Case study
in a digital age Trauma reconstruction
By Dr E Eilertsen and Dr M Skinner T
oday dental implants are considered a reli- able and highly predictable treat-
ment modality with favourable survival and success ratesı,2. Even in areas of severe bone atrophy the advent of augmen- tation techniques has allowed for reliable implant placement in areas that were previously considered unsuitable3. Recently however, my
team and I were faced with a challenge that forced us to rely on advanced technology and reconsider conventional surgical techniques in a bid to achieve a suitable outcome for this patient.
Background This 40-year-old patient had been involved in a serious RTA in which she was the sole survivor. A copy of her report from the maxillofacial surgeon detailed: A LHS le Forte III unilateral fracture; bilateral Le Fort II fractures; LHS Le Fort I fracture; nasal bone
fracture; and mid-palatal frac- ture. The mandible sustained a compound comminuted fracture of the symphyseal and parasymphysis, and a dento- alveolar fracture resulting in the loss of teeth 43, 42, 4ı, 3ı, 32. She has been struggling with her existing -/p, and has reduced masticatory function and aesthetics since.
Previous medical/ dental history The patient is an otherwise fit and well lady, never smoked, takes no routine medications and has no known allergies. She has had routine dental treat- ment prior to and post RTA and is a regular dental attendee.
Extra-oral examination There was no indication of any lymphadenopathy or TMJD, although minor facial asym- metry and tissue scarring was noted. She had a high smile line and medium resting lip line.
Intra-oral examination She had an obvious large
dento-alveolar bony defect in the anterior mandibular region. She had a thin gingival biotype with intra-oral scarring evident. Her -/p was ill fitting and inadequate for masticatory function.
Radiographs The initial OPT (Figure ı) revealed evidence of good bony union to the initial inju- ries. However, a large bony defect was evident in the ante- rior mandible. At this time a CBCT scan was taken to deter- mine the extent of bone loss, fracture union, and proximity of vital structures.
Treatment plan/ considerations Due to the large bony defect in the anterior mandible, one of the treatment options was to consider referral to a maxillofacial unit for vertical augmentation utilising autolo- gous bone from either the mandible or iliac crest to reconstruct the defect prior to conventional implant place-
ment. However, the patient felt she had been through enough major surgery after the acci- dent and was not prepared to risk some of the more common outcomes of such surgery. Harvesting from the iliac
crest can lead to significant donor site morbidity4 as well as problems due to resorption of the graft due to it being of endochondral embryologic derivation 5. While harvesting of the mandible can lead also lead to donor site morbidity including dehiscence and sensory disturbances6. At this time we consid-
ered utilising CBCT and CAD-CAM technology (Figures 2 and 3) to create a stereolithographic template to place two Ankylos implants in the available bone and mask the vertical defect associated with the final prosthesis with pink acrylic. From the CBCT we could
determine the optimum posi- tion for implant placement.
Continued »
Fig 1
Fig 2
Fig 3
Scottish Dental magazine 57
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