Simultaneous Le Fort I Osteotomy and Computer-Guided Implant Placement

Since 1977, osseointegrated implants have played a strong role in oral rehabilitation. Despite the large success of this technique for the edentulous maxilla and mandible with sufficient bone height, patients with atrophic jaws continue to be the challenging cases for an adequate reconstruction of aesthetics and functionality. Orthognathic surgical procedures have been developed to reposition the jaws and have been traditionally used in the dentate patient to correct a skeletal malocclusion; these procedures can be used on the edentulous patient to correct the discrepancies between the jaws followed by the placement of implants to rehabilitate the oral cavity. Recently, surgeons can use a computer-assisted software package that enables them to insert implants after a digital analysis of the residual alveolar and basal bone that makes for greater implant osseointegration. We describe a one-step oral rehabilitation with Le Fort I osteotomy and computer-guided implant placement to correct a posttraumatic deformity.The first step of the definitive treatment, the implant placement, was planned with the aid of a computer-assisted surgery software package (NobelGuide; Nobel Biocare AB, Goteborg, Sweden). Ten computer-planned implants (Nobel Biocare AB) were inserted (6 on the maxillary arch and 2 on each posterior area of the mandible). Simultaneously, the patient underwent a Le Fort I osteotomy to correct the maxillary deficiency without any bone grafts.The use of Le Fort I osteotomy as a preprosthetic procedure for the atrophic edentulous maxilla has been well accepted. This is a technically demanding procedure, and there are some described complications such as unfavorable fractures of the maxilla, oroantral fistulas, bone exposure, and low implant survival rates. However, in selected cases, this reconstructive method has the advantages over the other commonly used preprosthetic techniques of simultaneously allowing the placement of osseointegrated implants while correcting an unfavorable intermaxillary relationship and improving facial aesthetics. Computer-assisted surgery offers to the surgeons the possibility to visualize anatomic structures, evaluate implant position and inclination, insert accurately implants, prefabricate prosthesis, and avoid the morbidity of bone grafting procedures.One-step oral rehabilitation by Le Fort I and computer-guided implant placement can be used in selected patients. Despite the difficulty of this procedure, this approach enabled the authors to solve simultaneously a double problem: the malocclusion and the partially atrophic and edentulous jaws. According to the literature, this is the first case of a simultaneous Le Fort I osteotomy and computer-guided implant placement. The patient introduced had a posttraumatic deformity, but we think that this procedure could be extended in the future to manage other situations.