Rehabilitación protésica implanto-soportada en un paciente con epidermolisis ampollar distrófica recesiva. 4 años de seguimiento clínico / Implant-supported dental prostheses in a patient with recessive dystrophic epidermolisis bullosa. Four-year followup

Se describe la evolución de una paciente con diagnóstico molecular de Epidermolisis Ampollar Distrófica Recesiva, quien a los 35 años de edad inicia una rehabilitación bucal mediante prótesis fija implanto-soportada, luego de haber realizado las exodoncias de las piezas remanentes en boca. Todos los implantes se mantuvieron oseointegrados a lo largo de cuatro años de seguimiento clínico y no se encontró flora periodontopática peri-implantar en los controles microbiológicos realizados. Este tipo de rehabilitación es un caso paradigmático para personas con este tipo de genodermatosis, constituyéndose en una posibilidad válida para una mejor calidad de vida frente a las circunstancias adversas que plantea la enfermedad. (AU)

Oral rehabilitation of a 35-years old female patient with Recessive Dystrophic Epidermolisis Bullosa is described. After removal of all remaining teeth, cemented implantasisted prosthesis with shortened arches were installed over three implants in the mandible and four implants in the upper jaw. At the four- year follow up, all the implants conserved osseointegration as well as absence of peri-implantar periodontopatic biofilm was observed. The success achieved in this case becomes a paradigmatic landmark for the oral rehabilitation of patients with such genodermatoses, providing a new resource to improve their quality of life. (AU)

Rehabilitation of the Work Accident-Related Traumatic Mandible With Iliac Free Flap, Distraction Osteogenesis, and Dental Implants.

Mandibular bone defects due to extensive trauma impair occlusion and affect the aesthetics of facial contouring, making it difficult to obtain a satisfactory outcome. Distraction osteogenesis and free flap is an effective and aesthetic treatment option for rehabilating these defects. In this clinical report, the authors present rehabilitation of a wide mandibular traumatic defect due to a work-related accident with iliac free flap, distraction osteogenesis, and dental implants.

Epidemiología de las fracturas mandibulares tratadas quirúrgicamente en el Instituto Traumatológico de Santiago (Chile): 10 años de revisión / Epidemiology of surgically treated jaw fractures in the Traumatology Institute of Santiago (Chile): a 10-year review

Los traumatismos en Chile son la tercera causa de muerte en la población general y la primera entre jóvenes. Se ha reportado una epidemiología variable alrededor del mundo asociada a diferencias demográficas y socioculturales, con escasos estudios en Latinoamérica. Objetivo. Conocer la epidemiología de las fracturas mandibulares en el Instituto Traumatológico de Santiago, Chile. Material y método. Estudio retrospectivo descriptivo de tipo cuantitativo en el Servicio de Cirugía Maxilofacial del IT, consistente en la recolección de datos mediante revisión de fichas clínicas de pacientes operados por fracturas mandibulares entre enero de 2001 y diciembre de 2010. Los datos fueron recopilados utilizando una base de datos Microsoft Access 2007 y luego tabulados y graficados con Microsoft Excel 2007. Resultados. De un universo de 783 fracturas faciales, 240 fichas de fracturas mandibulares operadas estuvieron disponibles para su análisis. La proporción hombres:mujeres fue de 5,9:1 y el grupo etario más afectado fue aquel entre 20 y 29 años. Las agresiones por terceros fueron su causa más frecuente. La mayoría de los pacientes fueron tratados en un promedio de 8,6 días desde su ingreso. En conclusión, estos resultados en general son concordantes con la literatura, salvo asociaciones entre sitio anatómico afectado y etiología (AU)

The traumatic injuries in Chile are the third cause of death in the general population and the first in young people. Their epidemiology varies around the world, and is linked to demographic and sociocultural differences, with few studies in Latin America. Objective. To determine epidemiological profile of the jaw bone fractures in the Traumatology Institute (IT) of Santiago, Chile. Material and method. Retrospective descriptive and quantitative study was conducted in the Maxillofacial Surgery Department of the IT, developed by recording data from a review of clinical records of patients with surgicaly treated jaw fractures. Data were collected between January-2001 and December-2010 using Microsoft Access 2007© and then tabulated and plotted using Microsoft Excel 2007©. Results. Out of a total of 783 facial fractures, 240 clinical files of surgically treated jaw fractures were available for analysis. The male:female ratio was 5.9:1, and the most afected age group was between 20 and 29 years old. The most frequent cause of the fracture was aggressions. Most patients were treated in an average of 8.6 days from admission. In conclusion, these results are consistent with the literature, except for the associations between the affected anatomical site and etiology (AU)

Prosthetic rehabilitation of a patient with mandibular resection prosthesis using mini dental implants (MDIs)--case report.

Physical disfigurement and functional impairments associated with facial trauma are a challenge to a prosthodontist, because even novel sophisticated surgical reconstructive techniques fail to provide adequate support for dental resection prosthesis. Therefore, different endosseous implants are often used as prosthesis-supporting elements. Manufacturers of dental implants have recently presented mini dental implants (MDIs) with diameter of only 1.8-2.4 mm. These implants allow very suitable prosthetic solutions within the range of their indications due to good osseointegration success rates, simple surgical technique, and immediate loading possibility. In this report, a case was presented for prosthetic rehabilitation including implantation of two Sendax type (IMTEC, Ardmore, Oklahoma, USA) MDIs in mental region, to obtain better retention and stability of the mandibular resection prosthesis and to improve function, phonation and aesthetics. The use of these implants, among aforementioned preferences, is also very cost-effective, so this implantation possibility should be taken into consideration during prosthetic treatment planning.

Free vascularized flaps for reconstruction of the mandible: complications, success, and dental rehabilitation.

PURPOSE: To evaluate complications and success of mandibular reconstruction with free fibula flaps, iliac crest flaps, and forearm flaps with reconstruction plates and to evaluate dental rehabilitation after these reconstructions. PATIENTS AND METHODS: Eighty-three patients with segmental mandibular defects were included. Correlation analyses were used to determine the relationship between reconstruction type and clinical parameters with recipient-site complications and success. The dental rehabilitation was evaluated in successfully reconstructed survivors. RESULTS: Multivariate analyses showed significant correlations between flap type and success (P < .0001). Of the patients, 51 (61%) were alive 2 years after the reconstruction. Mandibular reconstruction with a free forearm flap and reconstruction plate was associated with higher complication rates at the recipient site and higher failure rates compared with reconstruction with free vascularized bone flaps. Of the 32 successfully reconstructed survivors, 14 (44%) had a complete dental rehabilitation, of which 10 had dental implants and 4 did not. Only 6 (29%) of the edentulous survivors ultimately had an implant-supported prosthesis. CONCLUSIONS: Reconstruction of the mandible with a free vascularized bone flap is superior to reconstruction with a free forearm flap with a reconstruction plate. Complete dental rehabilitation was reached in fewer than half of the surviving patients.

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.

Fratura cominutiva grave de mandíbula por arma de fogo: relato de caso / Severe gunshot comminuted mandible fracture: case report

Relata-se o caso de paciente atendido no Pronto-Socorro com fratura exposta cominutiva grave de mandíbula, com perda óssea importante causada por projétil de arma de fogo. Foi submetido àa operação de urgência, sendo necessário o uso de placas de fixação e reconstrução. Apresentou evolução demorada, com período de internação hospitalar de 28 dias. À alta, apresentava deformidade facial e dificuldade na movimentação da mandíbula e articulação de palavras. Devido ao tratamento com cirurgia precoce e ao uso de recursos adequados, o paciente obteve bons resultados estéticos e funcionais no controle ambulatorial.

Mandible fractures are among the most common lesions encountered in the trauma centers. They are usually caused by assault or gunshot and the risk factors include low socioeconomic level, drug abuse and unemployment, being male young adults the most frequent victims. This report is about a patient who was brought to the emergency room with a severe gunshot comminuted mandible fracture. He was submitted to an early surgical repair, in which fixation and reconstruction plates were needed. There was a 28 day in-hospital stay and the patient showed facial deformation and difficulty in word pronunciation at discharge. Due to the aggressive management with early surgical repair and adequate resources the patient presented with good functional and aesthetical results in the follow up.

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 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.

Prosthetic rehabilitation of a bone defect with a teeth-implant supported, removable partial denture.

The use of teeth-implant, mucosa-supported removable dentures for rehabilitation of partially edentulous patients involves highly complex biomechanical aspects. This type of prosthesis associates 3 kinds of support that react differently to the functional and parafunctional forces developed in the oral cavity. Although the construction of removable partial dentures may seem paradoxical when osseointegrated implants are placed, in some cases, this option is an excellent alternative to solve difficulties related to the anatomic, biologic, psychomotor, and financial conditions of the patient. This article reports on a case in which a teeth-implant, mucosa-supported removable partial denture was the option of choice for a patient with financial and anatomic limitations, having a large structural loss of the residual alveolar ridge caused by trauma by a gunshot injury at the mandible. The 5-year follow-up did not reveal any type of biomechanical or functional problem.

Vertical distraction osteogenesis of fibula transplant for mandibular reconstruction: a case report.

Bone continuity defects in the mandible are caused by tumor surgery, trauma, infection, or osteoradionecrosis. Today, reconstruction of long-span mandibular defects with a free fibular flap is a routine procedure. However the bone height of the mandible after reconstruction is about half that of the dentulous mandible. Therefore, the deficiency in bone height makes implant placement impractical. In our case, because it was necessary to restore the mandibular height, a vertical distraction osteogenesis was performed on the grafted mandible of the patient who was referred to our clinic with a reconstructed mandible owing to a gunshot injury. As a result, the vertical discrepancy between the fibula and the native hemimandible of the patient was corrected. And the placement of dental implants was performed without any complications. In conclusion, we believe that the vertical distraction osteogenesis of free vascularized fibula flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation.

Prosthetic rehabilitation of a mandibular gunshot defect with an implant-supported fixed partial denture: a clinical report.

This report describes the clinical evaluation of a patient with a mandibular gunshot defect and the prosthodontic treatment with an implant-supported screw-retained fixed partial denture. Treatment included cemented crowns for 2 maxillary implants and an implant-supported screw-retained fixed partial denture supported by 8 mandibular implants. Despite the implant malposition limitations, the esthetic and functional demands of the patient were fullfilled.

ITI implants and Dolder bars in the treatment of large traumatic defect of mandible: a clinical report.

The development of more sophisticated implant techniques to produce satisfying results improves the precise planning of both the surgical phase of the implantation and the following prosthetic rehabilitation. Ball and bar attachments are the main retainer systems for implant-bearing overdentures to achieve a successful treatment in the partial or full edentulism. In this clinical report, a 23-year-old male patient, presented with a large traumatic defect in the anterior mandible, was treated with ITI implant and ITI Dolder bar combinations. The reason to prefer this kind of treatment depends on the highest retention capacity and cleaning facilities of the system.

Rehabilitation of a patient with severe dentoalveolar injuries: a case report with a 10-year follow-up.

This clinical report describes the emotional and physical rehabilitation of a young man. The impact of the injuries sustained and repeated failure of traditional dental treatment methods had caused the patient to become quite withdrawn. A successful outcome followed surgical placement of multiple titanium plasma-sprayed cylindrical fixtures in severely damaged dental supporting tissues to serve as intermediary abutments for complex maxillary and mandibular fixed prostheses. The loss of crestal bone during the postprosthetic years is determined. The advantages only implant dentistry could bring are identified.

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.

[Low-frequency pulsed magnetotherapy combined with electrostimulation of biologically active points in the combined treatment of traumatic mandibular osteomyelitis]. / Nizkochastotnaia impul'snaia magnitoterapiia v sochetanii s élektrostimuliatsiei biologicheski aktivnykh tochek v kompleksnom lechenii travmaticheskogo osteomielita nizhnei cheliusti.

The results of treatment are analyzed in 51 patients (35 with exacerbation of chronic traumatic mandibular osteomyelitis and 16 with chronic traumatic mandibular osteomyelitis). Low-intensity pulsed magnetic therapy of the focus in combination with electric stimulation of segmentary bioactive points, synchronized by the patient's pulse, are proposed to be added to the therapeutic complex. Such a modality improved the regional hemodynamics, promoted liquidation of the postoperative edema on days 1-2 after intervention, and sooner than after traditional therapy repaired the energy of the patient's organism.

[The combined treatment of children with congenital and acquired mandibular defects and deformities]. / Kompleksnoe lechenie detei s vrozhdennymi i priobretennymi defektami i deformatsiiami nizhnei cheliusti.

A total of 280 children and adolescents with congenital and acquired mandibular defects and deformations were treated. The main principle in the treatment of such children is to begin treatment as early as possible. Stages of rehabilitation and scope of therapeutic measures for each stage are determined. The best results were attained in patients administered multiple-modality treatment by surgical, orthodontic, physiotherapeutic methods and therapeutic exercises at an early age immediately after the defect was diagnosed.