Under the guidance of

Presented by Dr. SI Joephin soundar Rajas dental college

Tirunelveli dist

My sincere thanks to :- Dr. Suneetha Jain, MDS, Professor & HOD,

Dr. Dadu George MDS, Dr. Paulin vijayaChandran MDS,
Dr. Somasundaran MDS, Dr. Arthi MDS, Dr. Lin Kovoor MDS,
Dr. TC Giri, Dr. Jude Sudhakar MDS, Dr. Ramesh MDS.
INTRODUCTION

Loss of continuity of the mandible destroys the balance and symmetry of

mandibular function, leading to altered mandibular movements, facial
asymmetry, malocclusion and deviation of the residual fragment towards the
surgical side. This clinical report gives a brief review of prosthetic
management of hemimandibulectomy patient, that foresees using only one
device both for corrective mandibular movement therapy and masticatory
function.
 METHODS REDUCE OR ELIMINATE
MANDIBULAR DEVIATION

use of An implant
palatally-
mandibularly- supported fi
intermaxillary based
based xed prosthesis
fixation guidance
guidance if bone graft
restorations
restorations, are used

For best results, these methods and restorations should be combined with a well
organized mandibular exercise regimen.
 Objective of rehabilitation

To re-educate the mandibular muscle to reestablish an acceptable occlusal

relationship.

Total rehabilitation physically as well as psychologically.

 CLINICAL REPORT

A 30 year old male patient named Vivekanandan

reported to Department of Prosthodontics with
difficulty in speech, mastication, mandibular
deviation shifting towards right side. His past
medical history revealed he underwent
hemimandibulectomy in the right side due to
ameloblastoma.
 CLINICAL REPORT

Intraoral view of patient CT scan portraying Fragments of mandible

with Ameloblastoma Ameloblastoma after segmental resection
Patient with difficulty in speech with mandibular deviation shifting towards the
right side 2 weeks after surgery
 The mandibular defect was classified as Cantor and Curtis Class II
(ie) Resection defects involve loss of mandibular continuity distal to the canine area
Diagnostic cast taken for further diagnosis & treatment planning
 Treatment plan

The success of mandibular guidance therapy depends on early

initiation of the same.

Normally, patients can use a guide flange device all day

except for night and meals.

Here only one mandibular prosthesis can be used both for

physiotherapy and eating, by simply inserting and removing
the guide flange.

Precision attachment were inserted into the buccal side of

cast partial denture with their patrix and the corresponding
matrixes were inserted into the guide flange.
Putty-wash Impression made for mandibular arch after tooth
preparation done to receive cast-partial framework
Designing with Wax pattern for cast partial framework with precision attachment.
Cast partial framework with Precision Attachment

Framework Precision attachment

Bite registration taken with cast partial framework & precision attachment
in patients mouth
 Articulation done on WHIPMIX
articulator done with framework
placed on cast

Definitive resin splint

made on Dentulous side

Edentulous side replaced

with acrylic teeth
Cast partial framework with
precision attachment self-
cured with tooth color acrylic
resin (guiding flange)
Guiding flange in patients mouth to guide him into centric occlusion after
acrylization
INTRAORAL VIEW

Without guide flange

With guideflange
 ADVANTAGE

Total rehabilitation physically as

well as psychologically.

Comfortable to wear also without

guide flange inserted.

Functional for patients disease so

that expected results are
obtained.

Easy to make and repair

Easy to clean
Disadvantage

Cost of precision attachment

 Conclusion

The prosthetic rehabilitation was done to correct mandibular

deviation. Bar-type precision attachment was fabricated with
cast partial framework where their male part, corresponding
female part inserted into the guide flange. This mandibular
prosthesis can be used both for physiotherapy and eating by
simply inserting and removing the guide flange.
Thank you