In the month of March 2005, a 30 year old patient presented for observation at the Department of Odontostomatological Surgery of the Università degli studi di Milano-Bicocca, at the San Gerardo di Monza Hospital, for a consultation on dental element 2.8 (upper left third molar). The patient did not present any relevant clinical symptoms, except for a slight pain in the area of the third molar.
The extraoral examination revealed no relevant signs and palpation of the neck lymph nodes showed a normal situation.
Intraoral examination revealed partial mucosal inclusion of element 2.8, with no particular variations in colour and consistency on palpation of the area under examination.
Radiographic analysis with orthopantomography, element 2.8 showed increased radiolucent areas.

The patient, who had no systemic pathologies, had element 2.8 removed in March 2005 and a biopsy of the adjacent tissues, measuring approximately 1.0 x 1.0 x 1.0 centimetres.
The diagnosis on the basis of the histological report was plexiform ameloblastoma.

Further radiographic diagnosis by means of computerised axial tomography with the Dentascan programme showed the involvement of a large area of the left maxilla reaching the base of the orbit.

In May 2005, under general anaesthesia, a hemi-maxillectomy was performed with wide safety margins starting from the first upper left premolar, according to the principle, supported by many authors, which inspires the therapy of malignant tumours, of "resection in apparently healthy tissues".

Further histological analysis of the surgical specimen confirmed the diagnosis of plexiform ameloblastoma.
Regarding the prosthetic treatment, impressions of the jaws were made prior to surgery and after casting, a simulation of the surgical procedure was performed on plaster models.
With the help of CT, the margins of the resection were established, with particular attention to the anterior margin, which was important in order not to prejudice the correct positioning of the palatal prosthesis.

The palatal obturation prosthesis was mucosa-supported and dento-retained with hooks in elements 2.3 and laterally 1.4 and 1.5 and 1.7 and 1.8. At the end of the operation, the fit of the prosthetic restoration was checked and found to be adequate.

Figure 9 shows how after 6 months, normotrophic and well vascularised tissues can be observed in the resection area.

The prosthesis has been periodically checked and adapted to the tissue conditions according to the healing and the possibility of adding the teeth, keeping them out of occlusion, will be considered until the reconstruction phase with implants.

