Andrew Dawood, MRD RCS, MSc, BDS1/Susan Tanner, MRD RCS, MSc, BDS2
Iain Hutchison, FFDRCSI, FRCS (Eng and Edin), FDSRCS, MBBS, BDS3/
Extraoral implants have been used for many years to anchor silicone nasal prostheses. This report describes
the design and use of a specially engineered bifunctional implant, which is placed via an intraoral approach,
to simultaneously anchor nasal and oral prostheses for an edentulous patient who has undergone a
complete rhinectomy. The bifunctional implant was designed and milled from commercially pure titanium
using computer-aided design/computer-assisted manufacturing (CAD/CAM) technology. The nasal part of
the implant was designed to fit through the prepared site and protrude into the piriform aperture. A hex
attachment was orientated perpendicular to the axis of the implant on this extension. The intraoral head
of the implant was provided with a standard Brnemark hex configuration. Implants were placed using the
guide and associated instrumentation. This case demonstrates the potential for CAD/CAM technology to
produce bespoke implantable components at low cost. In this report, the implant greatly facilitated the
surgical and prosthetic management for the simultaneous provision of nasal and oral prostheses. Int J Oral
Maxillofac Implants 2012;27:e90e92
Key words: bifunctional implant, nasal implant, nasal reconstruction
1Specialist
Case Report
This report describes the design and use of a bifunctional implant to treat an edentulous patient who had
undergone a complete rhinectomy. The objective was
to design an implant capable of retaining a nasal prosthesis inserted into the nasal cavity from an intraoral
approach. The intention was to utilize standard surgical
instruments and prosthetic components. The implant
was designed in computer-aided design/computer-assisted manufacturing (CAD/CAM) software with a nasal
extension that could fit through the prepared site. This
nasal extension incorporated a standard hex connection. The implant (Fig 1) was machined from a type IV
titanium rod using a computer controlled lathe and
multiaxis mill.
To facilitate access to the nasal prosthetic platform,
the hex was orientated perpendicular to the axis of
the implant, on a flattened extension of the implant.
To fit this portion through the prepared site, the hex
was given a narrow platform (NP) configuration, and
the diameter of the body of the implant was slightly
increased from that of a standard Brnemark regular
platform implant to 4.3 mm.
The aim was to surface treat the portion of the implant that was in contact with the bone. Those portions
of the implant that traveled into the nasal aperture, or
were in contact with the nasal mucosa or gingivae,
were left with a machined surface. The intraoral head
of the implant was provided with a standard regular
platform (RP) Brnemark hex configuration.
Dawood et al
2012 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
Dawood et al
Acknowledgment
The authors thank Lars Jorneus and Fredrick Stromberg of Nobel Biocare for the provision and prompt delivery of the bifunctional implants for the treatment carried out for this patient.
References
1. Singh G, Withey S, Butler P, Kelly M. Forehead flap method for total
nasal reconstruction. Asian J Surg 2006;29:101103.
2. Lundgren S, Moy P, Beumer J III, Lewis S. Surgical considerations for
endosseous implants in the craniofacial region: A 3-year report Int J
Oral Maxillofac Surg 1993;22:272277.
3. Roumanas E, Freymiller E, Chang T, Aghaloo T, Beumer J III. Implantretained prostheses for facial defects: An up to 14-year follow-up
report on the survival rates of implants at UCLA. Int J Prosthodont
2002;15:325332.
4. Bowdena J, Flood T, Downie IP. Zygomaticus implants for retention
of nasal prostheses after rhinectomy. Br J Oral Maxillofac Surg
2006;44:5456.
5. Dimitroulis G. Nasal implants following nasectomy. Int J Oral Maxillofac Surg 2007;36:447449.
6. Karakoca S, Aydin C, Yilmaz H, Bal BT. Survival rates and periimplant
soft tissue evaluation of extraoral implants over a mean follow-up
period of three years. J Prosthet Dent 2008;100:458464.
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