Every one should update himself according to the recent advances in every single profession/department. These are some of advancements We got in OMFS. We have also some latest advances and future advances under study that is going to be released in near future. BE HIGHTECH HIGH QUALITY UPDATED AND INFORMED PROFESSION.
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
Recent Advances in Oral and Maxillofacial Surgery Imaging and Navigation
1. Recent Advances in Oral
and Maxillofacial Surgery
By: LIDETU AFEWORK ANJULO
(DMD, MSc, OMFS) and
Dr. BETHEL MESFIN SEYOUM, DMD
2. Outlines
• Introduction
• Advances in the Field of Radiology
and Imaging
• Intraoperative Navigation
And Robotic Surgery
• Minimal Invasive Surgery and Role of
Endoscopes in Oral and Maxillofacial Region
• Tissue Regeneration/Engineering in
Oral and Maxilla-Facial Surgery
• Advances in Local Anesthetics
• Advances in General Anesthesia
• Advances in TMJ
• Recent Advances in Maxillofacial
Trauma Management
• Approaches to facial skeleton
• Advances in Primary care
• Facial transplant
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
2
3. Introductions
• As clinicians involved in direct patient care, it
is our fundamental duty to keep abreast with
latest advances in the field of medical
sciences and use these technologies
judiciously for the benefit of the patients.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
3
4. Advances in the Field of Radiology
and Imaging
• There are faster and powerful computed
tomography (CT) and magnetic resonance
imaging (MRI) machines backed by advanced
soft wares and graphics, which have given the
capability to capture images of any part of the
body in great detail.
• With the use of digital radiography it is possible
to see images instantaneously with decreased
dose of ionizing radiation. The images can be
stored, manipulated, and retrieved easily.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
4
5. Cont………
• CT angiograms give accurate pictures of
vascular anatomy in vascular lesions. Further,
data generated by CT in the form of ‘Digital
imaging and communication in medicine’
(DICOM) files can be used to construct actual
3 dimensional (3D) models.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
5
6. Cont………
• MRI is an important tool in
the diagnosis of head and
neck pathologies.
• Major advantage is that it
does not use ionizing
radiations and gives
excellent soft tissue details.
• It is useful in evaluation of
head and neck
malignancies,
temporomandibular joint
(TMJ) pathologies and
vascular lesions.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
6
7. Cont………
• MRI angiograms are
helpful in differentiation
between high flow and
low flow vascular
malformation.
• DICOM data generated
from MRI can also be
used for production of
stereolithographic
models.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
7
8. Positron Emission Tomography
(PET) and PET/CT
• These modalities have the potential to help in
staging, identifying responses to nonsurgical
therapy and allowing early detection of
recurrence of patients with head and neck
cancer.
• The positron emission tomography is used to
study in vivo metabolic processes by using
physiologically active compounds labelled
with short acting positron emitting isotopes.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
8
9. Cont………
• Positron emitting tracers, e.g. oxygen-15, nitrogen-13,
and fluorine-18 can bound to a variety of molecules,
which are used in the human metabolic pathways.
Fluorodeoxyglucose (FDG) is the most widely used
tracer with PET imaging.
• When administered intravenously, FDG is trapped as 2-
deoxyglucose-6-phosphate within cells. The unstable
photon rich fluoro nucleus rids itself of excessive
charge with emission of a positively charged electron,
becoming a more stable nucleus.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
9
10. Cont………
• These positrons travel a millimetre or less in the tissues
before interacting with electron resulting in an annihilation
reaction, which results in release of two photons at
approximately 180 degrees to one another (gamma
photons). Detection of these photons by detectors is used
to build-up three dimensional representations of these
events. The data are displayed in a manner similar to
conventional sectional imaging.
• These images produced reflect glucose uptake within
various tissues.
• The application of PET-FDG in detection of malignancy
arises because of the hallmark of the malignant cells,
which is increased glucose metabolism.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
10
12. Cont………
• One of the main advantages
of PET/CT is that, it can
pick-up the lesions in early
stage before these are
morphological evident,
which leads to earlier
diagnosis of tumors.
• It is helpful in head and
neck malignancy to detect
metastatic or recurrent
disease and occult primary
unknown cancer.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
12
13. Cont………
• It can demarcate tumor
margins at sites, where it is
difficult to evaluate the tumor
clinically.
• It is particularly helpful in
areas, where it is difficult to
separate recurrence from
changes resulting from
previous treatment, such as
surgery and radiotherapy.
• It can establish whether
enlarged lymph nodes contain
tumor or are reactive and it
can detect small foci of
disease
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
13
14. Cont………
• It assess the whole
body in one step with a
much lower dose of
radiation than whole
body CT.
• Other use of PET/CT is
in evaluating growth
abnormalities of the
temporomandibular
joint such as condylar
hyperplasia
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
14
16. Stereophotogrammetry and
Laser Surface Scanning
• These are the two most
commonly used
techniques to capture the
three dimensional surface
images of face.
• Stereophotogrammetry
uses two or three
cameras configured to a
computer to capture a
stereo image of face by
means of triangulation.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
16
17. Cont………
• In laser surface scanning the
light and camera technology is
used to capture the image
exact position of surface point
on the object.
• Then computer software is
used to synchronize the data
and generate a 3D image.
• These images can be used for
diagnosis, treatment planning
and comparison of surgical
outcome, as these images are
highly accurate (up to 0.5 mm
accuracy).
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
17
18. Co
• The maxillofacial applications of
these 3D cameras are growing,
especially in orthognathic
surgery, orthodontics and
evaluation of craniofacial
deformities.
• It is possible to superimpose
photographic soft tissue data
over the bony data set obtained
from CTor CBCT. This fusion of
hard tissue images and surface
images of face provides
opportunities for diagnosis and
planning corrective surgeries and
postoperative comparisons.
• 3D cephalometric measurements
can be done on these images.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
18
19. Rapid Prototyping and
Stereolithography
• Rapid prototyping is the
process of creation of physical
models from medical scan
data.
• The physical model is built in a
layered manner and it
reproduces internal and
external anatomy accurately.
• Medical scan data can be
obtained from CT, CBCT or
MRI. There are many
technologies for
manufacturing of medical
models.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
19
20. Cont………
• Stereolithography is the
most commonly used
technology and involves
selectively solidifying an
ultraviolet sensitive liquid
medical resin using laser
beam.
• Stereolithographic
models can be used for
diagnosis, surgical
planning, teaching,
custom made implants
and prosthetic devices.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
20
21. Cont………
• The models allow for wax
replacement of avulsed
structures or generation of
mirror-image structures,
prebending of
osteosynthesis bone plates,
fabrication of templates,
choosing of stock alloplasts.
• These technologies are also
used for making surgical
guides, and scaffolds for
tissue engineering.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
21
22. INTRAOPERATIVE NAVIGATION
AND ROBOTIC SURGERY
• The development of image-
guided surgery provides new
revolutionary opportunities by
integrating presurgical 3D
imaging and intraoperative
manipulation.
• Integration of imaging with
surgical field allows
visualization of different types
of images and simultaneously
shows structures that are
normally visible
intraoperatively and permit
navigation in areas of
anatomical sensitivity.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
22
23. Cont………
• Clinical benefits of
image guided surgery
include use of smaller
incisions, direct access
to targeted areas and
consequently less
invasive procedures.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
23
24. Cont………
• Computer aided surgery
systems are commonly used in
neurosurgery, endoscopic
sinus surgery, and some
orthopedic procedures.
Because of the complex nature
of maxillofacial reconstruction
procedures, these systems are
now being used for
maxillofacial surgery.
• Intra-operative navigation
gives the surgeon control in
difficult access areas and
complex procedures, thus
reducing the chances of
human error.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
24
25. Cont………
• In computer aided surgical systems a virtual patient is
generated from the preoperative scans. Certain stable
landmarks are identified on both the virtual patient
and actual patient. In technical language, these
markers are known as ‘Fiducial markers’.
• These markers serve as a guide for tracking of the
patient and surgical instrument in space. Tracking is
mainly done with the help of transmitters, which uses
an optical source or electromagnetic source.
• There are two transmitters, one to be placed on the
patient and other to be placed on surgical instrument.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
25
26. Cont………
• Further step in the advancement with fusion of these
technologies is robotic surgery. In robotic surgery, a
robotic arm controlled by the surgeon, sitting far away
from the operation table, actually performs the
procedure.
• Surgery with great precision in difficult areas through
minimal access is possible with the help of robotic arm.
Many advanced hospitals in the world have robotic
surgery suites to perform difficult surgeries in head and
neck with the help of robotic arm (Trans-oral robotic
system—TORS based on Da Vinci robotic arm)
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
26
29. Cont………
• TORS has the benefits of being less invasive, with
fewer complications and shorter hospital stays.
There is less blood loss, little scarring, and fewer
temporary and permanent side effects, such as
loss of speech or swallowing ability.
• Surgeons operate with greater precision and
control using the TORS approach, minimizing the
pain, and reducing the risk of possible nerve and
tissue damage linked to large incisions.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
29
30. Minimal Invasive Surgery and Role of
Endoscopes in Oral and Maxillofacial
Region
• Flexible endoscopes have revolutionized many fields of
surgery including maxillofacial surgery. First application
of endoscopic surgery was in sinus surgery and
functional endoscopic sinus surgery has become a
standard of care.
• Endoscopic surgery has been applied to many areas of
craniomaxillofacial surgery, which includescorrection of
cranial synostosis, esthetic procedures like brow lift,
forehead contoring, frontal sinus fracture repair, orbital
decompression, various osteotomies and fracture
repair including mandibular condyle fractures.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
30
32. Cont………
• Endoscopically assisted
approaches have been
advocated for open reduction
and internal fixation of
condylar fractures. This
approach allows fracture
treatment with limited
transoral incision.
• In conjunction with transoral
approach, scars are invisible
and risk of facial nerve
damage is minimal.
• Fiberoptic assisted intubation
for general anesthesia also has
made the job of anesthetist
easy in difficult airway cases.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
32
33. Tissue Regeneration/Engineering in
Oral and Maxilla-Facial Surgery
• Autogenous bone grafting,
regional or free microvascular
flaps have been the main stay
for reconstruction, but this
causes possible donor and
recipient site morbidity.
• The development of effective
reconstructive procedures
using tissue engineering
techniques without the need
for conventional tissue
transplantation procedures
can have a tremendous impact
on surgery of head and neck
area.
• Tissue engineering is an
interdisciplinary field
comprising of cell biologists,
bio-chemists, material
scientists, engineers, and
clinicians, and an
understanding of the complex
role of the various
components with the aim to
create limitless and readily
available supply of off- the-
shelf tissue regenerates.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
33
34. Cont………
• Tissue engineering involves the vital
collaboration between the three key
components, stem cells, resorbable scaffolds
and bioactive molecules such as growth
factors.
• The combination of scaffolds and cells is often
referred to as a construct. Constructs may be
fashioned ex vivo, and then implanted into an
individual.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
34
35. Cont………
Approaches to Tissue Engineering
• (a) Growth factors/Bone Morphogenic Proteins: BMPs are
a group of osteoinductive sequentially arranged amino
acids and polypeptides that are capable of stimulating
adult mesenchymal cells to become osteoblasts and form
bone.
• Adult mesenchymal cells are supplied by periosteum and
paraperiosteal connective tissue.
• Recombinant human BMP-2 (rh-BMP-2) (Infuse,
meditronics) was approved as an alternative to autogenous
bone graft for sinus augmentations and for
localizedalveolar ridge defects associated with extraction
sockets.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
35
37. Cont………
• (b) Stem Cells: Stem cells can
dedifferentiate in the correct
setting into simple,
unspecified forms. They, then
have the ability to form new
structures based on the
stimulus and chemical factors
that are present in the matrix.
• There are two types of stem
cells – adult stem cells and
embryonic stem cells. Human
embryonic stem cells are
pluripotent stem cells isolated
from the inner mass of human
blastocysts.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
37
38. Cont………
• Currently, adult stem cells
used in clinical setting are
autologous cells.
• For the tissue engineering of
bone, cells from the bone
marrow and adipose tissue
have been used as autologous
cells, These have the ability to
dedifferentiate from
mesenchymal cells to
osteoblasts and then to
osteocytes, which have the
ability to lay bone in a
laminated form.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
38
39. Cont………
• The seeded cells can be stimulated physically
with magnetic or galvanic stimulation,
ultrasound, hypoxic or hyperoxic gradients,
growth factors such as transforming growth
factor beta-1 (TGFB-1), bone morphogenetic
proteins (BMPs) or vascular endothelial
growth factor (VEGF), to guide the
differentiation and growth of the cells.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
39
40. Cont………
• Stem cells from dental pulp from developing
teeth, shed deciduous teeth and dental follicle
provide other source of adult epithelial and
mesenchymal stem cells.
• Third molar removal also presents some
opportunity for harvesting follicular cells,
cementoblast-like cells and dental pulp stem
cells, which have been cultured and studied.
• The receptors of these cells can be characterized,
an important first step in understanding these
cells and their potential future use.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
40
42. Cont………
• There is a hope to create synthetic form of
bone, skin, cartilage and muscle that can
function as well as normal tissues depends on
ability to effectively integrate multiple
technologies and components that are
capable of meeting the complex demands of
reconstruction in head and neck area.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
42
43. Advances in Local Anesthetics
Articaine
• It is a new aminoamide class of local anesthetic,
approved by FDA in 2000 for clinical use. It is available
in 4% strength with 1: 100,000 o 1: 200,000
epinephrine.
• It has thiopentone ring instead of benzene ring, which
makes it more lipid soluble. Therefore, it has got better
tissue penetration and diffusion than the lidocaine.
• Because of better bone penetration and diffusion it
can anesthetise palatal side and anterior lingual sides
with buccal infiltration only.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
43
44. Reversing Effects of Local Anesthesia
• Soft tissue anesthesia after local anaesthetic
infiltration or block may linger on for several
hours. This may not be desirable in certain case
especially in children.
• In 2009, FDA approved phentolamine mesylate
(Oraverse, Novalar Pharmaceuticals Inc. USA) for
the reversal of the local anesthetic.
• This can be used both in adults and children, but
not recommended below six years of age or
weight <15 kg.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
44
45. Cont……….
• Phentolamine is an α adrenergic agonist, it
acts by providing vasodilatation, thus
allowing the faster diffusion of local anesthetic
into vascular system.
• It is injected in same volume as the local
anesthetic and it accelerates the reversal of
soft tissue anesthesia.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
45
46. Local Anesthesia Delivery Devices
• Newer local anesthetic delivery devices
not only provide reduction in pain on
injection and failure rates, but also
produce more precise anesthetised area.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
46
47. Cont……….
• Vibrotactile, Vibraject,
dental vibe, accupal,
compudent are the few
local anesthetic delivery
devices which uses
vibration technology to
decrease the pain on
injection.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
47
49. Submental Intubation in Maxillofacial
Trauma Patients
• Intraoperative assessment of occlusion and
maxillomandibular fixation is often required
for exact reduction of facial fractures.
• Conventional oral tracheal intubation does not
allow intraoperative assessment of the
occlusion and maxillomandibular wiring.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
49
50. Cont……..
• Submental intubation is a
procedure in which
endotracheal tube is passed
through a surgically created
opening in submental region.
• It allows free intraoperative
access to the dental occlusion
and the nasal pyramid.
• Therefore, simultaneous
treatment of all the facial
fractures, without
interference of the tube or
the need of switching tube
from nasal to oral or vice
versa during surgery.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
50
51. Retromolar Intubation Technique
• In this technique, the
endotracheal tube is placed in
the retromolar space behind
the last erupted teeth.
• Arora and Rattan, for the first
time demonstrated that there
is sufficient space in
retromolar region for
successful placement of the
endotracheal tube in children
and certain adults.
• Intermaxillary fixation of teeth
is possible
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
51
53. Advances in TMJ Arthroscopy and One
Point Arthroscopy
• The TMJ arthroscope is
a small, tube like
camera that projects
the image of the joint
onto a monitor,
allowing the surgeon to
view the inside the joint
without making any
large incisions.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
53
54. BUCCAL PAD OF FAT IN
TMJ RECONSTRUCTION
• In this technique dead space
created after gap arthroplasty
is blocked with the help of
buccal pad of fat.
• Buccal pad of fat is harvested
through the same preauricular
approach as used for TMJ
surgery.
• Blunt dissection is done
anteromedial to the coronoid
process, where buccal pad of
fat is located and it is
transposed to TMJ area.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
54
55. .
• This fat can completely
block the dead space as
compared to any other
tissue, because of its
fluidity.
• This prevents formation
of blood clot, which is
primary factor for
heterotopic bone
formation and
reankylosis of TMJ.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
55
57. Cont……..
• To manage the panfacial complex fractures, there have
been improvements in techniques of fracture fixation and
reduction.
Other advances in the field of surgery are also applicable to
trauma management. This include
improved diagnostic imaging,
minimal access surgery and endoscopic surgery,
biomaterial advances,
intra-operative imaging,
rapid prototyping techniques,
computer assisted surgery, and
customised implants.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
57
58. Intermaxillary Fixation Screws
• Special screws for
intermaxillary fixation are
available, which have a hole
for passage of wire below the
screw head.
• The screws are inserted above
the root apices in maxilla and
mandible, and wire is passed
through the holes to close the
mouth in occlusion.
• Screws are quick to place,
maintain better oral hygiene,
and there is no risk of prick
injury, as compared to fixation
with arch bars and wires.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
58
59. Rapid IMF
• An adjustable flexible plastic
band that wraps around the tooth
to create an anchorage point for
temporary maxillomandibular
fixation and immobilization.
• These have been developed to
reduce the risk of needle-stick
injury.
• Intermaxillary fixation is done
with the help of elastic chain.
• These anchorage points can
retain intermaxillary fixation up
to three weeks.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
59
60. Resorbable Implants
• Drawbacks of currently used
titanium implants may include
soft tissue irritation and cold
intolerance, creation of
distortion artefact on
computed tomography and
magnetic resonance imaging,
weakening of bone from
excessively rigid fixation,
‘‘stress shielding’’ possible
interference with facial
growth, implant migration
over time, and the possible
need for subsequent implant
removal.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
60
61. Resorbable plates
• Resorbable plates
provide initial osseous
fixation strength for
direct bone healing and
then they disappear
over a period of time
leaving behind no
foreign body.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
61
62. Self-Drilling, Self-Tapping Screws
• The self-drilling principle has
the advantage of avoiding the
necessity to drill a hole, thus
shortening the process of
osteosynthesis and requiring
less instrumentation.
• The self-drilling, self-tapping
screws were essentially equal
to the retentiveness of self
tapping screws in thin bone,
but were much superior in
cancellous bone.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
62
64. Cont……..
• This is presumably due to self-drilling screws
compressing rather than cutting the cancellous
bone around the threads of the screws.
• The clinical implication is that self-drilling, self-
tapping screws are much superior when fixing
screws into a cancellous bone graft.
• It should be noted that self-drilling screws may be
difficult to apply in extremely dense bone such as
the mandible.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
64
65. LOCKING PLATES AND SCREWS
SYSTEM
• In locking plates, the screw locks not
only to the bone, but to the bone
plate as well.
• This is accomplished by having a
screw with a double thread.
• One thread will engage the bone;
another will engage a threaded area
of the bone plate.
• Since the plate locks to the screw
rather than gaining its rigidity by
being compressed against the bone,
it also avoids the cortical necrosis,
which is sometimes seen under a
plate ,which is compressed against
the bone.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
65
66. Locking plate and screw systems have several
advantages over the conventional screw systems.
Locking plate and screw
• It becomes unnecessary for the
plate to intimately contact the
underlying bone in all areas.
• As the screws are tightened, they
“lock” to the plate,thus
stabilizing the segments without
the need to compress the bone to
the plate.
• A decreased incidence of
inflammatory complications from
loosening of the hardware.
• Provide more stable fixation
CONVENTIONAL plate and screw
• require precise adaptation
of the plate to the
underlying bone.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
66
67. Multidirectional Fixation.
• Another advancement in locking
technology is multidirectional
fixation.
• TriLock technology (Medartis, Basel,
Switzerland) represents a significant
step forward in multidirectional and
angular stable fixation.
• The spherical three-point wedge-
locking creates a connection between
the head of the screw and the plate
hole which is stable in angle and axial
plane.
• The locking can be adjusted up to
three times within ± 15º without loss
of stability.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
67
69. Trapezoidal Condylar Plates
• The primary stability
achieved by TCPs is
superior to that obtained
by single plating
techniques, by axial lag
screw osteosynthesis, and
by rectangular plates in
the sagittal plane.
• This is due both to the 3D
concept and to the
trapezoidal shape itself.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
69
71. Delta Plate Fixation for Condylar
Fractures
• The plate’s delta shape can
handle changing loads, with
the highest tensile strain
occurring at the anterior and
lateral surfaces and the
highest compressive strains on
the posterior surface.
• The plate can be easily placed
in the confined space at the
condylar neck.
• These plates are made of pure
1.3-mm-thick titanium and
are fixed with 2.0-mm TriLock
titanium monocortical screws.
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
71
84. Cont……..
• Various grafts are available for condylar reconstruction after
removing the ankylotic mass such as:
costochondral,
sternoclavicular,
posterior border of mandibular ramus,
fibular, coronoid process, and
metatarsophalangeal,
alloplastic graft like hydroxyappatite collagen and
recently condylar distraction osteogenesis.
To date, there is no ideal autogenous graft for condylar
reconstruction that satisfies the complex anatomy and the
myriad of functions of a missing condyle.
International Journal of Dental Research, 2 (2) (2014) 45-49
LIDETU and BETHEL, WOLAITA SODO
UNIVERSITY
84