Multiprofessional approach for class III malocclusion rehabilitation with autogenous calvarial bone graft followed by Le Fort 1 osteotomy and implant-supported prostheses – case report

Paulo Sérgio Borella,Larissa Ayres Scagliarini Alvares,Júlio César De Carvalho Alves,Karla Zancopé,Flávio Domingues Das Neves,Karoline Ferreira Da Mota,Áquila Valente De Souza,Sérgio Antônio Araújo Costa,Marcel Santana Prudente

doi:10.33448/rsd-v10i7.16276

Abstract

Extensive treatments can eventually be challenging. Even more so when the patient has limitations such as extensive tooth loss and skeletal changes, including overgrowth of the lower jaw. When indicated, these treatments tend to discourage patients due to the history of previous failures. Therefore, in addition to an interdisciplinary dental team composed of oral and maxillofacial surgeons, and prosthodontists, a nutrologist, a speech therapist, and a psychotherapist were involved in the treatment of this case. A 52-year-old female patient, Angle Class III malocclusion, with few teeth and extensive maxillary bone loss, attended the dental clinic of the Brazilian Association of Dentistry in Uberlândia. The treatment involved reverse planning, extraction of the dental remnants, calvarial bone grafting, placement of 6 titanium implants (Neodent) in the maxilla (upper jaw) and 5 in the mandible (lower jaw), orthognathic surgery, and installation of implant-supported fixed complete dentures in both jaws. Furthermore, psychotherapeutic and nutrologist’s interventions were necessary during the dental treatment, concluding the treatment with speech therapy. Within the limitations of this case, the multidisciplinary approach proved to be efficient. It promoted the reestablishment of the stomatognathic system functions without compromising nutrition during the periods when it was impossible to wear prostheses for better healing of the tissues.

Highlights

Edentulism is a frequent problem in some places, depending on the culture and socioeconomic conditions
In the following case report, we present a clinical case of facial skeletal deformities in which the rehabilitation was possible performing a calvarial bone grafting in association with implant installation, followed by orthognathic surgery and implant-supported fixed complete dental protheses
A nutrologist was consulted for food supplementation and a speech therapist conclude the treatment adapting the patient to the new prostheses and correct functioning of the stomatognathic system

Summary

Introduction

Edentulism is a frequent problem in some places, depending on the culture and socioeconomic conditions Populations affected by this condition present changes in masticatory performance, which negatively impact the quality of life, self-esteem, and nutritional status. Changes in the bone bases of the maxilla and mandible in relation to the skull base are major factors for the diagnosis of dentofacial deformities. Class III patients have the bone bases of their jaws badly positioned in relation to the skull base uni or bimaxillary. In the following case report, we present a clinical case of facial skeletal deformities in which the rehabilitation was possible performing a calvarial bone grafting in association with implant installation, followed by orthognathic surgery and implant-supported fixed complete dental protheses

Methodology

Discussion

Final Considerations