Is it possible to achieve favorable maxillofacial re-construction from a natural and physiological standpoint, if implant placement is involved during treatment planning?
Hello, Haroon!
It is quite complex maxillo facial rehabilitation of patients with major loss in this area, but dental implants are one of the best options for fixing these prostheses.
Best regards!
Thank you. but are there any limitations when we talk about placing implants ? like anatomical limitations etc ?
do we use the same implants as we use for restoring teeth or is there any modification ?
It all depends upon how you look at the question of maxillofacial rehabilitation.
Are you looking at situations where you are doing primary reconstruction? If you're doing primary reconstruction without an ora-nasal (meaning that the communication was closed surgically), or any other, communication and if you have relatively thin mucosa, in contrast to thick skin, implant should proved to be a great benefit in the reconstruction of the patient as you are trying to replace dental units (Teeth).
The thing that we have to be careful of however is the notion that teeth are involved in trituration but not in manipulation of the food bolus.(see Curtis, D et al). So if there has been A fundamental change in the anatomy of the buccal mucosa, buccal musculature, Hard or soft palate, tongue, Floor the mouth, etc. The issues related to manipulation of the food bolus are probably more critical than the patient's ability to triturate food. Manipulation of the bolus puts that bolus of food either on the occlusal table or fails to put it in a position where trituration would occur. The functional deficit in this situation is the poor manipulation of the food bolus more so than the poor trituration of the bolus.
If you are not looking at reconstruction of the defect but instead are looking at a communication between the oral and nasal cavities and you are using an obturator to close that defect the immobility of the implants is a bit of a disservice because the obturator generally does move, hopefully just a little, in function. The patient generally does not chew on the side of the defect but that doesn't mean but nothing ever goes on to that side. If I have my preference I would prefer retention of teeth to support an obturator because there is physiologic mobility which is then magnified by the length of the lever arm before you get to supporting areas within the defect such as the pterygoid plate.
If you're talking about a mandibular defect, Whether reconstructed or not, there is almost always some discrepancy from the normal, Let's call that the pre-surgical, condition. This generally means that if you are using implants there is a horizontal discrepancy in many instances that must be accommodated. Of course if the lateral border of the tongue was also resected, which happens frequently when a mandibular discontinuity defect is created whether it is restored or not, the question of manipulation of the food bolus comes into play once again.
The short answer to your question is that dental implants usually serve the valuable purpose in the management of a maxillofacial defect. The long answer however is that there are a number of new and different considerations that must be made when implants are used in the management of maxillofacial defect. The thought processes that we may have used 30 years ago may need to be rethought as we introduce a new components into the treatment armamentarium. Implants are often an acceptable root substitute but they are not always going to function in the same way as the natural tooth root and we need to be cognizant of this and must modify our treatment appropriately.
hello haroon
Use of implants for retention and stability of maxillofacial prosthesis is a promising solution.Understanding the type of defect,size of defect,area involved,anatomic structures favouring and restricting planning,type of prosthesis, techniques incorporated, skill of an operator,availability of materials and finances will greatly influence the treatment. Most of the defects can be treated using fixed detachable type of prosthesis using implants in maxillofacial region.
Haroon-
Your ? is a bit confounding as it comes under the banner of "Maxillofacial Prosthetics" which is a sub-specialty area of prosthodontics. These patients have acquired (trauma, cancer) or congenital (Cleft palate, Ectodermal Dysplasia) maxillofacial defects which usually requires team treatment to accomplish the goals of your treatment planning. Is this the topic you are addressing?
Regards
Haroon Rashid Baloch look here:
Article Survival and complications of implants to support craniofaci...
For most of the cases requiring maxillofacial prostheses (ear, nose, and orbital prostheses) the implant used is not exactly the same used for implant-supported oral prostheses, but a much shorter version of it.
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