Oral and Masticatory Rehabilitation Using Osseointegrated Dental Implants After Resective Treatment of Multicystic Ameloblastoma in the Lower Jaw with a Fibula Graft – A Case Report

Case Report

J Dent & Oral Disord. 2017; 3(2): 1060.

Oral and Masticatory Rehabilitation Using Osseointegrated Dental Implants After Resective Treatment of Multicystic Ameloblastoma in the Lower Jaw with a Fibula Graft – A Case Report

Deliberador TM¹, Grossi JRA¹*, Saad T¹, Scariot R², Zielak JC¹ and Giovanini AF³

¹Department of Implanthology, Positivo University, Brazil

²Department of Head and Neck Surgery, Positivo University, Brazil

³Department of Pathology, Positivo University, Brazil

*Corresponding author: Joo Ricardo Almeida Grossi, Department of Implanthology, Positivo University, Brazil

Received: March 03, 2017; Accepted: May 03, 2017; Published: May 10, 2017


Aim: Ameloblastoma is an aggressive odontogenic tumor which typically occurs between third and fourth decade of life, that often needs resective approach. Immediate reconstruction may show better results.

Methods: The treatment of multicysticameloblastoma in the mandible, being a rare case that occurred in the late second decade of life, which was surgically removed along with the affected teeth with safety margins and the region was immediately reconstructed using a vascularized graft, removed from the fibula.

Results: Its integration, in combination with osseointegrated dental implants and fixed implant-supported prostheses, restored chewing function and aesthetics.

Conclusion: After 7 years from fibular graft and 36 months of dental implants, an excellent outcome was observed, with oral health and normal functions properly restored and the immediate reconstruction of the mandible in resective cases, associated with oral rehabilitation with dental implants, may be considered a suitable treatment option.

Keywords: Ameloblastoma; Bone Graft; Dental Implants; Prosthetic rehabilitation; Immediate fibulae reconstruction


Ameloblastoma represents approximately 10% of odontogenic epithelial tumors [1-4] the second most prevalent neoplasm after odontomas [5], accounting for 1% of all tumors and jaw cysts that predominantly affect the mandible [2,4,6,7], in the body of the mandible and its ascending branch [2], characterized by asymptomatic slow expansion with persistent and aggressive behavior, capable of infiltrating adjacent tissues, causing cortical bone expansion, and severe facial deformities, functional impairment, paresthesia, and trismus [2,6,8]. In addition, it may induce root resorption and high rates of relapse when inadequately treated [1,8].

Ameloblastomas are classified into different types: solid or multicystic, unicystic, desmoplastic, peripheral or soft tissue [2,4,5,9], and malignant, which is the most aggressive type [2,7].

Diagnosis is achieved through radiographic examination or when the tumor leads to facial asymmetry. Radiographically, ameloblastoma shows significantly variation, but multilocular and unilocular characteristics are commonly seen, which may or may not be well defined [2], appearing as “honeycomb” or “soap bubbles” [6].

The recommended treatment for ameloblastoma relies on a surgical approach, andradical surgical treatment involves resection of the ameloblastoma with safety margins of at least 1 to 3 cm of normal bone [1,2,5,9,10]. Conservative surgery involves total tumor enucleation and subsequent curettage; however, this method leads to an increased rate of relapse, usually occurring a few years following conservative treatment [1,2,4,5,9].

These tumors usually develop between the third and the fourth decades of life [1,2,4,8]. In young patients, unicysticameloblastomas are rare and their resections may interrupts the growth and development of the anatomical structures affected by these tumors [3]. Moreover, these tumors can lead to functional and aesthetic problems, including chewing difficulties, which may benefit from more conservative treatment [5].

The aim of this study was to report a clinical case of oral rehabilitation with dental implants and fixed prostheses, after the resective treatment of a multicysticameloblastoma associated with immediate micro vascularized fibular grafting.

Case Presentation

The patient was diagnosed with endodontic periapical cyst with chronic inflammation in lower right pre-molars at 18 years of age (Figure 1), during a follow-up Rx examination at the end of orthodontic treatment and revealed the presence of a radiolucent circumscribed lesion located in the right side of the body of the mandible, with no cortical bone expansion or dental displacement.