Journal List > J Korean Acad Prosthodont > v.53(1) > 1034849

Lee, Yoo, and Lee: Prosthetic rehabilitation of partially edentulous patient after hemimandiblectomy: Case report

Abstract

Loss of continuity of the mandible destroys the balance and symmetry of mandibular function, leading to altered mandibular movements and deviation of the residual fragment towards the resected side. Apart from deviation, other dysfunctions include difficulty in swallowing, speech, mandibular movements, mastication, and respiration are accompanied. In general, surgical reconstruction is considered first then proceeds to the prosthetic restorations. However, patients with systemic disease such as BRONJ (Bisphosphonate related osteonecrosis of the Jaw), surgical reconstruction may be limited. Thus, the prosthetic restoration remains as the only resort. Numerous prosthetic methods are employed to minimize deviation and to improve masticatory efficiency, function and esthetics. If a removable partial denture is the selected treatment modality, maximum stability of the partial denture base may be accomplished with a functional impression procedure by means of eliminating lateral and horizontal forces caused by the functional movements of the lips, cheeks and tongue. Also, Twin occlusion is used to obtain a favorable occlusal relationship and check support for esthetics. The purpose of this case report is to demon-strate how neutral zone impression technique and twin occlusion scheme were applied to restore a hemimandiblectomy patient with BRONJ syndrome to achieve satisfactory results in functional and esthetic aspects.

REFERENCES

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Fig. 1.
Initial photographs. (A) Frontal view, (B) Lateral view, (C) Opening position, (D) Panoramic view.
jkap-53-39f1.tif
Fig. 2.
(A) Maxillary occlusal view. (B) Mandibular occlusal view.
jkap-53-39f2.tif
Fig. 3.
(A) Maxillary temporary denture, (B) Mandibular temporary denture, (C) Intraoral photograph after the placement of temporary denture.
jkap-53-39f3.tif
Fig. 4.
Modified mandibular temporary denture. (A) Occlusal surface of temporary denture. (B) Tissue surface of temporary denture. (C) Intraoral photograph after the placement of modified temporary denture.
jkap-53-39f4.tif
Fig. 5.
(A) Teeth preparation for attachment & coping, (B) Final impression, (C) Intraoral photograph of placement of attachment & coping.
jkap-53-39f5.tif
Fig. 6.
Final impression. (A) Upper functional impression, (B) Lower functional impression.
jkap-53-39f6.tif
Fig. 7.
(A) Upper wax rim with two rows on the unaffected side, (B) Resin base with wire loops, (C) Adaptation of wire loops in accordance with obtained vertical dimension.
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Fig. 8.
(A) Recording neutral zone with tissue conditioner, (B) Putty index surrounding neutral zone impression.
jkap-53-39f8.tif
Fig. 9.
Wax denture. (A) Maxillary waxed up denture with two rows of teeth, (B) Mandibular wax denture, (C) Denture teeth physiologically arranged within neutral zone space.
jkap-53-39f9.tif
Fig. 10.
Definitive prostheses. (A) Upper definitive denture, (B) Lower definitive denture, (C) Intraoral photographs after placement of definitive prostheses.
jkap-53-39f10.tif
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