Ameloblastoma: Digital Workflow Key to Restoring Hemimaxillectomy Patient
Katya Archambault, DMD
A 32-year-old healthy man, referred by his general dentist, presented with mild numbing sensation symptoms on the left aspect of his maxilla. Four months before the referral, when the patient had no symptoms, a panoramic radiograph revealed the splaying of teeth. Possibly because of the superimposition of radiopaque structures, this went unnoticed. Upon the author's clinical examination, a CBCT revealed a well-defined, multilocular radiolucent lesion present between teeth Nos. 13 and 14. The general behavior of the lesion was rather aggressive. Biopsy results confirmed ameloblastoma, a common benign tumor of the jaws that requires marginal resection due to its high recurrence rate. A treatment plan with the surgical and restorative team was presented to the patient. The treatment would begin with a hemimaxillectomy with secured margins and mucocutaneous fibula graft with implant placement at the time of resection. After 6 months of healing, the second-stage surgery would follow with the insertion of a 3D-printed long-term temporary restoration. Several months later, after occlusion changes and complete healing, the final prosthesis would be inserted. The case was completed in 12 months using a digital workflow plan (DEXIS, dexis.com) that involved the use of intraoral scanning, virtual surgical planning (VSP) software, advanced imaging, exocad software, 3D printing, and more.
· Massive surgical intervention requires fluid communication with the entire surgical and prosthetic rehabilitation team. The morbidity of the procedures can be very high in patients with benign aggressive tumors.
· Reliable state-of-the-art oral and maxillofacial reconstruction is needed to create a predictable, esthetic, and functional outcome. Use of the latest technologies helps ensure that patient needs are met.
· In an extreme case like this, which involves the synergy of the medical and dental team, the digital workflow is crucial to a successful outcome for the patient and the entire team.
About the Author
Katya Archambault, DMD
Board-Certified Oral and Maxillofacial Radiologist, Private Practice, La Jolla, California; Adjunct Faculty, Departments of Otolaryngology and Plastic Surgery, University of California San Diego; Diplomate, American Board of Oral and Maxillofacial Radiology
The author thanks the UCSD Head & Neck Surgical team and Plastics Surgical team Drs. Ryan Orosco and Frederic Kolb; Dr. Thanos Kristallis, oral and maxillofacial prosthodontist at UCSD, and M. Jordan Reiss, Senior Director, Global Sales & Clinician Professional Development, DEXIS.