Advanced implant reconstruction with simultaneous facial cosmetic surgery
1
fashion, including preoperative appointments, the tech- nique of the procedure, and the postoperative course. In addition, the indications, contraindications, risks, and complications will be discussed. On completion of the course, the clinician should have a good understanding of this procedure, and a great start to incorporating submental liposuction into the practice. References Ota BG: Cervicomental lipectomy as an adjunct to orthognathic surgery. Oral Maxillofac Surg Clin North Am 8, 1996 Kennedy B: Suction lipectomy of the youthful neck. Oral Maxillofac Surg Clin North Am 2, 1990 S315 Advanced Implant Reconstruction With Simultaneous Facial Cosmetic Surgery Gregory Thomas, DDS, Rochester Hills, MI Zenon Kossak, DDS, Rochester Hills, MI Dental implants are well recognized as the standard of care to replace missing teeth. Patients are actively seek- ing this restorative option and are well-informed con- sumers. This demographic of patient also possesses the high self-image to desire facial cosmetic enhancement. Our highly competitive marketplace, with its tight time restraints, encourages our patients to seek care with high regard to their professional convenience. This desire compels patients to “bundle” procedures. They then can use the same anesthesia experience, re- covery time, and surgical episode commitments of both dental implant reconstruction and facial cosmetic sur- gery. The convenience and economic savings of merging these procedures is becoming very popular. References Epker E: Esthetic Maxillofacial Surgery. 1994 Seckel B: Facial Danger Zones. 1994 Rotskoff K: Oral Maxillofac Surg Clin North Am 9, 1997 S316 Alveolar Cleft Surgery Lester Machado, DDS, MD, Chula Vista, CA Adel Tawfilis, DDS, San Diego, CA Secondary bone-grafting of the maxilla and the resid- ual alveolar clefts at the stage of transitional dentition, and in conjunction with orthodontic treatment, has be- come a well-accepted treatment modality. It has been incorporated in the management protocol of many cleft/ craniofacial teams as an adjunct procedure aiming to further improve the functional and aesthetic habilitation of patients with unilateral or bilateral cleft of the lip and palate. The decision and timing for secondary bone grafting are based on a combination of developmental, dental, orthodontic, and surgical factors. The dental rather than the chronological age of the patient should be the pri- mary factor guiding the decision for surgery. Ideally, bone grafting should be performed at the early transi- tional dentition stage, after the eruption of the perma- nent incisors but prior to the eruption of the permanent maxillary canines. Our center has favored orthodontic maxillary arch alignment, when possible, prior to bone grafting. Bone grafting is deferred in patients presenting with dental caries and severe gingival inflammation. The importance of adequate oral health and hygiene is emphasized, and necessary dental care is instituted prior to the proce- dure. All necessary extractions of deciduous teeth around the area of the cleft are performed at least 8 weeks prior to surgery to allow for soft-tissue healing and optimal soft-tissue conditions during the time of surgery. Using the gingival-mucosal 6-flap technique in combi- nation with iliac crest bone harvesting has yielded ex- cellent, predictable clinical results in the repair of uni- lateral and bilateral alveolar cleft defects. The protocol and surgical technique outlined allow for appropriate growth, function, and aesthetics of unilateral or bilateral alveolar clefts. References Boyne PJ: Bone grafting in the osseous reconstruction of alveolar and palatal clefts. Oral Maxillofac Surg Clin North Am 3:589, 1991 Boyne PJ, Sands NR: Secondary bone grafting of residual alveolar palatal defects. J Oral Maxillofac Surg 30:87, 1972 Troxell JB, Fonseca RJ, Osbon DB: A retrospective study of alveolar cleft grafting. J Oral Maxillofac Surg 40:721, 1982 S317 Soft Tissue Closure Techniques in Alveolar Cleft Grafting Chris Skouteris, DMD, DrDENT(Path), Athens, Greece Unilateral and bilateral alveolar clefts are associated with a variety of soft tissue problems that are usually the result of previous procedures for cleft lip and palate repair. These residual soft tissue deficiencies include exten- sive labial and palatal scarring, dense tissue bands that cause tethering of the upper lip with obliteration of the labial vestibule, and vestibular as well as palatal oronasal communications. Most of the existing soft tissue closure techniques in alveolar cleft grafting fail to address all of these soft tissue problems expeditiously. Moreover, they set the stage for the development of complications, namely Surgical Clinics AAOMS • 2003 123
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Transcript of Advanced implant reconstruction with simultaneous facial cosmetic surgery
fashion, including preoperative appointments, the tech-nique of the procedure, and the postoperative course. Inaddition, the indications, contraindications, risks, andcomplications will be discussed.
On completion of the course, the clinician shouldhave a good understanding of this procedure, and a greatstart to incorporating submental liposuction into thepractice.
References
Ota BG: Cervicomental lipectomy as an adjunct to orthognathicsurgery. Oral Maxillofac Surg Clin North Am 8, 1996
Kennedy B: Suction lipectomy of the youthful neck. Oral MaxillofacSurg Clin North Am 2, 1990
S315Advanced Implant Reconstruction WithSimultaneous Facial Cosmetic SurgeryGregory Thomas, DDS, Rochester Hills, MIZenon Kossak, DDS, Rochester Hills, MI
Dental implants are well recognized as the standard ofcare to replace missing teeth. Patients are actively seek-ing this restorative option and are well-informed con-sumers. This demographic of patient also possesses thehigh self-image to desire facial cosmetic enhancement.Our highly competitive marketplace, with its tight timerestraints, encourages our patients to seek care withhigh regard to their professional convenience.
This desire compels patients to “bundle” procedures.They then can use the same anesthesia experience, re-covery time, and surgical episode commitments of bothdental implant reconstruction and facial cosmetic sur-gery. The convenience and economic savings of mergingthese procedures is becoming very popular.
References
Epker E: Esthetic Maxillofacial Surgery. 1994Seckel B: Facial Danger Zones. 1994Rotskoff K: Oral Maxillofac Surg Clin North Am 9, 1997
S316Alveolar Cleft SurgeryLester Machado, DDS, MD, Chula Vista, CAAdel Tawfilis, DDS, San Diego, CA
Secondary bone-grafting of the maxilla and the resid-ual alveolar clefts at the stage of transitional dentition,and in conjunction with orthodontic treatment, has be-come a well-accepted treatment modality. It has beenincorporated in the management protocol of many cleft/craniofacial teams as an adjunct procedure aiming tofurther improve the functional and aesthetic habilitation
of patients with unilateral or bilateral cleft of the lip andpalate.
The decision and timing for secondary bone graftingare based on a combination of developmental, dental,orthodontic, and surgical factors. The dental rather thanthe chronological age of the patient should be the pri-mary factor guiding the decision for surgery. Ideally,bone grafting should be performed at the early transi-tional dentition stage, after the eruption of the perma-nent incisors but prior to the eruption of the permanentmaxillary canines.
Our center has favored orthodontic maxillary archalignment, when possible, prior to bone grafting. Bonegrafting is deferred in patients presenting with dentalcaries and severe gingival inflammation. The importanceof adequate oral health and hygiene is emphasized, andnecessary dental care is instituted prior to the proce-dure. All necessary extractions of deciduous teetharound the area of the cleft are performed at least 8weeks prior to surgery to allow for soft-tissue healingand optimal soft-tissue conditions during the time ofsurgery.
Using the gingival-mucosal 6-flap technique in combi-nation with iliac crest bone harvesting has yielded ex-cellent, predictable clinical results in the repair of uni-lateral and bilateral alveolar cleft defects. The protocoland surgical technique outlined allow for appropriategrowth, function, and aesthetics of unilateral or bilateralalveolar clefts.
References
Boyne PJ: Bone grafting in the osseous reconstruction of alveolar andpalatal clefts. Oral Maxillofac Surg Clin North Am 3:589, 1991
Boyne PJ, Sands NR: Secondary bone grafting of residual alveolarpalatal defects. J Oral Maxillofac Surg 30:87, 1972
Troxell JB, Fonseca RJ, Osbon DB: A retrospective study of alveolarcleft grafting. J Oral Maxillofac Surg 40:721, 1982
S317Soft Tissue Closure Techniques inAlveolar Cleft GraftingChris Skouteris, DMD, DrDENT(Path), Athens, Greece
Unilateral and bilateral alveolar clefts are associated witha variety of soft tissue problems that are usually the result ofprevious procedures for cleft lip and palate repair.
These residual soft tissue deficiencies include exten-sive labial and palatal scarring, dense tissue bands thatcause tethering of the upper lip with obliteration of thelabial vestibule, and vestibular as well as palatal oronasalcommunications.
Most of the existing soft tissue closure techniques inalveolar cleft grafting fail to address all of these softtissue problems expeditiously. Moreover, they set thestage for the development of complications, namely
Surgical Clinics
AAOMS • 2003 123
