A new approach for reconstruction of a severely atrophic mandible

The purpose of this study is to report a case of a patient with a severely atrophic mandible (less than 5 mm) who was treated without bone graft using short implants and internal rigid fixation.

A 61-year-old woman was referred to a private clinic in the city of Recife (Brazil) with a severely resorbed mandible (less than 5 mm). The patient reported a history of nearly 15 years of complete edentulism and consecutive treatment failures. Cone beam tomography was performed and severe atrophy was confirmed, revealing total bilateral exposed inferior alveolar nerves. There was a high risk of pathologic mandible fracture, since bone density in critical areas was very low. Treatment of choice was the placement of 4 Shorty (3.75 x 5.5 mm) implants (Nobel Biocare, Göteborg, Sweden) at the symphysis for immediate functional reasons and a 2.0-mm large profile Unilock bone plate (Synthes Maxillofacial, Paoli, PA) to reinforce the mandible. A rapid prototype model was made to help precontour the plate, enabling the insertion of the plate through the transoral approach.

A week after surgery, a Brånemark prosthesis protocol was performed and the patient was satisfied with the result. At 29 months after surgery, the patient was still satisfied and had excellent function without complications.

Because of the reported advances in implantology and internal rigid fixation, more patients would be able to improve their severe dental condition without the use of more invasive techniques.