Extraoral Implants for Anchoring Facial Prostheses: Evaluation of Success and Survival Rates in Three Anatomical Regions.

PURPOSE: The aim of this study was to evaluate the success and survival rates of extraoral implants for the fixation of facial prostheses in three anatomical regions. MATERIALS AND METHODS: Subjects were consecutive patients with facial defects who underwent implant placement by the same surgeon in the orbital, nasal, and auricular regions between 2003 and 2012. After a minimum of 4 months of osseointegration, prostheses were anchored to the implants, and the patients were monitored for 11 to 111 months. Success rate, implant survival time, and occurrence of previous radiotherapy were evaluated. Rate of implant survival was estimated as a function of the anatomical region of the three groups (orbital, nasal, or auricular), and confidence intervals were calculated using Kaplan-Meier analysis with α = .05. RESULTS: In the 68 patients' 138 fixed implants, 48 showed defects in the orbital, 9 in the nasal, and 11 in the auricular region. The success rates and survival times were 95.9% and 8.6 years for the orbital, 92.9% and 2.8 years for the nasal, and 92% and 9.0 years for the auricular region, respectively. The success rate of implants in previously irradiated regions was 90.3% for the orbital and 100% for the auricular region. None of the patients was irradiated in the nasal region. CONCLUSION: No significant differences in implant success or survival were observed with regard to anatomical region or previous irradiation.

Influence of implant-retained silicone oculo-palpebral prosthesis on stress distribution: a pilot study using a photoelastic model.

PURPOSE: The purpose of this pilot study was to evaluate the behavior of stresses surrounding orbital model implants subjected to a load of a silicone oculo-palpebral prosthesis. MATERIALS AND METHODS: A photoelastic model was constructed mimicking the orbital cavity of an adult patient who underwent left orbital resection. Two 3.75 × 5-mm extraoral implants with 3.75 × 5.25-mm magnetic connectors were placed in the model to anchor a silicone oculo-palpebral prosthesis. The stress generated by prosthesis retention was evaluated using photoelasticity at 15, 30, and 60 minutes. The polariscope images were analyzed qualitatively at five areas surrounding the implants. These same areas were analyzed quantitatively using Matlab software based on the RGB color pattern. Data were compared with the Wilcoxon test. RESULTS: Using fringe localization, the qualitative analysis demonstrated that the area between the implants had the greatest stress. The quantitative analysis showed that the peri-implant stress increased significantly in proportion to the increase in prosthesis retention time. CONCLUSION: The oculo-palpebral prosthesis generated stress around the implants, and the stress intensity was directly proportional to the duration of use.

Orbit rehabilitation with extraoral implants: impact of radiotherapy.

PURPOSE: The aim of the study was to compare the success rates of osseointegration among irradiated and nonirradiated cases submitted to implant placement for anchorage of orbit prostheses from 2003 to 2011. MATERIALS AND METHODS: Charts of 45 consecutive patients were analyzed, 31 men and 14 women, and they were divided in two groups, considering previous irradiation therapy. Nonirradiated group had 33 patients, and irradiated group had 12 patients. In total, 138 implants were installed, 42 (30.4%) in previously irradiated bone. RESULTS: The overall implant survival rate was 96.4% with a success rate of 99.0% among the nonirradiated patients and 90.5% among the irradiated patients (p = 0.03). CONCLUSIONS: Results showed that irradiated sites had a worse prognosis related to success of osseointegration, although the 90.5% survival rate in this group indicates that implant placement is a feasible alternative to anchor orbit prostheses considering the benefits that this technique offers to patients.

Extraoral implants in irradiated patients.

UNLABELLED: The aim of this study is to analyze the success of extraoral osseointegrated implants used to support designed to rehabilitate craniofacial deformities. METHOD: This study was based on the retrospective assessment of charts from 59 patients submitted to cancer surgery and who received 164 extraoral implants to contain facial prosthesis. RESULTS: Among 164 implants, 42 were fixed in previously irradiated regions. Eight of the implants did not have osseointegration; and from these, two were fixed in irradiated bone. The result show 116 (95.1%) successfully osseointegrated implants in non-irradiated sites. The success rate among 42 implants fixed in previously irradiated bones was 40 (95.3%) osseointegrated implants. CONCLUSION: The use of extraoral craniofacial implants represents a safe and effective approach to treat facial deformities as a support for the rehabilitation prosthesis. Radiotherapy treatment does not prevent osseointegration.

Implantes extraorais em pacientes irradiados / Extraoral implants in irradiated pacients

O objetivo deste trabalho foi avaliar o resultado da osseointegração de implantes extraorais lemento de suporte e retenção de próteses nas reabilitações de deformidades faciais. MÉTODO: Estudo retrospectivo de prontuários de 59 indivíduos operados de câncer, submetidos a 164 implantes para retenção de prótese facial. RESULTADOS: Dos 59 indivíduos, 14 foram previamente irradiados e receberam 42 implantes. Quarenta e cinco indivíduos não foram irradiados e receberam 122 implantes. Do total de 164 implantes, oito não osseointegraram, dos quais dois foram instalados em osso previamente irradiados. O resultado representou o sucesso de 116 (95,1%) implantes osseointegrados nos indivíduos não irradiados. E sucesso de 40 (95,3%) implantes osseointegrados em ossos irradiados. CONCLUSÃO: Concluiu-se que o uso de implantes extraorais é uma técnica segura e eficaz como suporte e retenção para próteses faciais em indivíduos com deformidades nessa região. A radioterapia não impede a osseointegração.

The aim of this study is to analyze the success of extraoral osseointegrated implants used to support designed to rehabilitate craniofacial deformities. METHOD: This study was based on the retrospective assessment of charts from 59 patients submitted to cancer surgery and who received 164 extraoral implants to contain facial prosthesis. RESULTS: Among 164 implants, 42 were fixed in previously irradiated regions. Eight of the implants did not have osseointegration; and from these, two were fixed in irradiated bone. The result show 116 (95.1%) successfully osseointegrated implants in non-irradiated sites. The success rate among 42 implants fixed in previously irradiated bones was 40 (95.3%) osseointegrated implants. CONCLUSION: The use of extraoral craniofacial implants represents a safe and effective approach to treat facial deformities as a support for the rehabilitation prosthesis. Radiotherapy treatment does not prevent osseointegration.

Reabilitação de pacientes oncológicos maxilectomizados: uma abordagem multidisciplinar / Orofacial rehabilitation of total maxillectomy defects after tumor surgery: a multidisciplinary approach

A reabilitação orofacial do paciente após a remoção do tumor em maxila é um desafio para o cirurgião-dentista. Normalmente as próteses ficam suportadas apenas por tecidos moles e não são capazes de restabelecer a função e estética para o paciente. Na literatura recente e com nossa experiência proporcionamos novas formas de reabilitação cada vez mais seguras e eficientes. Como por exemplo, o uso de implantes zigomáticos e também o uso de enxertos ósseos microvascularizados capazes de receber implantes osseointegrados. Nesse artigo descrevemos duas diferentes formas de se reabilitar o paciente maxilectomizado bilateralmente apresentando os casos.

Auricular rehabilitation by means of bone grafting from the iliac crest in combination with porous extraoral implants: a case report.

BACKGROUND: Maxillofacial defects caused by cancer treatment are a huge problem affecting the quality of life of patients. Some of these deformities are minimized using facial epitheses, which need some additional retention devices like glasses or skin adhesives. The use of extraoral fixtures as bone anchorage was introduced many years ago and since then many patients were rehabilitated with better results. PURPOSE: Because of poor bone conditions, for example, irradiated bone, the success rate of extraoral implants is less than in the oral cavity, causing difficulties to rehabilitation. One possible cause of fixture failure could be the poor primary stability achieved in some cases, hence, with an increased bone contact implant stability and survival could be improved. The present report discusses possibilities to use extraoral fixtures with a modified surface structure. MATERIALS AND METHODS: A new porous surfaced Brazilian extraoral implant (MasterExtra, Conexão, Sistema de Próteses, São Paulo, Brazil) was used. A bone transplant from the iliac crest was taken to make it possible to insert at least three extraoral implants for an auricle epithesis. Clinical evaluation and resonance frequency analysis (RFA) measurements were performed during the course of the treatment. RESULTS: Eight months after grafting, four fixtures were inserted. Three fixtures were used for connection of an auricular epithesis. RFA measurements did show high initial values and the values remained stable during the course of the treatment and at later checkups. CONCLUSION: Porous fixture is a good option in areas where the bone is compromised. RFA is a good tool also in the clinical setting to evaluate immediate and long-term stability of extraoral fixtures.

Escultores da face / Face scultures

A Prótese Bucomaxilofacial ainda é considerada o patinho feio da Odontologia, mas muitos especialistas acreditam que, no futuro, essa especialidade pode se transformar em um cisne raro

Câncer de boca: controle no Estado de Säo Paulo; manual de orientaçäo / Mouth neoplasms

Aborda o câncer bucal e o estímulo ao exame regrado da cavidade bucal, na rotina do profissional da saúde

Coloração de próteses faciais com pigmentos porcelanizados / Coloration of facial prosthesis with pigments incorporated with porcelain

O autor procura analisar os resultados da coloração de acrílico e silicona, materiais empregados na confecção de próteses faciais, quando a eles se juntam pigmentos corantes à base de óxidos minerais puros, incorporados à porcelana ou não. A estabilidade da coloração dos pigmentos porcelanizados apresentou resultados bem superiores aos demais pigmentos