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ePaper created 2015-09-15, 12:06:46 | version 1.38.0
I case report Fig. 6_The middle piece should hold two pieces in place at the front. Fig. 7_The prosthetic, permanent middle section. Fig. 8_After the healing period: Insertion of the prosthetic component with unscrewing und removing of the surgical middle part. Fig. 9_Insertion of the prosthetic middle section, carrying the teeth. Fig. 10_Fixation of the prosthetic middle section. Fig. 11_Final prosthesis shown over the patient's model. fibula.Owingtotheextentofstructureloss,thegraft alone failed to yield the anticipated results. Needless to say, the ultimate goal of the treatment was to im- prove the aesthetics and retrieve the function of the reconstructedjawbyaprosthetictreatmentandgiv- ingthepatientachancetoexperienceanalmostnor- mal mastication once more. However, the form and size of the grafted bone could not provide the re- quiredsupportforprostheticstructuressuchasden- tal fixtures. Eventually, the surgical team decided to seek as- sistance from DRSK and use its 3-D services expert- isetodesignandmanufactureanadhocmandibular implant that fully complies with the patient’s un- favourable conditions and enables the complemen- tary prosthodontics treatment. The overall shape of the implant and its relation with other anatomic structures, including the grafted bone and the soft tissue were all fleshed out and requested by the sur- gical team. One stipulation of the surgical team was tokeepthepreviouslygraftedfibula.Theyconsidered it as a safety measure in event of implant’s failure. Thedesignsolution Onebigchallengetocarryoutthisparticularproj- ectwastodesigntheimplantinsuchawaythatitcan be easily seated in the correct position. There were twomajorimpedimentstoaone-pieceimplantsolu- tion. First of all, the implant was intended to be mounted over the remaining parts of the patient’s jaw, i.e. his two rami. To achieve the maximum an- chorage from the rami, those parts of the implant connectingthemweresupposedtoadapttotheirex- ternalanatomy.Sincetheramiconvergetothefront, the same was expected from the corresponding im- plant design. However, such designing choice would have made the matters complicated for surgical place- mentoftheimplant.What’smore,thefibroustissues resulting from the previous surgeries have dramat- icallyreducedthepatient’sabilitytoopenhismouth. Therefore, DRSK 3-D design team had to cross out theone-pieceimplantsolution.Eventuallybytaking differentlimitationsintoaccountandafterconsult- ing with the surgical team and receiving their en- dorsement, it was decided to make the prosthesis in three pieces. Each of the two larger left and right segments of the implant was designed to be placed and screwed individually over the corresponding ramus (Fig. 3), while at the front they met and dovetailed into each other (Fig. 4). A third part then had to be placed over the two pieces at their interface, embrace both and holdthemtogethersecurely(Figs.5&6).Thiswaythe whole thing turned into a unified structure. 26 I implants3_2015 Fig. 9 Fig. 11Fig. 10 Fig. 6 Fig. 8Fig. 7