Journal of Oral Implantology August 2013 - (Page 497)

CASE REPORT Computer Guided Surgery for Implant Placement and Dental Rehabilitation in a Patient Undergoing Sub-Total Mandibulectomy and Microvascular Free Flap Reconstruction Andrew Dawood, MSc1* Susan Tanner, MSc2 Iain Hutchison, Prof3 A 58-year-old patient presented with an extensive, destructive, recurrent pleomorphic adenoma occupying the mandibular body and the soft tissues of the mouth and neck. Resection of the mandible from right ramus to left condylar process, and implant rehabilitation in both jaws with fixed bridgework was planned. Comprehensive presurgical prosthetic work up was carried out to record the existing dental relationship and guide all stages of the reconstruction. The jaw was first grafted with a segmented, fibular microvascular free-flap, which was fixed in place with a fixation plate prebent on a Rapid Prototype Anatomical Model of the jaw. Reconstruction with implant supported fixed partial dentures took place to the dental scheme planned preresection, using a computer guided approach to implant placement in the complex and unfamiliar anatomy of the extensively grafted mandible. This approach facilitated and expedited implant surgery such that treatment could take place using a minimally invasive approach relatively soon after surgery, prior to commencement of radiotherapy, and highlights the importance of a multidisciplinary approach to treatment for patients having extensive surgery to the jaws. The patient’s personal assessment 2 years post surgery was recorded using 1999 University of Washington Quality of Life Questionnaire. Key words: fibula free flap, jaw reconstruction, dental implants, anatomical model, computer guided implant surgery INTRODUCTION T he osseocutaneous fibula flap used to reconstruct large segments of the mandible after resection for cancer1 has become a routine procedure in orofacial reconstruction. A prospective study concluded the fibula free flap bone graft allows predictable and reliable restoration with conven1 The Chelsea and Westminster Hospital, Department of Craniofacial Surgery, London, UK. 2 The Dawood and Tanner Specialist Dental Practice, London, UK. 3 Oral and Maxillofacial Surgery, St Bartholomew’s Hospital, London, UK. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-11-00142 tionally placed dental implants.2 Although dental rehabilitation is considered to be a significant factor in the assessment of quality of life,3 such surgery often leaves the patient unable to tolerate conventional dentures, presenting an indication for implant treatment. The use of rapid prototype models of the jaw permits the prefabrication of fixation plates,4 greatly facilitating intraoperative positioning of the graft to avoid dental malocclusion, which may result from inaccurate contouring of the reconstruction plate.5 Computer-guided planning using custom-made surgical drilling guides based on 3-dimensional (3D) computerized tomography (CT) scanning6 is used increasingly in routine dental implant cases. Journal of Oral Implantology 497

Table of Contents for the Digital Edition of Journal of Oral Implantology August 2013

Literary Responsibility—Everyone Has a Role to Play
Rehabilitation of Surgically Relocated Integrated Dental Implants With and Without Bone Morphogenesis Protein-2
Marginal Fit of Implant-Supported All-Ceramic Zirconia Frameworks
Influence of the Implant Diameter With Different Sizes of Hexagon: Analysis by 3-Dimensional Finite Element Method
Autologous Dental Pulp Stem Cells in Regeneration of Defect Created in Canine Periodontal Tissue
Histologic and Biomechanical Evaluation of 2 Resorbable-Blasting Media Implant Surfaces at Early Implantation Times
Efficacy of Guided Bone Regeneration Using Composite Bone Graft and Resorbable Collagen Membrane in Seibert’s Class I Ridge Defects: Radiological Evaluation
Minimal Iliac Bone Harvesting in Sinus Lift Surgery
Functional Load in Oblique Bicortical Implants: Parasinusal Implants and Palatine Implants
Ultrasonic Oscillations for Conservative Retrieval of a Rare Fracture of Implant Healing Abutment
Craniofacial Implant-Retained Auricular Prosthesis: A Case Report
Gingival Conditioning in an Implant-Supported Prosthesis: A Clinical Report
An Early Loaded Implant-Supported Mandibular Complete Arch Fixed Prosthesis in a Young Completely Edentulous Patient: A Case Report
Computer Guided Surgery for Implant Placement and Dental Rehabilitation in a Patient Undergoing Sub-Total Mandibulectomy and Microvascular Free Flap Reconstruction
Guided Bone Regeneration for Socket Preservation in Molar Extraction Sites: Histomorphometric and 3D Computerized Tomography Analysis
Osseointegration of Dental Implants and Osteonecrosis of the Jaw in Patients Treated With Bisphosphonate Therapy: A Systematic Review
Review of Current Literature

Journal of Oral Implantology August 2013