The prosthetic rehabilitation of a panfacial fracture patient after reduction: a clinical report.

Panfacial fractures involve trauma to the lower, middle, and upper facial bones and often require a team approach for management. Early and complete restoration of preinjury facial contours and function should be the goal of the oral and maxillofacial surgeon and the prosthodontist. When the intraoral landmarks are lost, overall facial anatomic landmarks can be used to restore the oral cavity. A patient with complex clinical panfacial fractures, including a vertically and horizontally malpositioned native alveolar bone and severe facial asymmetry, is presented. A functional and esthetic rehabilitation was successfully accomplished by using a partial removable dental prosthesis retained with telescopic crowns and magnetic attachments in the maxilla and osseointegrated implants to support a definitive dental prosthesis in the mandible.

Prosthetic rehabilitation of an edentulous maxilla with microstomia, limited interarch space, and malaligned implants: a clinical report.

BACKGROUND: Although dental implant treatment is a very successful option today, a meticulous treatment planning and close collaboration between the oral surgeon and restorative doctor is crucial to eliminate undesired outcomes. PURPOSE: To present a challenging case restored with a maxillary screw-retained fixed prosthesis using malpositioned/malaligned implants. MATERIALS AND METHODS: A 47-year-old female had a Lefort I fracture and lost all maxillary teeth due to traumatic injury in a traffic accident. Seven maxillary implants were placed using a 1-stage surgical approach, 6 months after open reduction surgery in a private practice. Radiographic and clinical evaluation indicated marginal bone loss around 3 anterior implants. The malposition and malalignment of implants made impression and casting procedures very complicated. The other challenging factors with this patient were microstomia, limited mouth opening due to scar tissue from previous plastic surgery, and a very small maxilla. The 1-piece metal framework did not fit accurately so it was sectioned into 3 segments. The 3 separate segments were screwed on the abutments individually, then connected to each other using an acrylic resin. The 3 framework segments were laser welded. After the laser welding, a passive fit of the framework was achieved. CONCLUSION: It has been suggested that providing an implant treatment to a patient with implants placed in wrong positions with undesired angulations can be very difficult. Also, laser welding may be a viable option to eliminate misfit of full-arch metal frameworks.

Redução de defeito ósseo maxilar por meio de distração osteogênica horizontal / Reduction of maxillary bone defect by horizontal distraction osteogenesis

A reabilitação de maxilas edêntulas em muitas situações pode se tornar um desafio para os implantodontistas. Em um grande numero de casos a instalação de implantes só pode ser realizada após o procedimento de enxertia óssea. No entanto existem casos em que o defeito ósseo atinge níveis tão severos que não permite a instalação de implantes mesmo após procedimentos de enxertia. No presente trabalho, relatamos um caso clinico onde o paciente apresentava um grande defeito ósseo na região posterior da maxila causado por projétil de arma de fogo. Devido a inviabilidade de se realizar um procedimento de enxertia convencional, foi optado por realizar a distração osteogênica horizontal. Após o período de ativação e de consolidação o aparato foi removido e foi instalada uma placa para garantir a estabilidade do local. O procedimento se mostrou de fácil realização e o resultado obtido foi a quase que completa eliminação do defeito ósseo

The rehabilitation of edentulous jaws in many situations can become a challenge for implantodontists. In a large number of cases the installation of implants can only be performed after the bone grafting procedure. However there are cases where the bone defect so severe that reaches levels not allow the installation of implants even after grafting procedures. In this paper, we report a clinical case where the patient had a large bony defect in the posterior region of the maxilla caused by a projectile from a firearm. Because of the impracticality of conducting a conventional grafting procedure was chosen to perform the horizontal distraction osteogenesis. After the activation period of consolidation and the apparatus was removed and a plate was installed to ensure the stability of the site. The procedure proved easy to perform and the result was the almost complete elimination of the bone defect

Outcome of postsurgical sequential functional exercise of jaw fracture.

BACKGROUND: A large number of studies and clinical cases show that an ideal prognosis for mouth function cannot be obtained without sufficient and reasonable postsurgical functional exercise after jaw fracture. However, no unifying criteria exist on postsurgical functional exercise with jaw fracture. The study was designed to explore effective methods of postsurgical functional exercise of jaw fracture. MATERIALS AND METHODS: One hundred seventeen inpatients with jaw fracture between August 2005 and August 2006 were subjects in this study. Sequential function exercise methods were used to recover patients' gape degree, chewing, and so on. Gape degree was recorded, and healing of the jaw was assessed using x-ray. RESULTS: All 117 patients with jaw fracture who underwent surgery were involved in the analysis. After sequential function exercise, gape degree and chewing function improved; good occluding relations were retained. Gape degree was significantly improved at 8 or 12 weeks postsurgery compared with 1 or 4 weeks postsurgery (P < 0.01). However, no significant differences in gape degree were observed between 1 and 4 weeks postsurgery and between 8 and 12 weeks postsurgery (P > 0.05). CONCLUSIONS: Sequential function exercise contributes much to patient recovery of mouth function. This method is effective for postsurgical functional recovery of jaw fracture.

Maxillary post-traumatic outcome correction literature review and our experience. Part I: maxillary bone non-unions-"poor bone positioning".

Still today, there is no classification of non-unions in maxillofacial traumatology. There is a broad spectrum of definitions that simultaneously describe the pathological conditions and functional implications determined by the anatomical location of the fractures and the time factor. In this article the authors describe a literature review about bone non-union classification. Weber, in 1973, introduced the term "pseudo-arthrosis" to describe an altered process of bone healing characterised by the presence of fibrous tissue interposed between the fracture segments, that was lined with cartilaginous tissue and joined by a capsule; Spiessl, in 1988, used the term "non-union" to define any alteration of the bone healing process after a time period of more than 6 months from the initial traumatic event; Rosen, in 1990, proposed a new classification of the modes of altered bone healing in fractures, distinguishing 5 categories: delayed consolidation, non-union, non-union vascular, non union avascular, pseudoarthrosis. The authors also talk about "poor bone positioning". This factor describes the incorrect anatomical position of the bone fragments despite perfectly normal healing according to Gruss. In this article they also discuss about the treatment of non-unions and the treatment of occlusal alterations caused by poor post-traumatic bone positioning.

Occlusal reconstruction: orthodontic techniques for treatment of jaw fracture.

AIM: Treatment by the multidisciplinary-team approach for jaw fractures, and the role of the orthodontist, are discussed and illustrated through case reports. METHODS: Two cases of jaw fractures treated with orthodontic techniques, as an alternative noninvasive procedure, are presented. One subject with a fresh mandibular fracture did not consent to surgery, despite a good indication for open reduction. The other subject had maljoined mandibular fractures from surgery, with insufficient occlusal consideration. CONCLUSION: Orthodontists, as well as oral surgeons, participate in every stage of the treatment of jaw fractures, including treatment decisions, in-patient management, dietary guidance, etc. Orthodontists also attend surgical operations to determine the most stable occlusion, making possible more detailed occlusal reconstruction.

[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.

[Kinesitherapy in the field of maxillofacial surgery]. / La kinésithérapie dans le domaine de la chirurgie maxillo-faciale.

The aim of this article is to present the possibilities offered by physiotherapy in maxillo-facial surgery. Physiotherapy has different objectives: to restore normal function in all mandibular movements to improve tissue trophicity to oppose fibrosis pain treatment We show different reeducation techniques and their indications by the means of two clinical cases. The punctual analysis of the obtained results allows to show the repercussions of treatment modifications on the TMJ mobility recuperation.

Utilización del BOP en el tratamiento de fracturas de órbita y fronto-orbitales / The use of bio-compatible osteo-conductor polymer (BOP) for treatment of orbital and fronto-orbital fractures

Desde hace muchos años, se han usado diferentes materiales en el tratamiento de las fracturas orbitarias y fronto-orbitarias. Estos materiales generalmente han sido silastic, proplast, hidroxiapatita, e injertos óseos autólogos u homólogos. Sin embargo, desde hace 13 años se desarrolló en la entonces Unión Soviética un compuesto de N-vinyl 2 pirrolidona, líquido de color amarillo soluble en metanol, acetona, metilmetacrilato, gluconato de calcio y fibras de poliamida a alta tensión; este material fue denominado polímero osteoconductor biocompatible (BOP). Se reportan los resultados preliminares de 20 casos de estas fracturas tratadas con BOP; no hubo complicaciones y se corroboró que el BOP es un material inerte, biocompatible y útil para corregir asimetrías faciales. De acuerdo con los resultados obtenidos hasta el presente, se propone seguir los casos por un periodo más largo, con el objeto de demostrar la osteointegración, ya que la razón del éxito en las 20 fracturas ha sido el hecho de que se ha utilizado el BOP en esta serie como un implante, más que como un injerto, en una zona de efectos biomecánicos mínimos