Total edentulism has been noted in 5% of adults whoare 40-44 years old. This percentage gradually increasesto almost 42% in seniors. By the time the baby boomersreach ages 65 and higher, it is expected that the numberof fully edentulous patients will become even higher.

The majority of general dentists are still fabricatingconventional complete removable dentures for theirfully edentulous patients. However, many of the patientsexperience instability of the lower denture and progres-sive loss of alveolar ridge.

The implant supported overdenture is a cost effectivetreatment modality for the edentulous patient. Educationon how to evaluate and treat patients for an implantsupported overdenture is paramount in providing excel-lent care without generating excessive expenses. One ofthe reasons contributing to the lack of interest amongrestorative dentists to offer implant supported overden-tures is the availability of over two hundred differentimplant attachments. This creates confusion regardingthe choice of attachment for each clinical situation.

Implant supported overdentures should be standard ofcare for all of the fully edentulous patients. Conventionalremovable complete denture should be offered to pa-tients only if there is a medical or dental contraindicationfor implant placement.

Discussion will focus on:a) Guidelines for patient selection, indications and

contraindications for implant-supported over-denture

b) Biomechanical analysis of different implant-sup-ported overdentures

c) Attachment selection guideline for implant-sup-ported overdentures

d) Various occlusal schemes for implant-sup-ported overdentures

e) Maximizing the communication between oralsurgeon, restorative dentist and lab technician

f) Surgical considerations for immediate implantplacement and loading in fixed detachable im-plant supported overdenture

g) Common surgical mistakes in implant overden-ture surgeries, reasons and solutions

h) Surgical considerations associated with implantoverdentures utilizing mini implants.

References

Oetterli J, Kiener P, Mericske-Stern R, A longitudinal study on man-dibular implants supporting an overdenture: The influence of retentionmechanism and anatomic-prosthetic variables on peri-implant param-eters. Int J Prosthodont 2001;14:536-542

Duyck J, Van Oosterwyck H, Vander Sloten J, Cooman M, Puers R,Naert I. In vivo forces on implants supporting a mandibular overden-ture: influence of attachment system. Clin Oral Inve 1999;99:201-207

Gotfredsen K, Holm B. Implant-supported mandibular overdenturesretained with ball or bar attachments: A randomized prospective 5-yearstudy. Int J Prosthodont 2000;13:125-130

Naert I, Hooghe M, Quirynen M, van Steenberghe D. The reliabilityof implant-retained hinging overdentures for the fully edentulous man-

dible. An up to 9-year longitudinal study. Clin Oral Invest 1997;1:119-124

S412Presurgical Psychological RiskAssessment: When, Why, and HowHillel D. Ephros, DMD, MD, Patterson, NJJennifer D. Lyne, MA, New York, NY

The success of elective maxillofacial procedures, par-ticularly those which may alter appearance, depends notonly on surgical outcomes but on patient perceptions.Adverse outcomes related to the patient’s psyche may beas devastating as medical and surgical complications. Assuch, it is of critical importance for surgeons to be ableto gauge patients’ psychological fitness before subject-ing them to experiences that might prove emotionallychallenging. Protocols for medical assessment of thepotential surgical patient lead to risk stratification and,when indicated, to treatment modification or deferralaimed at protecting the patient’s interests. In the ab-sence of protocols for psychological risk assessment,surgeons often rely on intuition and experience to assesspatients’ emotional fitness. The results of a recent surveyconducted by the presenters provide insight into psy-chological issues of importance to plastic and recon-structive and oral and maxillofacial surgeons. A detailedanalysis of the survey results will be presented. Thisprogram is designed to provide the basis for an objectivemethod of presurgical psychological screening and toidentify personality traits likely to be associated withperioperative difficulties.

References

Sarwer DB et al. The psychology of cosmetic surgery: a review andreconceptualization. Clin Psych Rev 18:1-22, 1998

Castle DJ et al. Does cosmetic surgery improve psychosocial well-being? MJA 176:601-604, 2002

Body dysmorphic disorder: 30 cases of imagined ugliness. Am JPsychiatry 150:302-308, 1993

S413The Microvascular Fibula: Applicationsfor Maxillofacial ReconstructionJason Potter, DDS, MD, Portland, ORDavid Hirsch, DDS, MD, New York, NY

Since its first description in the late 1980’s the freefibula flap has been the “work horse” flap for bonymaxillofacial defects. The combination of ease of har-vest, minimal donor sight morbidity, composite tissuetransfer, and reliability make it the flap of choice for bothmandibular and maxillary reconstruction. This surgicalclinic will cover harvest, microvascular technique and

Surgical Clinics

102 AAOMS • 2007

reconstruction of specific maxillofacial sites. The clinicwill also cover the challenging pre-operative, peri-oper-ative and post-operative management principles associ-ated with this microvascular free flap.

The two presenters will present clinical cases to illus-trate technical aspects relating to fibula harvest and con-siderations in maxillofacial reconstruction. A variety ofclinical cases will be presented for benign, malignant,congenital, and osteomyelitic processes. In addition, sitespecific reconstruction will be discussed.

Long term results including cosmetic and dental reha-bilitation will be presented. In addition, complicationsand donor site morbidity will be addressed.

The free fibula flap is a viable option to replace com-posite tissue defects in the maxillofacial skeleton. Thesurvival rates of this flap have been well documented forall maxillofacial sites.

References

Choi S, Schwartz DL, Farwell DG. Austin-Seymour M. Futran N.Radiation therapy does not impact local complication rates after freeflap reconstruction for head and neck cancer. [Journal Article] Ar-chives of Otolaryngology – Head & Neck Surgery. 130:1308-12, 2004Nov

Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-yearfollow-up study. [Journal Article] Plastic & Reconstructive Surgery.110:438-49; discussion 450-1, 2002 Aug

Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, LawsonW, Biller HF. Oromandibular reconstruction using microvascular com-posite flaps: report of 210 cases. [Journal Article] Archives of Otolar-yngology – Head & Neck Surgery. 124:46-55, 1998 Jan

S414Update on Management of Oral CancerJon D. Holmes, DMD, MD, Birmingham, ALEric J. Dierks, DMD, MD, Portland, OR

Approximately 30,000 patients will be diagnosed withoral cancer in the United States this year. The vast ma-jority (90%) of these will be squamous cell cancers. Oraland maxillofacial surgeons are involved in the manage-ment of patients with oral cancer. Frequently, it is anoral and maxillofacial surgeon who first sees a patientwith a suspicious lesion, and is confronted with breakingthe news regarding a biopsy that reveals malignancy. Forthese reasons, it is incumbent for them to be conversantin current diagnostic and treatment modalities.

The goal of this surgical clinic is to update the clini-cian in current diagnostic and treatment modalities fororal cancer. Included in the presentation will be newmodalities such as positron emission tomography (PET)scanning, intensity modulated radiation treatment(IMRT) and the role of combined chemo-radiotherapy, aswell as, advances in ablative and reconstructive surgicaltreatments.

References

Holmes J, Dierks E: Oral Cancer Treatment In Miloro (ed): Peterson’sPrinciples of Oral and Maxillofacial Surgery, Second Edition. Lewist-own, New York: BC Decker, 2004

Jemal A, Murray T, Samuels A, et al. Cancer Statistics, 2004. CACancer J Clin 2004;54:8-29

Pillsbury HC, Clark M. A rationale for therapy of the N0 neck.Laryngoscope 1997;107:1294-1315

S415Temporalis Muscle Flap forReconstruction of Intraoral DefectsA. Omar Abubaker, DMD, PhD, Richmond, VA

For reconstruction of small intraoral defects, localflaps can be used successfully with minimal morbidity.However, for moderate to large size defects, regional orfree flaps are often necessary. Because of the potentialmorbidity associated with free flaps, in some patients,regional flaps provide a more viable alternative. Amongthe regional flaps used, the temporalis muscle flap is themost versatile, associated with the least morbidity, andone of the most commonly used. In a case-based format,this lecture will review the different local and regionalflaps used for reconstruction of oral defects with empha-sis on the temporalis muscle flap. It will also review thesurgical anatomy and the surgical technique of tempora-lis flap, its uses, advantages and disadvantages in recon-struction of intraoral defects.

S416Management of Maxillofacial InjuriesSustained in Terrorist Attacks andWarfare: Protocols Based on theExperiences of Operation Iraqi FreedomDavid B. Powers, DMD, MD, Lackland AFB, TX

No abstract provided.

S421Diagnostic Imaging and SurgicalManagement of Cervical Lymph NodeMetastases in Patients With Oral CancerTakafumi Hayashi, DDS, PhD, Niigata, JapanHideki Tanzawa, MD, DDS, PhD, Chiba, Japan

This course provides the review of the recent ad-vances in research on the diagnostic imaging of cervicallymph node metastases in patients with oral cancer andthe interpretation of characteristic features of metastaticlymph nodes shown on various imaging modalities such

Surgical Clinics

AAOMS • 2007 103