Department of General Dentistry, Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Township, Taoyuan County, 33305, Taiwan.
Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
BMC Oral Health. 2024 Sep 13;24(1):1080. doi: 10.1186/s12903-024-04821-6.
The microvascular free fibula (MFF) flap is a reliable treatment modality for mandibular reconstruction and is suitable for dental implant placement after oncologic surgery. The most common issue with the MFF flap is its limited bone height, which typically results in excessive interarch space and complicates prosthodontic therapy. Overcoming the physical limitations from tumor excision and reducing the treatment time for prosthodontic rehabilitation to improve quality of life are critical clinical challenges.
A 64-year-old male with lower left gum and bilateral buccal cancer received a single-layer microvascular MFF flap to reconstruct a mandibular defect post-tumor excision. He underwent a bilateral modiolus Z-plasty combined with a skin flap debulking procedure to relieve oral contracture, achieving adequate mouth opening for prosthodontic rehabilitation. Scar tissue bands on the bilateral cheeks significantly affected retention and stability, hampering dental impression performance. The patient sought prosthodontic rehabilitation to enhance his chewing function and quality of life promptly. Prosthodontic rehabilitation with all-on-4 implant therapy, utilizing computer-aided design and computer-assisted manufacturing (CAD/CAM), was completed within one month.
This case utilized the all-on-4 implant system to address the insufficient fibular height for conventional dental implant placements. Dental CAD/CAM was employed to mill custom prosthetic abutments and a large titanium framework for the implant bar overdenture, compensating for the excessive interarch space between the grafted fibula and maxilla. This treatment approach successfully shortened the prosthodontic rehabilitation time and overcame anatomical limitations.
游离腓骨皮瓣（MFF）是下颌骨重建的可靠治疗方法，适用于肿瘤手术后牙种植体的植入。MFF 皮瓣最常见的问题是其骨高度有限，这通常会导致牙弓间过大的间隙，从而使修复治疗复杂化。克服肿瘤切除带来的物理限制，减少修复治疗的时间，提高生活质量，是临床面临的关键挑战。
一位 64 岁男性，左下牙龈和双侧颊部患有癌症，接受了单层游离 MFF 皮瓣修复肿瘤切除后的下颌骨缺损。他接受了双侧 Modiolus Z 成形术联合皮瓣缩减术以缓解口腔挛缩，实现了足够的张口度以进行修复治疗。双侧脸颊上的疤痕组织带严重影响了固位和稳定性，妨碍了牙印模的制取。患者寻求修复治疗以尽快恢复咀嚼功能和提高生活质量。采用计算机辅助设计和计算机辅助制造（CAD/CAM）的全口种植体 4 颗种植体即刻负重治疗技术，在一个月内完成了修复治疗。
本病例采用全口种植体 4 颗种植体即刻负重治疗技术解决了常规牙种植体植入时腓骨高度不足的问题。采用 CAD/CAM 技术制作定制的修复体基台和种植体杆覆盖义齿的大型钛合金支架，补偿了移植腓骨和上颌骨之间过大的牙弓间隙。该治疗方法成功缩短了修复治疗时间，并克服了解剖学限制。
