Mandibular brown tumors represent rare osseous manifestations of primary hyperparathyroidism. Although parathyroidectomy results in regression of 90% of lesions within 6-10 months, substantial lesion size may necessitate 2-5 years for complete remineralization. Complete denture rehabilitation following osseous recontouring presents significant clinical challenges due to severe mandibular resorption. This case is distinctive for its integrated surgical approach: a preoperatively validated surgical guide designed to simultaneously optimize surgical safety and prosthodontic outcomes.

A 58-year-old female with primary hyperparathyroidism underwent parathyroidectomy in 2021, with incidental discovery of a mandibular brown tumor confirmed histopathologically. Clinical examination demonstrated Class IV Atwood mandibular resorption, severe vestibular depth reduction, and residual fibrous tissue. Conservative osseous recontouring, strategically planned using a preoperatively validated surgical guide, was performed. Three months post-operatively, comprehensive prosthodontic rehabilitation was initiated with fabrication of complete maxillary and mandibular dentures using refined vestibular support zone design and border molding to compensate for severe resorption.

At three-month follow-up post-denture insertion, the patient demonstrated secure denture retention, restoration of vertical dimension of occlusion and facial contours, optimal functional restoration, and complete absence of tumor recurrence. Patient satisfaction and adaptation were excellent. Radiographic evaluation confirmed continued osseous stability.

Conservative osseous recontouring planned with specific consideration of prosthodontic rehabilitation objectives, combined with meticulous complete denture fabrication, provides an effective management approach for patients with mandibular brown tumors requiring complex prosthodontic rehabilitation. This coordinated multidisciplinary approach achieves favorable functional, esthetic, and psychosocial outcomes.