the post-surgical prosthetic rehabilitation of a patient with squamous cell carcinoma faghrie meer...
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The Post-Surgical Prosthetic Rehabilitation of
a Patient with Squamous Cell Carcinoma
Faghrie Meer
BTech Student in Dental Technology
Contents
Patient history Background and condition Clinical treatment options Technical treatment options Most desirable technical treatment
options
Contents…continued
Chosen technical treatment option
Laboratory procedures
Final placement
References
Patient History
68 years old
Female
Fair-skinned
Sun exposure
Fully edentulous
Patient History…continued
Main Complaint: Inability to wear lower denture
Dental Faculty
Squamous cell carcinoma in 3rd quadrant
Chin and alveolar ridge
Patient History…continued
April 2002- Fibula graft; Skin graft.
May 2002- Both plates broke.
June 2002 - Both plates removed and re-evaluated.
Patient History…continued
July 2002 - Thinning of skin flap.
Sept. 2002 - 2 implants inserted.
Oct. 2002 - Liposuction in chin area.
Background and Condition
Malignant epithelial tumour 1
Overgrowth of tissue cells
Destruction of living cells
Background and Condition…continued
Common and fatal if unrecognized 2
Favourable prognosis
Curable
Clinical Treatment Options
Two options:
a) Radiation or
b) Surgical removal
Radiation
• Highly contra-indicated: 1
1) Not precise
2) Oral sensitivity
3) Destruction of oral structures:
Radiation…continued
a) Dry oral cavity
b) Poor tissue healing
c) Difficulty in mastication
d) Difficulty in digestion
Surgical Removal
• Desired treatment option
• Cancer and healthy tissue removed2
• Growth initiation
Surgical Removal…continued
• Regular check-ups essential
• Unnoticed growth is fatal
Technical Treatment Options
Bar and clips attachment system
Technical Treatment Options…continued
Magnetic attachment system
Technical Treatment Options…continued
Ball attachment system
Most Desirable Technical Treatment Option
Bar and Clips Attachment System
Greatest retentive ability 3, 5, 6
Strong and rigid attachment Anti-corrosive clips Good load distribution
Chosen Technical Treatment Option
Ball Attachment System
Most cost-effective system 3, 4, 6
Accurate and repeatable denture placement
Satisfactory retention and stability
Ball Attachment System…continued
Maligned abutments not critical
Little space required
Better hygiene
Ease of fabrication
Magnquateetic Attachment System
Accurate clinical techniques Inadequate shear loads Discolouration Allergic reactions Loses retentive abilities
Laboratory Procedures
1° impressions
2° impressions
Surgical stent
Tissue integration
Laboratory Procedures…continued
Temporary mandibular denture
Phase 2 treatment plan
2° impressions
Permanent denture
Laboratory Procedures…continued
Female counterpart
Implant too far facially
Attachment selection difficult
Laboratory Procedures…continued
Molloplast-B
Flasked and processed
References
1) J. C. E. Underwood. Skin. General
and Systematic Pathology. 2nd ed. London: Churchill Livingstone. 1996: 764-765.
2) R. N. M. MacSween & K. Whaley.
Alimentary tract. Muir’s Textbook
of Pathology. 13th ed. London: Arnold. 1995: 680-681.
References…continued
3) H. W. Preiskel. Stud attachments and
magnets, Bar attachments.
Overdentures Made Easy: A Guide to
Implant and Root Supported
Prostheses. Berlin: Quintessence
Publishing Co Ltd. 1996: 81-89, 101-
108, 119-133.
References…continued
4) Guerra et al. Alternative retention for
an implant-retained prosthesis. Journal
Of Oral Implantology. 2002; 28(3): 117-120.
5) K. Bergstom. Anaplastological
technique for facial defects.
Osseointegration Anchorage Of
Craniofacial Prostheses. 1998: 101-106.
References…continued
6) E. J. Penn & R. P. Renner. Overdentures-an
overview for the general practitioner.
Quintessence Of Dental Technology. 1991; 14: 131-141.
Acknowledgements
Dr Van Zyl Prof. Morkel Mrs Nortje Mrs Wright Mr Steyn Mr Mazema Mr Lategan
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