the post-surgical prosthetic rehabilitation of a patient with squamous cell carcinoma faghrie meer...

The Post-Surgical Prosthetic Rehabilitation of

a Patient with Squamous Cell Carcinoma

Faghrie Meer

BTech Student in Dental Technology

Contents

Patient history Background and condition Clinical treatment options Technical treatment options Most desirable technical treatment

options

Contents…continued

Chosen technical treatment option

Laboratory procedures

Final placement

References

Patient History

68 years old

Female

Fair-skinned

Sun exposure

Fully edentulous

Patient History…continued

Main Complaint: Inability to wear lower denture

Dental Faculty

Squamous cell carcinoma in 3rd quadrant

Chin and alveolar ridge

Patient History…continued

April 2002- Fibula graft; Skin graft.

May 2002- Both plates broke.

June 2002 - Both plates removed and re-evaluated.

Patient History…continued

July 2002 - Thinning of skin flap.

Sept. 2002 - 2 implants inserted.

Oct. 2002 - Liposuction in chin area.

Background and Condition

Malignant epithelial tumour 1

Overgrowth of tissue cells

Destruction of living cells

Background and Condition…continued

Common and fatal if unrecognized 2

Favourable prognosis

Curable

Clinical Treatment Options

Two options:

a) Radiation or

b) Surgical removal

Radiation

• Highly contra-indicated: 1

1) Not precise

2) Oral sensitivity

3) Destruction of oral structures:

Radiation…continued

a) Dry oral cavity

b) Poor tissue healing

c) Difficulty in mastication

d) Difficulty in digestion

Surgical Removal

• Desired treatment option

• Cancer and healthy tissue removed2

• Growth initiation

Surgical Removal…continued

• Regular check-ups essential

• Unnoticed growth is fatal

Technical Treatment Options

Bar and clips attachment system

Technical Treatment Options…continued

Magnetic attachment system

Technical Treatment Options…continued

Ball attachment system

Most Desirable Technical Treatment Option

Bar and Clips Attachment System

Greatest retentive ability 3, 5, 6

Strong and rigid attachment Anti-corrosive clips Good load distribution

Chosen Technical Treatment Option

Ball Attachment System

Most cost-effective system 3, 4, 6

Accurate and repeatable denture placement

Satisfactory retention and stability

Ball Attachment System…continued

Maligned abutments not critical

Little space required

Better hygiene

Ease of fabrication

Magnquateetic Attachment System

Accurate clinical techniques Inadequate shear loads Discolouration Allergic reactions Loses retentive abilities

Laboratory Procedures

1° impressions

2° impressions

Surgical stent

Tissue integration

Laboratory Procedures…continued

Temporary mandibular denture

Phase 2 treatment plan

2° impressions

Permanent denture

Laboratory Procedures…continued

Female counterpart

Implant too far facially

Attachment selection difficult

Laboratory Procedures…continued

Molloplast-B

Flasked and processed

References

1) J. C. E. Underwood. Skin. General

and Systematic Pathology. 2nd ed. London: Churchill Livingstone. 1996: 764-765.

2) R. N. M. MacSween & K. Whaley.

Alimentary tract. Muir’s Textbook

of Pathology. 13th ed. London: Arnold. 1995: 680-681.

References…continued

3) H. W. Preiskel. Stud attachments and

magnets, Bar attachments.

Overdentures Made Easy: A Guide to

Implant and Root Supported

Prostheses. Berlin: Quintessence

Publishing Co Ltd. 1996: 81-89, 101-

108, 119-133.

References…continued

4) Guerra et al. Alternative retention for

an implant-retained prosthesis. Journal

Of Oral Implantology. 2002; 28(3): 117-120.

5) K. Bergstom. Anaplastological

technique for facial defects.

Osseointegration Anchorage Of

Craniofacial Prostheses. 1998: 101-106.

References…continued

6) E. J. Penn & R. P. Renner. Overdentures-an

overview for the general practitioner.

Quintessence Of Dental Technology. 1991; 14: 131-141.

Acknowledgements

Dr Van Zyl Prof. Morkel Mrs Nortje Mrs Wright Mr Steyn Mr Mazema Mr Lategan