AESTHETIC REHABILITATION OF COMINED LE FORT AND DENTOALVEOLAR FRACTURE: A CASE REPORT WITH 3 YEARS FOLLOW

Dr kumar Saket,*
Dr spriha Singh,
Dr Suhas Rao K,
Dr Mahabaleshwara C H

Abstract

Abstract Maxillofacial trauma involving one or both dental arches is one of the most frequent consequences of automobile crashes. The management of maxillofacial trauma necessitates a surgical approach requiring systemic evaluations such as hemodynamic assessment, thorough wound assessment, presence of foreign bodies, and lesions involving nerves, vessels, or glandular ducts, among other evaluations that need to be meticulously evaluated together with preoperative instrumental examinations. Surgical treatment for trauma involving one or more dental components is a complicated procedure that, depending on the nature of the lesion and the patient's age, is often carried out in phases. A transverse fracture is a Le Fort I fracture that is above the level of the apices of the maxillary teeth section, including the entire alveolar process of the maxilla, vault of the palate, and inferior ends of the pterygoid processes in a single block from the upper craniofacial skeleton. Le Fort fractures are seldom linked to tooth loss aggravates the difficulties for a clinician in meeting young patients' aesthetic demands. However, if treated improperly, they result in both a cosmetic and a functional impairment. The upper central incisors are the teeth most frequently affected in trauma cases because of their length, location, and inadequate lip support. The placement of implant-supported bridges and crowns has emerged as the most reliable and favored method of restoring lost teeth because of its excellent biological and mechanical consequences. An optimal implant placement is necessary to enable screw access hole emergence in an acceptable esthetic region. Implant placement in the maxilla can be challenging due to several anatomical considerations, the most common of which is a lack of favorable bone anatomy, which necessitates the implant to be positioned by the available bone. Once positioned optimally, they provide a prosthesis that is cement-retained, hence eliminating the need for buccal or labial screw access holes. The combined le fort and dento-alveolar trauma cases present an enormous challenge for a clinician placing an implant while taking both the prosthetic and surgical aspects of his treatment plan into consideration. As the implants might be placed non-axially which will adverse the biomechanical stresses subjected to the implants. An alternative solution in certain inevitable situations would be the angle-corrected abutments, critical for implants positioned off-axis. Implant-protected occlusion is another important aspect that has to be taken into consideration for the long-term success of the implant. Numerous studies have demonstrated that implants placed at an angle may be recovered using angled custom abutments while still satisfying the biological and mechanical demands of the implant and maintaining the patient's functionality and aesthetics. This case report has described the management of combined Le-fort and dentoalveolar fracture by a multidisciplinary approach. It is possible to rehabilitate the patient’s aesthetics even after a complex facial fracture in a very natural way. The reduction and fixation of Le-fort and dentoalveolar fracture followed by placement of implants non-axially in the anterior maxillary region has been done and the implant has been successfully loaded by satisfying biomechanical considerations as well as managing aesthetic complications using angulated custom abutments during prosthetic rehabilitation. The placement of implants in the anterior region after fixation of fracture showed satisfactory results after a follow-up of 3 years without any complications. Implants placed off-axis restored with angulated abutments improved aesthetic outcomes and biological as well as mechanical demands were fulfilled when restored with mutually protected occlusion with anterior guidance and evenly distributed contacts with wide freedom in centric. Implants oriented in different angulations are acceptably placed as per the patient’s preferred treatment option and distribution of bone. It sometimes necessitates the placement of implants in a non-axial direction especially in combined facial and dentoalveolar fracture cases due to unfavorable bone distribution also to avoid injury to certain vital anatomical structures and minimize the need for procedures like bone grafting, sinus lift, and nerve repositioning.