Plastic Surgery Simulator
Esthetic implant therapy should not be a separate treatment discipline, but rather an integral part of all other treatment modalities (Sorensen 1997). Function should complement esthetics and vice versa, because the final objective of esthetic implant dentistry is a perfect prosthetic outcome that simulates the natural tooth appearance. See Figure 1.3. Many simple principles of prosthetic design that have been routinely used for decades can be applied to anterior dental esthetics to create harmony while maintaining natural beauty, and can turn an average case into an ideal one (Golub-Evans 1994). The goal of esthetic implant therapy is to complement any given treatment plan, because the treatment planning for an esthetic case will slightly differ from that for a functional case. The delivery of a state-of-the-art implant-supported prosthesis enriches the implantology practice, not vice versa, and solves clinical issues and mysteries such as the interimplant papilla. This surely will...
Fabricating an esthetic implant-supported prosthesis is unlike fabricating a merely functioning implant-supported prosthesis. The first scenario may involve higher treatment costs due to the possibility of using tooth-colored or laser-milled abutments or performing extra corrective surgeries. The fact that some clinicians charge more for esthetic rehabilitative cases than for regular cases requires an explanation to the client. An anterior implant-supported prosthesis invariably requires that the clinician spend more time, effort, and skill than they would on replacements in the posterior zone.
Esthetic implant therapy is an advanced treatment modality in today's field of implantology, aiming to achieve an ideal esthetic and functional treatment outcome within the alveolar ridge or the edentulous spaces. Esthetic implant therapy has become an integral part of modern implant dentistry, because it complements the overall results of oral implantology. Significant advances have been introduced recently, including novel techniques to develop or regenerate implant recipient sites by stimulating both hard and soft tissues and to reproduce healthy peri-implant tissue contours that resist mechanical forces and masticatory trauma. Despite the advances and the success seen in many clinicians' practices, there is insufficient scientific support regarding the overall success and longevity of esthetic implant therapeutical techniques in well-controlled, long-term studies. The advances in esthetic implant therapy and soft tissue and hard tissue regeneration are more the author's...
Osseous housing for any future implant site is the main supporting structure that keeps the implant functioning and surviving on a long-term basis (Misch 1999b, Misch 1999c, Holmes and Loftus 1997), thus the importance of healthy and sufficient bone volume becomes a great value to implant therapy. Therefore, emphasis should be placed on inserting an implant in an optimal osseous foundation when a predictable, successful esthetic and functional outcome is to be achieved. Achieving an optimal esthetic implant restoration requires a thorough and meticulous anatomic site analysis of the alveolar ridge anatomy. The analysis must assess many factors bone width, height, and density, and the presence or absence of bone atrophy.
Using an accurately fabricated surgical template ensures a predictable esthetic implant-supported restoration. The template is also another key determining factor to the optimal implant position in a 3-D fashion, because the precise implant placement complements esthetics and function, clear patient phonetics, and easier oral hygiene. Thus, transfer of the information regarding the predetermined position and angulation for the implant fixture from the study cast onto the surgical site becomes mandatory to allow a prosthetic driven implant placement protocol. A precisely fabricated surgical template or guide has an active role in executing the treatment plan at the first stage of surgery it assists in the maintenance of a healthy natural biological space between the implant and the neighboring roots. In addition, it assists in keeping the recommended distance between implant fixtures themselves.
Esthetic implant-supported restorations should duplicate the original contours and profile characters of the natural teeth from all aspects (Higginbottom and Wilson The entire assembly is then placed into a pressure vessel at 10 pounds psi, and the index is removed when polymerization is completed. The method provides a completed provisional restoration that only requires polishing and finishing with no discontinuities to fill. A natural flat emergence profile of any esthetic implant-supported restoration is important for hygiene, gingival health, and appearance. The vertical length of the subgingival portion of the restoration is particularly important because guided gingival growth is indirectly
Tials and training and decide if the practitioner has had the proper training and experience to be granted the specific surgical privileges requested. If the applicant has the proper credentials and performs satisfactorily on supervised cases, he is granted privileges in the specific area of surgery requested. But keep in mind that being awarded privileges in the department of orthopedic surgery does not confer privileges in the department of plastic surgery. A physician must show evidence of proper training and competence in each area of requested surgical privileges in order to be granted those privileges.
Optimizing clinical results through esthetic implant positioning is predicated on several factors that cannot be ignored. These factors embrace two very important themes. First, clinicians should strictly adhere to clinical guidelines to achieving predictable osseointegration. These guidelines include using a relatively gentle surgical technique, preparing a precise osteotomy, exerting as little pressure as possible to the alveolar bone, minimizing heat generation to the bone, achieving primary implant stability (Buser et al. 1999, Burger and Klein-Nulend 1999, Herrmann 2000), and avoiding direct biting loads at the bone-implant interface during a sufficient healing period (Szmukler-Moncler et al. 1998, Block et al. 1997, Brunski et al. 2000).
The multidisciplinary approach to the treatment of oral and oropharyngeal cancer is now fundamental and all units treating this disease should have a team of specialists. The surgical disciplines of otolaryngology, plastic surgery and maxillofacial surgery should all be involved. A clinical or radiation oncologist with a specialist interest in head and neck malignancy is also mandatory. A specialist nurse, speech and language therapist and nutritionist should also be present and a cytopathologist should be on hand to give the result of any fine-needle aspirates while the patient waits in the clinic. A psychologist and social worker are also helpful in pre-treatment assessment and post-treatment rehabilitation.
Incorrect implant position in the alveolar ridge may occur due to many factors such as the imprecise fabrication of surgical template, the lack of control during the drilling procedure, poor presurgical planning, poor armamentarium, and the lack of knowledge or experience. The minor deviation from the standard known clinical guidelines for esthetic implant positioning in any dimension will surely result in esthetic fallout. Some can be treated, while for others, implant removal will be the only possible option. As is the case of any positioning error, there is always a consequence or repercussion.
The primary outcome is the prevention of extravasation events using proper administration techniques. Instruct patients to promptly report any symptoms of extravasation. If extravasation occurs, select the proper antidote and thermal application for immediate administration. Promptly refer the patient for plastic surgery if pain persists or ulceration develops.
Another unresolved issue is whether the target person's sex moderates the effects of attractiveness. Contrary to the common belief that physical attractiveness is unimportant for men, attractive men are consistently preferred over unattractive men. A possible manifestation of the importance of looks to men is the increasing frequency with which men are undergoing cosmetic surgery to enhance their careers ( Men try to put a new face on careers, Wall Street Journal, August 28,1991 Workplace edge plastic surgery. Journal of Commerce, August 23, 1999 Leaders The right to be beautiful, The Economist May 24, 2003). The effect of attractiveness for women is much less clear. Although most studies seem to show that attractive women are preferred over unattractive women, a few studies show that attractive women are disadvantaged in traditionally male jobs (Heilman & Saruwatari, 1979 Heilman & Stopeck, 1985a, 1985b). However, this beauty is beastly effect is possibly the result of the...
Succeed are continued and those that fail are discarded, providing an ever-evolving, highly sophisticated armamentarium of splint options from which clinicians may select the designs that best meet their patient needs. This progressive advancement of splint designs has served clinicians well over many years with few clinicians stopping to question the underlying basis for the achieved improvements in motion. As third-party insurers challenge the value of using splints to correct joint stiffness, clinicians are faced with proving the obvious. Fortunately, splinting is not the only treatment modality founded on soft tissue remodeling concepts. Research generated by other fields often provides insight and understanding on topics of mutual interest. The disciplines of hand upper extremity rehabilitation and orthopedic surgery, plastic surgery, dentistry, bioengineering, biochemistry, and cellular biology share common interests in regard to understanding the underlying mechanism of tissue...
Due to the significant advancements in dental implan-tology, new titanium or ceramic abutments have been developed for esthetic implant restorations. Also, anatomical abutments that replicate tooth morphology have been introduced to create a better emergence profile (Pow and McMillan 2004). This in turn has facilitated impression making and provisional restoration fabrication. Upon the second-stage surgery, conventional healing abutment is installed that is smaller in size, and therefore the soft tissue profile created does not replicate the original tissue profile, which makes it difficult to make an impression and a provisional restoration because of the tight soft tissue cuff. The search for a customized healing abutment with an optimal finishing line to produce an ideal emergence profile is always a concern for many clinicians.
The use of connective tissue grafts in modern esthetic implant therapy is considered to be one of the most predictable basic methods to improve tissue height and topography, treat minor ridge defects, assist in flap closure, and mask any metallic discoloration around abutments collars. (See Figures 5.23A-B.) Connective tissue grafts offer an alternative way to compensate for the fragility and thinning of the oral epithelial tissues. Most of the current technological advancements date back to the work of Langer and Calagna (1982, 1985),
Vargas and his co-author Sucar describe in Chapter 7 their ongoing research that applies Bayesian artificial intelligence networks and computer graphics to forensics and anthropometry of the head and face. Their system attempts to predict facial features from skeletal. This technique is also highly relevant to corrective plastic surgery.
Anaesthesia should be administered using humidified gases in a warmed theatre environment. To avoid protracted recovery from anaesthesia for prolonged procedures, an insoluble volatile agent which undergoes minimal biotransformation (e.g. isoflurane, des-flurane or sevoflurane) is preferable. Nitrous oxide may produce marrow depression with exposure of more than 8 h duration and an oxygen air mix should be substituted. A total intravenous technique may be used, although the vasodilatation produced by volatile agents may be beneficial to surgical outcome. Fluid balance should be maintained scrupulously. Haemorrhage is a common occurrence during plastic surgery, and blood transfusion is frequently required. However, blood rheology studies suggest that microvascular flow is optimal with a haematocrit of approximately 0.3. Overtransfusion should be avoided, and normother-mia, normovolaemia and cardiac output maintained, to maximize peri- and postoperative perfusion of the surgical site.
Suspicion for frontal sinus fracture is best evaluated with CT. Fractures involving only the anterior table of the frontal sinus can be treated conservatively with referral to ENT or plastic surgery in 1 to 2 days. Fractures involving the posterior table require urgent neurosurgical consultation. Frontal sinus fractures are usually covered with broad-spectrum antibiotics against both skin and sinus flora. Emergency department management also includes control of epistaxis, application of ice packs, and analgesia.
(e.g., University of Michigan's Comprehensive Gender Services Program www.med.umich.edu transgender ) or concurrent care from a mental health professional with experience in this area, a primary care physician knowledgeable about hormone supplementation and general transgender medical care, and urology, gynecology, and plastic surgery specialists. The World Professional Association for Transgender Health (formerly the Harry Benjamin International Gender Dysphoria Association) has resource links for patients (www.wpath.org).
Polymethylmethacrylate, polytetrafluoroethylene, polyurethanes, and silicones. Products made from these polymers have been used as bone and tissue replacements, as drug delivery devices, and have been variously employed in nearly all medical disciplines, including heart surgery, orthopedic surgery, ophthalmology, gynecology, and plastic surgery with remarkable success. Synthetic polymers are also utilized in topical applications and as coatings for stents and other implants.
Restoring function is and will continue to remain the primary goal of oral implantology. The functional aspect of the implant-supported prostheses should be emphasized and predicted first, because dental implants should be placed for long-term survival. Esthetics should be viewed as a complementary clinical benefit. Any planned implant-supported restorations in the esthetic zone should fulfill both functional and esthetic goals, but function should not be jeopardized due to overemphasizing esthetics. Any esthetic implant-supported restoration that fails to meet the functional goal cannot be considered a success, and vice versa. The delicate balance between function and esthetics must be maintained because they both complement the treatment outcome, which emphasizes the value of the presurgical stage as an integral part of the treatment. Misch (1999d) stated that too often the profession concentrates only on esthetics and soft tissue contours that might be accomplished at the expense...
Office-based surgery is defined as any procedure done in a doctor's office, be it cosmetic surgery, aesthetic surgery, plastic surgery, oral surgery, dental procedures, or any other painful procedure that requires the administration of potent consciousness-altering drugs or general anesthesia to accomplish. This does not refer to
Regular evaluation of progress is important for patients with an altered body image. Learning to cope with the new image may take time, and strategies may have to be altered along the way. This may be particularly true for those undergoing a series of plastic surgery operations. They may have to cope with a constantly changing body image.
The skin of the head and neck has several unique features that differentiate it from other areas in the body. It communicates with the respiratory tract via the nostrils, the digestive tract via the oral cavity and the conjunctival lining of the eyelids. The skin of the head and neck has a rich blood supply via a complex network of intercommunicating vessels. These can dilate under physical or emotional stress, changing skin colour and appearance (e.g. blushing). This high intensity blood supply opens up plastic surgery techniques that are not routinely available elsewhere in the body. Table 15.1 Plastic surgery techniques The skin is also not a single entity. There are variations in skin thickness and in the distribution of hair growth, the latter being a sexual characteristic. There are differences in fixity and laxity of the skin with the eyelids being very thin and elastic to allow free mobility. Elasticity and mobility is seen in facial expression and in the development of...
The details of wound closure and wound healing have been discussed previously (Ch. 3). As far as plastic surgery techniques are concerned,wounds may be closed directly by edge-to-edge apposition or by techniques that involve the import of tissues. Tissue can be imported either as a graft, which is a non-vascularised piece of skin, or as a flap, which brings with it, its own blood supply. The advent of the operating microscope has opened up new possibilities in reconstructive surgery. The ability to revascularise tissue by anastomosing small vessels of 1-3 mm in diameter has enabled the transfer of specific tissue types. The golden rule of plastic surgery is to reconstruct like tissue with like. For example, the ability to reconstruct the jaw with vascularised bone has revolutionised head and neck cancer surgery (see Ch. 17) (Fig. 15.7). Similarly, facial paralysis can be improved by transferring a functioning muscle flap, reconstituting its vascular and neural supply. Large volumes of...
As a consequence of tooth extraction, the interdental papilla remodels in a sloping fashion from the palatal to the more apical facial osseous plate, and becomes depressed in comparison with the healthy adjacent marginal tissue (Engquist et al. 1995). Unfortunately, the lost interdental papilla usually cannot regenerate to regain its original dimensions (Holmes 1965). The nature of the interimplant (scar-like) soft tissues also complicates the overall clinical prognosis and mandates special reconstructive procedures. The greatest challenge today in implant and periodontal plastic surgery is the reconstruction of lost or incomplete interproximal papillae.
Clinical microdialysis has been applied in the ward, in intensive care, in the operating theatre and to ambulatory patients. Microdialysis catheters may be secured in position by tunnelling and suturing to the scalp or inserted via a fixation bolt in combination with other monitoring probes such as intracranial pressure transducers and brain oxygen sensors.2241 42 In addition to cerebral monitoring, the technique has been used in other sites including skin,43 subcutaneous adipose tissue,44-45 myocardium and skeletal muscle.46 Peripheral microdialysis has been used to measure subcutaneous glucose concentrations in diabetic patients47 and to monitor the metabolism of flaps in plastic surgery.48
Many encounters between patients and physicians result from similar social and cultural pressures. The middle-aged executive who resorts to plastic surgery to eliminate his perfectly normal, and even honorable, facial wrinkles is dis-eased, as are most who undergo cosmetic surgery. And, of course, the vast majority of persons seeking psychotherapy are dis-eased, in that it is basic to human existence to experience anxiety, insecurity, loneliness, and even depression. Certainly when physicians treat persons whose complaint is not only diagnosed as normal, but almost universal, dis-ease in the older sense must be involved rather than disease as it has been analyzed in the ontological or physiological meanings.