Rehabilitating a Maxillofacial Defect with Transplanted Free Vascularized Fibula Segments and a Full-Arch Fixed Dental Prosthesis - Clinical Case Report - Home

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Clinical Case Report

Rehabilitating a Maxillofacial Defect with Transplanted Free Vascularized Fibula Segments and a Full-Arch Fixed Dental Prosthesis

Gerry M Raghoebar, Rutger Schepers

This case outlines a complex reconstruction involving use of a preconstructed fibula graft pre-installed with implants. It demonstrates the benefits of backwards planning from the desired occlusion using digital planning and 3D printing. A 43-year-old male patient was referred to the department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Netherlands for secondary reconstruction of the maxilla. Twelve years previously, a hemimaxillectomy had been performed elsewhere because of a maxillary osteosarcoma. The resulting defect had been reconstructed using a deep circumflex iliac-artery flap and radial forearm flap.

Surgical SAC classification: Complex
Prosthodontic SAC classification: Complex

Source: Treatment Guide 11
Purchase price: 10 Academy Coins
CPD/CME: 0.25 hours

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General information

Case Type
Jaw	Maxilla
Area	Full-Arch
# of Teeth	-
# of Implants	6
Type of Implants	Two-Piece
Attachment	Two-Piece

Bone Augmentation	Vertical
Augmentation Materials	Autogenous block(s)
Guided Surgery	Yes
Soft Tissue Grafting	Staged
Abutment Type	CAD/CAM
Prosthesis Type	RDP

Esthetic Risk Assessment

Esthetic Risk Factors	Low	Medium	High
Medical Status	Healthy		Compromised
Smoking Habit	Non-smoker	Light smoker (< 10 cigarettes per day)	Heavy smoker (>= 10 cigarettes per day)
Patient's Esthetic Expectations	Low	Medium	High
Lip Line	No exposure of papillae	Exposure of papillae	Full exposure of mucosa margin
Periodontal Phenotype	Low-scalloped, thick	Medium-scalloped, medium-thick	High-scalloped, thin
Shape of Tooth Crowns	Rectangular		Triangular
Infection at Implant Site	None	Chronic	Acute
Bone Level at Adjacent Teeth	<= 5 mm to contact point	5.5 to 6.5 mm to contact point	> 7 mm to contact point
Prosthodontic Status of Neighboring Teeth	Virgin		Restored
Width of Edentulous Span	1 tooth (>= 7 mm)	1 tooth (< 7 mm)	2 teeth or more
Soft Tissue Anatomy	Intact		Defective
Bone Volume	Horizontally and vertically sufficient	Horizontally deficient	Deficient vertically or deficient vertically AND horizontally

* General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.
** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.

Surgical SAC classification

SAC Level	Complex
Defining Characteristics	Fully edentulous upper jaw to be rehabilitated with four or more implants
Modality	Overdenture on 4 implants
Placement Protocol	-
Tooth Site	Tooth site
Socket Morphology	Socket morphology
Socket Integrity	Socket integrity
Bone Volume	Deficient vertically or deficient vertically AND horizontally
Anatomic Risk	High
Esthetic Risk	High
Complexity	High
Risk of Complications	High

Prosthodontic SAC classification

SAC Level	Complex
Defining Characteristics	Fully edentulous upper jaw to be rehabilitated with an implant-borne removable overdenture
Loading Protocol	Immediate (bar only)
Retention	-
Maxillomandibular Relationship	-
Mesio-Distal Space	-
Inter-Arch Distance	-
Bruxism	-
Esthetic Risk	High
Provisional Implant-Supported Prosthesis	-
Interim Prosthesis during Healing	-
Occlusion/Articulation	-
Occlusal Scheme/Issues	-

Surgical SAC Modifiers

Periodontal Status	History of periodontitis or genetic predisposition

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume	-

General SAC Modifiers

Oral Hygiene and Compliance	Sufficient
Access	Adequate
Craniofacial/Skeletal Growth	Completed

Publication date: May 25, 2022 Last review date: May 18, 2022 Next review date: May 18, 2025

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