Case

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Clinical Case Report

Rehabilitating a Maxillofacial Defect with Transplanted Free Vascularized Fibula Segments and a Full-Arch Fixed Dental Prosthesis

Gerry M Raghoebar, Rutger Schepers

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
Source
Treatment Guide 11
Purchase price
10 Academy Coins
CPD/CME
0.25 hours

Recommended content

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
Publication date: May 25, 2022 Last review date: May 18, 2022 Next review date: May 18, 2025

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