Eric S. Asher

Osseointegrated Implants and Auricular Defects: A Case Series Study

PURPOSE The objective of this study was to report on the survival rate of 16 patients treated with extraoral implants in the auricular region, analyze treatment outcomes, and discuss important clinical variables encountered during treatment. MATERIALS AND METHODS Sixteen patients who received extraoral dental implants to retain auricular prostheses between 1987 and 2003 were followed retrospectively. The variables recorded were gender, initial diagnosis, number and size of implants, implant placement date, age at implant placement, history of radiation to the treated field, abutment size, design of initial prosthesis, age of initial prosthesis (when a remake was indicated), date of prosthesis delivery, soft tissue response, grafting procedure, date of last follow-up, and complications. All patients were thoroughly evaluated presurgically by the reconstruction team, which consisted of prosthodontists, a facial prosthetist, and an otolaryngologist. Surgical templates were used for all patients. The criteria for success of the prostheses included marginal accuracy, overall stability and function, symmetry/position, texture, color stability, and patient acceptance. RESULTS Thirty-nine implants were placed in 16 patients. All 16 patients were completely satisfied with their reconstructions. No surgical complications, implant failures, or prosthetic failures were encountered. Therefore, the survival rate was 100%. Three patients (18.75%) had grade 0, seven (43.75%) had grade 1, five (31.25%) had grade 2, and one (6.25%) had grade 3 soft tissue inflammation. The inflammation completely resolved in 7 of the 13 patients (54%) with hygiene reinforcement or soft tissue reduction. CONCLUSIONS The survival rate for bone-anchored titanium implants and prostheses was 100%. Bone-anchored titanium implants provided the 16 patients in this study with a safe, reliable, adhesive-free method to anchor auricular prostheses with recovery of normal appearance. Under the guidance of an appropriate implant team, proper positioning of implants was optimized to allow prosthodontic rehabilitation using implant-retained prostheses.

FABRICATION AND USE OF A SURGICAL TEMPLATE FOR PLACING IMPLANTS TO RETAIN AN AURICULAR PROSTHESIS

A procedure is described for the fabrication of a 3-dimensional surgical template to guide the placement of implants to retain an auricular prosthesis. This procedure requires a diagnostic wax pattern that is checked while on the patient to ensure it is positioned correctly and is also the correct size. The wax pattern is processed into a clear, methyl methacrylate resin, 3-dimensional surgical template. The most effective type of surgical template for planning implant placement is a 3-dimensional acrylic template that closely resembles the final prosthesis. This template will direct the implant placement where the retentive elements are most easily concealed, under the thickest areas of the prosthesis, which are the antihelix and antitragus. This location allows the best esthetic and functional results. An additional advantage of this technique is that it allows the retrieval of the diagnostic wax pattern of the auricle so that it can be used to fabricate the definitive prosthesis.

Procedure for construction of a custom tracheostomal obturator: a clinical report.

SUMMARY This clinical report describes the treatment of apatient with Congenital Central Hypoventilation Syn-drome using a simple impression procedure and pros-thesis fabrication. Treatment required only the basicinformation provided by the otolaryngologist, mea-surements were taken at the initial appointment, andbasic skills were used in fabrication of intraoral andextraoral prosthetic devices. It is recommended that theclinical phase of this procedure be performed in thepresence of an otolaryngologist. Patients who live withthis syndrome have undergone many trials physically,emotionally, psychologically, and socially. The presenceof this type of prosthesis has many advantages such asallowance of speech without obvious air leakage, andbeing relatively inconspicuous. Compared with the WRIGHT ET AL THE JOURNAL OF PROSTHETIC DENTISTRY OCTOBER 1999 389 Fig. 5. Ten-year-old girl with CCHS with tracheostomal obtu-rator assembly in place. Prosthesis is esthetically pleasing topatient and held in place through bulb on terminal end ofobturator with beaded necklace.