MANDIBULAR_DEFECTS( SEMI 4).pptx

PROSTHETIC MANAGEMENT OF MANDIBULAR DEFECTS

1. PROSTHODONTIC MANAGEMENT OF MANDIBULAR DEFECTS MUGILARASAN MUNISAMY DEPARTMENT OF PROSTHODONTICS PDCH

2. Contents Introduction Definition Mandibular defects Classification Factors affecting treatment Prosthetic rehabilitation Conclusion

3. INTRODUCTION Malignancies of maxillofacial region are most common etiology for the acquired defects of that region. Oral squamous cell carcinoma is the most common cancer in India, and its prevalence ranges around 45% of all cancers. Unfortunately, most of these lesions are diagnosed at a late stage and requires surgical resection along with adjacent anatomical structures such as mandible, floor of the mouth. tongue, etc.Lose of mandibular continuity results in cosmetic, functional and psychological discomfort for the patient. If condylectomy has been performed the prime most difficulty encountered is deviation of mandible towards the defect side, and inferiorly.

4. DEFINITION Maxillofacial prosthesis is the art and science of anatomic, functional or cosmetic reconstruction by means of nonliving substitutes in the regions of maxilla, mandible and face that are missing or defective because of surgical intervention, trauma, pathology or congenital malformation

5. Mandibular defects

6. Cantor and curtis classification of mandibular defects Class I: Mandibular resection involving alveolar resection and preservation of mandibular continuity

7. Class II: Loss of continuity distal to the canine area

8. Class III : Mandibular resection involving a minimum of midline loss of continuity

9. Class IV: Resection of lateral portion of the mandible with subsequent augmentation to restore form and function.

10. Class V: Midline resection with subsequent augmentation to restore form and function.

11. Class VI: Similar to class V but there is no augmentation following resection

12. Based on the amount of resection or bone loss

13. Factors affecting treatment of mandibulectomy patient Location & extent of mandibular defects Presence of remaining natural teeth / pre existing implants. Degree of post mandibulectomy rotation and deviation . Available mouth opening . Functional limitations of tongue . Compromise of vestibular extentions . Skin grafting . Radiation theraphy

14. Prosthetic rehabilitation All basic principles of complete denture construction must be considered and modified because of the unusual anatomic and functional situation.

15. Treatment options

16. Prosthetic rehabilitation of completely edentulous mandibular defects To improve the prognosis the following procedures can be followed: • Vestibuloplasty to create vestibule. Mandibular guidance flange to guide the mandibular movements Lip bumpers are given to support the lower lip. Neutrocentric occlusion with nonanatomic teeth to distribute the occlusal forces.

17. Procedure in complete denture

18. Primary impression Irriversible hydrocollids Altered / sectional stock tray

19. Secondary impression Green stick compound Zinc oxide eugenol

20. Processed bases Which is used to evaluate the retention and stability

21. Jaw relation Centric jaw relation is not exists in partial mandibulectomy patients Jaw relation is very haed to obtain I n these cases

22. Teeth selection and arrangement Zero degree cuspal angulation Placement of posterior teeth to the buccal of the residual alveolar ridge .

23. Prosthetic rehabilitation of partially edentulous mandibular defects

24. Prevention of mandibular deviation Correct mandibular deviation Mandibular guide flange prosthesis Mandibular guide flange prosthesis

25. Magnet retained snap on prosthesis Bar supported over denture Implant supported overdenture

26. CONCLUSION Surgical and prosthodontic rehabilitation of the mandibulectomy patient can provide satisfactory results, improving the oral functions of the patient which overall makes a positive impact on the quality of life for the patient. However proper treatment planning pre and post surgery is necessary to obtain the most optimal results

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