Full Mouth Rehabilitation with Modified Andrew’s Bridge Following Le Fort Osteotomy for a Patient with Maxillary Retrognathia

Case Report

J Dent & Oral Disord. 2017; 3(2): 1058.

Full Mouth Rehabilitation with Modified Andrew’s Bridge Following Le Fort Osteotomy for a Patient with Maxillary Retrognathia

Saumyendra SV¹, Gaurav B¹, Varun B¹, Kumar SK², Kamleshwar S¹ and Deeksha A*¹

¹Department of Prosthodontics & Dental Material Sciences, K.G. Medical University, India

²Department of Plastic Surgery, K.G. Medical University, India

*Corresponding author: Deeksha Arya, Department of Prosthodontics & Dental Material Sciences, F.O.D.S, K.G. Medical University, Lucknow, India

Received: April 03, 2017; Accepted: April 26, 2017; Published: May 03, 2017


Oro-facial trauma may lead to irreversible soft and hard tissue loss requiring complex multidisciplinary intervention for satisfactory functional and esthetic rehabilitation. This requires efficient diagnosis and an elaborate treatment plan to optimize stomatognathic function, health and esthetics which translates to patient comfort and satisfaction. This case report describes such a rehabilitation of a 38 year old female who lost her anterior teeth with adjacent bone in an accident. An interdisciplinary approach using an intentional Le forte 1 osteotomy and an Andrew’s fixed partial denture was used to successfully rehabilitate the patient.

Keywords: Andrew’s bridge; Full mouth rehabilitation; Le Fort osteotomy; Retrognathia


Trauma to the facial structures affects a patient physically as well as mentally. The personality, personal & social life and confidence levels may be badly affected as a result of the disfigurement. Such esthetic challenges often require a complex and well defined treatment plan involving various specialties to achieve a successful conclusion with an ultimate treatment goal to achieve normal function and appearance [1].

The area of soft tissue and teeth displayed when a patient smiles is referred to as the esthetic zone and normally includes the teeth in the maxillary arch till the second premolar. Tooth and tissue replacement in this area presents a challenge especially when the loss includes significant amounts of alveolar bone and accompanying tissue. At the same time, designing a method for achieving reasonable esthetics in such cases can be most rewarding [2].

Restoration of esthetics, comfort, and function should be the major focus of oral rehabilitation. The term ‘esthetic’ refers to theory and philosophy relating to beauty and the beautiful, and in dentistry, this term applies especially to the appearance of the dental restoration, achieved through form and/ or color [3].

The prosthetic options for replacement of missing anterior teeth are resin-bonded partial dentures, conventional Fixed Partial Dentures (FPDs), removable partial dentures and implant-supported fixed prostheses [4,5]. In this clinical report, because of prevailing limitations, a full mouth rehabilitation after a Le forte-1 osteotomy, utilizing an anterior removable-fixed prosthesis was done [6].

Case Presentation

A 38-year-old woman presented with the complaint of depressed middle face and missing anterior teeth 3 years back. She gave a history of having visited several clinicians for a solution to her problem before coming to us. Dental history of the patient revealed that the patient fell from a roof 7 years earlier, when she lost her upper anterior teeth and adjacent bone with a Le forte-1 fracture. She also lost her mandibular central incisors. Later on, the missing maxillary teeth were replaced with a fixed partial denture but the patient was not satisfied with the esthetic results obtained because of depressed mid face and insufficient upper lip support. Extraoral examination of profile of the patient was straight with depressed premaxilla (Figue 1&2). Clinical examination revealed an asymmetric edentulous space in the maxillary incisor region consisting of missing 11, 12, 21 and 22 (Figure 3a). The other teeth that were missing were 17, 31 and 41. Silver amalgam restorations were present in 18 and 48. Crown preparations had been done previously on 13, 23, 24 and 33, 32, 42, 43 (Figure 3a). 33, 32, 42 and 43 had tilted labially because of no antagonist contact, with gingival recession on 32 and 42. The patient presented with a fixed partial denture replacing the upper missing teeth but was not satisfied with this restoration and therefore had left the previous clinician (who had attended her 3 and a half years ago) before the mandibular fixed partial denture could be completed. She was not wearing any replacement for her remaining missing teeth. Her medical history was non-contributory without contraindications for dental treatment.