Jaw Defects Research Articles

Reconstruction of Mandible: A Fully Digital Workflow From Visualized Iliac Bone Grafting to Implant Restoration

Although digital aids can help surgeons compensate for the shortcomings of traditional mandibular reconstruction techniques to perform surgery more precisely and effectively, the use of these digital techniques has often been fragmented, divided, and incomplete. This article describes the workflow of a fully digital mandibular reconstruction to explore the proper indications and discusses innovations based on the accuracy and effectiveness of digital techniques. A restoration-oriented mandibular reconstruction was performed by applying different digital techniques. Preoperative virtual surgery and rapid prototyping were used to aid the vascularized iliac bone graft surgery, which offered a solid basis for the ensuing treatment. Subsequently, implant rehabilitation was accomplished with the assistance of computer-assisted design and manufacture, laser treatment, and selective laser melting techniques. The workflow of the fully digital mandibular reconstruction successfully achieved a restoration-oriented treatment. These predictable, accurate, and effective digital techniques improved the consistency of pretreatment design and follow-up treatment. The treatment sequence achieved high predictability and reproducibility owing to the use of digital techniques. This study shows that a digital workflow can be predictable, accurate, and effective, which suggests that it could be a valid digital protocol for developing a treatment sequence for patients with jaw defects caused by trauma, congenital anomalies, or mandibular tumor resection.

Additively manufactured sub-periosteal jaw implants

Severe bone atrophy jeopardizes the success of endosseous implants. This technical note aims to present the innovative concept of additively manufactured sub-periosteal jaw implants (AMSJIs). Digital datasets of the patient’s jaws and wax trial in occlusion are used to segment the bone and dental arches, for the design of a sub-periosteal frame and abutments in the optimal location related to the dental arch and for the design of the suprastructure. The implants and suprastructure are three-dimensionally (3D) printed in titanium alloy. The provisional denture is 3D-printed in polymer. AMSJIs offer an alternative approach for patients with extreme jaw bone atrophy. This report refers to the use of this technique for full maxillary rehabilitation, but partial defects in either jaw and extended post-resection defects may also be approached using the same technique. This customized, prosthesis-driven reverse-engineering approach avoids bone grafting and provides immediate functional restoration with one surgical session.

Rationalization of constructional material postrezektsionny of the artificial limb obturator on the top jaw

The acquired defects of the top jaw owing to injuries or surgeries concerning new growths, in most cases lead to violations of functional and esthetic character. Rational prosthetics of this category ofpatients is important in a complex of rehabilitation actions. The greatest difficulty in orthopedic treatment is presented by defects of the top jaw in the presence of the oro-nasal message. The purpose of work was improvement of quality of orthopedic treatment ofpatients with the acquired defects of the top jaw. In article use option for production of difficult and maxillary artificial limbs obturators of the polyamide constructional material reinforced by the nanomodified dioxide of the titan is considered. Production of difficult and maxillary artificial limbs according to indications from the polyamide material Vertex ThermoSens allows to enter an artificial limb into retentsionny zones, remote for rigid materials, that improves his fixing and obturiruyushchy characteristics, lack of metal elements of fixing considerably improves esthetic parameters of an artificial limb. There is technically easily feasible possibility ofproduction of the facilitated designs of difficult and maxillary artificial limbs, without loss of strength characteristics, due to reinforcing of basic material the nanostructured dioxide of the titan. As a result of rational prosthetics ofpatients with the acquired defects of the top jaw psychological and social rehabilitation is reached them.

Treatment of Postextraction Sites With Allograft-Stabilized Dental Implants: A Clinical Case Series.

Additional grafting procedures for the treatment of extremely atrophic jaws may be demanding, expensive, and sometimes require long time and multiple surgical sessions, which may reduce patient's acceptance and quality of life. This study evaluated the outcomes of 10 patients with extensive alveolar bone defects in the posterior jaws, treated in a single surgical session with grafting and implants. Ten consecutive patients were treated within 3 months of extraction. After ridge exposure, implants were positioned in 4-wall defects without contact with pristine bone, and mineralized particulate allograft packed around to stabilize them. Sites were covered with resorbable membranes and soft tissues were sutured tension-free. Five months later, implants were restored in centric occlusion. At uncovering, newly formed bone filled all defects and all implants resisted at 30 Ncm of reverse torque. No complication was recorded throughout the study; survival rate was 100% for both implants and grafts. After 24 months of follow-up, mean periimplant bone level change was 0.15 ± 0.53 mm and mean bone gain at the defect site was 11.62 ± 1.04 mm. Rehabilitation of wide postextraction defects may achieve successful outcomes using allograft and a special implant design, even in the absence of optimal primary stability.

Reconstruction of posttraumatic and postoperative defects of lower jaw

Reconstruction of posttraumatic and postoperative defects of lower jaw

Clinical and Functional Outcomes of Implant Prostheses in Fibula Free Flaps

ABSTRACT Introduction Functional reconstruction of jaw defects due to surgical resection is a challenge in maxillofacial surgery. The fibula free flap in combination with dental implants has exhibited growing popularity for such reconstructions. This study aimed at evaluating the clinical and functional outcome of dental implants inserted in fibula free flaps and dental implants used for orofacial reconstruction following ablation of tumors. Materials and methods A clinical follow-up study of 10 patients was conducted after oral surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 12-year period. The follow-up protocol included a clinical examination and radiological evaluation and interview using a questionnaire. Information on postoperative recovery after the surgical reconstruction phase and implant placement, type of diet, swallowing problems, speech intelligibility, lip competence, and perceived facial appearance was collected and analyzed. Results The survival rate of fibula free flap was 100%. The survival and success rates of implants placed in the fibula flaps at the end of the follow-up period were 100 and 94% respectively. Conclusion Implants placed in fibula bone grafts have been shown to integrate normally. Surgical reconstruction with vascularized fibula bone grafts followed by placement of dental implants after jaw resection can provide good clinical and functional outcomes for oral rehabilitation with a prosthesis. How to cite this article A riga P, N arayanan V, J ain A R, Philip JM, Nathan S. Clinical and Functional Outcomes of Implant Prostheses in Fibula Free Flaps. World J Dent 2017;8(3):171-176.

Reparative processes in jaw bones under using of different plastic materials.

The comparative experimental study of osseous tissue regeneration in the createdforaminous mandibular defects being implanted with bioceramics Kergap T-300 and osteoplastic material Osteopor, as well as justifying the possibility ofusing the developed reparative material in the maxillofacial surgery clinics based on the analysis ofhistomorphological research results for are the paper objectives. 78 nonlinearwhite male rats weighing 240-300 g withforaminous mandibular defects were used as models for studying impact on the reparative osteogenesis processes made by the bonegraft material. Reparative changes in the implantation sites were studied in real time with the help of histological drugs under the optical microscopy. The graft components were the morphometry object calculated at the percentage ratio per the graft space unit in three cuts from each section. In 27.7% cases the rats'mandibular defects repair under the natural environment conditions of osseous tissue regeneration achieved with a blood clot was complicated by purulence, the surgical wound dehiscence with pyorrhea or perimandibular abscess. In other cases regeneration caused the development of heterogeneous graft made of chondroid-fibroblastic and osteoid tissues of different organization levels. The comparative experimental morphological and histomorphometric studies of the bone regeneration involving the replacement of created jaw defects with osteoplastic material Kergap-T alone and- in the combination with the lyophilized biological placenta implant Osteopor proved that the latter speeded up the beginning of active regenerative processes promoting the early defect filling with the neogenic organotypic osseous tissue comprising 52(43-63)[46-58]% and 74(57-85)[64-79]% of the bone graft in 60 and 90 days after the surgical intervention correspondingly (being equal to 24(13-29)[20-28]% i 32(27-38)[30-34]% correspondingly in cases when Kergap-Twas applied. According to the morphometric researchfindings, in cases of Osteopor and Kergap-T application the tabular bone element ofthe graft was equal to 53 (43-60) [46-561% and 15(13-18) [14-16]% correspondingly.

Bone Grafting as a Method to Regenerate Jaw Defects Present and Future

Bone Grafting as a Method to Regenerate Jaw Defects Present and Future

Outcome of Immediate Allograft Reconstruction of Long Span Defects of the Inferior Alveolar Nerve

Contemporary management of ablative jaw defects includes not only bony and soft tissue reconstruction, but also addresses restoration of neurosensory function. The goal of this study is to determine the outcome of immediate reconstruction of long span defects (≥5 cm) of the inferior alveolar nerve (IAN) following ablative mandibular resection using allogenic nerve grafts.

EFFICIENCY OF PROSTHETIC TREATMENT WITH POST RESECTION PROSTHESES WITH SOLID SUBSTITUTE PART

Aim: The aim of this study is to track the effectiveness of prosthetic treatment with post resection dentures with solid substitute part and their role in the restoration of damaged functions. Materials and methods: The study included 14 patients (9 men and 5 women) with different size and location of defects in the upper jaw treated in the period 20102016 with post resection prostheses with a solid substitute part. The impressions were taken with irreversible hydrocolloid impression material. The prostheses were completed by heat-curing acrylic with low quantity residual monomer. The effectiveness of prosthetics was evaluated by the method of Mihaylov for both oral-nasal examination of the pressure with the device “Oronasopneumotest.” For objectifying and assess the occlusal-articulation ratios was held computerized occlusal analysis with the system T-SCAN 8. Results: The results showed successful obturation and sealing of defects in all patients. It was found satisfactory recovery of the speaking function and normalization of occlusal-articulation ratios. Conclusion: The prosthetic treatment with post resection prostheses with a solid substitute part allows successful recovery of the lost speech and chewing functions, helping to restore self esteem and social rehabilitation of patients.

Outcomes of Immediate Allograft Reconstruction of Long-Span Defects of the Inferior Alveolar Nerve

Contemporary management of ablative jaw defects includes not only hard and soft tissue reconstruction, but also restoration of neurosensory function. The goal of this study was to determine the outcomes of immediate reconstruction of long-span defects (≥50mm) of the inferior alveolar nerve (IAN) after ablative mandibular resection using allogeneic nerve grafts. A retrospective cohort study of patients who underwent immediate reconstruction of IAN gaps of at least 50mm with allogeneic nerve graft (AxoGen Avance, Alachua, FL) at a single academic medical center by a single surgeon (M.M.) from September 2013 to March 2015 was completed. Demographic and clinical data were collected for each patient and analyzed using clinical neurosensory testing and were reported using the Medical Research Council Scale (MRCS) for functional sensory recovery. In addition, patient subjective perception of neurosensory recovery was recorded using a visual analog scale (VAS). Subjective (VAS) and objective (MRCS) measurements of functional sensory recovery were recorded and compared across the study population. In addition, examined demographic and clinical data included patient age, gender, pathology, length of nerve allograft, and follow-up period. Of 12 with nerve repairs, 7 patients met the inclusion criteria. The average age was 34.7years (range, 18 to 61yr) and 71.4% were men. All IAN defects resulted from resection of mandibular pathology (6 benign lesions, 1 malignant lesion). Six of the 7 IAN defects were reconstructed with a 70-mm nerve allograft, and 1 nerve defect was reconstructed with a 50-mm graft. Mean follow-up time was 17.7months (range, 10 to 27.5months). Mean VAS score reported was 3.7 (range, 0 to 7). In addition, 85.7% of patients displayed return of some superficial pain and tactile sensation without over-response (S3), with 14.3% displaying good stimulation localization (S3+). The patient who displayed S3+ recovery underwent reconstruction with the 50-mm graft. Only 1 of the 7 patients had no neurosensory recovery (S0). Immediate reconstruction of the IAN with allogeneic nerve grafting of long-span defects (≥5cm) is a viable and predictable option to achieve useful functional sensory recovery.

Combination of Bioactive Polymeric Membranes and Stem Cells for Periodontal Regeneration: In Vitro and In Vivo Analyses.

Regeneration of periodontal tissues requires a concerted effort to obtain consistent and predictable results in vivo. The aim of the present study was to test a new family of bioactive polymeric membranes in combination with stem cell therapy for periodontal regeneration. In particular, the novel polyester poly(isosorbide succinate-co-L-lactide) (PisPLLA) was compared with poly(L-lactide) (PLLA). Both polymers were combined with collagen (COL), hydroxyapatite (HA) and the growth factor bone morphogenetic protein-7 (BMP7), and their osteoinductive capacity was evaluated via in vitro and in vivo experiments. Membranes composed of PLLA/COL/HA or PisPLLA/COL/HA were able to promote periodontal regeneration and new bone formation in fenestration defects in rat jaws. According to quantitative real-time polymerase chain reaction (qRT-PCR) and Alizarin Red assays, better osteoconductive capacity and increased extracellular mineralization were observed for PLLA/COL/HA, whereas better osteoinductive properties were associated with PisPLLA/COL/HA. We concluded that membranes composed of either PisPLLA/COL/HA or PLLA/COL/HA present promising results in vitro as well as in vivo and that these materials could be potentially applied in periodontal regeneration.

Bloch-Sulzberger症候群（色素失調症）を有する顎形態異常患者を顎矯正手術により治療した1例

Bloch-Sulzberger syndrome (Incontinentia pigmenti) is a genetic disease that displays multiple forms of symptoms including those of the skin, teeth and eyes. Here, we report the case of a patient with Bloch-Sulzberger syndrome on whom we performed orthognathic surgery under general anesthesia. The patient was a 21-year-old female. Oral cavity findings were congenital defects in the right upper jaw 7542, left upper jaw 12578, right lower jaw 754, and left lower jaw 125. Late-stage residual E in the left upper jaw, and abnormal crown morphology of tooth 23 in the right lower jaw and tooth 3 in the left upper jaw were observed. Right cephalometric radiographic analysis revealed marked skeletal mandibular protrusion at SNA: 77.6°, SNB: 89.1°, and ANB: −11.5°. Mandibular protrusion with anomaly in the number of teeth was diagnosed; sagittal split ramus osteotomy and Le Fort 1 osteotomy were performed under general anesthesia. At 18 months postsurgery, the patient is wearing the final prosthesis and occlusion has been confirmed. The present status of occlusion is good and the patient is also satisfied.

Spontaneous regeneration of a wide mandibular defect following segmental mandibulectomy for ameloblastoma: A case report and review of the literature

Mandibular defects may be congenital or arise from a number of causes including surgery, infections, and trauma. Sporadic cases of spontaneous regeneration of jaw defects have been reported in the literature, however, the exact mechanism of this occurrence has not been fully understood. Some of the suggested factors that have been advanced for this phenomenon include age, periosteum, and genetics. Further studies are needed to elucidate the molecular basis of this phenomenon. We report a case of spontaneous regeneration of the mandible in a 14-year-old Nigerian boy following segmental mandibulectomy for ameloblastoma.

The clinical outcome of implant-supported prosthesis after vascularized bone graft reconstruction of large jaw defect

The clinical outcome of implant-supported prosthesis after vascularized bone graft reconstruction of large jaw defect

Improvement of orthopedic dental treatment of patients suffering post-surgery defects of the maxilla of cancer genesis

The paper presents a comprehensive study identifying the key issuesand giving the mathematical, and clinical and microbiological substantiation of modern principles of providing orthopedic dental care to patients with acquired defects of the upper jaw of cancer genesis.

Oral rehabilitation with dental implants and quality of life following mandibular reconstruction with free fibular flap.

Bony reconstruction of jaw defects using the free fibular flap and dental rehabilitation mostly requires insertion of dental implants within the transferred fibula bone. The aim of this paper was to discuss results of the implant stability with data on the possible benefit for the patient's quality of life after such treatment. For clinical outcome of implants, we evaluated 26 patients with a total number of 94 dental implants after a follow-up period of 12 to 132 months. A group of 38 patients who underwent mandibular reconstruction with free fibular flap could be included in the life-quality study. Evaluation included 23 patients with and 15 patients without implant-borne restoration. The quality of life was assessed using the standard QLQ C-30 questionnaire and the H&N35 module of the European Organisation for Research and Treatment of Cancer (EORTC). Of implants, 94.7 % were stable at the time of investigation and could be used for prosthesis. Patients with dental implants reported improvement of life quality along with better scores in most function and symptom scales; however, only values for global health status (QL2), absence of dyspnea (DY) and absence of feeding tube (HNFE) were significantly better than in the control group. Dental implant insertion in fibula grafts along with implant-borne restoration is a proven concept and might lead to improved quality of life following ablative surgery of the jaw. The effect on the quality of life is not as predictable as on the implant stability. Patients with bony defects of the jaw require bony reconstruction. This allows further masticatory rehabilitation using dental implants and might lead to improved quality of life.

Rehabilitation of patients with big residual jaw defects by dental implants

Rehabilitation of patients with big residual jaw defects by dental implants

Bone defects of the jaws: moving from reconstruction to regeneration

Jaw reconstruction is necessary for a variety of reasons including neoplastic disease, traumatic injuries, infective/inflammatory lesions, and congenital defects. Such defects can be a significant handicap for patients leading to physiological and psychological morbidity. Maxillofacial bone reconstruction remains challenging for the reconstructive surgeon; yet it has evolved significantly over recent years. The current state of the art reconstruction is via the use of vascularized osseous flaps. Modern developments in regenerative medicine propose a future for stem cells in the regeneration of bone for jaw defects. Clinical Relevance: Knowledge of the current methods of reconstruction and advances in the field of tissue engineering is of interest to dental clinicians.

Application of computer aided surgery technique in free flaps reconstruction of jaw defect

Objective To explore the indication of CAS technique base on reviewing cases which used different transfer methods,and evaluate the advantages and disadvantages of each transfer method.Methods During August 2011 and Febreary 2014,there were 35 patients received surgical jaw reconstruction under the aid of CAS.According to the different transfer methods used,those cases were divided into 3 groups:①Navigational surgery group:5 cases,all were mandible defect reconstruction.②Stereolithographic Model/Template/Implant group:12 cases (including 2 maxilla defect reconstruction and 10 mandible defect reconstruction).③Navigation and template group:18 cases (including 9 maxilla defect reconstructions and 9 mandible defect reconstructions).Results All 3 methods could effectively transfer the virtual surgical planning information,the reconstruction achieved better outcome.All patients were satisfied with the post-operative aesthetical and functional outcome.Conclusion Computer aided surgery technique can improve aesthetic and functional reconstruction outcome in jaw defect reconstruction,leading to higher efficiency,accuracy and safety.It is highly recommended to select a proper transfer method according to the reconstruction goal and volume of defect. Key words: Digital surgical techniques; Jaw reconstruction; Navigational surgery; Surgical template