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Clinical Paper
Implants
extraoral implants
G. Pekkan1, S. H. Tuna2,
F. Oghan3
1
Department of Dentistry, Dumlupinar
University, Kutahya, Turkey; 2Department of
Prosthodontics, Faculty of Dentistry,
Suleyman Demirel University, Isparta, Turkey;
3
Department of Otolaryngology, Dumlupinar
University, Medical School, Kutahya, Turkey
G. Pekkan, S.H. Tuna, F. Oghan: Extraoral prostheses using extraoral implants. Int. J.
Oral Maxillofac. Surg. 2011; 40: 378383. # 2010 International Association of Oral
and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Abstract. The aim of this study was to evaluate extraoral prostheses and the use of
extraoral implants in patients with facial defects. 10 cases were treated utilizing
maxillofacial prostheses employing extraoral implants in five cases. 16 extraoral
implants were installed. Seven implants were placed in irradiated sites in the orbital
regions. Six implants were placed in mastoid regions and three in a zygoma region
that was irradiated. Two implants failed before initial integration was achieved in
irradiated areas. Using 14 extraoral implants as anchors, five extraoral prostheses
were set. The other five cases were treated with extraoral prostheses without using
extraoral implants due to cost and patient-related factors. The data included age,
sex, primary disease, implant length, implant failure, prosthetic attachment,
radiation therapy, and peri-implant skin reactions. The use of extraoral implants for
the retention of extraoral prostheses has simplified the placement, removal, and
cleaning of the prosthesis by the patient. The stability of the prostheses was
improved by anchors. Clinical and technical problems are presented with the
techniques used for their resolution. Using extraoral implants resulted in a high rate
of success in retaining facial prostheses and gave good stability and aesthetic
satisfaction.
Introduction
This study was presented as an oral presentation, European Prosthodontic Association Congress 2007, 1113 October, Athens,
Greece.
0901-5027/040378 + 06 $36.00/0
# 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
This study includes the prosthetic rehabilitation of 10 patients with facial defects
referred between September 2001 and
March 2006 (Table 1). Five patients were
treated with extraoral prostheses using 16
extraoral implants and the other five cases
were rehabilitated without using extraoral
implants. The patients mean age was 37
years (range 1362 years). Five males and
five females were included in the study.
Three females and 2 males were treated
with implants.
Figure 1 shows patient no. 7, who had
undergone numerous surgical revisions
over the years and was dissatisfied with
the result. She had right-sided hemifacial
dysostosis and an associated microtia. She
was treated with an extra-oral implant
retained auricular prosthesis. Figure 2a
shows patient no. 9, who was edentulous
379
Table 1. Patient data, date of referral, primary disease, defect size, radiation and treatment time.
Patient
no.
Age
(years)
Date of
referral
Gender
Primary disease
62
December 2001
46
November 2002
48
June 2003
50
December 2003
Congenitally
missing ear
Basal cell
carcinoma
Adenoid cystic
carcinoma
Squamous cell
carcinoma
40
November 2004
13
December 2004
14
May 2005
23
October 2005
60
October 2005
Squamous cell
carcinoma
10
14
February 2006
Goldenhar
Syndrome
Adenoid cystic
carcinoma
Congenitally
malformed ear
Hemifacial
dysostosis
and microtia
Traffic accident
Radiation
(Gy)
Time between
last operation or
irradiation to
implantation
(months)
Time between
implantation or
last operation
to prosthetic
treatment
(months)
>120
>36
> 60
15
50
60
18
380
[()TD$FIG]
Pekkan et al.
Fig. 1. (a) Close up of the defect area in patient no. 7, showing soldered Dolder bars and bar abutments screwed in implant abutments; (b) lateral
and (c) frontal view of the patient with auricular prosthesis in place.
[()TD$FIG]
Fig. 2. (a) Extraoral view of patient no. 9 before extraoral implant treatment; (b) Dolder bars soldered to the bar abutments were screwed in
implant abutments 6 months after implant surgery; (c) midfacial prosthesis in place.
[()TD$FIG]
Fig. 3. (a and b) Patient no. 10 with Goldenhar Syndrome and partial ear defect; (c) partial auricular prosthesis was attached to the frame of the
glasses.
Table 2. Data from the follow-up, including implantation site, implant size and failure, prosthetic treatment and challenges.
Retention and
prosthetic
attachment type
Length
of follow
up (month)
Implant number
and implantation
site
Implant size
(diameter/length)
Implant failure
diameter/length
58
46
22
18
32
3.3 mm/3.5 mm
24
3, supra and
infraorbital
rim
2, mastoid region
3.3 mm/4 mm
Grade 1
(one implant)
22
2, mastoid region
3.3 mm/4 mm
Grade 1
(one implant)
21
2, mastoid region
3.3 mm/4 mm
Grade 0
17
7, supraorbital
and zygoma
region
10
18
3.3 mm/3.5 mm
(5 implants)
3.3 mm/5 mm
(2 implants)
External auditory
canal and eyeglasses
Grade 1
(one implant),
excluding failed
implants)
External auditory
canal and
adhesives
External auditory
canal and
adhesives
Anatomical undercut
of orbital defect
Anatomical undercut
of orbital defect
Magnetic retention
Skin reactions*
Prosthetic challenges
Patients
prosthetic
complaints
Retention
Retention
Use of adhesives
and eyeglasses
Slight erythema
due to skin
adhesive
Orbital flour
secretion of
body fluids
Retention
Ocular positioning,
edge adaptation
Retention
0.2%
Nitrofurazone
Retention
Colour of
prosthesis
0.2%
Nitrofurazone
Marginal
adaptation
Relining
Marginal
adaptation
Relining
Difficulty in
seating the
prosthesis
Training
Colour
mismatch
in winter
Grade 1
(one implant)
Troubleshooting
The skin reactions were graded as follows: grade 0, no reaction; grade 1, reddish discolouration of the skin around the implant; grade 2, moist surface of skin around the implant; grade 3, formation
of granulation tissue around the implant; and grade 4, extensive soft tissue reaction requiring implant removal9,13.
Patient
no.
381
382
Pekkan et al.
None.
Competing interests
None declared.
Ethical approval
None.
Acknowledgements. The authors thank
Professors Dr. Yavuz Aslan, Dr. Canan
Hekimoglu, and Dr. Filiz Keyf for helpful
discussions on treatment of the cases.
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