Divisions of Prosthodontics, Beth Israel MedicalCenter, Institute for Head and Neck and Thyroid Diseases, New York, NY 10003, USA.
JAMA Otolaryngol Head Neck Surg. 2013 Apr;139(4):371-81. doi: 10.1001/jamaoto.2013.83.
Functional recovery for patients who undergo maxillomandibular reconstruction with vascularized bone free flaps (VBFFs) is potentially more attainable with computer-assisted implant rehabilitation. This prosthodontic-driven approach uses software planning and surgical templates for implant placement supporting fixed dental prostheses (FDP). Implant success with immediate load (IL) provisional and definitive FDP restorations in VBFFs is reported for the first time in a patient cohort.
To determine implant success for FDP restorations and IL restorations. To determine factors that may influence success and predictability to provide FDP restorations in VBFFs.
A retrospective medical chart review was conducted of patients who underwent VBFF reconstruction and computer-assisted planning (CP) for FDP implant rehabilitation. This study was conducted with approval from the institutional review board at Beth Israel Medical Center, New York, New York.
Clinical procedures were conducted in operating room and outpatient facilities in a tertiary referral medical center.
Twenty-eight consecutive patient treatments were reviewed. Inclusion criteria for all patients were VBFF reconstruction and CP for FDP restoration prior to stage 1 implant surgery. Patients were evaluated for implant success, surgical templates, IL provisional restorations, and prosthodontic framework design. A comparison is made between patients with IL provisional restorations and those patients who did not receive an immediate restoration.
Implants that achieved osseointegration and used for prosthetic reconstruction determined success. Prosthodontic design considerations included whether the patient received an IL provisional restoration and 3 categories of FDP metal framework design. RESULTS Ninety-nine implants of 116 implants placed were used for prosthetic restorations, achieving an 85.4% success rate. Twenty-five of 28 patients received FDP restorations. Thirteen of 28 patients received IL provisional restorations at stage 1 implant surgery. Fifty of 56 implants were successful (89.3%) in the IL group.
Computer-assisted implant rehabilitation of reconstructed defects can achieve superior results to provide FDP and IL provisional restorations. This prosthodontic-driven approach also uses unique framework design to account for mandible height discrepancy after fibula free flap reconstruction. Patient management for FDP rehabilitation is also dependent on radiation status, soft-tissue modification, and patient selection.
对于接受血管化骨游离皮瓣（VBFF）进行下颌骨重建的患者，计算机辅助植入物修复的功能恢复更有可能实现。这种修复体驱动的方法使用软件规划和手术模板进行植入物放置，以支持固定义齿修复体（FDP）。首次在患者队列中报告了 VBFF 中使用即刻负载（IL）临时和最终 FDP 修复体的植入物成功。
确定 FDP 修复体和 IL 修复体的植入物成功率。确定可能影响成功率和可预测性的因素，以为 VBFF 中的 FDP 修复体提供支持。
对接受 VBFF 重建和 FDP 植入物修复计算机辅助规划（CP）的患者进行回顾性病历审查。本研究经纽约 Beth Israel 医疗中心机构审查委员会批准。
临床程序在三级转诊医疗中心的手术室和门诊设施中进行。
回顾了 28 例连续患者的治疗。所有患者的纳入标准均为 VBFF 重建和 FDP 修复的 CP 在前一期植入手术之前。对患者的植入物成功率、手术模板、IL 临时修复体和修复体框架设计进行评估。比较了接受 IL 临时修复体和未接受即刻修复体的患者。
达到骨整合并用于修复体重建的植入物被认为是成功的。修复体设计考虑因素包括患者是否接受 IL 临时修复体以及 FDP 金属框架设计的 3 个类别。结果：在放置的 116 个植入物中，99 个植入物用于修复体，成功率为 85.4%。28 名患者中有 25 名接受了 FDP 修复体。28 名患者中有 13 名在一期植入手术时接受了 IL 临时修复体。IL 组中有 50 个（89.3%）植入物成功。
重建缺损的计算机辅助植入物修复可以获得更好的结果，以提供 FDP 和 IL 临时修复体。这种修复体驱动的方法还使用独特的框架设计来考虑腓骨游离皮瓣重建后的下颌骨高度差异。FDP 修复体的患者管理还取决于辐射状态、软组织修改和患者选择。
