Suganna M et al. Cantor and Curtis Class II Mandibular Defect.

Journal of Advanced Medical and Dental Sciences Research

@Society of Scientific Research and Studies
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr UGC approved journal no. 63854

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

CASE REPORT
Prosthodontic Rehabilitation of Cantor and Curtis Class II Mandibular Defect
using Cast Partial Denture Therapy: A Case Report
Mahesh Suganna1, Anuj Kumar Chowdhary2, Soumalya Banerjee3, Shivam Sulok4, Raushan Kumar5, Rafi Ahmed6
1
Prof and Head, 2-6P.G Student, Department of Prosthodontics, Crown and Bridge & Oral Implantology, Mithila Minority
Dental College and Hospital, (A Postgraduate Institute), Affiliated to L.N. Mithila University, Ekmi, laheriasarai,
Darbhanga - 846001, Bihar- India

ABSTRACT:
Surgical removal of tumors in mandible leads to discontinuity of bone. Loss of mandibular continuity causes deviation of remaining
mandibular segment towards the resected side and rotation inferiorly due to muscle pull and scar contracture affecting mastication and
esthetics. The resection can be total or segmental depending on the lesion. The restoration of the masticatory function is most important.
Cosmetic improvement is rarely sufficient to restore the patient’s face to the normal facial contour. Surgical reconstruction may not be
always possible. Thus Prosthetic rehabilitation plays a major role in these patients. Cast partial denture prosthesis for mandibular defects
is a permanent solution to mandibular deviations, as surgical reconstruction by implants and grafts is always not feasible in every patient.
This clinical report describes rehabilitation of Cantor and Curtis Class II Mandibular Defect using simple and most effective prosthesis,
Cast Partial Denture in economic constraints.
Keywords; Cantor and Curtis II, Hemimandibulectomy, Cast Partial Denture, Prosthetic Rehabilitation.

Received: 8 February, 2019 Revised: 27 February, 2019 Accepted: 28 February, 2019

Corresponding Author: Dr. Rafi Ahmed, P. G Student, Department of Prosthodontics, Crown and Bridge & Oral
Implantology, Mithila Minority Dental College and Hospital, (A Postgraduate Institute), Affiliated to L.N. Mithila
University, Ekmi, laheriasarai, Darbhanga - 846001, Bihar- India

This article may be cited as: Suganna M, Chowdhary AK, Banerjee S, Sulok S, Kumar R, Ahmed R. Prosthodontic
Rehabilitation of Cantor and Curtis Class II Mandibular Defect using Cast Partial Denture Therapy: A Case Report. J Adv
Med Dent Scie Res 2019;7(4): 26-29.

INTRODUCTION resected which leads to deviation of the residual fragment

Mandibular defects resulting from ablative tumour surgery towards the surgical site apart from the other disturbances.
can lead to functional disturbance in deglutition, speech, A classification of mandibular defects has been described
and patient psychology1.Restoration of form, function and by Cantor and Curtis. Although the classification system is
esthetics in a patient who has undergone hemi suggested primarily for edentulous patients, it is also
mandibulectomy is a valuable service, and pose a challenge applicable to partially edentulous patients. This system
for the prosthodontist. The prosthodontic treatment classifies defects based on remaining structures.
outcome is often unpredictable and restoration of esthetics
provides patient with marked self-confidence and Improves CANTOR AND CURTIS CLASSIFICATION4 (Figure
and restores normal occlusion to the patient. 1)
Mandibular defects can be classified into continuity and Class I: Mandibular resection involving alveolar defect
discontinuity defects2.Loss of continuity of the mandible with preservation of mandibular continuity.
destroys the balance and symmetry of mandibular function, Class II: Resection defects involve loss of mandibular
leading to altered mandibular movements3. and in continuity distal to the canine area.
Discontinuity defects the entire segment of the mandible is Class III: Resection defect involves loss up to the
mandibular midline region.

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Suganna M et al. Cantor and Curtis Class II Mandibular Defect.

Class IV: Resection defect involves the lateral aspect of revealed missing right mandible from distal to canine to the
the mandible, but are augmented to maintain pseudo condyle along with severe deviation of the mandible
articulation of bone and soft tissues in the region of the towards the resected site with lack of proper contact
ascending ramus. between maxillary and mandibular teeth. An
Class V: Resection defect involves the symphysis and orthopantomogram (OPG) [Figure:2] revealed Titanium
para-symphysis region only, augmented to preserve reconstruction plate was used to reconstruct and give
bilateral temporomandibular articulations. proper shape to the affected side of the mandible. An
Class VI: Similar to class V, except that the mandibular extraoral examination showed facial asymmetry, concave
continuity is not restored. profile and ovoid face [Figure: 3]. Based on the clinical
situation, a Cast partial removable partial denture was
planned.
Impressions was made and a guide Flange Prosthesis
[Figure: 4] was fabricated and delivered to the patient that
had to be used for two to three weeks for the correction of
the deviation of the mandible.
In the next appointment impression was made and
diagnostic casts were prepared. Initial survey of diagnostic
cast was performed and mouth preparation was done
following which the final impression was made using
polyvinyl siloxane impression material. The cast was
subjected to scanning for fabrication of CPD frame work
using CAD CAM technology [Figure: 5].
The design was completed and milling was carried out. The
finished metal framework was tried in patient’s mouth for
fit and finish [Figure: 6]. The framework was also carefully
evaluated for any interferences by hard and soft tissue in
the oral cavity. Further, Jaw relation, try-in of denture and
acrylisation procedures was carried out and finally the Cast
Partial Denture was made ready for delivery to patient.
Figure 1: CANTOR AND CURTIS CLASSIFICATION Tissue surface was relined with soft-liner prior to final
delivery, Prosthesis was checked for comfort, masticatory
efficiency and buccal fullness and instructed about the
CASE REPORT:
A 36 yrs old male reported to the department of insertion and removal of the prosthesis. Daily oral hygiene
prosthodontics with Chief complaint of loss of teeth and instruction was reinforced. After the initial period of
difficulty in eating food due to missing teeth in lower right postinsertion adjustment, follow-up appointments were
teeth region of the jaw. Past dental history revealed that he scheduled. The patient reported improvement in speech
was diagnosed with benign growth in the right side of the quality and mastication in the subsequent appointments.
mandible. The patient underwent with segmental [Figure: 7].
mandibulectomy 6 months ago.Clinical examination

Figure 2: An orthopantomogram (OPG)

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Suganna M et al. Cantor and Curtis Class II Mandibular Defect.

Figure 3: Extraoral examination showed facial asymmetry, Figure 6: Finished metal framework
concave profile and ovoid face

Figure 4: Guide Flange Prosthesis

Figure 7: Follow-up

DISCUSSION
The patient discussed in this case report had resection of
mandible on the right side involving the dentition distal to
canine. It may be discussed as the class II situation as per
Cantor and Curtis classification. Following resection of
mandible, the part of the bony mandible and teeth that
Figure 5: Fabrication of CPD frame work using CAD CAM remains has to articulate with normal structures of maxilla.
When a part of mandible has been resected, the movements

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Suganna M et al. Cantor and Curtis Class II Mandibular Defect.

of the mandible in the functional range and occlusal

proprioception differ from that of movements and CONCLUSION
occlusion of the normal mandible. The remaining Under the light of above mentioned data, it can be
mandibular segment retrudes and deviates towards the concluded that fabrication of cast partial denture is a
surgical site. On opening the mouth, the deviation goodtreatment option in rehabilitation of patients who have
increases, leading to an angular pathway of opening and undergone hemi mandibulectomy due to various reasons. It
closing. The mandibular surgical resection also appears to be the most effective and least expensive
significantly alters the maximum occlusal force5 and treatment procedures in economic constraints. However;
masticatory performance seems to improve with further studies in future are recommended.
prosthodontic rehabilitation6. Several prosthesis have been
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Source of support: Nil Conflict of interest: None declared

This work is licensed under CC BY: Creative Commons Attribution 3.0 License.

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