Figure 4. Post-orthodontic treatment photographs and X-rays. Treatment results The active orthodontic treatment utilizing fixed appliances in both dental arches nearly lasted 11 months. Superimposition of the initial and final tracings of the lateral cephalometric X-rays indicated that slight labial proclination of the upper and lower incisors occurred post-treatment (Figure 5). Prosthodontic rehabilitation of the partially edentulous right mandibular dental arch region was achieved through the placement of two implants and two crowns, respectively (Figure 6). Figure 5. Overall superimposition of initial and final lateral cephalometric tracings. Figure 6. Post-treatment photographs. DISCUSSION Ameloblastoma is a benign odontogenic tumor arising from the residual epithelial components of tooth development.

It is a slow growing, locally aggressive tumor capable of causing facial deformity, with a high recurrence rate due its capacity to infiltrate trabecular bone. The treatment of ameloblastoma varies from curettage to en block resection. Bone grafts replace the surgically removed bone, with autologous bone grafting being the most desirable. It is typically harvested from intraoral sources (e.g., chin) or extraoral sources (e.g., iliac crest, fibula, calvarial bone). The most commonly used graft material for alveolar ridge reconstruction is free autogenous iliac bone.12 In this case, however, autologous calvarial bone grafts were used to reconstruct the missing mandibular bone following the surgical resection of the tumor and the removal of three teeth in the region.

The advantages of calvarial bone grafting include good integration, absence of pain from the donor site, and no visible scar. These advantages, however, are not applicable in the case of thin calvaria bone with a thickness of less than 5 mm.12 Recent reports on the use of calvarial bone grafting for the reconstruction and subsequent placement of dental implants have presented good clinical outcomes, with low rates of graft resorption and high implant survival rates.13�C16 The results of these studies have showed that calvarial bone grafting appears to be less prone to resorption than iliac grafts are. In this case, complete functional rehabilitation of the patient included the replacement of the lost three teeth. This goal could have been achieved by the placement of two implants and a bridge, replacing all three teeth.

However, this treatment plan would not have addressed the patient��s chief complaint, nor would it result in optimum functionality and esthetics. Accordingly, the placement of the two implants was decided in relation to the orthodontic treatment plan, aiming for an optimum result. The two implants were placed in the posterior region of the edentulous area, hence replacing only Carfilzomib two of the missing teeth, with the extra space being used to correct crowding and to improve dental occlusion.