Rehabilitation of a patient with an elusive medical history and loss of occlusal vertical dimension.

In this clinical report, we describe the medical history, diagnosis and prosthodontic treatment of a 61-year-old man with a previous history of oral cancer. Loss of a full upper denture and severe erosion of his teeth prompted the patient to seek treatment at the dental clinic at the British Columbia Cancer Agency. Although he stated that he was being treated for a sleeping disorder, hospital records revealed multiple recent admissions for alcoholism and depression. The patient's limited finances prevented complex restoration of worn lower dentition; thus, definitive treatment consisted of extraction of teeth with a poor prognosis, removal of a glandular odontogenic cyst and fabrication of a full maxillary prosthesis and a removable mandibular cast-metal overlay.

[The value of 3-dimensional model in the reconstruction of mandibular segment defect. Observations in a clinical case]. / Valoarea modelului tridimensional in reconstructia pierderilor de substanta segmentare ale mandibulei. Observatii pe marginea unui caz clinic.

The use of autogenous bone graft in the reconstruction of mandibular defects following tumor extirpation is a reliable method for further functional rehabilitation. The exact amount of bone needed for harvesting is usually achieved by estimation of the gap and direct measuring. We present the case of a 51-years old patient referred to our clinic for a recurrent mandibular keratocyst. Besides clinical examination, the diagnosis work-up consisted of ortopantomography and computertomography (CT). Based on CT images, a graphic reconstruction of the mandible was realized and a 3D negative template of the scheduled mandibular defect was printed. The tumor was removed by a segmental resection of the mandible, while a fragment of bone tissue similar to the 3D model was harvested from the iliac crest. This bone fragment replaced the mandible defect and was fixed by means of four plates and titanium screws. No postoperative complications occurred. The pathology result confirmed the diagnosis of keratocyst. In conclusion, this method proved to be useful for precise planning of the shape and size of the graft in addition to exact placement of the graft in an acceptable prosthodontically position for future dental implant rehabilitation.

Case report--odontogenic keratocysts: enucleation, bone grafting and implant placement: an early return to function.

The odontogenic keratocyst (OKC) is a developmental odontogenic cyst accounting for approximately 3%-17% of cysts of the jaws. This is an uncommon lesion both clinically and pathologically because of the unusual growth pattern and high tendency for recurrence. The recommended surgical management of the lesion varies from marsupialisation to en bloc resection. In the treatment of a large mandibular OKC, enucleation and immediate bone grafting maintains mandibular integrity, reduces the risk of pathological fracture permits restoration of function with implant-supported prostheses. We recommend the following protocol in the management of large mandibular OKC: 1. Biopsy of the lesion. 2. CT scans in axial and coronal planes. 3. Enucleation of the cyst and removal of the associated teeth. 4. The excision of the overlying mucosa. 5. Immediate mandibular reconstruction with a corticocancellous iliac crest bone graft. 6. Placement of endosseous implants four months following bone grafting. 7. Reconstruction of the dentition six months following implant placement.

Osseointegrated implants in post-surgical prosthodontic rehabilitation.

The advent of osseointegrated implants and their use in dentistry has been well documented and continues to become more and more a part of conventional dental treatment. Apart from their use in simple situations they can prove invaluable when there is little hope of success with the other options. Two cases are presented here that involve multiple tooth loss as a result of surgical intervention and treatment of pathological lesions.