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Clinical Case Report

Treatment of a Fractured Edentulous Mandible Following Extraction of All Residual Teeth Using Computer-Guided Surgery and Immediate Loading

Paolo Casentini

A 65-year-old female patient was referred to our clinic by another patient for evaluation and treatment of her compromised dental clinical situation. The patient presented with a pessimistic attitude and declared she had no confidence in the possibility of improving her oral situation. Her main complaint was discomfort, inability to chew, and collapse of the facial tissues related to her medical history. The patient had a serious domestic accident 18 months before the consultation and suffered from a head injury, followed by 4 months in a coma. She then gradually progressed toward almost complete neurological recovery, although, at the time of the consultation, she still had difficulty walking. The patient suffered a mandibular fracture in that accident, but because her life had been in danger, the fracture had been ignored. Since the patient was immobilized at the hospital for 4 months, the mandibular fracture had healed spontaneously, but the fragments reossified in an incorrect position, which resulted in a complete discrepancy between the positions of the remaining mandibular teeth and the maxillary teeth

Surgical classification
Complex
Prosthodontic classification
Complex
Source
Treatment Guide 15
Purchase price
10 Academy Coins
CPD/CME
25 hours

Recommended content

General Risk Assessment

Patient-related Factors
Oral hygiene Fair
Compliance Good
Patient-medical Factors
Medical Fitness Healthy, able to undergo planned anesthesia and surgical procedure (ASA I)
Medications No medications that would negatively affect the surgical procedure and outcomes.
Radiation Treatment None
Growth Status Complete
Site-related Factors
Access Adequate
Pathology near the implant site None
Previous surgeries in planned implant site Previous procedures resulting in significant bone and soft tissue changes.

Surgical Classification

Surgical Complexity
Timing of placement Healed (Type IV)
Simultaneous or Staged grafting procedures Implant placement as part of staged hard and/or soft tissue procedures
Number of implants > Three
Anatomy
Bone Volume - Horizontal Adequate
Bone Volume - Vertical Adequate
Keratinized Tissue Insufficient (< 2 mm)
Soft Tissue Quality Presence of minimal scars/no inflammation
Proximity to vital anatomic structures Minimal risk of involvement

Prosthodontic Classification

Complicating Factors
Biological Framework/Bar with appropriate contours and accessible maintenance procedures
Mechanical/Technical Absence of contributing factors
Planned contour of tissue-fitting surfaces Appropriate contours (hygienic - accessible for maintenance)
Prosthesis Factors
Prosthetic volume Adequate. Space available for ideal anatomy of the restoration
Inter-occlusal space Adequate. Capable to create an anatomically & functionally correct planned restoration
Volume and characteristics of the edentulous ridge (fixed) Inadequate. Adjunctive therapy or prosthetic materials may be necessary to achieve optimal result
Occlusal Factors
Occlusal scheme User-defined occlusal scheme achievable
Involvement in occlusion Involvement
Occlusal parafunction Absent
Complexity
Loading Protocol Immediate
Implant-supported provisional restoration Required, elevated esthetic and/or functional demands
Number of implants >2 (non-splinted) or ≥ 2 (splinted)
Timing of placement Healed (Type IV)

Esthetic Risk Assessment

Edentulous Esthetic Risk Assessment (fixed)
Facial Support Minimal changes in facial support tolerated by patient
Labial Support Desired tooth position provides sastifactory labial support
Buccal Corridor Narrow corridor
Smile Line No display of the Maxillary ridge at full smile
Maxillomandibular Relationship Class I
Publication date: Dec 9, 2025 Last review date: Dec 2, 2025 Next review date: Dec 2, 2028

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