Objectives: Treatment of nose mutilation resulting from cancer treatment requires use of a technique that allows good aesthetic rehabilitation. Plastic surgery is an option, but involves several surgeries, which are time consuming and often have only partial aesthetic results. Using an extraoral fixture for bone anchorage of a removable nose prosthesis results in quicker and better aesthetic results. Methods: We present the case of a 60-year-old man who had undergone a total nasal resection for a large basal cell carcinoma of the nose. Anatomopathologic analysis of the resection showed free margins, and did not reveal any ganglionic metastasis. No radiotherapy was applied. One year later, two extraoral fixtures were inserted in the frontonasal bone, under general anaesthesia, and 4 months after insertion, the fixtures were denudated under local anaesthesia, and prosthetic abutments placed. After 2 weeks, prosthetic steps were realised, and the patient received a removable nasal prosthesis that was fixed by two magnetic devices on the implants. This report describes and illustrates the various surgical and prosthetic steps involved. Results: Patient satisfaction was achieved with this technique. Surgical reconstruction following a centrofacial mutilation is challenging because of the need to recreate a complex 3-D nasal form. Extraoral craniofacial fixtures have an average success rate of 95% in non-irradiated patients and have made it possible for the nasal epithesis to be considered as a forerunner in cosmetic rehabilitation strategies. Conclusions: The clinical case presented here shows that transcutaneous extraoral fixtures may be used as bone anchorage for nasal epitheses, in cases of nasal mutilation resulting from cancer treatment.

Thin gingival tissue over implants. Free gingival graft simultaneous with abutment connection surgery.

Objectives: Autogenic and allogenic bone block materials of different companies are increasingly used in guided bone regeneration (GBR) procedures. Adjusting block-shaped allogenic transplants to fit the recipient area is time consuming and technically challenging. A method of bone block formation using a 3-D stereolithography (SLA) model is reported here.
Methods: A tomographic image of the area for augmentation was obtained and edited using Implant Assistant. Data from the image of the prepared 3-D jaw model were transferred to a 3-D printer (Objet Stratasys to produce a model of the jaw fragment. Unicortical cancellous block (Maxgrapht cortico-spongiosa) was moulded onto the model and holes for fixation screws were drilled into the material. The bone block was added to a 100-grams syringe filled with serum, emptied out in to a container and refilled. This procedure was repeated several times. After raising a flap, the recipient area was decorticated and the prepared block put in place. The edges were shaped by adding natural bovine bone graft (Cerobone) material and the surface was covered with native pericardium membrane (Jason membrane). A platelet-rich fibrin (PRF) membrane was then applied and the soft tissues sutured without strain to avoid flap tension.
Results: After 6 months, the augmented area was re-operated for implant placement. Integration was observed between the bone block and recipient tissue after raising the flap. The volume of jaw atrophied bone had increased as a result of augmentation. There was adequate vascularisation of the transplanted bone block, which was integrated into the tissue of the recipient area. Bone resorption in the form of a thin fissure was observed in the external cortical layer, close to the alveolar crest of the block. Nevertheless, the growth in alveolar crest volume was deemed adequate for implant placement. A temporary crown was fixed immediately after placement because there was adequate stability, and alveolar crest defect was re-grafted with Cerabone and covered with Jason membrane before the flap was closed. After 4 months, an image was taken that showed bone augmentation and osseointegration around the implant.
Conclusions: Preparing a jaw bone fragment as an allogenic bone block using an SLA model done successfully in GBR-type surgeries. The method allows block bone to be adapted for the recipient area, and is associated with significant time savings. Post-operative tomographic scans confirm augmentation of the alveolar ridge, making this a promising way for restoring aesthetics in the frontal area.