Dr Paul Betts
Maxillo-Facial Surgeon
T: 011 462 5628| E-mail: accounts@drbetts.co.za
Sunset Square, 7 Sunset Lane, 3rd Floor
Lonehil, 2191
Originally researched by Prof Branemark and collaborators, in the late 1950’s, following research using a live microscope model on the microcirculation following injury, the science of osseointegration of bone anchored titanium implants was born. Implants have since been widely and comprehensively researched over several decades. Subsequently the clinical use of dental implants has been widely utilized internationally, and locally, with ever improving clinical protocols and understanding of bone and oral biology. This assists patients in restoring their masticatory function, oral health, aesthetics and hence their dignity and overall sense of well-being and normal functioning in society.
This treatment may take the form of implant supported removeable dentures or single, multiple or full arche replacement of teeth. These procedures may be staged with healing periods between implant placement and restoration or very often with immediate provisional restoration whenever possible.
In many instances the patient may have atrophy of the jaws following longstanding tooth loss that requires bone and/or soft tissue reconstruction prior to, or at the time of implant placement. In such cases, guided bone regeneration, Khoury graft, sinus lifting or distraction osteogenesis may be needed to reconstruct a predictable implant receptor site. These procedures demand a higher time and cost burden to the patient as well as a more challenging and advanced skill set for the clinician. In some cases, these procedures are contra-indicated due to medical problems or habits such as smoking or due to patients seeking a simpler approach. In many instances the popular all on-6 or all on-4 protocol may be effectively used.
When these treatments are not feasible, the practice of placing remote anchored or extra-oral implants in order to offer graft less surgery may be considered. These sites are known to offer better quality bone than the atrophied upper jaw and usually allow good primary stability. Well known examples include trans nasal, pterygoid and zygomatic implants. A combination of these implants, as well as ultra short implants often allow a faster more affordable patient solution that may be immediately loaded. Solid research exists to substantiate the use of these treatments and their long-term outcome.
A further use of extra oral implants is in the treatment of post-resection oncology cases. Implants are used to secure facial prostheses when skin adhesives are inadequate for retention. With the expert artistry of the maxillofacial prosthetist large facial prosthetics can be implant retained to provide the illusion of a natural face. These include auricular and orbital implants as well as partial or full-face prostheses. A clinical example of a simple case of extra oral implant use follows
Recently a 68-year-old female patient was referred to Cure Day Hospitals Fourways by her prosthetist. Her left orbital contents were removed 15 years prior due to a malignant tumour. She functioned with an implant secured ocular prosthesis until one implant was lost. Following clinical assessment and CBCT scanning a surgical guide was used to position three further 4mm extra-oral implants into a prosthetically driven implant position. One implant was placed in the supra-orbital ridge and two in the lower orbital margin, respecting the relevant surrounding anatomical structures. All implants achieved good primary stability. The patient was discharged the same day and reported minimal discomfort. She was subsequently referred for prosthetic ocular reconstruction.
While this case is relatively simple the planning and team collaboration is central to the outcome which should vastly improve the patient’s life.
