Case Report 1

(Single Stage Reconstruction Maxilla)

The Cantilevered Maxillary Implant®

Biomodel and Custom Implant

assembled system

Customised Titanium Maxilla
Abutments: Nobel Bio-Care SDCB116

Customised Titanium Maxilla Overdenture




Post Surgery X Ray Outcome




Year 1
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Photomorphanalysis

The relationship of the implant to the skull and soft tissues is illustrated.

Outcome


   



Year 6

6 year outcome movie file .wmv (1.92 MB)
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Patient Comment @ 6 years

for replay button right mouse click over image

note the remarkable quality of speech following this huge resection

Case Summary

1. Disease free @ 9.5 years (December 2005).
2. Atraumatic Surgical Technique - increased margins of safety.
3. No reconstructive flap surgery required
4. No second donor surgical site required for successful reconstruction.
5. Surgery time - only 2.5 hours required to complete the surgery..
6. No post operative intensive care required.
7. Enhanced rehabilitation.
8. Reduction in morbidity
9. Implant aesthetics and function excellent.
10. Normal speech and swallowing.
11. Significant Cost Savings for Purchasers of Health Care.


Conclusions

It is advocated that stereolithography and customised implant techniques have converted a very difficult and potentially dangerous multistaged reconstruction into a simple single staged procedure, without the need for an osseous component to the reconstruction. This reconstruction is stable in the long term (6years). No significant complications were encountered. It is likely that these principles of Engineering Assisted Surgery™ will have applications not only in other aspects of head and neck surgery, but surgery in general.


In particular, the quality of speech in this case is remarkable for such an extensive resection of tumour, which involved the removal of the entire upper jaw and preservation of the soft palate. This resection leaves a huge defect which is extremely difficult to reconstruct safely with conventional flap surgery and associated osseous component. There are considerable technical problems with the placement and stability of conventional endosseous titanium implants in these cases for the retention of an upper overdenture or obturator. Such complex reconstructions involve high risk to the patient with major complications of morbidity, flap loss and perioperative mortality, with considerable costs in human terms for the patient and for the purchasers of health care.


This patient was presented to a peer review group of international experts for personal examination by Professor Per-Ingvar Brånemark of the Institute of Applied Biotechnology Goteborg, Sweden. The quality of this outcome of maxillary reconstruction was judged to be the best ever seen.


Update 2004

The prosthesis is stable at 7 years 8 months (January 2004) with no further complications.