Placement of implants in an ossifying fibroma defect obliterated with demineralized, freeze-dried bone allograft and Plasma-rich growth factor
A 3- year-old lady patient appeared to the Department of Oral and Maxillofacial Surgery, FODS CSMMU, Lucknow. The patient's chief complaint was an asymptomatic slowly progressive growth in the right mandible. The exact date, when swelling was first observed, was not clear. She also felt pain in this area. She had no noteworthy family history and her medical history was negative for trauma, pain, paresis, paresthesia, or lymphadenopathy. No symptoms, signs, or laboratory findings suggestive of parathyroid disturbances were detected.\nClinical examination revealed a swelling about 3 × 2 cm in size, causing slight facial asymmetry in the region of submandibular area, including parasymphysis region of the mandible. Assessment with palpation showed a hard, non-tender mass with smooth surface adhered to the mandible. The mouth opening of the patient was normal and there were no decayed teeth in the lesion area, and there was no malocclusion. Intraoral examination showed that permanent teeth were correctly erupted. An expansion of the buccal cortex was visible in the lower vestibular sulcus between the right canine and left first molar. We observed neither tooth mobility nor inflammation in this area. The oral mucosa was intact with normal color. The mass was firm and non-tender to palpation and was non-adherent to the overlying mucosa. No enlarged regional lymph nodes were found on palpation. Oral hygiene was good. There were no assessed pathological changes of the mucous membrane in the tumor region.\nA panoramic radiograph showed a large well demarcated radiolucency surrounded by radiopaque line in the right body region of the mandible []. The radiograph did not detect any evidence of calcification within the lesion. In the absence of any symptoms, signs, or laboratory findings suggestive of a systemic disease, the differential diagnosis included central osteoma, ameloblastic fibroma, ameloblastoma, odontogenic cyst, vascular lesion, and giant cell lesion. These differential diagnoses were discussed with the patient and her parents, and subsequently after getting normal blood investigation we planned for excisional biopsy.\nDuring surgical removal, the lesions showed delimitation and separation from the surrounding bone and were entirely enucleated. The excisional biopsy was taken from the lesion. Because a radical en bloc resection of the lesion could result in damage to the mandibular nerve, a more conservative excision of the mass (tumor curettage and removal of the permanent right first and second premolar) under local anesthesia was performed. And the defect was filled with biocompatible Bio-Oss bone graft material []. Histological examination of the excised tissue showed dense, cellular, fibrous connective tissue stroma containing areas of immature bone formation and cementum-like tissue consistent with a diagnosis of juvenile ossifying fibroma.\nThere was no recurrence of the lesion at 2-month follow-up []. During follow up after 6 months a panoramic radiograph was taken. Radiograph shown that there was amazing regeneration of bone with all symptoms totally reduced []. Sufficient bone volume was available to achieve the primary implant stability and satisfy both functional and esthetic demands. After that, the edentulous region of the mandible was planned to be rehabilitated by an implant-supported fixed prosthesis and two implants were placed at the diseased site. Implant success was defined by clinical and radiographic evaluation []. There was no evidence of implant mobility. No adverse soft-tissue reactions or signs of infection or pain were observed. Three months after the placement of implant, a fixed prosthesis was given.