Reconstruction of comminuted jaw with iliac crest graft and implant-supported prostheses – case report

Camila Fernanda Vasconcelos,Andressa Bolognesi Bachesk,Angelo José Pavan,Willian Pecin Jacomacci,José Henrique Santana Quinto,Caio Cesar Santos Patron Luiz

doi:10.33448/rsd-v9i10.9175

Abstract

Comminuted jaw fractures represent a challenge in terms of treatment. The advancement of fixation techniques and materials has contributed to the surgeon providing faster treatment and less complication. Even so, cases that present severe mandibular fragmentation require additional therapies, such as the use of bone grafts and dental implants, in order to recover function, aesthetics and anatomy of the mandible. This work aims to report a case of comminuted mandibular body fracture, which was treated with reconstruction, initially by rigid internal fixation, and secondly, by iliac bone graft and implant-supported oral rehabilitation. Although studies in the literature demonstrate that autogenous grafts show significant resorption, they are still considered the gold standard, and allow an ideal basis for obtaining osseointegration of dental implants. Thus, we concluded that the use of the autogenous bone graft coming from the iliac crest and rehabilitation with implants can be a satisfactory option for functional and aesthetic repair of patients who presented high impact fractures, and developed significant bone defects.

Highlights

Situations that produce a high-energy impact, as seen in traffic accidents and firearm shots, can generate sufficient concentrated force to cause mandibular comminution
This work aims to report a case of comminuted mandibular body fracture, which was treated with reconstruction, initially by rigid internal fixation, and secondly, by iliac bone graft and implant-supported oral rehabilitation
The surgeon should aim to restore the jaw function and anatomy, in addition to the patient's aesthetic appearance (Ellis et al, 2003), which is often achieved through open reduction and rigid internal fixation (Kazanjian & Converse, 1959)

Summary

Introduction

Situations that produce a high-energy impact, as seen in traffic accidents and firearm shots, can generate sufficient concentrated force to cause mandibular comminution This type of injury is defined by the presence of multiple fracture lines, resulting in several fragments within the same area (Finn et al, 1996; Lee et al, 2014). It proved to be an excellent base for implantation due to its adequate height and thickness (Kumar et al, 2015) In this context, this article aims to report a clinical case of a patient victim of a motorcycle accident, diagnosed with a comminuted fracture of the mandibular body, which required the bone defect reconstruction with iliac graft, and allowed a successful implant-supported oral rehabilitation

Objectives

Methods

Conclusion