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Sturge-Weber syndrome is an uncommon condition characterized by presence of Portwine stains on the face along with ocular disorders, mental retardation, oral involvement and leptomeningeal angiomas. A report of a case with atypical manifestations of this syndrome along with a step-by-step protocol oral rehabilitation of such patients is described.
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In maxillectomy patients, speech intelligibility between before and after insertion of prostheses has been reviewed by many investigators. Speech intelligibility was not related to the size of the defect, but rather to the defect region. Speech intelligibility was considerably improved by the use of prostheses. A great difference could not be found in escape rate from the nasal cavity between before and after insertion of prostheses, but there was a remarkable change in the spirometer. Postmaxillectomy functions are also easily restored by prosthetic oral rehabilitation, necessary to aid surgical procedure.
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Oromandibular reconstruction is one of the greatest challenges of the head and neck surgeon. The ideal rehabilitation of the mandible and associated soft tissues requires maintaining premorbid occlusion, providing the opportunity for dental restoration, and preventing salivary incontinence. The approach to each patient must be individualized to maximize speech, swallowing, and mastication. Additionally, the surgeon must strive to fulfill these goals while achieving the most pleasing cosmetic result possible. Although some patients may be treated without reconstruction or with a metal plate and soft tissue flap, the majority of patients benefit from bony reconstruction utilizing a free flap. Reconstruction with free flaps results in more primary healing and fewer wound complications. Challenges specific to reconstructing the temporomandibular joint are discussed. We also review the indications for the different rehabilitative options and the merits of the individual flaps.
Using internationally accepted indices, the authors studied the caries and gingivities frequency as well as the oral hygiene in 112 successfully treated orthodontic patients 35 months or thereabout after termination of the treatment and retention. The results obtaines are compared with those from an adequate control group and statistically evaluated. The general dental condition and the degree of oral rehabilitation of the orthodontic patients was better than those of the subjects in the control group.
Dental teaching must keep in stride with the latest trends. Evolution and challenge are very much a part of every day life for both students and dentists. At the University of Laval, the faculty of dentistry has developed an interactive multimedia apprenticeship system. This system will be incorporated into the curriculum of Laval's doctor of dental medicine degree, as well as the organizational framework of its continuing education program. It will only be a first step for the faculty's department of oral rehabilitation, which ultimately hopes to see the system used by dental schools across Canada. Known as "Médent," the prototype system is designed to teach the principles of osseointegration, and the rehabilitation of oral function using osseointegrated implants.
Treatment of the edentulous obturator patient requires the same basic fundamentals as used in the treatment of the complete-denture patient. Problems and considerations unique to the development, delivery, and follow-up of the complete maxillary obturator prosthesis and mandibular denture in the patient with an acquired maxillary defect are discussed. Combining laboratory and clinical research in maxillofacial prosthodontics and plastic and reconstructive surgery continues to improve the rehabilitation of these patients.
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We describe a case with a severely resorbed atrophic edentulous ridge in both the maxilla and mandible. The maxilla was reconstructed using a sinus-lifting procedure and onlay bone graft. The mandible was reconstructed by anterior osteotomy with an interpositional sandwich iliac bone graft at the symphysis area, subperiosteally with iliac bone chips mixed with hydroxylapatite bilaterally at the posterior atrophic ridge, and vestibuloplasty with a split thickness skin graft (STSG). After full-mouth implant rehabilitation, a 5-year follow-up of this case shows a satisfactory result.
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As one of the most demanding tasks facing the restorative dentist, planning and executing an occlusal rehabilitation should not be undertaken lightly. The stakes are high and failure is costly. Treatment planning decisions should be undertaken on the basis of scientific evidence, where this is available, or on the basis of documented experience where it is not. This review article identifies the major biological and clinical considerations used when planning an occlusal rehabilitation. These include the indications for reorganising the occlusion, the choice of condylar position and occlusal scheme, the implications of and indications for increasing the vertical dimension, replacing missing teeth and the choice of materials. Finally, the literature surrounding the controversial issue of occlusal rehabilitation as a means to treat temporo-mandibular disorders is also reviewed.
When the edentulous condition has existed for many years, extensive ridge resorption may complicate the ability to function with a conventional prosthesis. Implant therapy in conjunction with bone augmentation procedures may provide new options for the predictable restoration of the edentulous state. However, complex implant reconstruction may place considerable stress on the patient's ability to function throughout therapy. Providing stable interim prostheses and smooth transitions between procedures may alleviate the problem. This can be accomplished only with extensive diagnosis, treatment planning, and the judicious use of transitional prostheses. The first part of this case report focuses on the planning stages of a complex implant dental rehabilitation.
It is necessary to visualize and reconstruct tissue anatomic surfaces accurately for a variety of oral rehabilitation applications such as surface wear characterization and automated fabrication of dental restorations, accuracy of reproduction of impression and die materials, etc. In this investigation, a 3-D digitization and computer-graphic system was developed for surface characterization. The hardware consists of a profiler assembly for digitization in an MTS biomechanical test system with an artificial mouth, an IBM PS/2 computer model 70 for data processing and a Hewlett-Packard laser printer for hardcopy outputs. The software used includes a commercially available Surfer 3-D graphics package, a public domain data-fitting alignment software and an inhouse Pascal program for intercommunication plus some other limited tasks. Surfaces were digitized before and after rotation by angular displacement, the digital data were interpolated by Surfer to provide a data grid and the surfaces were computer graphically reconstructed: Misaligned surfaces were aligned by the data-fitting alignment software under different choices of parameters. The effect of different interpolation parameters (e.g. grid size, method of interpolation) and extent of rotation on the alignment accuracy was determined. The results indicate that improved alignment accuracy results from optimization of interpolation parameters and minimization of the initial misorientation between the digitized surfaces. The method provides important advantages for surface reconstruction and visualization, such as overlay of sequentially generated surfaces and accurate alignment of pairs of surfaces with small misalignment.
A one-step procedure has been designed to help the patient with abnormal maxillary anterior alveolar atrophy. The technique combines an anterior maxillary osteotomy with a maxillary vestibuloplasty. Bone grafting and skin grafting are not required, and prosthetic rehabilitation can begin 6 to 8 weeks postoperatively. This is a preliminary report; however, 18-month follow-up examinations show continued stability and minimal regression.
This article shows that once topical fluoride applications have been prescribed, oral rehabilitations should be adapted to each patient. Post radiotherapy maintenance is also essential to maintain a good dental equilibrium. This adequate dental condition is the best preventive measure against late osteoradionecrosis of dental origin.
Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time.