The prosthodontic rehabilitation of a hemimandibulectomy patient

Abstract

Across Europe, Hungary ranks first in the incidence and the prevalence of oral cancers, which are usually detected in a relatively late stage. Consequently, major resective surgeries are often the only final solution. Due to the complexity of restoration, a multi-disciplinary team approach with close interaction amongst several health science disciplines is required, in which dentist’s contribution is crucial.
Maxillofacial prosthodontics, which deals with rehabilitation of patients with deficit and defects of jaws and surrounded soft tissue, is a less known specialty of dentistry. Unfortunately those patients are scarcely referred to these specialists. Yet, as the number of affected patients in Hungary is significantly higher than a European average, such patient’s care requires complex treatment planning and creativity to deliver a custom made, individual solution.
This case report presents a review of a successful solution to patient rehabilitation following a mandibular segment resection. Following the resection, several deficiencies caused by the absence of the segment, required compensation. In order to achieve normal function and aesthetics Normally, lack of masticatory muscles attachment causing severe malocclusion and a strong deflection during the opening could be compensated with either a double denture or a removable prosthesis with a guiding flange. In this case report, the latter solution is presented.
After a successful completion of the mandibular resection and the prosthodontic treatment planning, the lower and upper dentures were prepared simultaneously. A combined, fixed and partially removable denture with a palatal ramp was devised for the upper jaw. For the lower jaw, a removable partial denture with a guiding flange was fabricated. After the first two steps,- preparation and impression taking – an extremely challenging registration of the lower-upper jaw relationship was performed, which was repeated several times using different set of tools. Subsequently, the guiding flange and the palatal ramp were constructed and individualized. During the insertion, the occlusion and the proper function of the guiding flange were checked. As a result, completed upper and lower dentures functioned properly, resulting in the patient’s satisfaction with the final outcome. During the short and the long-term recalls only minor corrections were performed