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Objective: The purpose of this study was to investigate the relationship between habitual chewing side and perception of the oral mucosa following reconstruction with dental implants., Study Design: Five patients comprised 2 males and 3 females, with ameloblastoma in 2 patients, odontogenic myxoma in 2 patients, and oral squamous cell carcinoma in 1 patient. They were treated using mandibular reconstruction with bare bone graft after segmental resection of the mandible. Perception (tactile, warm, and cold) was measured at 8 points (chin, lower lip, gingiva, and lateral edge of the tongue, bilaterally). Habitual chewing side was evaluated using a computerized index, the first chewing cycle, and a question on chewing., Results: Perception on resected sides was improved at all measurement points for tactile and cold sensitive evaluation, although sensitivities on the resected side remained below the normal range. In the relationship between habitual chewing side and implanted prostheses in reconstructed bone, the chewing side was the resected side in 2 of the 5 patients. When those 2 patients underwent prosthesis implantation after removal of denture, the chewing side changed from the nonresected side to the resected side. Implant prostheses on resected side were suggested to contribute to masticatory function. Perception in those patients was incomplete but was improved compared with other patients. When prosthesis implantation is performed on the reconstructed side, the resected side may become the habitual chewing side., Conclusions: Recovery of perception can influence acquisition of the habitual chewing side.

The natural mandible has 2 arcs, the marginal arc and the occlusal arc. The marginal arc is situated along the lower margin of the mandible and affects the contour of the lower third of the face. The occlusal arc is situated along the dental arc and affects the stability of prosthodontics. The gap between these 2 arcs widens in the molar area. Our developed concept of "double arc reconstruction" involves making these 2 arcs for the reconstructed mandible. For the double-barrel fibula reconstruction, 2 bone segments are used to make both arcs. For reconstructions using the iliac crest, the double arc is made by inclination of the top of the bone graft toward the lingual side. Ten patients underwent double arc reconstruction: 2 underwent reconstruction with the double-barrel fibula, and 8 underwent reconstruction with the iliac crest. Four patients had a removable denture prosthesis, 1 had an osseointegrated dental implant, and 5 did not require further prosthodontic treatment. The shape of the reconstructed mandible after double arc reconstruction resembles the native mandible, and masticatory function is good with the use of a dental implant or removable denture prosthesis, or even without prosthodontics.

Background: "Bare bone graft" with a vascularised iliac crest is a procedure involving no soft tissue for intraoral lining, and the intraoral defect is covered with epithelial cells through secondary healing of the exposed bone., Methods: A vascularised iliac crest flap is transferred to a segmental mandibular defect intraorally in the position of the osteotomized stump upwardly. Granulation tissue is usually observed on the stump of the bone graft about 1 week after surgery. When sufficient granulation is observed after approximately 4 weeks, "resurfacing" is performed to prevent interference of hypergranulation tissue with epithelization. Resurfacing involves wiping the granulation tissue from the surface of the bone and covering with a plastic prosthesis fitted to the alveolus., Results: A total of 11 patients underwent bare bone graft with a vascularised iliac crest. Resurfacing was performed at an average of 2.1 times for each patient. All wounds in the oral cavity were completely epithelialized from 2 weeks to 3 months after surgery. Complications with the recipient side occurred in four patients., Conclusions: Bare bone graft with the iliac crest is one favourable option for mandibular reconstruction utilising the particular shape of the bone without the attached soft tissue., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Bare bone graft is a method of mandibular reconstruction involving vascularised iliac bone graft without a skin flap, and secondary epithelialisation of the exposed iliac bone surface in the oral cavity. We herein report two cases of bare bone graft with dental implant for mandibular defect after tumour resection. Case 1: A 36-year-old woman with odontogenic myxoma of the left mandible underwent reconstruction with a free vascularised iliac flap after segmental resection of the mandible. The exposed iliac bone surface in the oral cavity required about 2 months for epithelialisation. Two implants were placed into the reconstructed mandible 12 months after initial surgery, and prosthetic rehabilitation was performed successfully after 6 months of osseointegration period. Case 2: A 32-year-old woman with desmoplastic ameloblastoma of the right mandible underwent reconstruction using free iliac bone after segmental resection of the mandible. As the reconstructed bone failed after surgery, the left mandible was reconstructed using a free vascularised iliac flap. The exposed iliac bone surface in the oral cavity required about 2 months for epithelialisation. Four implants were placed into the reconstructed mandible 17 months after surgery, and prosthetic rehabilitation was performed successfully after 6 months of osseointegration period. In both cases, the mandibular contour and occlusal function were satisfactory. [ABSTRACT FROM AUTHOR]