Immediate Oral Rehabilitation Using Dental Implants After Marginal Mandibulectomy: A Case Report
Mandibular reconstruction techniques are always a challenge to oral and maxillofacial (OMF) surgeons. Techniques and treatment plans that offer the patient OMF rehabilitation should always be available. Technological innovations have enabled more rapid, safer, and more secure treatment than in the past. This article describes a case using a different approach. The patient was treated with marginal mandibulectomy and immediate rehabilitation with osseointegrated implants; a hybrid prosthesis was fabricated a short time thereafter. This treatment plan demonstrated its utility and efficiency in this case. An approach with fewer surgeries and OMF rehabilitation needs be considered in all cases.
Figure 1. Intraoral examination revealed nonspecific growth between teeth 26 and 27. Figure 2. Imaging examinations revealed radiolucent areas, undefined contours, and a multilocular in the anterior part of the mandible.
Figure 3. Incisional biopsy performed and sutured. Figure 4. Microscopic exam revealed islands. Arrow indicates myxomatoso and fibrosis aspect; Mct, microcystic compatible by desmoplastic ameloblastoma. *Epithelial islands. Figure 5. Three-dimensional model of the mandible used a pre-bent reconstruction plate and plan of the marginal mandibulectomy and implants' positions.
Figure 6. Transoperatory view with reconstruction plate placed (left) before the marginal mandibulectomy (middle). After marginal mandibulectomy was performed, the narrow and short osseointegrated implants were placed (right). Figure 7. Surgical piece and teeth removed (left, middle). Multiunit abutments and cylinders were placed and sutures with Vicryl 4-0 were completed (right). Figure 8. The hybrid acrylic-metal prosthesis was placed 48 hours after surgery. Figure 9. Extraoral aspect of the patient 48 hours after surgery, before and after the prosthesis was placed. Figure 10. Lateral view of the patient 48 hours after surgery, before and after the prosthesis was placed.
Figure 11. Intraoral exam after 6 months (left). Adjusting the base of the prothesis to improve the oral hygiene and facial contour (middle). Occlusal view after 12 months, second time the prothesis was removed (right). Figure 12. Imaging examinations are also performed every 6 months. Cone beam computerized tomography 11 months after surgery. Shows the plate and osseointegrated implants working very well and with no signs of lesion. Figure 13. Extra oral pictures, 18 months after surgery, without prosthesis (left), and during smile with the prosthesis (middle, right). Figure 14. Panoramic x-ray 6 years after treatment.
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