Options to optimize function of partially resected mandible?

Hi. In terms of reduced bucco-lingual thickness, there are many implants in diameter of 3.3 - 3.75 that can support you. The main challenge is the vertical height. Grafting is an option but in my too invasive with reduced predictability in this case. Maybe an option is to go custom made dental implants through their special request service. Nobel Biocare offers that service to their customers in exceptional cases like these, Hope that helps.

Are you sure it was a rib graft, they usually resorb completely in three years anyway this case would benefit with additional grafting prior to implant restoration. Lots of positives here no recurrence intact mandible looks like v3 nerve is present, how is patient's sensation? Advanced case.

There is the option for a unilateral subperiosteal implant. Perhaps a RAMUS blade abutting to the Mandibular right cuspid. One could place a RAMUS blade in the posterior and a tilted root form just distal to the Mandibular right cuspid. Yes additional grafting may be in order if root forms are considered. The prosthetics would be straight forward with any of the above options.

very interesting post. please followup and post on this case upon completion. thankyou for posting~!

The graft looks pretty nice. Are we sure it was a rib graft; it might have been an iliac crest graft or fibula. The IAC seems preserved, so could it be that the treating surgeon used the same bone after clearing it well of tumour (or autoclaving it) used it again as a bone graft with marrow? Something that surgeons wouldn't probably do with ameloblastoma. The contiguous bone tends to do creeping substitution, so the resultant 5 year post op density might actually look like that of the native bone, and might shed off the rib graft look. Leaving the periosteum intact at the primary surgery because probably of no cortical perforation led to a little better bone graft uptake then what you would expect/see from a rib graft. A CBCT/CT will tell about the thickness. The same CT reconstruction and the state of intra oral soft tissues can help you decide about whether to do an onlay graft, distraction osteogenesis or GBR. It will be arduous to reconstruct for dental implant placement, but as I said earlier, will depend on the bone stock/volume of the reconstructed bone. If possible, please post intra oral pictures and CT reconstructs, plus if possible 3D reconstruction to show the bone contour in addition to volume.

Reconstruction modified from the "Marx-protocol", seems advisable IMHO. Initially a CT is needed for evaluation, then: 1. Submandibular incision, Ti-mesh packed with spongious bone harvested from posterior iliac crest. Add PRP/PRF/BMP if you feel it's needed. 4 months healing. 2. Re-entry, full or partial removal of Ti-mesh and placement of dental implants. The Ti-mesh can be adapted preop on a 3D-model. Collaboration with a competent prosthodontist is mandatory.

Subperiosteal is the way to go here. If you've never done a unilateral then refer to someone who has or to the Uni and ask to sit in on the procedure.

Hello, I know this is an old thread but I have a patient in an almost identical situation. Patient does not wish to have any more augmentation surgeries and desires a fixed prosthesis in the LR quad. They have at least 15-20mm of tissue above the bone in some areas. What was your final treatment plan for your patient and the success thus far? (implant company/abutment/components used?) Thank you!