A 12 years old male patient reported to the department of oral and maxillofacial surgery at the national hospital of Hama with visible swelling, intraorally there was a noticeable expansion of the mandible body In the posterior section, After the radiographic examination
it was suspected that the presence of multicystic Ameloblastoma (Fig 1), which was confirmed by histological examination. On cbct scan, the tumor was extending from the tooth 34 to 38 with part of the ramus. According to (ord et all)30, the treatment of ameloblastoma would be complicated
because of continued growth and a higher percentage of cancellous bone which increased bone turnover and high periosteal reactivity, so the treatment should be in the same way used with adults, so a partial resection of the mandible from the tooth 33 Until the ramus was done while keeping the condyle (Fig 2).
A titanium reconstruction plate was adapted and contoured to mandible body to reinforce and help stabilize a nonvascularized block graft which was taken after8 months if the first surgery from the
anterior iliac crest and Because the patient's bone is spongy and fragile, it was waited a whole year to confirm the success of the graft and the stability of its dimensions, during this period a transpalatal arch was applied to prevent rotation of upper molars and maintain the arch width,
(Fig 3)(Fig 4).
The second stage of treatment was involved a removable partial denture Until the growth and calcification of the bone is complete to place implants and fixed prosthetic.
Intraoral examination showed an obvious volume of soft tissue in the graft region which had healed well (Fig 5). All options were discussed with the patient parents and their finance and expectation, They refused to perform another surgical procedure to remove the flabby soft tissue. Prosthodontic plan was designed for the fabrication of a flexible partial Denture.
As usually the procedures began with making a primary impression using Irreversible Hydrocolloids material, The custom tray was made by auto polymerizing acrylic resin (Simplex Hi, Kemdent, UK) and checked in the patient mouth and to fill the missed area in the tray of the resected mandible, impression compound sticks (Kerr, Italy) were used to support the final impression material and to make a functional impression which was made with Irreversible Hydrocolloids material(Zeta plu, Zhermak, Italy) and poured with the pink gypsum type IV (Shera, Italy), (Fig 6).
The relationship was registered using a register plate made with auto polymerizing acrylic resin and modeling wax(Tenatex, Kemdent, UK) to make the rim that hold the medium (chemi sil bite, Hyvincare, Korea), taking into account the situation of the mandible and its deviation. This stage is considered critical so the relationship was manually directed until reaching the most stable position, taking advantage of the remaining teeth on the natural side Then confirmed during the clinical trial. The denture was processed With flexible acrylic resin (valplast, Tinjin iris, china). the denture was delivered to the patient after assessment for the speech, mastication, and adjustment procedures (Fig 7)(Fig 8), The teeth were prepared according to class I of Black and restored with an amalgam filling to create a natural look for a young man of this age. A digital panoramic radiograph was made on the same day with a silicone bite on the biting block of the radiographic device to ensure that the patient bites the same situation after the end of the observation period which was 9 months, (Fig 9).