PROSTHETIC MANAGEMENT OF MANDIBULAR DEFECTS

1. PROSTHODONTIC
MANAGEMENT OF
MANDIBULAR DEFECTS
MUGILARASAN MUNISAMY
DEPARTMENT OF PROSTHODONTICS
PDCH

2. CONTENTS
• Introduction
• Definition
• Mandibular defects
• Classification
• Factors affecting treatment
• Prosthetic rehabilitation
• Conclusion

3. INTRODUCTION
Malignancies of maxillofacial region are most common etiology for the acquired defects
of that region. Oral squamous cell carcinoma is the most common cancer in India, and
its prevalence ranges around 45% of all cancers. Unfortunately, most of these lesions
are diagnosed at a late stage and requires surgical resection along with adjacent
anatomical structures such as mandible, floor of the mouth. tongue, etc.Lose of
mandibular continuity results in cosmetic, functional and psychological discomfort for
the patient. If condylectomy has been performed the prime most difficulty encountered
is deviation of mandible towards the defect side, and inferiorly.

4. DEFINITION
Maxillofacial prosthesis is the art and science of anatomic, functional
or cosmetic reconstruction by means of nonliving substitutes in the
regions of maxilla, mandible and face that are missing or defective
because of surgical intervention, trauma, pathology or congenital
malformation

5. MANDIBULAR DEFECTS
DEVELOPMENTAL
DEFECTS
• MICROGNATHIA
• MANDIBULO FACIAL
DYSOSTOSIS
• ANKYLOSIS OF TMJ
ACQUIRED DEFECTS
• NEOPLASTIC
RESECTIONS

6. CANTOR AND CURTIS CLASSIFICATION OF
MANDIBULAR DEFECTS
Class I: Mandibular resection
involving alveolar resection and
preservation of mandibular
continuity

7. Class II: Loss of continuity distal to
the canine area

8. Class III: Mandibular resection
involving a minimum of midline
loss of continuity

9. Class IV: Resection of lateral portion of
the mandible with subsequent
augmentation to restore form and
function.

10. Class V: Midline resection with
subsequent augmentation to restore
form and function.

11. Class VI: Similar to class V but
there is no augmentation
following resection

12. BASED ON THE AMOUNT OF RESECTION OR
BONE LOSS
•The superior portion of mandible is
resected and lower border is left intact.
Continuity
defects
•Entire segment of of mandible is
resected .
•
Discontinuity
defects

13. FACTORS AFFECTING TREATMENT OF
MANDIBULECTOMY PATIENT
• Location & extent of mandibular defects
• Presence of remaining natural teeth / pre existing implants.
• Degree of post mandibulectomy rotation and deviation .
• Available mouth opening .
• Functional limitations of tongue .
• Compromise of vestibular extentions.
• Skin grafting .
• Radiation theraphy

14. PROSTHETIC REHABILITATION
• All basic principles of complete denture construction must be considered and
modified because of the unusual anatomic and functional situation.

15. TREATMENT OPTIONS
Prosthetic
rehabilitation of
completely edentulous
mandibular defects
Prosthetic rehabilitation
of partially edentulous
mandibular defects

16. PROSTHETIC REHABILITATION OF
COMPLETELY EDENTULOUS MANDIBULAR
DEFECTS
• To improve the prognosis the following procedures can be followed:
• •Vestibuloplasty to create vestibule.
• Mandibular guidance flange to guide the mandibular movements
• Lip bumpers are given to support the lower lip.
• Neutrocentric occlusion with nonanatomic teeth to distribute the occlusal forces.

17. PROCEDURE IN COMPLETE DENTURE
Primary
impression
Border
moulding &
secondary
impression
Fabrication
of base
Jaw relation
Teeth
selection and
arrangement

18. PRIMARY IMPRESSION
• Irriversible hydrocollids
• Altered / sectional stock tray

19. SECONDARY IMPRESSION
• Green stick compound
• Zinc oxide eugenol

20. PROCESSED BASES
• Which is used to evaluate the retention and stability

21. JAW RELATION
• Centric jaw relation is not exists in partial mandibulectomy patients
• Jaw relation is very haed to obtain I n these cases

22. TEETH SELECTION AND ARRANGEMENT
• Zero degree cuspal angulation
• Placement of posterior teeth to the buccal of the residual alveolar ridge .

23. PROSTHETIC REHABILITATION OF PARTIALLY
EDENTULOUS MANDIBULAR DEFECTS
Marginal
mandibular
resection
Mandibular
guide flange
prosthesis
Palatal ramp
prosthesis
Segmental
mandibular
defect
Magnet
retained snap
on prosthesis
Bar
supported
over denture
Implant
supported
overdenture

24. Prevention of mandibular
deviation
Correct mandibular deviation
Mandibular guide flange prosthesis Mandibular guide flange prosthesis

25. Magnet retained snap on prosthesis
Bar supported over denture
Implant supported overdenture

26. CONCLUSION
Surgical and prosthodontic rehabilitation of the mandibulectomy patient can provide
satisfactory results, improving the oral functions of the patient which overall makes a
positive impact on the quality of life for the patient. However proper treatment
planning pre and post surgery is necessary to obtain the most optimal results

27. THANK YOU