Advanced implant reconstruction with simultaneous facial cosmetic surgery

Advanced implant reconstruction with simultaneous facial cosmetic surgery
August 2003
Gregory Thomas, DDS, Zenon Kossak, DDS
Journal of Oral and Maxillofacial Surgery Online
Dental implants are well recognized as the standard of
care to replace missing teeth. Patients are actively seeking
this restorative option and are well-informed consumers.
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 ǃ?bundleǃ? procedures.
They then can use the same anesthesia experience, recovery
time, and surgical episode commitments of both
dental implant reconstruction and facial cosmetic surgery.
The convenience and economic savings of merging
these procedures is becoming very popular.
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 primary
factor guiding the decision for surgery. Ideally,
bone grafting should be performed at the early transitional
dentition stage, after the eruption of the permanent
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 procedure.
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 combination
with iliac crest bone harvesting has yielded excellent,
predictable clinical results in the repair of unilateral
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