Background: Mandibular reconstruction, after extensive resection of the mandible for the treatment of oral cancer, is a well-known procedure, however, relatively little is known about bone integration into the titanium implant after reconstruction with a temporary plastic implant. The main goal of this experimental study was to study the process of osseous integration into the titanium implant in an in vivo experiment following prior mandibular reconstruction with a temporary plastic implant. Materials and Methods: Four ewes initially underwent a partial one-sided resection of the mandible, with the formation of an approximately 3 × 1 cm defect. All of the subjects received reconstruction with an implantation of a plastic plate (3 cm). The plastic plate was removed and replaced by a titanium implant at 1, 3, 6, and 12 months, accordingly. Both plastic and titanium implants were made via 3D-printing technology and personalized modeling. A total of 6 months after titanium implantation, a histological evaluation of biointegration was performed. Results: All surgeries were uncomplicated. The integration of osseous tissue into the titanium implant was seen in all cases. Histologically, each case showed variable integration of dense fibrotic tissue with fibroblasts and non-mature bone tissue with a definitive layer of bone matrix with many osteoblasts on the periphery. The prior implantation of the plastic plate did not interfere with bone integration into the titanium implant. Conclusion: Preliminary results demonstrated that a temporary plastic implant for mandibular reconstruction does not interfere with the consequent osseous biointegration of a permanent titanium implant. This shows that temporary reconstruction is a safe solution when delayed mandibular reconstruction is required due to disease severity.
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет), Москва, Россия РЕЗЮМЕ В статье описан клинический случай, иллюстрирующий необходимость минимизировать объем хирургического вмешательства по установке имплантатов в зоне дискредитированных тканей после многократных хирургических и лучевых вмешательств. Пациентка перенесла 13 оперативных вмешательств, 4 реконструктивные операции и 3 курса облучения, что привело к формированию обширного дефекта лица. Ортопедическая конструкция была установлена на механически стабильные одноэтапные имплантаты в зоне дефекта с винтовой ортопедической платформой и остеоинтегрированные чресскуловые имплантаты в противоположной от дефекта зоне. Методика базируется на использовании результатов цифровой диагностики, подбора материалов для 3D-прототипирования каркаса, замещающего дефект и служащего опорным элементом для фиксации и стабилизации протеза обтуратора и лицевой маски. Ключевые слова: имплантат-протезная реабилитация, интраоперационное непосредственное протезирование, ангулярная, транс-скуловая имплантация, одноэтапная имплантация, атрофия верхней челюсти, постонкологическая реконструкция верхней челюсти.
With extensive damage of the facial skeleton, multiple bony and soft tissue cicatricial defects and deformations are formed. Traditional methods of reconstructive are reliably not able to restore the defects fully. Often the bony structures of the facial skeleton can't be restored in one stage. Additional reconstructive surgeries are needed. A problematic situation is the condition after multiple surgeries in the defect area. Failure of bone grafting is associated with cicatricial deformities and lack of soft tissue, lack of gingiva, defects in the vestibule and damaged periosteum. The main problem is constriction and subsequent atrophy and deformation of the soft tissue in the area of the defect. This complicates further treatment and often it isn't possible to restore the bone volume required for a successful dental implantation.Implant prosthetic rehabilitation in the area of extensive bone defects after a facial injury requires preparation that is more careful, design and prototyping of the outcome with the use of computer programs and diagnostic models. Biocompatible materials for dentistry and maxillofacial surgery are clinically proven and recommended for usage in patients at the treatment stages. Clinical experience with individual temporary endoprosthesis, so called "tissue expander", produced by layer-by-layer synthesis (3D-printing) from biologically inert plastic based on CT data of the patient is presented in this article. The expander is made in the form of a 3D element to form the required soft tissue volume in the patient for 4-6 months and is fixed in place subcutaneously, in the area of mandibular frontal defect, using intraosseous screws. Dental implants were placed laterally on both sides. The following was carried out intraoperative direct replacement, fabrication and placement in the mouth of a temporary screw-retained prosthesis.
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