Department of Prosthodontics, Government Dental College & Hospital, GMC Campus, Medical Square, Nagpur 440003, Maharashtra, India.
J Prosthodont Res. 2010 Oct;54(4):192-7. doi: 10.1016/j.jpor.2009.12.003. Epub 2010 Jan 18.
A patient who had undergone left segmental mandibulectomy reconstructed with an autogenous bone graft presented with the chief complaint of difficulty in eating and speaking. Intraoral examination revealed thick, freely movable soft tissues with scar formation, loss of alveolar ridge, and obliteration of buccal and lingual sulcus in the entire left half of mandibular region. When given the options of pre-prosthetic surgery and dental implants, patient refused to undergo an additional surgery and requested a non-surgical treatment option. Consequently, conventional complete denture therapy modified by neutral zone technique was undertaken.
Prosthetic rehabilitation of this patient was challenging due to inadequate amount of supporting tissues on the defect side resulting from cancer surgery. The fabrication procedure of the denture was carefully modified to achieve retention and stability. Tissue surface of the denture was relined with resilient liner, polished surface contours and tooth positioning were recorded with neutral zone technique and occlusal surfaces were modified to achieve balanced occlusion.
Conventional complete denture therapy with carefully recorded intaglio surface, cameo surface, and balanced occlusal surface can provide favorable retention and stability even though the denture bearing tissues are unfavorable especially in segmental mandibulectomy patients.
患者曾行左侧节段性下颌骨切除术并用自体骨移植重建,现主要诉咀嚼和说话困难。口腔检查显示整个左下颌区域有厚而可自由移动的软组织,有瘢痕形成,牙槽嵴丧失,颊沟和舌沟消失。当提供术前手术和种植牙的选择时,患者拒绝进行额外的手术,并要求选择非手术治疗方案。因此,采用中性区技术对常规全口义齿治疗进行了修改。
由于癌症手术后缺陷侧的支持组织量不足,该患者的修复治疗具有挑战性。义齿的制作过程经过仔细修改,以获得固位和稳定性。义齿组织面用弹性衬里重新衬里,用中性区技术记录表面轮廓和牙位,并修改咬合面以达到平衡咬合。
即使义齿承载组织不利,特别是在节段性下颌骨切除术患者中,仔细记录凹面、凸面和平衡咬合面的常规全口义齿治疗也可以提供良好的固位和稳定性。