Rehabilitating a Maxillofacial Defect with Transplanted Free Vascularized Fibula Segments and a Full-Arch Fixed Dental Prosthesis
This case outlines a complex reconstruction involving use of a preconstructed fibula graft pre-installed with implants. It demonstrates the benefits of backwards planning from the desired occlusion using digital planning and 3D printing. A 43-year-old male patient was referred to the department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Netherlands for secondary reconstruction of the maxilla. Twelve years previously, a hemimaxillectomy had been performed elsewhere because of a maxillary osteosarcoma. The resulting defect had been reconstructed using a deep circumflex iliac-artery flap and radial forearm flap.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 11
CME/CPD
0.25 hours
Purchase price
10
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General information
| Case Type | |
|---|---|
| Jaw | Maxilla |
| Area | Full-Arch |
| # of Teeth | - |
| # of Implants | 6 |
| Type of Implants | Two-Piece |
| Attachment | Two-Piece |
| Bone Augmentation | Vertical |
|---|---|
| Augmentation Materials | Autogenous block(s) |
| Guided Surgery | Yes |
| Soft Tissue Grafting | Staged |
| Abutment Type | CAD/CAM |
| Prosthesis Type | RDP |
Esthetic Risk Assessment
| Esthetic Risk Factors | Low | Medium | High |
|---|---|---|---|
| Medical Status | Healthy | Compromised | |
| Smoking Habit | Non-smoker | Light smoker (< 10 cigarettes per day) | Heavy smoker (>= 10 cigarettes per day) |
| Patient's Esthetic Expectations | Low | Medium | High |
| Lip Line | No exposure of papillae | Exposure of papillae | Full exposure of mucosa margin |
| Periodontal Phenotype | Low-scalloped, thick | Medium-scalloped, medium-thick | High-scalloped, thin |
| Shape of Tooth Crowns | Rectangular | Triangular | |
| Infection at Implant Site | None | Chronic | Acute |
| Bone Level at Adjacent Teeth | <= 5 mm to contact point | 5.5 to 6.5 mm to contact point | > 7 mm to contact point |
| Prosthodontic Status of Neighboring Teeth | Virgin | Restored | |
| Width of Edentulous Span | 1 tooth (>= 7 mm) | 1 tooth (< 7 mm) | 2 teeth or more |
| Soft Tissue Anatomy | Intact | Defective | |
| Bone Volume | Horizontally and vertically sufficient | Horizontally deficient | Deficient vertically or deficient vertically AND horizontally |
* General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.
** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.
Surgical SAC classification
| SAC Level | Complex |
|---|---|
| Defining Characteristics | Fully edentulous upper jaw to be rehabilitated with four or more implants |
| Modality | Overdenture on 4 implants |
| Placement Protocol | - |
| Tooth Site | Tooth site |
| Socket Morphology | Socket morphology |
| Socket Integrity | Socket integrity |
| Bone Volume | Deficient vertically or deficient vertically AND horizontally |
| Anatomic Risk | High |
| Esthetic Risk | High |
| Complexity | High |
| Risk of Complications | High |
Prosthodontic SAC classification
| SAC Level | Complex |
|---|---|
| Defining Characteristics | Fully edentulous upper jaw to be rehabilitated with an implant-borne removable overdenture |
| Loading Protocol | Immediate (bar only) |
| Retention | - |
| Maxillomandibular Relationship | - |
| Mesio-Distal Space | - |
| Inter-Arch Distance | - |
| Bruxism | - |
| Esthetic Risk | High |
| Provisional Implant-Supported Prosthesis | - |
| Interim Prosthesis during Healing | - |
| Occlusion/Articulation | - |
| Occlusal Scheme/Issues | - |
Surgical SAC Modifiers
| Periodontal Status | History of periodontitis or genetic predisposition |
|---|
Prosthodontic SAC Modifiers
| Soft Tissue Contour and Volume | - |
|---|
General SAC Modifiers
| Oral Hygiene and Compliance | Sufficient |
|---|---|
| Access | Adequate |
| Craniofacial/Skeletal Growth | Completed |
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