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CASE REPORT
Year : 2014  |  Volume : 3  |  Issue : 5  |  Page : 55-58

Prosthetic rehabilitation of maxillectomy patient with telescopic cast partial denture


Department of Prosthodontics, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Date of Web Publication10-Mar-2014

Correspondence Address:
Srujana Zakkula
Department of Prosthodontics, SIBAR Institute of Dental Sciences, Guntur - 522 509, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.128492

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  Abstract 

Surgical management of Benign or Malignant neoplasm, congenital malformations, maxillofacial trauma or neuromuscular disease would result in maxillofacial defects. The size and location of these defects influence the degree of impairment and difficulty in prosthetic rehabilitation. Lack of support, retention, and stability of the prosthesis are some of the common problems in maxillectomy patients. Apart from these, social integration also becomes difficult as the quality of their lives is altered. Retention of partial denture prosthesis in rehabilitation of maxillectomy patient has been an enigma for prosthodontist. However, a well-planned prosthesis fabricated in accordance to the designing principles, reinforced by knowledge and skill of the prosthodontist would result in prosthesis with improved retention and stability. This case report presents management of a female patient with hemimaxillectomy using a telescopic cast partial denture treatment modality that resulted in enhanced quality of life with optimal aesthetics and functional adequacy.

Keywords: Definitive obturator telescopic cast partial denture, maxillectomy, maxillofacial prosthesis


How to cite this article:
Manne P, Muvva SB, Zakkula S, Atla J. Prosthetic rehabilitation of maxillectomy patient with telescopic cast partial denture. J NTR Univ Health Sci 2014;3, Suppl S1:55-8

How to cite this URL:
Manne P, Muvva SB, Zakkula S, Atla J. Prosthetic rehabilitation of maxillectomy patient with telescopic cast partial denture. J NTR Univ Health Sci [serial online] 2014 [cited 2019 Nov 13];3, Suppl S1:55-8. Available from: http://www.jdrntruhs.org/text.asp?2014/3/5/55/128492


  Introduction Top


Surgical management of benign or malignant neoplasm, congenital malformations, maxillofacial trauma or neuromuscular disease would result in maxillofacial defects [1] compromising functions as well as esthetics of many patients that would lead to dwindling their quality-of-life. Obturator prosthesis for maxillectomy defects are frequently associated with problems such as traumatic functional occlusion, inadequate oronasal seal that result from lack of retention and stability. [2] In the present case, Aramany class IV maxillectomy defect [3] was treated with a complex partial denture incorporating telescoping crowns to improve the retention and stability of the prosthesis thus preserving health of remaining tissues.


  Case Report Top


A 52-year-old female reported to the out-patient unit of the Department of Prosthodontics complaining of difficulty in speech and nasal regurgitation. Medical records of the patient revealed that the patient had osteomyelitis of the right alveolus region and underwent hemimaxillectomy on the right side of the hard palate and alveolus region 1 year ago. Extraoral examination revealed gross facial asymmetry and inappropriate facial contours on the right side [Figure 1]. Intraoral examination revealed an intact mandibular dentition. The maxillary arch presented with very few remaining teeth that are 22, 23, 24, 25 and 27. The first quadrant of the maxillary arch presented an oval shaped defect of 2 × 1 × 1 inch size. The defect had an oro-nasal fistula in the posterior region of the hard palate [Figure 2]. The mandibular and maxillary teeth had generalized attrition. The teeth were evaluated clinically and radiographically for periodontal condition and they were found satisfactory.
Figure 1: Pre-operative photograph

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Figure 2: Pre-operative intraoral view (mirror image)

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Maxillary and mandibular irreversible hydrocolloid impressions were made taking care to block out undercuts with petrolatum laden gauze and an inter-occlusal record was taken. The impressions were poured with dental stone and the diagnostic models were mounted on a mean value articulator. A diagnostic surveying of the models was performed. Considering her functional and esthetic requirements, a telescopic denture for the maxillary arch was planned. Maxillary left permanent second pre-molar and second molar were used as telescopic retainers. Conventional I-bar clasp was planned on the maxillary left permanent lateral incisor. Conventional circumferential clasp was planned on the maxillary permanent left first pre-molar.

Tooth preparation was done by preparing a shoulder finish line as adequate reduction must be made in the gingival area to permit the double layer of alloy and the veneer to reside in physiologic harmony with the gingival tissue [Figure 3]. Following the designing principles mesial occlusal rest seat were prepared on maxillary permanent first pre-molar and Cingulum rest seats were prepared on the maxillary left lateral and canine. After the mouth preparation in the maxillary arch, gingival retraction was performed and a final impression was made with addition silicone using the putty wash technique. The first master model was prepared from the impression for fabrication of the primary copings. This was followed by making an interocclusal record and a face bow transfer. The wax patterns were prepared for the primary copings. The patterns were then casted in nickel chrome alloy in a conventional way. The primary copings were evaluated for fit [Figure 4] and the copings were luted with temporary cement (zinc oxide eugenol) and transfer impression was made using the medium viscosity addition silicone impression material [Figure 5] [4] and the second master model was made. This model was used for the fabrication of cast partial framework. Models with the copings were mounted on a semi-adjustable articulator using the same face bow record. Copings on the second model were milled with a parellelometer. The second master model along with the primary copings was duplicated and the refractory model was prepared. The cast partial framework with the secondary coping was waxed up, which was then cast using a cobalt-chrome alloy. The fit of the framework was evaluated intraorally [Figure 6]. This framework was used as a carrier for cementing the primary copings. The primary copings were evaluated for fit and the copings were luted with glass ionomer cement. Occlusal rim was prepared on the framework and vertical dimension was established. Centric and eccentric relation was recorded and transferred to the articulator for the arrangement of artificial teeth. The trial denture was checked intraorally. Patient's esthetics, functions were verified followed by the processing of maxillary denture [Figure 7] and the final prosthesis was inserted.
Figure 3: Prepared teeth to receive primary telescopic copings

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Figure 4: Evaluation of proper fit of primary copings

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Figure 5: Final impression made by transfer impression technique

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Figure 6: Metal try-in of cast partial framework

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Figure 7: Post-operative view

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  Discussion Top


Obtaining the normal facial contour, functional mastication, articulation and speech intelligibility during the prosthetic rehabilitation of a patient with Armany's class IV defect would be a challenging task. [5],[6] During the rehabilitation of such challenging cases, the obturator portion should be well-extended in to the defect area so that the resultant prosthesis will be retentive and stable enough and aids in holding the prosthesis intact. A stable and retentive prosthesis can better be achieved with adjunctive support of dental implants or natural teeth rather than conventional modalities in maxillectomy patients. [7] Support from the natural teeth was chosen for this patient rather than dental implants because of the compromised bone in the maxilla and poor economic status. Basic principle to be considered in such cases is preservation of health of the remaining teeth by not subjecting them to stress exceeding their physiologic limit. [8] Telescoping crowns, introduced in the 20 th century, proved to be more effective than conventional direct retainers for preserving health of the abutment teeth. They provide the best possible force distribution to the abutment teeth. [9] Telescoping refers to the use of a primary full coverage casting luted to the prepared tooth with a secondary casting, which is part of partial denture framework and is connected by means of interfacial surface tension over the primary casting. [10] The degree of retention can be planned to suit different situations by modifying the design of telescope crowns with internal Tach-E-Z springs. [4] The telescopic cast partial denture with well-extended hollow bulb obturator offered adequate retention. Satisfactory occlusion and stability was achieved and the prosthesis boosted up the patients confidence levels and also enhanced the esthetics.

 
  References Top

1.Carr AB, Brown DT. McCracken's Removable Partial Prosthodontics. 12 th ed.Mosby Elsevier Inc , missouri; 2012. p. 316-37.  Back to cited text no. 1
    
2.Taylor TD. Clinical Maxillofacial Prosthetics. Quintessence publishing co, Illinois; 2000; p. :205-14.  Back to cited text no. 2
    
3.Aramany MA. Basic principles of obturator design for partially edentulous patients. Part I: Classification. J Prosthet Dent 1978;40:554-7.  Back to cited text no. 3
    
4.Isaacson GO. Telescope crown retainers for removable partial dentures. J Prosthet Dent 1969;22:436-48.  Back to cited text no. 4
    
5.Fukuda M, Takahashi T, Nagai H, Iino M. Implant-supported edentulous maxillary obturators with milled bar attachments after maxillectomy. J Oral Maxillofac Surg 2004;62:799-805.  Back to cited text no. 5
    
6.Aydin C, Delilbaºi E, Yilmaz H, Karakoca S, Bal BT. Reconstruction of total maxillectomy defect with implant-retained obturator prosthesis. N Y State Dent J 2007;73:38-41.  Back to cited text no. 6
    
7.Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. Int J Oral Maxillofac Implants 1986;1:11-25.  Back to cited text no. 7
    
8.Kelly EK. Partial denture design applicable to the maxillofacial patient. J Prosthet Dent 1965;15:168-73.  Back to cited text no. 8
    
9.Langer A. Telescope retainers for removable partial dentures. J Prosthet Dent 1981;45:37-43.  Back to cited text no. 9
    
10.Weaver JD. Telescopic copings in restorative dentistry. J Prosthet Dent 1989;61:429-33.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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