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

Abstract

Background 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. Methods Three cases of maxillary reconstruction and dental rehabilitation using free tissue transfer with implant‐borne or implant‐retained prostheses are presented. Patient selection, reconstructive technique, and the biomechanical considerations in maxillary dental rehabilitation of large palatomaxillary defects are presented. Results The patients in this report were restored to full maxillary dental functioning. One implant of 17 implants placed in free flap bone was lost due to failure of osseointegration; 94% of the implants placed are stable an average of 18 months after dental rehabilitation was complete. Conclusions In selected patients with extensive palatomaxillary defects due to ablative surgery or trauma, the use of free tissue transfer and osseointegrated implant‐borne or implant‐retained dentures may be the only method possible to restore maxillary dental function. Dental rehabilitation of large maxillary defects presents a number of biomechanical challenges which must be clearly understood and overcome to achieve a long‐term, functional dental rehabilitation. © 1998 John Wiley & Sons, Inc. Head Neck 20: 38–51, 1998.

Magnesium ion implantation on a micro/nanostructured titanium surface promotes its bioactivity and osteogenic differentiation function

“…Satisfactory osseointegration must be achieved to ensure that a long and stable functional dental implant is retained in the mandible or long bone. 1 Since surface characteristics are critical factors influencing interactions between the cell or extracellular matrix and implants that can lead to eventual osseointegration, 2 various surface treatment methods have been employed to optimize dental implant surfaces for improving their bioactivity and osseointegration. …”

Microsurgical Reconstruction of Maxillary Defects

“…Dentures that do not require osseointegrated implants are tissue-borne and tooth-supported, relying on the native tissues for retention and stabilization. [96] Tissue-borne prostheses generally cannot be used in extensive maxillary defects because of insufficient residual palatal and alveolar tissues to provide support and retention. Funk et al [96] defined such defects as those involving more than two-thirds of the maxillary arch.…”

“…[96] Tissue-borne prostheses generally cannot be used in extensive maxillary defects because of insufficient residual palatal and alveolar tissues to provide support and retention. Funk et al [96] defined such defects as those involving more than two-thirds of the maxillary arch. These defects typically require surgical reconstruction of the maxillary arch to provide neoalveolar bone of adequate thickness (approximately 10 mm) to accommodate osseointegrated implants, support a denture, and prevent its movement during mastication (Figure 30-34).…”

“…[96] Osseointegrated implants may be placed at the time of the reconstruction or secondarily, 6 to 8 weeks later. [96] Three to 8 months after placement, the osseointegrated implants are uncovered and prepared for final prosthetic reconstruction by a prosthodontist.…”

“…This procedure successfully restored facial contour and allowed full dental rehabilitation. Funk et al [59] used free scapular osseocutaneous flaps with primary or secondary osseointegrated implants for large palatomaxillary defects in three patients. These patients all underwent successful dental rehabilitation, with 94 percent stability of the implants at an average of 18 months after the completion of rehabilitation.…”