Abstract
Introduction: Alveolar distraction osteogenesis (ADO) is one of vertical bone augmentation technique used to restore the vertical bone discrepancy between the transplanted graft and the residual alveolar bone after mandibular reconstruction. The aim of this article is to present the clinical outcomes of ADO applied to reconstructed mandible for three patients. Observation: Three patients underwent alveolar distraction osteogenesis procedure on mandibula reconstructed by fibula free flap (n = 2) or iliac crest free flap (n = 1). The mean bone height increase was 11 mm. 16 implants have been placed in all patients, with a success rate of 100% and a mean follow-up of 25 months. Two complications occurred without compromising the final outcome of the procedure: one fracture of the basal bone and one bony interference, both during activation phase. Commentaries: ADO can be performed on reconstructed mandible with free flap to restore alveolar height. An acceptable implant-to-crown ratio allows an optimal supported implant prosthesis. The particular antecedent of our patients can lead to uncommon complications such as basal bone fracture, but doesn't seem to compromise implant placement with good success rate. Conclusions: ADO performed on reconstructed mandible allows appropriate dental implant rehabilitation, achieving good esthetics and occlusal outcomes.
Highlights
Vascularized free flap has become an indispensable modality for aesthetical and functional reconstruction for mandibular defects [1]
An alveolar vertical augmentation could prevent these outcomes, and several methods exist such as Guided Bone Regeneration (GBR), autologous bone blocks, osteotomy and alveolar distraction osteogenesis (ADO) [4]
Mac Carthy et al [9], in 1992, used it in maxillo-facial surgery. This cases series presents the outcomes of ADO in reconstructed mandibles for dental implant rehabilitation
Summary
Vascularized free flap has become an indispensable modality for aesthetical and functional reconstruction for mandibular defects [1]. Mac Carthy et al [9], in 1992, used it in maxillo-facial surgery This cases series presents the outcomes of ADO in reconstructed mandibles for dental implant rehabilitation. Oral evaluation objectives an important vertical ridge discrepancy (ranging from 15 mm to 20mm) with insufficient amount of keratinized gingiva of the reconstructed site (Fig. 1). A mandibular distractor (KLS Martin), shaped to the planed site using 3D printed mandible before surgery, is fixed with screws (∅1.5 mm  5 mm screw for the transport fragment and ∅2mm bi cortical screw for basal bone). The fragment is stabilized into its final position by the rigid device for 12 weeks, leading to the mineralization of the callus present in the distraction gap [10].
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