Implant-Prosthetic Rehabilitation of Mandibular Posttraumatic Severe Dentoalveolar Loss With a Reconstructive Staged Approach: A Clinical Report With 3-Year Follow-Up
This clinical report describes the oral rehabilitation of a 25-year-old male patient who lost the lower incisors, right canine, and a significant amount of anterior mandibular bony and soft tissue following severe dentoalveolar trauma due to a car accident. The patient’s young age, anterior esthetic zone in the lower jaw, previous mandibular fracture, and extended bony and soft-tissue defect hindering ideal 3-dimensional implant placement oriented the therapeutic plan toward a staged approach, with several reconstructive surgical procedures before implant rehabilitation. The treatment involved deepening the labiobuccal vestibule and lingual sulcus to correct cicatricial shrinkage due to previous surgical fixation of the mandibular fracture, vertical guided bony augmentation to regenerate adequate volumes of bone, free gingival graft to achieve sufficient height and thickness of peri-implant soft tissues, and a prosthetic-driven surgical procedure to place the implants in a good functional and esthetic position. This therapeutic approach restored function and esthetics and achieved outcome stability at 3-year follow-up.
Patient’s clinical and radiographic initial presentation: (a) extraoral view; (b) 3-dimensional computerized tomography scan; (c) intraoral view; (d) occlusal view.
Labiobuccal vestibule and lingual sulcus deepening: (a) split-thickness flap incision and elevation; (b) suture of the mucosal flap to the periosteum; (c) absorbable collagen membrane positioned onto the periosteum; (d) healing by secondary intention.
Vertical guided bone regeneration: (a) buccal and lingual flap incision and elevation; (b) fixation of the nonresorbable titanium-reinforced membrane on the buccal aspect and grafting of allogenic particulate and autogenous bone chips; (c) membrane folded over the graft and fixed on the lingual aspect; (d) suture of the flap coronally advanced.
Implant positioning: (a) cone-beam computerized tomography scan with virtually planned implants position; (b) leukocyte- and platelet-rich fibrin (L-PRF) membranes; (c) full-thickness paramarginal flap elevation and 3 implants in situ; (d) PRF block placed over the surgical area; (e) L-PRF membranes sutured; (f) flap repositioned and sutured.
Implants uncovering: (a) preoperatory view; (b) implants uncovered; (c) free gingival graft; (d) suture of the apically repositioned flap.
Intraoral view of prosthetic rehabilitation: (a) screw-retained provisional prosthesis; (b) screw-retained feldspathic ceramic-metal final restoration.
Clinical and radiographic findings at 3-year follow-up: (a) intraoral view of prosthetic rehabilitation showing soft-tissue stability; (b) 3-dimensional computerized tomography scans showing no bone resorption around the implants.
Contributor Notes