2D and 3D imaging for morphological assessment of maxillofacial cyst and tumors: a case series / Imagen 3D para la evaluación morfológica de quistes y tumores maxilofaciales: serie de casos

SUMMARY: The use and importance of cone beam computed tomography (CBCT) in the diagnostic, treatment and long term follow up of odontogenic tumours, as well as one reconstruction and dental implants rehabilitation is reported. This clinical series shows diagnosis of odontogenic tumors using selected and used CBCT for initial diagnosis, morphological characterization, and follow up for 5 to 10 years. The CBCTs showed the size and form of the tumor and the follow up showed a satisfactory remodelling of bone and the success in the rehabilition with dental implants. No signs of recurrence were observed. The conventional radiographies, Fan Beam CT, Cone Beam CT and Magnetic Resonance Imaging (MRI) are discussed in the use for follow up of odontogenic tumors. It is concluded that CBCT is an efficient tool for diagnosis, follow up and assessment of the morphology and size of the tumor in order to achieve the best treatment plan, returning the functional conditions to the patients.

RESUMEN: Se reporta el uso y la importancia de la tomografía computarizada de haz cónico (CBCT) en el diagnóstico, tratamiento y seguimiento a largo plazo de tumores odontogénicos, tal como en una reconstrucción y rehabilitación de implantes dentales. Esta serie clínica muestra el diagnóstico de tumores odontogénicos utilizando CBCT seleccionados y usados para el diagnóstico inicial, caracterización morfológica y seguimiento durante 5 a 10 años. Los CBCT mostraron el tamaño y la forma del tumor y el seguimiento mostró un remodelamiento óseo satisfactorio y el éxito de la rehabilitación con implantes dentales. No se observaron signos de recurrencia. Las radiografías convencionales, el uso de TAC, TAC de haz cónico y resonancia magnética nuclear (RMN) se consideran para el seguimiento de tumores odontogénicos. Se concluye que CBCT es una herramienta eficaz en el diagnóstico y seguimiento a largo plazo para evaluar la morfología del tumor y de su tamaño, y además, para obtener los mejores resultados en el tratamiento y eventuales condiciones funcionales de los pacientes.

An alternative solution for a complex prosthodontic problem: a modified Andrews fixed dental prosthesis.

This report describes the prosthodontic rehabilitation of an alveolar defect in the posterior mandible after the excision of an odontogenic myxoma. A minimally invasive technique that involves a modification of the traditional Andrews fixed dental prosthesis was used to replace both soft and hard tissues. The clinical stages and materials used to provide this treatment are discussed.

Prosthodontic rehabilitation of a patient using a swing-lock lower denture after segmental mandibulectomy.

A swing-lock denture is useful in partially dentate patients where the configuration of the remaining teeth means that either the retention or stability available for a conventional removable partial denture is compromised. Such removable prostheses can also prove to be extremely useful when providing prosthodontic rehabilitation following surgical resection of oral cancer. A 20 year-old patient was referred to the Restorative Department of Cork University Dental Hospital following segmental mandibulectomy to treat a calicifying epithelial odontogenic tumour (Pindborg Tumour). Initial treatment using a conventional lower partial denture failed. This paper outlines the successfully rehabilitation using a lower Cobalt-Chromium swing-lock partial denture.

Reconstruction of the mandible using preshaped 2.3-mm titanium plates, autogenous cortical bone plates, particulate cancellous bone, and platelet-rich plasma: a retrospective analysis of 20 patients.

PURPOSE: The purpose of this retrospective study was to evaluate a group of 20 patients who underwent a reconstruction of the mandible by use of free bone grafts and platelet-rich plasma (PRP). MATERIALS AND METHODS: In a period of 8 years, 20 patients underwent a reconstruction of the mandible, by use of preshaped 2.3-mm titanium plates, autogenous cortical bone plates, autogenous particulate bone, PRP, and a special fixation technique. The patients were divided into 3 groups. Group 1 consisted of 10 patients who underwent secondary reconstruction after ablative surgery for malignant tumors. Of these, 4 had preoperative or postoperative radiotherapy. Group 2 comprised 7 patients who underwent primary reconstruction after resections for benign but aggressive odontogenic tumors. Group 3 consisted of 3 patients with severe atrophy and malunion. The defects ranged in size from 8 to 12 cm in groups 1 and 2 and from 2 to 4 cm in group 3, and the follow-up ranged from 1 to 8 years. RESULTS: The initial healing was uneventful in all but 3 patients. In these 3 patients additional bone grafts had to be placed to allow for optimal implant placement. At the time of implant insertion, some areas of granulation tissue were found, possibly because of the rather high dose of PRP used. Continuity in all cases was achieved, and the patients considered the results good in 10 cases and satisfactory in 9 cases. One patient could not be approached for the last assessment. CONCLUSION: The grafting and fixation technique used proved to be rather reliable. The antimicrobial effect and the proliferation of osteoblasts are likely to be responsible for the results achieved.

Total mandibular reconstruction after resection of rare "honeycomb-like" ameloblastic carcinoma--a case report.

PURPOSE: This case report describes a rare and aggressive ameloblastic carcinoma that infiltrated the mandible in a "honeycomb" pattern. METHODS: A total mandibulectomy with bilateral modified neck dissection was followed by primary reconstruction with a single free vascularised fibula flap. RESULTS: The postoperative course was uneventful. The one year follow-up revealed no signs of recurrent tumour or metastases. Nine months later distant metastases occurred in the lung. CONCLUSION: Ameloblastic carcinoma is a highly malignant lesion, which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged.

Distraction osteogenesis: role and clinical applications in the maxillofacial region.

Distraction osteogenesis or callostasis is a technique of new bone formation by gradual separation of bony fragments. The method was first developed for limb lengthening but recently this process was widely applied to the cranio-maxillofacial bones. The application included unlimited bone lengthening and reconstruction of segmental defects. Several designs of extra-oral and intra-oral distraction devices were invented to suit different areas of craniofacial bone. Nevertheless intraoral distractors have several advantages including minimal scarring and being less cumbersome. Clinical cases using distraction osteogenesis as an alternative treatment to conventional surgical procedures for maxillo-mandibular lengthening and reconstruction of alveolar segmental defects after tumour resection before implant installation are presented and discussed.

Application of a surgical navigation system for implant surgery in a deficient alveolar ridge postexcision of an odontogenic myxoma.

PURPOSE: The study's purpose was to describe the application of a surgical navigation system for the treatment-planning and subsequent precise placement of dental implants in a patient, 2 years postexcision of a mandibular odontogenic myxoma. PATIENTS AND METHODS: A 25-year-old male patient presented for rehabilitation of a deficient edentulous ridge at the right mandible following excision of an odontogenic myxoma. The patient was imaged by dental computed tomography while wearing an individually fitted interfacing acrylic splint. Thereafter, computed tomography data were imported to the Image-Guided Implantology system (IGI; DenX Advanced Dental Systems Ltd, Moshav Ora, Israel), and a precise 3-dimensional implant treatment plan was contemplated considering the compromised anatomy and the anticipated prosthesis. RESULTS: Three dental implants were placed using a surgical navigation approach with precise coordination to the presurgical treatment plan and subsequently were restored with a screw-retained fixed prosthesis. At the 1-year follow-up, the implants were osseointegrated and the fixed prosthesis was fully functional. CONCLUSIONS: Computerized navigation is indicated for dental implant surgery in patients with deficient alveolar ridge where coordination of the positioning of the implants to the final prosthesis is difficult.

Repair of a defect following the removal of a maxillary adenomatoid odontogenic tumor using guided tissue regeneration. A case report.

Adenomatoid odontogenic tumors (AOT) make up 3% of odontogenic tumors. This tumor, most commonly found in the maxillary arch, mimics a follicular cyst associated with an impacted tooth. This is a case report of an AOT found in a 14-year-old female undergoing active orthodontic therapy. The surgical removal of the lesion resulted in the exposure of a large bony cavity surrounding the maxillary left canine. Placement of freeze-dried bone and coverage with an expanded polytetrafluoroethylene membrane resulted in rapid and complete healing of the lesion and restoration of osseous support.

[Resection and reconstruction of mandible for treatment of two rare benign tumors]. / Résection et reconstruction de la mandibule pour le traitement de deux tumeurs bénignes rares.

Odontogenic myxoma and particularly juvenile fibromatosis are rare benign tumors in the maxillo-facial region. The aggressive local and sometimes voluminous development of these tumors may necessitate partial mandibulectomy. Autologous bone graft from the iliac crest is the best material for mandibular reconstruction because of its functional and esthetic results. If osteosynthesis of the graft is achieved by means of internal wiring, several weeks of intermaxillary fixation are required, whereas internal rigid fixation with plate and screws allows the patient to open the mouth more rapidly.

Improvement of speech sound disorder with figure deformation case to a bone-defected patient.

This report describes improvement of pronuciation in a bone-defected patient with a partial denture. The patient's chief complaints were difficulty of fricative and africative consonant utterance. Insertion of partial denture improved the pronunciation to some degree. Furthermore, the patient's figure deformation was corrected.