Stabilising a planning guide in post-mandibulectomy prosthodontic rehabilitation.
Patients presenting with grafted reconstructions of the mandible often lack anatomical features that allow for the consistent placement of a diagnostic denture and planning guide. The mucosa covering the graft appears flat with no discernible ridge form. A method was therefore adapted to provide stability to a guide for the placement of implants. A diagnostic denture was constructed to the try-in stage and duplicated in clear acrylic, with radio-opaque markers placed into potential implant positions. Three mini-implants (Southern implants, Irene, SA) were then placed under local anaesthetic trans-mucosally into the bone graft at positions corresponding to teeth 46, 31 and 36. Access holes were created in the flanges of the diagnostic denture/planning guide to enable it to seat over the mini implant heads and to allow for final positioning. Auto-polymerising resin was then placed to cover each of these heads, thus stabilising the guide. The patient was then referred for a CT scan, to be taken with the planning guide in situ, and a surgical guide was made from the CT data, which also used the mini implants for orientation. At surgery, this ensured the optimal placement of the definitive implants, and the mini-implants could then be removed. This method thus provides enormous beneft to both the planning for, and the placement of, implants into grafted bone in mandibulectomy patients.
Department of Prosthodontics, School of Oral Health Science, Faculty of Health Sciences, University of the Witwatersrand.
H
H
Cachalia
D G
DG
Howes
C P
CP
Owen
D000180:Acrylic Resins / Q000737:chemistry; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003287:Contrast Media; D003758:Dental Implantation, Endosseous / Q000295:instrumentation*; D015921:Dental Implants; D003764:Dental Materials / Q000737:chemistry; D019094:Dental Prosthesis, Implant-Supported; D003779:Denture Design; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000534:rehabilitation*; D010027:Osteotomy / Q000379:methods; D010347:Patient Care Planning
D000180:Acrylic Resins; D003287:Contrast Media; D015921:Dental Implants; D003764:Dental Materials