Insertion Of Implants Research Articles

Defining the iliac wing osseous fixation pathways: anatomy and implant constriction points.

Insertion of iliac wing implants requires understanding of the curvilinear shape of the ilium. This study serves to quantitatively identify the area of iliac inner-outer table convergence (IOTC), characterize the iliac wing osseous corridor, and define the gluteal pillar osseous corridor. Computed tomography scans of 100 male and 100 female hemipelves were evaluated. The iliac wing was studied using manual best-fit analysis of the bounds of the inner and outer cortices. The IOTC was defined as the location of the iliac wing with an intercortical width less than 5mm. The shortest distance from the apex of the iliac crest to the superior border of the IOTC was defined as the iliac wing osseous corridor. Finally, the width of the gluteal pillar corridor from the gluteus medius tubercle to the ischial tuberosity was measured. The IOTC is an elliptical area measuring 22.3cm2. All ilia had an area where the inner and outer cortices converged to an intercortical width of less than 5mm; 48% converged to a single cortex. The shortest mean distance from the superior edge of the iliac crest to the beginning of the IOTC was 20.3mm in men and 13.8mm in women (p<0.001). The gluteal pillar diameter averaged 5.3mm in men and 4.3mm in women (p<0.001). All ilia converge to a thin and frequently unicortical central region. A 4.5mm iliac wing lag screw will not breach the cortex if it remains within 20mm or 14mm distal to the cranial aspect of the iliac crest in males and females, respectively. Not only is the gluteal pillar smaller than previously thought, in 41% of males and 73% of females, it is not be large enough for 5mm implants. This study quantitatively assesses the dimensions of the IOTC, the iliac crest osseous corridor, and the gluteal pillar. Overall, our findings provide improved understanding of the limits for implant use in the iliac wing as well as better appreciation of the complex osteology of the ilium. This will help surgeons to identify safe areas for implant placement and avoid inadvertent cortical penetration.

Dynamics of biochemical markers of the connective tissue metabolism in the blood of rats after insertion of steel implants with diamond-like carbon coating into the femur

Objective: It is known that the regeneration of bone tissue after implantation of any structuresdepends on the coating of their surface. Therefore, the research of the influence of steelimplants with diamond-like carbon coating on regeneration of bone tissue in the dynamics afterimplantation is a topical issue.&#x0D; Material and Methods: The study was conducted on 61 male rats,5 of them were intact animals. There were also 2 groups of rats with 28 animals in each group(the 1st group was the control one where implants were without diamond-like carbon coating,the 2nd group was experimental where the implants were without coating). We determined thecontent of glycoproteins, chondroitin sulfates, alkaline phosphatase, total calcium, oxyprolineand osteocalcin in the blood of rats on the 7th, 14th, 30th and 90th days after implantation.&#x0D; Resultsand Discussion: Group 2 rats had a faster osteointegration compared with the group 1 rats, whichwas manifested by the normalization of biochemical markers of bone metabolism (glycoproteins,chondroitinsulfats, oxyproline and osteocalcin) on the 90th day of an experiment.&#x0D; Conclusion:Using steel implants with diamond-like carbon coatings showed that the content of glycoproteinsand chondroitin sulfates increased only on the 7th day; oxyproline and osteocalcin increasedon the 7th, 14th and 30th days after implantation; on the 90th day the rates of these biochemicalmarkers reached the norm, indicating a high efficiency of osteointegration.&#x0D; Bangladesh Journal of Medical Science Vol.20(1) 2021 p.81-85

Correction of Orbital Deformity in Camurati-Engelmann Disease with PEEK Lateral Wall Implants

Camurati-Engelmann Disease is a rare congenital sclerosing bone dysplasia condition. Affected patients manifest bony abnormalities including thickening of the skull base and orbital bones. The resulting orbital volume reduction associated with this condition can cause exophthalmos, distorting the facial profile. The authors report a 33-year-old man with a diagnosis of Camurati-Engelmann Disease exhibiting exophthalmos who was successfully treated with the insertion of bilateral lateral orbital wall patient specific PEEK implants via a bi-coronal flap approach. This case highlights the novel application of modern cutting-edge technology in the treatment of proptosis in Camurati-Engelmann Disease.

Relevance of Otago University postgraduate programmes in women's health to general practice: a case study.

INTRODUCTION There are important changes in the health care needs of women presenting to general practice in New Zealand, which prompted an evaluation of postgraduate training needs of general practitioners (GPs) who care for women in the community. AIM To evaluate the perceived relevance of the curriculum of Otago University postgraduate programmes in women's health to GPs' work profile to identify any need for curricular change. This study was also performed to investigate the need for refresher courses or a Master's degree in obstetrics, gynaecology and women's health. METHODS In total, 426 GPs and GP trainees who had completed the postgraduate Certificate and Diploma programmes in women's health were invited to complete an online survey. The survey consisted of multiple-choice questions with five-point Likert scale ratings to rate the relevance of papers to general practice, and options for free-text comments. RESULTS There were 86 responses (20.2% response rate) and we analysed 73 (17.1%). Curriculum modules related to gynaecological care were rated as more relevant than obstetric and newborn care. GPs suggested more training in contraception and management of infertility, abnormal uterine bleeding and pelvic pain including procedural skills such as insertion of long-acting reversible contraceptives, implants and intrauterine devices. An interest in a refresher course was indicated by 76.6% of GPs. DISCUSSION GPs recognised the need for enhanced training in women's gynaecological care. Revision of the postgraduate women's health curriculum and development of new refresher courses will enable GPs, trainees and prospective GPs to improve their care for women in the community.

A novel technique to prevent the breast implant from exposure after mastectomies

Introduction After mastectomies, we do our reconstruction, either immediately or delayed. In both ways of reconstruction for post mastectomies defect, the most commonly performed reconstruction is by using breast prosthesis [1]. For many years, surgeons have been trying to find out any solution to reduce the rate of implant exposure and develop some new techniques and modifications. However, once the infection develops or implant expose the only permanent solution is to remove the implant [2-3]. Although there is less evidence found in the literature regarding the salvage of implant once the infection occurs and when implant becomes expose in implant-based reconstruction [4]. Radiation also plays additional role in post-operative complication rates following implant-based breast reconstruction, as it is well documented that the incidence of complications is to be higher in radiated breasts compare to similar non-radiated breasts [5]. With the new advancement in radiation therapy the number of patients have been increasing who are receiving radiation therapy after immediate breast reconstruction [5]. Description of the Technique For more than 15 years we have been reconstructing the breasts deformities after different types of mastectomies, ranging from skin sparing, nipple areola sparing to different types of lumpectomies, by immediate insertion of breast implants. The main problem which we face during post-reconstruction, is the exposure of implant in addition to infection. With the advent of ADM (Artificial Dermal Matrix) [6], serratus anterior muscle [7], rectus fascial flap [7] and inferior dermal flaps [8] although they do an addition to thickness of skin envelop over the implant after mastectomy, but still the rate of implant exposure has not changed noticeably. It has been well understood that of ADM expose in air it dries immediately which later on results in implant exposure. Meanwhile we have developed a novel tech- nique to augment the soft tissue coverage under the incision line over the ADM and implant. By this way, if there is any dehiscence over suture line, there will be no implant exposure as there is additional soft tissue layer of dermal flap. These dermal flaps are actually a de-epithelialized dermal flap from the inferior half of the breast skin, which we used to excise and throw it to the garbage, particularly in skin sparing mastectomies. In this technique we suture the inferior based dermal flap over the artificial dermal matrix in a way that suture lines of skin flaps of mastectomy lie over the de-epithelialized dermal flap, which actually in- crease the survivability of ADM as well as increase the thickness of soft tissue over the implant (figure 1 and 2). By addition of this layer of de-epithelialized dermal flaps over the artificial dermal matrix and breast implants have promising reduction effect over implant exposure as well as it provides the additional vascularized soft tissue layer over the implant. Although we are using dermal flap with ADM frequently in most of our skin spring mastectomies but we did this new technique in 2 patients till now with the mean follow up of 8 weeks till now there is not a single case report of implant exposure in those patients (figure 3).

EVALUATION OF SHORT IMPLANTS’ SUCCESS FOR TEETH REPLACEMENT IN ATROPHIC POSTERIOR MANDIBULAR RIDGE (CLINICAL TRIAL)

Introduction: Atrophic mandibular jaws have been challenging to treat, using long implants. Techniques as jaw ridge augmentations, mandibular canal lateralization, and osseous distraction were proposed to allow the insertion of long Implants. However, complications as nerve injuries, tissue morbidity and prolonged healing have been inconvenient. Therefore, short implants with advanced surface treatments have been suggested. Objectives: Clinical and radiographic evaluation of splinted and single short implants, before and after loading, for teeth replacement in atrophic posterior mandibular alveolar ridges. Materials and Methods: A prospective study was done on 16 Patients with missing posterior teeth, with 6-8 mm of crestal height above the mandibular canal, and at least 7mm of bone width. Group A: 8 patients received 2 short implants loaded by splinted crowns. Group B: 8 patients received single short implants loaded by single crowns. Osstell and CBCts were used for implant stability and bone condition assessment. Results: Both groups maintained high implant stability with a mean of (68.79±4.61) for group A and (71.71±3.55) for group B, 6 months postoperative. Mean marginal bone loss for group A and group B was (0.11±0.04) and (0.16±0.10) respectively; however the difference is insignificant with P value 0.535. A remarkable increase in bone density for both groups among the follow up time with P value Conclusions: Short Implant is a useful solution for teeth replacement in atrophic posterior mandibular ridges, with an 87.5% of success recorded.

Quad Zygomatic Implants: A Systematic Review and Meta-analysis on Survival and Complications.

To assess the postoperative complications and outcome (implant survival) of quad zygomatic implants inserted in patients with edentulism and severely atrophic maxillae. Two independent reviewers conducted an electronic search of the literature (PubMed, Scopus, EBSCO, Web of Science) from January 2000 to February 2019. The inclusion criteria were articles published in English reporting data of at least five patients with severely atrophic edentulous maxillae undergoing placement of four zygomatic implants without additional insertion of standard implants, with a minimum of 6 months of follow-up. Data extracted included number of patients, characteristics of the maxillary defect, number of zygomatic implants, implant details, surgical procedure, prosthetic rehabilitation, postoperative complications, survival rate, and length of follow-up after definitive prosthesis delivery. Eleven studies with 166 patients were included. The heterogeneity among studies was not significant. The pooled incidence rates of complications were as follows: sinusitis 12% (95% confidence interval [CI]: 4% to 23%), malposition and surgical guiding failure 11% (95% CI: 3% to 21%), local infection/injury 10% (95% CI: 3% to 18%), and prosthetic complications 5% (95% CI: 0% to 13%). The implant survival rate ranged between 95.8% and 100%, and the pooled implant survival rate in the meta-analysis was 98% (95% CI: 97% to 99%). Quad zygomatic implants inserted in patients with severely atrophic edentulous maxillae have a high implant survival rate, but the incidence of complications should not be underestimated.

Влияние микроструктуры поверхности, конструктивных и размерных особенностей дентальных имплантатов на их стабильность и процесс остеоинтеграции при проведении непосредственной и отсроченной имплантации. Часть II

Abstract. This article presents the results of a clinical study of the stability and process of osteointegration implants of 11 known implant dental systems. The effect of the microstructure of 3 types of implant surface (HSTTM, SLA and RBM) and their design features (shape, size, type of carving) on the indicators of their stability and osteointegration process during immediate and delayed implantation with immediate functional load is shown and analyzed. The stability of the implants and the dynamics of the quality of osteointegration were determined by the devices «Osstell Mentor» and «Periotest» in the process of treatment, starting from the moment of implant installation in different eras (2 weeks, 1 month, 2 months and 3 months). 414 patients between the ages of 20 and 70 were monitored. Of these, there are 249 and 165 male women. The average age of the operated patients was: for men – 54 years for women – 49 years. All patients were divided into two groups of the first – 109 patients who after extraction were directly implanted into the hole of the remote tooth with the subsequent immediate load, the second group – 305 patients who were delayed implantation with immediate load. A total of 1,302 implants were installed. The study revealed a link between the type of surface of the implant, primary stability and the time of its osteointegration during certain periods of clinical observation. The results of the study demonstrated the important role of combining microstructure of the surface, design and dimension features, the type of insertion of implants on their primary stability and the process of osteointegration in the conduct of both immediate and delayed implantation. Key words: frequency resonance analysis, damping, stability, osteointegration, fixation, implants, periotestometry, immediate implantation.

Влияние микроструктуры поверхности, конструктивных и размерных особенностей дентальных имплантатов на их стабильность и процесс остеоинтеграции при проведении непосредственной и отсроченной имплантации. Часть І

Abstract. This article presents the results of a clinical study of the stability and process of osteointegration implants of 11 known implant dental systems. The effect of the microstructure of 3 types of implant surface (HSTTM, SLA and RBM) and their design features (shape, size, type of carving) on the indicators of their stability and osteointegration process during immediate and delayed implantation with immediate functional load is shown and analyzed. The stability of the implants and the dynamics of the quality of osteointegration were determined by the devices «Osstell Mentor» and «Periotest» in the process of treatment, starting from the moment of implant installation in different eras (2 weeks, 1 month, 2 months and 3 months). 414 patients between the ages of 20 and 70 were monitored. Of these, there are 249 and 165 male women. The average age of the operated patients was: for men – 54 years for women – 49 years. All patients were divided into two groups of the first – 109 patients who after extraction were directly implanted into the hole of the remote tooth with the subsequent immediate load, the second group – 305 patients who were delayed implantation with immediate load. A total of 1,302 implants were installed. The study revealed a link between the type of surface of the implant, primary stability and the time of its osteointegration during certain periods of clinical observation. The results of the study demonstrated the important role of combining microstructure of the surface, design and dimension features, the type of insertion of implants on their primary stability and the process of osteointegration in the conduct of both immediate and delayed implantation. Key words: frequency resonance analysis, damping, stability, osteointegration, fixation, implants, periotestometry, immediate implantation.

Implant insertion angle and depth: Peri-implant bone stress analysis by the finite element method.

BackgroundThe study aimed to assess the influence of different implant insertion angles and depths on the stresses produced on the surface of peri-implant bone tissue under axial and oblique loading. Material and MethodsThe entire study followed the recommendations of the Checklist for Reporting In-vitro Studies (CRIS). The implant was placed in the region of element 36, according to the following models: M1 (0 mm / 0°); M2 (0 mm / 17°); M3 (0 mm / 30°); M4 (2 mm / 0°); M5 (2 mm / 17°); M6 (2 mm / 30°). The models were subjected to loading, with intensity of 100 N. The stress assessment followed the Mohr-Coulomb criterion and qualitative and quantitative analyses were performed. ResultsAngled implants and installed below the bone crest produced the highest stresses on the cortical bone, and the axial load presented the highest stress peaks on the buccal side of implants perpendicular to the bone crest. Regardless of the type of load (axial or oblique), inclined implants presented the highest stress peaks on the lingual side of the cortical bone. ConclusionsImplants installed perpendicular to and with a prosthetic platform at bone crest height provided the lowest stresses to peri-implant bone tissue under both axial and oblique loading. Key words:Finite element analysis, dental implants, axial loading, biomechanical phenomena.

Does the Immediate Dental Implant Placement into Fresh Extraction Sockets Decrease the Marginal Bone Lose?

The insertion of dental implants immediately after teeth extractions has become a routine clinical procedure in implant dentistry. This treatment modality has received much attention and has shown favorable results.

Adherence to Swedish national recommendations for long acting reversible contraceptive provision at the time of medical abortion

ObjectiveTo investigate if abortion clinics follow Swedish national guidelines regarding early insertion of long-acting reversible contraception (LARC) after medical abortions up to 9 weeks of gestation and, if not, the reasons for not doing so. Study designWe attempted to survey representatives of all 60 known Swedish abortion clinics by telephone in November 2019, including public hospitals and private clinics. We asked questions about clinic characteristics, clinic routines concerning early insertion of IUDs and implants, adherence to guidelines and, when applicable, perceived reasons for nonadherence. Current guidelines include offering implant placement at the time of mifepristone administration and intrauterine device (IUD) insertion within 7 days of misoprostol treatment. ResultsWe obtained responses from 57 (95%) clinics of which 22 (40%) followed guidelines for both implants and IUDs. Slightly more than half (n = 33, 58%) follow implant guidelines and fewer (n = 25, 44%) follow IUD guidelines. Respondents most commonly cited lack of updated local guidelines at the clinic (7/24, 29%) and a perceived lack of time (6/25, 24%) as the most common reasons for nonadherence to guidelines for insertion of implants and insufficient number of nurse midwives for insertion of IUDs 8/32, 25%). ConclusionsLess than half of Swedish abortion clinics fully adhere to national evidence-based guidelines regarding early LARC insertion at the time of abortion. ImplicationsNational guidelines alone are not always sufficient to effect change in practice; awareness of existing guidelines is needed in Swedish abortion clinics and work is needed to address barriers that limit LARC access after abortion

A Minimally Invasive Technique for Short Spiral Implant Insertion with Contextual Crestal Sinus Lifting in the Atrophic Maxilla: A Preliminary Report.

The most recently reported techniques for the rehabilitation of the atrophic posterior maxilla are increasingly less invasive, as they are generally oriented to avoid sinus floor elevation with lateral access. The authors describe a mini-invasive surgical technique for short spiral implant insertion for the prosthetic rehabilitation of the atrophic posterior maxilla, which could be considered a combination of several previously described techniques based on the under-preparation of the implant site to improve fixture primary stability and crestal approach to the sinus floor elevation without heterologous bone graft. Eighty short spiral implants were inserted in the molar area of the maxilla in patients with 4.5–6 mm of alveolar bone, measured on pre-operative computed tomography. The surgical technique involved careful drilling for the preparation of implant sites at differentiated depths, allowing bone dislocation in the apical direction, traumatic crestal sinus membrane elevation, and insertion of an implant (with spiral morphology) longer than pre-operative measurements. Prostheses were all single crowns. In all cases, a spiral implant 2–4 mm longer than the residual bone was placed. Only two implants were lost due to peri-implantitis but subsequently replaced and followed-up. Bone loss values around the implants after three months (at the re-opening) ranged from 0 to 0.6 mm, (median value: 0.1 mm), while after two years, the same values ranged from 0.4 to 1.3 mm (median value: 0.7 mm). Clinical post-operative complications did not occur. After ten years, no implant has been lost. Overall, the described protocol seems to show good results in terms of predictability and patient compliance.

Endoscopic Approach for Insertion of Custom-Designed Facial Implants.

The objective of this article is to describe the combination of virtual planning used to produce a custom-made facial implant, along with the minimally invasive endoscopic approach used to place it, for the reconstruction of the frontal bone. This management reduces the sequelae that occur with the traditional incisions while restoring the proper contour of facial surfaces at the same time.

A Micro-Computed Tomography Study of Round Window Anatomy and Implications for Atraumatic Cochlear Implant Insertion.

The goal of this study was to interrogate high-resolution three-dimensional reconstructions of round window anatomy to illustrate and characterize structural variability with implications for atraumatic cochlear implant insertion. Cochlear implants are increasingly used to improve sound detection in patients with substantial residual hearing. However, traumatic cochlear implant insertion through the round window involving upward deviation of the electrode into the spiral ligament, basilar membrane, and osseous spiral lamina, medial impaction on the modiolus, or interscalar excursion into the scala vestibuli are associated with lower rates of hearing preservation and poorer speech perception.Successful atraumatic insertion is dependent on an anatomical understanding of the middle and inner ear. The round window bony niche lacks distinct demonstrable anatomical landmarks for the position of the round window membrane, and there is limited guidance on the amount of bony overhang that can be safely drilled away. A greater understanding of the anatomical variation around the round window could enhance treatment efficacy. Fourteen human cadaver temporal bones were imaged using microcomputed tomography. Resulting scans were digitally reconstructed, segmented, and measured. Round window niche walls vary substantially in size and projection. Round window average short diameter measured 1.30 mm (range 1.07-1.44), and is limited by the crista fenestrae at the inferoanterior margin of the round window. Crista fenestrae size and morphology varied considerably. Reconstructions with solid and translucent panels are presented. Anatomical heterogeneity should be considered in cochlear implant selection, drilling, and choice of insertion vector.

Immediate Postextractional Implant Insertion in Posterior Maxilla. Therapeutic Attitude

Abstract The immediate postextractional implant insertion is a specific way of surgical approach to implanto-prosthetic treatment. This article addresses the indications, advantages, and surgical techniques of immediate postextraction insertion, illustrated with a clinical case. Objectives: presentation of the indications, advantages and surgical procedure of immediate postextractional implant insertion. Materials and methods: The present study considered the presentation of a case in which we opted for the insertion of implants immediately postextractionally as a therapeutic attitude. Results and discussions: The advantages and disadvantages of this therapeutic technique were represented as follows. The advantage of this technique is given by the shortening of the time necessary to complete the treatment until the prosthetic phase, the disadvantage being represented by the insertion of the implant in positions sometimes less advantageous to the prosthesis. Also, the fact that we could not preserve the alveolar ridge, keeping the bone volume necessary to insert the implant in the best position of the prosthesis by complying with the biomechanical principles, made over time, a series of complications that occurred due to vicious insertion of the implant and non-compliance with those biomechanical principles. Conclusions: The analysis of the case as a whole, represents the main premise from which any dental treatment must be started, so that the functionality of the prosthetic and aesthetic reconstruction will have to be taken into account when we choose the best treatment option.

Assessment of Pterygomaxillary Region for Insertion of Pterygoid Implants - A Cone Beam Computed Tomography (CBCT) Study

Assessment of Pterygomaxillary Region for Insertion of Pterygoid Implants - A Cone Beam Computed Tomography (CBCT) Study

The Alveolar Ridge Splitting Technique on Maxillae: A Biomechanical Human Cadaveric Investigation.

The alveolar ridge splitting technique (ARST) offers an alternative to classic ridge augmentation techniques for successful insertion of dental implants. However, the buccal lamella is at risk of fracturing during ARST distraction. To better understand the fracture mechanisms and displacement limits of the split lamella, this study conducted biomechanical tests on human cadaveric maxilla specimens having extremely atrophied alveolar ridges treated with ARST. A total of 12 standardized alveolar splits were prepared on the maxillae of 3 elderly female donors using an oscillating piezoelectric saw. Mimicking the surgical distraction process of the lamella, each split was tested to failure using a dental osteotome attached to the crosshead of an electromechanical testing system. All specimens were scanned by means of high-resolution peripheral quantitative computed tomography prior to and post testing to evaluate split geometries and failure modes. Split stiffness, failure force, and displacement were 27.4 ± 18.7 N/mm, 12.0 ± 8.4 N, and 0.97 ± 0.31 mm, with no significant differences between anatomical sides and split locations (p ≥ 0.17). Stiffness correlated significantly with failure force (R2 = 0.71, p < 0.01). None of the alveolar split widths correlated significantly with the outcomes from biomechanical testing (p ≥ 0.10). The results suggest that simple geometrical measures do not predict the allowed extent of lamella distraction prior to failure. More sophisticated methods are required for surgical planning to optimize the ARST outcomes. Still, the present study may advocate a clinical protocol for the maxilla where the implant site is prepared directly after osteotomy setting and immediately before full lamella dislocation, when the lamella is still stable, resistant to mechanical stress, and bone loss caused by the abrasion of the burr is minimized.

Treatment of extensive tumors of the jaws by hemimandibuloectomy with simultaniouse reconstruction of the mandible, arthroplasty of temporomandibular joint, orthopedic rehabilitation supported by dental implants

Background. Reconstruction of subtotal and total defects of maxillofacial region after ablative tumor surgery is a challenging task of reconstructive surgery. The “golden rule” is maintaining of radicalism of ablative surgery as well as appropriate surgical reconstruction and prosthodontic rehabilitation, that allows patient return to normal life. Wherein reconstructive procedure is focusing on restoring of mandibular continuity by the means of different flaps and grafts, while prosthodontic rehabilitation is performing after some period of time (usually around year) by the means of removable and non-removable prosthodontic devices. Non-removable device requiring dental implants insertion into grafted material followed by period of osteointegration, that is requiring some time as well. However, within this period of time one could observe significant soft tissue deformity.The objective is to improve the outcomes of surgical reconstruction of extensive defects of the mandible and to carry out rapid prosthodontic rehabilitation supported by dental implants by application of 3D preoperative planning and navigation devices.Clinical case. Forty-nine years-old female patient with recurrent ameloblastoma, that affects vertical and horizontal ramus of the mandible. Within virtual preoperative planning one performed: resection of the mandible associated with exarticulation of condylar head, virtual plate bending according to contours of the mandible (that were determined by application of “mirror” function of virtual planning software), arthroplasty of temporomandibular joint, determination of donor site on fibula bone, osteotomy of fibula free flap, positioning of dental implants, transferring of composite flap and it’s fixation by reconstructive plate. According to acquiring data one performed fabrication of patient specific navigation guides for both fibula flap segmentation and dental implants positioning. Surgical procedure included single-step tumor ablation and exarticulation of condylar head, reconstruction of defect by the means of osseo-myo-cutaneous fibula free flap, that was pre-implanted by dental implants, total joint reconstruction by titanium condylar head and polypropylene fossa, fixation of the flap and condylar head in recipient site by the means of prebended reconstructive plate, as well as insertion of non-removable bridge prosthodontic device. Postoperative result was asses clinically and radiologically. No significant postoperative complications occurred. Restoration of facial contours, mouth opening, I class occlusion, as well as adequate meal and speech were detected. Postoperative radiological investigation revealed adequate positioning of dental implants within neo-mandible, as well as positioning of artificial joint.Conclusion. In cases of extensive tumors of the jaws single-step ablative surgical procedure, reconstruction of missing anatomical structures of the jaws and simultaneous prosthodontic rehabilitation allows to prevent possible deformities of the soft tissues and due to rapid restoration of vital functions has great impact to quality of patient’s life. Adequacy of performing procedures could be reached by implementation of virtual preoperative planning and fabrication of patient-specific surgical guides.

A custom-made brachytherapy applicator for recurrent endometrial and vaginal cancer: A dental technique for prosthesis fabrication

The role of the prosthodontist in radiation therapy includes fabrication of radiation therapy prosthetic applicators. Brachytherapy is a form of cancer treatment that involves direct insertion of radioactive implants into the tissue. In the case of vaginal cancer, brachytherapy requires the radiation oncologist to use a device called an applicator. Conventional applicators have limitations in terms of the number of radiation tubes that can be inserted, positioning of the tubes, applicator misfit, and pain when inserted. A well-fitted applicator is needed to improve the orientation of the radiation source toward the target area and to reduce the amount of scatter radiation and tissue irritation. Using an appropriate dental material to make an impression can serve to achieve these aims. This article describes a technique for fabricating an acrylic resin custom-made applicator by using techniques used in dentistry.