Maxillofacial Surgeon Dr. S. M. Balaji successfully planned to surgically remove the infected graft and place a composite mandibular reconstruction with rib graft fixed with reconstruction plate and reinforced with rhBMP-2. As she also had a missing 21, 22, 23, dental implants were also planned as a part of this procedure.
Intraorally, crestal incision was placed from tooth 21 to 23 regions. Mucoperiosteal flap reflected, implants placed and flap repositioned and closed. Later after osseo-integration, super structures would be placed.
Right submandibular incision was placed through the existing scar. The scar and the sinus tract were carefully excised. The reconstruction plate along with resorbed fibular graft was identified and removed. A new titanium reconstruction plate was contoured, adapted and fixed to the jaw bone using screws. The rib graft was now placed along the medial aspect of the reconstruction plate and stabilized using screws. rhBMP-2 was placed over this reconstructed area and the closure was done layer wise. rhBMP-2 will induce new bone formation that will ensure complete healing of the defect.