Rehabilitation of a Severely Resorbed Posterior Mandible with 4-mm Extra-Short Implants and Guided Bone Regeneration: Case Report with 3-year Follow-up.

Alveolar bone resorption has been a major challenge for implant placement in regions limited by anatomical structures. New alternatives have been introduced with the inclusion of extra-short implants in dentistry. The association of guided bone regeneration (GBR) with the use of extra-short implants might be a viable alternative for regions with limited bone height. This case report aimed to present the rehabilitation of a patient with severe mandibular bone resorption in the posterior region. The association of GBR with the use of extra-short implants was a viable alternative after a 3-year follow-up.

The outcome of coronoidectomy in bilateral coronoid process hyperplasia.

OBJECTIVE: Coronoid process hyperplasia (CPH) of the mandible is a rare condition that can be defined as an abnormal bony elongation of histologically normal bone with the symptoms of progressive, painless difficulty in opening the mouth. The purpose of this study is to evaluate the outcomes of five patients with CPH treated by coronoidectomy, relative to post surgery jaw function. METHODS: Five patients with CPH were included in this study. The diagnosis of CPH was confirmed by radiographic and clinical examination of the mandible. All five patients underwent bilateral intraoral coronoidectomy under general anesthesia. The mean maximum interincisal mouth opening for the patients was determined by measurements taken pre-surgery, intraoperative, and at longest follow-up. All five patients underwent postsurgical physical therapy directed towards jaw function. RESULTS: All the patients with limited mouth openings presented with a preoperative maximum interincisal mouth opening of 12.4 mm (range 9-20.3 mm), which was increased to 37 mm (range 22-52 mm) in the operating room after bilateral intraoral coronoidectomy and 42 mm (range 32-52 mm) during the late follow-up. CONCLUSIONS: Patients with limited jaw function related to bilateral CPH can benefit by undergoing bilateral coronoidectomies and physiotherapy.

Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report.

Although pharmacologic treatments for central giant cell lesions have gained much emphasis, these treatment modalities do not always have successful outcomes, and surgical treatment may be necessary. The purpose of the present study was to report a case of aggressive central giant cell lesion initially treated by nonsurgical methods without satisfactory results, necessitating segmental mandibular resection for definitive treatment and oral rehabilitation. A 20-year-old woman was diagnosed with an aggressive central giant cell lesion in the mandible. The patient was first treated with intralesional corticosteroid injections. Subsequently, the lesion increased in size. Therefore, a second pharmacologic treatment was proposed with salmon calcitonin nasal spray, but no signs of a treatment response were noted. Because of the lack of response, surgical excision was performed, and a mandibular reconstruction plate was installed. At 12 months after surgical resection, the patient underwent mandibular reconstruction with bone grafts. After 6 months, 7 dental implants were installed, and fixed prostheses were made. After installation of the prostheses, the patient experienced persistent mandibular laterognathism, and a mandibular orthognathic surgery was performed to correct the laterognathia. The follow-up examination 4 years after orthognathic surgery showed no signs of recurrence and good facial symmetry.

Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system.

Osteoradionecrosis of the jaw is a common radiation-induced complication that may be observed in oral cancer patients. Several classifications and staging systems have been proposed for osteoradionecrosis of the mandible based on clinical symptoms, radiological findings, and/or the response to diverse treatments. However, none has been universally accepted because of their individual deficiencies. The aim of this study was to introduce a new clinical classification that can be applied to the treatment of osteoradionecrosis in an easier and more acceptable way, through a retrospective analysis of patients with osteoradionecrosis of the mandible. A review was conducted of 99 patients diagnosed with osteoradionecrosis of the mandible in the study institution between 2000 and 2013. A novel classification was established on the basis of bone necrosis and soft tissue defects. A new staging system with four different stages (stage 0, stage I, stage II, and stage III) is proposed. We believe that this new classification and staging system is easier and more acceptable for clinical evaluation than previous ones.

Surgical and prosthetic management of a complex edentulous patient for fabrication of complete dentures.

Fabrication of well-fitting complete dentures becomes a challenge in the presence of epulis fissuratum in the maxilla or severely resorbed alveolar tissue in the mandible. This clinical report describes the surgical and prosthetic treatment of a patient who presented with both problems. The neutral zone technique was used to improve the stability of the mandibular complete denture. Both dentures were fabricated prior to surgical excision of the epulis fissuratum and inserted immediately following the surgery.

Reconstruction and rehabilitation of severe mandibular atrophy using distraction osteogenesis technique: a case report.

PURPOSE: The purpose of this article is to describe a rehabilitation technique for patients with severe anterior atrophy using a combination of distraction osteogenesis and implants to support fixed or removable prostheses. MATERIALS AND METHODS: The surgical technique involves the use of an extraosseous distraction device followed by more than 14 mm of distraction of the mandibular symphysis. RESULTS: The patient was successfully treated by the application of 4 implants in the region of the mandibular symphysis, stabilized by an Ackerman bar, and a removable prosthesis. CONCLUSION: Osseous distraction techniques, when possible, are preferable to block bone grafting techniques because they present considerable advantages for patients and surgeons. The combination of distraction and implant placement can rehabilitate patients with severe defects.

Functional outcomes with dental prosthesis following simultaneous mandibulectomy and mandibular bone reconstruction.

PURPOSE: This study sought to ascertain masticatory outcomes in patients who underwent mandibulectomy or hemimandibulectomy together with mandibular bone reconstruction to allow for placement of a removable dental prosthesis. METHODS: Perioperative changes in masticatory performance, masticatory ability for solids, and patients' subjective satisfaction were evaluated for 101 patients who had mandibulectomy immediately followed by bone reconstruction. Differences in masticatory performance and masticatory ability for solids after surgery were determined according to occlusal support after surgery and whether the patient was wearing a removable dental prosthesis or not. Occlusal support areas were classified according to Eichner's classification. RESULTS: Preoperative Eichner's class A patients had no experience of wearing a dental prosthesis before surgery and after surgery did not want one. Their masticatory performance was better than that of patients who wanted a dental prosthesis after surgery. Retrospective analysis of postoperative Class B and C patients revealed that masticatory performance was lower in those who wanted a dental prosthesis than in those who did not want one. When patients wore a dental prosthesis after surgery, masticatory performance was markedly improved over not wearing it. All patients' subjective satisfaction was significantly improved after surgery. CONCLUSIONS: Increasing the number of occlusal support areas by wearing a removable dental prosthesis after simultaneous mandibulectomy or hemimandibulectomy and mandibular bone reconstruction may improve masticatory functions. Those professional involved in the rehabilitation for the mandibular defect should be mindful that masticatory functions after such surgeries were affected by the masticatory functions before surgery and the number of occlusal support areas after surgery.

Implant treatment in atrophic posterior mandibles: vertical regeneration with block bone grafts versus implants with 5.5-mm intrabony length.

PURPOSE: To retrospectively compare the outcomes of implants placed in posterior mandibles vertically regenerated with onlay autogenous block bone grafts and short dental implants. MATERIALS AND METHODS: Consecutive patients with vertical bone atrophy in edentulous mandibular posterior regions (7 to 8 mm of bone above the inferior alveolar nerve) were treated with either implants placed in regenerated bone using autologous block bone grafts (group 1) or short implants (with 5.5-mm intrabony length) in native bone (group 2) between 2005 and 2010 and followed for 12 months after loading. The procedure used was the established treatment protocol for this type of patient at the Oral Surgery Unit (University of Valencia, Spain) at the time of surgery. All grafts were obtained using piezosurgery. The outcomes assessed were: complications related to the procedure, implant survival, implant success, and peri-implant marginal bone loss. Statistical analysis was done using the Fisher exact test and the Mann-Whitney test. RESULTS: Thirty-seven patients were included, 20 (45 implants) in group 1 and 17 (35 implants) in group 2. In group 1, 13 implants were less than 10 mm long (2 were 7 mm and 11 were 8.5 mm), and 32 were 10 mm or longer; the diameter was 3.6 mm in 6 implants, 4.2 mm in 31, and 5.5 mm in 8. In group 2 all implants were 7 mm long; the diameter measured 4.2 mm in 14 implants and 5.5 mm in 21 implants. Complications related to the block bone grafting procedure were temporary hypoesthesia in one patient, wound dehiscence with graft exposure in three patients, and exposure of the osteosynthesis screw without bone graft exposure in one patient. After 12 months, implant survival rates were 95.6% in group 1 and 97.1 % in group 2; success rates were 91.1% and 97.1%, respectively. The average marginal bone loss was 0.7 ± 1.1 mm in group 1 and 0.6 ± 0.3 mm in group 2. CONCLUSIONS: When residual bone height over the mandibular canal is between 7 and 8 mm, short implants (with 5.5-mm intrabony length) might be a preferable treatment option over vertical augmentation, reducing chair time, expense, and morbidity.

Implant reconstruction of a large mandibular defect following removal of a nonossifying fibroma.

The fixed implant-supported restoration of this mandibular surgical defect deliberately violated the principles of mandibular flexure, crown-to-implant ratio, and off-axis loading. A custom-made implant-mounted jig revealed no mandibular flexure in this patient, but crown-to-root ratios of up to 39:12 were unavoidable. The restoration has needed no maintenance for 14 years. This apparent success calls into question the blind application of prevailing clinical principles.

Rehabilitation of a maxillary defect secondary to recurrent giant cell granuloma.

This is a presentation of the treatment history of a young woman with a benign lesion resulting in a large maxillary defect. This patient's complex treatment resulted in a full spectrum of rehabilitation modalities. Her story shows alternative treatment options with the ultimate goal of restoring form, function, and quality of life to a patient with an extensive maxillary defect.

The use of root form implants in overdenture treatment for the atrophic mandible: a clinical report.

Four short root form implants were inserted in an atrophic mandible and the case restored with a lower connecting bar and an overdenture, opposing a complete maxillary denture. Root form implants were selected, as opposed to a subperiosteal implant in this case. The patient had a favorable medical history, appeared healthy, did not smoke, drink, or do illicit drugs, and had good bone quality.

Prosthodontic rehabilitation of dental implants with exposed threads: a clinical report.

An unconventional technique was used to address the challenge of exposed dental implant threads. Titanium dental implants were prepared with rotary instruments to eliminate the exposed threads and to receive a fixed cementable prosthesis. The technique required fabrication of a gold casting of 2 copings connected by a round bar to fit the prepared implants and an implant-retained overdenture. This technique may be applied to other situations when multiple implants present with thread exposure and bone resorption. These include single crowns, partial fixed dental prostheses, and attachments for overdentures.

[The value of 3-dimensional model in the reconstruction of mandibular segment defect. Observations in a clinical case]. / Valoarea modelului tridimensional in reconstructia pierderilor de substanta segmentare ale mandibulei. Observatii pe marginea unui caz clinic.

The use of autogenous bone graft in the reconstruction of mandibular defects following tumor extirpation is a reliable method for further functional rehabilitation. The exact amount of bone needed for harvesting is usually achieved by estimation of the gap and direct measuring. We present the case of a 51-years old patient referred to our clinic for a recurrent mandibular keratocyst. Besides clinical examination, the diagnosis work-up consisted of ortopantomography and computertomography (CT). Based on CT images, a graphic reconstruction of the mandible was realized and a 3D negative template of the scheduled mandibular defect was printed. The tumor was removed by a segmental resection of the mandible, while a fragment of bone tissue similar to the 3D model was harvested from the iliac crest. This bone fragment replaced the mandible defect and was fixed by means of four plates and titanium screws. No postoperative complications occurred. The pathology result confirmed the diagnosis of keratocyst. In conclusion, this method proved to be useful for precise planning of the shape and size of the graft in addition to exact placement of the graft in an acceptable prosthodontically position for future dental implant rehabilitation.

Avoiding osseous grafting in the atrophic posterior mandible for implant-supported fixed partial dentures: a report of 2 cases.

Bone atrophy occurs after tooth extraction in the posterior mandible, placing the mandibular canal and its neural, arterial, and venous contents closer to the osseous facial aspect and the coronal crest. This proximity places the structure in danger of damage when dental implants are surgically placed to support fixed or removable prostheses. Several options are available to treat these areas for implant-supported fixed and removable complete or partial dentures. Osseous grafting and ridge expansion are surgical options that enable acceptance of standard sized dental implants but have serious morbidities. Additionally, vertical osseous augmentation is not predictable at this time. Narrow diameter dental implants can be placed to avoid the mandibular canal, but some bone volume situations preclude this. Very wide and very short (6.5 × 5 mm) dental implants may be placed at an angle in atrophic sites to successfully support fixed partial dentures. An anterior guidance occlusal scheme may be used in maxillary dentate patients or group function in maxillary complete denture patients. A 100 micron occlusal relief in fixed partial dentures in dentate patients may be required to account for natural tooth intrusion and to prevent occlusal overload of the implant-supported partial denture.

[Does the combination syndrome exist? A case report]. / Existiert das Kombinationssyndrom? Ein Fallbericht.

This case report documents the prosthetic rehabilitation of a patient showing the typical features of combination syndrome. This case documentation gives a general overview of the suspected development and the prevalence of this "syndrome". A treatment option should be shown by the example of a patient from the starting situation until the prosthetic therapy by means of a complete maxillary denture and an implant-supported mandibular overdenture rigidly retained with a milled bar.

Accurate reconstruction of discontinuous mandible using a reverse engineering/computer-aided design/rapid prototyping technique: a preliminary clinical study.

PURPOSE: To improve the reconstructive surgical outcome of a discontinuous mandibular defect, we used reverse engineering (RE), computer-aided design (CAD), and rapid prototyping (RP) technique to fabricate customized mandibular trays to precisely restore the mandibular defects. Autogenous bone grafting was also used to restore the bony continuity for occlusion rehabilitation. PATIENTS AND METHODS: Six patients who had undergone block resection of the mandible underwent reconstruction using a custom titanium tray combining autogenous iliac grafts. The custom titanium tray was made using a RE/CAD/RP technique. A virtual 3-dimensional model was obtained by spiral computed tomography scanning. The opposite side of the mandible was mirrored to cover the defect area to restore excellent facial symmetry. A bone grafting tray was designed from the mirrored image and manufactured using RP processing and casting. The mandibular defects were restored using the trays in combination of autologous iliac grafting. An implant denture was made for 1 of the 6 patients at 24 weeks postoperatively for occlusion rehabilitation. RESULTS: The trays fabricated using this technique fit well in all 6 patients. The reconstructive procedures were easy and time saving. Satisfactory facial symmetry was restored. No severe complications occurred in the 5 patients without occlusion rehabilitation during a mean 50-month follow-up period. The reconstruction in the patient with occlusion lasted for only 1 year and failed eventually because of bone resorption and infection. CONCLUSIONS: Mandibular reconstruction was facilitated using the RE/CAD/RP technique. Satisfactory esthetic results were achieved. However, the rigidity of the cast tray could cause severe stress shielding to the grafts, which could lead to disuse atrophy. Therefore, some modification is needed for functional reconstruction.

Prosthodontic treatment of a patient with bisphosphonate-induced osteonecrosis of the jaw using a removable dental prosthesis with a heat-polymerized resilient liner: a clinical report.

Bisphosphonate-induced osteonecrosis of the jaws (BONJ) is reported frequently in patients receiving oral or intravenous bisphosphonates. To minimize potential complications, dental treatment must be performed with care. There are invasive and noninvasive treatment options for patients with active BONJ or a history of this complication. This clinical report describes the prosthodontic treatment of a patient who developed BONJ after receiving intravenous bisphosphonates (pamidronate). Because of the recurrent incidence of BONJ, noninvasive prosthetic therapy with telescopic overdentures and a heat-polymerized resilient liner was provided. After 2 years, there were no biological or technical complications.

The tent pole splint: a bone-supported stereolithographic surgical splint for the soft tissue matrix expansion graft procedure.

This report details the use of computer-aided planning and intraoperative stereolithographic direct-bone-contact surgical splints for the accurate extraoral placement of dental implants in the soft tissue matrix expansion (tent pole) graft of the severely resorbed mandible.