Possibilities of reconstruction and implant-prosthetic rehabilitation following mandible resection.

INTRODUCTION: Mandible reconstruction is still very challenging for surgeons. Mandible defects could be the consequence of ablative surgery for malignancies, huge jaw cysts, infection and trauma. Segmental resection of the mandible may compromise orofacial function and often lead to patients psychological disorders. Despite very frequent use of microvascular flaps, autogenous bone grafts are still very reliable technique for mandible reconstruction. Comprehensive therapy means not only mandible reconstruction, but prosthodontic rehabilitation supported by dental implants, which can significantly improve patients quality of life. The aim of this paper was to evaluate possible techniques of mandible reconstruction and to present a patient who had been submitted to mandible resection and reconstruction with autogenous iliac bone graft and prosthodontic rehabilitation with fixed denture anchoraged by disc-shaped implants in early loading protocol. CASE REPORT: Mandible reconstruction was performed simultaneously with resection. Autogenous iliac bone graft was taken, reshaped and placed in two parts, to the required optimal contour of the mandible. After graft consolidation, decision was made for prosthodontics rehabilitation with fixed dentures supported by implants. In addition to the standard preoperative procedures, planning was done based on a biomodel gained by rapid prototyping after CT scan. It offered a real 3D planning to obtain a proper shape, dimension and the position of implants. CONCLUSION: If bone dimensions of a reconstructed mandible are insufficient, like in the presented case, the use of basal osseointegrated implants may be a method of choice. Avoiding bone augmentation procedures, as well as early loading protocol for this type of implants, shorten the total rehabilitation time, which is very convenient for patients. Fixed denture supported by dental implants is the best solution for comprehensive rehabilitation after mandible resection.

Nasal epithesis retained by basal (disk) implants.

AIM: To report the case of a patient who underwent facial reconstruction with nasal epithesis anchored on basal (disk) implants after ablation of midface squamous cell carcinoma. METHODS: Ablative surgery of the midface region and insertion of 3 basal implants into the glabellar area of the frontal bone, the upper part of the right side of the alveolar crest, and the lateral side of the maxillary bone, which forms the left lateral wall of the nose, respectively, was performed. Implants were placed at the time of the primary surgical attempt. RESULTS: After an unloaded osseointegration phase of 3 months, all implants appeared well integrated according to radiologic criteria and clinical stability. At the end of the osseointegration process, the final epithesis was delivered. Epithesis was anchored to the bars that were fabricated to provide retention and better stability, whereas the implant on the left side was used individually only to improve stability. At the control examinations after 1, 3, 6, 12, and 18 months, respectively, there were no signs of recurrence of the tumor or any complications related to the implants. CONCLUSIONS: Disk implants that were applied to our patient present an excellent alternative, particularly in cases with minimal available bone, resulting in reduced complications in elderly oncologic patients.