Indication 7, Case 3

Distal extension situation mandible

George K.B. Sandor
Robert P. Carmichael
Hospital for Sick Children, Bloorview MacMillan Centre, The Toronto Hospital, and
The University of Toronto, Toronto, Canada

Reconstruction of an adoloescent female severely afflicted with Gorlin Goltz Syndrome.

	This 19 year old female with Gorlin Goltz Syndrome presented with four cyst-like lesions in both jaws. The following clinical features were present: 1. multiple cyst-like lesions of both jaws; 2. multiple basal cell carcinomas of the skin; 3. calcification of the falx cerebri; 4. bifid ribs; and 5. palmar skin pits.

	Orthopantomogram demonstrating four cyst-like lesions at the following locations: 1. left maxillary sinus; 2. apical to tooth 7.5. Note that tooth 3.5 is congenitally absent; 3. sites 4.7 and 4.8, previously edentulated; and 4. between the roots of teeth 4.5 and 4.6.

	The small cystic lesion between teeth 4.5 and 4.6 was removed by curettage.

	The large cystic lesion of the maxillary sinus was removed in toto.

	The large cystic lesions at sites 4.7 and 4.8 were removed. The teeth associated with the cystic lesion apical to tooth 7.5, that is teeth 7.5 and 3.6, were removed because their roots had been invaded by the walls of the cystic lesion. All four lesions were treated with an application of Carnoy's solution.

	Post-operative orthopantomogram following removal of the four cysts.

	Orthopantomogram one year after removal of the cysts demonstrates satisfactory healing of the bony cavities. The edentulous ridge of the left mandibular body was, however, too narrow to accommodate dental implants.

	Post-operative orthopantomogram following simultaneous guided bone regeneration and placement of solid ITI screw implants (Straumann, Canada). Cancellous bone was harvested using a motorized trephin (Osteocore TM, Straumann AG, Waldenburg). Stainless steel screws (Memfix, Straumann AG, Waldenburg) were used to anchor the PTFE membrane (Gore, Flagstaff, AZ).

	Removal of the membrane.

	Following removal of PTFE membrane, placement of 5 mm extension healing caps in an effort to gain control of the soft tissue contours during healing.

Bild fehlt	Orthopantomogram demonstrating satisfactory bone levels surrounding osseointegrated fixtures.

	The custom impression tray is fabricated.

	Consolidation of peri-implant mucosa following placement of Octa abutments and temporary protective caps

	Octa transfer copings secured to fixtures using guide screws in preparation for impression with poyether elastomer

	Try-in of the gold alloy (Duceragold, Degussa, Canada) framework

	Porcelain added to the framework shown on the master cast.

	Occlusal view of bridge secured in mouth with occlusal screws.

	Access channels filled with a cotton pellet covered by composite resin.

	Orthopantomogram demonstrating completed reconstruction.

	Othopantomogram 2 years post-treatment showing stability of the surgical and prosthodontic reconstruction.