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Table of Contents
CASE REPORT
Year : 2016  |  Volume : 6  |  Issue : 1  |  Page : 37-40

Prosthodontic management of hemimandibulectomy patient: Implants, a better solution


1 Department of Prosthodontics, JCD Dental College, Sirsa, Haryana, India
2 Department of Prosthodontics, KLES Dental College, Bengaluru, Karnataka, India

Date of Web Publication20-Sep-2016

Correspondence Address:
Supriya Manvi
KLES Dental College, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.190385

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   Abstract 

One of the most challenging and demanding maxillofacial endeavours is the construction of functional dental prosthesis for an edentulous patient who has undergone a mandibular resection. A hemimandibulectomy can have many debilitating consequences such as eccentric occlusion, a disoriented masticatory cycle, facial disfigurement, distorted speech and salivation problems. There are many treatment options for restoring the defect like guiding flange prosthesis, conventional acrylic removable partial prosthesis, cast partial dental prosthesis etc; implants today are a better treatment option as it provides good retention, stability and support for a prosthesis. This case report presents the management of the Hemimandibulectomy patient with implant retained overdenture.

Keywords: Hemimandibulectomy, implants, overdenture


How to cite this article:
Goyal P, Manvi S, Arya S. Prosthodontic management of hemimandibulectomy patient: Implants, a better solution. J Dent Implant 2016;6:37-40

How to cite this URL:
Goyal P, Manvi S, Arya S. Prosthodontic management of hemimandibulectomy patient: Implants, a better solution. J Dent Implant [serial online] 2016 [cited 2022 Jan 25];6:37-40. Available from: https://www.jdionline.org/text.asp?2016/6/1/37/190385


   Introduction Top


Maxillofacial prosthodontics is the world of art and science which is full of challenges. One has to strive hard for getting the natural function and lifelike appearance of the prosthesis since every human has the divine right to look human. [1] Advances in maxillofacial materials and techniques have been remarkable in the past decade. [2] To minimize the psychological trauma that will be associated with the facial disfigurement in hemimandibulectomy patients, a maxillofacial prosthodontics should meet the challenges associated with the fabrication of a prosthesis which meets the functional and esthetic requirements of the patient so as to help him/her in leading a normal social life. [3] Implants mandibular implant-supported overdenture treatment has gained considerable acceptance. It has effectively replaced the tooth-borne version and has been recommended as the new standard of care treatment when compared with conventional mandibular complete dentures. [4] Therefore, the implant-retained overdenture provides better support, stability, and retention, especially in cases of hemimandibulectomy patients.


   Case report Top


A 72-year-old male patient had undergone left hemimandibulectomy for squamous cell carcinoma of the left mandibular alveolus. The patient reported to the Prosthodontic Department, KLES VK Institute of Dental Sciences, Belgaum, 1 year after the surgery.

On intraoral examination, completely edentulous upper and lower arches with partially resected lower ridge on the left side were observed [Figure 1] and [Figure 2]. Radiographically, the segmental resection of mandible was seen from the left first premolar area to the ascending ramus of the mandible [Figure 3]. Extraoral examination revealed deviation of the mandible to the left side.
Figure 1: Extraoral photograph before treatment

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Figure 2: Intraoral view

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Figure 3: Orthopantomograph reveals edentulous arches with partial mandible

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Treatment plan

Implant-supported overdenture was planned where three implants were placed on the right side of the mandible in the incisal, the canine, and the premolar area after the 6 months of the implant placement; the patient was prosthodontically rehabilitated with bar-retained implant-supported overdenture [Figure 4].
Figure 4: Bar fabrication

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Prosthodontic management

Preliminary impression was recorded using alginate impression material to cover maximum extension and tissue coverage. The custom impression trays were fabricated for open tray to obtain final impression with transfer copings [Figure 5]. The objective of the secondary impressions was to obtain retention, to provide support and stability, and to create the appropriate esthetic support for lips and cheeks [Figure 6]. The metal Hader bar was fabricated on the cast and then tried on the implants in the patient's mouth to check for seating. Then, it was transferred back to the cast and record bases were fabricated. Face bow transfer was done and maxillomandibular jaw relations were recorded [Figure 7]. Phonetics and closest speaking space were used as a method for the determination of vertical dimension of occlusion. Neutral zone was determined for arranging the lower teeth. Semianatomic acrylic resin posterior teeth were used. Teeth were arranged in balanced occlusion. Both the dentures were checked for function and esthetic inside the patient's mouth [Figure 8].
Figure 5: Elastomeric impression for bar fabrication

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Figure 6: Recording jaw relation with face bow

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Figure 7: Hader bar attachments

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Figure 8: Postoperative view

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After trial prosthesis was done, they were processed following customary procedure. After processing, prosthesis was remounted, adjusted, and delivered with conventional prosthodontics guidelines [Figure 9]. Subject's follow-up was done with periodical recalls.
Figure 9: Three implants placed in the mandible

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   Discussion Top


The goals of prosthodontic treatment include providing lip support, improving articulation, reducing drooling, and regaining favorable esthetics. [5] Recent advancements in facial reconstructive surgery and osseointegrated dental implants provide a treatment modality that may adequately rehabilitate oral cancer patients so that they can return to a healthy, productive life. [6] The placement of multiple implants for fixed prostheses has been shown to be a predictable method for long-term treatment of edentulous patients. [7] Limitations such as severely resorbed jaws, large antra, unfavorable jaw relations, and financial restrictions sometimes prevent the placement of a sufficient number of implants to accommodate a fixed prosthesis and therefore require an alternative for edentulous patients with compromised oral function. [8],[9]

The Hader system is an excellent bar attachment. Similar to the customized bar, it consists of a plastic bar pattern with gingival extension and small plastic clips that are processed into the overdenture. This system has some advantages over others; the plastic bar pattern's gingival extension can be trimmed to conform to the ridge. In addition, worn clips can be easily replaced at chairside using a special seating tool. Advantages of the Hader system are as follows:

  • The plastic bar pattern is easily adapted to differences in the surface of the gingival ridge and gingival curvature
  • The plastic bar pattern simplifies the laboratory technique by eliminating a soldering step
  • Plastic riders give adequate retention and are easily replaced
  • Its rotational, joint action relieves stresses from the abutment teeth.


The main disadvantage of this system is its plastic rider which cannot be altered for additional retention. However, the adjustable metal riders can be used to eliminate this problem. [10] In addition, there is no provision for developing vertical function with the overdenture. Commercial retentive clips can be used with these customized bars.


   Conclusion Top


Implants serve better retention, support, and stability compared to the conventional cast partial denture and can be cantilevered to provide the lip support. Patient's defect was successfully restored and rehabilitated with the implant-retained placed overdenture.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Chalian VA, Drane JB, Standish SM. Maxillofacial Prosthetics. Baltimore: Williams and Wilkins Co.; 1972. p. 127.  Back to cited text no. 1
    
2.
Majage B, Chandrakar N, Chowdhary R, Gala V, Moldi A, Mahoorkar S. Prosthodontic rehabilitation of hemi mandibulectomy patient with magnet retained overdenture - A case report. Int J Clin Dent Sci 2010;1:30-2  Back to cited text no. 2
    
3.
Rahn AO. Maxillofacial Prosthetics. Principles and Concept. Toronto: W.B. Saunders Co.; 1970. p. 127.  Back to cited text no. 3
    
4.
Brown KE. Complete denture treatment in patients with resected mandibles. J Prosthet Dent 1969;21:443-7.  Back to cited text no. 4
    
5.
Cheng AC, Wee AG, Morrison D, Maxymiw WG. Hinged mandibular removable complete denture for post-mandibulectomy patients. J Prosthet Dent 1999;82:103-6.  Back to cited text no. 5
    
6.
Mou SH, Chai T, Shiau YY, Wang JS. Fabrication of conventional complete dentures for a left segmental mandibulectomy patient: A clinical report. J Prosthet Dent 2001;86:582-5.  Back to cited text no. 6
    
7.
Carini F, Gatti G, Saggese V, Monai D, Porcaro G. Implant-supported denture rehabilitation on a hemimandibulectomized patient: A case report. Ann Stomatol (Roma) 2012;3 2 Suppl: 26-31.  Back to cited text no. 7
    
8.
Patil PG, Patil SP. Guide flange prosthesis for early management of reconstructed hemimandibulectomy: A case report. J Adv Prosthodont 2011;3:172-6.  Back to cited text no. 8
    
9.
Nakajima J. Application of the palatal ramp in a reconstructed mandibulectomy patient. Nihon Hotetsu Shika Gakkai Zasshi 2008;52:388-91.  Back to cited text no. 9
    
10.
Bergendal T, Engquist B. Implant-supported overdentures: A longitudinal prospective study. Int J Oral Maxillofac Implants 1998;13:253-62.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]


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[Pubmed] | [DOI]



 

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