Int Poster J Dent Oral Med 14 (2012), No. 1 15. Mar. 2012
Int Poster J Dent Oral Med 2012, Vol 14 No 1, Poster 585
Prosthetic Rehabilitation by Casted Denture with Modified Reducted Base Fabricated after Chemotherapy
Assist. Prof. Srdjan D. Postic, MSc., PhD.,
University of Belgrade, University School of Dental Medicine, Clinic of Dental Prosthetic, Belgrade, Serbia
27-30th October 2010
25th Congress of the International College for Maxillo-Facial-Surgery joint with 13th Congress of Serbian Association of Maxillofacial Surgeons and 2nd Meeting of Maxillofacial Surgeons of Balkan
Introduction. After completion of chemotherapy, the invent of prerequisites allow fabrication of denture and rehabilitation of occlusion and oro-facial system's function.
Case report. The patient N.L. aged 64 yrs., was inspected at the University Clinic of dental prosthetic in Belgrade. She submitted the confirmation on completion of chemotherapy, after removing of tumour.
The fabrication of partial casted denture was indicated in prosthetic therapy of the upper jaw. The denture was initially designed respecting remaining teeth in the upper jaw, with particularly designed base of the denture respecting shapes and form of palatal tissues (figures 1-6). Mastication, speech and swallowing were rehabilitated in this patient (figure 7). There were not pathologic changes in her mouth, at recall (figure 8).
|Fig. 1: After polishing casted framework was positioned in the mouth
||Fig. 2: Wax rims
|Fig. 3: Determination and verification of vertical dimension, established maxillo-mandibular jaw relation record and interocclusal relationship with wax-rim record
||Fig. 4: The try-in appointment and patient's acceptance of the arrangement of artificial teeth
|Fig. 5: The casted maxillary partial denture positioned in the mouth of a patient in oppening position
||Fig. 6: The casted maxillary partial denture in the mouth of a patient in occlusion
|Fig. 7: The casted maxillary partial denture in function of oro-facial system
|Fig. 8: Situation in a mouth in recall
In the significant number of cases breast cancers could expose metastasis to distanced bone hard tissues (1). A one of the bones in which metastases could develop are maxilla as well as mandible. Breast cancer's metastases in jaws stay on the consequences. Because of the presence of metastases, structure of a bone should be disordered, malignant osteoporosis is developing, and loosening of teeth could be accelerated.
Up-to now, significant number of breast cancers' metastases to bone could be medically treated (2-12). Before initiation of prosthetic-oral rehabilitation of patients of this kind it should have been important to focus two parameters: weather each hazard of tumours' recidivism could be pronounced, and what kind of medical therapy was conducted, or was conducting at the moment of initiation of oral cleanliness with prosthetic rehabilitation.
In this woman patient bisphosphonates were implicated within chemotherapy, in spite of the fact that in dental and medical literature some of the experts advocated different and certain unfavourable comments on bisphosphonate therapy of jaws (13-17). In the case of this woman patient, bisphosphonates showed very successful medication which influenced regularity of secondary mineralization of cancellous bone of her upper jaw. As the clinical result, fortifying of the remaining teeth in the jaw has happened.
Casted denture should have been considered in prosthetic therapy of this patient because of the reason that casted denture could have prevented loosening of teeth in the bone, and it could have reinforced the positions of the teeth after fortifying (figure 1 and figure 5).
Casted denture for the upper jaws should have been usually designed with massive and moderately extended palatal bar, or with anterior and posterior palatal bars (18-21). In the case of this woman patient palatal bar was significantly reduced and designed as much as anterior in position. This prevented redundant forces to previously changed structure of osseal palatal supporting tissue of her maxilla. Moreover it should have been free of Ni (nicle) to avoid inflammatory and allergic reactions o f supporting tissue and denture. For this patient Co-Cr-Mo alloy has been provided in the fabrication of the denture.
Fabrication of attachments and designing attachments in the casted denture for this woman patient seemed to be redundant and ineffectual.
Partial casted denture for upper jaw, when designed in accordance with shape of supporting tissues after chemotherapy, is successful mode of treatment of partially edentulous patients after surgery and removal of tumour.
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This Poster was submitted by Assist. Prof. Srdjan D. Postic, MSc., PhD..
Assist. Prof. Srdjan D. Postic
University of Belgrade
University School of Dental Medicine, Clinic of Dental Prosthetic