MRONJ of the Mandible—From Decortication to a Complex Jaw Reconstruction Using a CAD/CAM-Guided Bilateral Scapula Flap

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) has been an integral part of the maxillofacial patient population for some time. The therapeutic concept ranges from conservative approaches over less extended decortications to major jaw resections, which can result in a considerable loss of quality of life. Based on three case reports, this paper presents the long-term history of patients with MRONJ of the mandible, whose disease ultimately resulted in partial or total mandibular resection and subsequent multisegmental reconstruction using a microvascular anastomosed bone flap. Furthermore, a suitable alternative for complex mandibular reconstruction is demonstrated when using a free fibula flap is not possible. The options are limited, particularly when multisegmental restoration of mandibular continuity is required. One case presents a mandible reconstruction using a CAD/CAM-guided bilateral scapular free flap (CAD/CAM = Computer-Aided Design and Manufacturing), which has not been described for this purpose before. Due to the complexity, computer-assisted surgery and patient-specific implants seem reasonable, which is why a special focus was applied to this topic.

Clinical Performance of Implant-Supported Prostheses in the Rehabilitation of Patients Previously Treated for Medication-Related Osteonecrosis of the Jaws (MRONJ): A Systematic Review

“…Data from subgroup 1 of the study of Hjortholt et al [51] were excluded as these patients did not suffer MRONJ. Only data from patients who received dental implants were retrieved from the retrospective study from Caldroney et al [52] and from the case series from Kasper et al [53]. Finally, 14 articles were included in the review [51][52][53][54][55][56][57][58][59][60][61][62][63][64].…”

“…Only data from patients who received dental implants were retrieved from the retrospective study from Caldroney et al [52] and from the case series from Kasper et al [53]. Finally, 14 articles were included in the review [51][52][53][54][55][56][57][58][59][60][61][62][63][64]. A summary of the study selection process in a Flow Diagram adapted from Page et al [45] is presented in Figure 1.…”

“…The 14 articles finally included in the review [51][52][53][54][55][56][57][58][59][60][61][62][63][64] corresponded to 12 case reports/series, one prospective observational study, and one retrospective study that involved 25 patients and 52 implants. All the included articles were published from 2008 onwards.…”

Exceptional Cases Demand Exceptional Personalized Solutions: The Next Level in Dental Rehabilitation

“…However, the conventional concepts of dental implants may encounter limitations when faced with difficult hard- and soft tissue conditions, or when patients are unwilling to undergo prolonged or invasive rehabilitation protocols, especially after experiencing failure in single or multiple bone augmentation and dental implant surgeries. This challenge is particularly pronounced in oncology patients following maxillary or mandibular ablation, where oral function may be significantly compromised, exacerbated directly or indirectly by adjuvant therapies such as radiation, chemotherapy, or long-term sequelae like growth restriction or scarring [ 1 ].…”

Predictability and Effectiveness of Jaws Reconstructive Prosthesis after Tumor Removal: A Systematic Review and Meta-Analysis

“…These innovations lessen the need for a surgeon's specific skill set. When using CAD/CAM techniques, several outcomes have been discussed in the literature, including accuracy, postoperative complications, aesthetics, and cost [9]. This review aims to evaluate the accuracy of the reconstructive process performed by 3d and CAD/CAM technology in terms of surgical precision; in fact, a meta-analysis of the literature regarding the primary studies was performed.…”