FUNCTIONAL RECONSTRUCTION IN MANDIBULAR AVULSION INJURIES

Yoav Leiser, DMD, PhD, Dekel Shilo, DMD, PhD, Amir Wolff, DMD and Adi Rachmiel, DMD, PhD 
Published: The Journal of Craniofacial Surgery, Volume 27, Number 8, November 2016

ABSTRACT

The present report describes the planning and surgery as well as pitfalls and management of a patient with a near total mandibular avulsion injury that was rehabilitated using three-dimensional (3D) laser printing of a titanium lower jaw.

Laser-sintering involves zapping layers of powdered metal to recreate a 3D implantable skeletal defect.

The process involves using either mirror imaging of the unaffected side or using archival image database of healthy individuals. A 25-year-old man presented with a gunshot injury that left him with a near total avulsed mandible.

The patient received state-of-the-art treatment using a laser 3D printed mandible which was connected to the muscles of mastication for functionality.

The inner side of the titanium jaw was filled with the patient’s comminuted fractured bones in addition to harvested iliac crest bone graft that was covered with the patient’s remaining periosteal tissue.

The implantation of a near total mandible using 3D laser printing is a fast and predictable process that in selected patients can result in aesthetically as well as functionally excellent results. The authors believe that the future of craniofacial reconstruction will employ these methods for facial bony reconstruction.

Oral & Maxillofacial Surgery

RECONSTRUCTION OF COMPLEX MANDIBULAR DEFECTS USING INTEGRATED DENTAL CUSTOM-MADE TITANIUM IMPLANTS

A.Rachmiel, D.Shiloa, O.Blanc ,O.Emodi . Published: British Journal of Oral and Maxillofacial Surgery, 9 January 2017

ABSTRACT

Reconstruction of the craniofacial complex is challenging because of the unique anatomy, the presence of vital structures, and the diversity of defects. In craniofacial reconstruction, restoration of appearance and function is the primary goal. Autografts are the gold standard treatment, but they have several disadvantages, which has led to research into alloplastic materials.

The development of CADCAM systems allows for precise preoperative planning and design of patient-specific implants.

The workflow of custom-made implants is shown in Fig.1. Two-dimensional DICOM files were converted into 3-dimensional stereolithographic (STL) files and the custom-made implant was designed using ABGuided 3-dimensional software (A.B.Dental,Ashdod,Israel).

The skull and the implant were printed as an STL model in resin for compatibility tests using a 3-dimensional Objet260 Dental Selection printer (Stratasys©, Rehovot, Israel).

The titanium implant was then printed using a laser sintering 3-dimensional printer (EOS, Novi, MI, USA).

We present the case of a patient who had his facial bones reconstructed because of a large deficiency in the ramus, body, and angle of his right mandible caused by an ameloblas-toma.

BIOFILL-S is a porous synthetic ceramic, containing 99.9% beta tricalcium phosphate (β-TCP), designed for the filling of bone voids or defects, and is available in several geometries (granules, blocks, cylinders and wedges).

BIOFILL-S macro porosity and porous interconnectivity allows an excellent osteointegration, as well as a total vascularization of the implant with an excellent mechanical resistance.

BIOFILL-S is highly bioactive, stimulating the proliferation and differentiation of osteoblasts, allowing a total replacement by new vital bone during the healing process, within 1-6 months.

• Excellent mechanical resistant
• Excellent malleability
• Excellent bioactivity

Bone Grafts and Tissues from Human Source.

A cooperation between A.B. Dental and DIZG, the largest European Tissue Bank.

Indications for use

Granules:

• Ridge augmentation for future implant placement
• Osseous defects
• Socket Preservation
• Sinus lift
• Periodontal defects

Blocks:

• A predictable and highly effective alternative to traditional block grafting
• Ridge augmentation

• These 3D libraries enable precise computerized planning of the future restoration by scanning the implants and/or abutments of all types.
• The scanning information is used to produce precise restoration on AB implants using CAD/CAM.
• CAD/CAM technology simplifies the work flow, ensuring accuracy, speed and patient comfort.
• AB Dental products have been added to the libraries of a wide range of companies.
• Also for intraoral Scanning.
• Made from PEEK – A high performance, biocompatible thermoplastic polymer.

• These 3D libraries enable precise computerized planning of the future restoration by scanning the implants and/or abutments of all types.
• The scanning information is used to produce precise restoration on AB implants using CAD/CAM.
• CAD/CAM technology simplifies the work flow, ensuring accuracy, speed and patient comfort.
• AB Dental products have been added to the libraries of a wide range of companies.
• Also for intraoral Scanning.
• Made from PEEK – A high performance, biocompatible thermoplastic polymer.

• These 3D libraries enable precise computerized planning of the future restoration by scanning the implants and/or abutments of all types.
• The scanning information is used to produce precise restoration on AB implants using CAD/CAM.
• CAD/CAM technology simplifies the work flow, ensuring accuracy, speed and patient comfort.
• AB Dental products have been added to the libraries of a wide range of companies.
• Also for intraoral Scanning.
• Made from PEEK – A high performance, biocompatible thermoplastic polymer.
• Narrow platform-3mm diameter.

• These 3D libraries enable precise computerized planning of the future restoration by scanning the implants and/or abutments of all types.
• The scanning information is used to produce precise restoration on AB implants using CAD/CAM.
• CAD/CAM technology simplifies the work flow, ensuring accuracy, speed and patient comfort.
• AB Dental products have been added to the libraries of a wide range of companies.
• Also for intraoral Scanning.
• Made from PEEK – A high performance, biocompatible thermoplastic polymer.
• Narrow platform-3mm diameter.

• An abutment that connects a detachable prosthesis to an implant and stabilizes it.
• The abutments are provided with a stainless steel and silicon caps.
• Silicon caps are available in three degrees of hardness, 1-3, from the hardest to the softest.
• Available in different heights: 1mm- 6mm.
• Platform switching by design, allowing perfect environment for the soft-tissues growth and helps preventing bone resorption.
• The conical connection is shaped to assure sealing closure and absolute implant-abutment fastening.

• Multi-optional angular ball attachment, which is designed to stabilize a denture on tilted implants, provides the dentist a solution even at extreme angles.
• The angular ball attachment is provided with a stainless steel cap and a silicon intermediate cap.
• The silicon cap is available in three degrees of hardness 1-3, from the hardest to the softest.
• Available in different heights: 1mm- 6mm.
• Issued patent.
• The ball is not welded to the abutment, but made of one unit.
• This feature reduces the possibility of potential detachment of the ball from the abutment.
• Provides multiple solutions for difficulties in affixing and removing over dentures, side pressures from other teeth/implants and prevents wear of ball attachment.
• Excellent solution for non-parallel implants, even at extreme angles, for accurate joints on over denture implants.
• Platform switching by design, allowing perfect environment for the soft-tissues growth and helps preventing bone resorption.
• Narrow platform-3mm diameter.