, BDS.Head of Oral Implantology, Riyadh Dental Center and Dental Services, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.P.J. Dhanrajani
, BDS, MDS, MSc.Implantologist, Riyadh Dental Center, Riyadh, Kingdom of Saudi Arabia.
Patients and clinicians experience difficulty after the loss of multiple teeth and the supporting structures as a result of the surgical treatment of pathological lesions (cysts, tumors, etc.) of the oral cavity. These difficulties may be related to either functional or esthetic deficits, but they are usually the result of a combination of both. The prosthodontic rehabilitation may vary and will depend on many factors that will dictate the use of fixed or removable prostheses. The most important factors to be considered are the location, the number of teeth lost, and any related change in anatomical structure as a result of the surgery.
The ability of the patient to subsequently manage and maintain the definitive prosthesis, especially with a removable prosthesis, may be the ultimate determinant of success. In certain situations, even conventional fixed or removable options may not succeed. The case that is reported is typical of such a situation. The patient had a unilateral free-end saddle area in the mandible and could not tolerate the thought of having to wear a unilateral removable prosthesis.
Osseointegrated implants have become an extremely valuable treatment option in oral and maxillofacial prosthetic reconstruction. Advances in the understanding of osseointegration and the development of placement techniques that ensure a high success rate have resulted in more applications for implants. They are particularly useful intraorally because they can replace the missing dentition without involving the adjacent teeth, especially in the case use of free-end saddle situations.
The aim of this article is to provide an example of the successful use of dental implants in a situation in which conventional treatments had little chance of success. CASE REPORT.
A 22-year old girl was referred to the oral and maxillofacial department at the Riyadh Dental Center. She complained of a bony, hard swelling in the left posterior region of the mandible. The patient had also noticed a transient tingling sensation of the lower lip on the same side. Radiographic examination revealed an extensive radiolucency involving teeth Nos. 35, 36, 37, and 38 with resorption of roots (Fig. 1A). There was significant buccolingual expansion intraorally. The radiolucency extended to the ascending ramus and involved the lower border of the mandible. The lower occlusal view confirmed the clinical finding of buccolingual expansion (Fig. 1B). A biopsy was performed under local anesthesia. The histopathologic report revealed features of a large fibro-osseous lesion.
The patient was admitted to the hospital and the extraction of teeth Nos. 35, 36, 37, and 38 was performed under general anesthesia, allowing access to enucleate and curette the lesion completely. The cavity was irrigated with hydrogen peroxide and saline (Fig. 2), and a length of ribbon gauze was then soaked in iodoform paraffin and packed into the cavity.
The postoperative phase was uneventful. The patient initially kept a recall schedule of every two days to change the intraoral dressing and then twice a week as the cavity filled with bone secondarily. Histopatho logic examination revealed that the lesion was consistent with ossifying fibroma.
Regular radiographic follow-up demonstrated an almost complete regeneration of bone at the surgical site after two years (Fig. 3).
Fig. 1. A, Radiograph at initial presentation of the lesion; B, radiograph (occlusal view) that shows buccolingual expansion.
Fig. 2. Radiograph after surgical intervention of the lesion.
Fig. 3. Radiograph after complete bone healing (two years after installation).
Fig. 4. Radiograph after the installation of fixtures.