Luis R. Guerra

Alveolar ridge augmentation using nonresorbable hydroxylapatite with or without autogenous cancellous bone.

A four-year prospective evaluation of the use of nonresorbable, particulate hydroxylapatite (HA) to augment deficient alveolar ridges was performed. The material was used alone and in combination with finely crushed autogenous cancellous bone. Implants were delivered subperiosteally by syringe injection, usually using local anesthesia for Class I to Class III ridges and general anesthesia for Class III and Class IV ridges. The improved ridge height and width were stable. Postoperative resorption with significant loss of ridge height, frequently seen with rib and iliac crest onlayed grafts, was not observed with HA augmentation. Permanent denture construction began as early as three weeks postoperatively and by four to six weeks if HA was combined with autogenous cancellous bone. It was possible to place mandibular staple implants simultaneously or following HA augmentation. Visor osteotomy techniques were improved by use of HA to produce a wider, more convex stable ridge. Although skin, mucosa, or dermal vestibuloplasties were performed as early as three months postoperatively in a small number of patients, there appeared to be a lesser need for vestibuloplasty after HA augmentation than after onlay bone grafting. In addition, prosthodontists performed fewer denture relines after HA augmentation than after onlay bone grafts. The authors believe the most significant factor accounting for these observations is the firm, nonmobile mucosal base resulting from augmentation with HA. The resultant stable, soft tissue base and improved ridge height and contour have contributed to a comfortable, retentive, stable denture for these patients. The prosthetic and surgical procedures are easier to perform and have produced superior, more permanent results than onlay bone grafts and alloplasts. Preliminary studies also point to exciting possibilities for use of HA as a bone substitute/marrow extender in maxillary and mandibular defects, cysts, and clefts and in osteotomies for orthognathic surgery.

Hydroxylapatite alveolar ridge reconstruction: Clinical experiences, complications, and technical modifications

Results of the reconstruction of 228 deficient alveolar ridges (208 patients) using hydroxylapatite with or without autogenous cancellous bone over a six-year period are reported. Complications included erosion, mental nerve neuropathy, migration and displacement of particles, overfill, and loose material. Modified techniques are presented that minimize the occurrence of these complications in Class III and IV ridge-deficient patients.

Prosthodontic management of the hydroxylapatite denture patient: A preliminary report

A 4-year study and evaluation of nonresorbable hydroxylapatite to augment different alveolar ridges has been reported. The technique used resulted in improved contour, height, and width of the alveolar ridge. It was found that denture comfort improved with ridge augmentation as this allowed improved stability, support, and preservation of the ridge. Patient satisfaction was correlated to both surgical and prosthodontic success with the use of hydroxylapatite. The state and health of the tissues were found to be improved with the use of hydroxylapatite or hydroxylapatite and bone marrow. The prosthetic and surgical procedures were found to be easier to perform, and they produced more permanent and superior results than those previously experienced with only bone grafts and other alloplasts.

Alternative Retention for an Implant-retained Auricular Prosthesis

The introduction of intraoral endosseous implants was inevitably followed by their external use in maxillofacial prosthodontics. Bar and clip attachments provide satisfactory retention for auricular prostheses, although the bar may inhibit patient hygiene by limiting access to the defect area. A simple clinical and laboratory technique to enhance the retention of an implant-retained auricular prosthesis is described, with custom-made stud attachments used for retention. Improved access for hygiene is provided. A clinical case is presented.

Clear acrylic resin device for orientation and placement of a small facial prosthesis

A small-sized facial prosthesis can be difficult to orient accurately in correct relationship to a defect. This problem may be reduced by embedding a magnet in the prosthesis and constructing a magnetic holding device from clear acrylic resin. This device can be used as a stand during adhesive application to reduce adhesive contamination and acts as orientation guide during prosthesis placement.

Tissue-supported implant overdentures.

Overdenture techniques can be modified for use with implants. Generally the implants, which replace the tooth roots, can be placed in a position to permit optimum retention and stability as well as enhancing esthetics. Bony undercuts, which at times are present with the retention of tooth roots, are not a problem when using implants. Various retentive schemes are available to retain the prosthesis and can be matched to the individual needs of patients in regard to retention, stability, and the ability to insert and remove prostheses. Two implants can adequately support an overdenture. The superstructure must be designed to enable the patient to maintain a healthy oral environment. The patient must understand and be able to perform required oral hygiene procedures. The use of overdentures over implants affords the dentist another option in meeting the needs of the patients. (Implant Dent 1992;1:69–77)

Modifications of the superstructure for the staple implant

Two techniques have been described to expedite fabrication and reduce the cost of prostheses made for staple implants. The techniques permit placement of a simulated transosseous pin within the master cast. At the time of denture placement in technique No. 1, the coping-bar attachment assembly is cemented (Fig. 12). In technique No. 2 the superstructure is placed over the transosteal pins and secured between the locknuts to maintain the base of the lower locknut 1.5 mm from the crest of the alveolar ridge (Fig. 13). Technique No. 2 permits removal of the superstructure as desired. Patients should be instructed in proper oral hygiene and denture care.

Skin grafting alveoloplasty following resection of intraoral tumors

Abstract Intraoral skin grafts are used often for patients who undergo surgical therapy for oral cancer. There must be an awareness on the part of the dentist that, although the skin graft in the oral cavity has many disadvantages from a prosthetic point of view, its use is dictated by the amount of mucosa removed in the operation. Cooperation between the surgeon and the prosthodontist is stressed in planning the over-all rehabilitation of patients with oral tumors.

A multiple tray technique for implant-retained orital prostheses

The use of implants in retaining orbital prostheses has gained favor in recent years. Not all patients may be candidates for use of medical adhesives or anatomic retention as advocated by some. Osseointegrated implants offer an alternative method for retaining an orbital prosthesis. Because of the confining nature of an orbital defect, it may be difficult to reproduce the spatial arrangement of implants accurately with one impression. The technique presented here accomplishes the objectives of minimal trauma to the tissues, accuracy, and elimination of consecutive impression technique.

Implant reconstruction of a facial trauma patient: clinical report.

Dental implants can be used for the replacement of lost teeth as a result of trauma, even in complex cases with extensive loss of hard and soft tissues. Cooperation between the surgeon and restorative dentist is essential. The sequence of steps each team member must take to reach the definitive prosthesis stage must be clearly defined during treatment planning. A clinical report is presented.