Dr. med. Dr. med. dent. Manfred Nilius MSc.
@aesthetik-dortmund.de
Oral- and maxillofacial Surgery, aesthetic facial plastic surgery
www.niliusklinik.de
RESEARCH, TEACHING, or OTHER INTERESTS
Surgery, Multidisciplinary, Oral Surgery, Dentistry
Scopus Publications
Scopus Publications
Manfred Nilius, Charlotte Mueller, Minou Helene Nilius, Dominik Haim, Bernhard Weiland, and Guenter Lauer
Springer Science and Business Media LLC
AbstractIn the case of maxillary involution, augmentation is necessary for implant-supported prosthetics. The use of bone grafts is standard; customized allogeneic bone blocks may be a predictable alternative before dental implantation. For maxillary full-arch reconstruction, this case shows a horse-shoe augmentation by four allogeneic blocks, followed by guided dental implantation and fixed prosthetics after 6 months of healing. Using allogeneic blocks is an option for full-arch maxillary augmentation and comparable with autologous bone grafts. There is no donor site comorbidity. Bone height is stable for a minimum of 3 years after loading with resorption less than 10% in vertical, buccolingual, and mesiodistal directions. Short-implants allow for the long-term stability of prosthetic fixtures. Prefabricated customized allogeneic blocks for augmentation may increase the fitting accuracy of the graft, decrease morbidity, and lower operation time in maxillary full-arch reconstruction. The percentage of resorption after 3 years is comparable to the commonly used iliac crest.
Manfred Nilius, Minou Hélène Nilius, Charlotte Mueller, Bernhard Weiland, Dominik Haim, Anna Krahe, and Guenter Lauer
Hindawi Limited
Purpose. In cases of severe atrophic maxilla or maxillary involution, augmentation is necessary for implant-supported prosthetics. Using bone grafts is a standard procedure, and using customized allogeneic bone blocks may be a predictable alternative before dental implantation. Clinical Findings. This case study shows the digital workflow, including a preimplantological augmentation by a customized allogeneic block, followed by soft tissue optimization and template-based dental implantation, after six months of healing. It is part of a three-year follow-up study on the resorption rate of allogeneic bone blocks. Outcomes. Allogeneic bone augmentation is an alternative treatment option to autologous bone grafts. It allows predictable advanced backward planning (ABP) even in the maxillary esthetic zone. Diameter-reduced implants show long-term stability of a minimum of three years after loading and excellent results of prosthetic fixtures. Conclusion. Prefabricated customized allogeneic blocks for augmentation may increase the fitting accuracy of the graft, decrease morbidity, and reduce the operation time in esthetic maxillary rehabilitation.
Manfred Nilius and Jörg Winterhoff
Hindawi Limited
Purpose. The density of the jaw bone has an inhomogeneous distribution and, even within partial volumes, varies more or less strongly from the size of typical implants. Consequently, the primary stability of implants using conventional techniques can only ever be determined postimplantation. The aim of the present case report is to present digital volume tomography (DVT) osteodensitometry as a procedure for assessing the primary stability preimplantation and to evaluate its benefits. Methods. An orthopantomogram (OPT) and vertical sections, including bone density measurement, were obtained from a DVT in the course of preimplantological diagnosis. Conventional implant planning and densitometric simulation were performed on this basis. Results. Densitometric simulation enabled assessment of the bone density at the interface to the implant body preimplantation. This procedure provides not only an overall value (averaged density) but also allocation of bone areas with different densities to the adjacent areas on the implant surface. This then allows the implant with the best possible macroscopic geometry and optimum position to be selected, with the aim of maximising primary stability. In the present case, the maximum torques during insertion confirmed the densitometric values recorded in advance. Conclusion. DVT osteodensitometry enables selection of an implant optimised to bone density distribution. At the same time, the point at which loading occurs can already be defined at the planning stage, thanks to the predictable primary stability. A standard integration of DVT osteodensitometry in the algorithms of implant planning software thus seems desirable.
Manfred Nilius, Minou Nilius, Charlotte Müller, Henry Leonhardt, Dominik Haim, Patrick Novak, Adrian Franke, Bernhard Weiland, and Guenter Lauer
Elsevier BV
Manfred Nilius and Minou Hélène Nilius
Springer Science and Business Media LLC
Abstract Background Computer-assisted surgery optimises accuracy and serves to improve precise surgical procedures. We validated oral splints with fiducial markers by testing them against rigid bone markers. Methods We screwed twenty bone anchors as fiducial markers into different regions of a dried skull and measured the distances. After computed tomography (CT) scanning, the accuracy was evaluated by determining the markers’ position using frameless stereotaxy on a dry cadaver and indicated on the CT scan. We compared the accuracy of chairside fabricated oral splints to standard registration with bone markers immediately after fabrication and after a ten-time use. Accuracy was calculated as deviation (mean ± standard deviation). For statistical analysis, t test, Kruskal-Wallis, Tukey's, and various linear regression models, such as the Pearson's product–moment correlation coefficient, were used. Results Oral splints showed an accuracy of 0.90 mm ± 0.27 for viscerocranium, 1.10 mm ± 0.39 for skull base, and 1.45 mm ± 0.59 for neurocranium. We found an accuracy of less than 2 mm for both splints for a distance of up to 152 mm. The accuracy persisted even after ten times removing and reattaching the splints. Conclusions Oral splints offer a non-invasive indicator to improve the accuracy of image-guided surgery. The precision is dependent on the distance to the target. Up to 150-mm distance, a precision of fewer than 2 mm is possible. Dental splints provide sufficient accuracy than bone markers and may opt for higher precision combined with other non-invasive registration methods.
Manfred Nilius, Frank Hölzle, Minou Hélène Nilius, and Guenter Lauer
Elsevier BV
Manfred Nilius, Katrin Hess, Dominik Haim, Bernhard Weiland, and Guenter Lauer
Hindawi Limited
Purpose. Schizodontism is complete separation of a dental germ. It results in a twin tooth and supernumerary teeth. The treatment of transverse constriction in combination with supernumerary dental germs and impacted central incisors can pose a challenge, especially in young patients, when the number of permanent teeth is not adequate to ensure secure anchorage. The use of navigation templates based on three-dimensional X-ray images allows for precise insertion of temporary mini-implants for the acquisition of palatal distractors. In addition, templates allow for minimally invasive biopsies and osteotomies. Methods. The treatment of schizodontism, dentitio tarda, and transverse constriction is to be assessed as an interdisciplinary method by using mini-screw-assisted devices. Minimized osteotomy of impacted supernumerary teeth or dental implantation can be carried out in a one-step-procedure based on digital preplanning and prefabrication of orthodontic devices. Results. Multifunctional templates allow for early planning, preoperative fabrication, and intraoral fixation of orthodontic appliances. In the case of an adolescent patient, a sustainable, interdisciplinary treatment concept could be demonstrated that shows age-appropriate gnathological development and stable growth conditions over a follow-up period of 10 years. Conclusion. One can likely assume that multifunctional templates allow for minimally invasive one-step surgeries as an interdisciplinary tool between orofacial surgery and modern orthodontics.
Manfred Nilius, Jürgen Kohlhase, Johann Lorenzen, Günter Lauer, and Matthias C. Schulz
Springer Science and Business Media LLC