PMC7341383_01
Three-dimensional computed tomography revealing severe mandibular atrophy with perforations at the implant sites.
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Clinical and radiographic examinations revealed severe mandibular atrophy with bilateral exposure of the lower alveolar nerve, perforations at the implant sites (Figure 1), and a bone height of 7 mm (Class VI, Cawood and Howell).
Mandible with severe bone resorption and exposure of the inferior alveolar nerve (yellow arrow).
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The nerves were disinserted with the aid of a piezoelectric device, after which the reconstruction plate with 16 holes was fixed using seven fixed screws, three in the region of the genial spines and two on the angles of the mandible intended to prevent fractures and reinforce the mandible to make it functional (Figures 2 and 3). The presence of perforations corresponding to the site of the implants was observed (Figure 2).
Fixation of the reconstruction plate.
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The nerves were disinserted with the aid of a piezoelectric device, after which the reconstruction plate with 16 holes was fixed using seven fixed screws, three in the region of the genial spines and two on the angles of the mandible intended to prevent fractures and reinforce the mandible to make it functional (Figures 2 and 3).
Fixation of the graft.
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Then, grafting of the three blocks from the iliac crest was performed with one screw in each block (Figure 4).
Tissue repositioning with a synthesis operation on the suprahyoid muscles.
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Finally, tissue repositioning was performed with a synthesis operation on the suprahyoid muscles by using simple stitches interrupted with Monocryl 4.0 thread and skin and intradermal sutures with 5.0 nylon thread and interrupted simple reinforcement stitches (Figure 5).
Postoperative healing of the extraoral access site (2 months).
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The extraoral access site showed satisfactory healing and no sequelae (Figure 6).
Postoperative panoramic radiography (6 months) demonstrating increased bone height.
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The patient was followed for 6 months, at which point imaging studies revealed successful grafting, and an increase of 9 mm was seen in the jawbone height, which indicated favorable conditions for beginning the dental implant process (Figures 7 and 8).
Postoperative computed tomography (6 months).
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The patient was followed for 6 months, at which point imaging studies revealed successful grafting, and an increase of 9 mm was seen in the jawbone height, which indicated favorable conditions for beginning the dental implant process (Figures 7 and 8).