Andrew Dawood

Computer guided surgery for implant placement and dental rehabilitation in a patient undergoing sub-total mandibulectomy and microvascular free flap reconstruction.

A 58-year-old patient presented with an extensive, destructive, recurrent pleomorphic adenoma occupying the mandibular body and the soft tissues of the mouth and neck. Resection of the mandible from right ramus to left condylar process, and implant rehabilitation in both jaws with fixed bridgework was planned. Comprehensive presurgical prosthetic work up was carried out to record the existing dental relationship and guide all stages of the reconstruction. The jaw was first grafted with a segmented, fibular microvascular free-flap, which was fixed in place with a fixation plate prebent on a Rapid Prototype Anatomical Model of the jaw. Reconstruction with implant supported fixed partial dentures took place to the dental scheme planned preresection, using a computer guided approach to implant placement in the complex and unfamiliar anatomy of the extensively grafted mandible. This approach facilitated and expedited implant surgery such that treatment could take place using a minimally invasive approach relatively soon after surgery, prior to commencement of radiotherapy, and highlights the importance of a multidisciplinary approach to treatment for patients having extensive surgery to the jaws. The patients personal assessment 2 years post surgery was recorded using 1999 University of Washington Quality of Life Questionnaire.

Re-thinking 3D printing: A novel approach to guided facial contouring

Rapid prototyped or three dimensional printed (3D printed) patient specific guides are of great use in many craniofacial and maxillofacial procedures and are extensively described in the literature. These guides are relatively easy to produce and cost effective. However existing designs are limited in that they are unable to be used in procedures requiring the 3D contouring of patient tissues. This paper presents a novel design and approach for the use of three dimensional printing in the production of a patient specific guide capable of fully guiding intraoperative 3D tissue contouring based on a pre-operative plan. We present a case where the technique was used on a patient suffering from an extensive osseous tumour as a result of fibrous dysplasia with encouraging results.

Management of Failure and Implant-Related Complications in Graftless Implant Reconstructions (for Atrophic Jaws)

This chapter examines the management of some of the complications associated with graftless implant solutions which may lead to and include implant failure for patients with atrophic jaws. In an anatomically constrained environment, the use of a limited number of angled or short implants and, in extremely atrophic maxillae, the use of zygomatic implants are becoming widespread. Though such treatment has been shown to be predictable and generally trouble free, failure can not only lead to loss of function, but in the graftless treatment there is the potential to create a range of complications, such as sinus infection and extra-oral infection which may be more serious than those encountered in conventional dental implant treatments. Managing failure can be complex, and so careful forethought is required to avoid complication and leave scope to salvage a compromised reconstruction. Failure and complication will cause disruption and upset for the dentist and for the patient, who must be carefully counselled and consented. Treatment should be undertaken by well-trained and skilled operators with the support of an experienced team.

Percutaneous implant retention of a nasal prosthesis

This report describes an approach to the simultaneous retention of a nasal prosthesis and an intraoral prosthesis for a patient who had undergone a total rhinectomy with resection of the upper lip and premaxilla. At the time of the nasal resection, 2 dental implants were placed adjacent to the resection margins in the first premolar positions. These were used to anchor an intraoral, milled titanium bar and overdenture to replace the missing anterior teeth and provide support for the upper lip, which had been reconstructed with a vascularized radial forearm free-flap. The titanium bar also incorporated a connection for a tissue-penetrating percutaneous nasal extension, which pierced the radial forearm flap near the junction with the hard palate. Magnetic attachments screwed to the nasal extension retained a nasal prosthesis. The predictable and straightforward implementation of this novel concept with digital design and manufacture of the titanium components and guided placement of the nasal extension was made possible with software planning.

A New Approach to Implant-Based Midface Reconstruction Following Subtotal Maxillectomy.

This case presentation describes the reconstruction of an extensive maxillary-orbital defect following subtotal resection of the maxilla en bloc with orbital exenteration in a young adult following the diagnosis of chondrosarcoma. A new approach to composite midface reconstruction with dental implants is described, in which computer-guided surgery (CGS) was used to obliquely position dental implants interradicularly in the residual maxilla, such that the implant tips lie in close proximity to the root apices of the remaining teeth. The implants were then used to fixate a milled-titanium bar, fabricated using computer-aided design and manufacture (CAD/CAM), and provided with attachments for the stabilization and retention of a maxillary obturator.

44 A new implant for the retention of nasal prostheses after total rhinectomy

Objective: To assess long term skeletal stability following Kufner’s maxillary osteotomy. Methods: 7 patients with follow up greater than 5 years were assesed following Kufner’s osteotomy. Photographic and cephalometeric analysis were carried out at yearly intervals to assess for relapse following osteotomy. Results: 6 of the 7 patients showed good long term stability. In the 1 patient who showed relapse surgery was performed to correct a deformity secondary to Cleft lip and palate. Conclusion: The authors discuss the indications for this osteotomy and causes of relapse in this select group of patients.