Case Report 6

(Maxillary Atrophy)



The bone of the upper jaw ( Maxilla ) may sometimes disappear, leading to difficulties in wearing a upper denture.

Bone grafting procedures and placement of traditional ( endosseous ) implants involves complicated multi staged procedures, which are of high risk and involve considerable expense. The main problem relates to loss of bone and wound breakdown, which results in loss of the bone graft.

Customised Implants obviate the need for bone graft procedures, and permit a Single Stage Reconstruction which is successful, despite areas of wound breakdown, which may occur in these patients.

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The Cantilevered Maxillary Implant
(Veneer Option)



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Pre surgical fabrication of dental prostheses

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1 month - note:- minor wound breakdown

Outcomes

  

Pre Surgery Photomorphanalysis Post Surgery. This case was managed jointly with Dr Aneu Sood B.D.S, Oakwood Dental Centre, Oakwood, Derby, U.K.

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Patient Comment 32 months



Case Summary

1. Implant functioning @ 41 months (May 2002)

2. AtraumaticSurgical Technique - increased margins of safety.

3. No second donor surgical site required to effect primary reconstruction.

4. Surgery time - these implants may be placed in a 20 minute procedure..

5. No post operative intensive care required.

6. Earlier rehabilitation of dentition.

7. Reduction in morbidity - no bone grafting required.

8. Implant aesthetics and function excellent.

9. Normal speech and swallowing.

10. Significant Cost Savings for Purchasers of Health Care.



Comment

1. Minimal Access Techniques

This patient underwent a simple surgical procedure using minimal access techniques. The implant is functioning well at 25 months and the patient is wearing a lower Bicon implant retained overdenture.

2. Function

Quality of life is dramatically improved for the patient who has no regrets to date with respect to the surgical procedure. Retention of the overdenture and masticatory function is excellent.

3. Aesthetics

Aesthetics are excellent, and superior to results possible with conventional overdentures. In particular there is a reduction in the depth of nasolabial folds; this is related to the nasal flange support in this area. There appears to be an elevation of the malar fat pad, and the jowling appearance at the lower border of mandible is eliminated with the lower overdenture.

Many of the patient's friends have commented that this treatment has resulted in a more youthful appearance and this comment has been made with respect to two other patients treated with this method.

The use of titanium implants in this area may be a useful adjunct or alternative to the procedure of rhytidectomy (facelift).

4. Complications

Intraoral wound breakdown (this would have resulted in loss of bone graft had this technique been used).

Intermittent oedema of cheek.

Recurrent bouts of oedema of the cheek have been observed first thing in the morning in two patients. This is postural and may be related to the interruption of lymphatic drainage channels and becomes less frequent with time. One possible solution for the prevention of oedema may be the manufacture of a perforated implant to encourage adhesion of the periosteum to the zygoma rather than to the implant's titanium flange. This complication will be monitored closely.

It is interesting to note that our case of Maxillary Reconstruction (Cantilevered Maxillary Implant) has not demonstrated this complication in a 57 month period. No surgical emphysema (air in the tissues) has been reported to date.

5. Long Term Review

To date we have treated three patients with this technique and currently can place such an implant in a 20 minute procedure. All patients have excellent function and remarkable aesthetics at a maximum follow up of 41 months.

Three year outcomes will be presented on this website, and this technique is to be subject to independent external peer review.

Maxillary Atrophy CD-ROM


Surgical Technique


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