Objectives: Surgical excisions of facial areas are often very difficult to rehabilitate. Defects in the maxillofacial region may be rehabilitated surgically or by prosthetic means to protect the defect from environmental conditions that may cause infection. Such defects are aesthetically displeasing and affect the social life of patients directly, therefore rehabilitation should be begun as soon as possible. The prosthesis increases quality of life, and allows adaptation to a social life. The aesthetic appearance is improved and preservation of the defect is achieved. Methods: An 81-year-old woman had a defect of the upper side of her nose caused by surgical intervention for a brain tumour. After the operation, surgeons were unable to restore the defect surgically due to her age and systemic condition. Thus the only choice for defect closure was an artificial prosthesis. Results: The patient had used cotton pads to cover up the defect before prosthetic intervention, which inevitably caused infections, but after placement of the silicone prosthesis the defect was healthy. Conclusion: Maxillofacial defects can be restored surgically, prosthetically, or both. Tissue engineering techniques are also available, but when the systemic condition of the patient is not suitable prosthetic techniques are the only choice, and these techniques should be improved.

Objectives: Guided bone regeneration by means of membranes and bone substitutes is one of the most documented approaches for restoring deficient alveolar ridges. Despite routine use of the techniques, it is not known to what extent these approaches can restore the tissue volume lost after tooth extraction. The aim of this study was to analyse the volume loss occurring after extraction and how much lost volume can be recovered by three different bone augmentation procedures. Methods: To create the alveolar ridge defects, the teeth were sectioned in a buccal–lingual direction at the furcation level, and the mesial roots of M1 and P4 and distal roots of P3, P2 and P1 (monoradicular) were individually extracted. Three vertical grooves of about 6mm in height and 6mm in depth (as far as the lingual cortical bone) were prepared in order to eliminate the buccal bone plate. After 12 weeks, the dogs were randomly assigned to one of three regenerative procedures: graft-only (B) in which the defect was filled with a particulate bone substitute (Bio-Oss Collagen); membrane only (M) in which the defect was covered with a bioabsorbable collagen membrane (Bio-Gide); and combination group (T) in which the defect was filled with a particulate bone substitute (Bio-Oss Collagen) and membrane was added. Conventional polyvinyl impressions were taken before extraction and defect creation at one time point (T1), before regenerative surgery (T2) and after 3 months of healing (T3). The cast models were optically scanned to obtain stereolithography (STL) files. Linear and volumetric measurements included volumetric analysis, distance between surfaces, and tissue thickness at three levels below the alveolar ridge on the buccal side of the regenerated site(at 1, 3 and 5mm). Results: A total of 18 casts were obtained at T1, with 18 at T2 and 9 at T3. No impressions were taken at the time of sacrifice to avoid disturbing early healing. The box-shaped defects were effective in creating horizontal and vertical ridge deformities (comparison T1–T2). None of the three regenerative approaches resulted in complete reconstitution of the alveolar ridge to baseline dimensions (comparison T1–T3), although volume gain in groups B and T was significantly better than in groupM (comparison T2–T3). Conclusion: The three regenerative approaches failed to rebuild the post-extraction loss in tissue volume.

Dr. Dominik Büchi performed an immediate implant placement in the aesthetic area. Therefore the esthetic risk factors had to be evaluated carefully before starting the treatment.