Optimizing Facial Esthetic Outcomes: Adding Distraction Osteogenesis to Your Classic Orthognathic Surgery Armamentarium.

Classical orthognathic procedures have long been known to improve the facial esthetic contours and proportions of face by restoring the skeletal foundation, on which the soft-tissue drapes. Distraction osteogenesis was introduced to solve complex skeletal abnormalities in patients with craniofacial conditions that could not be solved by classical orthognathic surgery techniques. The gradual expansion in this group of patients showed not only greater skeletal stability, but the expansion at various tissue planes improved the facial appearance. In this report we review our experience in 22 cases with dentofacial skeletal abnormities for whom we believe achieved aesthetic outcomes could not habe been with classical orthognathic techniques alone. In addition, distraction at the interdental regions allowed for "tailoring" of the osteotomies and for simultaneous expansion at the occlusal level.

Prefabricated Composite Tissues for the Reconstruction of Complex Maxillary Defects: Functional and Aesthetic Principles.

The anatomical structures of the maxilla include the mucosa lining attached to the bone in a pneumatized "light weight construction" to support facial tissues and to provide physiological oral and nasal function. Therefore, the anatomically correct restoration of the maxilla in the case of "full thickness defects" still represents a barely resolved surgical challenge from a functional and aesthetic point of view. Since exactly similar tissues are hardly available for reconstructive purposes, reconstruction with various flaps remains highly accepted.As there is no clear evidence, that any reconstructive option is superior to another, the surgeon's preference remains the main factor determining the treatment of choice for maxillary defects.In order to provide for an anatomically correct reconstruction the concept of prefabrication of bone grafts accompanying soft tissues flaps could have a valuable option. This concept has been presented in the past but still has not gained wide acceptance. In this review paper, the authors will discuss the philosophy of our rational and approach, present details of the reconstruction to achieve improved functional and aesthetic results for full thickness maxillary defects based in almost 30 years of experience.

Osteoplastic reconstruction of severely resorbed maxilla by stack plasty: combining sinus augmentation with lateral and vertical onlay bone grafting.

Progressive loss of the alveolus with aging leads to defects in the buccolingual and vertical dimensions. Maxillomandibular spatial discrepancies and deficits in sagittal facial projection develop at the same time as deficiencies of the periodontal unit, alveolar bone, and attached gingiva increase, depending on the extent of the atrophy. To restore the anatomy, a sinus lift should be combined with lateral and vertical bony augmentation in an osteoplastic procedure. To achieve this, "block over block" replacement with bone from the iliac crest allows precise functional and aesthetic restoration of the alveolus and the nasomaxillary region by combining inlay, interpositional, and onlay grafting. To our knowledge, preprosthetic osteoplastic reconstruction with stacked bone grafts has not previously been documented with a large number of patients. We report the results of this procedure in 62 patients with severe maxillary atrophy.

Reconstruction of the maxilla with prefabricated scapular flaps in noma patients.

BACKGROUND: Noma (cancrum oris) is a devastating gangrenous disease that leads to severe tissue destruction in the face and is associated with a high rate of mortality. When untreated, it results in disfiguring midface defects and severe scarring. Ideal reconstruction of complex maxillofacial defects requires the restitution of bone, dental implants, soft tissue, and the thin and durable lining of the oral and paranasal cavities. Prefabricated composite grafts from the scapula are used to restore the maxilla in patients with this disease. METHODS: A new concept of osteosynthesis involving titanium plates connected to dental implants, achieving greater mechanical stability of the reconstructed bony framework, is described. Nine complex midface defects were reconstructed with dermis-prelaminated scapular flaps. A bone flap from the lateral margin of the scapula was taken and osseointegrated implants were inserted. The bone flap was then prelaminated with dermis and covered with a Gore-Tex sheath to prevent adhesion. Two to 3 months later, the composite flap was transferred to the midface. RESULTS: Restoration of a maxilla with pneumatized paranasal cavities and a keratinized attached epithelium covering the alveolus and hard palate was successfully performed in all noma patients. The reconstructed "masticatory gingiva" and osseointegrated dental implants enabled patients to exercise oral functions shortly after surgery. CONCLUSION: Long-term observation of selected noma patients showed restoration of oral function and stability of the maxilla after several years.

The iliac prefabricated composite graft for dentoalveolar reconstruction: a clinical procedure.

Prefabricated composite grafts were introduced in reconstructive oral and maxillofacial surgery in the mid-1990s. The purpose of this report is to introduce a novel technique-the iliac prefabricated composite graft-for reconstruction of the alveolar ridge simultaneously with masticatory attached gingiva and integrated implants in a single procedure. Clinical and immunohistologic results are reported and reveal this technique to be an attractive alternative in dentoalveolar surgery and implant dentistry.