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Reconstruction of the Mandible with a Fixed Implant Supported Prosthesis
A. S. Jochelson
In Partial Fulfilment of BTech: Dental Technology
Department of Dental Sciences
Tygerberg Campus
CPUT
2007
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CONTENTS
Patient history
Odontogenic myxomas
Clinical history
Technical history
Reasons for choice of acrylic bridge
Problems encountered
Future treatment plan
Conclusion
References
Acknowledgements
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PATIENT HISTORY
25 year old female
Rare non-capsulated benign tumour1
Misdiagnosis, tumour became worse
Panoramic radiograph and biopsy
Odontogenic myxoma of the mesenchymal tissue2
Fourth quadrant
Referred to dental faculty, UWC, Tygerberg hospital
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RADIOGRAPH OF ODONTOGENIC MYXOMA
Faculty of Dentistry UWC
Radiograph of the odontogenic myxoma
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ODONTOGENIC MYXOMAS
Odontogenic Myxoma, Thomas and Goldman, 19473
Slow growing, locally invasive lesion2
Do not metastisise4
Involves mandible4
Patients between ages of 20 and 402
Reports show predilection to females5
Presents as pain, diasthesia, ulcerations, tooth mobility6
Initiates in dental papilla, follicles, or periodontal ligaments2
Uni-or multioccular radiolucency, “soap bubble” appearance3
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CLINICAL HISTORY
Treatment started in, 2005
20/04/2005, right hemi-mandibulectomy
Fibula free flap, reconstruction of mandible7
6 month healing period
Stent fabricated, 4 externally hexed implants placed
Healing abutments, March 20068
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REMOVAL OF DISEASED BONE
Faculty of Dentistry UWC
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RADIOGRAPH OF MANDIBLE AFTER FIBULA FREE FLAP
Faculty of Dentistry UWC
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HEALING ABUTMENTS
Faculty of Dentistry UWC
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TECHNICAL HISTORY
24/04/2006, impressions taken, 2 treatment options
Fixed acrylic bridge, fixed ceramic bridge9
13/06/2006 to 15/08/2006, 3 substructures tried in
None achieved a passive fit
17/08/2006, laser welded substructure tried in
passive fit not achieved
Set-up was done
Acrylic bridge processed, polished, placed in patients mouth
Temporary fixed appliance
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REASONS FOR CHOICE OF APPLIANCE
Lack of space, distortion, long span substructure
Lower cost than fixed ceramic bridge9
Manufacturing process less complicated and time consuming10
No distortion, no firing cycles, creep of metal11,12
Substructure, titanium screws can be re-used10
Mandibular teeth not as visible
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PROBLEMS ENCOUNTERED
Metal substructure, no passivity
Substructure sectioned, 3 parts
Seated and joined, non-shrinkage acrylic
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FUTURE TREATMENT PLAN
Decided future treatment plan similar
Submucosal abutments change to transmucosal abutments
Advantage: implant abutment junction, gingival level
Access for better oral hygiene
Cementation, could achieve passive fit
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CONCLUSION
Predicted success rate high
Success with previous treatment plan
Previous student, acceptable results, no passivity
May be overcome with future treatment plan
Could not provide necessary treatment
Case will be taken further, numerous improvements
Patient satisfied and grateful
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REFERENCES
1.1. Dezotti MSG, Azevedo BJ, Fontao FNGK, Capelozza Dezotti MSG, Azevedo BJ, Fontao FNGK, Capelozza ALA, Sant’ana E. Odontogenic Myxoma – A Case ALA, Sant’ana E. Odontogenic Myxoma – A Case Report and Clinico – Radiographic Study of Seven Report and Clinico – Radiographic Study of Seven Tumours. The Journal of Contemporary Dental Tumours. The Journal of Contemporary Dental Practice.2006; 7(1): 2.Practice.2006; 7(1): 2.
2.2. Simon ENM, Merkx MAW, Stoelinga PWJ. Simon ENM, Merkx MAW, Stoelinga PWJ. Odontogenic Myxoma: a Clinico – pathological study Odontogenic Myxoma: a Clinico – pathological study of 33 cases. International Journal of Oral and of 33 cases. International Journal of Oral and Maxillofacial Surgery.2004: 1.Maxillofacial Surgery.2004: 1.
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REFERENCES (Cont.)
3. Noffke CEE, Raubenheimer EJ, Chabikuli NJ, Michael. Odontogenic myxoma: review of the literature and report of 30 cases from South Africa. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2007; 104: 101
4. Spencer KR, Smith A. Odontogenic Myxoma: Case Report with Reconstructive Considerations. Australian Detnal Journal. 1998; 43(4): 1.
5. Slootweg PJ, Witkamp ??. Myxoma of the Jaws. An anylasis of 50 cases. Journal of maxillofacial Surgery. 1986; 14: 46-52
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REFERENCES (Cont.)
6. Khogare S, Deshpande MD, Malik NA. Odontogenic Myxoma:A Case Study. International Journal Of Oral and Maxillofacial Surgery 2007;16: 107.
7. Smolka K, Kraehenbuehl M, Eggensperger N, Hallrmann W, Thoren H, Iizuka T, Smolka W. Fibula free flap reconstruction of the mandible in cancer patients: Evaluation of a combined surgical and prosthodontic treatment conceptOral Oncology 2007: 1-3, 5, 8, 9
8. Rosentiel SF, Land MF, Fujimoto J. Contoemporary fixed prosthodontics, 4th ed. Missouri, Mosby Inc. 2006: 426
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REFERENCES (Cont.)
9. Pagniano R. Bridges, Advantages and Disadvantages of Fixed Bridges [online]. Available:http://www.dublindentalcare.gomaker.com/page/page/1655218.htm#Bridges
10.Tipton P. Bridge Desgn: Full Arch Implant-supported Porcelain-fused-to-metal Bridgework. Dentistry South Africa. 2002; May/June:50-52
11.Hostede TM, Ercoli C, Hagan ME. Alternative complete-arch cement-retained implant-supported fixed partial denture, The Journal of Prosthetic Dentistry. 1999;82: 94-99
12.Bryant RA, Nicholls JI. Measurement of distortion of fixed partial dentures resulting fro degassing. Journal of prosthetic Dentistry. 1979; 42: 515
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ACKNOWLEDGEMENTS
Dr. Z Patel
Ms. Z Norjte
Mr. LA Steyn
Mr. W Spencer