PMC7533758_01
Initial appearance of the intraoperative showing apical fragment intrusion.
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On physical examination, during the inspection and palpation, crepitation was observed in the body region and right mandibular angle and apical displacement of the bone fragment in the premaxilla, corresponding to elements 13, 14, and 15, with an evident sign of alveolar tooth fracture (Figure 1).
Alveolar fragment after removal of granulation tissue brought between it and the maxilla.
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In order to eliminate the granulation tissue at the interface of the fragment and maxilla, which would certainly prevent good bone repair, the fragment was removed (Figures 2-4).
Super-inferior view of the premaxilla alveolar fragment.
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In order to eliminate the granulation tissue at the interface of the fragment and maxilla, which would certainly prevent good bone repair, the fragment was removed (Figures 2-4).
Occlusal view of the premaxilla alveolar fragment.
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In order to eliminate the granulation tissue at the interface of the fragment and maxilla, which would certainly prevent good bone repair, the fragment was removed (Figures 2-4).
Curved surgical bed for functional reimplantation of the fragment.
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However, it was again juxtaposed through the FRAF technique, which consists of the removal of the bone fragment and subsequent repositioning of it in its pretraumatic place, being fixed by using guided plates and titanium screws, by steel wires positioned in Modified Kazagian ties (Figures 5 and 6).
Functional reduction of the fragment with the aid of the "L" plate and 2.0 system titanium screws.
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However, it was again juxtaposed through the FRAF technique, which consists of the removal of the bone fragment and subsequent repositioning of it in its pretraumatic place, being fixed by using guided plates and titanium screws, by steel wires positioned in Modified Kazagian ties (Figures 5 and 6). Note the absence of the element 15 in Figure 6, extracted due to loss of bone support, is understood as functional reduction when the occlusion prior to trauma is overcome through occlusal wear or even dental impression, which does not necessarily mean Angle Class I.
Exposure of complex mandible fracture.
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With the separation of the fragments and evaluation of the lingual space, the reconstruction and anatomical repositioning of the fragments with transfixing screws and plates and screws of the 2.0 system (Figures 7 and 8) were started.
Reduction and stabilization of fractures with the lag screw, X-plate, and 2.0 system titanium screws.
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With the separation of the fragments and evaluation of the lingual space, the reconstruction and anatomical repositioning of the fragments with transfixing screws and plates and screws of the 2.0 system (Figures 7 and 8) were started.
Rebuild plate installation overlapping stabilization material.
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To support the reduction, a plaque reconstruction was attempted, which promoted stability and the possibility of functional adaptation to occlusion (Figure 9).
Orthopantomographic radiographic image of titanium plates and screws in position.
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A radiographic examination of the control was performed, in which titanium plates and screws were positioned, indicating a satisfactory reduction of the bone fragments (Figures 10 and 11).
Postoperative appearance of 7 days, good healing aspect of the surgical approach, suture stitches in position, and reestablishment of functional occlusion.
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A radiographic examination of the control was performed, in which titanium plates and screws were positioned, indicating a satisfactory reduction of the bone fragments (Figures 10 and 11).