The patient was born with a bilateral cleft lip and palate deformity, which was surgically addressed during his infancy. He is now left with a residual deformity of his nose and upper lip. There was also deficiency of mustache growth in the region affected by the surgical scars on his upper lip. He desires for correction of his flat nose with collapsed columella and stunted prolabium with a short upper lip.

The prolabium was dissected and used to reconstruct the collapsed columella and raise his flat nose. The resultant upper lip defect was reconstructed with an Abbe flap harvested from the lower lip. There was good growth of mustache in his three month postoperative visit.

The patient was very happy with the esthetic and functional results of his surgical correction.

This middle aged man had lost his upper front teeth to a combination of gum disease and diabetes mellitus. Wishing for a permanent solution, he presented to our hospital for dental implants.
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The importance of maintaining meticulous oral hygiene was explained to him. Dental implants were fixed at the site of the missing teeth in his upper jaw. Ceramic crowns were fixed to the dental implants after osseointegration of the implants with surrounding alveolar bone.

He expressed his happiness at having his teeth back to the hospital staff.

This young man had been born with a unilateral cleft lip and palate. His upper left lateral incisor is congenitally missing. He wanted to address this issue as his marriage had been fixed recently and presented to our hospital for dental implant.

A premium dental implant was fixed at the site of the missing tooth followed by a ceramic crown after osseointegration of the dental implant to surrounding alveolar bone.
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He was extremely happy at the esthetic results of treatment at our hospital.

CASE REPORT

This is a case of a 42 year old female patient who approached our dental hospital with a complaint of asymptomatic swelling in the right lower back teeth region for the past 3 months. The patient stated that the swelling had increased in size over the time. Her medical and family history was unremarkable and there was no history of trauma to the involved site.
The patient was very much in distress due to her condition and wanted to get rid of the cyst.

EXAMINATION OF THE PATIENT

The patient had undergone biopsy of the lesion elsewhere which had diagnosed the swelling to be an aneurysmal bone cyst.
“An Aneurysmal bone cyst (ABC) is a benign, rapidly growing, destructive bone lesion, characterized by replacement of normal bone with blood- filled connective tissue matrix. It is a rare lesion infrequent in craniofacial skeleton”

On extraoral examination, facial asymmetry was apparent with diffuse swelling involving right side of the lower jaw. The swelling was firm and non-tender on palpation. On radiological examination, OPG taken shows the exact extent of the cystic lesion in the right lower jaw extending from the right lower canine tooth till the first molar tooth with expansion of the surrounding bone. On aspiration with a syringe, blood tinged fluid was obtained.

TREATMENT PLAN

Renowned Maxillofacial surgeon, Dr.S.M.Balaji, planned to surgically resect the cystic lesion completely, with extraction of the involved teeth followed by reconstruction of the defective site with rib graft, under general anesthesia. Later replacement of missing teeth with Dental implants was intended.

Dr.S.M.Balaji planned to take rib graft to reconstruct the jaw defect, as Autogenous graft (bone obtained from the same individual receiving the graft ), taken from donor’s extraoral site like chest( rib bone ) has always been regarded to be the “gold standard” due to its properties and absence of immunological reactions. The thick rib graft reduces resorption and helps in bone regeneration.

The patient was clearly explained about the surgical procedure and consent was obtained.

SURGICAL PROCEDURE
Under general anesthesia, the excision of the lesion was done with complete resection of all tissues lining the cyst and any of its components from the surrounding hard and soft tissues. The involved teeth were also extracted. After successful removal of the cyst, the defective bone area was reconstructed with the rib graft taken from the patient amidst the surgical procedure. The rib graft was fixed with the adjacent jaw bone by means of screws. Finally, the surrounding gum tissues were approximated with absorbable suture.
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POST SURGICAL FOLLOW-UP

Patient reported after 6 months post surgically for review. Post-operative OPG taken shows well integrated bone graft with the jaw bone. There is no sign of recurrence of the cyst. A 3DCT scan taken revealed perfectly formed bone at the involved site with no signs of bone resorption, which took us to the final step of replacing her missing teeth with dental implants.

DENTAL IMPLANT PLACEMENT

Under local anesthesia, Dr.S.M.Balaji opened the gum tissues surrounding the relative site exposing the newly formed bone. Dental implants of appropriate size and height were fixed in the underlying jaw bone with precision. Finally the gum tissue were closed with absorbable suture.
The patient was asked to wait for a period of 3-4 months for the final prosthesis, as to allow the dental implants to completely osseointegrate with the jaw bone obtaining maximum stability and retention. Meanwhile, a removable prosthesis was given temporarily for replacement of missing teeth to avoid supraeruption of the opposing teeth.
 
THE HAPPY PATIENT

The patient returned after 4 months for the final prosthesis. OPG taken shows dental implants in integration with the jaw bone. Hence, the final impression was taken and after a couple of bite trials, a natural looking fixed ceramic bridge was fixed onto the dental implants. The prosthesis was in perfect contact with the opposing teeth. The patient and her family members were very happy and satisfied with the entire process and the outcome. Patient was able to chew properly without any discomfort. Patient is on a regular follow up for the past 2 years.

A patient of age 43 years who had visited multiple dental clinics looking for an immediate and cost effective solution for his oral rehabilitation; visited our hospital seeking the expert opinion of Maxillofacial Surgeon and Implantologist Dr. S. M. Balaji.
The patient complained of several missing and mobile teeth in the upper arch. The patient explained about his difficulty to chew foods and that he was experiencing a stutter. After thorough clinical and radiological examination, Maxillofacial Surgeon and Implantologist Dr. S. M. Balaji planned to perform complete extraction of the periodontally weak maxillary teeth followed by immediate implants placement along with zygoma implants, thereby providing a graft less and affordable alternative for tooth replacement.
All the maxillary teeth were extracted and dental implants along with zygomatic implants were placed. The zygomatic implants were placed by creating a window on the lateral wall of the sinus; the sinus mucosa was lifted away from the area where the implant would pass through; ensuring not to penetrate the membrane.
After a period of 3 months, complete osseointegration of implants with the alveolar bone was achieved and cosmetically well blended fixed ceramic prosthesis was placed onto the implants. The patient was greatly overjoyed to have a complete smile makeover using dental implants and also stated that he experienced an immediate change in his speech after placement of the prosthesis.
Keywords: Zygoma implants, implants, graft less technique, cheekbone implants, immediate implants.

A 30 year old man came to our dental clinic with the complaints of fractured upper front teeth due to an accident.
After thorough clinical and radiological analysis, Maxillofacial Surgeon and Implantologist Dr. S. M. Balaji successfully removed the fractured upper front teeth without damaging the supporting teeth structures. Immediate dental implants were fixed into the extraction sockets with good stability and retention. Following complete osseointegration of implants with that of the alveolar bone cosmetically well blended fixed ceramic prosthesis was given. Patient feels very happy to have permanent fixed replacement for his broken teeth and complete smile makeover with the ceramic prosthesis.

This is a case of periodontally weak lower anterior teeth replaced with dental implants. She reported to our hospital with the complaint of severely mobile teeth. After thorough clinical and radiological examination, Maxillofacial Surgeon and Implantologist Dr. S. M. Balaji planned to do extraction and replacement with dental implants in single sitting. Mobile teeth were extracted and replaced with immediate dental implants. After complete osseointegration of implants with that of the alveolar bone, cosmetically well blended fixed ceramic prosthesis were placed onto the implants.

A 26 year old lady reported to our dental clinic with the complaints of pain in upper front region of jaw due to failed endodontic treatment done elsewhere. She wanted to replace the tooth with dental implant.
After thorough clinical and radiological examination, Maxillofacial Surgeon and Implantologist Dr. S. M. Balaji successfully planned to remove the infected teeth and replace it with immediate implants. Infected upper central incisor was extracted without any damage to the adjacent tooth structure and immediate implant was placed into the extraction socket with good stability and retention. After complete osseointegration of dental implant with that of the alveolar bone, implant was loaded with fixed ceramic prosthesis giving naturally well blended appearance.

A 26 year old boy visited our hospital seeking for correction of his facial profile to enhance the appearance. He was under orthodontic treatment for past 2 years elsewhere. But he was not satisfied with the results and thus he wants to have surgical correction of his jaw without any scars on the face.
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After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S.M.Balaji planned to correct his face by following corrective jaw surgery. He has short upper lip due to vertical maxillary excess which was corrected by Lefort I osteotomy. His profile shows short chin giving round face appearance. This was corrected by augmenting the genium using costochondral rib graft. Thus entire surgery was done inside the mouth and his facial appearance improved dramatically. Patient feels very happy to have the entire facial correction in a single surgery and without any visible surgical marks on the face.