It is a considerable challenge for a prosthodontist to rehabilitate and sustain the prosthesis in edentulous patients with bilateral maxillectomy. Compelling evidence is lacking with respect to the treatment outcome when the maxillary defects are closed surgically in comparison to their prosthetic rehabilitation. Four edentulous male patients, with bilateral maxillectomy defects were referred for prosthodontic intervention to meet their nutritional and speech issues. In the absence of intra oral supporting and retentive structures, it was decided to retain the obturator utilizing extraoral aid to address their functional needs.
Customized headgear face‐bow retained obturators were adequately retentive and did serve its purpose well in all four patients. It also gave the liberty to alter retention and refine the prosthesis at will, provided access to the operated site for a quick evaluation of disease recurrence, and was economical to the patients. Considering the encouraging outcome experienced in this special category of individuals, it would be reasonable to believe that the headgear face‐bow assembly has an immense potential to function as a valuable, prudent, and a viable retentive aid for a non‐implant retained obturator in edentulous patients with extensive maxillary defect.
Diode lasers have been used for multiple applications in dentistry; however, its use for soft tissue management around dental implants has not been reported much. The role of symmetrical gingival tissue with properly positioned zenith is paramount to achieving aesthetics. The gingival zenith can be described as the most apical point on the marginal gingiva; its ideal placement should be at the crest of the curvature of the gingival margin for the central incisors, canines, and premolars, this should be ideally located slightly distal to the middle of the long axis on these teeth. This produces a slight inclination of the distal root which plays a vital role in the foundation of a beautiful smile. If this gingival complex is malpositioned in maxillary anterior region, it may result in an unaesthetic appearance even if the artificial teeth are perfectly aligned. Here, authors are presenting two patients with missing anterior teeth, who were not satisfied with the final aesthetic outcome of their implant supported prostheses. Due to history of trauma and painful course of treatment, patients were not comfortable with one more exposure to injectable anaesthesia, use of scalpel, or long healing process when they were almost nearing completion of their treatment. So, Diode laser was used for soft tissue excision around implants followed by gingival contouring in pontic region to achieve the desired gingival zenith and contour. The procedure was painless, blood free, followed by quick healing and effective in achieving optimal aesthetic outcome for both the patients.
Soft tissue healing around implants may turn out to be the most decisive factor in the success or failure of the prosthesis. Dimension, configuration, and material of the healing abutments play a pivotal role in achieving optimal soft tissue architecture around implants. Digital imaging with computer-aided designing and computer-aided machining (CAD-CAM) technology, has made it easier to illustrate, design, replicate maxillofacial structures, and generate its supporting elements in a reliable, faster, and more convenient manner. This case report highlights the issue relevant to the implant-supported prosthetic replacement, on a site previously attempted for surgical reconstruction of the missing ear. Presurgical DICOM data were used to obtain custom CAD-CAM polyetheretherketone (PEEK) healing abutments on implants in a patient with an excessive amount of tissue in the missing right ear region. It is probably the first extraoral use of PEEK as a healing abutment in the workflow of implant retained maxillofacial prosthetics. No issue warranting the removal of the PEEK component was observed during the duration of its use.
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