Hiromasa Sakurai

Functional and aesthetic rehabilitation with maxillary prosthesis supported by two zygomatic implants for maxillary defect resulting from cancer ablative surgery: a case report/technique article

We report herein a case of functional and aesthetic rehabilitation with maxillary prosthesis supported by only two zygomatic implants for a patient with severe maxillary defect resulting from subtotal maxillectomy for malignant melanoma of the upper gingiva. A 76-year-old woman was referred to our facility with non-painful discoloration of the upper gingiva. After several examinations, a clinical diagnosis of malignant melanoma of the upper gingiva (cT3N1M0 stage IVA, American Joint Committee on Cancer) was made. Subtotal maxillectomy utilizing Le Fort I osteotomy and functional neck dissection were performed. A conventional resection denture was made and employed postoperatively, but was unable to be suitably retained due to insufficient residual maxillary structures. Six months after tumor resection, two zygomatic implants were inserted into bilateral zygomatic bones. Magnetic attachments were applied as a mechanism for attaching the implants and resection denture. After application of these implants, retention and stability of the prosthesis was considerably improved. The patient became able to eat a normal diet. From an aesthetic perspective, the depressed upper lip was also properly restored, leading to an acceptable facial appearance.

Oral Rehabilitation of Oral Cancer Patients Using Zygomatic Implant-Supported Maxillary Prostheses with Magnetic Attachment: Three Case Reports

Maxillectomy for malignant tumor often results in a maxillary defect and serious oral dysfunction. A prosthesis is usually provided for postoperative oral rehabilitation of such patients with maxillary defects. However, the further the resected region extends, the less stable the prosthesis becomes, due to insufficient bone and tooth support. Therefore, in many cases, conventional resection dentures may not be adequate to restore the oral function. Effective utilization of dental and zygomatic implants may help to restore oral function in patients with severe maxillary defects. This clinical report describes the management of three patients with severe maxillary defects following cancer ablative surgery who were rehabilitated using maxillary prostheses with magnetic attachments supported by dental and zygomatic implants. Occlusal reconstruction was performed with removable prostheses supported with two or four implants and magnetic attachment. The oral function was evaluated before and after prosthodontic treatment with implants using the Oral Health Impact Profile (OHIP-14) and functional chewing score. Results indicated improvement in all cases. These findings show that quality of life (QOL) and oral function were improved.

Mandibular Reconstruction With Fibula Bone Graft Followed by Particulate Cancellous Bone and Marrow Graft With Titanium Mesh Tray

P atients with mandibular tumor sometimes undergo extensive bony resection with mandibular reconstruction. Although there are many methods available for mandibular reconstruction, no consensus on a definitive method has been reached. Currently, mandibular reconstruction with vascularized free fibula flap technique has become a routine procedure for the functional reconstruction of the mandible. In addition, with the advent of endosseous dental implants, dental prosthetic rehabilitation has been considered the final goal of the treatment. However, because the vertical height of the reconstructed mandible by fibula is insufficient to compare with the native mandible, occlusal reconstruction with dental implants is often disturbed. Therefore, the reconstruction of alveolar ridge is essential to provide a better prosthetic rehabilitation with dental implants. With regard to bone augmentation, it is important not only to increase bone volume but also to form proper alveolar ridge being well-harmonized with opposing or adjacent teeth. To accomplish such augmentation, the particulate cancellous bone and marrow (PCBM) graft in combination with custom-made titanium mesh (Ti-mesh) tray is now a reliable method for reconstruction of the alveolar ridge. This report describes the 2-staged approach of mandibular reconstruction with fibula graft followed by iliac PCBM with a custom-made Ti-mesh tray. This reconstruction procedure enables favorable occlusal reconstruction with dental implants for the patients with large mandibular defect. CASE PRESENTATION