Removable Partial Denture After Gunshot Injury: Five Year Follow-Up.

The aim of this study was to report a patient of rehabilitation with removable partial denture retained by implants in-patient who suffered injury after firearm shooting. A 19-year-old man presented to the hospital of the Val Paraíso city after being hit by a bullet in the right on the face, affecting the teeth 12 to 16. The surgery to remove the shards of teeth, and bullet was performed. Surgical team opted for installation of implants without bone grafts; however, due to extensive loss of alveolar bone, only 3 tilted implants (2 Ø3.75 × 8.5 mm and 1 Ø3.75 × 10 mm) were installed. After recovery, the patient was referred to the Araçatuba Dental School-UNESP for the rehabilitation on the affected region. The difficulty of rehabilitation with conventional fixed prostheses was verified during the prosthetic phase. This way, it was opted for rehabilitation with removable partial dentures associated with dental implant. Two attachment system ERA (ERA, Sterngold) were positioned in the bar to make the removable partial denture. After 5 years of follow-up, the authors can conclude that the use of removable partial denture retained by implants is effective for functional and aesthetic rehabilitation, favoring socialization and self-esteem of the patient.

Rehabilitation of a patient with gunshot injury through the iliac graft and implant-retained restorations with a 3-year follow-up: a brief clinical study.

Trauma is one of the most common causes of teeth loss. Assault with a gunshot and bullet shot is life threatening, and for patients who survive the injury, it results in hard and soft tissue loss in the tissues and organs crossed by the bullet. The tissue loss results in the loss of structure and function. Rehabilitation of these patients to function and aesthetics requires surgical and prosthodontic procedures over time. This report is of a 24-year-old male patient who had a bullet injury resulting in hard and soft tissue deficiency. The ridge deficiency was augmented with iliac bone graft, and 3 months later, implants were placed. Five months later, hybrid prosthesis was delivered. At 3-year follow-up visit, the hybrid prosthesis was replaced with porcelain fused to a metal bridge. The bone levels on all the implants were stable.

Prosthodontic rehabilitation of a shotgun injury: a patient report.

This report describes the prosthodontic rehabilitation of a shotgun patient traumatized in the maxillary, mandibular, and nasal areas resulting in severe problems in her esthetics, phonetics, and mastication. The patient was treated with removable partial prostheses using tooth, soft tissue, and implant support.

Surgical and prosthodontic treatment of a patient with significant trauma to the middle and lower face secondary to a gunshot wound: a clinical report.

Large defects of dentofacial structures may result from trauma, disease (including neoplasms), and congenital anomalies. The location and size of the defects are related to difficulties that patients report relative to speech, mastication, swallowing, facial esthetics, and self-image. This article reports on the evaluation and treatment of a patient who suffered significant trauma to the lower and mid-face secondary to a gunshot injury. It describes the initial presentation, life-saving procedures, and subsequent bone grafts, implant placement, and prosthetic treatments required to rehabilitate the patient to a condition that closely approximated his preoperative condition. This clinical report confirms that no matter the degree of complexity involved in treating the results of significant facial trauma, successful treatment is dependent on thorough physical and radiographic examinations, development of the appropriate diagnoses, and treatment based on sound prosthodontic and surgical principles.

[The prosthetic rehabilitation of a patient after gunshot wound and initial maxillofacial surgical reconstruction. A case report]. / Die defektprothetische Versorgung eines Patienten mit Status nach einer Schussverletzung und chirurgischer Rekonstruktion. Ein Fallbericht.

An improvement of prognosis after tumour therapy as well as a rather high number of multiple traumas in the craniofacial area imply a high treatment need for craniofacial tissue defects. For a successful rehabilitation of these individuals, reconstructive oral and maxillofacial surgery and prosthodontics must collaborate closely and synergistically. Besides medical and psychological findings, functional and esthetical aspects need to be taken into account. In this case report the prosthetic reconstruction of a patient with a tooth-supported telescopic defect prosthesis in the maxilla and with a multiple-unit implant-supported fixed prosthesis plus two full ceramic crowns in the mandible is shown. The prosthetic solution was indicated after maxillofacial reconstruction due to the consequence of a suicide attempt.

Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defects.

OBJECTIVE: To review our results using free-tissue transfer to reconstruct midfacial and cranio-orbito-facial defects. DESIGN: Case series. SETTING: The University of Iowa Hospitals and Clinics, Iowa City. PATIENTS: Fourteen of 21 patients had defects that resulted from ablative oncologic surgery; six had severe mid-facial trauma; and one had Romberg's disease. INTERVENTIONS: Four latissimus dorsi, 11 rectus abdominis, three scapula, and four forearm free-tissue transfer flaps were used. MAIN OUTCOME MEASURES: Adequate flap separation of vital structures (intracranial contents and carotid artery) from the sinonasal or oropharyngeal cavities; restoration of palatal competence, oral diet, and speech intelligibility; maxillary dental rehabilitation; aesthetic results; complications; and the patient's return to social activities outside the home after surgery. RESULTS: The intracranial contents (six cases) or carotid artery (four cases) were protected from sinonasal or oropharyngeal contamination by the reconstructive flap in all cases in which this was required. Functional closure of the palate with the flap or a prosthesis was possible in 12 of the 13 patients with a palatal defect; seven of these 13 patients have had full maxillary dental rehabilitation. Twenty patients take an oral diet. Sixteen patients have normal or easily understood speech. Fourteen patients engage in social activities outside the home, and eight have returned to full-time employment. No vascular flap failures occurred in this series. CONCLUSIONS: The use of free-tissue transfer flaps is a safe and effective technique for repairing large midfacial and cranio-orbito-facial defects resulting from ablative oncologic surgery or trauma.

Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: case report.

The authors report a case of vertical distraction osteogenesis of a free revascularized fibula flap used to reconstruct an hemimandible lost as a result of a gunshot injury. The reconstruction procedure and the distraction protocol are described; clinical and radiological results are presented. The vertical discrepancy between the fibula and the native right hemimandible was corrected.

Reconstruction and rehabilitation of short-range, high-velocity gunshot injury to the lower face: a case report.

War injuries can range from the most minor to the devastating and life-threatening. Multidisciplinary care is required for successful management of survivors. In the acute phase, care may involve emergency surgeons, anaesthetists, neurosurgeons, ophthalmic surgeons, vascular surgeons and ENT specialists in addition to the oral and maxillofacial surgeon. Afterwards, definitive treatment of facial hard and soft tissue gunshot injuries depends ultimately on the abilities and skills of the oral and maxillofacial surgeon and his appreciation of such injuries. The timing and sequence of the surgical procedures used for reconstruction and rehabilitation of maxillofacial gunshot injuries are crucial to a successful outcome and aesthetic result. If incorrect, they may lead indefinitely to infection, graft rejection, wound dehiscence with consequent multiple revisional operations and complications which will prolong hospital stay, and increase treatment costs and morbidity in these patients. In this article, we describe the treatment protocol for reconstruction and rehabilitation of a typical case of devastating gunshot injury to the lower face and propose a staged sequence of surgical treatment based on an 8-year experience gained in treating war casualties during the Iraq-Iran war (1980-1988).

Functional oromandibular reconstruction with the microvascular composite groin flap.

Ten patients were reconstructed with the microvascular osteocutaneous groin flap for oromandibular defects with the objective of improving function. The flap was based on the superficial and deep circumflex iliac vessels for optimal positioning of the bone and contouring of the skin. Patients with major glossectomies and arch resections had intelligible speech and were able to eat a soft diet without aspirating. Cineradiographic studies to evaluate swallowing in selected patients showed that the shape of the intraoral flap and the location of the bone graft played an important role in swallowing and prevention of aspiration.

Prosthetic rehabilitation of a warfare facial trauma.

This case report presents the prosthetic treatment of a warfare facial trauma patient with the aim of providing satisfactory function, esthetics, and alleviation of deformities. Veneer crowns with rests, root coping, and metal-base partial prostheses were used for the patient therapy and treatment.

Mandibular reconstruction with full thickness calvarial bone and temporal muscle flap.

Eleven patients underwent mandibular reconstruction with pedicled temporal muscle flaps combined with vascularised or free full thickness calvarial bone grafts. Six were primary and five secondary reconstructions. The indications were squamous cell carcinoma (n = 6), radio-osteonecrosis (n = 4), and gunshot wound (n = 1). Five patients also had endosseus implants, either simultaneously or delayed. The only major complications were necrosis of the whole calvarial bone (n = 1) and permanent facial nerve palsy (n = 1). The advantages of using full thickness calvarial bone are that it is thick enough to take an endosseous implant, morbidity is low, there is virtually no postoperative pain, the scar is invisible, and there is only one donor area for both hard and soft tissue. Transplantation of full thickness calvarial bone and temporal muscle is a viable alternative to an osseomyocutaneous microvascularised free flap for reconstruction of the mandible when the neck has been previously operated on or irradiated, and anastomosis may be critical.

[Implant-prosthetic rehabilitation in posttraumatic maxillomandibular tissue losses]. / Riabilitazione implanto-protesica nelle perdite di sostanza maxillo-mandibolari post-traumatiche.

Trauma in the maxillary-facial region can causes loss of mucous, dental and bone tissues, particularly in cases of ballistic trauma in which the explosive force disperses the affected tissues to some distance. This circumstance greatly complicates functional rehabilitation, a process requiring not only the construction of prostheses to replace the lost dental structures, but also the reconstruction of the mucous and bone tissues that will support the prostheses. Using methods involving the formation of pedicle bone grafts and the use of implantation techniques, it has been possible to guarantee a satisfactory functional rehabilitation, and in addition good results from the point of view of appearance have been obtained.

The use of mucosal inserts.

Mucosal inserts increase the retention of any well-made denture but should not be attempted as a substitute for good prosthetic technique. They are especially useful with the trauma or cancer patient where functional anatomy has been altered. Final results of the patient's removable prosthesis will depend on mechanical, anatomical and psychological factors. The mucosal insert denture can satisfy the expectations of many of these patients, if the patients are informed and managed properly.

[Up-to-date reconstruction of gunshot wounds of the face]. / Az arc lött sérülésének korszerü helyreállítása.

The extensive damage after gunshot injuries needs excellent primary closure, secondary reconstruction and functional rehabilitation. The huge bone defect can best be reconstructed with vascularized iliac bone graft. An additional advantage of vital bone transplant is the possibility of its support with endosseal implants, which leads to a very good chance for longtime restauration of the masticatory function with a low rate of complications.

Zygomatic implants as a rehabilitation approach for a severely deficient maxilla.

A gunshot injury is one of the main trauma injuries that affect the head and neck region. Severe esthetic, functional, and psychologic deficiencies are consequences of gunshot injuries. The use of implants anchored in the zygomatic bone has been advocated as an approach to the prosthetic rehabilitation of a severely deficient maxilla. This approach provides the patient with an immediate, high-quality, esthetic, and functional complete fixed prosthesis and eliminates the need for bone grafting. In this case report, a patient with a severely deficient maxilla caused by a gunshot injury was rehabilitated by placement of four zygomatic and two pterygomaxillary implants, which were immediately loaded with a complete fixed all-acrylic resin interim prosthesis. The definitive CM Prosthesis (CM Prosthetics) was constructed using computer-aided design/computer-assisted manufacture (CAD/CAM) technology.

Maxillary reconstruction using microvascular free flaps.

OBJECTIVE: Loss of all or part of the maxilla as a result of tumor ablation has both functional and aesthetic consequences. Reconstruction of the maxilla remains a challenge despite the availability of several flaps and the skills of the prosthodontist. We have analyzed a series of maxillary resections that underwent flap reconstruction to guide planning of the rehabilitation of patients with such defects. STUDY DESIGN: The authors present 83 patients with various types of maxillary defects that were reconstructed with different microvascular free flaps. All clinical data, including data on the functional and aesthetic outcome, are analyzed. RESULTS: Flap transfer was successful in 80 of 83 patients who underwent maxillary reconstruction. Separation of the oral and nasal cavities was achieved in all cases. Flap compromise occurred in 6 cases, which made revision necessary. Three of these flaps were salvaged and 3 flaps failed. In 10 of 28 patients with transferred bone, osseointegrated implants were inserted and dentally rehabilitated with excellent functional and aesthetic results. CONCLUSION: Various types of maxillary defects can be reconstructed successfully using different microvascular free flaps. This procedure is challenging because of the anatomical site of reconstruction creating a steep learning curve. If the reconstruction is successful, both facial appearance and oral function can be improved. Microvascular flaps containing bone of the fibula, scapula, or iliac crest facilitate complete dental rehabilitation.

The prosthodontic restoration of a self-inflicted gunshot maxillofacial defect: a short-term follow-up case report.

A self-inflicted gunshot maxillofacial defect was restored with dental implants and various attachments. Following mandibular surgical reconstruction, a fixed full-arch implant-supported prosthesis was fabricated. The maxillary defect was restored with an obturator retained with bar-clip and ball attachments. Crowns with an unfavorable crown-to-root ratio were used to rectify a compromised unilateral interocclusal space. Functional rehabilitation was achieved without any pathologic sequelae and maintained over a 1-year observation period. Provision of a fixed implant-retained mandibular prosthesis opposing a specific design for a maxillary obturator provided short-term and optimistic prognosis in the management of a serious traumatic injury.