Nag P Venkat Ratna, Bhagwatkar Tejashree
Department of Prosthodontics, S B Patil Dental College and Hospital, Bidar, Karnataka, India.
Director, Institute for Dental Implantology, Hyderabad, Telangana, India.
J Indian Prosthodont Soc. 2020 Jul-Sep;20(3):326-330. doi: 10.4103/jips.jips_415_19. Epub 2020 Jul 17.
Surgical resection of the mandible due to the presence of benign or malignant tumor commonly results in the deviation of the remaining mandible toward the defective side. Based on the location and extent (mandible), various surgical approaches such as marginal, segmental, and hemi or subtotal or total mandibulectomy can be executed. The restoration of normal form, function, and esthetic is often challenging in the prosthetic rehabilitation of patients with hemimandibulectomy. A 36-year-old male patient reported with a chief complaint of difficulty in eating and speech. Past dental history of the patient revealed ameloblastoma of the left mandibular alveolus, which was surgically operated 6 years back with a wide resection of the tumor with left-sided hemimandibulectomy without disarticulation and reconstruction with an osteocutaneous free fibula flap (from the right leg) fixed with a screw plate system. This case report suggests that the rehabilitation of surgically resected patients using tilted implant technique can reach a desirable prosthetic outcome. This clinical report describes prosthetic management (implant-supported fixed prosthesis) of a hemimandibulectomy patient using tilted implants and screw-retained prosthetic solutions using multiunit abutments. It improves speech, masticatory efficiency, and esthetics without any further deviation of the mandible with a 3-year follow-up.
由于良性或恶性肿瘤而进行下颌骨手术切除通常会导致剩余下颌骨向缺损侧偏斜。根据肿瘤的位置和范围（下颌骨），可以采用多种手术方法，如边缘性、节段性、半侧或次全或全下颌骨切除术。在半侧下颌骨切除患者的修复重建中，恢复正常形态、功能和美观往往具有挑战性。一名36岁男性患者主诉进食和说话困难。患者既往牙科病史显示左下颌牙槽成釉细胞瘤，6年前接受手术，广泛切除肿瘤并行左侧半侧下颌骨切除术，未进行关节离断，采用带血管蒂游离腓骨瓣（取自右腿）并用螺钉钢板系统固定进行重建。本病例报告表明，使用倾斜种植体技术对手术切除患者进行修复重建可达到理想的修复效果。本临床报告描述了一名半侧下颌骨切除患者使用倾斜种植体和多单位基台的螺钉固位修复方案进行的修复治疗（种植体支持的固定修复体）。经过3年随访，该方案改善了患者的语音、咀嚼效率和美观，且下颌骨无进一步偏斜。
