This is a case of a 42 year old female patient who approached our dental hospital with a complaint of asymptomatic swelling in the right lower back teeth region for the past 3 months. The patient stated that the swelling had increased in size over the time. Her medical and family history was unremarkable and there was no history of trauma to the involved site.
The patient was very much in distress due to her condition and wanted to get rid of the cyst.
EXAMINATION OF THE PATIENT
The patient had undergone biopsy of the lesion elsewhere which had diagnosed the swelling to be an aneurysmal bone cyst.
“An Aneurysmal bone cyst (ABC) is a benign, rapidly growing, destructive bone lesion, characterized by replacement of normal bone with blood- filled connective tissue matrix. It is a rare lesion infrequent in craniofacial skeleton”
On extraoral examination, facial asymmetry was apparent with diffuse swelling involving right side of the lower jaw. The swelling was firm and non-tender on palpation. On radiological examination, OPG taken shows the exact extent of the cystic lesion in the right lower jaw extending from the right lower canine tooth till the first molar tooth with expansion of the surrounding bone. On aspiration with a syringe, blood tinged fluid was obtained.
Renowned Maxillofacial surgeon, Dr.S.M.Balaji, planned to surgically resect the cystic lesion completely, with extraction of the involved teeth followed by reconstruction of the defective site with rib graft, under general anesthesia. Later replacement of missing teeth with Dental implants was intended.
Dr.S.M.Balaji planned to take rib graft to reconstruct the jaw defect, as Autogenous graft (bone obtained from the same individual receiving the graft ), taken from donor’s extraoral site like chest( rib bone ) has always been regarded to be the “gold standard” due to its properties and absence of immunological reactions. The thick rib graft reduces resorption and helps in bone regeneration.
The patient was clearly explained about the surgical procedure and consent was obtained.
Under general anesthesia, the excision of the lesion was done with complete resection of all tissues lining the cyst and any of its components from the surrounding hard and soft tissues. The involved teeth were also extracted. After successful removal of the cyst, the defective bone area was reconstructed with the rib graft taken from the patient amidst the surgical procedure. The rib graft was fixed with the adjacent jaw bone by means of screws. Finally, the surrounding gum tissues were approximated with absorbable suture.
POST SURGICAL FOLLOW-UP
Patient reported after 6 months post surgically for review. Post-operative OPG taken shows well integrated bone graft with the jaw bone. There is no sign of recurrence of the cyst. A 3DCT scan taken revealed perfectly formed bone at the involved site with no signs of bone resorption, which took us to the final step of replacing her missing teeth with dental implants.
DENTAL IMPLANT PLACEMENT
Under local anesthesia, Dr.S.M.Balaji opened the gum tissues surrounding the relative site exposing the newly formed bone. Dental implants of appropriate size and height were fixed in the underlying jaw bone with precision. Finally the gum tissue were closed with absorbable suture.
The patient was asked to wait for a period of 3-4 months for the final prosthesis, as to allow the dental implants to completely osseointegrate with the jaw bone obtaining maximum stability and retention. Meanwhile, a removable prosthesis was given temporarily for replacement of missing teeth to avoid supraeruption of the opposing teeth.
THE HAPPY PATIENT
The patient returned after 4 months for the final prosthesis. OPG taken shows dental implants in integration with the jaw bone. Hence, the final impression was taken and after a couple of bite trials, a natural looking fixed ceramic bridge was fixed onto the dental implants. The prosthesis was in perfect contact with the opposing teeth. The patient and her family members were very happy and satisfied with the entire process and the outcome. Patient was able to chew properly without any discomfort. Patient is on a regular follow up for the past 2 years.