Avtor/Urednik		Prodnik, Luka; Didanovič, Vojislav; Ihan Hren, Nataša; Eberlinc, Andreja; Maver, Tomaž; Kuhar, Milan; Kansky, Andrej
Naslov		Rekonstrukcija obraza z epitezo, sidrano na vsadkih
Prevedeni naslov		Facial reconstruction with an implant-supported epithesis
Tip		članek
Vol. in št.		Letnik 84, št. 5
Leto izdaje		2015
Obseg		str. 403-408
ISSN		1581-0224 - Zdravniški vestnik
Jezik		slv
Abstrakt		Izhodišče: V članku opisujemo rekonstrukcijo obraza z epitezami, sidranimi na titanijevih vsadkih. Podajamo naše klinične izkušnje z nadomeščanjem uhlja in orbitalnega predela. Materiali in metode: V niz primerov smo vključili devet bolnikov, ki smo jim med letoma 2006 in 2013 v kost vstavili 28 ekstraoralnih titanijevih vsadkov. Šestim bolnikom smo vstavili titanijeve vsadke po dvosejnem protokolu, trem po enosejnem. Štirje bolniki so imeli prirojeno pomanjkanje uhlja, pet bolnikov smo rehabilitirali po onkoloških operacijah, trije od njih so bili obsevani po operaciji. Dva bolnika sta imela pred vstavitvijo vsadkov in po njej pripravo s hiperbarično oksigenacijo. Analizirali smo uspešnost kombiniranega kirurško-protetičnega zdravljenja. Rezultati: Devetim bolnikom smo v obrazne kosti vstavili skupno 28 titanijevih vsadkov. Uspešno se je s kostjo zraslo (osteointegracija) 27 vsadkov, en kostni vsadek pa se ni integriral s kostjo in je izpadel (pri obsevani bolnici). Pri šestih bolnikih smo uspešno zaključili zdravljenje. Redno nosijo izdelano epitezo. V petih primerih smo nadomestili manjkajoči uhelj, v enem primeru oko in orbitalni predel. Pri treh bolnikih epiteze nismo mogli izdelati: pri enem zaradi tvorbe keloida nismo uspeli namestiti protetičnega ogrodja, dva sta zaradi napredovanja onkološke bolezni umrla. Zaključek: Rekonstrukcija obraznih struktur z epitezami, sidranimi na titanijevih vsadkih, je predvidljiva in uspešna. V določenih primerih je edina možnost za primerno estetsko in psihosocialno rehabilitacijo bolnika. Pogosta težava je pomanjkanje kostnega tkiva in spremenjena mehka tkiva neposredno ob vsadkih. Epiteze, sidrane na titanijeve vsadke, imajo zaradi boljše stabilnosti in izgleda prednost pred adhezivnimi epitezami.Background: In this article, a facial reconstruction with implant-supported craniofacial epitheses and our clinical experience with the substitution of auricular and orbital region are described. Materials and methods: In this case series, 9 patients with 28 endosseous implants performed in the period between 2006 and 2013 were included. Two-stage and one-stage procedures were opted for; the former in six patients, and the latter in three patients. There were four patients with congenital defects of facial structures, and five patients who had undergone ablative oncological surgery; three among them received postoperative radiotherapy. In two patients adjuvant therapy with hyperbaric oxygen was used before and after implantation. We analysed the success of combined surgical-prosthodontic treatment. Results: We placed 28 titanium implants in 9 patients. A successful osseointegration was observed in 27 implants; only one endosseous implant failed to integrate and fell out of the bone (in an irradiated patient). The final implantsupported epithesis was achieved in six patients. Among them there were five ear-substituting epitheses and one epithesis substituting the eye and periorbital region. The final epithesis could not be made in three patients; in one patient too much keloid formed to fix a prosthodontic bar to the implants, the other two patients died because of the progression of malignancy. Conclusion: The surgical technique for rehabilitation using implant-supported facial epitheses is simple and reliable. In certain indications, it is the only proper option for aesthetic and socially acceptable rehabilitation. The major problem remains soft tissues surrounding the implants. Due to their stability and appearance, the implantsupported epitheses are superior to the adhesiveretained epitheses.
Proste vsebinske oznake		facial deformities ekstraoral titanium implants epithesis reconstruction deformacije obraznih struktur ekstraoralni titanijevi vsadki epiteza rekonstrukcija