PMC8021463_01
Intraoral image of the lesion. Note the swelling on the right mandibular premolar region.
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Initially, the patient was referred from his Primary Health Center with an inflammatory process in the right mandible, which was being treated as a dental abscess (Figure 1).
Preoperative orthopantomography.
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The following complementary tests were performed: orthopantomography (OPG) (Figure 2), computed tomography (CT) (Figure 3), and biopsy.
Preoperative computed tomography.
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The following complementary tests were performed: orthopantomography (OPG) (Figure 2), computed tomography (CT) (Figure 3), and biopsy.
Stereolithographic surgical template from CT and reconstruction plate.
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A stereolithographic surgical template from CT scan was created prior to the surgery to design the reconstruction plate and plan the surgery (Figure 4).
Microvascularized graft of the right fibula and reconstruction plate.
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Excision of the lesion by segmental mandibulectomy of the body and mandibular symphysis of the right side and mandibular reconstruction by microvascularized flap of the right fibula with cutaneous island were performed (Figure 5).
Postoperative intraoral image.
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After the first surgery, a 6-month period was allowed to achieve an adequate osseointegration of the flap and soft tissue metaplasia (Figure 6).
Orthopantomography after 6-implant placement on the fibula.
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Six dental implants (Tapered Screw-Vent; Zimmer Biomet Dental, Warsaw, IN, USA) were placed in the fibula (Figure 7).
Design of the hybrid prosthesis by CAD-CAM.
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After prosthetic planning, the decision was taken to rehabilitate the patient with a lower hybrid prosthesis fabricated by CAD-CAM (Figures 8-10).
Frontal view of the finished lower hybrid prosthesis.
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After prosthetic planning, the decision was taken to rehabilitate the patient with a lower hybrid prosthesis fabricated by CAD-CAM (Figures 8-10).
Intraoral image of the hybrid prosthesis placed into the mouth.
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After prosthetic planning, the decision was taken to rehabilitate the patient with a lower hybrid prosthesis fabricated by CAD-CAM (Figures 8-10).
Intraoral image of the patient at the end of the treatment after a 7-year and 5-month follow-up.
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After the healing process, the hybrid prosthesis was placed again and an improvement of the peri-implant tissue was observed after a 7-year and 5-month follow-up (Figure 11).