Maxillofacial Reconstruction and Implantology
Maxillofacial Reconstruction and Implantology
This domain tests defect assessment, graft and flap selection, and implant planning in compromised bone. The exam expects biological and biomechanical reasoning, not just implant brand knowledge.
Core rules
- Define the defect: size, location, soft-tissue quality, bone stock, occlusion, and previous surgery or radiotherapy.
- Reconstruct with local grafts for small defects, regional flaps for moderate soft-tissue needs, and free flaps for large composite defects.
- Implant planning uses CBCT, ridge width and height, bone density, prosthetic space, and planned angulation.
- Primary stability depends on bone quality and quantity; excessive torque in poor bone can cause necrosis.
- Sinus floor elevation is considered when residual posterior maxillary bone is insufficient; staged grafting may be needed.
Worked example
A posterior maxilla has 5 mm of residual bone and adequate sinus health. Reasoning: a lateral sinus lift with particulate graft can create vertical height; implant placement may be simultaneous if primary stability is achievable or staged after healing. The plan must include prosthetic space and keratinized tissue assessment.
Traps
Ignoring smoking, uncontrolled diabetes, or prior radiotherapy; placing implants without prosthetic planning; excessive cantilevers; missing peri-implantitis; grafting an infected sinus.