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Complete smile makeover following successful jaw reconstruction & dental implants for African boy

28/5/2016

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​A young African boy from Nigeria suffering from Ectodermal Dysplasia was referred to our Hospital for expert care. He had multiple missing teeth & had previously undergone bone grafting elsewhere but the graft had already resorbed & failed.
Maxillofacial Surgeon and Dental Implantologist Prof. Dr. S.M. Balaji performed the complete jaw bone reconstruction using costochondral rib graft . Implants were placed to replace his missing teeth. Following osseointegration of the implants, cosmetically well blended fixed ceramic prosthesis was given enhancing the appearance.
Multiple missing teeth in a boy suffering from Ectodermal Dysplasia
Xray before surgery
Failed bone graft done elsewhere
Harvested rib graft fixed to upper jaw bone
Lower jaw bone strengthened with rib graft
X-ray taken just after jaw reconstruction & implant surgery
Following ceramic prosthesis fixation giving enhanced natural smile
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Simultaneous upper jaw reconstruction with bone graft, implant fixation and reduction rhinoplasty

16/6/2015

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A young man from the Middle East was referred to our hospital for fixed replacement of his multiple missing teeth (anodontia). Along with placing implants, the patient also wanted to correct his nose shape to improve his appearance. A 3D CT scan revealed extreme deficiency of bone in his upper and lower jaw insufficient for placement of implants. Maxillofacial Surgeon & Implantologist Dr. S.M. Balaji reconstructed the maxilla and mandible using bone graft taken from the rib region.

Dr. Balaji successfully placed implants with good retention and stability in the reconstructed jaws. His nose was very long, broad, crooked and misshapen giving him an unattractive appearance. Simultaneously reduction rhinoplasty was performed to correct the nose shape. Lateral osteotomy was done to correct the deviated septum. Lower lateral nasal cartilages were trimmed to improve the appearance of the nose giving it a more balanced form enhancing the appearance. The patient was very happy with the surgery outcome without any scar on the face.
3DCT scan view showing complete anodontia of both maxilla and mandible with thin alveolar process
Intraoral view showing completely edentulous maxilla and mandible
Preoperative digital orthopantamogram showing completely edentulous jaws with iildefined alveolar process in maxilla
Harvested rib graft used to augment the maxillary alveolar ridge
Dental implants fixed in the lower jaw and stabilized with rib graft for good retention
3DCT scan showing good uptake of bone graft and osseointegration of lower implants
Facial view showing long deviated nose
Good bone formation following bone grafting
Implants fixed with good stability and retention in the newly formed bone
Immediately after suturing the gingivomucoperiosteal flap
Removal of caudal portion of lateral nasal septal cartilage to corret the bulkiness in the tip of the nose
Septal deviation was corrected intranasally
Immediate postoperative view showing pristine nose without any visible surgical marks on the face
Pre and post operative nose views
Postoperative OPG showing dental implants fixed with good retention in reconstructed maxilla and mandible
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Impacted canine surgery followed by successful rehabilitation with bone graft & implant

5/10/2014

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An 18-year-old girl was brought to our hospital by her parents with a complaint of spacing between her upper teeth. She wanted to align her teeth to enhance her smile and appearance.

She had an overretained maxillay deciduous left canine. A 3D CBCT scan showed permanent canine was impacted (deeply embedded in an abnormal position in the jaw bone). Maxillofacial Surgeon & Implantologist Dr. S.M. Balaji surgically removed the impacted tooth along with the deciduous tooth and placed an immediate implant in the same socket. Bone graft from the chin was taken to completely close the residual bone defect after removal of impacted tooth and to further fortify the bone for implant stability. Following osseointegration of the implant with the bone, ceramic crown will be fixed giving her a beautiful smile that enhances her appearance. 
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Miracle protein rhBMP-2, bone graft and implants placed to replace missing teeth in deficient jaw bone

30/9/2014

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A 45-year-old man from Australia came to our hospital seeking fixed replacement of his multiple missing teeth. The loss of many teeth over a long time led to progressive shrinkage of the jaw bone. The height of bone in the lower jaw was inadequate to place implants. Doctors elsewhere advised only removable dentures but the patient wanted fixed teeth to be able to chew and speak comfortably without the fear of dentures slipping off.

Maxillofacial Surgeon & Implantologist Dr. S.M. Balaji successfully reconstructed the deficient jaw using rhBMP-2 and bone graft to enable placement of implants and fixed teeth. The broken upper front teeth were extracted and immediate implants were placed in the same sockets without any bone loss. Implants were also placed in the right upper jaw. Implants and rhBMP-2 protein were placed in the lower jaw. This miracle protein stimulates the body’s own cells to form new bone thereby augmenting the jaw.

A costochondral rib graft was harvested & used to reconstruct the deficient height of the lower jaw and implants were placed. Subsequently, ceramic crowns closely resembling natural teeth will be fixed to the implants to complete the rehabilitation. The patient was very happy that he will have fixed teeth that will help him chew foods easily & give him a beautiful smile. 

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Combined corrective jaw surgery & sinus-lift with implant placement

16/8/2014

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A 30 year old lady from Saudi Arabia reported to our hospital with the complaints of missing teeth and more forwardly placed upper front teeth. She wanted to correct both the proclination and to replace the missing teeth with the dental implants in the same visit. She consulted various dental implantologists regarding her missing teeth replacement where they refused fixed replacements due to lack of bone support. 

Maxillofacial Surgeon and Implantologist Dr. S. M. Balaji successfully corrected both the proclination and replacement of her missing teeth in the same surgery. By following Le Fort I osteotomy the severely protruding upper jaw was set back to a more balanced occlusion. A sinus-lift procedure was done to enable implant placement in the decreased height region of the upper jaw. A “window” was cut & the lining of the maxillary sinus was lifted. The excess bone from the jaw correction was ingeniously packed in the space below the sinus membrane thereby increasing the width of jaw bone & implant was successfully placed. Later ceramic crowns will be fixed for complete dental rehabilitation. 
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Odontome removal and complete rehabilitation with bone graft & implant

11/8/2014

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A 20-year-old man reported to our clinic with a complaint of missing upper left front tooth. It appeared the tooth was buried in the gums and did not erupt completely causing an unsightly gap in the upper front teeth.

A digital X-ray revealed multiple miniature tooth-like structures in the upper left central incisor region. These are called compound odontomas. These structures obstructed the complete formation and eruption of the permanent central incisor tooth causing it to remain deeply embedded (impacted) in the upper anterior jaw bone.

Maxillofacial Surgeon & Implantologist Dr. S.M. Balaji completely removed the odontomas and impacted central incisor tooth. A bone graft was taken from the oblique ridge of the left lower jaw & fixed to the upper central incisor region. Following successful augmentation of the upper front jaw, an implant was placed & ceramic crown of exact color match was fixed. The man was very happy to have a pleasing smile with superior aesthetics. 

Multiple teeth like structures (odontomes) in the front upper jaw
Digital radiograph showing odontomes obstructing the formation and eruption of central incior
Multiple teeth like structures (odontomes) surgically removed along with impacted, incompletely formed incisor
Insufficient residual bone following removal of extensive defect
Bone graft taken from oblique ridge of left lower jaw
Harvested graft fixed to the upper left central incisor region
Following good healing bone screw is removed
Implant placed in the jaw bone
Digital radiograph showing implant fixed with good stability and retention
Enhanced aesthetics after complete rehabilitation with ceramic crown
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Successful jaw reconstruction with rhBMP-2 & complete rehabilitation with implants

12/6/2014

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A 30 year old man from Oman came to our hospital with the complaints of severe pain and swelling in the right side of his lower jaw. A 3D CT scan & thorough histopathological examination revealed he had multilocular ameloblastoma in the right lower jaw.

Maxillofacial surgeon Dr. S.M. Balaji expertly planned the complete jaw reconstruction. The affected portion of the mandible (lower jaw) was surgically ressected. A rib graft was harvested & used to reconstruct the excised portion. Miracle protein rhBMP-2 was placed. This stimulates the body’s own cells to form new bone at the site thereby ensuring complete healing of the bone defect.

Few months following surgery, remarkable healing of the jaw bone defect was seen. Implants were placed in the missing teeth region of the lower jaw and ceramic prosthesis were fixed. The man was very happy that his jaw bone defect is cured completely and with the implants he is able to chew & eat well. 
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Bone deficient region of upper jaw reinforced with bone graft & implants placed

27/3/2014

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A 29-year-old man from Singapore reported to our hospital seeking expert treatment for his widely spaced upper right teeth due to which there was food impaction problem & caused an aesthetic concern. Also his upper right teeth were mobile which made it very difficult to bite & chew food. 

Digital X-ray taken showed bone loss in the region of upper right incisor, canine & first premolar that caused mobility of the teeth. Maxillofacial Surgeon Dr. S.M. Balaji performed the jaw bone reconstruction. The periodontally weakened teeth were extracted and implants placed. A symphysis bone graft was harvested from the lower jaw chin region & placed in the bone deficient region of the upper jaw to compensate the bone deficiency. The surgical site was sutured. Crown prosthesis will be given later to completely replace his missing teeth. 
Pre operative intra oral view showing spacing between the teeth due to week periodontal attachments
Pre operative digital radiograph showing severe supporting bone loss due to periodontal infection
During procedure - Periosteal flap raised showing severe bone loss
Upper anterior teeth with severe mobility was extracted
Extraction socket showing severe bone loss
Bone grafting done from the symphyseal region to enhance the bone support for implants
Implant fixed and harvested bone was placed to close the severe bone defect
Periosteal flap was sutured
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