Treatment of Hemi-Mandibulectomy Defect with Implant-Supported Telescopic Removable Prosthesis. A Clinical Report Athanasios Ntounis, DDS, MS, 1 Michael Patras, DDS, MS, 2 Stavros Pelekanos, DDS, Dr. Med. Dent, 3 & Gregory Polyzois, DDS, MScD, Dr.Dent 4 1 Prosthodontist, Resident in Graduate Periodontology Clinic, University of Alabama, Birmingham, AL 2 Prosthodontist, Clinical Assistant, Department of Prosthodontics, Dental School, University of Athens, Greece 3 Assistant Professor, Department of Prosthodontics, Dental School, University of Athens, Greece 4 Associate Professor and Chief of Maxillofacial Prosthetics Unit, Dental School University of Athens, Greece Keywords Fibula free flap; telescopic; removable dental prosthesis; implants. Correspondence Athanasios Ntounis, 1530 3rd Avenue South; SDB 412, Birmingham AL 35294. E-mail: thanosnt@uab.edu The authors deny any conflicts of interest . Accepted October 8, 2012 doi: 10.1111/jopr.12012 Abstract Excision of head and neck tumors (benign or malignant) often leads to large segmental resections of the mandible. The following clinical report describes the oral rehabilita- tion of a 60-year-old Caucasian man after partial mandibulectomy due to primary oral leiomyosarcoma. Treatment consisted of a free fibula flap and an implant-supported telescopic removable prosthesis. Oral cancer is an important public health concern and has pre- sented an alarming global increase during the last few decades. Statistics show oral cancer to be one of the most common forms of the disease. 1,2 Primary oral leiomysarcoma is an extremely rare malignant mesenchymal carcinoma with only 70 cases re- ported worldwide. 3 Farman and Kay estimated an incidence of 0.064% for primary smooth muscle tumors with oral ap- pearance. 4 The tumor presents aggressive behavior with local or distal metastasis and high recurrence. 5 Traditional treatment modalities primarily include surgical interventions by means of oncologic tumor resection. Contemporary advances in surgical techniques and grafting procedures have enabled surgeons to correct tumor postablative defects with predictable and effective means. Large volumes of autogenous combined soft- and hard-tissue grafts can be trans- ferred from various donor sites and used for the reconstruction of deficiencies. 6,7 Among the numerous available options, the osteocutaneous free fibula flap (FFF) represents a widely used treatment modality for the reconstruction of mandibular defects and allows for repair of the mandibular continuity. 8-11 After reconstructive surgery, drastic changes in oral anatomy as well as the establishment of new anatomical relationships make dental rehabilitation with a conventional prosthesis chal- lenging. 11-14 Although removable prostheses can adequately support the facial soft tissues, the new denture-bearing surfaces occasionally fail to provide ideal retention and stability. 11,12,15 During the last few decades, osseointegrated implants have become a very important adjunct treatment option for tumor patients. Their placement significantly adds to the retention and support of the prostheses, thus improving chewing ef- ficiency and comfort. 12,15 Numerous studies report favorable survival rates for implants inserted in FFFs and indicate long- term success of the corresponding restorations. 14,16,17 Implant- supported prostheses can help restore facial contours and function. 15,18,19 Implant-supported telescopic restorations (also referred to as “double crown” or “conical crown” retained removable pros- theses) may fulfill the requirements for a successful treatment concept. 14,20,21 The objective of this clinical report is to describe the oral rehabilitation of a patient who underwent a mandibular resection due to a leiomyosarcoma. The prosthetic rehabilita- tion included the use of implants in conjunction with conical crowns to support a removable dental prosthesis (RDP). Clinical report A 60-year-old Caucasian man presented to the Maxillofacial Prosthetics Unit, University of Athens, Greece, to restore his Journal of Prosthodontics 00 (2013) 1–5 c  2013 by the American College of Prosthodontists 1