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A systematic approach in rehabilitation of hemimandibulectomy: A case report

View Article: PubMed Central - PubMed

ABSTRACT

Loss of mandibular continuity results in deviation of remaining mandibular segment toward the resected side primarily because of the loss of tissue involved in the surgical resection. The success in rehabilitating a patient with hemimandibulectomy depends upon the nature and extent of the surgical defect, treatment plan, type of prosthesis, and patient co-operation. The earlier the mandibular guidance therapy is initiated in the course of treatment; the more successful is the patient's definitive occlusal relationship. Prosthodontic treatment coupled with an exercise program helps in reducing mandibular deviation and improving masticatory efficiency. This case report describes prosthodontic management of a patient who has undergone a hemimandibulectomy and was rehabilitated using provisional guide flange prosthesis followed by a definitive maxillary and mandibular cast partial denture with precision attachments designed to fulfill the patient's needs and requirements.

No MeSH data available.


(a) Selected custom trays (b) Sectional impression
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Figure 2: (a) Selected custom trays (b) Sectional impression

Mentions: Preliminary impressions were made in addition silicone-putty (Ad-Sil Putty, Prime Dental Pvt. Ltd., Mumbai, Maharashtra, India) in an adhesive coated custom tray. Due to limited mouth opening, a satisfactory impression could not be made in a stock tray. Custom trays were fabricated in autopolymerizing acrylic resin (DPI Auto polymerized acrylic resin, Mumbai, Maharashtra, India) on primary casts of another patient having a closely resembling arch form [Figure 2a]. The maxillary impression was made in two parts, held together by orientation blocks made on polished surface of custom tray [Figure 2a and b]. Casts were poured in Type III dental stone (Dutt Stone, Dutt Industries, Mumbai, Maharashtra, India). Denture base was fabricated in autopolymerizing acrylic resin (DPI Auto polymerized acrylic resin, Mumbai, Maharashtra, India), and occlusal rims were fabricated in modeling wax (Maarc, Shiva Product, Mumbai, Maharashtra, India) and jaw relation was recorded. The patient's tactile sense or sense of comfort was used to assess the vertical dimension of occlusion. The patient was advised to move the mandible as far as possible to the untreated side manually and then gently close the jaw into position to record a functional maxillomandibular relationship. Maxillary cast was mounted using facebow record (Hanau Spring bow; Whipmix Corporation, Louisville, KY, USA) on a semi-adjustable articulator (Hanau Wide–Vue; Whipmix Corporation, Louisville, KY, USA) and mandibular with reference to the recorded jaw relation. The prosthesis was designed with a buccal guiding flange and a supporting flange on the lingual side [Figure 3a]. Retention was provided by retentive clasps made from 19 gauge round, stainless steel orthodontic wire (KC Smith and CO, Monmouth, UK). The guide flange extended superiorly on the buccal surface of the maxillary premolars allowing the determined occlusal closure. The guide flange was sufficiently blocked to avoid trauma to the maxillary teeth and gingival during functional movements. Acrylization was done using heat cure acrylic resin (DPI Heat polymerized acrylic resin, Mumbai, Maharashtra, India). Clear acrylic (DPI Heat polymerized clear acrylic resin, Mumbai, Maharashtra, India) was used for flange for esthetic purpose. The prosthesis was finished and polished and inserted intraorally [Figure 3b]. The patient wore the guiding flange for 4 months followed by extraction of root pieces in the region 46, 47.


A systematic approach in rehabilitation of hemimandibulectomy: A case report
(a) Selected custom trays (b) Sectional impression
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837783&req=5

Figure 2: (a) Selected custom trays (b) Sectional impression
Mentions: Preliminary impressions were made in addition silicone-putty (Ad-Sil Putty, Prime Dental Pvt. Ltd., Mumbai, Maharashtra, India) in an adhesive coated custom tray. Due to limited mouth opening, a satisfactory impression could not be made in a stock tray. Custom trays were fabricated in autopolymerizing acrylic resin (DPI Auto polymerized acrylic resin, Mumbai, Maharashtra, India) on primary casts of another patient having a closely resembling arch form [Figure 2a]. The maxillary impression was made in two parts, held together by orientation blocks made on polished surface of custom tray [Figure 2a and b]. Casts were poured in Type III dental stone (Dutt Stone, Dutt Industries, Mumbai, Maharashtra, India). Denture base was fabricated in autopolymerizing acrylic resin (DPI Auto polymerized acrylic resin, Mumbai, Maharashtra, India), and occlusal rims were fabricated in modeling wax (Maarc, Shiva Product, Mumbai, Maharashtra, India) and jaw relation was recorded. The patient's tactile sense or sense of comfort was used to assess the vertical dimension of occlusion. The patient was advised to move the mandible as far as possible to the untreated side manually and then gently close the jaw into position to record a functional maxillomandibular relationship. Maxillary cast was mounted using facebow record (Hanau Spring bow; Whipmix Corporation, Louisville, KY, USA) on a semi-adjustable articulator (Hanau Wide–Vue; Whipmix Corporation, Louisville, KY, USA) and mandibular with reference to the recorded jaw relation. The prosthesis was designed with a buccal guiding flange and a supporting flange on the lingual side [Figure 3a]. Retention was provided by retentive clasps made from 19 gauge round, stainless steel orthodontic wire (KC Smith and CO, Monmouth, UK). The guide flange extended superiorly on the buccal surface of the maxillary premolars allowing the determined occlusal closure. The guide flange was sufficiently blocked to avoid trauma to the maxillary teeth and gingival during functional movements. Acrylization was done using heat cure acrylic resin (DPI Heat polymerized acrylic resin, Mumbai, Maharashtra, India). Clear acrylic (DPI Heat polymerized clear acrylic resin, Mumbai, Maharashtra, India) was used for flange for esthetic purpose. The prosthesis was finished and polished and inserted intraorally [Figure 3b]. The patient wore the guiding flange for 4 months followed by extraction of root pieces in the region 46, 47.

View Article: PubMed Central - PubMed

ABSTRACT

Loss of mandibular continuity results in deviation of remaining mandibular segment toward the resected side primarily because of the loss of tissue involved in the surgical resection. The success in rehabilitating a patient with hemimandibulectomy depends upon the nature and extent of the surgical defect, treatment plan, type of prosthesis, and patient co-operation. The earlier the mandibular guidance therapy is initiated in the course of treatment; the more successful is the patient's definitive occlusal relationship. Prosthodontic treatment coupled with an exercise program helps in reducing mandibular deviation and improving masticatory efficiency. This case report describes prosthodontic management of a patient who has undergone a hemimandibulectomy and was rehabilitated using provisional guide flange prosthesis followed by a definitive maxillary and mandibular cast partial denture with precision attachments designed to fulfill the patient's needs and requirements.

No MeSH data available.