PMC3308318_01
Orthopantomography showed long mandibular circular
lesion involving several lower jaw teeth.
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F1
A panorex investigation showed a large tissue mass and extension of the lesion, and a more ominous growth was suspected (Figs.1, 2, 3). 
A significant swelling in the left mandible may be appreciated
before the tumor resection.
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A panorex investigation showed a large tissue mass and extension of the lesion, and a more ominous growth was suspected (Figs.1, 2, 3). 
Clinical left mandibular swelling.
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F3
A panorex investigation showed a large tissue mass and extension of the lesion, and a more ominous growth was suspected (Figs.1, 2, 3). 
Dentinogenic Ghost Cell Tumor Histological features.
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Tumor (Fig. 4). The decision was made to manage the local tumor with en bloc resection and immediate reconstruction by using an inferior titanium plate, in order to maintain, without alteration, the mandibular soft tissue space.
Anatomic tumor extension after the elevated flap.
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Moreover, rhBMP2 and absorbable collagen sponge (ACS) were applied inside a titanium mesh (Figs. 5-6).
Tumor consistence is clear at the resection time.
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Moreover, rhBMP2 and absorbable collagen sponge (ACS) were applied inside a titanium mesh (Figs. 5-6).
Mandibular reconstruction is performed with low titanium
plate, rhBMP-2 and ACS covered by a titanium mesh.
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Next, the rhBMP-2/absorbable collagen sponge/allograft was placed into the mesh (Fig. 7).
Post op radiographic evaluation.
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TC and OPT post op were performed (Figs. 8, 9).
Post op TC evaluation.
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TC and OPT post op were performed (Figs. 8, 9).
A 3-4 months clinical evaluation. A good soft tissue healing
can be appreciated.
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The patient exhibited radiographic evidence of bone formation as early as 3 or 4 months post-operatively, and mandibular continuity was regained as demonstrated both clinically and radiographically (Figs. 10, 11).
No more swelling is underlined at frontal image 6 months
post op.
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The patient exhibited radiographic evidence of bone formation as early as 3 or 4 months post-operatively, and mandibular continuity was regained as demonstrated both clinically and radiographically (Figs. 10, 11).
OPT evaluation at 9 month follow up at removing titanium
mesh time. Bone regeneration can be appreciated on the left
body mandible.
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At the 9 month follow up, the titanium mesh was removed and dental implants were placed in position (Figs. 12, 13).
4 dental implants positioned at 9 month follow up after
tumor resection in order to reconstitute function and aesthetic of the
left mandible area.
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F13
At the 9 month follow up, the titanium mesh was removed and dental implants were placed in position (Figs. 12, 13).