再建下顎におけるインプラント治療

Abstract

Mandibular defects resulting from trauma or resection of malignant tumors are reconstructed by using particulate cancellous bone and marrow(PCBM)graft combined with titanium mesh tray or vascularized bone flap for the purpose of esthetic and functional recovery. Although implants are optimal for the occlusal rehabilitation, their placement requires sufficient mandibular osseous bulk and an appropriate morphology. With the use of vascularized bone graft following the resection of malignant tumors, the reconstructed mandible often becomes narrower than the maxilla due to the extensiveness of tissue defect and the scar contraction resulted from former surgery and radiotherapy. In addition, bone height and width are often insufficient for implant placement because of the intrinsic form the bone flap. Therefore, in these cases, implant therapy can be performed only after augmentation of the grafted bone through bone lengthening or other methods.In secondary reconstruction following the resection of malignant tumors, graft of the vascularized bone flap frequently become difficult due to soft tissue defects or scar contracture. In such cases, a sufficient amount of bone should be grafted after performing tissue expansion using the remaining mandibular bone in advance. In this paper, we report favorable outcomes obtained for the patients who underwent implant therapy after vascularized bone graft using tissue expansion or secondary elongation of reconstructed mandible.