[show abstract][hide abstract] ABSTRACT: 3D technology is increasingly being applied in dentistry and in oral and maxillofacial surgery. An important field of application is reconstructive surgery, especially in the reconstruction of large defects ofthe jaw. In such cases of reconstruction, the goal is the restoration of both the continuity of the defective area and its function. For the functional restoration implant supported dental structures are often employed. In such cases, CAD/CAM superstructures, 3D printed drill and saw templates, anatomical models, wafers and surgical outcome models are used. The combination of the digital planning and the digital fabrication ofsuperstructures and surgical aids offers many preoperative advantages. The use of saw, drill and positioning templates provides for accurate segmentation and implant positioning, by means of which the reconstruction can be carried out in a predictable way.
Nederlands tijdschrift voor tandheelkunde 09/2013; 120(9):462-8.
[show abstract][hide abstract] ABSTRACT: In the reconstruction of maxillary or mandibular continuity-defects of (dentate) patients, the most favourable treatment goal is placement of implant retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two step surgical approach for reconstruction of a mandibular defect using a free vascularized fibula graft with implants and a bridge.
A 68-year old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting/drilling guides were 3D printed and the bridge was CAD/CAM milled. During the first surgery, 2 implants were placed in the fibula according the digital planning and the position of the implants was scanned using an intra oral optical scanner. During the second surgery, a bridge was placed on the implants and the fibula was harvested and fixed in the mandibular defect guided by the occlusion of the bridge.
3D planning allowed for positioning of a fibula bone graft by means of an implant supported bridge which resulted in a functional position of the graft and bridge.
Head & Neck Oncology 01/2012; 4(2):44. · 3.13 Impact Factor
[show abstract][hide abstract] ABSTRACT: During the past decade, cosmetic facial treatments have become a standard element of the work of both dentists and oral and maxillofacial surgeons. A shift has taken place from invasive surgical treatments in the direction of minimally invasive treatments. One of the most frequently carried out minimally invasive treatments is the treatment with botulinum neurotoxin type A. Since botulism was first described in the 18th century, this neurotoxin has undergone a slow development to botox which is now manufactured. Botox attaches itself to the nerve endings and is subsequently taken up in the vesicles which contain acetylcholine. Botox blocks, there, the protein which is responsible for the production of acetylcholine. Botox reduces wrinkles in the skin at the muscles offacial expression and is therefore employed in areas with dynamic wrinkles. Appropriate areas include frown lines in the glabella, lines in the forehead, lateral periorbital lines, hyperactivity in the muscles of the upper lip, hypertrophy of the musculus masseter.
Nederlands tijdschrift voor tandheelkunde 10/2011; 118(10):488-94.
[show abstract][hide abstract] ABSTRACT: A 12-year-old boy was referred to the Department of Oral and Maxillofacial Surgery of a university clinic, one week after initial treatment related to a dental trauma due to a fall on a swimming pool slide. The treatment by the dentist on duty consisted of repositioning and splinting the maxillary central incisors. However, a radiograph of the affected teeth showed some unrecognizable objects around the left incisor. The nature and localization of the objects were not clear. Therefore, a cone beam computer tomography was incisor's socket and that this tooth was not repositioned correctly. A retreatment was carried out consisting of removing the objects and repositioning and splinting the left central incisor. Cone beam computer tomography may be of great value in determining the nature and extent of a dental trauma as well as in evaluating the treatment provided.
Nederlands tijdschrift voor tandheelkunde 06/2011; 118(6):317-9.
[show abstract][hide abstract] ABSTRACT: We assessed the microbiota of a tongue abscess in which twelve different aerobic and anaerobic bacteria were identified using fluorescent in situ hybridisation (FISH), sequencing of the 16S rRNA gene and phenotypic methods. By applying the 16S rRNA based probes directly on the clinical material, a quick insight of the bacteria present was obtained and the species which were not cultured but present in the abscess were identified.
[show abstract][hide abstract] ABSTRACT: Introduction:
Implant supported dentures enhance the masticatory and speech function in edentulous patients. Prefabrication of the fibula in cases of secondary reconstruction allows the planning of implant insertion in the fibula before harvesting the fibula. Here the first case is described of a 3D digitally planned implant placement and immediate prosthetic reconstruction of a mandible with a free vascularised fibula in a two step surgical approach.
A 54 year old male treated for oral squamous cell carcinoma developed osteoradionecrosis of the mandible. Reconstruction of the mandible with fibula bone was digitally planned from CT scans. The osteonecrosis of the mandible was virtually resected in the software. Next, the upper dentition and new lower prosthesis were digitally scanned and imported into the software in an anatomical correct position. Two pieces of the digitized fibula were virtually placed in the correct position in the mandible to support the lower dental prosthesis. Implants were digitally planned in the fibula bone for support of the prosthesis. Drilling guides were printed from the software to fit on the actual fibula.
First operation: the drilling guide was used to insert the dental implants in the fibula bone while still in position in the lower leg. After the actual insertion in the fibula, the position of the dental implants was digitized and the further prosthetic planning was done from these data. The wound was closed and left for 5 weeks for osseointegration of the implants.
After this a suprastructure and prosthesis were made and a cutting guide was digitally planned and printed.
Second operation: the osteoradionecrosis was resected, fibula was harvested and osteotomies performed according to the cutting guide. The suprastructure with denture was fixed on the pre-inserted implants after which the fibula was placed in the mandible followed by the vascular anastomosis.
It was possible to digitally plan backward from the desired occlusion of the dental prosthesis to the necessary implant position in the fibula. This new and exciting approach yields an optimal placement of the fibula bone in the jaw and immediate loading of the implant supported denture inserted in fibula bone.