Intrasinusal locking technique: a novel use of the ring block technique at sinus perforations for simultaneous implant placement.

Ten patients who underwent sinus lift surgery with simultaneous implant placement using the intrasinusal locking technique were evaluated retrospectively. All patients were scheduled for sinus floor elevation procedures with simultaneous implant placement. Schneiderian membrane perforation occurred during the lifting procedure, and conventional methods failed to repair the perforation. Therefore, an autogenous bone ring was placed at the base of the maxillary sinus and was locked to the alveolar crest with a dental implant. Marginal resorption around the dental implants was measured on panoramic radiographs. Prosthetic rehabilitation was performed at 6 months postoperative. The overall survival rate of the implants over a mean follow-up of 24.3 months was 90%. One case failed due to resorption of the alveolar crest around the implant as a result of infection; the implant and the adjacent ring were removed at 1 month postoperative. At the time of writing, the nine implants placed using the documented technique continue to function well, without any signs of peri-implant disease. The proposed approach allows for simultaneous dental implant placement in the extremely atrophic maxilla, even if there is extensive perforation of the Schneiderian membrane.

Articulation performance of patients wearing obturators with different buccal extension designs.

OBJECTIVES: The primary goal of prosthetic obturation is closure of the maxillectomy defect and separation of the oral cavity from the sinonasal cavities by use of different bulb designs. The aim of this study was to evaluate the articulation performance of obturator patients with three different buccal extension designs. METHODS: Five patients with palatal defects of comparable sizes at ages ranging from 42 to 74 were evaluated. Starting at postoperative 4 months, speech intelligibility (SI) was assessed without a prosthetic obturator and with an obturator of buccal extensions 15 mm (high), 10 mm (medium) and 5 mm (low), respectively. Assessments were performed at four week intervals for adaptation. The articulation performance of patients with different buccal extension designs were evaluated on speech intelligibility. The data tested using Friedman test. RESULTS: The mean SI score without an obturator was 45.04%+/-5.86%. SI was found to be significantly increased with obturators of any buccal extensions with the mean values 90.50%, %94.24% and 91.20% for high, medium, and low buccal extensions respectively. When the SI score was compared between three buccal extension types medium was found to be significantly higher compared to others (P<.05). CONCLUSIONS: Obturators improve speech intelligibility irrespective of their buccal extension levels. Nevertheless, medium size buccal extension enables the optimum sealing for better articulation.

Influence of immediate and permanent obturators on facial contours: a case series.

INTRODUCTION: Rehabilitation of patients after surgical removal of carcinomas in facial skeleton is one of the most difficult therapies of the stomatognathic system. Significant deformation of tissues, dysfunctions of the stomatognathic system with concurrent biological imbalance of the oral cavity environment frequently affect the treatment to become arduous. Scars and contraction of the oral crevice may cause serious psychological deficiencies that are another aspect of the treatment schedule. CASE PRESENTATION: Three Turkish patients ages 46 (male), 61 (male) and 24 (female) who experienced similar operations were rehabilitated with maxillary obturators. The situations was ideal for patient no 1. Patient no 2 could not receive an immediate obturator and patient no 3 rejected using permanent obturator. The paper describes the advantages of a surgical obturator which is constructed before operation and inserted immediately following partial maxillectomy and expresses long term complications when neglecting the use of definite obturator prosthesis, in the light of three cases. CONCLUSION: The primary objective of oral-maxillofacial and plastic surgeons and prosthodontists when treating tumors is to eliminate disease and to improve the quality of life including the facial contours which influences the psychological condition of patient. Neglecting immediate obturator construction may cause serious facial appearance problems due to soft tissue contracture. When permanent obturator is rejected, serious contracture of soft tissues and facial disharmony is inevitable.

Bedside glue blepharorrhaphy for recalcitrant exposure keratopathy in immobilized patients.

PURPOSE: To report the practical use and the effectiveness of cyanoacrylate glue blepharorrhaphy in immobilized patients with recalcitrant exposure keratopathy. METHODS: Retrospective case series. Temporal two thirds of upper eyelid eyelashes were glued to lower eyelid skin with tissue adhesive n-butyl-2-cyanoacrylate (histoacryl blue) after application of a contact lens. The systemic condition for immobilization; duration of exposure signs in the ocular surface; location, depth, and dimensions of the corneal ulcer; duration of effective blepharorrhaphy; and the time to heal were recorded. RESULTS: Twelve eyes of nine patients were treated. The reasons for immobilization were coma due to malignancy (3 patients), ischemic encephalopathy (2 patients), subarachnoid hemorrhage (2 patients), head trauma (1 patient), coma and hypotony of unknown cause (1 patient). All of the corneal ulcers healed within 4 to 11 days (mean: 5.5 days). Blepharorrhaphy opened spontaneously in 4 to 21 days (mean: 8.6 days). CONCLUSIONS: Bedside glue blepharorrhaphy with tissue adhesive n-butyl-2-cyanoacrylate is a practical, economic, and effective procedure in the treatment of exposure keratopathy in immobilized patients.