Application of the "All-on-Four" concept and guided surgery in a mandible treated with a free vascularized fibula flap

• Published in: The Journal of craniofacial surgery Vol. 23; no. 6; pp. e628 - e631
• Main Authors: Nocini, Pier Francesco, Albanese, Massimo, Castellani, Roberto, Zanotti, Guglielmo, Canton, Luciano, Bissolotti, Guido, De Santis, Daniele
• Format: Journal Article
• Language: English
• Published: United States 01-11-2012
• Subjects: Aged; Alveolar Ridge Augmentation - methods; Atrophy; Dentistry; Female; Fibula - blood supply; Fibula - transplantation; Free Tissue Flaps - blood supply; Humans; Immediate Dental Implant Loading; Mandible - pathology; Mandible - surgery; Mouth, Edentulous - rehabilitation; Surgery, Computer-Assisted
• ISSN: 1049-2275; 1536-3732
• DOI: 10.1097/SCS.0b013e318270fdcf

In this article, we describe the first case in the literature in which 3D computer-assisted treatment planning and guided surgery enabled a patient affected by extreme paraphysiologic mandibular bone atrophy to be treated with a free vascularized fibula flap and, after a period of healing, the flapless installation of 4 immediately loaded dental implants. The computer-fabricated surgical guide allowed placement of the implants according to the "All-on-Four" concept in a proper spatial preplanned position and by tilting 1 implant, avoiding an area of bone discontinuity. Additionally, this technique allowed the production of a prefabricated temporary prosthesis, delivered after implant insertion, which could be immediately loaded. The use of a fibula flap makes it possible to create greater bone thickness while computer-assisted treatment planning and guided surgery provide several advantages over the traditional technique.