M631: CT Guided Surgery Versus Conventional Surgery: Pros and Cons

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  • Wolford LM, Chemello PD, Hilliard FW: Occlusal Plane Alteration inOrthognathic Surgery. J Oral Maxillofac Surg 51:730-740, 1993

    Cottrell DA, Wolford LM: Altered Orthognathic Surgical Sequencingand a Modified Approach to Model Surgery. J Oral Maxillofac Surg52:1010-1029, 1994

    M631CT Guided Surgery Versus ConventionalSurgery: Pros and ConsEdmond Bedrossian, DDS, San Francisco, CA

    The growing interest for flapless surgery in conjunc-tion with immediate loading of the edentulous patientshas led to the development of software programs whichallow for treatment planning, fabrication of a surgicaltemplate as well as the production of a prosthesis whichcan be secured to the patient immediately following theplacement of the implants. This presentation will helpthe implant team understand the steps required for treat-ment planning as well as the fabrication of the provi-sional, immediate-load prosthesis once the surgical tem-plate has been produced from the stereolithographicmodel. The fact that the prosthesis is connected to theimplants immediately following the surgical procedureleaves no room for error. It is imperative that the Oraland Maxillofacial surgeon, the restorative dentist and thelaboratory technician be aware of each others abilitiesand limitations. Understanding each others responsibil-ities will lead to a more predictable outcome, minimizeerrors and allow for correction of minor discrepanciesduring the execution of this treatment concept.

    Immediate loading of the edentulous patient may alsobe predictably executed using chair side conversiontechniques immediately following the installation of theimplants. Treatment of certain clinical conditions includ-ing patients who have an existing full complement ofnon restorable teeth or existing implants with peri im-plantitis are better managed using chair side conversiontechnique. This presentation will compare and contrastanalogue vs. computer assisted protocols for the im-mediate loading of the edentulous patients.

    References

    van Steenberghe D, Naert I, Andersson M, Bajnovic I, Van Cleynen-breugel J, Suetens P, A custom template and definitive prosthesisallowing immediate implant loading in the maxilla: a clinical report, IntJ Oral Maxillofac Implants 2002;17:63-70

    Marchack CB, An immediately loaded CAD/CAM-guided definitiveprosthesis: A clinical report. J Prosthet Dentistry 2005. 93:8-12

    Verstreken K, Van Clynenbreugel J, Marchal G, Naert I, Suetens P,van Steenberghe D, Computer-assisted planning of oral implant sur-gery. A three-dimensional approach. Int J Oral Maxillofac implants1996;11:806-10

    Bedrossian E. Immediate stabilization at stage II of Zygomatic im-plants: Rationale and technique. Int J Oral Maxillofac implants 2000;15:10-14

    M632Advanced Approaches to OdontogenicCysts and TumorsRobert E. Marx, DDS, Miami, FL

    The odontogenic keratocyst is a cyst of known recur-rence potential. This is due to the potential of any onesingle cell left behind to clone into a new cyst. Ap-proaches to remove the entire cyst including wide ac-cess transoral approaches and extra oral approachesreduce recurrence to less than 3%. Straightforward enu-cleation and curettage is all that is necessary if accom-plished in a controlled direct vision access manner. Theuse of adjuncts such as Carnoys solution, phenol, andcryotherapy are unnecessary and only risk wound heal-ing complications and compromise bone regeneration inthe defect.

    Odontogenic tumors typified by the ameloblastomaare predictably cured by resective surgery with frozensection control. Today this resective surgery is combinedwith nerve preservation techniques, nerve re-anastomo-sis techniques, and more rarely nerve grafting to returnor restore sensation. In addition, when the condyle re-quires resection titanium condylar replacements inadults allow for precise retention of occlusion and max-imum function. In children, an allogeneic mandibularcondylar/ramus support acts as a scaffold for spontane-ous bone regenerations that will include the condyle andeven the curettage later pterygoid attachment for pro-trusive and working functions of the mandible.

    These improvements in surgical approach and materi-als permits surgeons to realize a higher quality outcomeand reduced recurrence rates.

    References

    Marx RE and Stern ed: Oral and Maxillofacial Pathology: A rationalefor diagnosis and treatment. Quintessence Publishing, Hanover Park,IL, 2004

    Carlson ER and Marx RE. The Ameloblastoma: Primary curativesurgical management. J Oral Maxillofac Surg 64:484-494, 2006

    Marx RE: Mandibular Reconstruction. J Oral Maxillofacial Surg 51:466-482, 1993

    M633Systematic Pretreatment Evaluation andTreatment of the Edentulous MaxillaWith Fixed ProsthesisEdmond Bedrossian, DDS, San Francisco, CA

    Many potential candidates for implant restoration ofthe fully edentulous maxilla are primarily interested inreceiving a fixed prosthesis as opposed to a bar/clipoverdenture. In a general sense, three alternative fixedprosthetic designs have been developed. The ability todetermine early in the consultation process which of the

    Surgical Mini-Lectures

    138 AAOMS 2008