Michael R. Arcuri

Functional dental rehabilitation of massive palatomaxillary defects: Cases requiring free tissue transfer and osseointegrated implants

Mandibular reconstruction with functional dental rehabilitation using a free tissue transfer bone flap as the substrate for osseointegrated implant‐borne or implant‐retained dental prostheses is well described. Similar use of these techniques in maxillary dental rehabilitation is less frequent and has received less attention in the literature. However, in selected cases of extensive composite defects of the maxilla, free tissue transfer reconstruction of the maxillary arch and the use of implant‐borne or implant‐retained dental prostheses is the only satisfactory method of achieving functional dental rehabilitation.

Prosthetic complications of extraoral implants

The use of tissue-integrated fixtures for the retention of an extraoral prosthesis has simplified the placement, removal, and cleaning of the prosthesis by the patient. Tissue evaluation, structural designs, and retention mechanisms, combined with patient compliance and the ability to perform hygiene around retentive substructures, has produced an array of new problems. Clinical and technical problems are presented with techniques used in their resolution.

An evaluation of root canal treatment in patients who have received irradiation to the mandible and maxilla

OBJECTIVE The purpose of this study was to evaluate the success and failure of root canal treatment performed in areas of previous irradiation and to examine any cases of osteoradionecrosis associated with such treatment. STUDY DESIGN A retrospective analysis was done on 22 teeth that had root canal treatment after radiation therapy. Strict radiographic and clinical criteria were used to determine success and failure. RESULTS There was a mean follow-up period of 19 months. Of 22 cases, 20 (91%) were considered successful. Both failures occurred with a diagnosis of pulpal necrosis. There were no occurrences of osteoradionecrosis. CONCLUSIONS Our study showed that root canal treatment in previously irradiated patients may be successful. In addition, treatment approaches, as well as the criteria for success and failure, should be the same for irradiated patients as for those who have not received radiation treatment.

Scanning electron microscope analysis of tooth enamel treated with rotary instruments and abrasives

This study compared the effects of various rotary instruments and polishing agents on tooth enamel. Topographical features of enamel were studied at consecutive stages of polishing with photoanalysis of scanning electron micrographs. The results indicate that enamel modified by diamond burs may be polished to produce the smoothest surface with white finishing stones, Ceramist finishing points, and flour of pumice.

Fabrication procedure for cranial prostheses

A procedure for duplication of cranial bone flaps used in cranioplasty is described. This procedure overcomes the difficulties inherent in direct duplication of irregular-shaped bone flaps through primary replication of the flap in wax. The wax pattern is used to fabricate the definitive prosthesis.

Odontogenic myxoma of the maxillary sinus: A clinical report

This report describes the transoral maxillary resection of an odontogenic tumor and prosthetic reconstruction with titanium implants placed horizontally in the residual palate. The treatment provided enabled the removal of the lesion and prosthetic restoration of the missing structures, while maintaining optimal facial esthetics and obtaining support, retention, and stability for the prosthesis (Fig. 5).

The effects of a maxillary speech-aid prosthesis for the combined tongue and mandibular resection patient

The purpose of this investigation was to develop a protocol for the fabrication of a prosthesis that would improve speech in individuals who have undergone complete removal of the tongue and mandible. A 60-year-old man was suffering from severe xerostomia and was unable to produce intelligible speech. Speech analysis without the prosthesis revealed a profound articulatory disorder. With the prosthesis, xerostomia was eliminated and the subject had fewer articulatory errors of severity. Improvement in speech intelligibility was significant at p less than 0.001.

Framework night guards for implant-retained auricular prostheses

Prosthetic ear rehabilitation with osseointegrated implants involves using a cast or preformed framework (bar) constructed to fit the implant abutments. Retention of the prosthesis is obtained through clips or magnets. Because the prosthetic ear is not worn during sleep, the ends of the retention bar are left exposed. These projections may become entangled with the linen or hair. To prevent this problem a night guard constructed of soft mouth-guard material is worn over the retentive bar while the patient is sleeping.

Impression technique for nonosseous free-tissue transfer reconstruction after cranioorbitomaxillary resection: A clinical report

The use of vascularized free-tissue transfers has given the head and neck surgeon the ability to offer enhanced oncologic therapy with less risk of exposing vital structures to the aerodigestive tract. Resulting free-flap tissue consistencies and contours inhibit the successful use of routine impression techniques. The technique described in this clinical report uses a previously reported procedure to obtain an accurate impression of residual palatal and free-flap structures. The significance of this technique is that it improves the tissue reproduction of surgically closed palatal defects.