A Rare Case of Front Mandible Orthokeratinized Odontogenic Cyst - Surgical Management with Preventive Rigid Osteosynthesis

Purpose: Cysts and other intrabony lesions can grow asymptomatic until being diagnosed by occasionally done radiologic examination. Missing tooth and malposition of adjacent teeth should induce clinicians to perform X-Ray diagnostic. Methods: A 37-year-old, male patient was admitted with a hopeless tooth 36, to be extracted and replaced with an implant. Clinical examination revealed also missing one of lower incisors and malposition of remaining lower incisors. Cone-beam computed tomography revealed horizontally impacted lower incisor surrounded by bone defect -15 × 20 × 8 mm with the bone thickness remaining only 3.5 mm in the narrowest area. The basis on strong masticatory muscles and low thickness of bone after surgical removal of tooth and lesion, prophylactic osteosynthesis was planned. To explain the surgery to the patient model of the mandible was 3D printed. Results: Two treatment plans were presented to the patient: 1. custom plate production according to the bone defect and the shape of remaining bone and 2. choosing a standard plate and adjusting it on the 3D printed model. Costs of the material were 10 times higher in a custom solution. Plan 2 was then accepted. 1.2 mm straight plate was prebend on the model and sterilized. Lesion and impacted tooth were removed in local anesthesia. Prepared plates were fixed. Conclusions: In the presented case custom 3D printed osteosynthesis plate was about 10 times more expensive compared to the standard osteosynthesis plate used. 3D printing of bone model may be helpful for prebending chosen standard plate and planning the surgery.