Funk G F, Arcuri M R, Frodel J L
Department of Otolaryngology-Head and Neck Surgery, University of Iowa College of Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Head Neck. 1998 Jan;20(1):38-51. doi: 10.1002/(sici)1097-0347(199801)20:1<38::aid-hed7>3.0.co;2-4.
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.
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.
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.
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.
使用游离组织移植骨瓣作为骨结合种植体支持或种植体固位义齿的功能牙修复的下颌骨重建已有详细描述。这些技术在上颌牙修复中的类似应用较少见，在文献中也较少受到关注。然而，在某些上颌广泛复合缺损的病例中，上颌弓的游离组织移植重建以及使用种植体支持或种植体固位义齿是实现功能性牙修复的唯一令人满意的方法。
介绍了3例使用游离组织移植结合种植体支持或种植体固位假体进行上颌重建和牙修复的病例。介绍了患者选择、重建技术以及上颌大腭颌骨缺损牙修复中的生物力学考虑因素。
本报告中的患者恢复了上颌牙的全部功能。游离瓣骨中植入的17颗种植体中有1颗因骨结合失败而丢失；在牙修复完成后平均18个月，94%的植入种植体稳定。
对于因切除手术或创伤导致上颌腭颌骨广泛缺损的特定患者，使用游离组织移植和骨结合种植体支持或种植体固位假牙可能是恢复上颌牙功能的唯一可行方法。上颌大缺损的牙修复存在许多生物力学挑战，必须清楚理解并克服这些挑战，才能实现长期的功能性牙修复。
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