mandible reconstruction

1. REHABILITATING MANDIBULAR DEFECT
A case report
Presented by: Dr. GAURAV GARG
DEPARTMENT OF PROSTHODONTICS,
CROWN, BRIDGE AND IMPLANTOLOGY

2. INTRODUCTION
• Mandible reconstruction has been a challenge for the
clinicians for more than a century.
• Mandible defects resulting in face deformity of various
stages are mostly the consequence for ablative surgery for
malignancies, huge jaw cysts, infections as osteomyelitis
and trauma, that may compromise orofacial functions and
cause subsequent psychological disorders.

3. • Even new surgical reconstructive techniques may not
sufficiently restore sensory-motor functions, and in most instances
they fail to provide adequate support for dental prostheses.Loss of
the proprioceptive sense of occlusion leads to the uncoordinated,
less precise movement of the mandible.
• Poor tissue support after mandibular reconstruction along with
the addition of impaired tongue function, may totally compromise
mastication and has hindered prosthodontists in constructing stable
and functional dental prostheses for these patients.

4. CASE REPORT
• A 32 Years old male patient reported to our Out Patient
Department with the chief complaint of missing teeth in
the lower arch.
• The clinical examination and past history revealed that
that the patient had an infected Radicular Cyst
in the mandibular region.The enucleation of the cyst was
done followed by chemical cauterization.The procedure
also accompanied extraction of tooth #31, # 32, # 33,
# 34, # 35, # 41, # 42, # 43, # 44.

5. RADIOGRAPHIC EXAMINATION

6. PRE-OPERATIVE PROFILE VIEWS

7. PRE-OPERATIVE INTRA-ORAL VIEW

8. PRE-OPERATIVE INTRA-ORAL OCCLUSAL VIEW

9. PRE-OPERATIVE INTRA-ORAL OCCLUSAL VIEW

10. CANTOR AND CURTIS CLASSIFICATION OF
PARTIAL MANDIBULECTOMY
•CANTOR AND CURTIS in 1971 classified mandibular
resection patients by amount of mandible that remains
after resection and surgical reconstruction.

11. TYPE I - Mandibular resection involving alveolar defect
with preservation of mandibular continuity

12. • TYPE II - Resection defects involve loss of mandibular
continuity distal to the canine area

13. • TYPE III - Resection defect involves loss up to the
mandibular midline region.

14. • TYPE IV - Resection defect involves the lateral aspect of
the mandible, but are augmented to maintain pseudo
articulation of bone and soft tissues in the region of the
ascending ramus.

15. • TYPE V - Resection defect involves the symphysis and
parasymphysis region only, augmented to preserve bilateral
temporomandibular articulations.

16. •The criteria of this classification suggested that this case will
come under Type I resection of the mandible as the inferior
border was intact.
•For Type I resection the denture bearing area is compromised
by closure of defect with the use of adjacent lining mucosa
which reduces the bucco-lingual width.

17. TREATMENT OPTIONS
1) Mandibular reconstruction by autogeneous Bone Graft
2) Implant supported fixed prosthesis
3) Cast Partial Removable prosthesis with the
Clasp Assembly
4) Cast Partial Removable prosthesis with the semi –
precision attachment.

18. TREATMENT PROCEDURE

19. •The primary impression of the patient was made and the
casts were surveyed for the treatment planning.
•The crown preparation of the tooth #36,#45 and #47 was
done .
•Final impression was made after preparation and then the casts
were mounted on a Semi adjustable articulator with the
Face-Bow transfer.

20. FACE BOW TRANSFER

21. PRECI – VERTIX SEMI PRECISION ATTACHMENT
3
2
1
4

22. POSITIONING OF THE SEMI- PRECISION
ATTACHMENT USING THE NEY’S SURVEYOR

23. FINAL TRY-IN OF THE CROWNS WITH THE
SEMI- PRECISION ATTACHMENT

24. CAST PARTIAL FRAME-WORK IN POSITION

25. TRY IN OF THE CAST PARTIAL FRAME-WORK

26. CROWN IN POSITION ALONG WITH THE
RETENTIVE KEEPERS

27. FINAL PROSTHESIS AFTER INSERTION

28. POST – OPERATIVE OCCLUSAL VIEW

29. PERMANENT SOFT – LINED TISSUE SURFACE WITH
RETENTIVE KEEPERS IN POSITION

30. POST-OPERATIVE LATERAL VIEW

31. PRE AND POST- OPERATIVE PROFILE VIEW

32. PRE AND POST- OPERATIVE PROFILE VIEW

33. 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.
• Proper treatment planning pre and post surgery is necessary
to obtain the most optimal results.

34. REFERENCES
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Endod 2002; 93(1): 13-20.
6) Carr AB, Mc Givney GP, Brown DT. Mc Crackens removable partial prosthodontics.11th ed,
India, MOSBY Inc, pp. 414.

35. REFERENCES
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36. THANK YOU