Page 16 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings
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Chapter 1
2.2 Craniomaxillofacial (CMF) prosthetic rehabilitation
Craniomaxillofacial (CMF) prosthetic rehabilitation postures a valid alternative when surgical reconstruction is not feasible or desirable19,20.
Traditionally, retention of maxillofacial prostheses involves the use of medical- grade skin adhesives, anatomic undercuts, or connection to spectacles or intraoral prostheses21. The use of adhesives, however, has several disadvantages, including instability, discoloration of the prosthesis, dermatologic reactions, and poor performance during activity or perspiration22-24.
3. CRANIOMAXILLOFACIAL (CMF) IMPLANTOLOGY
Since the success of intraoral endosseous implants, the introduction of the osseointegration concept in the late 1970s/early 1980s, has drastically improved prosthetic rehabilitation of CMF defects with regard to improved retention, aesthetic outcome, and ease of placement21,25. Endosseous implants are nowadays established as viable, secure treatments in prosthetic rehabilitation of CMF defects, allowing tumor cavities to be accessed for inspection of possible recurrences and improving patient acceptance, level of function and quality of life26,27. Disadvantages include the inapplicability for replacement of mobile parts of the face, necessity of prosthetic- and implant maintenance and the risk of implant dislodgment when loaded unfavorably4,21,28. CMF implants can be categorized as systems with solitary implants, such as the Brånemark System (Nobel Biocare AB, Gothenburg, Sweden), or the ITI System (Institut Straumann AG, Waldenburg, Switzerland.) and sub-periostal systems that are fixed with several bone screws, like the Epitec® system (Leibinger Stryker, Freiburg, Germany.) and the Epiplating Plate System® (Medicon, Tuttlingen, Germany.). The latter can be combined with a hearing device abutment4,24.
3.1 Virtual planning and surgical templates
Successful prosthetic driven rehabilitation depends upon accurate diagnosis, preoperative planning, and subsequent placement of endosseous implants29,30.
The development of multi-slice computed tomography (MSCT), multi-detector computed tomography (MDCT) and cone-beam computed tomography (CBCT) allows all three dimensional (3D-) visualization and objective measurement of bony dimensions prior to implant placement31.

























































































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