Implant rehabilitation is often the ideal solution to restore function and esthetics in a patient. However, it is seldom inhibited by anatomic limitations, such as bone defects either as a result of loss of teeth, trauma or congenital conditions, like the one that will be described henceforth. Such limitations also affect the prosthetic management of a case and require close collaboration of surgeon and prosthodontist to achieve the best possible result for the patient.To present the surgical and prosthetic management of a patient with atypical shape of the mandible and extreme cross bite. A 45 year old male patient was referred to practice, for implant rehabilitation of the left mandible and maxilla. The patient’s major complaint was dysfunction of the left side due to extreme cross bite that originated from an atypical shape of the mandible in the left posterior area. The patient was a non smoker, with unremarkable medical history and a cutaneous hemangioma in the middle third of the facial height, that did not expand in the maxilla or mandible according to the CT scans realized for the surgery planning. The position of the lower posterior teeth was extremely lingual due to the shape of the mandible, having no occlusal points with the upper teeth. Extractions of the upper and lower posterior teeth were performed. An osteotomy and recontouring of the mandibular alveolar bone was made to achieve a more typical shape and implants were placed. A screw-retained prosthesis was placed 6 months later, that is completely functional up to date and free of complications. The surgical and prosthetic management of this case presented with many difficulties and required thinking out of the box to overcome the limitations. In such cases compromises have to be made on both sides, as the implant placement was not ideal and the prosthesis resulted in a more lingual position than was expected. Increased, non axial, cantilever forces had to be considered, especially for the mandibular prosthesis that could put the success of the restoration at risk.
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