J Korean Acad Prosthodont.  2017 Oct;55(4):451-457. 10.4047/jkap.2017.55.4.451.

Complete denture rehabilitation of a fully edentulous patient with unilateral facial nerve palsy: A case report

• Choi E
• Lee JH
• Choi S

• KMID: 2393918
• DOI: http://doi.org/10.4047/jkap.2017.55.4.451

Abstract

Bell's palsy is an acute-onset unilateral peripheral facial neuropathy. For patients with sequelae of facial paresis, the successful rehabilitation of fully edentulous arches is challenging. This case report described the treatment procedures and clinical considerations to fabricate complete dentures of a patient who showed unilateral displacement of mandible, unilateral chewing pattern and parafunctional jaw movement due to sequelae of Bell's palsy. Gothic arch tracing was used to record reproducible centric relation and lingualized occlusion was performed to provide freedom to move between centric relation and the patient's habitual functional area in fabricating satisfactory dentures in terms of function and esthetics.

Keyword

Facial paralysis; Gothic arch tracing; Lingualized occlusion

MeSH Terms

Bell Palsy
Centric Relation
Denture, Complete*
Dentures
Esthetics
Facial Nerve Diseases
Facial Nerve*
Facial Paralysis
Freedom
Humans
Jaw
Mandible
Mastication
Paralysis*
Rehabilitation*

Figure

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  Fig. 1. Initial intraoral photograph. (A) Lateral view (right), (B) Frontal view, (C) Lateral view (left).

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  Fig. 2. Definitive impression making for (A) maxilla and (B) mandible.

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  Fig. 3. Registration of centric relation using an intraoral gothic arch tracer. (A) Intraoral photograph wearing the gothic arch tracer, (B) Frontal view and (C) Posterior view of mounted master casts using the gothic arch tracer, (D) Gothic arch tracing.

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  Fig. 4. (A) Lateral view (right), (B) frontal view, maxillary posterior teeth are rotated slightly to avoid all contact of the buccal cusp (arrows). and (C) lateral view (left) of wax denture at centric relation, (D) Lateral view (right), working side contact is limited to maxillary lingual cusp (arrow), (E) frontal view, and (F) lateral view (left) at eccentric position to right side, (G) Lateral view (right), (H) frontal view, and (I) lateral view (left) at eccentric position to left side, working side contact is limited to maxillary lingual cusp (arrow).

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  Fig. 5. Clinical remounting of definitive dentures at (A) centric relation, (B) eccentric position to right side, and (C) eccentric position to left side.

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  Fig. 6. Indentation marks during excursive movements on (A) mandibular wax denture and (B) mandibular denture after selective grinding.

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  Fig. 7. Intraoral photograph of definitive prostheses.

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  Fig. 8. Extraoral photographs (A) without dentures and (B) with definitive dentures.

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  Fig. 9. Discrepancy between two registration methods, gothic arch tracing and chin point guidance. Displacement of lower cast in chin point guidance compared to gothic arch tracing generates premature contact on right side. (A) Lateral view (right), (B) Frontal view, (C) Lateral view (left).

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