Page 274 - Demo

Chapter 10272reconstruction plate had been segmented out and was removed during implant insertion. The residual bony and titanium irregularities were difficult to match in the parasymphyseal region.(Fig. 4) Finally, the bony surface was smoothened, and extreme force was required to guide the condyle into a proper position mediolaterally. Intraoperative 3D Pulsera imaging (Phillips, Eindhoven, The Netherlands) was repeated three times. Stable occlusion and articulation were achieved, with full occlusal contact at both sides checked with thin double-sided articulating paper and a spontaneous maximal mouth opening of 31 mm. Still, the alloplastic condyle seemed caudally positioned in relationship to the fossa on the computed tomography (CT) scan, even taking into account, the ultra-high-molecular-weight polyethylene part of the fossa component being radiolucent.Fig. 4: Case # 2. Planning and postoperative result. (A) Surface tesselation language render with arrow indicating the mandibular defect. The left zygoma was replaced with a polyether ether ketone implant (blue). (B) Surface tesselation language render with the arrow indicating bony irregularities at the mandibular border after virtual removal of the titanium reconstruction plate using segmentalization. (C) Surface tessellation language render with the extended temporomandibular joint replacement indicated in gray. (D) Postoperative frontal view of the computerized scan of the cranium showing the condylar sag (arrow)Case #3This patient initially had pericoronitis of the lower right third molar, and subsequently developed osteomyelitis after the tooth was extracted. The infection did not resolve with antibiotics and decortication, so the patient Nikolas de Meurechy NW.indd 272 05-06-2024 10:15