Alloplastic reconstruction of the mandible after subtotal mandibulectomy for medication-related osteonecrosis of the jaw: An update of the method.

BACKGROUND: Reconstruction of continuity defects following osteonecrosis in multimorbid patients is challenging. In all cases of the predescribed palliative treatment method for alloplastic mandible reconstruction, plate fractures were detected in follow-up. We hypothesized that a modification could avoid these fractures, leading to stable long-term results. METHODS: This retrospective study compares the original method with a modification using single, laser-sintered CAD-CAM plates instead of manually bent miniplates. The predescribed shuttering technique was used to reconstruct the mandible in its original shape with bone cement. RESULTS: Uneventful wound healing was observed in 86% of the cases after modification of the method. No implant or plate fracture occurred. CONCLUSIONS: The presented method should be considered as a treatment option for mandible reconstruction in elderly, multimorbid patients in palliative situations. The results of this study suggest that the modification of the method leads to significantly improved long-term stability. Donor site morbidity is avoided with this method of palliative surgery.

A retrospective study of the clinical performance of porcelain-fused-to-metal resin-bonded fixed partial dentures.

PURPOSE: This study investigated the clinical performance of resin-bonded fixed partial dentures (RBFPDs) using minimally invasive, nonretentive abutment tooth preparation. MATERIALS AND METHODS: Forty-four patients received 56 porcelain-fused-to-metal RBFPDs (52 three-unit RBFPDs, 4 four-unit RBFPDs). All RBFPDs were inserted between 1995 and 2010 according to a standardized protocol. Thirty-eight RBFPDs replaced anterior teeth in the maxilla, 18 RBFPDs replaced anterior teeth in the mandible, and 3 RBFPDs replaced premolars (1 maxillary, 2 mandibular). At annual recall appointments, RBFPDs were carefully inspected for technical and biologic failures or complications (eg, debonding, abutment tooth caries). RESULTS: The mean observation period was 76 months, with a minimum of 4 months and a maximum of 198 months. Five RBFPDs debonded. Further complications comprised one instance of porcelain chipping and one caries lesion underneath a loose retainer. One patient was dissatisfied with the esthetic appearance of her RBFPD. The cumulative survival rate with the event "debonding" dropped to 90% after 23 months and then remained constant. Survival rate with the event "any restoration complication" dropped to 84% after 77 months and then remained constant. CONCLUSIONS: With regard to the high patient satisfaction and relatively low incidence of failures and complications, the clinical performance of nonretentive RBFPDs can be considered satisfactory. Hence, within the limitations of this study, the data justify nonretentive RBFPDs as long-term provisional restorations.

Planning implant positions for an auricular prosthesis with digital data.

The esthetic result of an auricular prosthesis is influenced by the position of the prosthesis incorporating the implants. The entire surface of the patient's head is captured by means of a conventional computed tomography (CT). The digital data are used to mirror the contralateral unimpaired ear for restoration of the impaired side. The virtual ear is integrated into a template covering the auricular defect and indexed to the nasal area with computer-aided technology (CAD/CAM). This virtual template is converted into an acrylic resin template. With that the surgeon and the anaplastologist should determine the optimal implant position of the auricular prosthesis.