Treatment of a Fractured Edentulous Mandible Following Extraction of All Residual Teeth Using Computer-Guided Surgery and Immediate Loading
A 65-year-old female patient was referred to our clinic by another patient for evaluation and treatment of her compromised dental clinical situation. The patient presented with a pessimistic attitude and declared she had no confidence in the possibility of improving her oral situation. Her main complaint was discomfort, inability to chew, and collapse of the facial tissues related to her medical history. The patient had a serious domestic accident 18 months before the consultation and suffered from a head injury, followed by 4 months in a coma. She then gradually progressed toward almost complete neurological recovery, although, at the time of the consultation, she still had difficulty walking. The patient suffered a mandibular fracture in that accident, but because her life had been in danger, the fracture had been ignored. Since the patient was immobilized at the hospital for 4 months, the mandibular fracture had healed spontaneously, but the fragments reossified in an incorrect position, which resulted in a complete discrepancy between the positions of the remaining mandibular teeth and the maxillary teeth
Surgical classification
Complex
Prosthodontic classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 15
CME/CPD
25 hours
Purchase price
10
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General Risk Assessment
Patient-related Factors
| Oral hygiene | Fair |
|---|---|
| Compliance | Good |
Patient-medical Factors
| Medical Fitness | Healthy, able to undergo planned anesthesia and surgical procedure (ASA I) |
|---|---|
| Medications | No medications that would negatively affect the surgical procedure and outcomes. |
| Radiation Treatment | None |
| Growth Status | Complete |
Site-related Factors
| Access | Adequate |
|---|---|
| Pathology near the implant site | None |
| Previous surgeries in planned implant site | Previous procedures resulting in significant bone and soft tissue changes. |
Surgical Classification
Surgical Complexity
| Timing of placement | Healed (Type IV) |
|---|---|
| Simultaneous or Staged grafting procedures | Implant placement as part of staged hard and/or soft tissue procedures |
| Number of implants | > Three |
Anatomy
| Bone Volume - Horizontal | Adequate |
|---|---|
| Bone Volume - Vertical | Adequate |
| Keratinized Tissue | Insufficient (< 2 mm) |
| Soft Tissue Quality | Presence of minimal scars/no inflammation |
| Proximity to vital anatomic structures | Minimal risk of involvement |
Prosthodontic Classification
Complicating Factors
| Biological | Framework/Bar with appropriate contours and accessible maintenance procedures |
|---|---|
| Mechanical/Technical | Absence of contributing factors |
| Planned contour of tissue-fitting surfaces | Appropriate contours (hygienic - accessible for maintenance) |
Prosthesis Factors
| Prosthetic volume | Adequate. Space available for ideal anatomy of the restoration |
|---|---|
| Inter-occlusal space | Adequate. Capable to create an anatomically & functionally correct planned restoration |
| Volume and characteristics of the edentulous ridge (fixed) | Inadequate. Adjunctive therapy or prosthetic materials may be necessary to achieve optimal result |
Occlusal Factors
| Occlusal scheme | User-defined occlusal scheme achievable |
|---|---|
| Involvement in occlusion | Involvement |
| Occlusal parafunction | Absent |
Complexity
| Loading Protocol | Immediate |
|---|---|
| Implant-supported provisional restoration | Required, elevated esthetic and/or functional demands |
| Number of implants | >2 (non-splinted) or ≥ 2 (splinted) |
| Timing of placement | Healed (Type IV) |
Esthetic Risk Assessment
Edentulous Esthetic Risk Assessment (fixed)
| Facial Support | Minimal changes in facial support tolerated by patient |
|---|---|
| Labial Support | Desired tooth position provides sastifactory labial support |
| Buccal Corridor | Narrow corridor |
| Smile Line | No display of the Maxillary ridge at full smile |
| Maxillomandibular Relationship | Class I |
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