J Korean Acad Prosthodont.  2015 Jan;53(1):39-45. 10.4047/jkap.2015.53.1.39.

Prosthetic rehabilitation of partially edentulous patient after hemimandiblectomy: Case report

• Lee DH
• Yoo DS
• Lee JH

• KMID: 2057205
• DOI: http://doi.org/10.4047/jkap.2015.53.1.39

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 demonstrate how neutral zone impression technique and twin occlusion scheme were applied to restore a hemi-mandiblectomy patient with BRONJ syndrome to achieve satisfactory results in functional and esthetic aspects.

Keyword

Mandibular osteotomy; Neutral zone technique; Twin occlusion; Bisphosphonate-associated osteonecrosis of the Jaw

MeSH Terms

Bisphosphonate-Associated Osteonecrosis of the Jaw
Cheek
Deglutition
Denture, Partial
Denture, Partial, Removable
Esthetics
Health Resorts
Humans
Lip
Mandible
Mandibular Osteotomy
Mastication
Osteonecrosis
Rehabilitation*
Respiration
Tongue

Figure

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  Fig. 1. Initial photographs. (A) Frontal view, (B) Lateral view, (C) Opening position, (D) Panoramic view.

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  Fig. 2. (A) Maxillary occlusal view. (B) Mandibular occlusal view.

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  Fig. 3. (A) Maxillary temporary denture, (B) Mandibular temporary denture, (C) Intraoral photograph after the placement of temporary denture.

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  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.

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  Fig. 5. (A) Teeth preparation for attachment & coping, (B) Final impression, (C) Intraoral photograph of placement of attachment & coping.

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  Fig. 6. Final impression. (A) Upper functional impression, (B) Lower functional impression.

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  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.

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  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.

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  Fig. 10. Definitive prostheses. (A) Upper definitive denture, (B) Lower definitive denture, (C) Intraoral photographs after placement of definitive prostheses.

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