Dental rehabilitation of a patient with chronic maxillary osteomyelitis and multiple oronasal fistulas using a revascularized fibular autograft: A clinical case

Abstract

A clinical case of dental rehabilitation is presented in a patient with severe complications caused by chronic osteomyelitis and multiple failed surgeries involving zygomatic implants. Digital preoperative planning was employed using 3Diagnosys and Materialise Mimics software. A fibular autograft and a titanium reconstructive plate were virtually designed. Surgical guides were fabricated for the 3D modeling of the autograft and titanium plate. The surgery involved the use of a free vascularized fibular graft followed by the placement of dental implants. The procedure was successfully performed, with complete reconstruction of the alveolar ridge defect using the vascularized fibular graft. Six months later, eight dental implants were placed. Digital simulation enabled precise determination of the graft’s dimensions, shape, and position, contributing to the high accuracy of the surgical outcome. The patient regained full masticatory function, and the oronasal fistulas were resolved.
Conclusions.
The use of digital modeling and customized surgical templates made it possible to achieve high-precision correction of a complex defect in the alveolar process of the maxilla. The successful use of a free revascularized fibular autograft, along with dental implantation, made it possible to restore the patient’s chewing function, which is a promising approach in treatment similar cases.