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Treatment of a patient who requires a mandibular complete prosthesis opposing a natural maxillary dentition presents a unique set of problems for the clinician. Proper prosthodontic care can not only result in a functional and comfortable prosthesis, but may reduce the rate of resorption of the remaining mandibular ridge.
Inferior alveolar nerve lateralisation is a new technique. Mostly indicated in implantology, the techniques described are partial and located at the anterior part of the nerve, near the foramen mentalis. The authors describe a technique of total inferior alveolar nerve lateralisation, from the lingulae mandibulae to the foramen mentalis. Total lateralisation technique can be used in dental prosthesis (in mandibular posterior edentulism when the alveolar bone is reduced and when the prosthesis compresses the nerve in the foramen region), in implantology (when terminal implant restitution is needed), or in benign tumors (when the horizontal branch of the mandible is resected).
This report describes the provision of an implant-supported hybrid overdenture in an 8-year-old child with mandibular anodontia. An interdisciplinary approach to treatment planning was employed. Two implant fixtures were placed in the canine regions and ball attachments connected to provide support and retention for the prosthesis. There was only one implant-related complication during the first follow-up year. Close follow-up during the child's growing years is essential for the maintenance of the peri-implant tissues and to replace the prosthesis as mandibular growth occurs.
TMJ devices have been used for many years in reconstruction of the temporomandibular joint (TMJ). The most common endosseous implant currently used in TMJ reconstruction is a mini-anchor that is placed in the posterior head of the condyle to support artificial ligaments to stabilize the articular disk in the proper position. A 2-year follow-up study shows a success rate of 90% in reference to incisal opening jaw and occlusal stability, and significant reduction in presurgical pain level. Some materials that have been used in TMJ reconstruction, including Proplast-Teflon (PT) and Silastic devices, have caused devastating problems for patients. These materials, (particularly the PT) can cause severe foreign-body giant-cell reaction, severe bone and soft-tissue destruction, and migration of particles to other body areas, and may initiate or exacerbate connective tissue and autoimmune disease problems. Christensen joint prosthesis has been reported to have very good success in TMJ reconstruction. The most thoroughly studied TMJ total joint device is the Techmedica custom-made total joint prosthesis, with a 5-year follow-up study on 31 patients and 52 reconstructed joints. All patients have functioning prostheses with good jaw and occlusal stability and an average pain reduction of 4.4 points on a 0-to-10 visual analog pain scale. However, this device currently is unavailable. In complex cases requiring multiple TMJ operations, particularly those with previously failed alloplast, a custom-made total joint prosthesis, using materials with proven safety and efficacy in orthopedic joint reconstruction, may be the only option available to improve predictably the quality of life of these patients.
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An orthopedic treatment mode is described of patients with hemiresection of the lower jaw with the retention of several teeth on the residual fragment. A postresectional overdenture with telescopic fixation and leading buccal phalanges have been worked out upon the properly formed, capped and splinted supporting teeth. The good results from the treatment reveal that overdentures are indicated for maxillofacial prosthesis.
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A stainless steel wire mesh prosthesis was used as a primary mandibular replacement in 102 patients after resection of malignant neoplasms arising in the head and neck. In sixty-seven patients the prosthesis was considered successful. Failure of the host to tolerate the prosthesis was associated with a history of previous irradiation, extensive resections, and loss of distant skin flaps used for coverage of the prosthesis. We conclude that the wire mesh mandibular prosthesis is an excellent means to accomplish prompt functional and cosmetic reconstruction after mandibular loss and does not preclude the use of a more complex modality of reconstruction if the initial implant is removed.