FUNCTIONAL DENTAL REHABILITATION OF MASSIVE PALATOMAXILLARY DEFECTS -CASES REQUIRING FREE TISSUE TRANSFER AND OSSEOINTEGRATED IMPLANTS

Background: Mandibular reconstruction with functional dental rehabilit ation using a free tissue transfer bone flap as the substrate for osse ointegrated implant-borne or implant-retained dental prostheses is wel l described, Similar use of these techniques in maxillary dental rehab ilitation is less frequent and has received less attention in the lite rature, However. in selected cases of extensive composite defects of t he maxilla, free tissue transfer reconstruction of the maxillary arch and the use of implant-borne or implant-retained denial prostheses is the only satisfactory method of achieving functional denial rehabilita tion. Methods. Three cases of maxillary reconstruction and dental reha bilitation using free tissue transfer with implant-borne or implant-re tained prostheses are presented. Patient selection, reconstructive tec hnique, and the biomechanical considerations in maxillary denial rehab ilitation of large palatomaxillary defects are presented. Results. The patients in this report were restored to full maxillary dental functi oning, One implant of 17 implants placed in free flap bone was lost du e to failure of osseointegration; 94% of the implants placed are stabl e an average of 18 months after dental rehabilitation was complete. Co nclusions. In selected patients with extensive palatomaxillary defects due to ablative surgery or trauma, the use of free tissue transfer an d osseointegrated implant-borne or implant-retained dentures may be th e only method possible to restore maxillary denial function. Dental re habilitation of large maxillary defects presents a number of biomechan ical challenges which must he clearly understood and overcome to achie ve a longterm, functional dental rehabilitation. (C) 1998 John Wiley & Sons, Inc.