Functional Mandibular Reconstruction With Integrated Nerve Repair: A Pathway to Dental Implant Rehabilitation

Functional reconstruction of large mandibular defects, especially in young patients, presents a significant clinical challenge. The ideal approach should not only restore skeletal contour but also address nerve deficits and facilitate final occlusal rehabilitation, all while minimizing morbidity. This report describes a comprehensive, multi-staged strategy for such a case. A 22-year-old male patient was diagnosed with a large cemento-ossifying fibroma (COF) located in the molar region of the left mandible. He underwent a segmental mandibulectomy, resulting in a 40-mm defect. Immediate reconstruction was performed using a custom-made titanium mesh tray filled with autologous particulate cancellous bone and marrow (PCBM). Concurrently, the 40-mm gap in the inferior alveolar nerve (IAN) was bridged with a polyglycolic acid (PGA)-collagen nerve conduit. Subsequent procedures included secondary bone augmentation at 18 months and placement of two dental implants at 30 months, followed by final prosthetic delivery. At the 6.5-year follow-up, the patient showed excellent bone stability with no tumor recurrence and was highly satisfied with both the functional and aesthetic outcomes. Postoperative imaging confirmed successful graft integration and the formation of a new canal-like structure. While quantitative sensory testing indicated only partial nerve recovery, this was attributed to the large 40-mm defect size, which was at the upper limit of the conduit's indication. This case demonstrates that a holistic approach, integrating custom-made devices for both skeletal and neural repair, provides a viable pathway to full functional rehabilitation and represents a valuable treatment paradigm for improving quality of life in young patients with extensive mandibular defects.