ABSTRACT
Background: There is no standard protocol for immediate implant placement and subsequent loading in the smile zone. We aimed to evaluate the long-term outcomes of simultaneous implant placement, soft tissue grafting, and immediate prosthetic loading in the esthetic zone. Methods: Thirty-five implants were placed in the maxillary aesthetic zone. Twenty-two patients were evaluated using the Pink Esthetic Score (PES) and White Esthetic Score (WES). Also, the degree of peri-implant bone resorption and patient survey were applied for the esthetic and functional outcomes. Results: The esthetic and harmonizing outcomes were achieved according to the mean total PES/WES value (17.9±2.0). The mean overall PES was 8.5±1.66. The papilla level had the highest mean score (1.8±0.36). Furthermore, the combination of root convexity/color and soft tissue color and texture was one of the key values in evaluating the effectiveness of this method (the mean value was 1.5±0.5). The mesial and distal papillae were 1.6±0.5 and 1.8±0.4, respectively. None of the 35 implants reached below 6 points (which is considered an esthetically unsatisfactory result). The mean WES score was 9.5±0.57. The average degree of total peri-implant bone resorption was 1.05±0.3 mm after 12 months. According to the questionnaire, all the patients smiled without hesitation and were satisfied with the treatment (100%). Conclusion: This study showed that restoring one or more teeth in the smile zone using the concept of one-stage implant placement, soft tissue flap augmentation, and loading with provisional crowns was an esthetically successful and predictable method.
ABSTRACT
Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.
ABSTRACT
Today, microsurgery is an integral part of plastic surgery, maxillofacial surgery, hand surgery, and neurosurgery. More and more surgical procedures are accompanied by microsurgical intervention. Long training is required to develop the necessary skills for fine work with microsurgical instruments and delicate tissues under magnification. We suggest a methodology as to how to organize an inexpensive microsurgical training laboratory with minimal investment. Suggested guidelines provide information about cost-effective ways of arranging a comfortable training environment. An adapted stereoscopic microscope allows working with a wide range of magnification and focus distance. An ergonomic working position is set up by adjustable handmade table and chair. For performing basic microsurgical manipulations, a set of four instruments and inexpensive suture materials are used. A total amount of 323.5 USD was spent to purchase all of the necessary components for the microsurgical laboratory. The described components are available worldwide regardless of manufacturers. We suggest an inexpensive way to arrange a microsurgical laboratory. This approach is especially beneficial for students and residents from low-income countries.