DENTAL IMPLANTS J Oral Maxillofac Surg 67:2455-2459, 2009 A New Approach for Reconstruction of a Severely Atrophic Mandible Nadja Lopes, DDS,* David M. Oliveira, DDS, MSc, PhD,† André Vajgel, DDS,‡ Ivo Pita, DDS,§ Tácio Bezerra, DDS, and Ricardo José de Holanda Vasconcellos, DDS, MSc, PhD¶ Purpose: The purpose of this study is to report a case of a patient with a severely atrophic mandible (less than 5 mm) who was treated without bone graft using short implants and internal rigid fixation. Patient and Methods: A 61-year-old woman was referred to a private clinic in the city of Recife (Brazil) with a severely resorbed mandible (less than 5 mm). The patient reported a history of nearly 15 years of complete edentulism and consecutive treatment failures. Cone beam tomography was performed and severe atrophy was confirmed, revealing total bilateral exposed inferior alveolar nerves. There was a high risk of pathologic mandible fracture, since bone density in critical areas was very low. Treatment of choice was the placement of 4 Shorty (3.75  5.5 mm) implants (Nobel Biocare, Göteborg, Sweden) at the symphysis for immediate functional reasons and a 2.0-mm large profile Unilock bone plate (Synthes Maxillofacial, Paoli, PA) to reinforce the mandible. A rapid prototype model was made to help precontour the plate, enabling the insertion of the plate through the transoral approach. Results: A week after surgery, a Brånemark prosthesis protocol was performed and the patient was satisfied with the result. At 29 months after surgery, the patient was still satisfied and had excellent function without complications. Conclusions: Because of the reported advances in implantology and internal rigid fixation, more patients would be able to improve their severe dental condition without the use of more invasive techniques. © 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:2455-2459, 2009 Loss of teeth results in resorption of the alveolar process and, in more advanced stages, resorption of the underlying basal bone. A severely resorbed mandi- ble generally results in problems for the lower prosthe- sis, such as insufficient retention, pain by overloading the mucosa, impaired masticatory function, speech dif- ficulties, loss of soft tissue support, 1 altered facial ap- pearance, and psychosocial problems. 2 Reconstruc- tion of a severely resorbed mandible (greatest height 7 mm) to restore oral function remains a surgical and prosthetic challenge due to the minimal amount of residual bone support and the progressive nature of the resorptive process. 3 The purpose of this study is to report a case of a patient with a severely resorbed mandible, who was treated without bone graft, using short implants and internal rigid fixation. Patient and Methods A 61-year-old woman was referred to a private clinic in the city of Recife, Brazil, with a severely resorbed mandible (less than 5 mm). The patient reported a history of nearly 15 years of complete edentulism and consecutive treatment failures. Cone beam tomography was performed and severe atrophy *Postgraduate Student, MSc Program in Implantology, São Leopoldo Mandic University, Campinas, SP, Brazil. †Professor, Maurício de Nassau University, Recife, PE, Brazil. ‡Postgraduate Student, MSc Program in Oral and Maxillofacial Surgery, University of Pernambuco, Recife, PE, Brazil. §Postgraduate Student, MSc Program in Dentistry, Federal Uni- versity of Ceará, Fortaleza, CE, Brazil. Postgraduate Student, MSc Program in Dentistry, Federal Uni- versity of Ceará, Fortaleza, CE, Brazil. ¶Assistant Professor, Oral and Maxillofacial Surgery, University of Pernambuco, Recife, PE, Brazil. Address correspondence and reprint requests to Dr Vajgel: Facul- dade de Odontologia de Pernambuco, Departmento de Cirurgia e Traumatologia BMF, Av General Newton Cavalcanti, 1650, 54.753-220 Camaragibe, PE, Brazil; e-mail: avajgel@hotmail.com © 2009 American Association of Oral and Maxillofacial Surgeons 0278-2391/09/6711-0021$36.00/0 doi:10.1016/j.joms.2009.04.090 2455