Masahiko Ozeki

Immediate loading of two freestanding implants placed by computer-guided flapless surgery supporting a mandibular overdenture with magnetic attachments.

PURPOSE The present article describes a novel clinical procedure for mandibular overdentures supported by two freestanding implants loaded immediately after placement via computer-guided flapless surgery. METHODS A conventional acrylic complete denture was fabricated, and CT scans obtained using the denture as a radiographic guide. Preoperative computer-assisted planning was performed using commercially available software, permitting simulation of implant placement at optimal positions. Using simulation data, a surgical guide was manufactured and used during surgery. The surgical guide was placed and local anesthesia injected for drilling of anchor pins to stabilize the surgical guide. The drilling protocol for each osteotomy site achieved an insertion torque greater than 35 Ncm. Immediately after implant placement, a keeper of the magnetic attachment was connected to each implant, and the magnetic assembly incorporated into the denture. The mucosal surface of the denture around the magnet was relieved to avoid excessive tissue pressure. The patients were instructed to wear the denture in place continually for the following 7 days. After six months of healing and follow-up, a final denture with a metal framework may be fabricated if necessary. CONCLUSION A novel treatment protocol for immediately loaded implant-supported mandibular overdentures is described in detail. The protocol ensures secure precise and safe implant placement, successful osseointegration, and immediate improvement of oral health-related quality of life for patients with unstable complete dentures.

Multidisciplinary Treatment for Correction of Malocclusion due to Maxillofacial Deformity from Fractures: a Report of 2 Patients

Abstract This report demonstrates the importance of multidisciplinary treatment for achieving optimal results for secondary correction of malocclusion. This report describes 2 patients who were treated for malocclusion due to maxillofacial deformity from fractures sustained in traffic accidents. Patient 1 was a 22-year-old man who presented with malocclusion and scar contracture after undergoing treatment for brain contusion from a fracture of the skull base and multiple fractures of the maxillofacial bone. Patient 2 was a 24-year-old woman who presented with an infection after undergoing treatment for multiple maxillofacial fractures (Le Fort Type I + II), mandibular fracture, and facial lacerations. Separate treatment plans developed for each individual by multidisciplinary teams of specialists involved orthodontic treatment, osteotomy, and dental implant therapy. In both patients, a team approach successfully achieved cosmetic reconstruction as well as recovery of maxillomandibular function and occlusion.