Patient-Specific Oral Rehabilitation Following Mandibular Gunshot Injury: A Case Report

Abstract Mandibular gunshot injuries are devastating traumas that often result in extensive bone loss, soft tissue scarring, neurosensory dysfunction, and profound impairment of oral function. While reconstructive techniques restore skeletal continuity, persistent soft tissue deficiencies and relapse of vestibular depth frequently compromise prosthetic rehabilitation. A 43-year-old male military officer sustained a mandibular gunshot injury in 2017 and underwent multiple reconstructive surgeries, including plate fixation and plastic surgical interventions, at different centers. Upon presentation to our clinic, a staged treatment plan was implemented: removal of the superior segment of the reconstruction plate, technically demanding vestibuloplasty in a heavily scarred field, and stabilization with a custom-made clasp-retained acrylic vestibuloplasty splint. The splint, fabricated from heat-cured pink acrylic resin with metallic clasps engaging adjacent tooth, was worn continuously for 3 months to maintain vestibular depth. After mucosal stabilization, three implants were placed, with continued splint use for an additional 6 weeks postoperatively. A fixed implant-supported prosthesis was subsequently delivered. At 1-year follow-up, vestibular depth was preserved, implants were functional, and esthetic and functional outcomes were satisfactory. Importantly, the patient demonstrated strong compliance, expressed high satisfaction, and reported significant improvement in quality of life despite partial persistence of inferior alveolar nerve hypoesthesia. This case highlights the importance of a patient-specific, multidisciplinary approach to mandibular gunshot trauma. Combining staged soft and hard tissue surgery with individualized prosthetic planning and patient cooperation can successfully restore oral function, esthetics, and quality of life in complex trauma cases.