in prosthodontics, especially in those oncological patients with relevant lost of tissues and modified anatomy.