scholarly journals A multidisciplinary approach for the rehabilitation of a patient with chondrosarcoma: prosthetically-driven digital workflow for maxillary reconstruction and implant treatment

2021 ◽  
Vol 8 (3) ◽  
pp. 207-215
Author(s):  
Yanjun Ge ◽  
◽  
Danni Guo ◽  
Xiaofeng Shan ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Treatment Plan ◽  
Maxillofacial Surgery ◽  
Tumor Resection ◽  
Previous Treatment ◽  
Functional Results ◽  
Primary Treatment ◽  
Virtual Design ◽  
Anterior Teeth ◽  
Guide Plate

Aim To describe a comprehensive digital therapy oriented towards the final restoration for treating an oral maxillofacial defect caused by maxillary chondrosarcoma. Summary The prosthetically-driven multidisciplinary approach was applied to achieve perfectly functional-aesthetic reconstruction for a male patient with maxillary chondrosarcoma. The complete tumor resection was ensured by the design of virtual osteotomy and surgical guide plate. A reverse engineering technique was used to reconstruct the bone defect in the maxillary aesthetic area, which offered reference for a three-dimensional printing guide plate to shape and fix the free vascularized iliac bone flap. On the solid basis of previous treatment, the implant placement was performed under the guidance of the prosthetic-driven implant plate. Vestibular extension and tissue graft were performed to increase keratinized gingiva width to improve implant-supported fixed prosthesis effect. Key learning points 1. A multidisciplinary approach including maxillofacial surgery, prosthodontic and periodontal treatment can provide better esthetic and functional results for complex rehabilitation of a patient with oral maxillofacial defect. 2. Predictability of maxillary reconstruction and implant restoration can be increased with prosthetic-driven treatment plan. 3. Applying preoperative virtual design and personalized guide plate is beneficial to achieve an ideal outline of reconstructed upper jaw. 4. Obtaining comprehensive aesthetic parameters of the expected restoration is one of the key principles of upper anterior teeth rehabilitation. 5. Digital technology provides an opportunity for consistency between the primary treatment design and the final restoration outcome.

scholarly journals Aesthetic rehabilitation in a patient with skeletal mandibular deficiency and open bite: journey from splinted metalloceramic prosthesis to all-ceramic crowns

2020 ◽  
pp. 1-14
Author(s):  
Rizwan Nazeer ◽  
Shizrah Jamal ◽  
Farhan Raza Khan
Keyword(s):  
Multidisciplinary Approach ◽  
Treatment Plan ◽  
Open Bite ◽  
Anterior Teeth ◽  
All Ceramic ◽  
Abutment Teeth ◽  
Ceramic Crowns ◽  
Crown Lengthening ◽  
Periodontal Healing ◽  
Endodontic Retreatment

Abstract This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. Continuous...  

scholarly journals Imaging, Virtual Planning, Design, and Production of Patient-Specific Implants and Clinical Validation in Craniomaxillofacial Surgery

2012 ◽  
Vol 5 (3) ◽  
pp. 137-143 ◽  
Author(s):  
Per Dérand ◽  
Lars-Erik Rännar ◽  
Jan-M Hirsch
Keyword(s):  
Additive Manufacturing ◽  
Treatment Plan ◽  
Maxillofacial Surgery ◽  
Bone Substitutes ◽  
Patient Specific ◽  
Virtual Design ◽  
Patient Specific Implants ◽  
Cutting Guide ◽  
Ablative Surgery ◽  
Cutting Guides

The purpose of this article was to describe the workflow from imaging, via virtual design, to manufacturing of patient-specific titanium reconstruction plates, cutting guide and mesh, and its utility in connection with surgical treatment of acquired bone defects in the mandible using additive manufacturing by electron beam melting (EBM). Based on computed tomography scans, polygon skulls were created. Following that virtual treatment plans entailing free microvascular transfer of fibula flaps using patient-specific reconstruction plates, mesh, and cutting guides were designed. The design was based on the specification of a Compact UniLOCK 2.4 Large (Synthes®, Switzerland). The obtained polygon plates were bent virtually round the reconstructed mandibles. Next, the resections of the mandibles were planned virtually. A cutting guide was outlined to facilitate resection, as well as plates and titanium mesh for insertion of bone or bone substitutes. Polygon plates and meshes were converted to stereolithography format and used in the software Magics for preparation of input files for the successive step, additive manufacturing. EBM was used to manufacture the customized implants in a biocompatible titanium grade, Ti6Al4V ELI. The implants and the cutting guide were cleaned and sterilized, then transferred to the operating theater, and applied during surgery. Commercially available software programs are sufficient in order to virtually plan for production of patient-specific implants. Furthermore, EBM-produced implants are fully usable under clinical conditions in reconstruction of acquired defects in the mandible. A good compliance between the treatment plan and the fit was demonstrated during operation. Within the constraints of this article, the authors describe a workflow for production of patient-specific implants, using EBM manufacturing. Titanium cutting guides, reconstruction plates for fixation of microvascular transfer of osteomyocutaneous bone grafts, and mesh to replace resected bone that can function as a carrier for bone or bone substitutes were designed and tested during reconstructive maxillofacial surgery. A clinically fit, well within the requirements for what is needed and obtained using traditional free hand bending of commercially available devices, or even higher precision, was demonstrated in ablative surgery in four patients.

scholarly journals Aesthetic Rehabilitation in Teeth with Wear from Bruxism and Acid Erosion

2018 ◽  
Vol 12 (1) ◽  
pp. 486-493
Author(s):  
Pamella Tomazi Godoy de Oliveira ◽  
Deise Caren Somacal ◽  
Luiz Henrique Burnett Júnior ◽  
Ana Maria Spohr
Keyword(s):  
Joint Pain ◽  
Multidisciplinary Approach ◽  
Treatment Plan ◽  
Dental Erosion ◽  
Gingival Tissue ◽  
Clinical Report ◽  
Functional Disorder ◽  
Time Intervals ◽  
Anterior Teeth ◽  
Ceramic Restorations

Background:Bruxism is defined as a repetitive activity of grinding the teeth through lateral or protrusive movements of the mandible, and it is considered the most complex and destructive functional disorder. In addition, erosion caused by diet or reflux can damage the remaining teeth.Objective:In this report, a patient with bruxism and dental erosion was treated with a multidisciplinary approach to restore the function and aesthetic.Methods:This clinical report describes the management of an adult woman, 33 years old, who was dissatisfied with the aesthetics of her smile and complained of joint pain and headaches. As result of her condition, the patient’s dentition exhibited generalized wear on the vestibular and incisal surface of the upper incisors incompatible with her age, moderate darkening of the teeth and excess gingival tissue in the upper incisors. After a detailed anamnesis and clinical examination, a diagnosis of bruxism and acid erosion caused by a diet rich in citrus foods and beverages was obtained. Forthwith, a treatment plan was established, and the patient underwent home bleaching, gingivoplasty and ceramic laminates of lithium disilicate on the anterior teeth. After the rehabilitation was completed, a night guard was made to reduce the symptoms of bruxism and avoid fracture of the ceramic restorations. The patient was followed at different time intervals.Conclusion:The improvement in the aesthetics of the teeth was significant and remained stable after periodic controls in which no adverse effects were observed.

scholarly journals Residual Deformities of the Maxillofacial Region

2021 ◽  
pp. 1303-1339
Author(s):  
Samson Jimson
Keyword(s):  
Treatment Planning ◽  
Treatment Plan ◽  
Maxillofacial Surgery ◽  
Trauma Surgery ◽  
Primary Treatment ◽  
Vital Role ◽  
Delay In Diagnosis ◽  
Form And Function ◽  
And Function ◽  
Primary Management

AbstractA maxillofacial surgeon plays a vital role in not only restoring the structural form of the maxillofacial unit but also aims to restore the pre-traumatic functional status of the patient. Diagnosis and Clinical evaluation with enhanced treatment planning and restoration of aesthetics and function is the key for any maxillofacial surgery. However, it is not always possible to achieve the most appropriate results in all cases. It is not uncommon to see failure or more mediocre outcomes following maxillofacial trauma surgery. The outcome of the primary treatment may depend on factors like the extent of the injury/defect, delay in diagnosis/management, improper treatment plan, lack of use in modern diagnostic/treatment planning utilities, poor execution of treatment plan, inexperience of the surgeon leading to not expecting the eventful deformities, not coordinating with other specialists to yield the most standard and deserving treatment for the patient with restoration of both form and function. Residual deformities are seen following primary treatment of trauma due to one more reason mentioned earlier. Correction of such residual deformities may be challenging to the surgeon but very often a life-changing experience for patients. It is the experience of the surgeon that helps to recognise the challenges ahead in restoring the form and function. Residual deformities are often evaluated by the extent of deformities following primary management. Apart from reasons that may pertain to the experience of the operating surgeon, pathobiology of the healing zone may also contribute to the residual deformities. This chapter discusses in detail about the traumatic residual deformities and its management, also in brief about post-oncosurgical residual deformities.

Cirurgia de aumento de coroa clínica e confecção de facetas diretas em resina composta orientadas por mock-up.

2020 ◽  
Vol 12 (45) ◽  
pp. 24-33
Author(s):  
Fábio Shiniti Mizutani ◽  
Atila de Freitas ◽  
Adriano Sapata ◽  
Claudio Sato
Keyword(s):  
Case Report ◽  
Composite Resin ◽  
Treatment Plan ◽  
Diagnostic Information ◽  
Good Treatment ◽  
Restorative Dentistry ◽  
Laboratory Technician ◽  
Crown Length ◽  
Anterior Teeth ◽  
Anterior Posterior

Keeping in mind the final result is the basis of any type of treatment, especially those in which the morphology, size and proportion of the anterior teeth will be changed. This is where a good treatment plan based on a diagnostic wax-up tested with a mock-up and approved by the patient becomes crucial. This case report aims to exemplify how to transfer the diagnostic information to the patient’s mouth and direct it not only to the restorative dentistry, but also to the surgeon when performing the crown length. Diagnostic waxing was performed by the laboratory technician, obeying anterior posterior incisal and gingival criteria and curvatures, which were transported to an aesthetic guide through mock up to mark the surgical points. Then, surgery to increase the clinical crown with bone access and after healing, direct venners in composite resin also guided by waxing. In conclusion, a workflow can be established using the wax-up / mock-up that serves as a guide for the periodontist in the approach to surgical lengthening of the crown and for the rehabilitator who uses it to produce changes in the shape of dental dimensions .

scholarly journals Time-to-Treatment in Oral Cancer: Causes and Implications for Survival

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1321
Author(s):  
Constanza Saka-Herrán ◽  
Enric Jané-Salas ◽  
Antoni Mari-Roig ◽  
Albert Estrugo-Devesa ◽  
José López-López
Keyword(s):  
Oral Cancer ◽  
Previous Treatment ◽  
Diagnostic Procedures ◽  
Original Data ◽  
Primary Treatment ◽  
Medical Attention ◽  
Time Interval ◽  
Pre Treatment ◽  
The Impact ◽  
Lack Of Knowledge

The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

scholarly journals A New Classification System to Predict Functional Outcome after Laryngectomy and Laryngopharyngectomy

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1474
Author(s):  
Stefan Grasl ◽  
Elisabeth Schmid ◽  
Gregor Heiduschka ◽  
Markus Brunner ◽  
Blažen Marijić ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Classification System ◽  
Salvage Surgery ◽  
Tumor Resection ◽  
Previous Treatment ◽  
Extent Of Resection ◽  
Voice Rehabilitation ◽  
Pharyngocutaneous Fistula ◽  
Oral Nutrition

(1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome; (2) Material and Methods: Between 1993 and 2019, 258 patients underwent TL (n = 85), TLPP (n = 101), or TLTP (n = 72). Based on the extent of tumor resection, all patients were stratified to (i) localization I: TL; II: TLPP; III: TLTP and (ii) surgical treatment (A: primary resection; B: salvage surgery). Type and rate of complication and functional outcome, including oral nutrition, G-tube dependence, pharyngeal stenosis, and voice rehabilitation were evaluated in 163 patients with a follow-up ≥ 12 months and absence of recurrent disease; (3) Results: We found 61 IA, 24 IB, 63 IIA, 38 IIB, 37 IIIA, and 35 IIIA patients. Complications and subsequently revision surgeries occurred most frequently in IIIB cases but rarely in IA patients (57.1% vs. 18%; p = 0.001 and 51.4% vs. 14.8%; p = 0.002), respectively. Pharyngocutaneous fistula (PCF) was the most common complication (33%), although it did not significantly differ among cohorts (p = 0.345). Pharyngeal stenosis was found in 27% of cases, with the highest incidence in IIIA (45.5%) and IIIB (72.7%) patients (p < 0.001). Most (91.1%) IA patients achieved complete oral nutrition compared to only 41.7% in class IIIB patients (p < 0.001). Absence of PCF (odds ratio (OR) 3.29; p = 0.003), presence of complications (OR 3.47; p = 0.004), and no need for pharyngeal reconstruction (OR 4.44; p = 0.042) represented independent favorable factors for oral nutrition. Verbal communication was achieved in 69.3% of patients and was accomplished by the insertion of voice prosthesis in 37.4%. Acquisition of esophageal speech was reached in 31.9% of cases. Based on these data, we stratified patients regarding the extent of surgery and previous treatment into subgroups reflecting risk profiles and expectable functional outcome; (4) Conclusions: The extent of resection accompanied by the need for reconstruction and salvage surgery both carry a higher risk of complications and subsequently worse functional outcome. Both factors are reflected in our classification system that can be helpful to better predict patients’ functional outcome.

scholarly journals Treatment of severe maxillary cleft hypoplasia in a case with missing premaxilla with anterior maxillary distraction using tooth-borne hyrax appliance

2015 ◽  
Vol 5 ◽  
pp. 220-224
Author(s):  
Akshai Shetty ◽  
Anjana Shetty ◽  
Krishnamurthy Bonanthaya ◽  
Pritham Shetty ◽  
Dipesh Rao
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Treatment Plan ◽  
Maxillary Hypoplasia ◽  
Anterior Teeth ◽  
Anterior Maxillary Distraction ◽  
Maxillary Cleft ◽  
Maxillary Distraction ◽  
Hyrax Appliance

Cleft orthodontics generally poses a challenge and a missing premaxilla adds to the difficulty in managing them. The lack of bone support and anterior teeth in a case with missing premaxilla accounts not only for difficulty in rehabilitation but also in increasing the maxillary hypoplasia. This article presents a case report where planned orthodontic and surgical management using distraction has helped treat a severe maxillary hypoplasia in a patient with missing premaxilla. The treatment plan and method can be used to treat severe maxillary hypoplasia and yield reasonably acceptable results for such patients.

scholarly journals Primary Tuberculous Lymphadenitis: a Rare Case Report

2018 ◽  
Vol 22 (2) ◽  
pp. 106-110
Author(s):  
Mustafa Mert Açikgöz ◽  
Ayşem Yurtseven ◽  
Gülsüm Ak
Keyword(s):  
Case Report ◽  
Multidisciplinary Approach ◽  
Maxillofacial Surgery ◽  
Excisional Biopsy ◽  
Oral And Maxillofacial Surgery ◽  
Tuberculous Lymphadenitis ◽  
Rare Case Report ◽  
Long Term Follow Up

SummaryBackground/Aim: Our aim is to describe multidisciplinary approach to primary tuberculous lymphadenitis with a case report.Case Report: A 6-year-old boy was referred to İstanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery with the symptoms of painless extra-oral abscess and lymphadenopathy. The diagnosis of primary tuberculous lymphadenitis was proved by microbiological culture and ultrasound imaging.Conclusions: Combine tuberculosis treatment should be applied and long term follow up is necessary. Excisional biopsy for tissue diagnosis and bacterial examination with culture should be performed for an early diagnosis as a delay in treatment can lead to devastating consequences.

scholarly journals Vulva Cancer Treatment with Cryosurgery

2018 ◽  
Vol 4 (1) ◽  
pp. 1-10
Author(s):  
Mauro JE ◽  
Storino C ◽  
Bianconi MI ◽  
Farah C ◽  
D’Atri FJ
Keyword(s):  
Quality Of Life ◽  
Genital Tract ◽  
Vulvar Cancer ◽  
Tumor Resection ◽  
Safety Margin ◽  
Previous Treatment ◽  
Complete Healing ◽  
High Morbidity

Vulvar cancer represents 4% to 5% of Low Genital Tract Tumors (LGTT) and 1% of all cancers in women. Treatment depends on stage, and when possible surgery is preferable. Advanced cancers require large resections (with needs grafts and-or rotating flaps), radio and/or chemotherapy, all of which can lead to high morbidity and quality of life impairment. To minimize these effects, in 1994, we developed a cryosurgery prospective protocol to manage vulvar cancer in patients with comorbid conditions.Patients and Methods: Between 1994 and 2019 we treated n=41 patients: FIGO stages I: n=2 (4.88%) II: n=9 (21.95%), III: n=28 (68.29%), IV: n=2 (4.88%). Median age 64.3 (28 to 90 years old), and 70% were 70 years old or older, 59% had severe comorbidities (diabetes, autoimmune diseases, immunosuppressive user).Cryosurgery Protocol:Firstly, tumor resection, hemostasis, and 2 rapid freezing- slow thawing cycles with Liquid Nitrogen (LN) spray. The cycles should include the logde and a 1.5 cm safety margin. After complete healing (between 45 and 95 days after cryosurgery), nodes are treated according to FIGO stages. Result:All patients after the effects of the anesthesia were able to urinate spontaneously, walk, had minimal analgesic requirements, with good postoperative. The patients remained in the hospital for one or two days, and with rare exceptions, were discharged the following day with controls twice a week at the hospital. None of the patients required flaps or grafts to repair the treated areas. After complete healing they maintained the vulvar sensitivity and considerably improved their quality of life. Some of them, who had a partner, were able to resume their sexual intercourse.Mean follow-up: 55.39 (3 months to 258 months). Five patients had local recurrences between 12 and 72 months after treatment, and were controlled with a new cryosurgery. Six patients had HPV related lesions located in other areas of the lower genital tract, which were also controlled with cryosurgery. Twenty five of them died 19 due to an unrelated cause of death, and 6 due to disease progression in the nodes without vulvar recurrence, 9 patients survived and were free of disease with a mean follow-up of 53 months. Seven patients, after a disease free follow up of 17.2 months, weren ́t able to be controlled, as they lived more than 400 km way from the hospital. Local control was achieved in all patients.Comments: Cryosurgery can be done after any previous treatment, and can be repeated to control recurrences.Conclusion: Given the simplicity of the technique, its low cost, the possibility of being used in patients with multiple co-morbidities, the absence of major complications, and the anatomical and functional results obtained, we believe that cryosurgery can be considered among the best options to control of vulvar cancer, even large or advanced cases, in elderly patients and-or with severe comorbidities.

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