Jennifer, D. Legree, DDS
Allison Rascon, DDS
| Jennifer, D. Legree, DDS | Allison Rascon, DDS |
Jennifer D. Legree1,2
Allison Rascon2, Jonathan Korostoff2, Brian, M. Chang3
1Division of Restorative Services, Preventive & Restoratice Sciences, University of Pennsylvania School of Dental Medicine; 2Periodontics, University of Pennsylvania School of Dental Medicine; 3Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine
Introduction
Peri-implantitis is the most common complication of the reconstructed mandible following fibula free flap procedure as a result of a sequala of other complications. Studies report the incidence of peri-implantitis is 38%. The aim of this paper is to highlight a case that reduces the incidence of peri-implantitis through a multidisciplinary approach. Periodontic management of peri-implantitis in combination with a prosthodontic approach via fabrication of a bar-supported removable prosthesis was implemented.
Methods
Electronic searches of MEDLINE (PubMed) with MeSH terms and the Cochrane database were conducted to identify studies from 2003 to the present day. Studies were narrowed down using inclusion and exclusion criteria to guide the treatment option presented in the case report. Periodontal intervention: For this patient’s treatment, an Er:YAG laser was used to treat the reoccurrence of hyperplastic tissue noted in the mandibular arch below the existing prosthesis. Prosthesis fabrication: Existing hybrid prosthesis removed along with existing bar. A new titanium bar was milled with custom locators. Utilizing frictional fit of the bar and the framework, a bite registration was recorded at the patient’s existing vertical dimension of occlusion. Teeth were selected and tried in. Final adjustments were made, and the final bar-supported removable partial denture was inserted.
Results
Common concerns with using a fibula free flap in the oral cavity are lack of fixed mucosa and attached gingiva and excessive soft tissue thickness and vestibular inadequacy. Both lead to poor hygiene and resultant hyperplastic peri-implant tissue, soft tissue infections, and abscesses that start as peri-implant marginal bone loss. In this case report, the patient was treated periodontally via regular maintenance visits, in combination with application of an Er:YAG laser to address the recurring hyperplastic tissue. Prosthetically, an implant-supported removable prosthesis allows for better hygiene management at the patient level. Upon insertion of the bar-supported partial overdenture, the patient demonstrated increased ability to access and clean peri-implant sites.
Conclusion
The removable prosthesis gives the patient improved access to the implants to maintain hygiene. From the initial success of the prosthetic treatment for this patient, long-term clinical success is expected.