Abstract
Introduction: Following oral cancer resection patients will have differing degrees of morbidity with regards to mastication, speech and aesthetics and this can be a difficult problem to manage. We present a case that describes an innovative technique involving implant placement and deepening of the labial sulcus in the atrophic mandible of a post-operative oral cancer patient to facilitate partial denture retention. Methods: a 70-year-old female patient presented with significant vertical and horizontal bone atrophy and a shallow, tethered labial sulcus in the anterior mandible, following cancer resection of the floor of mouth and alveolar ridge. She was unable to retain a partial denture. An initial procedure included an osteoplastic advancement flap and a horizontal "sandwich" osteotomy as a combined approach that improved the bone volume from a Cawood & Howell classification grade V to grade II. A sulcoplasty and insertion of Integra@ skin regeneration system improved sulcus depth in a second procedure. Dental implants were successfully placed 4 months after bone augmentation to allow retention of a lower partial denture. Results: These staged procedures were carried out with excellent healing and no complications in the post-operative 6 months. Conclusion: This technique for gaining bony height and width, with improved sulcus depth in an atrophic mandible is a useful adjunct in the rehabilitation of post-operative oral cancer cases. Maintaining the periosteal attachment in the osteoplastic flap promotes excellent healing in patients who have received adjunctive radiotherapy treatment in this safe and effective osteotomy procedure.
Highlights
Following oral cancer resection patients will have differing degrees of morbidity with regards to mastication, speech and aesthetics and this can be a difficult problem to manage
We present a case that describes an innovative technique involving implant placement and deepening of the labial sulcus in the atrophic mandible of a post-operative oral cancer patient to facilitate partial denture retention
Dental implants were successfully placed 4 months after bone augmentation to allow retention of a lower partial denture. These staged procedures were carried out with excellent healing and no complications in the postoperative 6 months. This technique for gaining bony height and width, with improved sulcus depth in an atrophic mandible is a useful adjunct in the rehabilitation of post-operative oral cancer cases
Summary
Oral rehabilitation of post-operative cancer survivors can be a challenge in cases when the resection has been extensive. We present a challenging case in which a combined approach of sandwich osteotomy, implant placement and soft tissue management with a skin regeneration template leading to successful oral rehabilitation of an oral cancer patient. A gingival, 3-sided flap was raised, and a horizontal osteotomy performed, maintaining periosteal attachment of the attached gingivae to the bony segment This was lifted, and allogenic, cancellous bone packed into the created space. The top silicone layer of the regeneration system was removed 3 weeks later, and the region left to granulate over the top of the neodermal layer that had formed over bone Six months following this course of treatment the patient has improved sulcal depth and soft tissue mobility. Figure 1.6: implant retained lower partial denture with good soft tissue movement
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