The document discusses the classification and management of mandibular defects resulting from mandibulectomy. It describes 5 classes of mandibular defects based on the Cantor Curtis classification which differ in the amount and location of resection. Factors affecting treatment include the location and extent of the defect, remaining teeth/implants, deviation of the mandible, available mouth opening, tongue function, and whether the patient received radiation therapy. Prosthetic rehabilitation aims to restore function, support, and appearance and depends on the specific class of defect and residual structures.

1. PROSTHODONTIC
MANAGEMENT OF
MANDIBULAR DEFECTS

2. Contents
1) Introduction
2) Classification of mandibular defects.
3) Factors affecting treatment of mandibulectomy patients.
4) Related surgical and prosthetic considerations.
5) Management of mandibulectomy patients.
6) Types of prosthesis used to rehabilitate mandibulectomy patient
7) Summary and Conclusion
8) References

3. INTRODUCTION
• The mandible is one of the most versatile bones of the
human body.
• Apart from enclosing the floor of the oral cavity, it
generates a variety of complex movements useful in speech,
swallowing, mastication and respiration.
• The mandible along with the bilaterally attached muscles of
mastication also give form to the lower third of the face.
• Thus defects of the mandible either due to trauma or any
other pathology alters not only its functions but also,
appearance of the patient.

4. MANDIBULAR DEFECTS
DEVELOPMENTAL ACQUIRED
TRAUMA
PATHOLOGY
Eg. Tumors
Eg. Mandibular
Prognathism/ Retrognathism
Rx – Mainly Surgical Mandibulectomy
After which, prosthodontic
treatment may be required for
restoration of appearance and
function i.e. in conjunction with
surgery.
For fractures of edentulous mandible-
Gunnings splint
Loss of teeth – implants
Loss of significant amount of alveolar
bone –restoration of factor form i.e.
soft tissue support to restore
appearance.

5. CLASSIFICATION OF MANDIBULAR DEFECTS
• Accordingto Laney(1979)
Based on Etiology,
A) Acquired
1. Marginal
2. Segmental
a. Lateral to midline
1. Body only
2. Ramus – body with disarticulation
b. Anterior body
3. Subtotal
4. Total

6. B) Congenital
1. Incomplete formation
2. Incomplete ossification ( Mandibulo-facial dysostosis) Eg. Hypoplasias,
Micrognathia etc
C) Developmental
As a result of post-natal insults on the growth centers e.g. trauma during
births, surgery, drugs.

7. • Basedon the amount of resection(Laney)
Continuity defect
(Marginal resection)
Discontinuity defect
(Segmental resection)
1. Inferior border and its continuity is
preserved
Complete segment of mandible from alveolar
crest to inferior border removed.
2. No deviation Mandible deviates to resected side.
3. Less facial disfigurement Marked facial disfigurement.
4. Occlusion rarely changed Occlusion altered.
5. Can be
Anterior defect
Posterior defect
Can be
Lateral discontinuity defect
Midline discontinuity defect.

8. Brown’s classification
Brown JS, Barry C, Ho M, Shaw R. A new classification for mandibular defects after oncological resection. Lancet Oncol. 2016 Jan;17(1):e23-30.

9. Jewer’s and Boyd’s classification
Mandible was divided into three segments.
Here mucosal component was added by Boyd.
• H stands for lateral defects of any length
up to midline including condyle,
• C for defects involve central segment
containing 4 incisors and 2 canines and
• L constitutes lateral defects excluding the
condyle.

10. ACCORDING TO CANTER & CURTIS (1971) AND REVISED
(2016)

11. Class I – Radical alveolectomy with preservation of mandibular
continuity
Tissues resected:
- Portion of alveolar process and body of mandible.
- Mucoperiosteum.
- Lingual and buccal sulcus mucosa.
- Portion of base of tongue and mylohyoid muscle.
- Lingual and inferior alveolar nerves.
- Sublingual and sub-maxillary salivary glands.
- Sometimes anterior part of digastric muscle.

12. - Sometimes resection of part of mylohyoid muscle and resultant
scarring can raise floor of the mouth causing reduction in tongue
mobility.
- Ability to control the tongue may be lost due to loss of some
intrinsic muscles.
- Resection of lingual and inferior alveolar nerves results in loss
of sensation in mucosa of cheek, alveolar process, lower lip, epithelium
of lower part of face and loss of taste on anterior 2/3rds of tongue.

13. Revised JPD 2016:
• A revision in the basic Cantor Curtis classification is suggested here in which
Class I is subdivided into ‘a’ and ‘b’ with no change in other classes.
• Class I - Radical alveolectomy with preservation of mandibular continuity.
• Subdivision a: resection of superior border of mandible
• Subdivision b: resection of inferior border of mandible

14. Class II – Lateral resection of mandible distal to canine
Tissues resected:
- Condyle, ramus and body of mandible distal to cuspid.
- Mylohyoid, hypoglossal, anterior belly of digastric, internal pterygoid, masseter,
external pterygoid, pharyngoglossal and palatoglossal muscles, most of intrinsic muscles of
tongue.
- Hypoglossal, lingual, inferior alveolar nerves.
- Sublingual and sub-maxillary glands.
- Mucoperiosteum and adjacent buccal and lingual sulcus mucosa.

15. - Speech, swallowing, saliva control, manipulation of food is impaired.
- Facial disfigurement apparent.
- Disarticulation and loss of muscles of mastication which hamper mandibular
movements.
- Taste, sensory and motor losses more extensive as compared to Class I.

16. Class III – Lateral resection of mandible to the midline
Resected tissues – All those described in Class II in addition to the
anterior portion of the mandible, the genioglossus muscle, geniohyoid
muscle, remaining portion of mylohyoid muscle with lingual and buccal
mucosa.
Structures remaining:
- Cheek mucosa.
- Small portion of palatoglossal and internal pterygoid muscles,
portion of the tongue.

17. -Restricted tongue mobility due to loss of tip of tongue and genioglossus muscle.
-Speech, swallowing, saliva control and manipulation of food severely restricted.
-Facial disfigurement is worst due to loss of anterior part of mandible.
Disarticulation and reduction in amount of basal bone reduce the prosthetic
prognosis.
-Scarring of orbicularis oris can interfere with expression of emotion.

18. Class IV – Lateral bone graft surgical reconstruction
Lateral bone and split thickness skin or pedicle graft can be performed on
patients who have had:
1. Radical alveolectomies.
2. Resection of mandible distal to cuspid with or without disarticulation.

19. Class V – Anterior bone graft surgical reconstruction
Tissues resected at time of surgery:
- Anterior portion of mandible (bicuspid to bicuspid).
- Large bilateral portions of mylohyoid, geniohyoid, genioglossus and anterior
digastric muscles.
- Bilateral lingual and inferior alveolar nerves.
- Bilateral sub maxillary and sublingual salivary glands.
- Mucosa of lower lip, anterior floor of mouth and ventral surface of tongue.

20. • The mucosa retained in the labial and buccal regions is sutured to the residual
stump of the tongue and a Kirschner wire (K-wire) often is positioned to help
maintain the mandibular fragments.
• Bone graft and split thickness (skin) graft or pedicle graft procedures can be used
to restore anterior facial contour and bilateral mandibular function.
• Preservation of hypoglossal nerve is critical for tongue mobility.

21. FACTORS AFFECTING TREATMENT OF MANDIBULECTOMY
1) Location and extent of mandibular defect.
2) Presence of remaining natural teeth/ pre-existing implants.
3) Degree of post-mandibulectomy rotation and deviation.
4) Available mouth opening.
5) Functional limitation of tongue.
6) Compromise of vestibular extensions.
7) Skin grafting.
8) Radiation therapy.

22. 1. LOCATION AND EXTENT OF MANDIBULAR DEFECT
3 Types
• Radical alveolectomy
• Vertical discrepancy
• Defects of the symphyseal region

23. Radical alveolectomy
• Includes a significant portion of the alveolar process without loss of mandibular
continuity.
- Least debilitating.
- Main problems – Loss of vertical ridge height and vestibular depth -
decreased stability for soft tissue supported prosthesis as well as loss of load bearing
tissues available for support.

24. VERTICAL DISCREPANCY
– Important when prosthesis supported by dental implants is considered.
• Rule of thumb
– The farther anterior the defect the more disfiguring and functionally
debilitating it are likely to be.
Reason: Loss of key muscle attachments(genioglossus and geniohyoid) located in
anterior mandible that control tongue function and mobility.

25. DEFECTS OF THE SYMPHYSEAL REGION
(Most debilitating and difficult to treatment)
– Surgical reconstruction necessary or at least segmental
stabilization.
Because in anterior resection loss of key muscle
attachments (genioglossus, geniohyoid) are lost which
control tongue mobility and function.

26. DEFECTS OF THE SYMPHYSEAL REGION
Mandibulectomy defects in molar region are well
suited for surgical reconstruction compared to anterior
defects because linear grafts are more easier to perform
compared to those requiring reconstruction of anterior
mandibular curvature.
If muscle attachments are intact – good prognosis
and nearly normal appearance and function is achievable.

27. 2. PRESENCE OF REMAINING NATURAL TEETH/ PRE-
EXISTING IMPLANTS
Patients after mandibulectomy frequently present with few or no remaining natural teeth
Mainly 2 reasons for this:
1) Patients with greatest risk of squamous cell carcinoma are heavy
users of tobacco and alcohol. Their lifestyle is not conducive to a high
level of oral hygiene resulting in early tooth loss.
2) Teeth are usually extracted prior to radiation therapy to prevent
complication such as osteoradionecrosis unless they have an excellent
prognosis.

28. • Prognosis of rehabilitative therapy depends upon number of teeth remaining or implants
in the mandibular arch following resection.
• Greater the number of teeth – better the retention, stability and support of the prosthesis.
• Teeth present on both sides of the midline permit greater prosthesis support because the
problem of straight line design can be avoided.
• All remaining mandibular teeth should be incorporated into design of the prosthesis to
maximize stability and dissipate functional forces to greatest number of abutments.

29. 3. DEGREE OF POST MANDIBULECTOMY ROTATION AND
DEVIATION
• Deviation towards defect and rotation of mandibular
occlusal plane inferiorly.
• Deviation – Primarily due to loss of tissue involved in
the surgical resection the need to gain primary closure
required that the margins of the defect be drawn together,
resulting in deviation of the remaining mandible towards
the defect.

30. 3. DEGREE OF POST MANDIBULECTOMY ROTATION AND
DEVIATION
• Rotation (inferior direction) vertical:
• 2 reasons:
- Pull of suprahyoid muscles on the residual
fragment causing inferior displacement and rotation around
the fulcrum of the remaining condyle.
- Gravity – loss of anchorage of levator muscles
causes mandible to fall vertically.

31. • Sequalae:
- Facial disfigurement.
- Loss of occlusal contact.
- Loss of ability to bring lips together.
- Drooling of saliva and difficulty to initiate swallowing process.
• Treatment:
- Osseous grafting to restore mandibular continuity.
- Early post resection physical therapy to reposition mandibular fragment to a more
normal position and to minimize effect of scar formation that will make deviation more
severe and less amenable to prosthodontic intervention.

32. • Physical therapy: Gently the patient is made to push the mandible toward the normal
side away from the defect side. While holding the mandible in this position the patient
should open the mouth as wide as possible to stretch the musculature and the resection
site.
• Repeated opening and closing: Trains the mandible and prevents scar formation.Should
be carried out immediately. If delayed more than 6-8 weeks postoperatively will not be
beneficial.
• Mandibular resection guidance prosthesis- If minimal pressure is required to maintain
the mandible in its correct position. A mandibular guide flange/maxillary guidance ramp
may be the solution.

33. • Maxillary guide flange – When deviation is less severe.
• Neither mandibular guidance prosthesis nor palatal guidance ramps are indicated
for edentulous patients without the use of dental implants to stabilize the denture
on account of the lateral forces generated.

34. 4. AVAILABLE MOUTH OPENING
• Trismus – due to surgical trauma- Physical therapy should be started immediately
postoperatively.
• Scar tissue formation – further decrease in mouth opening.
• Simple test – Insert a stock mandibular impression tray in the mouth. If this cannot
be accomplished, rehabilitation is unlikely.
• Treatment – Stretching exercises, moist heat, analgesics indicated within week
after surgery.

35. 5. FUNCTIONAL LIMITATION OF TONGUE
• Frequently surgical wound is closed by suturing the remaining tissues of the floor of the mouth or
tongue to the remaining buccal tissues. This severely limits mobility of the tongue.
• Compromises:
- Speech
- Swallowing.
- Mastication.
- Control of food bolus.
- Ability to control removable prosthesis.
• Lingual vestibuloplasty, skin or mucosal grafting used to increase tongue mobility.

36. • Evaluation of tongue mobility – Patient is asked to extend tongue into each cheek
and lick the lips. If this function can be performed, mobility is adequate for control
of prosthesis and food bolus.
• Patients in whom anterior mandibular resection is done, ability to move the lips
when artificial prosthesis is placed may become difficult (due to loss of
genioglossus). In such cases, consideration is given to lowering the anterior
occlusal plane to give the tongue a more direct path to the lips.

37. • Another method is to set the teeth lingually reducing
lip support thereby bringing them closer to tongue.
- Speech therapy.
- Partial/total glossectomy – palatal drop
prosthesis or glossectomy prosthesis.

38. • Loss of sensory innervation of buccal mucosa (long buccal nerve) and lower lip (mental
nerve) will reduce the patient’s ability to control food and saliva, but are not as
debilitating as loss of lingual sensory innervation.
• Loss of motor innervation of tongue (hypoglossal) is less frequent because it lies deep in
the floor of the mouth at the base of the tongue. It is more likely to occur due to
glossectomy than due to mandibulectomy.
• Motor innervation of tongue is sacrificed – prognosis for improved function and
prosthodontic rehabilitation is poor.
• Motor innervation of cheek and lower lip is lost (facial nerve)- patients ability to control
saliva and food bolus is lost.

39. 6. COMPROMISE OF VESTIBULAR EXTENSIONS
• Vestibular depth is critical for stability and
peripheral seal.
• It is also critical when mandibular continuity is
restored with bone grafting and implants are
considered.

40. • In case of a bone grafted mandible, the crest of the residual ridge or bone graft is at the
base of the ‘V’ shaped sulcus between the surgically altered buccal soft tissues and the
floor of the mouth or residual tongue. In such cases the soft tissues will fall over the
implant abutments leading to tissue trauma. This mainly occurs during the treatment
phase.
• The problem usually subsides once the prosthesis is placed. The other problem is oral
hygiene maintenance which will compound the soft tissue problem.
• Surgical location of vestibular depth should be considered.

41. 7. SKIN GRAFTING
- Pedicle flaps.
- Free fibula flaps.
- Vascularized bone.
- Soft tissue grafts.
Advantages:
1. Effective load bearing tissues.
2. Can withstand pressure and chafing
from prosthesis.
3. Protects underlying bone and
connective tissue due to rapid turnover of
keratin producing cells.
Disadvantages:
1. No sensory innervation.
2. Full thickness grafts may
incorporate hair follicles therefore split
thickness grafts should be used.
3. Skin is not very compatible with
titanium surface of dental implants.

42. 8. RADIATION THERAPY
• Irradiated tissue is fragile, sensitive to manipulation, desiccated, slow to heal,
prone to infection and at risk of osteoradionecrosis. Thus treatment should be
carefully planned for such patients.

43. Relating surgical considerations and prosthetic prognosis
1. MARGINAL MANDIBULECTOMIES
Soft tissues are used to reconstruct marginal mandibulectomies: They may be:
- Skin graft.
- Local flap.
- Pedicle flap.
- Neurovascular free flap.
Skin grafts:
- Thin and avascular.
- Bound to the mandible similar to attached gingival tissues.
- Not compressible.

44. Local and pedicle flaps:
- Bulky.
- Tether adjacent structures (primarily tongue).
- Displaceable and mobile.
- Poor prosthesis bearing surfaces due to bulk and may impinge on space for
dentition.
- Sutured to adjacent structures such as cheeks, lips, tongue because when
these structures move, flap moves and unseats prosthesis.

45. • Neurovascular free flaps:
- Ideal when associated structures in addition to mandible are resected.
- Offer volume and resistance to the bulk of soft tissue. Do not tether residual tongue
function.
- Ideal for reconstruction in irradiated areas as they anastomose with blood vessels in
head and neck.
- However when they cover mandible, they are compressible and mobile creating an
unstable prosthesis bearing surface.
- Whenever soft tissue bulk is not required and recipient bed is not previously
irradiated, skin graft reconstruction should be considered for prosthodontic advantages.

46. 2. DISCONTINUITY MANDIBULECTOMY
• Reconstruction of discontinuity defects has been revolutionized by MVFF(Microvascular
Free Flap).
• Previously soft tissue local flaps with residual tongue were sutured to the border of the
defect for primary closure and pedicle flaps (pectoralis flap rotated on a vascular pedicle
from the chest and tunneled through the neck to be positioned into the oral cavity) were
used.
• Disadvantages: Local soft tissue – tethering of tongue causing speech and swallowing
defects.

47. 2 primary sites for microvascularized bone:
1) Fibula – most common.
2) Iliac crest.
For posterior lateral defects only soft tissue MVFF’s can be used:
Sites – 1) Forearm, 2) Rectus muscle.
Mandibular malposition after bony reconstruction:
• Patients may present after bony reconstruction with residual deviation and rotation to the surgical
side.
• 2 reasons:
1) Minimal proximal mandible on the surgery side to attach bone graft.
2) Mandibular segments are not stabilized and maintained in their pre-operative relation to
each other during the grafting procedure.

48. Methods of recording denture space for the mandibulectomy
patient
• Shifman and Lepley (1982) (Marginal mandibulectomy) discussed a method
for fabrication of RP dentures for mandibulectomy patients with no flange or base.
They termed this approach as the neutral zone or ‘denture space’ concept.
• They supported this concept by quoting Fish (1933) who gave this concept, and
stressed on the importance of polished surface for the retention and stability of the
denture.

50. Cantor and Curtis (JPD 1971) – Swallowing technique (edentulous
patients)
• Primary (irreversible hydrocolloid) impression in modified stock
tray.
• Narrow area supported by bone and free of any muscular activity
drawn over the diagnostic cast.
• Perforated resin tray constructed over this.
• Two lateral columns that extend toward maxillary ridge constructed
over tray.
• Modeling compound stops placed under column tray for stability and
to provide space for impression material.
• Modeling compound is then added to the lateral columns, extending
them superiorly until firm bilateral contact is made with the
maxillary residual alveolar ridge.

51. • Lower part of oral cavity is filled with alginate impression material. It is made certain that
the sublingual space is filled.
• Column tray is then seated through hydrocolloid material until it is firmly seated on oral
mucosa.
• The mandible is then closed with the maxillary ridge seated against the columns and the
tongue in between them.
• At this point, the patient begins to swallow and between each swallowing cycle he
puckers his lips. This continues till the alginate sets.
• Because marginal mandibulectomy defects are narrow buccolingually, the width of the
retentive mesh needed for the framework is lacking. It is possible to place the acrylic resin
retentive elements of the framework in a vertical plane rather than horizontal.

52. Disjardens (JPD 1979)
• Gave the importance of occlusion as important factor, for stability of a prosthesis.
Continuity defects:
- Multiplicity of occlusal contacts in centric position.
- Long centric concept.
- Slightly decreased vertical dimension of occlusion.
- Group function on working cusps in eccentric position and no function on
balancing cusps in eccentric positions.

53. Discontinuity defects:
• Retaining of remaining mandibular muscles to provide acceptable maxillo-
mandibular relationship for repeatable occlusion.
• Debate exists whether to accept post-surgical mandibular position or to retain the
mandible to control its mediolateral position to prevent scar contracture.

54. Adisman (JPD 1962)
• Fabricated guide plane splints that were
used as postoperative inter maxillary
splints.
• After healing the fixed prosthesis was
replaced by a mandibular removable
partial denture guide plane.
• The RPD framework was made of cast
metal with an acrylic resin or heavy wire
loop that extended into the maxillary
mucobuccal fold.
• The extension functioned against the
maxillary posterior teeth and helped limit
degree of mandibular deviation.

55. Scanell (JPD 1968)
• Stated that a mandibular resection patient should be seen by the dentist within 7-
10 days.
• He noted that a corrective guide flange prosthesis inserted early could avoid later
difficulty in mandibular movement.

56. Swoope (JPD 1969)
• While treating edentulous mandibular resection patients formed a palatal ramp on
the maxillary denture to broaden the occlusal table and make it easier for the
patient to obtain stabilizing occlusal contacts.

57. Schaff (JPD 1976)
• Described a removable partial denture flange prosthesis for the patient with
remaining natural teeth.
• In partially edentulous patients if teeth are strong enough, a mandibular cast
removable partial denture flange prosthesis can be used to reduce mandibular
deviation.

58. Armany and Meyers (JPD 1977)
• Advocated use of inter maxillary fixation at the time of surgery for 5-7 weeks.
• For edentulous patients if mandibular deviation is observed after fixation is
removed, a guide flange prosthesis can be used until the patient returns to
intercuspal position.
Aramany MA, Myers EN. Intermaxillary fixation following mandibular resection. J Prosthet Dent. 1977 Apr;37(4):437-44.

59. Chalian et al (JPD 1979)
• Indicated that a guide plane prosthesis must be used if the resection includes the
body of the mandible, ramus and condyle. This prosthesis consists of a maxillary
and mandibular cast removable partial denture framework. A lower inverted U
shaped flange slides against a upper horizontal bar on the non-defect side.

60. Robinson and Rubright (JPD 1964)
• Described the use of mandibular guidance prosthesis. It was a removable partial
framework with a metal flange extending 7 to 10mm laterally and superiorly on
the buccal aspect of the bicuspids and molars on the nondefect side. This flange
engages the maxillary teeth during mandibular closure thereby directing the
mandible into appropriate intercuspal position.
J.E. Robinson, W.C. Rubright, Use of a guide plane for maintaining the residual fragment in partial or hemi-mandibulectomy, The Journal of Prosthetic Dentistry,
Volume 14, Issue 5, 1964, Pages 992-999, ISSN 0022-3913

61. Mandibular guide flange prosthesis
Features:
- Used as a training device till inter occlusal position can be attained.
- Due to strong lateral forces, palatal retainer provided to resist
palatal movement of maxillary teeth.
- Best positioned in 2nd premolar – 1st molar area.
- If used indefinitely constant monitoring required.
- Permits only vertical movements of mandible.
Patil, P. G., & Patil, S. P. (2011). Guide flange prosthesis for early management of reconstructed hemimandibulectomy: a case report. The journal of advanced prosthodontics, 3(3), 172–176.

62. Maxillary occlusal table
• In edentulous patients, maxillary occlusal table can provide an alternate surface
against which the natural or artificial teeth of the residual mandible can function
Koralakunte PR, Shamnur SN, Iynalli RV, Shivmurthy S. Prosthetic management of hemimandibulectomy patient with guiding plane and twin occlusion prosthesis. J Nat
Sc Biol Med 2015;6:449-53.

63. Maxillary inclined plane prosthesis (Desjardins)
- Used as training device.
- An acrylic resin ramp is given on the palatal incline of the non-affected side.
This is a functionally generated platform that slopes occlusally away from the
maxillary dentition and engages the remaining mandibular teeth as closure begins.
- The mandibular fragment is guided to a position of acceptable occlusion
through the path of this ramp.

64. Palatal augmentation prosthesis
• Considered if patients have residual food on the palate or in the sulci of the oral
cavity, complain of swallowing difficulties or have impaired speech sounds.
• In normal palate tongue relationship, palate cups around tongue at rest and in
function. The contours of the palatal augmentation should also cup the residual
tongue.
• In dental patients the occlusal vertical dimension will determine the thickness of
palatal augmentation. The thickness is increased until the tongue contacts the
palate in swallowing.

65. • Refinements in speech will evaluate the posterior contact of the palate (k sound).
• During speech air may leak laterally along the borders of the deviated tongue.
Slight addition of wax should be made to the augmentation to stop lateral air
escape during S sounds.
• Anterior contact for the ‘t’ and ‘d’ sound should be added at the anterior elevation
of the residual tongue which is the new functional tip.
• Tissue conditioner can be used for this purpose if the processing of the prosthesis
has already been completed.

66. Implant retained prosthesis
Nag, P. V. R., & Bhagwatkar, T. (2020). Prosthetic management of a hemimandibulectomy patient using
tilted implant protocol with 3-year follow-up. Journal of Indian Prosthodontic Society, 20(3), 326–330.

67. Gunning splint
• - Used in case of fracture of edentulous mandible.
• - Consists of 2 separate parts both having small metal hooks for inter
maxillary fixation.
• - The lower part is secured by circumferential wiring.
• - The maxillary and mandibular parts are then fixed together by inter
maxillary fixation.

68. Dharaskar, S., Athavale, S., & Kakade, D. (2014). Use of gunning splint for the treatment of edentulous mandibular fracture: a
case report. Journal of Indian Prosthodontic Society, 14(4), 415–418.

69. Summary and Conclusion
• Management of mandibular defects is one of the most challenging aspects of
maxillo-facial prosthetics. These defects affect not only function but also
appearance and thus the prosthodontist has to fulfill the dual responsibility of
restoring function and appearance.
• With the advent of advanced surgical and bone grafting techniques, satisfactory
prosthodontic prognosis can be achieved for such patients. However there are still
some inherent problems in these procedures which have not been completely
overcome.
• The prosthodontist should be able to efficiently plane and execute treatment
because the scope of patients with mandibular defects may vary form the
completely edentulous patient to the patient with few teeth remaining or patients
requiring implant supported prosthesis.

70. REFERENCES
• Ackerman AJ:- “The prosthodontic management of oral and facial defects” J
Prosthet Dent,1955;5:413-432.
• Aramany MA and Myers EN:- “Intermaxillary fixation following mandibular
resection” J Prosthet Dent,1977;37:437-443.
• Cantor R and Curtis TA:- “ Prosthetic management of edentulous
mandibulectomy patients - Part 1” J Prosthet Dent,1971;25:447- 455, Part 2- J
Prosthet Dent,1971;25:547-555, Part 3- J Prosthet Dent, 1971;25:671-678.
• Chalian VA :- “Maxillofacial prosthetics”
• Desjardins RP:- “ Occlusal considerations in partial mandibulectomy patients” J
Prosthet Dent,1979;41:308-311.

71. • Kelly EK:- “ Partial denture design applicable to the maxillofacial patient” J
Prosthet Dent,1965;15:168-173.
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• Scannell JB:- “Practical considerations in dental treatment of patients with head
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mandibulectomies” J Prosthet Dent,1976;36:292-297.
• Shifman A and Lepley JB:- “ Prosthodontic management of postsurgical soft
tissue deformities associated with marginal mandibulectomies J Prosthet
Dent,1982;48:178-183.
• Swoope CC:- “ Prosthetic management of resected edentulous mandibles” J
Prosthet Dent,1969;21:197-201.
• Taylor TD :- “Clinical maxillofacial prosthetics”,1st edition 2000.