Page 43 - DP20-2.qxd

complex case report of oral rehabilitation in a
Fig 2a-b: Healing by secondary intention and bone formation at surgical site and ENT surgeons, who suggested hemi-
Fig 3a-b: Healing by secondary intention and bone formation at surgical site smoothly, characterized by a regression in
Fig 3c: Follow-up OPG
Fig 4a-b: Free hand, flapless bone level implants placement (no bone augmentation) (computer-aided design and manufacturing),
Fig 4c: Stock abutments – digital abutment level impression
Dental Practice i March-April 2024 i Vol 20 No 2 43
young male after a successful and conservative
management of extensive ameloblastoma in
the mandible, with the placement of three
Swiss implants and lower prosthesis fabricated
with the help of a digital workflow.
CASE REPORT
21-year-old male reported to the clinic with
the chief complaint of swelling on one side
of the face for the last 3 years. Currently,
he was experiencing pain and was unable
to eat. He had previously consulted plastic
mandibulectomy under general anesthesia
followed by free fibula microvascular graft or
reconstruction plating as treatment options.
However, the patient was reluctant towards
this course of treatment, so we planned
for chairside conservative management
under local anesthesia (LA). After obtaining
informed consent, conservative surgical
management was performed to preserve the
surrounding structures. Careful enucleation
of the lesion, along with extraction of all
teeth present on the affected site was done
with curettage under local anesthesia. The
lesion was sent for a biopsy, which confirmed
ameloblastoma (Figures 1a, b, c).
The patient underwent periodic iodoform
dressing every 10th day for 3 months, which
facilitated healing by secondary intention
(Figures 2a, b). The healing process unfolded
pathology and a reduction in swelling. A
6-month follow-up revealed near-normal soft
tissues and bony architecture intraorally as
well as in an orthopantomogram (OPG). A
1-year postoperative OPG was taken to assess
for any recurrence (Figures 3a, b, c).
The patient expressed his willingness for teeth
placement at the treated site, so we proceeded
with the placement of two bone-level implants
(3.3 x 10 mm) and one tissue-level implant
(4.8 x 6 mm) for prosthetic rehabilitation.
Freehand, flapless implants were placed,
and no bone augmentation was performed.
Three months post-implant placement, after
achieving adequate Osseo integration, digital
impressions were taken with a digital intraoral
scanner (Primescan) (Figures 4a, b, c).
Following the design and manufacturing
of the prosthesis through CAD/CAM
cement-retained prostheses were delivered