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Literature Reading
Friday, March, 19th, 2004
Fari Ananda
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Tumor resection
Loss from trauma
Unsuccessful healing of mandibular fracture
Osteonecrosis following radiation therapy
Atrophy due aging and dimeneralization
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Normal Occlusion
Neurtocclusion
Retrocclusion
Retrusive bite
Mesioocclusion
Protrusive bite
0,4%
18%
5%
3%
9%
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23 %
41 %
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Complete
Disarticulation
Oblique
Subcondylar
Osteotomy
Horizontal
Osteotomy
Above Lingula
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Options in Mandibular
Reconstruction
Alloplasts
Kirschner wire
Steinmann pin
Preformed appliances
Silastic
Acrylic
Fluoroethylene (Teflon)
Titanium tray
Vitallium (chromiumcobalt) tray
Polyurethane and Dacron
mesh
Options in Mandibular
Reconstruction
Pedicle flaps
Rib/pectoralis
major
Rib/latissimus
major
Scapula/trapezius
Clavicle/sternocleid
omastoid
Calvarum/temporal
is
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Free flaps
Rib
Scapula
Fibula
Ilium
Radius
Ulna
Humerus
Metatarsus
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Immediate Phase
Hematoma formation
Inflammation
Cells induction
Reparation
Primary bone healing Close defect, normal
bone remodelling with rigid fixation, no
external callus, type I collagen
Secondary bone healing Gap exists in fracture
fragment, no rigid fixation, callus formation
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Ideally similar
morphology
Reconstructing ramus or
TMJ
Hollowed out to form crib,
adapted to remaining
fenestrated to facilitate
host tissue ingrowth
fixed with screw
packed with PBCM
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Muscle/musculocutaneous
flaps
Pectoralis major
Trapezius
Latissimus dorsi
Sternocleidomastoid
Temporalis
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Vascular pedicle
Ilium
Scapula
Fibula
Radius
Ulna
Humerus
Metatarsus
Rib
34
Well vascularized
Sufficient length,
width, height
Natural contour
simulates shape of
mandible
Minimal morbidity
Accessible for twoteam approach
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Circummandibu
lar Wiring
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Continuous Wiring
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Direct
Osesseous
Transosseous
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Metal
Splints
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Screw is used to
stabilize lamellar
fracture
V 4 AS steels screws
2.0 2.7 mm
Interfragmental
compressions
Drilling process is a
critical part
Complication
Loosening of bone
screw
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47
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For segmental,
comminuted
fractures and
fractures of the
atrophic senile
mandible
Usually function as a
monocortical
retention plate
Satisfied for treatment
of pediatric fractures
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Indication
Long term stabilization
Maintenance space and spatial relationships
Contraindicated for IMF
Advantages
Relatively rigid immobilization
Exact spatial relationships may be maintained
Lack of instruments ang foreign body implantation
on fracture site
Disadvantages
Not cosmetically
Scars are produced at pin puncture
Bone infection and requires special equipment
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2. Implant-borne denture
Fixed, retrievable, most stable form
It is useful for one-quadrant restoration
3. Implant-assisted denture
Removable prosthesis supported by two or more
implants
in the symphyseal region
More stable and retentive than conventional
dentures
and less costly than the implant-borne
prosthesis.
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