Possibilities of reconstruction and implant-prosthetic rehabilitation following mandible resection

Abstract

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.

Uvod. Rekonstrukcija mandibule još uvek predstavlja izazov za hirurga. Defekti mandibule mogu biti posledica radikalnog hirurškog tretmana malignih tumora, velikih vili- čnih cista, infekcija i povreda. Nedostatak dela vilične kosti kompromituje sve orofacijalne funkcije, a česti su i psihološki poremećaji. Pored sve učestalije primene mikrovaskularnih režnjeva, slobodni koštani graftovi su još uvek veoma pouzdan metod rekonstrukcije mandibule. Sveobuhvatna terapija pored rekonstrukcije mandibule podrazumeva i implantološko-protetičku rehabilitaciju, kojom se znatno poboljšava kvalitet života bolesnika. Cilj ovog rada bio je da se kroz pregled literature ocene metode rekonstrukcije mandibule i da se prikaže bolesnica kod koje je nakon segmentalne resekcije mandibule izvršena rehabilitacija fiksnom zubnom nadokanadom nošenom implantatima oblika diska. Prikaz bolesnika. U istom aktu sa resekcijom izvršena je i rekonstrukcija slobodnim koštanim ilijačnim graftom, koji je preoblikovan i postavljen iz dva dela, kako bi se uspostavio optimalan kontinuitet i forma mandibule. Po konsolidaciji grafta, postavljena je indikacija za izradu fiksne zubne nadoknade nošene implantatima. Pored standardnih preoperativnih procedura, izvršeno je realno trodimenzionalno planiranje na biomodelu dobijenim softverskom analizom CT podataka. Na taj način određen je oblik, veličina i najpovoljniji položaj implantata. Zaključak. Ukoliko su koštane dimenzije rekonstruisane mandibule nedovoljne, kao kod prikazane bolesnice, primena bazalnih oseointegrišućih implantata oblika diska može biti metoda izbora. Njihovom upotrebom izbegava se dodatna nadoknada kosti što uz rano opterećenje predstavlja pogodnost za bolesnike, jer se znatno skraćuje vreme rehabilitacije. Izrada fiksne zubne nadoknade nošene implantatima je najbolji način definitivne rehabilitacije bolesnika sa rekonstruisanom mandibulom.