Comprehensive rehabilitation of a patient with juvenile ossifying fibroma of the mandible: a clinical case

Relevance. Ossifying fibroma is a benign fibro-osseous neoplasm most frequently diagnosed in young patients. Conventional surgical techniques such as curettage are associated with a high recurrence rate; therefore, segmental resection of the affected area with a safety margin beyond the tumor border is generally recommended. This approach, however, creates a mandibular continuity defect of variable extent, leading to loss of multiple teeth, facial asymmetry, and malocclusion. Restoring mandibular integrity and the dental arch is therefore a central treatment goal. Objective. To present a comprehensive rehabilitation protocol for a patient with juvenile ossifying fibroma (JOF) of the mandible.

Case presentation. A 10-year-old girl presented with a progressive, painless enlargement of the left mandible. Cone-beam computed tomography (CBCT) and biopsy established the diagnosis of juvenile ossifying fibroma, trabecular variant, involving the left mandibular body with an approximate length of 6 cm. The lesion was treated by en bloc (segmental) resection with immediate reconstruction using a free vascularized iliac crest bone graft with microvascular anastomosis. Postoperatively, the patient exhibited distal occlusion (Class II malocclusion), loss of the mandibular segment in the region of teeth 33–38, and reduced interalveolar height on the left. Using a digital workflow, a surgical guide fabricated from domestically produced polymer materials was used for subsequent dental implant placement. Subsequently, orthodontic treatment was performed to restore interalveolar height at the mandibular defect, followed by placement of a temporary implant-supported prosthesis.

Conclusion. A multidisciplinary approach to the rehabilitation of growing patients with JOF—including tumor removal by segmental mandibular resection with immediate reconstruction using an autogenous bone graft, placement of dental implants within the grafted area, and orthodontic management—has proven highly effective in restoring the anatomy and function of the dentoalveolar system in young patients.

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