A Prosthetically Driven Approach for Immediate Dental Implant Reconstruction of a Maxillary Free Fibula Flap with the Aid of Virtual Three-Dimensional Planning and Intra-Operative Navigation

Objective: To describe a prosthetically-driven reconstruction of an edentulous atrophic maxilla and mandible using 3D surgical planning and intra-operative navigation. Methods: A twenty-eight-year-old male presented for reconstruction with fixed dental prostheses after a gunshot wound caused severe atrophy of the jaws and nasal deformity. His dentition was non-salvageable with insufficient maxillary bone for dental implant placement. To restore his midfacial deformity, reestablish upper lip support, and provide adequate bone, his maxilla was reconstructed using a free fibula flap. Dental implant placement is dictated by the planned prosthetic tooth position, and therefore the design of the maxillary reconstruction considered the necessary prosthetic space and the location of the planned prosthetics via Virtual Surgical planning. Intra-operative navigation confirmed the correct placement of the flap using surgical probe guidance. Results: Using our precise and prosthetically driven method, we were able to place dental implants to support fixed dental prostheses and correct the skeletal deformity in a single surgery. Conclusion: Traditional dental prosthetic design principles were applied to optimize functional and esthetic outcomes in a complex case of simultaneous maxilla-mandibular reconstruction. The use of 3D surgical planning and intra-operative navigation allowed us to shorten the treatment time providing a predictable and accurate outcome.