case_images: PMC7533758_01
case_images: Initial appearance of the intraoperative showing apical fragment intrusion.
case_images: CRIS2020-8853562.001.jpg
case_images: PMC7533758_01_CRIS2020-8853562.001.jpg
case_images: fig1
case_images: On physical examination, during the inspection and palpation, crepitation was observed in the body region and right mandibular angle and apical displacement of the bone fragment in the premaxilla, corresponding to elements 13, 14, and 15, with an evident sign of alveolar tooth fracture (Figure 1).
case_images: Alveolar fragment after removal of granulation tissue brought between it and the maxilla.
case_images: CRIS2020-8853562.002.jpg
case_images: PMC7533758_01_CRIS2020-8853562.002.jpg
case_images: fig2
case_images: In order to eliminate the granulation tissue at the interface of the fragment and maxilla, which would certainly prevent good bone repair, the fragment was removed (Figures 2-4).
case_images: Super-inferior view of the premaxilla alveolar fragment.
case_images: CRIS2020-8853562.003.jpg
case_images: PMC7533758_01_CRIS2020-8853562.003.jpg
case_images: fig3
case_images: In order to eliminate the granulation tissue at the interface of the fragment and maxilla, which would certainly prevent good bone repair, the fragment was removed (Figures 2-4).
case_images: Occlusal view of the premaxilla alveolar fragment.
case_images: CRIS2020-8853562.004.jpg
case_images: PMC7533758_01_CRIS2020-8853562.004.jpg
case_images: fig4
case_images: In order to eliminate the granulation tissue at the interface of the fragment and maxilla, which would certainly prevent good bone repair, the fragment was removed (Figures 2-4).
case_images: Curved surgical bed for functional reimplantation of the fragment.
case_images: CRIS2020-8853562.005.jpg
case_images: PMC7533758_01_CRIS2020-8853562.005.jpg
case_images: fig5
case_images: However, it was again juxtaposed through the FRAF technique, which consists of the removal of the bone fragment and subsequent repositioning of it in its pretraumatic place, being fixed by using guided plates and titanium screws, by steel wires positioned in Modified Kazagian ties (Figures 5 and 6).
case_images: Functional reduction of the fragment with the aid of the "L" plate and 2.0 system titanium screws.
case_images: CRIS2020-8853562.006.jpg
case_images: PMC7533758_01_CRIS2020-8853562.006.jpg
case_images: fig6
case_images: However, it was again juxtaposed through the FRAF technique, which consists of the removal of the bone fragment and subsequent repositioning of it in its pretraumatic place, being fixed by using guided plates and titanium screws, by steel wires positioned in Modified Kazagian ties (Figures 5 and 6). Note the absence of the element 15 in Figure 6, extracted due to loss of bone support, is understood as functional reduction when the occlusion prior to trauma is overcome through occlusal wear or even dental impression, which does not necessarily mean Angle Class I.
case_images: Exposure of complex mandible fracture.
case_images: CRIS2020-8853562.007.jpg
case_images: PMC7533758_01_CRIS2020-8853562.007.jpg
case_images: fig7
case_images: With the separation of the fragments and evaluation of the lingual space, the reconstruction and anatomical repositioning of the fragments with transfixing screws and plates and screws of the 2.0 system (Figures 7 and 8) were started.
case_images: Reduction and stabilization of fractures with the lag screw, X-plate, and 2.0 system titanium screws.
case_images: CRIS2020-8853562.008.jpg
case_images: PMC7533758_01_CRIS2020-8853562.008.jpg
case_images: fig8
case_images: With the separation of the fragments and evaluation of the lingual space, the reconstruction and anatomical repositioning of the fragments with transfixing screws and plates and screws of the 2.0 system (Figures 7 and 8) were started.
case_images: Rebuild plate installation overlapping stabilization material.
case_images: CRIS2020-8853562.009.jpg
case_images: PMC7533758_01_CRIS2020-8853562.009.jpg
case_images: fig9
case_images: To support the reduction, a plaque reconstruction was attempted, which promoted stability and the possibility of functional adaptation to occlusion (Figure 9).
case_images: Orthopantomographic radiographic image of titanium plates and screws in position.
case_images: CRIS2020-8853562.010.jpg
case_images: PMC7533758_01_CRIS2020-8853562.010.jpg
case_images: fig10
case_images: A radiographic examination of the control was performed, in which titanium plates and screws were positioned, indicating a satisfactory reduction of the bone fragments (Figures 10 and 11).
case_images: Postoperative appearance of 7 days, good healing aspect of the surgical approach, suture stitches in position, and reestablishment of functional occlusion.
case_images: CRIS2020-8853562.011.jpg
case_images: PMC7533758_01_CRIS2020-8853562.011.jpg
case_images: fig11
case_images: A radiographic examination of the control was performed, in which titanium plates and screws were positioned, indicating a satisfactory reduction of the bone fragments (Figures 10 and 11).