Prosthetic rehabilitation of maxillary and mandibular gunshot defects with fixed basal implant-supported prostheses: A 5-year follow-up case report

Abstract

Introduction: Gunshot injuries to the oral maxillofacial region have serious aesthetic and functional consequences.

Presentation of case: A 32-year-old male patient presented with a marginal mandibular resection owing to a gunshot wound. A clinical examination revealed destroyed crowns in teeth 12, 11, and 21; extraction in teeth 13, 22, 24, 31, 32-45; a fracture in tooth 38; and severe pain. Further, he had multiple submental scars and a completely obliterated sulcus. Consequently, a multidisciplinary team was formed who devised the following treatment plan: stage 1, root canal treatment for the maxillary anterior teeth, followed by crown construction and transitional mandibular removable partial denture construction, and stage 2, placement of immediately loaded basal implant definitive prostheses supported by 6 corticobasal screw implants. After 5 years of use, the patient presented with excellent peri-implant soft tissue health, prosthesis stability, and great improvements in aesthetics and function. The patient was highly satisfied with the treatment and restoration of his quality of life.

Discussion: Accurate treatment planning is vital for managing complicated cases, including gunshot defect cases, and should involve the selection of the most suitable reconstructive technique with lower susceptible complication rates and high success rates. The described treatment eliminates the need for bone grafting, reduces treatment duration, and involves fixed prosthesis placement.

Conclusion: To our knowledge, this is the first report on basal implant-based full-mouth rehabilitation in a gunshot mandibular defect patient. The fixed hybrid basal implant-supported prosthesis produced highly acceptable aesthetic and phonetic results and greatly improved the patient's life.

Keywords: Aesthetic results; Basal implant-supported prosthesis; Defect resection; Functional outcomes; Gunshot injury; Mandibular defect.

Fig. 1

Patient’s clinical presentation. A. The patient’s photograph presents his frontal view at the time of presentation with a slight facial deformity and multiple scars on the submental region. B. The intraoral view presenting severely destroyed crowns in teeth 12, 11, and 21; missing teeth 13, 22, 45, 44, 43, 42, 41, 31, and 32; and a fractured crown in tooth 38. C. The intraoral view of the patient with an obliterated sulcus. D. The panoramic radiograph shows the
 presence of a supporting wire and a fracture in crown 38.

Fig. 2

The intraoral view depicting the insertion of the transitional mandibular acrylic partial dentures and fixed maxillary bridge for the teeth 13, 12, 11, 21, and 22.

Fig. 3

Intraoral rehabilitation of a 32-year-old man with a gunshot defect using immediately loaded basal implant-supported fixed prostheses. A. Elevation of a periosteal flap, removal of the supporting wire, and implant insertion. B. Implant distribution and flap suturing. C. Post-operative panoramic radiograph.

Fig. 4

The prosthetic rehabilitation of the patient. A. The intraoral view depicting the impression copping tied over the abutments’ head. B. The frontal view depicting the final maxillary fixed bridge and final mandibular basal implant-supported prostheses. C. The intraoral view depicting the labial and lingual extensions of the mandibular implant-supported prostheses.

Fig. 5

Follow-up images of the immediately loaded basal implant-supported fixed prostheses fabricated for a 32-year-old man with a gunshot defect. A. The frontal view of the patient after 5 years of follow-up. B. The intraoral view of the patient depicting his clinical presentation exhibiting optimal peri-implant oral health. C. A panoramic radiograph showing the maxillary and mandibular prostheses after 5 years of function.