The removal of certain facial-bone defects is a prerequisite to restoration of function, stability, and appearance. Synthetic bone substitutes are beneficial in cases where other operative techniques would be an unacceptable burden for a patient. Satisfactory results can be achieved in one surgical intervention with low costs and low demand on technical equipment. Osteoconductive, biocompatible, non-resorbable glass-ceramic implants based on oxyfluoroapatite and wollastonite permit osteointegration--a direct physical and chemical bond between live bone tissue and the implant without formation of a fibrous capsule. They display better stress durability in simulated body fluid than hydroxyapatite implants do. This material was used for facial skeletal framework, contour restoration in 44 cases under conditions where other solutions were doubtful. Patients were observed for 24.8 months. Immediate healing occurred without any adverse reaction. The main problem was extrusion, observed in 20.45% cases over a 2-3 month period after the implantation. All cases, with one exception, were solved with a satisfactory final result by reoperation, implant size reduction, and increased soft tissue cover. This approach was found to be a suitable technique, especially for patients exhausted by prior incompetent treatment but still dissatisfied with their appearance. Successful reconstruction with a bone substitute may remarkably increase quality of life for affected persons and, at the same time, reduce surgery-related time and costs.
A dental implant may be used in prosthetic tooth reconstruction in cleft patients. There are three main indications for this approach: substitution of a missing single tooth, an abutment for the framework, and an abutment for a fixed dental prosthesis (we designate these as defect types I, II, and III). A clinical report about prosthetic rehabilitation using dental implants instead of a fixed or removable partial prosthesis is presented. A patient with a unilateral cleft defect was treated at the University Hospital in Prague, Czech Republic. Together with a missing lateral incisor, the defect was associated with agenesis of the two upper canines and three second premolars. The treatment was completed by prosthetic dental reconstruction using the framework with a dental implant as an abutment. This approach allowed minimizing the preparation of adjacent teeth to a single tooth functioning as the second abutment. If classical fixed prosthodontics had been performed, the preparation would have involved a larger group of intact teeth with the risk of their viability loss. The procedure had no complications. The outcome was of high quality and brought satisfaction to the patient.
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