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Dental Rehabilitation Using Alpha Dent Implant in Case of Reconstructed Mandible after Excision of Ossifying Fibroma

Dr. Parit Ladani

MDS (cirurgião- Buco-maxilo-facial)

Indiana placa certificada cirurgião Oral e maxilofacial. (IBOMSI)

Coordenador Diretor chefe do projeto fissura e cirurgião Craniofacial,

Centro de fissura Swiss (fissura crianças internacional, em Zurique)

BSES MG Hospital

Clinical Case 

18 year old male patient came with chief complain of Swelling over Rt side of lower jaw. He was diagnosed as Benign Ossifying fibroma. Surgery was made in Feb 2013 for excision of lesion and reconstruction using Iliac crest cortico-cancellous bone graft from right side. Bone graft fixed to the defect using a reconstruction plate. After 1 year we can see adequate bone formation at the defect side. He is planed for replacement of missing teeth using 3 Alpha Dent 5×13 mm classic implants.

 

Fig 1: Pre operative photo of 18 year old boy Mr. V. N. showing hard, non fluctuant, non tender swelling over Right side of mandibular parasymphysis-body region extending from right corner of mouth to upper part of neck and midline to body of mandibular area.
Fig 1: Pre operative photo of 18 year old boy Mr. V. N. showing hard, non fluctuant, non tender swelling over Right side of mandibular parasymphysis-body region extending from right corner of mouth to upper part of neck and midline to body of mandibular area.
Fig 2: Pre operative Intra operative view showing hard bony swelling obliterating buccal vestibule from lower left central incisor to lower right first molar region.
Fig 2: Pre operative Intra operative view showing hard bony swelling obliterating buccal vestibule from lower left central incisor to lower right first molar region.
Fig 3: 3D CT of face and X-ray OPG show well defined, unilocular radiolucent area with cotton wool appearance and well demarcated radio-opaque border extending from lower left central incisor to lower right first molar area. There is expansion of both buccal and lingual plate.
Fig 3: 3D CT of face and X-ray OPG show well defined, unilocular radiolucent area with cotton wool appearance and well demarcated radio-opaque border extending from lower left central incisor to lower right first molar area. There is expansion of both buccal and lingual plate.
Fig 4: Show the lesion covered with thin shell of bone after mucoperiosteal flap reflection. Show 5×7 cm lesion after excision. Histopathology report suggests the lesion is Ossifying Fibroma.
Fig 4: Show the lesion covered with thin shell of bone after mucoperiosteal flap reflection. Show 5×7 cm lesion after excision. Histopathology report suggests the lesion is Ossifying Fibroma.
Fig 5: Shows the defect in the mandible after excision of lesion. Very thin shell of bone is left behind after excision. 2.5mm Reconstruction plate is fixed to the defect area to avoid pathologic fracture and Intermaxillary fixation done.
Fig 5: Shows the defect in the mandible after excision of lesion. Very thin shell of bone is left behind after excision. 2.5mm Reconstruction plate is fixed to the defect area to avoid pathologic fracture and Intermaxillary fixation done.
Fig 6: iliac crest cortico-cancellous bone graft harvested from right iliac crest region of about 7x5cm.
Fig 6: iliac crest cortico-cancellous bone graft harvested from right iliac crest region of about 7x5cm.
Fig 7: Graft fixed to mandibular defect using reconstruction plate and screw.
Fig 7: Graft fixed to mandibular defect using reconstruction plate and screw.
Fig 8: After defect closure.
Fig 8: After defect closure.
Fig 9: Immediate post op x-ray OPG.
Fig 9: Immediate post op x-ray OPG.
Fig 10: Eight month post operative photos show normal face. no external deformation on the face.
Fig 10: Eight month post operative photos show normal face. no external deformation on the face.
Fig 11: Show healing of lower ridge after 8 months. occlusion is normal.
Fig 11: Show healing of lower ridge after 8 months. occlusion is normal.
Fig 12: Eight month post op opg shows new bone formation with good quality to support the implant.
Fig 12: Eight month post op opg shows new bone formation with good quality to support the implant.
Fig 13: Shows alpha dent classic 5×13 mm three implants in situ in new bone.
Fig 13: Shows alpha dent classic 5×13 mm three implants in situ in new bone.
Fig 14: Shows 15 days post op x-ray showing Alpha Dent implant in situ.
Fig 14: Shows 15 days post op x-ray showing Alpha Dent implant in situ.