Reconstruction of the Mandible with a Fixed Implant Supported Prosthesis

A. S. Jochelson

In Partial Fulfilment of BTech: Dental Technology

Department of Dental Sciences

Tygerberg Campus

CPUT

2007

CONTENTS

Patient history

Odontogenic myxomas

Clinical history

Technical history

Reasons for choice of acrylic bridge

Problems encountered

Future treatment plan

Conclusion

References

Acknowledgements

PATIENT HISTORY

25 year old female

Rare non-capsulated benign tumour1

Misdiagnosis, tumour became worse

Panoramic radiograph and biopsy

Odontogenic myxoma of the mesenchymal tissue2

Fourth quadrant

Referred to dental faculty, UWC, Tygerberg hospital

RADIOGRAPH OF ODONTOGENIC MYXOMA

Faculty of Dentistry UWC

Radiograph of the odontogenic myxoma

ODONTOGENIC MYXOMAS

Odontogenic Myxoma, Thomas and Goldman, 19473

Slow growing, locally invasive lesion2

Do not metastisise4

Involves mandible4

Patients between ages of 20 and 402

Reports show predilection to females5

Presents as pain, diasthesia, ulcerations, tooth mobility6

Initiates in dental papilla, follicles, or periodontal ligaments2

Uni-or multioccular radiolucency, “soap bubble” appearance3

CLINICAL HISTORY

Treatment started in, 2005

20/04/2005, right hemi-mandibulectomy

Fibula free flap, reconstruction of mandible7

6 month healing period

Stent fabricated, 4 externally hexed implants placed

Healing abutments, March 20068

REMOVAL OF DISEASED BONE

Faculty of Dentistry UWC

RADIOGRAPH OF MANDIBLE AFTER FIBULA FREE FLAP

Faculty of Dentistry UWC

HEALING ABUTMENTS

Faculty of Dentistry UWC

TECHNICAL HISTORY

24/04/2006, impressions taken, 2 treatment options

Fixed acrylic bridge, fixed ceramic bridge9

13/06/2006 to 15/08/2006, 3 substructures tried in

None achieved a passive fit

17/08/2006, laser welded substructure tried in

passive fit not achieved

Set-up was done

Acrylic bridge processed, polished, placed in patients mouth

Temporary fixed appliance

REASONS FOR CHOICE OF APPLIANCE

Lack of space, distortion, long span substructure

Lower cost than fixed ceramic bridge9

Manufacturing process less complicated and time consuming10

No distortion, no firing cycles, creep of metal11,12

Substructure, titanium screws can be re-used10

Mandibular teeth not as visible

PROBLEMS ENCOUNTERED

Metal substructure, no passivity

Substructure sectioned, 3 parts

Seated and joined, non-shrinkage acrylic

FUTURE TREATMENT PLAN

Decided future treatment plan similar

Submucosal abutments change to transmucosal abutments

Advantage: implant abutment junction, gingival level

Access for better oral hygiene

Cementation, could achieve passive fit

CONCLUSION

Predicted success rate high

Success with previous treatment plan

Previous student, acceptable results, no passivity

May be overcome with future treatment plan

Could not provide necessary treatment

Case will be taken further, numerous improvements

Patient satisfied and grateful

REFERENCES

1.1. Dezotti MSG, Azevedo BJ, Fontao FNGK, Capelozza Dezotti MSG, Azevedo BJ, Fontao FNGK, Capelozza ALA, Sant’ana E. Odontogenic Myxoma – A Case ALA, Sant’ana E. Odontogenic Myxoma – A Case Report and Clinico – Radiographic Study of Seven Report and Clinico – Radiographic Study of Seven Tumours. The Journal of Contemporary Dental Tumours. The Journal of Contemporary Dental Practice.2006; 7(1): 2.Practice.2006; 7(1): 2.

2.2. Simon ENM, Merkx MAW, Stoelinga PWJ. Simon ENM, Merkx MAW, Stoelinga PWJ. Odontogenic Myxoma: a Clinico – pathological study Odontogenic Myxoma: a Clinico – pathological study of 33 cases. International Journal of Oral and of 33 cases. International Journal of Oral and Maxillofacial Surgery.2004: 1.Maxillofacial Surgery.2004: 1.

REFERENCES (Cont.)

3. Noffke CEE, Raubenheimer EJ, Chabikuli NJ, Michael. Odontogenic myxoma: review of the literature and report of 30 cases from South Africa. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2007; 104: 101

4. Spencer KR, Smith A. Odontogenic Myxoma: Case Report with Reconstructive Considerations. Australian Detnal Journal. 1998; 43(4): 1.

5. Slootweg PJ, Witkamp ??. Myxoma of the Jaws. An anylasis of 50 cases. Journal of maxillofacial Surgery. 1986; 14: 46-52

REFERENCES (Cont.)

6. Khogare S, Deshpande MD, Malik NA. Odontogenic Myxoma:A Case Study. International Journal Of Oral and Maxillofacial Surgery 2007;16: 107.

7. Smolka K, Kraehenbuehl M, Eggensperger N, Hallrmann W, Thoren H, Iizuka T, Smolka W. Fibula free flap reconstruction of the mandible in cancer patients: Evaluation of a combined surgical and prosthodontic treatment conceptOral Oncology 2007: 1-3, 5, 8, 9

8. Rosentiel SF, Land MF, Fujimoto J. Contoemporary fixed prosthodontics, 4th ed. Missouri, Mosby Inc. 2006: 426

REFERENCES (Cont.)

9. Pagniano R. Bridges, Advantages and Disadvantages of Fixed Bridges [online]. Available:http://www.dublindentalcare.gomaker.com/page/page/1655218.htm#Bridges

10.Tipton P. Bridge Desgn: Full Arch Implant-supported Porcelain-fused-to-metal Bridgework. Dentistry South Africa. 2002; May/June:50-52

11.Hostede TM, Ercoli C, Hagan ME. Alternative complete-arch cement-retained implant-supported fixed partial denture, The Journal of Prosthetic Dentistry. 1999;82: 94-99

12.Bryant RA, Nicholls JI. Measurement of distortion of fixed partial dentures resulting fro degassing. Journal of prosthetic Dentistry. 1979; 42: 515

ACKNOWLEDGEMENTS

Dr. Z Patel

Ms. Z Norjte

Mr. LA Steyn

Mr. W Spencer