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Management of Mandibular Defects

The document discusses the prosthetic management of acquired mandibular defects, highlighting the common causes, classifications, and resulting disabilities from partial mandibular loss. It details rehabilitation strategies for both marginal and segmental resection defects, including surgical and prosthetic considerations, and emphasizes the importance of addressing both form and function. Additionally, it covers the management of mandibular deviation and factors influencing the prognosis for conventional complete dentures.

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8 views

Management of Mandibular Defects

The document discusses the prosthetic management of acquired mandibular defects, highlighting the common causes, classifications, and resulting disabilities from partial mandibular loss. It details rehabilitation strategies for both marginal and segmental resection defects, including surgical and prosthetic considerations, and emphasizes the importance of addressing both form and function. Additionally, it covers the management of mandibular deviation and factors influencing the prognosis for conventional complete dentures.

Uploaded by

r20626802
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Prosthetic Management

Of Acquired Mandibular
Defects

Dr.Eatemad Rekaby
What is the most common cause of
partial mandibular loss ?
 The resulting disabilities may include:
-Impaired speech articulation
-difficulty in swallowing
-Problems with mastication
-deviation of the mandible during functional
movements
-compromised control of salivary secretions
-Severe cosmetic disfigurement.
Therefore, rehabilitation of mandibulectomy
patient should consider both form and
function
Classification Of Mandibular Defects
Based on the amount of resection (Laney)

1. 1-Marginal resection  2-Segmental resection


(continuity defects) (discontinuity defects)
Classification Of Mandibular Defects
Based on the amount of resection (Laney)

1. 1-Marginal resection  2-Segmental resection


(continuity defects) (discontinuity defects)
 -Complete segment is removed
-Inferior border and its continuity from the alveolar crest to the
preserved inferior border

-No deviation  -Mandible deviate to resected


side
-Less facial disfigurement  -Marked facial disfigurement

-Occlusion rarely changed  -Occlusion altered

-Can be anterior or posterior  -Can be midline or lateral


Anterior continuity defect
and its associated problems
Posterior continuity defect
and its associated problems
Prosthetic rehabilitation of marginal
mandibular resection
 1-Surgical considerations
soft tissues are mainly used for
reconstruction as split thickness skin
graft ( ideal bearing surface), local
,pedicle flap and MVFF.
 2-Prosthetic considerations
-R.P.D.
 -Implant retained prosthesis
RPD in anterior continuity defect
 After reconstruction surgery, these patients
display unusual soft tissue configuration and
compromised bony support.
 The RPD will enhance esthetic , speech and
control of saliva. while mastication is only
restored in small defect with retained cuspid
 Design:

 Similar to Class IV
Implant retained prosthesis in
anterior continuity defects
 It is either placed in the remaining bony
segment or in the placed free bone graft (after
6-9 months )
 It have two forms:
 -Removable overlay prosthesis (2-4 implants)**
 -Implant supported prosthesis(min4-5 implants)
Prosthetic rehabilitation in
posterior continuity defect
 1-RPD :
 Difficult to design ….why ?

 Long lever arm and compromised edentulous


bearing surface causes excessive movements of the
prosthesis during function….dynamic fulcrum line.
 P.P., Ant. Clasp , max coverage , contact in c.occ.
 2- Implant retained prosthesis:
 It improves the retention, stability and support for
RPD in large defects .
Prosthetic rehabilitation of
segmental mandibular resection
 1-Surgical considerations
All segmental defects constructed with bone
Soft tissues MVFF may be used with posterior
lateral defect.
 2-Prosthetic considerations
A-Management of mandibular deviation.
 B-Definitive prosthesis
Segmental resection
Segmental resection
Complication Of Discontinuity Defects

 Deviation of the mandible.


 Facial disfigurment.
 Loss of occlusal contact between
maxillary and mandibular teeth.
 Impaired speech and swallowing
Management Of Mandibular
Deviation
) Immediate Post-surgical Intermaxillary
Fixation
-Using arch bar and elastics for 5-7 w
-is an old approach, feasible only in patients with
resections confined to the mandible, and with
little associated soft tissue loss.
2) Physio-therapy
 Reduce trismus .
 Prevent scar contraction
 Improve maxillo-mandibular relation
3) Resection Guidance Appliances
-Time of construction and requirement of guidance
appliance (The earlier mandibular guidance therapy is
initiated, the more successful the result)
-Presence of teeth is very important
-All are utilized on an interim bases until acceptable
occlusal relation is established.
-Types :
Mandibular guidance appliance
• Buccal training flange
Maxillary guidance appliance
• Palatal occlusal ramp
Buccal Training Flange
Buccal Training Flange
• Indication:
When the mandible can be manipulated into an
acceptable maxillomandibular relationship but the
patient lacks the motor control to bring the
mandible into occlusion.
• Structure
 It consists of a removable partial denture framework,
with a metal flange extending 7 to 10 mm laterally
and superiorly on the buccal aspect of the bicuspids,
and molars on the non-defect side.
 This flange engages the maxillary teeth during
mandibular closure, thereby directing the mandible
into an appropriate intercuspal position .
Palatal Occlusal Ramp
Palatal ramp
 Indication:
 Maxillary guidance ramps are more adjustable
than mandibular guidance ramps, and are
preferred for the patient with severe mandibular
deviation.
 Design & construction:
 It is a maxillary prosthesis usually constructed of acrylic
resin with either cast- or wrought-wire retainers.
 A full palatal coverage prosthesis is constructed and a
palatal index is made by auto polymerizing A .R. ,after
manipulation of the mandible to the desired position.
Prosthetic rehabilitation of edentulous
patients
1-Conventional complete denture
2-Implant Retained and Supported Overlay
Dentures
Factors determining the prosthetic prognosis
for conventional Complete dentures:

 1- The extent of the bony and soft tissue resection.


 2- The status of the remaining tongue.( If the motor
and/or sensory control of the tongue has been
significantly compromised by the resection, the
prosthetic prognosis becomes extremely guarded).
 3- Mandibular deviation and the character of
mandibular movements.
 4-Radiation therapy.
Thank You
Prosthetic Management of
acquired mandibular defects
 Causes, classifications and subsequent
disabilities ….2
 Prosthetic Management of continuity
defects………4
 Managements of mandibular
deviations…….4
 Prosthetic Management of edentulous
patient with mandibular defects………4
 Implant supported prosthesis for
mandibulectomy defects …..4

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