Prosthodontic Rehabilitation with All-on-Four Implant Treatment Combined CAD/CAM Prosthesis in an Oral Cancer Patient: A Case Report

Abstract

Background The microvascular free fibula (MFF) flap is a reliable treatment modality for mandibular reconstruction and is suitable for dental implants placement after oncologic surgery. The most encountered problem of the MFF flap is the limited bone height, which usually causes excessive interarch space and increases the difficulty of prosthodontic therapy. Overcoming the physical limitations derived from tumor excision and shortening the treatment time of prosthodontic rehabilitation to recover quality of life are critical issues in clinics. Case presentation: A 64 y/o male suffering from lower left gum and bilateral buccal cancer received a single layer microvascular MFF flap to reconstruct the mandibular defect after a tumor excision. He received a bilateral modiolus Z-plasty combined skin flap debulking procedure to relief the oral contracture, and the mouth opening was adequate for prosthodontic rehabilitation. The scar tissue band on the bilateral check greatly impacted the retention and stability and restricted the performance of dental impression. The patient requested prosthodontic rehabilitation to improve his chewing function and life quality as soon as possible. The prosthodontic rehabilitation with all-on-4 implant therapy combining computer aided design and computer assisted manufacturing (CAD/CAM) was accomplished within one month. Conclusion This case utilized the all-on-4 implant system to overcome the insufficient fibular height for conventional dental implant placements. The dental CAD/CAM was used to mill the custom prosthetic abutment and huge titanium framework of the implant bar overdenture derived from the excessive interarch space between the grafted fibula and maxilla. This treatment modality successfully shortened the time of prosthodontic rehabilitation and overcame anatomic limitations.