EXPLORING

VARIOUS
IMPLANT SITES
TO AID IN
RETENTION OF
MAXILLOFACIAL
PROSTHESIS
PRESENTED BY:
S68 and S1103
INTRODUCTION
Conventional methods for retention of maxillofacial
prostheses are far from providing efficient and
satisfactory retention.

OSSEOINTEGRATED IMPLANTS –
In the last decades, the high success rates of
osseointegrated implants has overcome the support,
stability and retention problems of maxillofacial
prostheses relative to adhesive attachment of
prostheses.
The following table outlines the advantages and
disadvantages of maxillofacial implant retained
craniofacial prosthesis.
Implant-supported restorations achieved by
use of –
× 1.Tissue bars with clip retention
× 2.Magnetic retentive mechanisms
× 3.Or both
The patients who may benefit –

× 1.Individuals who have undergone

surgical tumor resection

× 2.Suffered mutilating traumatic injuries

affecting structures such as the ocular
globe, ear, nose or even the maxillary
or mandibular bones
×

× 3.Congenital malformation
IMPLANT SITES
There are mainly six sites in maxillofacial
region for placement of osseointegrated
implants for retention of craniofacial
prostheses –
ALVEOLAR RIDGE
The anterior maxillary segment is a key site
for implant placement; however, anterior
implants displayed an accelerated rate of
bone loss almost threefold greater than that
of posterior implants.
MASTOID REGION
 Implant placement in the mastoid region is more
complicated.
 The greater severity of complications associated
with auricular region implants may be because of a
greater potential for incidental injuries to intracranial
structures.
 External ear canal is a good landmark , 18 to 22
mm from the center of the external auditory meatus.
and on the left-hand side it is between the 1o’ and
2o'clock positions for the upper cranial implant and
between the 3:30 and 4:30 positions for the caudal
implant.
ORBITAL RIM
Position- 3 to 4 sites are chosen for
implantation, with the superolateral and
the inferolateral rim the more frequent
sites

× Advantage - Allows adequate spacing for

proper positioning of a prosthesis. The
success rate in orbital bone has ranged
from 92% to 100% .

× Rehabilitating large defects in which the

prostheses become heavier, implant-
retained facial prostheses are better
tolerated than the adhesive-retained type .
× .
Disadvantage –

The orbital walls are thin, only the superior,

lateral, and inferior orbital rims are suitable for
osseointegration of titanium implants.

Subtotal exenteration or a partially filled orbit

restricts the facial prosthesis to being thin, with
a less natural appearance
ZYGOMATIC BONE
NASAL FLOOR
× Nasal defects produce severe cosmetic impairment.
× If lower portion of nose involve two osseointegrated
implants inferiorly in the maxilla are enough.
× For aesthetic reasons, glabella and lateral maxillary
sites are poor choices for implant.
× Implant-retained nasal prosthesis can be used for
reconstruction of large rhinectomy defects
× Implant-retained prosthesis is a reliable option for
reconstructing large full thickness rhinectomy defects
 PTERYGOID BONE
× The density of the bone in this area affords good anchorage
potential, which may be superior to any other part of maxilla. The
technique sensitivity and the difficulty in access for clinicians and
patients is the main disadvantage.
CONCLUSION
Implant-retained prostheses have both advantages
and disadvantages.
In the majority of cases the advantages prevail.
They are not the opposite of plastic reconstructive
measures, but can rather frequently be used
complementarily.
They can also be used as a temporary measure
before surgical reconstruction (interim provision).
This would be expedient, for example, in the case of
a defect after rhinectomy when complex
reconstruction is to be carried out only after a period
of 2 years so that the risk for tumour recurrence is
minimal. Here, an implantation would not hinder later
reconstruction.
Implant retained prostheses are indeed more than
just an alternative.
REFERENCES
• Baima RF. Implant supported facial prostheses. J Mich
Dental Assoc. 1996;78(4):50-54

• Federspil P. Implant-retained craniofacial prostheses

for facial defects. GMS curr top otorhinolaryngol head
neck surg. 2009;8:561-569

• Federspil PA. Craniofacial prostheses for facial

defects. HNO. 2010;58(6);621-631

• Chelakara S et al. Extra oral implants as retentive aids

for maxillofacial prosthesis: A review. Journal of applied
dental and medical sciences.2016;2(2):135-142

• Curi MM et al. Extra oral implants in the rehabilitation

of craniofacial defects: implant and prosthesis survival
rates and peri-implant soft tissue evaluation. J Oral
Maxillofac Surg. 2012;70(7):1551-1557