IMPLANT-BASED DENTAL REHABILITATION IN EXTREME MANDIBULAR RECONSTRUCTION CASES
Authors:
Lampros Megas1, Deepti Sinha2, Andrew Dawood2, Nicholas Kalavrezos2
Affiliation:
1 Department of Oral Surgery, Eastman Dental Hospital, University College London, 47-49 Huntley St, London WC1E 6DG, United Kingdom
2 Head & Neck Surgery, University College London Hospital (UCLH), 250 Euston Road, London, NW1 2PG, United Kingdom
Doi: 10.54936/haoms242p45
ABSTRACT:
Reconstruction of oromandibular defects poses numerous challenges. The most common mandibular defects occur secondary to oncological ablative surgery, namely, following a segmental resection or a hemi-mandibulectomy. Advances in microvascular surgery, implantology and computer sciences, with the ability to produce patient-specific reconstructions, have offered significant improvements in the anatomical and functional restoration of such defects. Current state-of-the-art mandibular reconstruction is based on computer-aided technology for preoperative virtual planning of the mandibular and donor site osteotomies, manufacturing of corresponding guides and fixation hardware in a ‘three-in-one’ concept. The aim of this oral presentation is to highlight the differences and challenges in adult and paediatric mandibular reconstructions and dental rehabilitation through the presentation of two unique cases.
In the first case, the mandibular reconstruction was performed using a prefabricated and Integra®-prelaminated vascularized fibula free flap. The dermal substitute Integra® was used for prelamination instead of a skin graft. The treatment was performed in two stages: the first consisted of fibula prefabrication (dental implant insertion) and prelamination, and the second consisted of tumor resection and reconstruction with the vascularized implant-bearing fibula flap. Integra® was shown to be able to generate complete mucosa-like tissue over the fibula flaps and in the peri-implant areas. Virtual three-dimensional (3D) planning and 3D-printed cutting guides were used for the mandibulectomies, the flap harvest and the positioning of the implants.
In the second case, a 13-year-old female was treated in a two-stage surgery. The first stage consisted of resection and reconstruction of the mandibular defect using a fibula free flap. The second stage – three years later – involved the implant placement and later dental rehabilitation.
KEY WORDS:
Authors:
Lampros Megas1, Deepti Sinha2, Andrew Dawood2, Nicholas Kalavrezos2
Affiliation:
1 Department of Oral Surgery, Eastman Dental Hospital, University College London, 47-49 Huntley St, London WC1E 6DG, United Kingdom
2 Head & Neck Surgery, University College London Hospital (UCLH), 250 Euston Road, London, NW1 2PG, United Kingdom
Doi: 10.54936/haoms242p45
ABSTRACT:
Reconstruction of oromandibular defects poses numerous challenges. The most common mandibular defects occur secondary to oncological ablative surgery, namely, following a segmental resection or a hemi-mandibulectomy. Advances in microvascular surgery, implantology and computer sciences, with the ability to produce patient-specific reconstructions, have offered significant improvements in the anatomical and functional restoration of such defects. Current state-of-the-art mandibular reconstruction is based on computer-aided technology for preoperative virtual planning of the mandibular and donor site osteotomies, manufacturing of corresponding guides and fixation hardware in a ‘three-in-one’ concept. The aim of this oral presentation is to highlight the differences and challenges in adult and paediatric mandibular reconstructions and dental rehabilitation through the presentation of two unique cases.
In the first case, the mandibular reconstruction was performed using a prefabricated and Integra®-prelaminated vascularized fibula free flap. The dermal substitute Integra® was used for prelamination instead of a skin graft. The treatment was performed in two stages: the first consisted of fibula prefabrication (dental implant insertion) and prelamination, and the second consisted of tumor resection and reconstruction with the vascularized implant-bearing fibula flap. Integra® was shown to be able to generate complete mucosa-like tissue over the fibula flaps and in the peri-implant areas. Virtual three-dimensional (3D) planning and 3D-printed cutting guides were used for the mandibulectomies, the flap harvest and the positioning of the implants.
In the second case, a 13-year-old female was treated in a two-stage surgery. The first stage consisted of resection and reconstruction of the mandibular defect using a fibula free flap. The second stage – three years later – involved the implant placement and later dental rehabilitation.
KEY WORDS: