PMC7104310_01
(a) Orthopantomogram showing an impacted 38 with an associated multilocular radiolucent lesion involving the left posterior mandible, which extends from the second premolar to the left condyle. (b) Axial view of a computed tomographic image of the facial bone showing a hypodense lesion in the left posterior mandible, with expansion and thinning of both the buccal and lingual cortices.
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Radiographic imaging showed a multilocular, radiolucent lesion involving the left posterior mandible, extending into the left condyle (Figure 1).
(a) Photograph showing the tumor and the expansion of both the buccal and lingual cortices. (b) Segmental resection of the left mandible stabilized with a 2.7 mm reconstruction plate. (c) Postoperative orthopantomogram.
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As this tumor is aggressive, we decided to proceed with a transcutaneous segmental resection under general anesthesia, followed by immediate reconstruction using a 2.7 mm reconstruction plate (Figure 2).
(a) Absorbable collagen sponges (ACS) impregnated with recombinant human bone morphogenetic protein-2 (rhBMP-2) (right side) and allogenic chips soaked in bone marrow aspirate concentrate (BMAC) with small cut pieces of ACS with rhBMP-2 (left side). (b) Photograph showing the entire defect filled with rhBMP-2 combined with demineralized bone allograft and BMAC.
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An additional allogenic block (measuring 3 x 1.5 cm) soaked in BMAC was placed in the posterior aspect of the defect, to allow greater dimensional stability (Figure 3).
(a) Orthopantomogram (OPG) at the three-month follow-up. (b) OPG after removing the reconstruction plate. Bone regeneration can be observed on the left mandible. (c) OPG showing implant rehabilitation. (d) OPG showing prosthetic rehabilitation with dental implants and an implant-supported partial denture.
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The patient showed radiographic evidence of bone formation three months after the operation; mandibular continuity was regained, as demonstrated both radiographically and clinically (Figure 4(a)). After six months of follow-up, the reconstruction plate was removed as it would have blocked the subsequent placement of implants (Figure 4(b)). Three dental implants were placed under local anesthesia (Figure 4(c)), and prosthetic rehabilitation with implant-supported partial dentures was initiated three months later (Figure 4(d)).