title: Mandibular reconstruction with a prefabricated free vascularized fibula and implant-supported prosthesis based on fully three-dimensional virtual planning.
abstract: Because optimal reconstruction of maxillofacial defects requires functional rehabilitation, the current study demonstrates the successful secondary reconstruction of a large mandibular continuity defect using a fully digitally planned prefabricated free vascularized fibula with immediate implant-supported prosthodontic restoration. A 56-year-old man presented with a large mandibular continuity defect after resection of an enlarged squamous cell carcinoma arising from the floor of the mouth. For secondary reconstruction, the shape of the neomandible and implant position for support of the lower prosthesis were planned virtually. The combined cutting and drilling guide was printed in 3 dimensions. In a 2-step surgical approach, first, the implants were inserted into the fibula and covered with a split-thickness skin graft to form a neogingiva. In a second operation, the fibula was harvested, osteotomized, and fixed with the denture on the preinserted implants. The fibula was placed to its final position guided by the occlusion. Using three-dimensional virtual backward planning, it was feasible to perform a mandibular reconstruction with immediate prosthetic rehabilitation.
authors.affiliation: From the *Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg; †Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, and ‡Department of Prosthodontics and Dental Material Sciences, Center for Oral Medicine and Dentistry, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Freudlsperger
authors.forename: Jens Philipp
authors.initials: JP
authors.lastname: Bodem
authors.forename: Eva
authors.initials: E
authors.lastname: Engel
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hoffmann
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D019094:Dental Prosthesis, Implant-Supported / Q000379:methods*; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D058752:Free Tissue Flaps; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007573:Jaw Neoplasms / Q000601:surgery; D008297:Male; D008341:Mandibular Prosthesis; D019930:Mandibular Prosthesis Implantation / Q000379:methods*; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D016038:Skin Transplantation / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome