Challenges With the Jaw in a Day Technique

Purpose: The Jaw in a Day (JIAD) procedure allows for complete primary reconstruction of bone and teeth during the same operation as tumor resection. We reviewed 12 cases, the largest published case series of the JIAD procedure, and discussed both the prosthodontic and surgical considerations.Materials and Methods: A multi-institutional retrospective chart review was completed to identify patients undergoing the JIAD procedure. Patients with a minimum of 6 months' follow-up were included. Variables included skeletal relationship, dental Angle classification changes, postoperative diet, prosthesis complications, flap failure, osseointegration of dental implants, hardware complications, infection, intelligible speech, and patients' subjective satisfaction with facial and dental esthetics.Results: The sample included 12 patients (8 male and 4 female patients) with a mean age of 38 years (range, 15 to 75 years) and an average follow-up period of 19 months (range, 7 to 42 months). Patients underwent the JIAD procedure at the same time as resection of an ameloblastoma (mandibular in 9 and maxillary in 1) or odontogenic myxoma (mandibular in 1 and maxillary in 1). Nine patients' Angle classification remained unchanged after the procedure, with 3 patients showing correction from dental Class III to Class I. On average, 4 implants (range, 2 to 6 implants) were placed. Hybrid or splinted crown prostheses replaced, on average, 8 teeth (range, 3 to 12 teeth) with no prosthetic fractures. All patients had viable fibular flaps, absence of infection, and completely intelligible speech. All but 1 patient had subjective satisfaction with facial and dental esthetics. Complications included plate fracture with fibrous union (1), premature contacts requiring occlusal equilibration (2), implant loss (1), delayed wound healing (1), heterotopic bone formation along the pedicle (1), and dissatisfaction with chin symmetry (1).Conclusions: The JIAD technique predictably reconstructs bone and teeth in a single operation. The tools and services streamlining this protocol are now widely available. However, there are still several challenges with this protocol that surgeons and patients must overcome. Further study and refinements are necessary to address these. (C) 2020 American Association of Oral and Maxillofacial Surgeons