Occlusal considerations for the partial mandibulectomy patient.

The occlusal scheme fabricated for a patient with a mandibular defect varies extensively from patient to patient, with some limitations in occlusal efficiency. Some patients may expect little or no occlusal efficiency if the defect is large and if the associated mandibular deviation and the lack of muscle control and excessive. If the continuity of the mandible can be restored by secondary surgical management (Fig. 10, A), most of the problems of the discontinuity defect can be resolved. Whether the teeth in the region of the defect are replaced or not may be dependent on other factors, but the mandible can be treated as a stable entity within itself, and the prosthodontic approach can be similar to that discussed for the continuity defect (Fig. 10, B). The mandibulectomy patient is difficult to manage because the prosthodontist is limited in his ability to provide a reasonable and practical occlusal scheme. However, these patients need the definitive clinical and psychological support of the prosthodontist. Most patients recognize the limitations of their rehabilitation and are appreciative of the prosthodontic therapy that enhances their rehabilitative progress.