22. Cernea P, Crepy C, Benoist M (1966) Reconstruction mandibulaire immediate apn:s resection. Mem Acad Chir 92: Cole PP (1918) Ununited

Transkript

1 Acknowledgments A great many persons contributed to the development of this work. My first experience with the practical problems of applying new implant designs was made possible by the support of my former chief, Prof. Dr. B. SPIESSL, head of the Division of Plastic and Reconstructive Surgery of the Department of Surgery in Basel (Director: Prof. Dr. M. ALLGOWER). My later chief, Prof. Dr. H. M. TSCHOPP, head of the Division of Plastic and Reconstructive Surgery at the Clinic for Visceral Surgery in Bern (Director: Prof. Dr. R. BERCHTOLD), aided the progress of my research with his keen interest and valuable suggestions. The implants and instrumentation were developed in close collaboration with the manufacturer, Dr. R. MATHYS of Bettlach, and his colleague, Mr. COT TING. Both gentlemen were very receptive to all our suggestions, and their wealth of experience helped greatly in the solution of many problems. The processing of histologic specimens was carried out under the direction of Prof. Dr. R. SCHENK, head of the Laboratory for Bone Histology of the Anatomical Institute in Bern (Director: Prof. Dr. E. WEIBEL). The animal operations were performed at the Experimental Surgical Unit (Head: Dr. W. SCHILT), the postoperative care was administered at the Equine and Domestic Animal Clinic (Director: Prof. Dr. H. GERBER). I am grateful to Prof. Dr. H. RIEDWYL, head of the Institute for Mathematical Statistics, for his advice on statistical evaluation. I extend special thanks to Prof. Dr. S. M. PERREN, head of the Swiss Research Institute for Experimental Surgery in Davos and Bern, for his helpful comments concerning revisions of the manuscript. I thank my wife for her assistance in the operations, for compling the list of references, and for taking the intraoperative and postmortem photographs. Photos of the implants were furnished by Mr. E. HUND and Mrs. M. KRETZ. 105

2 References 1. Albrektsson T, Branemark PI, Eriksson A, Lindstroem J (1978) The preformed autologous bone graft. An experimental study in rabbits. Scand J Plast Reconstr Surg 12: Allgower M, Perren S, Matter P (1970) A new plate for internal fixation - The Dynamic Compression Plate (DCP). Injury 2:40 3. Allgower M, Kinzl L, Matter P, Perren S, Rfidi T (1973) Die Dynamische Kompressionsplatte DCP. Springer, Berlin Heidelberg New York 4. Anastassov K, Popov K (1975) Regeneration complete du corps de la branche montante et du condyle de la mandibule chez un enfant apres desarticulation. Rev Odontostomatol (Paris) 4:43 5. Anderson R (1958) Prosthetic replacement of the hemisected mandible. Cleve Clin Q 25:18 6. Austermann KH, Becker R, Bruning K, Machtens E (1977) Titanium implants as a temporary replacement of mandible. A report of 30 cases. J Maxillofac Surg 5: Becker R, Machtens E (1972) Temporarer Ersatz des Unterkiefers. 1. KongreB der Europaischen Gesellschaft fur Kiefer- und Gesichtschirurgie. 28. Sept Okt. 1972, Ljubliana 8. Bergenfeldt E (1929) Prothesenbehandelter Fall nach halbseitiger Unterkieferexartikulation wegen Adamantinom, nebst einer kurzen Ubersicht fiber die Behandlungsmethoden fur Ersatz von Unterkieferdefekten. Acta Chir Scand 64: Bowerman JE (1974) A review of reconstruction of the mandible. Proc R Soc Med 67: Bowerman JE, Conroy B (1969) An universal kit in titanium for immediate replacement of the resected mandible. Br J Oral Surg 6: Boyne PJ (1969) Restoration of osseous defects in maxillofacial casualties. J Am Dent Assoc 78: Boyne PJ, Zarem H (1976) Osseous reconstruction of the resected mandible. Am J Surg 132: Branemark PI, Breine U, Hallen 0, Hanson B, Lindstroem J (1970) Repair of defects in mandible. Scand J Plast Reconstr Surg 4: Branemark PI, Lindstrom J, Hallen 0, Breine U, Jeppson PH, Ohman A (1975) Reconstrution of the defective mandible. Scand J Plast Reconstr Surg 9: Breine U, Branemark PI (1980) Reconstruction of alveolar jaw bone. An experimental and clinical study of ediate and preformed bone grafts in combination with osseointegrated implants. Scand J Plast Reconstr Surg 14: Brown KE (1971) Supportive metallic implant for autogenous mandibular graft. J Prosthet Dent 26: Burri C, Wolter D (1977) Das komprimierte autologe Spongiosatransplantat. Unfallheilkunde 80: Casson PR, Eitches A, Hayes CW (1972) Reconstruction of the mandible by iliac bone grafting. International symposium on plastic and reconstructive surgery of the face and neck. Aesthetic Plast Surg 1: Casterman A, Garsse A van, Vanwijck R (1977) Primary reconstruction of the mandible after resection for oral cancer. Acta Chir Belg 76: Castigliano SG, Gross PP (l951).immediate prosthesis following radical resection in advanced primary malignant neoplasm of the mandible. J Oral Surg 9: Catania VC, Cislaghi E, Bandettini MY (1970) Immediate replacement with metal prosthesis ofhemimandible removed for neoplasia. Minerva Stomatol19:

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7 126. Spiessl B (1976) Erste Erfahrungen mit einer Kiefergelenksprothese. Fortschr Kiefer Gesichtschir 21: Spiessl B (1978) Die Unterkiefer-Resektionsplatte der AO. Ihre Anwendung bei Unterkieferdefekten in der Tumorchirurgie. Unfallheilkund 81: Spiessl B (1981) A new method of anatomical reconstruction of extensive defects of the mandible with autogenous cancellous bone. J Maxillofac Surg 8: Spiessl B, Schroll K (1972) Gesichtsschadel, Bd Ill. In: Nigst H (Hrsg) Spezielle Frakturen- und Luxationslehre. Thieme, Stuttgart 130. Spiessl B, Tschopp HM (1974) Chirurgie der Kiefer. In: Naumann H (Hrsg) Kopf- und Hals-Chirurgie, Bd 2/2: Gesicht und Gesichtsschadel. Thieme, Stuttgart, p Spiessl B, Prein J, Schmoker R (l976a) Anatomical reconstruction and functional rehabilitation of mandibular defects after ablative surgery. In: Spiessl B (ed) New concepts in maxillofacial bone surgery. Springer, Berlin Heidelberg New York, p Spiessl B, Schmoker R, Mathys R (1976b) Treatment of ankylosis by a condylar prosthesis of the mandible. In: Spiessl B (ed) New concepts in maxillofacial bone surgery. Springer, Berlin Heidelberg New York, p Steinhauser E (1968) Unterkieferrekonstruktion durch intraorale Knochentransplantate, deren Einheilung und Beeinflussung durch die funktions- und tierexperimentelle Studie (Teil I, II). Schweiz Monatsschr Zahnheilkd 78: Stellmach R (1978) Die Fixierung des Spans bei der freien Knochentransplantation. Fortschr Kiefer Gesichtschir 23: Tarnai K (1954) Operative Metallallenthese-Implantation in einer Sitzung zum Ersatz des fehlenden Unterkieferkorpers. Dtsch Zahn Mund Kieferheilkd 19: Upadhyaya P, Dhawan IK, Sidhu S (1965) Replacement of the jaw following excisional surgery for malignant disease of the mandible. Indian J Cancer 2: Willenegger H, Schenk R (1963) Zum histologischen Bild der sogenannten Primarheilung der Knochenkompakta nach experimentellen Osteotomien am Hund. Experientia 19: Wilson JSP, Towers JF (1974) Mandibular reconstruction. Proc R Soc Med 67: Winter L, Lifton JC, McQuillan AS (1945) Embedment of a vitallium mandibular prosthesis as an integral part of the operation for removal of an adamantinoma. Am J Surg 69: Yoel J (1966) Mandibular reconstruction: methods and results. Int Surg 45:

8 Subject Index Page numbers printed in italics refer to an important and detailed description of the concept. Abrasion 66, 74 Abutment post 2,21,30,34-37,39, 42-43,56,59,62-66,71,74,77,101 anchoring 20,30-31,41 attachment 30, 66 intraoral base 74 preprosthetic 69 Adamantinoma 9 I Adapt 67,75,94,100 Adaptability 2,20, 69 Airway obstruction 85 Alveolar crest 30, 34-35, 87 Alveolar process 66 Anchorage 60 abutment post 69,74 in bone graft 101 on reconstruction plate 102 condylar stump 85,91,102 dental prosthesis I, 30 denture 2, lingual side with spherical-head nuts 69,100 screw 45,73,102 stumps 82 Anchoring elements 2,30-31,37,39, 74,101 Anesthesia 33 Animal experiments 19,32,67,71,74, 76 with abutments 74,100,101 with radiation 72 Ankylosis 1,2,67,94,101 Antagonists 66, 74 Antibiotic coverage 33 Approach 20,21,25,34-39,67,73,75, 91,96,100 combined intra- and extraoral 39 extra oral 96 intraoral 91,100 preauricular 94 asymmetry 67 atrophy 60 Base, mandible 66 Bendability 69, 100 Bending 25, 29 maximum tolerance 75 pliers 25,29, 38, 69, 75 templates 69 Biopsy 96 Bispherical transverse oval shape 27,77 Blood flow 60,66-67 Bonding 73 force 74 frictional 25 Bone changes 58 complete bridge 71 contact 60 continuous bridging 72 deposition 67,72 formation 67,73 fragments 100 graft 1,14-15,18,91, grafting 2, 16, 20, 7 I, 77, 99, 100 in irradiated tissue 100 new formation 32,41 reaction 60 regeneration 60-61,71-72,75,77 continuous bridging 72 remodeling 41,58 resorption 1,18,67,73, 100, 102 section 45 sequestra 66, 101 structure 71, 96 Bony consolidation 82 Cancellous bone 18,82,87,99 Center condylar head 75 Chemotherapy 96 Chin 3, 34-39, 59, 73, 82, 85, 87 Clinic 19-20,69,71-72, Clinical experience 2, significance testing 71 Closing in layers 100 Comminuted fracture 85,87,100,101 Complications 59,75,101 Compressed cancellous bone 99 Compression I, 25, 27, 71,

9 Condylar head 2,19-20,27-29,38,50,67,76, 89,96 prosthesis 2, 19,27-29,32,94 Connective tissue layer 50,67,73 Consumption coagulopathie 87 Containment of saliva 1 Continuity, mandible 1,98 disrupting 1 restoring 1,20 Contouring 67,69,73,100 over- 73, 100 under- 73,75, 100 Contours of mandible 69 Corrosion resistance 69 Cosmetic deformity 1 Craniofixateur externe 87, 102 Cutting of skin flop 21 DCP 25, DCP bidirectional hole 25, 69, 99 bidirectionally function 25 both longitudinal directions 25 double hole 102 two-way hole 25 Dead space 39 Decubitus ulcers 67, 74, 75, 100 Defect 1,3,18,20,61,71,75,76,82,85, 89, 101 anterior mandibular 82, 87 bridging 1, 18,61,72,75 extensive mandibular 71,76 extent 20 fracture 85, 101 from the chin to the condylar neck 85 mandibular angle to the condyle 89 mucosal 82 occurring 1 sequelae 1,3 skin 82 tumor-related mandibular 71 vertical ramus 85, 89 Deformation 75 Deformity 41,67 Dehiscence 60,63,67,74 Dental infection 100 Dental prosthesis 30 Denture 2,30,74,76,100 Delayed union 98 Design of internal fixation plate 2 Development implants 2,20,23-30,75 instruments 75 Deviation 1,67,91,99 Diet 69 Dietary measures 71,75 Difficulties with respiration Dimension Implant 2,67,76,99 Reconstruction plate 24-25, 67 Screw 99 Dislocation 39, 101 interposed material 101 risk 27, 101 Dog 32,71 Drill guide 69 Drychow 33 Dry feed 41 Dynamic Compression Implant 100 Dynamic Compression Plate Dystrophy 1 Eating I Eccentric Dynamic Compression Plate 23,89 EDCP 23,89 Epithelial downgrowth 20,63-67, 74 invagination 56,63-67 investment 20,63-67, 71, 74 margin 56,63-67, 74 seal Examinations 41 experimental histologic 41,73 microscopic 41, 73 radiograpahic 41,73 Exercise stability 20 Expanding-head 85 Expanding-head screw 85 Experience with mandibular reconstruction 79 Experimental animal 20,21,32-34, 71,74 dog 32,,71 number 74 sheep 32, 58, 71 still growing 32,56,67,71,72,75 design 34,75, 76 model 19,20,75 Experiments preliminary 34, Exploration 85 Exposure of plate 74 Extraction teeth 37 wound 63 Facial artery 38 nerve 3 vein 38 Fistula formation 60,67,87 114

10 Fixation condylar prosthesis 27 denture 2, 30 external 3 fracture 99 functionally stable 1, 17,67, 72, 99 grafted bone 99 intermaxillary 1,18,20,59,69,75,87 mandibular stumps 2,18,20,87 reconstruction plate 65 sutures 39 systems 74 Flap transfer 100 Floor of the mouth 85 Floor, oral 39 Follow-up 41,58,79 Food intake 69 Form of mandible 98 Fracture comminuted 85,87,100,101 defect 85, 101 fixation 99 horizontal ramus 89 plate 69, 75,91,98, 102 screw 68,74 Frictional bonding 25 Fully mature animals 32,72,75 Function articular 67 imposed stresses 2 joint 20 mandibular 98 masticatory 30,41,59, 66, 69,99 restriction I Functional stability 1, 18,20,59,69,71, 73-75,77, evaluation 73 experimental design 74 Functional stimulus 1,99 Grinding mastication 71 Growth 67, 71,72,75 curve 72 period 67 Gunshot injuries 1,82,85,89, 101 mandible 82, 85, 101 maxilla 82 Head condylar 2,19-20,27-29,38,50,67, 76,89,96 expanding 85 expanding-head screw 102 screw 74 Healing bone graft comminuted fracture or fracture with bone loss 100 dental extraction wound 66 Hemimandibulectomy 3,4,35,38-39, 96,101 Hemophilus infection 58 Hemostasis 87 Horizontal ramus 34,38,85,89,94 Iliac crest 82, 91 Implant 2-21,23-31,98 abutment post 2,21,30,34-37,39, 42-43,56,59,62-66, 71, 74, 77, 101 anchorage 69, 74 antagonists 66,74 clinical application 101 dental prosthesis 1, 30 denture 2, loading 74 transalveolar 20,37,39,59,62-66 transmucosal 20,37,39,59,62-66 transosseous 20,37,39,59,62-66 anchorage 41, 56,59,6~ 61, 74 dimension 2,67,76,99 Dynamic Compression 100 loading test 69 loosening 2,18,59,67,102 prosthesis removal 18,20,58,59,73-75, subperiosteal 100 Improvement implants 19, 75 operating technique Incision 38,94 Indication abutment 101 mandibular reconstruction 98 reconstruction plate 101 reconstruction plate with condylar head 101 Infection 58-60,66,74, risk 20,66,73,98,100 Ingrowth 73 Instability 60,63,66-.67,73-74 Instrumentation for transbuccal screw insertion 77 Instruments 75 Interfragmental compression 99 Intermaxillary fixation 1,7, 18,20,59, 69,75,87,89 temporary 91,94 Internal fixation 17,23, 74, 99 plate 1,25,99 sagittal split osteotomy

11 Interposed bone graft 99 material 101 Interval, recurrence-free 101 Jaw morphology 74 Joint ankylosis 1,67,94, articular changes 73 articular fossa 20 bispherical transverse oval shape of the head 27, 75 bone formation 45,67,73 bone resorption 45,67,73 center the head 75 condylar head 2, 19-20, 27-29, 38, 50,67,76 connective tissue layer 50, 67, 73 dislocation 67 function 20 glenoid fossa 3,18,27,39,67,75,96 motion 1,41,67 prosthesis 27, 58 reaction 73 replacing I - 2, 20, 98, 101 stump of condylar neck 85 Joint contralateral 67 articular changes 73 bone formation 73 bone resorption 73 condylar head 67 glenoid fossa 67 reaction 73 Kirschner wires 3, 4, 5, 17, 18 Lateral deviation 40,91 Le Fort fracture 87 Learning by the experimenters 74 Lingual side 69,73,75, 100 Load masticatory 60,71,75 stability 20, 69 Load-bearing ability 98 framework 102 properties 101 Loading test 69 Loose bone fragments 85 Loosening 2, 18,30, 59,6~ 62, 67 implant 2,18,59,67,102 screw 66,87,99 Luxation 27,39,67,101 interposed material 101 joint 39,67 risk 27,101 Malalignment 2 Mandible asymmetry 67 base 66 changes 73 continuity 1,98 contours 69 defect 1,3,18,20,61,71,75,76,82, 85,89, 101 anterior mandibular 82, 87 bridging 1,18,61,75 extensiv mandibular 71,76 extent 20 fracture 85, 10 I from the chin to the condylar neck 85 mandibular angle to the condyle 89 mucosal 82 occurring I sequelae 1,3 skin 82 tumor-related mandibular 71 vertical ramus 85, 89 deviation 1,67,91,99 form 98 joint angle 38-39, 67, 73, 89, 91, 96 ankylosis 1,67,94, articular changes 73 articular fossa 20 bispherical transverse oval shape of the head 27,75 bone formation 45, 67, 73 bone resorption 45,67,73 center the head 75 condylar head 2, 19-20,27-29, 38,50,67,76 connective tissue layer 50,67,73 dislocation 67 function 20 glenoid fossa 3,18,27,39,67,75, 96 loss 1,2 motion 1,41,67 prosthesis 27, 58 reaction 73 replacing 1 --;-2, 20, 98, 101 stump of condylar neck 85,91, 102 joint contralateral 67 articular changes 73 bone formation 73 bone resorption 73 condylar head 67 glenoid fossa 67 reaction 73 Load-bearing ability 98 neck condylar 27,87,94 116

12 reconstruction animal experiments 19,32,67,69, 74, 75 challenge 71 complications 59,75, 102 consolidation 82 experience 79 functionally stable 87,89 indication 98 modell 19,20,75 morbidity 2, 102 overcontouring 73, 100 results 58, 75 statement of problems 19,34 success 18, undercontouring 73,75, 100 reconstruction plate 24-26,28-30, 32,71,74,82,85,87 length 23, 34 lingual 69, 73, 75, 100 mini- 25,89, 102 prebent 85,91 replacement 91 three-dimensionally bendable 2, 24-26,28-30 withcondylarhead 2,19-20, 27-29,38,50,67,76,89,96 resection 1,3,34-39,71,91,94,96, 100, 101 shape 11,71 stump 1-3,7,21,61,71,82,85,96, 99, 100, 101, 102 attached 82 fixation 2, 18, 20, 87 stabilisation 1,7,99,101 Mandibular canal 99 partial resection 3 resection 1,3,34-39,71,91,94,96, 100, 101 Masseter muscle Mastication grinding 32, 71 shearing 71 Masticatory action 71 function 30,32,41,59,66,69,99 load 60,71,75 muscles 61 Material tests 69 Maxilla 25,87,89, 102 Maxillary injuries 89 Measure of funtional soundness 71 Measures, dietary 71,75 Metal plates 11, 18 prostheses 18 removal 18,20,58,59, 73-75, Metallic mesh tray 7,18 meshlike structure 73 prostheses 10 Microradiographs 45 Microtome sections 45 Midfacial fracture 87 Minimum number of screws 75 Minipig 33-38,40,58,69, 72, 75 age of operation 72,75 body weight 72 weight curve 72 Mini-reconstruction plate 25, 89, 102 Mobilisation 87,89, 102 Mobilising a skin flap 38,60,67,73 Model for experiments 19,20,75 Morbidity 2, 102 Morphology, jaw 32, 75 Mouth opening 91,94,96 Mucosal coverage 39 defect 82, 85, 87 Muscles, masticatory 61 Necropsy 41 Necrosis 59,60,67,73 Nerve canal 99 Neurologic status 87 Nonunion 99, 101 Occlusion 39,67,94,96 Ocular rupture 87 Operating technique 38-40, 74, 75, 100 Operative scar 41,60 Oral floor 39 Osteoporosis I Overcontouring 67,69,73,100 Partial mandibular resection 3 Patient's general condition 99 Periosteum 66,71,75 bone reaction 71 conservation 75 denude 21 preservation 76,77 removal 77 separation 34 spare 71 strip 21,37,59,62,65 Placement of a denture 101 Plate adapting 75 anchorage 41,56,59,60,61,74 bend ability 69 contouring

13 Plate cross-section 24 deformability 69 deformation 75 exposure 74 fixation 1,25,98,99,101 on the lingual side 69, 73, 75, 100 fracture 69,75,91,98,102 fracture resistance 75 internal fixation 1,25,69,99 length 24, 34 lingual 69,73, 75, 100 modelling 75 overcontouring 73, 100 reconstruction 24-26,28-30,32,71, 74,82,85,87 lingual 69, 73, 75, 100 mini- 25,89,102 prebent 85,91 three-dimensionally bendable 2, 24-26,28-30 with condylar head 2,19-20, 27-29,38,50,67,76,89,96 removal 73,75, seating 41, 60 undercontouring 73, 75, 100 Platysma muscle Pocket 66 formation 63 Polychromic labeling 41 Postprimary treatment 87 Preliminary experiments 32 Premedication 33 Preprosthetic procedures 100 Pressure lesion 75 side 17 Primary stability 74 treatment 82,85,87,89 Problem, statement 19,34 Prosthesis 19,27-28 anchorage 2 dental 30 head 27 metallic 10 neck stem Prosthetic condyle 19 Pterygoid muscle Radiation 72, 96, 99, 100 Radiation therapy 72 Radiograph 41,59,87,96 Radionecrosis I Ramus horizontal 34,38,85,89,94 vertical 27, 38, 39 Reattachment 100 Reconstruction animal experiments 19,32,67,69,74, 75 challenge 71 complications 59, 75, 102 consolidation 82 experience 79 functionally stable 87,89 indication 98 model 19,20,75 morbidity 2, 102 over contouring 73, 100 results 58, 75 statement of problems 19, 34 success 18, undercontouring 73,75, 100 Reconstruction Plate 24-26, 28-30, 32, 71,74,82,85,87 length 24, 34 lingual 69, 73, 75, 100 mini- 25,89, 102 prebent 85,91 replacement 91 three-dimensionally bendable 2, 24-26,28-30 with condylar head 2, 19-20,27-29, 38,50,67,76,89,96 Recurrence 91 Reestablishment of mandibular function I Remodeling 41, 58,99 of bone graft 99 Removability 73-75, Removal anchoring elements 69, 101 implants 1,8,20,58,59,73-75, reconstruction plate 69, 101 screw 69,75 Reoperation 100 Replacing soft-tissue coverage 100 temporomandibular joint 1-2, 20, 98, 101 Resection 1,3,34-39,71,91,94,96, 100, 101 partial mandibular 3 subperiosteal 77 Resorption 1,18,100,102 Restriction of function I Results 58, 75 Revascularization 2,18,71,99,102 Rods 3,7,17,18 Roentgenogram

14 Sagittal split osteotomy 110 Sarcoma 96, 101 Scar contraction 1,2,3 Screw anchorage 45,73, 102 fracture 68, 74 expanding-head 102 head 74 loosening 66,87,99 number 21,34 removal 67, 75, 99 seating 18,25; 41,60 size 98 spherical-head nuts 69, 100 Sequelae of mandibular defect 1,3 Sequential dye 41,58,61,73 Sequestra 63, 100 Shape implant 76 mandible 11,71 Shearing mastication 69 Sheep 32,58,71 Silastic 5 Silicone 10 I Size metallic mesh trays 18 metallic prostheses 10 Skin defect 82 Skin flap 21,34,38,60,67,73 Skull base 18 Soft tissue 38,60,67,71,73,75,87,99, 100, 101 closure 38, 100 damage 73 damaged 100 defect 18,87 flap 38,60,67, 73, 100 injury 60 irradiated 71, 100, 101 loss 99 mobilisation 73 pedicled 100 poorly perfused 100 pressure lesion 75 radiation 73, 99 stretched 73 tension free 100 trauma 38 traumatized 100 Spacing of the plates holes 19,25,67 Speaking difficulties I Special diet 69 Spherical gliding principle 25 Spherical-head nut 69, 100 Spike 27,69 Stability 2,20,40,41,45,63,73, 101, 102 anchorage 20,63 abutment 20 plate 63 connexion with: bone regeneration 61 bony contact 60 continuous bony bridge 60 decubitus ulcers 67,73 dehiscence 67, 73 epithelial seal 63 soft tissue coverage 73 weight gain 59 deflection 102 exercise 20 functional 20,76, 101, 102 joint 40 loading 2, 20 primary 74 reconstruction 40, 41, 45 rotation 102 Stabilization 1,27,98,99 bone graft 99 by compression I condylar prosthesis 27 mandibular stumps 99 Stabilizing I, 2, 3, 10 I deflection 102 denture 2 mandibular stumps 1,2,3,101 rotation 102 Statistical analysis 74 evaluation 67 Stiffness I, 98 Stress protection effect 99 Success 18,71-72 criteria rating 71 Surface properties 73 ' structure 72,75 Survival time Technique insertion 20 operating 38-40, 74, 75,100 Temporalis muscle 39,. Tension-free wound closure 100 Teeth abrasion 66, 74 antagonists 66,74 dental prosthesis 30 denture 2,30;74,75,100 attachment 100 fixation 2 extraction 37 extraction wound 63,

15 Teeth germs 37 roots 96 Tensile force 27 Tension-free wound closure 100 Tension side 17 Three-dimensionally bendable reconstruction plate 2, 24-26, 28-30, 32, 69-71,82,85,87 Time effect 75 surpass weight at operation 71 Tissue compatibility 20, 101 Titanium screws 74 Titanium sprayed surface 72,74 Tracheotomy 87 Transalveolar 20,37,39,59,62-66 Transbuccal screw insertion 77 Transmucosal 20,37,39,59,62-66 Transosseous 20,37,39,59,62-66 Trauma I Treatment of ankylosis 10, 10 I postprimary 87 primary 82,85,87,89 Tumor 71,77,91,96,99,100 recurrence 91 resection 1,3,34-39,71,91,94,96, 100, 101 Twist 29 Undercontouring 73, 75, 100 Vascular ingrowth 99 Vertical ramus 27,38,89 Wedging of a bone graft 100 Weight arrest 73 comparison operated/nonoperated animals 73 curve 72,74 gain 32,45,59,66-67,71-72,75 at operation 72, 73 quantitative comparison 72 surpass weight at operation 72 Wound closure 38, 75, 100 extraction wound