Dr. Mario E. Esquillo
Patients who received bone grafts after resection of benign tumors resulted in the removal of several teeth or none at all. Making rehabilitation of the dentition difficult, not only because of compromised abutments for prosthesis but also the effect of the oral musculature in providing a retentive and stable denture.
Dental implants can be an ideal solution to construct a fixed restoration. However, fibular bones are of limited height and width to accommodate the ideal implant size.
The presentation will show different techniques on handling the mandible with the fibular flap to receive endosteal implants. All implants used were fabricated by Laser Sintering.
In all cases, digital planning was used to ensure implants would be confined within the fibular bone in all dimensions.
The first patient who is partially dentate received six implants using dental implant navigation, which is a dynamic real-time guide implant placement. Pre-operative procedures were done according to the manufacturer's instructions before the actual implant placement. A removable partial denture was constructed as a provisional denture and ensured lip support.
The second patient with a fully edentulous mandible who had vestibuloplasty and conventional placement of nine endosteal implants using a paralleling device. A surgical guide was constructed using a 3D model to serve as a surgical guide as well as the fixed provisionary denture.
The third patient with a partially dentate mandible received four endosteal implants with the aid of a handmade surgical guide. A 3D-printed reconstructed mandible was used in the fabrication of the handmade surgical guide using an aluminum ribit as the drill guide. The removable partial denture was then used as a fixed provisional denture. The decision for immediate provisionary fixed prostheses was based on the result of the ISQ reading of above seventy percent.
Six months later, the three patients received a fixed removable hybrid prosthesis and were followed up monthly for six months. Oral hygiene was emphasized in all cases to ensure good mucosal condition.
Three patients exhibited satisfactory results based on masticatory function, gingival index, and hygiene control. It was also noted that all three cases have improved lip support.
Dental implants after mandible resection with Fibular Flap Reconstruction are the ideal option to complete dental rehabilitation and thus improve the quality of life of the patient.
