Journal of Oral Implantology October 2013 - (Page 609)

CASE REPORT Rehabilitation of a Patient With Mandibular Resection Using Osteointegrated Implants: A Case Report Sema Murat, DDS, PhD* Ayhan Gurbuz, DDS, PhD Kivanc Kamburoglu, DDS, MSc, PhD This case report details a 65-year-old male patient who underwent mandibular resection and radiotherapy as treatment for squamous cell carcinoma of the right mandible. The patient was rehabilitated with an implantsupported fixed partial denture and a maxillary occlusal ramp. The patient has been wearing his prosthesis for 2 years with no complaints. Key Words: mandibular resection, tooth-implant connection, maxillary occlusal guide INTRODUCTION M anagement of malignant tumors of the tongue, floor of the mouth, mandible, and adjacent areas represents a challenge for the clinician. Resection of the site, together with large parts of surrounding structures and regional lymphatic tissue, is often required. However, this may result in impaired speech and articulation; difficulty in chewing and swallowing; retrusion and deviation of the mandible towards the surgical side, with altered movement due to loss of continuity of the mandible and motor and sensory deficiencies of the jaw and lower lip; compromised control of salivary secretions; facial asymmetry; and severe cosmetic disfigurement.1–3 Surgical treatment must often be combined with radiation therapy, which further worsens oral functioning. Opportunities for dental treatment are limited by the lack of tissue support following surgery, which tends to severely inhibit the stability and function of conventional dentures. Given the importance of avoiding unnecessary trauma to the mandible caused by mobile dentures and retaining healthy soft tissue coverage in order to prevent bone exposure and osteoradionecrosis, a fixed prosthesis may offer the best solution.2,4 One of the basic objectives of rehabilitation is to retrain the muscles for mandibular denture control and repeated occlusal approximation. Due to the unstable interocclusal relationship that results from lack of posterior support and vertical overlap, it is important to provide the patient with a mandibular positioning and guidance device to help establish an acceptable interocclusal relationship in centric occlusion and during lateral movement so as to improve mastication and mandibular function.4 However, neither reconstructive surgery nor conventional prosthodontic techniques have been able to address these problems successfully. A combination of appropriate reconstruction and implantsupported or implant-retained prosthodontics such as a tooth-implant supported fixed partial denture (FPD) may provide better oral rehabilitation in terms of both function and esthetics.4–6 This article describes the treatment sequence and considerations in the rehabilitation of a patient with an implant-supported fixed prosthesis together with a palatal guide ramp-positioning device following mandibular resection and radiation therapy. CLINICAL REPORT Ankara University, Ankara, Turkey. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-11-00150 A 65-year-old male patient was referred to the Ankara University Faculty of Dentistry with the chief Journal of Oral Implantology 609

Table of Contents for the Digital Edition of Journal of Oral Implantology October 2013

Food and Drug Administration: Reclassification of Blade Form Dental Implants
Optimizing Platelet-Rich Plasma Gel Formation by Varying Time and Gravitational Forces During Centrifugation
Effect of Surface Roughness and Low-Level Laser Therapy on Removal Torque of Implants Placed in Rat Femurs
Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part I: Comparison of Three Direct Methods
Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part II: Comparison of Four Acrylic Resins
A Pig Model for the Histomorphometric Evaluation of Hard Tissue Around Dental Implants
In Situ Tooth Replica Custom Implant: A 3-Dimensional Finite Element Stress and Strain Analysis
Influence of Different Soft Liners on Stress Distribution in Peri-Implant Bone Tissue During Healing Period. A 3D Finite Element Analysis
Influence of Surface Nano-Roughness on Osseointegration of Zirconia Implants in Rabbit Femur Heads Using Selective Infiltration Etching Technique
Modified Titanium Surfaces Alter Osteogenic Differentiation: A Comparative Microarray- Based Analysis of Human Mesenchymal Cell Response to Commercial Titanium Surfaces
Hemorrhage Secondary to Interforaminal Implant Surgery: Anatomical Considerations and Report of a Case
Rehabilitation of a Patient With Mandibular Resection Using Osteointegrated Implants: A Case Report
Two-Stage Bone Expansion Technique Using Spear-Shaped Implants Associated With Overlapped Flap: A Case Report
Implant Esthetic Restoration in Ridge Deficiencies in Cases of Trauma: A Case Report
Rehabilitation of the Atrophic Maxilla With Tilted Implants: Review of the Literature

Journal of Oral Implantology October 2013