title: Application of the "All-on-Four" concept and guided surgery in a mandible treated with a free vascularized fibula flap.
abstract: In this article, we describe the first case in the literature in which 3D computer-assisted treatment planning and guided surgery enabled a patient affected by extreme paraphysiologic mandibular bone atrophy to be treated with a free vascularized fibula flap and, after a period of healing, the flapless installation of 4 immediately loaded dental implants. The computer-fabricated surgical guide allowed placement of the implants according to the "All-on-Four" concept in a proper spatial preplanned position and by tilting 1 implant, avoiding an area of bone discontinuity. Additionally, this technique allowed the production of a prefabricated temporary prosthesis, delivered after implant insertion, which could be immediately loaded. The use of a fibula flap makes it possible to create greater bone thickness while computer-assisted treatment planning and guided surgery provide several advantages over the traditional technique.
authors.affiliation: From the Department of Surgical Sciences, Dental and Maxillofacial Department, University of Verona, Verona, Italy.
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Nocini
authors.forename: Massimo
authors.initials: M
authors.lastname: Albanese
authors.forename: Roberto
authors.initials: R
authors.lastname: Castellani
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Zanotti
authors.forename: Luciano
authors.initials: L
authors.lastname: Canton
authors.forename: Guido
authors.initials: G
authors.lastname: Bissolotti
authors.forename: Daniele
authors.initials: D
authors.lastname: De Santis
mesh_terms: D000368:Aged; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001284:Atrophy; D005260:Female; D005360:Fibula / Q000098:blood supply* / Q000637:transplantation*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D057893:Immediate Dental Implant Loading; D008334:Mandible / Q000473:pathology* / Q000601:surgery*; D009066:Mouth, Edentulous / Q000534:rehabilitation; D025321:Surgery, Computer-Assisted