Malignant tumors of the maxilla: virtual planning and real-time rehabilitation with custom-made R-zygoma fixtures and carbon-graphite fiber-reinforced polymer prosthesis.
BACKGROUND
Oral cancer is a mutilating disease. Because of the expanding application of computer technology in medicine, new methods are constantly evolving. This project leads into a new technology in maxillofacial reconstructive therapy using a redesigned zygoma fixture.


OBJECTIVE
Previous development experiences showed that the procedure was time-consuming and painful for the patients. Frequent episodes of sedation or general anesthetics were required and the rehabilitation is costly. The aim of our new treatment goal was to allow the patients to wake up after tumor surgery with a functional rehabilitation in place.


METHODS
Stereolithographic models were introduced to produce a model from the three-dimensional computed tomography (CT). A guide with the proposed resection was fabricated, and the real-time maxillectomy was performed. From the postoperative CT, a second stereolithographic model was manufactured and in addition, a stent for the optimal position of the implants. Customized zygoma implants were installed (R-zygoma, Integration AB, Göteborg, Sweden). A fixed construction was fabricated by using a new material based on poly(methylacrylate) reinforced with carbon/graphite fibers and attached to the implants. On the same master cast, a separate obturator was fabricated in permanent soft silicon.


RESULTS
The result of this project showed that it was possible to create a virtual plan preoperatively to apply during surgery in order for the patient to wake up functionally rehabilitated.


CONCLUSIONS
From a quality-of-life perspective, it is an advantage to be rehabilitated fast. By using new computer technology, pain and discomfort are less and the total rehabilitation is faster, which in turn reduces days in hospital and thereby total costs.
Ekstrand
Karl
K
Department of Prosthodontics, Oslo University, Oslo, Norway.
Hirsch
Jan-M
JM
D017076:Computer-Aided Design; D015921:Dental Implants; D003764:Dental Materials / Q000737:chemistry; D019094:Dental Prosthesis, Implant-Supported; D003779:Denture Design; D006108:Graphite / Q000737:chemistry; D006801:Humans; D021621:Imaging, Three-Dimensional; D008437:Maxilla / Q000601:surgery; D008439:Maxillary Diseases / Q000601:surgery; D008441:Maxillary Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D009361:Neoplasm Invasiveness; D010025:Osteoradionecrosis / Q000601:surgery; D010158:Palatal Obturators; D010347:Patient Care Planning; D019904:Polymethyl Methacrylate / Q000737:chemistry; D019651:Plastic Surgery Procedures / Q000379:methods*; D019292:Skull Base Neoplasms / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface; D015050:Zygoma / Q000601:surgery*
D015921:Dental Implants; D003764:Dental Materials; D006108:Graphite; D019904:Polymethyl Methacrylate