Alveolar osteotomy--splint design.
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Surgery for cancer of the floor of the mouth often results in alteration of the muscles of the tongue and floor of the mouth. Both primary and secondary surgical procedures often result in scar formation with reduced mobility of the tongue during speech and deglutition. Speech is often used as a diagnostic tool in the placement of the anterior teeth during fabrication of a prosthesis. Speech can similarly be used to help determine the proper placement of a speech portion of the prosthesis. The prosthetic rehabilitation approach described lowers the palatal vault with a false palate to enable the tongue to function against it during speech (Fig. 15). Group studies have shown that the design and fabrication of speech prostheses for partial glossectomy patients have significantly improved speech and swallowing for these patients. A speech pathologist is helpful during diagnosis, and speech therapy is necessary for significant speech improvement. Prosthetic rehabilitation alone cannot be expected to improve speech.
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Rehabilitation of patients with severe dental wear is a complex diagnostic and restorative problem. As wear occurs, space for restorative materials is lost, and unique treatment techniques are needed to provide good esthetics and function. Use of orthognathic surgery to reposition mandibular anterior teeth and supporting alveolar bone can create a more ideal environment for restorative procedures.
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Successful clinical applications since early 1970 have occurred with the use of temporomandibular condylar prosthesis and endosseous blade-vent implants coated with porous proplast. Proplast as a bulk material has also been used to augment atropic mandibular alveolar ridges and deficient facial contours in the mental, mandibular border, and zygomatic areas.
A histologic comparison of the effects of an ultrasonic instrument, a low-speed rotary cutting bur, and a surgical chisel, all used with water coolant, on the rate of healing of dog alveolar bone was made. After reflection of a mucoperiosteal flap, each instrument was used to produce a 3 by 3 by 2 mm. defect in buccal alveolar bone, 3 mm. apical to the alveolar crest and directly overlying the root structure of the right premolar teeth. Dogs were killed immediately following flap replacement with sutures and 3, 7, 14, 28, 56, and 90 days later. Histologic examination of the surgical areas revealed that the bur produced the smoothest surface. At day 3, specimens prepared with the chisel and the ultrasonic instrument exhibited areas of cellular organization along surfaces with the defect and the formation of osteoid in adjacent marrow spaces. At day 7, osteoblastic activity was most pronounced in specimens prepared with the chisel and least in those prepared with the bur. The subsequent rate of healing in later periods appeared histologically to be the best with the use of the chisel, followed closely by the use of the ultrasonic instrument, and the slowest with the bur, the order of which is consistent with the over-all microscopic evaluation of the effect of the three instruments.