Report of Multidisciplinary Treatment of an Extensive Mandibular Ameloblastoma With Free Iliac Crest Bone Flap, Dental Implants, and Acellular Dermal Matrix Graft

Figure 1. Preoperative Panorex view of the mass located at the mandible. Note the typical unilocular radiolucent area producing soap bubble appearance. Figure 2. Preoperative 3-dimensional scan revealed the extension of the mass, resorption of the roots of almost all of the teeth above the lesion, and rupture of the external cortical layer. Figure 3. Intraoperative exposure of the anterior and the right hemimandible and the mass via submandibular incision. Figure 4. Anterolateral segment of the right hemimandible with a resection margin of at least 1 cm of normal bone beyond the tumor margin. Figure 5. The immediate reconstruction with microvascular free iliac crest bone flap harvested from the right iliac wing based on deep circumflex iliac vessels. Figure 6. In order to mimic the natural curve of the mandible, osteotomies are performed by preserving the periosteum. The inset of the flap is achieved by 1 reconstruction and 1 miniplate and screws. Figure 7. Early postoperative Panorex showing mandibular reconstruction and plate screw systems used for fixation. Note that the goal of obtaining cortical continuity and ideal bone height for implant placement is achieved. Figure 8. Late postoperative Panorex at the end of 3 years, after the removal of the plate system, shows osseointegration of the flap within native mandible, and the osteotomy segment healed without any problem.

Figure 9. Placement of dental implants following the removal of reconstruction plates. Figure 10. Presence of a mucogingival problem 7 months after the insertion of dental implants. Note the buccal mucosa is in continuum with the mucosa of the floor of the mandible. Figure 11. Increasing the keratinized tissue by using acellular dermal matrix graft. Figure 12. Early clinical view of postoperative healing of acellular dermal matrix graft at 1.5 months. Figure 13. Clinical view of acellular dermal matrix graft following a healing period of 3 months. Figure 14. Clinical view of the patient following the completion of prosthetic restorations.