Alveolar segmental sandwich osteotomy for anterior maxillary vertical augmentation prior to implant placement.

Over a 5-year period, 10 partially edentulous patients with anterior vertical maxillary deficiency were treated consecutively with segmental osteotomy and interpositional bone grafting prior to dental implant placement. Alveolar vertical projection and papillary form proved to be stable in all patients up to 5 years postsurgery. Implant aesthetic results were judged to be satisfactory. The technique is an alternative to alveolar distraction osteogenesis but is limited to a vertical increase of about 5 mm in the anterior maxilla.

Osseointegrated craniofacial implants in the rehabilitation of orbital defects: an update of a retrospective experience in the United States.

STATEMENT OF PROBLEM: Since their introduction, craniofacial implants have been used in prosthetic rehabilitation of facial defects. The literature, however, indicates marked variability in outcomes using implants for the retention of orbital prostheses. PURPOSE: A multicenter report updating the experience in the United States with the use of craniofacial implants for prosthetic rehabilitation of orbital defects is presented. MATERIAL AND METHODS: Surveys were sent to clinicians at 25 centers where maxillofacial prosthetic treatment is provided to obtain retrospective data regarding patients who completed implant-retained orbital prosthetic rehabilitation. Data on implant placement location, radiation treatment history, and use of hyperbaric oxygen therapy were collected and assessed in relationship to implant survival over time. The Kaplan-Meier life table and Wilcoxon analyses (alpha = .05) were used to assess the significance of the findings. RESULTS: Ten centers responded, providing data suitable for statistical analysis on 153 implants placed to retain 44 orbital prostheses and followed for a mean period of 52.6 months. Forty-one implant integration failures occurred during this follow-up period, resulting in an overall integration survival rate of 73.2%. No significant relationship was found between radiation treatment history, hyperbaric oxygen therapy history, or implant placement location and implant survival. Individual responses revealed large variability between reporting centers in treatment outcomes. CONCLUSION: Craniofacial implants may offer marked benefits in the prosthetic rehabilitation of orbital defects when compared to conventional adhesive retention designs. However, questions remain regarding long-term predictability and the impact specific factors may have on treatment outcomes. Insufficient data is currently available from which to draw statistically meaningful conclusions. The establishment of a national database designed to acquire adequate data to assess treatment outcomes is recommended.

Adjunctive commissure splint therapy: a revised approach.

The management of trauma to the commissures has been an ongoing challenge for the medical and dental professions. Multiple surgical and prosthetic approaches have been used. Commissure splint therapy is often effective in association with surgery in reducing the effects of scar contraction that ultimately results in microstomia and reduced quality of life. This article describes methods of fabrication of the commissure splint appliance, the rationale for its modification, advantages, and disadvantages.

Dental follow-up compliance in a population of irradiated head and neck cancer patients.

OBJECTIVE: This study assessed post-radiation therapy dental follow-up compliance in a population of head and neck cancer patients. STUDY DESIGN: A total of 334 dental charts were retrospectively reviewed to determine the follow-up status of dentate patients. All patients were informed of the importance of returning, after completing radiotherapy, for regular follow-up dental examinations on an indefinite basis. Data regarding compliance with these follow-up instructions over time were obtained. RESULTS: Approximately 170 (51%) of the 334 dentate patients were identified as being lost to dental follow-up. The mean point in time at which follow-up failure occurred was 7.5 months after the initial preirradiation dental examination. CONCLUSION: Dental follow-up compliance may be poor in this irradiated patient population, with follow-up failures potentially occurring less than 1 year after the completion of radiotherapy. Preradiation dental care planning must take into account the likelihood of patients being lost to follow-up.