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    55 Aquired Mandibular Defects Abo 2024 AST

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    55 Aquired Mandibular Defects Abo 2024 AST

    Uploaded by

    marymahmoud73737
    3 views22 pages

    Original Title

    55 Aquired Mandibular Defects Abo 2024 AST(2)

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    3 views22 pages

    55 Aquired Mandibular Defects Abo 2024 AST

    Uploaded by

    marymahmoud73737

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 22

    Acquired

    Mandibul
    ar
    Defects
    Dr. Abo Al- Mawaheb
    Lecturer of Prosthodontic
    Causes of Bony defects of the
    mandible

     Tumor resection
     Trauma
     Inflammatory disease
     Osteoradionecrosis
    Disabilities of mandibulectomy
    patients
    1. Impaired speech articulation
    2. Difficulty in swallowing
    3. Occlusion discrepancy
    4. Deviation of the mandible
    during functional movements
    5. Compromised control of
    salivary secretions
    6. disfigurement
    Predisposing factors of oral
    cancer
     The exact cause of oral cancer is
    unknown (carcinogenic initiator)
    1. Viruses
    2. Dentures
    3. Alcohol
    4. Tobacco
    5. Leukoplakia
    6. Oral lichen
    planus
    Classification of Mandibular
    Defects

    I. Cantor and Curtis classification


     Depend on extent of the defect and
    the method of reconstruction
    II. Second classification
    classify mandibular
    defects into two main
    groups
    1. Marginal resection
    2. Segmental resection
    Cantor and Curtis classification
    Class I: Radical alveolectomy
    with preservation of
    mandibular continuity
    Class II: Lateral resection distal
    to the cuspid area
    Class III: Lateral resection to
    the midline
    Class IV: Lateral bone graft and
    surgical
    reconstruction
    Class V: Anterior bone graft and
    surgical
    reconstruction
    Class VI: Anterior resection
    without surgical
    reconstruction
    Marginal resection

     It involves the alveolar bone


     The basal bone with the soft tissues
    are intact
     Mandibular continuity is retain
     The muscles of mastication are
    intact
     The mandibular movement is not
    Problems associated with alveolar
    resection
    1. Loss of vertical
    ridge height
    2. Loss of vestibular
    depth
    3. Loss of load
    bearing tissues
    available for
    support
    4. Tethered border
    tissues limit the
    Segmental Resection
     A complete resection of a
    segment of the mandible
    (mandibular discontinuity )
     the function of the
    remaining mandibular
    segment is severely
    compromised
     The mandible is deviated
    towards the resected side
     The mandibular occlusal
    plane is rotated inferiorly
    Problems associated with
    Segmental resection

    1. Facial
    disfigurement
    2. Loss of occlusal
    contact
    3. Loss of ability for
    lip approximation
    for proper
    salivary control
    Management of mandibular deviation
    I. Intermaxillary
    fixation
    II. Physio-therapy
    III. Mandibular
    guidance prosthesis
    A.Lower mandibular
    guidance prosthesis
    (Buccal training
    flange)
    B. Upper mandibular
    guidance prosthesis
    (Palatal ramp)
    Mandibular guidance prosthesis
     The earlier mandibular
    guidance therapy is
    initiated the more
    successful
     Presence of teeth is an
    important requirement
    for construction of
    guidance prosthesis
     All guidance prostheses
    considered as interim
    basis until acceptable
    occlusal relationships is
    re-established
    A.Lower mandibular guidance
    prosthesis
    (Buccal training flange)
     Indication
     When the mandible manipulated into an
    acceptable maxillomandibular
    relationship but the patient lacks the
    motor control to bring the mandible into
    occlusion
    Buccal training flange
     Design
    1. RPD framework with a metal flange
    extending 7 to 10 mm laterally and
    superiorly on the buccal side of the
    bicuspids, and molars on the non-defect
    side
    2. Flange engages the upper teeth during
    mandibular closure so directing the
    mandible into an intercuspal position
    B. Upper mandibular guidance
    prosthesis

    (Palatal ramp)
     Indication
     patients with severe
    mandibular deviation
    Palatal ramp

     Design
     Maxillary prosthesis
    constructed of acrylic resin
    with cast- or wrought-wire
    clasps
     The mandible is manipulated
    laterally toward the desired
    position
     The occlusal contact with
    the palatal prosthesis is
    established in a prepared
    acrylic resin index in the
    palate
    Palatal ramp
     Design
     This index is palatal to the
    maxillary teeth and the
    patient should be able to
    close into the index, using
    appropriate manual
    manipulation of the
    mandible.
     The index should not extend
    below the level of the
    maxillary teeth because if it
    does, it may interfere with
    speech, deglutition.
    Any
    Question…….. ?!

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