[Facial allografts and oral rehabilitation]

The main objective of facial allografts is functional. On this account, oral rehabilitation is pivotal. Two types of cases are possible. Firstly, the indication of facial allograft concerns only the soft tissues. If so, dental care is similar to the one of patients with an organ transplant. Dental implants are a priori contraindicated. A possible indication has to be discussed with the multidisciplinary team. Secondly, the indication is the one of a mandibular and/or maxillary reconstruction. The objective will be a total reconstruction. It could be performed immediately with the allotransplantation of a toothed mandible or maxillar, if the local status permits it. To date, among patients who have benefited from a toothed allotransplant, no tooth has been lost. The first cases have been operated in 2009. If donor teeth cannot be conserved with the allotransplant, the oral rehabilitation will have to be done ideally with adjunctive prostheses. It is rarely possible, for example because of the lack of crests. In case of impossibility, an implant-based rehabilitation can be discussed. One case has been performed with basal implants (cortically anchored disk-design implants) with a five-year follow-up without loosing any loss of implant or infection.