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complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
complete denture treatments for a cerebral palsy patient/ dentistry curriculum
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complete denture treatments for a cerebral palsy patient/ dentistry curriculum

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Indian Dental Academy: will be one of the most relevant and exciting

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implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic

Dentistry, Periodontics and General Dentistry.

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  • 1. COMPLETE DENTURE TREATMENTS FOR A CEREBRAL PALSY PATIENT BY USING A TREATMENT DENTURE. A CASE REPORT INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. INTRODUCTIONINTRODUCTION  Cerebral palsy is a physical disorder leading to failure of balance and unpredictable motion.  The frequent erratic movement of the limbs and trunk often interfere with daily life.  Individuals with cerebral palsy often have difficulties in mastication, speech, and deglutition because of the involuntary muscle spasms caused by their condition. www.indiandentalacademy.com
  • 3. Cerebral palsyCerebral palsy  Is described as a group of chronic conditions affecting body movement and muscle coordination. This is caused by brain damage occurring either during - Pregnancy - During delivery - Shortly after delivery  There are several different types of cerebral palsy, classified by the way in which they affect the individual.  Athetoid cerebral palsy is one of these types. www.indiandentalacademy.com
  • 4.  Is caused by damage to the basal ganglia, located in the midbrain  Approximately 25 percent of cerebral palsy patients are affected by athetoid cerebral palsy  Athetoid cerebral palsy can also be referred to as dyskenetic cerebral palsy  People with athetoid cerebral palsy often show a lot of movement in their face. Athetoid cerebral palsy also affect speech www.indiandentalacademy.com
  • 5. Prosthetic considerationProsthetic consideration  For mandibular movement, the most important information originates from the receptors of periodontal ligament, temporomandibular joint and muscle spindles of masseter  Edentulous patients are not able to receive information from the periodontal ligament  Furthermore input signals from the muscle spindles of the edentulous patient are decreased  Thus most edentulous patients cannot perform smooth and precise mandibular movementswww.indiandentalacademy.com
  • 6.  It is often observed that mandibular movements of edentulous patients are unstable  Most edentulous patients often have irregular mandibular movements  Hence it is difficult to make complete dentures for edentulous patients with cerebral palsy www.indiandentalacademy.com
  • 7. CASE REPORTCASE REPORT  A 69-year-old edentulous male presented to clinic with athetoid type cerebral palsy  Diagnosed at the age of three years  He had no medical complications or mental retardation  His lower limbs were paralyzed. He was able to move his arms voluntarily to a certain extent www.indiandentalacademy.com
  • 8.  Opening and closing movements of the jaw were possible, but a conspicuous mandibular shift towards the right was observed  He could not perform limiting or tapping movement of his mandible when instructed www.indiandentalacademy.com
  • 9. TREATMENTTREATMENT  Impressions were taken for study models  Custom trays were then prepared on these for taking precise impressions with silicone rubber impression material  Bite plates were made on the working models www.indiandentalacademy.com
  • 10.  Determined his bite plane using the conventional method based on Camper’s plane  However it was difficult to determine his occlusal vertical dimension because he could not maintain the position while biting on the bite plates  Therefore mandible is held in position to obtain the occlusal vertical dimension www.indiandentalacademy.com
  • 11.  With the occlusal bite registered, proceeded to make the treatment dentures  Artificial teeth were arranged in lingualized occlusion on an average value articulator  Dentures were fabricated by the conventional method www.indiandentalacademy.com
  • 12.  After occlusal adjustment on the articulator, posterior artificial teeth were removed from the mandibular denture to make the occlusal tables  Self- curing resin was applied to these surfaces www.indiandentalacademy.com
  • 13.  Maxillary and mandibular dentures were occluded on the articulator to mark the position of the palatal cusps of the maxillary teeth, before the resin was completely cured  Self-curing resin was reduced until all palatal cusps were in even contact www.indiandentalacademy.com
  • 14. The occlusal tables were flattened as much as possible www.indiandentalacademy.com
  • 15.  After the treatment dentures were delivered  The patient follow-up is done on a weekly basis  Then Performed occlusal adjustment and tissue conditioning at all recall appointments  In this method, cusps of maxillary denture should indent the mandibular flat tables during occlusion  They did not grind the maxillary artificial teeth. Adjustment of the mandibular flat tables by grinding was also limited to removal of the premature contacts that seemed to tip the dentures www.indiandentalacademy.com
  • 16.  After this preliminary treatment, it is observed his tapping movement and determined the frequency 4-6 times at every visit  During the first 3 weeks, the dentures were not stable and Pt could only perform tapping continuously for 1 to 13 times  The patient suffered from frequent ulcers in the oral cavity and had difficulty in eating www.indiandentalacademy.com
  • 17.  However after 4 weeks, the dentures became more stable and his tapping frequency improved to a maximum of 26 times  On the flat tables detected the indentation marks from cusps of the opposing maxillary denture  No more ulcers were observed in the oral cavity and the patient found it much easier to eat  After 6 weeks, the patient did not complain of any painwww.indiandentalacademy.com
  • 18.  By using treatment dentures with flat tables, the occlusal condition can be analyzed by observing the indentations on them  If the indentations are spread out the centric occlusion of the patient is not stable  On the contrary, if mandibular movement is stable and the centric spot becomes fixed  Thus it is concluded that the patient’s mandibular movement was stable www.indiandentalacademy.com
  • 19.  The bite was registered again with silicone material (EXABITE , GO Ltd., Japan)  These treatment dentures were remounted on an average value articulator to arrange posterior artificial teeth in the mandibular denture with lingualized occlusion and to rebase the maxillary and mandibular dentures www.indiandentalacademy.com
  • 20.  The definitive dentures are thus fabricated  occlusal papers are used to check and adjust the fitting and occlusal relationship of the definitive dentures  After the definitive dentures were delivered  The patient was recalled regularly, and he remains satisfied with his dentures www.indiandentalacademy.com
  • 21. Review of Literature Ogata K. A study of mandibular kineisograph in cerebral palsy patients. JJSDH 1986:7:26-41.  He recorded mandibular movements of four patients with athetoid type cerebral palsy using Mandibular Kinesiography (MKG) and reported extreme deviations to the right or left during opening movement. In addition, he reported that complex movements such as limiting the movement of mandible could not be made in severe cases  He reported that severe functional disability was the primary reason for failure of prosthodontic treatment in these patients www.indiandentalacademy.com
  • 22. CONCLUSIONCONCLUSION  It has been suggested that the mandibular movements in these patients should be analyzed and adjusted when necessary  Use of intermediate treatment dentures with flat occlusal tables is one of the techniques applied in severe cases  This method enables the patient’s condition to be analyzed prior to delivery of the definitive dentures www.indiandentalacademy.com
  • 23. ReferencesReferences  Ogata K. A study of mandibular kineisograh in cerebal palsy patients. JJSDH 1986:7:26-41. (in Japanese, English abstract)  Russell GM, Kinirons MJ. A study of the barriers to dental care in a sample of patients with cerebral palsy. Community Dent Health 1993:10:57-64.  Hallett KB, Lucas JO, Johnston T, et al. Dental health of children with cerebral palsy following sialodochoplasty. Spec Care Dentist 1995:15:234-238  Marukawa Y, Akiyama S, Morisaki I. Clinical application of dental prosthesis with magnetic attachment to patient with cerebral palsy. J. Osaka Univ Dent Sch 1994:34:45-49 www.indiandentalacademy.com
  • 24. For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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