title: Functional and cosmetic reconstruction of the facial lower third associated with placement of the transmandibular implant system.
abstract: OBJECTIVE
  Conventional preprosthetic procedures have typically focused on improvement of denture base stability and retention and have ignore patients' concerns about facial appearance and articulation difficulties. Soft tissue procedures have been developed, combined with insertion of the transmandibular implant (TMI) system through a submental incision, for functional and cosmetic reconstruction of the lower face to improve speech and facial esthetics, and prevent gingival hyperplasia along the lateral posts of the implant.
  
  
  METHODS
  The surgical procedure was evaluated in 146 patients with slight, moderate, severe, and extreme mandibular atrophy classified according to the proportion of muscle origin loss on the edentulous mandible. Preoperative, 3-month, and 1-year postoperative full-face and profile photographs were taken. Patients also were questioned about their satisfaction with their facial appearance and speech at these intervals. Gingival hyperplasia along the TMI posts was scored as present or absent.
  
  
  RESULTS
  Satisfaction with the soft tissue reconstruction in 146 patients treated according to this protocol was high, with almost every patient describing the positive comments they had received from their friends and relatives. Postoperatively, none of the patients requested a temporary denture to use during the 12-week incorporation period, although this was a common cosmetic and speech concern preoperatively. Gingival hyperplasia secondary to muscle pull was controlled satisfactorily.
  
  
  CONCLUSIONS
  With the described technique for placement of the TMI system, not only is masticatory function improved, but also the lower third soft tissues of the face are functionally and cosmetically reconstructed to the satisfaction of the patients.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH 44106-4905, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Powers
authors.forename: H
authors.initials: H
authors.lastname: Bosker
mesh_terms: D000273:Adipose Tissue / Q000601:surgery; D001284:Atrophy; D002680:Chin / Q000601:surgery; D003238:Connective Tissue / Q000601:surgery; D000044:Dental Abutments / Q000009:adverse effects; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D004955:Esthetics, Dental; D005152:Facial Muscles / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D005885:Gingival Hyperplasia / Q000517:prevention & control; D006801:Humans; D007575:Jaw, Edentulous / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D013516:Oral Surgical Procedures, Preprosthetic / Q000009:adverse effects / Q000379:methods; D017060:Patient Satisfaction; D013060:Speech
chemical_list: D015921:Dental Implants