• Journal of International Society for Simulation Surgery
• /
• v.2 no.1
• /
• pp.1-6
• /
• 2015

Purpose Bisphophonate-related osteonecrosis of the jaw (BRONJ) is an emerging problem. Extensive osteonecrosis of the jaw needs free flap reconstruction. Free fibular flap is the most useful flap for maxilla-mandibular hard and soft tissue reconstruction. The advantages of fibular free flap are simultaneous soft and hard tissue reconstruction and placing implant in reconstructed mandible and maxilla. In this study, four consecutive BRONJ patients who underwent fibula free flap reconstruction using simulation surgery were reviewed. Materials and Methods Four BRONJ patients who underwent free fibula reconstruction between May 2006 and September 2014 were included in this study. Male to female ratio was 1:3 and average age was 67.3 years old (62-70). All patients need mandibular bone reconstruction. Three patients suffered from osteoporosis and one male patient had multiple myeloma. Postoperative flap survival, functional reconstruction, esthetic results, food taking were evaluated. Results Three osseous flaps and one osteocutaneous flap were used. All the fibular flaps were survived and patients were recovered without complications. Oro-cutaneous fistula was resolved after operation. All patients were satisfied with the esthetic results. Patients reported improved solid food intake after operation with partial denture. One fully edentulous patient had semi-fluid diet after operation. Conclusion Treatment of the BRONJ is difficult due to lack of standard protocol. Fibular free flap using simulation surgery is the workhorse flap for mandibular hard and soft tissue reconstruction, especially in stage III BRONJ patient. In this study, functional and esthetic results were successful in all patients. Normal diet was possible with partial dentures.

• The Journal of Korean Academy of Prosthodontics
• /
• v.62 no.3
• /
• pp.193-200
• /
• 2024

In patients with severe alveolar bone resorption on mandibular anterior edentulous areas, it can be difficult to place implants in the location for crowns, and to create the fixed prosthesis having an adequate emergence profile or embrasure, which makes maintenance difficult. Fabricating a removable zirconia prosthesis with a milled bar on poorly positioned implants can be a good option because of easy maintenance. In this case, the patient had severe bone resorption on mandibular anterior region, and large vertical space. We report on the aesthetical and easy-to-maintain results by placing two implants and fabricating a zirconia prosthesis using milled bar.

• The Journal of Korean Academy of Prosthodontics
• /
• v.33 no.3
• /
• pp.517-538
• /
• 1995

Dental implantation is a method restoring missing teeth, especially in the case of severely resorbed edentulous patient. But the direct contact between bone and implant surface, induces stress concentration to the bone and eventually becomes a cause. The purpose of this study was to compare the stress distribution patterns between following two cylindrical implant models. One group has implant apex located in the inferior cortical bone and the other in the cancellous bone. Anterior edentulous mandible was modeled with two dimensional 953,878 nodes, 995,918 elements and compared the deflection and stress distribution under the 70 N,4 load cases for 26 models having variant mandibular height and length. The result were as follows; 1. The stress concentration was more affected by the height of the mandible than implant length. 2. Bicortication mitigates the stress of upper cortical and cancellous bone area at the same height of the mandible 3. Perforation of the inferior mandibular cortex significant stress concentration. 4. Stud type porstheses induced less stress concentration to the cortical and cancellous bone than bar type prostheses. 5. Stress of implant apex for stud type was larger than that of bar type.

• Journal of Korean Dental Science
• /
• v.10 no.2
• /
• pp.74-81
• /
• 2017

This report describes two cases of complete arch implant-supported restorations. The first patient had seven dental implants in each arch with monolithic zirconia frameworks. At four weeks' follow-up, the one-piece maxillary framework was fractured, which was re-designed and re-fabricated using laser-sintered cobalt-chrome alloy. The second patient had four implants in the mandible only. A mandibular monolithic zirconia framework and a maxillary conventional complete denture were fabricated and delivered. At five years' follow-up, the patient reported no significant discomfort. Careful consideration and monitoring of the status of antagonistic arches and stress distribution on zirconia frameworks were suggested for complete arch implant-supported fixed restorations.

• The Journal of Korean Academy of Prosthodontics
• /
• v.57 no.4
• /
• pp.374-381
• /
• 2019

A conventional approach for the treatment of long-span edentulous areas is the use of removable dentures. However, placing implants in these areas results in superior functional outcomes by increasing the stability, support, and resistance of the prostheses and improving the masticatory efficiency. Treatment modalities utilizing implants can be further classified into either removable or fixed-type prostheses. Several factors such as the amount of alveolar bone resorption, inter-arch relationship, patient preferences, and socioeconomic status should be considered when determining the appropriate treatment approach. Monolithic zirconia has been considered a suitable material for implant-supported fixed dental prosthesis, because of the drastic improvement in its mechanical properties. It exhibits fewer incidences of fracture and chipping of the prostheses, and has greater bulk of material than metal-ceramic crowns and zirconia-veneered ceramics. Moreover, highly translucent monolithic zirconia is also available in the market, and its application is gradually increasing for anterior tooth rehabilitation. The present report describes a patient who underwent full-mouth rehabilitation with fixed dental prostheses (eight upper and three lower implant placements). All teeth, except bilateral mandibular canines and left mandibular first and second premolars, were extracted after the diagnosis of generalized chronic moderate-to-advanced periodontitis of the remaining teeth. The patient reported satisfactory esthetic and functional outcomes during the one-year follow-up visit.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.17 no.2
• /
• pp.107-112
• /
• 2001

The prosthodontic treatment of severely resorbed edentulous patients has been one of the frustrating areas due to extensive loss of tissues. The integrated neuromuscular balance among tongue, lip, and cheek is compromised. The retention, stability, and support are the three major factors to influence the clinical outcome. Fish described a denture as having three surface, with each surface playing an independent and important role in the over all fit, stability, and comfort of the denture. He recommended that the polished surface should be a series of inclines so that pressure from muscular activity will retain dentures. Within the denture space there is an area that has been termed the neutral zone. The neutral zone is that area in the mouth where, during function, the forces of the tongue pressing outward are neutralized by the forces of the cheeks and lips pressing inward. According to Jacobson and Krol, neuromuscular control interacts to provide retention and the relationship of polished surface of denture base to the surrounding muscular structure of orofacial capsule facilitates the stability and retention. This neutral zone concept has been demonstrated with various modification by a number of authors. The theory used to develop the denture base contours is based on the belief that the muscle should functionally mold not only the border but the entire polished surface. Lott and Walsh reported the clinical success on complete mandibular dentures with application of neutral zone concept. A number of studies demonstrated that denture stability and retention are more dependent on correct position of the teeth and correct contour of external surfaces of the denture in a severely resorbed alveolar ridge. This article presents a prosthodontic approach to treatment of a edentulous patient using neutral zone technique to improve the retention and stability of the prosthesis.

• The Journal of Korean Academy of Prosthodontics
• /
• v.61 no.4
• /
• pp.284-292
• /
• 2023

Stable posterior occlusal support is crucial for adequate masticatory function and facial aesthetics. In elderly patients over the age of 65, masticatory ability has a significant impact on nutritional intake and overall health. This case report presents a prosthetic treatment of an elderly patient with edentulous maxilla and bilateral posterior edentulous mandible. The upper jaw was restored with a complete denture to establish an ideal occlusal plane, and the three-dimensional positions of the mandibular implants were determined accordingly. The implants were placed through computer-guided implant surgery and were immediately loaded with fixed provisional restorations. The implant-fixed zirconia final restorations were inserted in the lower posterior region, and the occlusal surface of posterior artificial teeth in the upper denture was substituted with cobalt-chrome alloy to resist occlusal wear. The patient's posterior occlusal support and masticatory function were promptly restored through this treatment process, and long-term stability against wear was also obtained.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.33 no.4
• /
• pp.321-328
• /
• 2017

Treatment options for edentulous patients are complete denture and implant prosthesis. A two implant-retained overdenture can be considered the first treatment in the edentulous mandible, but there is no clear consensus of treatment for edentulous maxilla. Implant-retention/support overdenture shows better retention and stability than complete denture and is less expensive and more esthetic than implant-supported fixed prosthesis. CM $LOC^{(R)}$ $Pekkton^{(R)}$ attachment is a solitary type attachment and evaluated to have excellent abrasion resistance and retention with a female part made of poly-ether-ketone-ketone. Meanwhile, SR Ivocap system is injection molding method and discussed to show few changes in the vertical dimension of denture and have excellent fracture resistance. In this case, we restored maxillary arch with a four implant-retained overdenture using CM $LOC^{(R)}$ $Pekkton^{(R)}$ and SR Ivocap system, and mandibular arch with a removable partial denture. Through this procedure, satisfactory outcomes were achieved both in functional and esthetic aspects.

• The Journal of Korean Academy of Prosthodontics
• /
• v.31 no.1
• /
• pp.151-162
• /
• 1993

The author installed $3.75mm\times10mm$ $Br{\aa}nrmark$ osseointegrated implants and $3.5mm\times8mm$ I.T.I. hollow screw implants(Benefit) as a free standing abutment to replace lower left and right molars of 44-year-old female patient. Form the foregoing procedure, the author obtained the following results. 1. Free-standing $Br{\aa}nrmark$ and I.T.I. Hollow screw implants(Benefit) could be used to replace molars effectively without reduction of adjacent natural teeth, 2. Rotation of occlusal gold screw of $Br{\aa}nrmark$ implants was observed under occlusal force. 3. Adjustment of height of I.T.I. abutments was necessary in the mandibular second molar because of the limited occlusal clearance. 4. Form the oral examination, patient comments, panoramic and periapical radiographs, there were no pain, gingival imflammation and mobility, but slight reduction of alveolar bone level was shown around both implant systems. 5. Patient comments were comfortable on both systems. but the patient complained about economic problem of $Br{\aa}nrmark$ system and long treatment treatment time of both systems.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.16 no.4
• /
• pp.317-320
• /
• 2016

A 47-year-old woman was referred for surgical treatment of osteomyelitis of the mandible. She had already undergone three previous surgeries. Pre-anesthetic airway evaluation predicted a difficult airway, due to the thin, retro-positioned mandible, tongue, and atrophic changes in the lips and soft tissue. We inserted packing gauzes in the buccal mucosa for easier mask fitting and ventilation. During direct laryngoscopic intubation with a nasotracheal tube (NTT), fracture of a thin mandible can easily occur. Therefore, we used a fiberoptic bronchoscope to insert the NTT. After surgery, we performed a tongue-tie to protect against airway obstruction caused by the backward movement of the tongue during recovery. The patient recovered without any complications. We determined the status of the patient precisely and consequently performed thorough preparations for the surgery, allowing the patient to be anesthetized safely and recover after surgery. Careful assessment of the patient and airway prior to surgery is necessary.