Implant-supported mandibular rehabilitation on microvascularised fibular graft. Use of computer-guided surgery

Resumen

Introduction: in the treatment of patients affected by malignant tumours of the oral cavity, surgery combines the resection and the immediate reconstruction with the aim of preserving the functions that are concentrated in the oral cavity (articulation, swallowing, mastication, aesthetics). The use of microvascularised flaps consists of a usual practice in those patients in order to replace the resected tissues. Dental rehabilitation in these patients is usually very complex, and the use of guided implant surgery systems avoids many of the problems that are presented in these patients. Clinical case: a patient subjected to a hemimandibulectomy without reconstruction and adjuvant treatment with radiotherapy who is referred for reconstruction. Initially, a microvascularised fibular flap is practiced that contributes bone and soft tissue. Subsequently, a hybrid prosthesis is used over implants, which are placed by means of a mucosasupported surgical guide after planning with the FacilitateTM tool. Discussion: the microvascularised fibular flap is the spearhead in mandibular reconstruction of the oncological patient. Its main disadvantage is the difficulty in placing the dental implants and their subsequent rehabilitation. The use of guided implant surgery avoids many of these problems. Conclusions: the reconstruction of the oral cavity in oncological patients using microvascularised grafts and the subsequent dental rehabilitation with osseointegrated implants allows offering the patient an acceptable quality of life.