Background: Ameloblastic fibroma is a rare odontogenic tumor of mixed origin. Surgical removal of the lesion is necessary and often leads to large size three-dimension defects. Hard and soft tissue augmentation of these defects is challenging, and a combination of several surgical techniques can be utilized.
Aim: Purpose of this poster is to present the 3D augmentation of a large size vertical and horizontal defect in the posterior mandible after enucleation of ameloblastic fibroma ten years ago on the same region.
Materials and methods: A 18-year-old male patient presented to the Postgraduate department of Oral and Maxillofacial Surgery of Athens Dental school, wishing rehabilitation with implants in the posterior right edentelous mandible. An ameloblastic fibroma had been surgically removed in the region ten years ago in the same clinic and since the patient was under close follow-up. Clinical and radiographical examination revealed a huge hard and soft tissue deficiency in the posterior mandible, lack of the canine, premolars and molars and abnormal anatomy of the inferior alveolar nerve. Under general anesthesia, the augmentation procedure was performed using guided bone regeneration (GBR) with allogenous graft and a dense PTFE titanium reinforced, non-resorbable membrane, in combination with autogenous bone block, harvested from the coronoid process of the same region and placed in the lingual part of the defect. Primary closure without tension was achieved with the development of a lingual and a buccal flap.    
Results: Combination of autogenous grafts harvested intraorally with GBR can provide sufficient materials in order to augment a region vertically and horizontally. The coronoid process of the mandible is an unusual site of harvesting autogenous bone blocks, although it can provide enough volume and great bone quality. Primary closure without tension is of great importance and the lingual flap can provide great amount of soft tissues to cover the grafted site.   
Conclusions and clinical implications: Atrophied mandibular reconstruction can be successfully achieved by means of horizontal/vertical GBR combined with bone block augmentation. It is an acceptable technique that highlights the importance of the surgeon’s flexibility to achieve the best possible result for the patient. However, proper training in hard and soft tissue management is necessary to avoid potential complications and to achieve successful outcomes.

Management of an atrophic posterior mandible in a patient with history of ameloblastic fibroma.