World Journal of Dentistry

Register      Login

VOLUME 10 , ISSUE 4 ( July-August, 2019 ) > List of Articles

CASE REPORT

Dental Implant-supported Rehabilitation on a Vascular-grafted Mandible: A Long-term and Multidisciplinary Approach

Rafael S de Molon, Mário FR Gabrielli, Rogerio Margonar, Jônatas C Esteves, Thallita P Queiroz, Marisa AC Gabrielli, Eloisa M Boeck, Claudio Marcantonio, Elcio Marcantonio

Keywords : Dental implant, Le Fort osteotomy, Mandibular fractures, Maxillofacial surgery, Vascular grafting

Citation Information : de Molon RS, Gabrielli MF, Margonar R, Esteves JC, Queiroz TP, Gabrielli MA, Boeck EM, Marcantonio C, Marcantonio E. Dental Implant-supported Rehabilitation on a Vascular-grafted Mandible: A Long-term and Multidisciplinary Approach. World J Dent 2019; 10 (4):310-315.

DOI: 10.5005/jp-journals-10015-1656

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Facial trauma may lead to severe fractures and loss of bone and dental structures. Depending on the magnitude of the trauma, whole segments of the jaws may be lost due to comminution, exposure of internal structures, or infection. The treatment of such lesions can be challenging, and success is often hindered by unsatisfactory esthetic, phonetic, and functional outcomes. The aim of this case report was to describe a multidisciplinary approach for implant rehabilitation in a complex case of trauma in the maxillofacial region in a young patient. Case description: A 22-year-old female patient was referred with extensive loss of soft and hard tissues in the mandible as well as loss of several teeth due to facial trauma. The patient was submitted to innumerous surgical reconstructive procedures throughout years of treatment, which included vascularized soft and hard tissue grafts, installation of dental implants, Le Fort I osteotomy for maxillary repositioning, and subsequent implant-supported prosthetic rehabilitation. Conclusion: A 24-year follow-up of comprehensive surgical and prosthodontic reconstruction of a facial injury with several fractures due to motorcycle accidents using the multidisciplinary approach was described. The multidisciplinary approach employed in this case demonstrated successful outcomes for the reconstruction of the maxillofacial region after extensive facial trauma. After six years postoperatively no complications with the rehabilitation treatment has been detected to the present date. Clinical significance: The multidisciplinary treatment planning employed was able to restore masticatory function and facial esthetics, enhancing patient quality of life and satisfaction.


PDF Share
  1. Ricketts S, Gill HS, Fialkov JA, et al. Facial Fractures. Plast Reconstr Surg 2016;137:424e–444e. DOI: 10.1097/01.prs.0000475760. 09451.49.
  2. Schneider D, Kammerer PW, Schon G, et al. Etiology and injury patterns of maxillofacial fractures from the years 2010 to 2013 in Mecklenburg-Western Pomerania, Germany: A retrospective study of 409 patients. J Craniomaxillofac Surg 2015;43:1948–1951. DOI: 10.1016/j.jcms.2015.06.028.
  3. Erdmann D, Follmar KE, Debruijn M, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg 2008;60:398–403. DOI: 10.1097/SAP.0b013e318133a87b.
  4. Guven Y, Zorlu S, Cankaya AB, et al. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries. Case Rep Dent 2015;2015:301013. DOI: 10.1155/2015/301013.
  5. Park KP, Lim SU, Kim JH, et al. Fracture patterns in the maxillofacial region: a four-year retrospective study. J Korean Assoc Oral Maxillofac Surg 2015;41:306–316. DOI: 10.5125/jkaoms.2015.41.6.306.
  6. Arcuri F, Brucoli M, Baragiotta N, et al. The role of fat grafting in the treatment of posttraumatic maxillofacial deformities. Craniomaxillofac Trauma Reconstr 2013;6:121–126. DOI: 10.1055/s-0033-1333877.
  7. Chung KJ, Kim YH, Kim TG, et al. Treatment of complex facial fractures: clinical experience of different timing and order. J Craniofac Surg 2013;24:216–220. DOI: 10.1097/SCS.0b013e318267b6f7.
  8. Khader R, Wallender A, Van Sickels JE, et al. Secondary reconstruction of panfacial fractures. Oral Maxillofac Surg 2014;18:99–109. DOI: 10.1007/s10006-013-0403-8.
  9. de Avila ED, de Molon RS, Loffredo LC, et al. Health-related quality of life and depression in patients with dentofacial deformity. Oral Maxillofac Surg 2013;17:187–191. DOI: 10.1007/s10006-012-0338-5.
  10. Chiapasco M, Zaniboni M, Boisco M. Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants. Clin Oral Implants Res 2006;17(Suppl 2):136–159. DOI: 10.1111/j.1600-0501.2006.01357.x.
  11. Foster RD, Anthony JP, Sharma A, et al. Vascularized bone flaps vs nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success. Head Neck 1999;21:66–71. DOI: 10.1002/(SICI)1097-0347(199901)21:1<66::AID-HED9>3.0.CO;2-Z.
  12. Schmelzeisen R, Schliephake H. Interdisciplinary microvascular reconstruction of maxillary, midfacial and skull base defects. J Craniomaxillofac Surg 1998;26:1–10. DOI: 10.1016/S1010-5182(98)80028-0.
  13. Kumar BP, Venkatesh V, Kumar KA, et al. Mandibular Reconstruction: Overview. J Maxillofac Oral Surg 2016;15:425–441. DOI: 10.1007/s12663-015-0766-5.
  14. Hidalgo DA, Rekow A. A review of 60 consecutive fibula free flap mandible reconstructions. Plast Reconstr Surg 1995;96:585–596, discussion 597–602, 10.1097/00006534-199509000-00010.
  15. Jones NF, Monstrey S, Gambier BA. Reliability of the fibular osteocutaneous flap for mandibular reconstruction: anatomical and surgical confirmation. Plast Reconstr Surg 1996;97:707–716, discussion 717–708, 10.1097/00006534-199604000-00003.
  16. Taylor GI, Corlett RJ, Ashton MW. The Evolution of Free Vascularized Bone Transfer: A 40-Year Experience. Plast Reconstr Surg 2016;137:1292–1305. DOI: 10.1097/PRS.0000000000002040.
  17. Chen YB, Chen HC, Hahn LH. Major mandibular reconstruction with vascularized bone grafts: indications and selection of donor tissue. Microsurgery 1994;15:227–237. DOI: 10.1002/micr. 1920150403.
  18. Smolka W, Iizuka T. Surgical reconstruction of maxilla and midface: clinical outcome and factors relating to postoperative complications. J Craniomaxillofac Surg 2005;33:1–7. DOI: 10.1016/j.jcms.2004. 09.001.
  19. Yamano S, Nissenbaum M, Dodson TB, et al. Multidisciplinary treatment for a young patient with severe maxillofacial trauma from a snowmobile accident: a case report. J Oral Implantol 2010;36:141–144. DOI: 10.1563/AAID-JOI-D-09-00058R1.
  20. Kokat AM, Ercocen AR, Karayazgan-Saracoglu B. Simultaneous Implant Placement in a Mandibular Defect Reconstructed With a Free Fibula Graft and Fabrication of a Fixed Metal Porcelain Prosthesis. J Craniofac Surg 2018;29:1307–1311. DOI: 10.1097/SCS.0000000000004526.
  21. Carbiner R, Jerjes W, Shakib K, et al. Analysis of the compatibility of dental implant systems in fibula free flap reconstruction. Head Neck Oncol 2012;4:37. DOI: 10.1186/1758-3284-4-37.
  22. Schepers RH, Kraeima J, Vissink A, et al. Accuracy of secondary maxillofacial reconstruction with prefabricated fibula grafts using 3D planning and guided reconstruction. J Craniomaxillofac Surg 2016;44:392–399. DOI: 10.1016/j.jcms.2015.12.008.
  23. Beumer 3rd J, Roumanas E, Nishimura R. Advances in osseointegrated implants for dental and facial rehabilitation following major head and neck surgery. Semin Surg Oncol 1995;11:200–207. DOI: 10.1002/ssu.2980110305.
  24. Chiapasco M, Colletti G, Romeo E, et al. Long-term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection. Clin Oral Implants Res 2008;19: 1074–1080. DOI: 10.1111/j.1600-0501.2008.01542.x.
  25. Viscioni A, Rigo L, Franco M, et al. Reconstruction of severely atrophic jaws using homografts and simultaneous implant placement: a retrospective study. J Oral Implantol 2010;36:131–139. DOI: 10.1563/AAID-JOI-D-09-00025.
  26. Jackson RS, Price DL, Arce K, et al. Evaluation of Clinical Outcomes of Osseointegrated Dental Implantation of Fibula Free Flaps for Mandibular Reconstruction. JAMA Facial Plast Surg 2016;18:201–206. DOI: 10.1001/jamafacial.2015.2271.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.