Dentaltown March 2020 - 81

was harvested with the f ibula. While
still perfusing on the leg, the fibula was
shaped to fit the defect and three implants
were placed in a guided fashion. Straight
multiunit abutments and temporary cylinders were placed on the implants. The
prefabricated milled plate was fixated on
the model with the fibula and prosthesis
in place (Fig. 8). The temporary cylinders
were picked up in the prosthesis with
Luxatemp, and final shaping of the intaglio
surface was performed to create a convex
cleansable surface. Palaseal was painted
on the prosthesis and cured.
The fibula vessels were ligated, and
the graft was transferred to the head and
neck region. The fibula was inset into the
mandibular defect using the milled plate
and screws. The dental prosthesis was seated
on the implants and hand tightened. The
skin paddle was sutured to close the oral

soft-tissue defect (Fig. 9). Revascularization
of the flap was performed by anastomosing
the peroneal vessels to the facial artery and
common facial vein. Final occlusion was
checked to verify the prosthesis was out of
occlusion (Fig. 10).

Conclusion
Virtual surgical planning and pointof-care 3D printing can expedite treatment
with predictable results. Immediate implants
and provisionalization have previously been
performed only for benign disease because
of the extra time required to fabricate a
prosthesis with traditional methods. Digital
design and point-of-care 3D printing
eliminates this delay and allows malignant
disease to be restored with immediate
teeth. However, case selection is critical,
because not all patients will be candidates
for this surgery. n

Fig. 7

Fig. 9

Fig. 8

Fig. 10

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Dentaltown March 2020

Table of Contents for the Digital Edition of Dentaltown March 2020

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Dentaltown March 2020 - Cover2
Dentaltown March 2020 - 1
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