PubMed · 801220
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O Neuner. 1975-01-17. [Preprosthetic surgery].. https://pubmed.ncbi.nlm.nih.gov/801220/
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Reconstruction of the edentulous atrophic mandible continues to be a treatment problem for the oral and maxillofacial surgeon. Clearly, endosteal osseointegrated implants are indicated for rehabilitation, but a total implant-supported prosthesis may not always be possible. The implant-supported overdenture is an excellent alternative, but modifications of the unfavorable residual ridge may be necessary. Attached crestal soft tissue, resistant to mechanical trauma, and improvement of the residual ridge anatomy are provided by adding a split-thickness skin graft vestibuloplasty (VSG) and lowering of the floor of the mouth (LFM). Simultaneous VSG and LFM with placement of endosteal implants provides the optimal condition for maximal rehabilitation of the atrophic mandible with specific indications. Results of four skin grafts and eight implants simultaneously placed are reported.
Using the same arguments as for early bone grafting of the alveolar process in unilateral clefts, the cleft team of the University of Nijmegen started about 10 years ago to apply early osteotomy-stabilization of the premaxilla to bilateral clefts. A series of 13 cases with a minimum follow-up of 15 months is presented. The patients were operated on at the age of 8 2/12 to 12 5/12 years. The results are considerably better than when doing the same operation in the adult. More than 90% are successful. In comparison with adults we additionally register more favourable eruption of the canine, the possibility of closing the dental arch without prosthetic appliances and in some cases also the elimination of a psychological handicap. The inhibition of growth by this operation seems not to be important. If need be, Le Fort I osteotomies are possible after completion of growth. They will be in one piece which is technically easier than the usual three-segment Le Fort I. In conclusion we prefer early secondary osteotomy and stabilization of the premaxilla to the tertiary operation.
Treatment planning for dental implants presents special challenges to the dentist. The authors review the conventional radiographic and non-radiographic methods for the assessment of the implant site. A new dental interactive treatment planning program under development at the University of Alabama School of Dentistry Department of Periodontics is described.