CATEGORY AUSTRALASIAN DENTIST 81 LINICAL rigidly secure the frame to the maxillary bone (Fig. 3). The incised gingival tissues were reapproximated and repaired with dissolving sutures, making sure the tops of the ex-hex connectors above the 4 posts were left exposed (Fig. 4), and allowed to engage the dental prosthesis which was fixed to the posts with internal M2 screws (Fig. 5). Minor occlusal adjustments were made to the dental prosthesis before the patient was woken up, recovered, and then discharged 2 hours later. He was sent home with written postoperative instructions, analgesics, antibiotics and disinfectant mouthwash. The patient was instructed to maintain a soft diet for 6 weeks until secondary osteoadhesion occurs between themaxillary bone and roughened titanium frame. Discussion: The evolution of the OsseoFrame has been driven by clinical challenges which the author has encountered over the last 7 years. The most valuable lessons learnt from the years of trial and error include; 1) reducing the amount of metal covering the alveolar margins 2) the need for absolute rigidity of the frame and 3) countersinking the posts so the top of the posts are at gingival or subgingival level. The original frames had metal covering the alveolar margins which invariably resulted in major wound dehiscence since the crestal gingivae did not heal over a metal surface. Secondly, we found that simply relying on the fit with the patient-specific surface and a few stabilizing micro-bone screws was not enough to counter the micromovement of the implant. So, we now advise surgeons to fill every hole available across the OsseoFrame with self-tapping bone screws especially along the palatal bone, zygomatic buttress, and anterior maxilla where bone is thickest. The additional self-tapping screws help achieve absolute rigidity to encourage osteoadhesion of the OsseoFrame to the soft maxillary bone. And finally, we discovered that placing the posts above the thin alveolar crestal bone resulted in wound dehiscence and exposure of the base of each post. This is likely due to bone resorption of the thin alveolar bone dissolved under the posts, thus we now advise alveolectomy so the posts are countersunk and sit on solid flat basal bone. Allowing the gingivae surrounding each post to cover almost the whole post so that the top of the post is at or just below gingival level. With these three modifications we have found the success rate of the OsseoFrame has improved significantly over the earlier designs. Conclusion: Time, experience, and extensive clinician feedback has made the OsseoFrame a successful Australian made medical device that is now ready for the global export market. The OsseoFrame is a simple, reliable, and dependable alternative fixed dental implant solution in cases of atrophic edentulous maxillae and mandible. Declaration: The Author is also the Founder and Clinical Director of MAXONIQ (www.maxoniq. com) a Melbourne based Med-Tech company that first conceived, developed and manufactures the OSSEOFRAMETM device described in this article. u Dr George Dimitroulis Consultant Oral & Maxillofacial Surgeon Epworth-Freemasons Hospital Suite 1, Ground Floor 124 Grey Street East Melbourne VIC 3002. Tel: 03 9654 3799 e-mail: geodim25@gmail.com Figure 3: The cutting guide is removed and the patient-specific OsseoFrame is placed over the flattened edentulous maxillary ridge, with metal arms extending palatally and labially to the zygomatic buttresses and anterior maxilla, where bone is thickest to accommodate self-tapping bone screws for absolute rigidity. Figure 5: The interim dental prosthesis is attached by M2 internal screws to the OsseoFrame via the 4 transmucosal posts which emerge from the lateral incisor and second premolar sites. The dental prosthesis is inserted and adjusted before the patient wakes up which is one of the most striking advantages of the OsseoFrame compared to other dental implant solutions. Figure 4: The soft tissues are repaired over the frame leaving just the tops of the posts exposed which attach the frame to the dental prosthesis with internal M2 screws. WWW.PROFDENT.COM.AU #SUPPORTAUSTRALIAN Give your patients a Lightening White Smile! 16% Carbamide Peroxide and Chlorofluor Gel
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