RESUMEN
This clinical report describes the prosthetic management of occlusion for a patient who had received condylar resection as part of cancer treatment. Previous reports have identified that patients with unrepaired segmental resection of the mandible experienced a frontal plane rotation of the mandible toward the nonsurgical side. In contrast, because of preservation of temporomandibular muscles and their attachments, the mandible rotated toward the surgical side, and occlusal contacts were limited to a pair of molars on that side. Manual manipulation and instructions for muscular stretching and massages were provided to reduce muscular tension. A mandibular guidance prosthesis was fabricated and gradually adjusted to guide the mandible progressively toward a normal position. These treatments helped improve general comfort, mastication, occlusion, and the gradual rotation of the mandible toward a normal position.
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Custom intraoral radiation devices protect normal tissues, minimizing the adverse effects of radiation therapy. These devices also help immobilize the target by placing the patient's head in a precise, repeatable position. This clinical report describes the fabrication and benefits of a modified mouth opening, tongue depressing radiation stent with bilabial protrusion of the lips that was used in proton radiation therapy for a malignancy of the upper lip.
Asunto(s)
Terapia de Protones , Protones , Humanos , Lengua , Labio , StentsRESUMEN
This clinical report describes the successful prosthetic rehabilitation of a deficient lower lip in an edentulous patient who had undergone surgery for removal of a squamous cell carcinoma of the anterior floor of the mouth and vestibule. The rehabilitation used a combined approach of an extraoral lip prosthesis joined by 3 magnets to an intraoral implant-retained mandibular resection prosthesis. The outcome demonstrated rehabilitation of the lower third of the face by eliminating loss of fluids and by improving the facial profile, lip contour and competence, esthetics, the patient's eating ability, speech intelligibility, and reported quality of life.
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Implantes Dentales , Neoplasias de la Boca , Humanos , Labio/cirugía , Calidad de Vida , Suelo de la Boca/cirugía , Estética Dental , Neoplasias de la Boca/cirugíaRESUMEN
The rehabilitation of a patient with a total glossectomy with a prosthetic device is challenging and depends on the individual patient. Ablation of a tongue tumor leaves defects that can be either surgically reconstructed or replaced by a prosthesis to help recreate normalcy and balance in the oral cavity. This clinical report describes a prosthetic design to rehabilitate a patient after a total glossectomy. This approach successfully recreated the glossal surface with a soft, hollow, depressible structure that emulates the tongue during speech and a solid structure to facilitate swallowing. The components were joined by magnets.
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Implantes Dentales , Neoplasias de la Lengua , Glosectomía/rehabilitación , Humanos , Suelo de la Boca/cirugía , Lengua/cirugía , Neoplasias de la Lengua/cirugíaRESUMEN
Clinical challenges occur when treating patients with maxillofacial defects with digital technology. This report describes a technique that combines intraoral scanning to fabricate a milled record base along with the conventional processing to fabricate a definitive maxillary obturator prosthesis.
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Diseño Asistido por Computadora , Prótesis Maxilofacial , Técnica de Impresión Dental , Diseño de Prótesis Dental , HumanosRESUMEN
PURPOSE: Many head and neck cancer patients who receive radiation therapy experience radiation-induced dysgeusia (RID), which has no standard treatment. The only supplement controlled clinical trials have evaluated for the treatment of RID is zinc. However, the results of these and other studies investigating the use of zinc for RID have been inconsistent. To assess the validity of zinc as a treatment for RID, we conducted a systematic literature search and performed a meta-analysis to determine the extent to which zinc affects RID incidence and the degree to which ongoing RID responds to zinc. METHODS: We searched the Ovid MEDLINE, Ovid Embase, PubMed, and Cochrane Library databases to identify studies investigating the use of zinc-based therapy for RID in head and neck cancer patients treated with radiation that were published between January 1, 2003, and November 9, 2017. Using American Society of Clinical Oncology criteria, we selected studies with a high level of evidence for inclusion in the meta-analysis. RESULTS: Of the 32 full-text articles eligible for inclusion, three were included in the final review and meta-analysis. The meta-analysis showed that, compared with placebo, zinc reduces the incidence of RID (risk ratio, 0.72; 95% confidence interval, 0.67-0.92) but does not improve taste acuity more rapidly following radiation therapy (risk ratio, 2.58; 95% confidence interval, 0.97-6.88). CONCLUSION: Our findings indicate that zinc-based therapy reduces the incidence of RID but has a minimal effect on ongoing RID. Our findings also highlight the need for additional evidence-based research on this topic.
Asunto(s)
Disgeusia/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Traumatismos por Radiación/tratamiento farmacológico , Zinc/uso terapéutico , Estudios de Casos y Controles , Estudios Transversales , Disgeusia/etiología , Humanos , Estudios Longitudinales , Estudios Prospectivos , Traumatismos por Radiación/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Zinc/farmacologíaRESUMEN
Patients who have undergone a bilateral maxillectomy are particularly difficult to rehabilitate prosthetically by using a conventional obturator prosthesis, mainly because of the extensive loss of tissues for retention and support. In these situations, adapting to existing undercuts within the defect is essential. Traditional impression techniques capture certain anatomic landmarks but may fall short of the needed sinus undercuts. This article describes an alternative impression technique for capturing 3 opposing undercuts to help retain, support, and stabilize a hollow 1-piece obturator prosthesis for a patient who underwent a total maxillectomy.
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Diseño de Prótesis Dental , Obturadores Palatinos , Humanos , MaxilarRESUMEN
This clinical report describes the prosthodontic rehabilitation of a 22-year-old woman with a substantial treatment history of Ewing sarcoma of the left maxillary sinus. The patient was diagnosed with Ewing sarcoma at the age of 7 years and went through chemotherapy, radiation, surgical resection, and free-flap reconstruction, initially without prosthodontic rehabilitation. The patient aged 22 years was referred to the oral oncology clinic at The University of Texas MD Anderson Cancer Center for prosthodontic treatment. The patient's prosthetic rehabilitation with dental implants and a definitive maxillary obturator prosthesis is presented in detail.
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Implantes Dentales , Sarcoma de Ewing , Adulto , Prótesis Dental de Soporte Implantado , Femenino , Humanos , Maxilar , Seno Maxilar , Prostodoncia , Adulto JovenRESUMEN
This report describes a case of osteonecrosis of the jaw developing after a routine dental extraction in a patient being treated with dasatinib, a tyrosine kinase inhibitor, for chronic myelogenous leukemia. As the role of tyrosine kinase inhibitors in cancer treatment expands, patterns of debilitating complications involving the osseous structures of the oral cavity have begun to emerge, and many long-term side effects of this promising therapy remain unknown. To limit the occurrence of known complications, health care providers and patients must be aware of the potential for serious complications of dasatinib, and appropriate protocols should be in place before administration of this medication.
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Dasatinib/efectos adversos , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Enfermedades Mandibulares/inducido químicamente , Osteonecrosis/inducido químicamente , Inhibidores de Proteínas Quinasas/efectos adversos , Anciano , Antibacterianos/administración & dosificación , Doxiciclina/administración & dosificación , Femenino , Humanos , Enfermedades Mandibulares/tratamiento farmacológico , Enfermedades Mandibulares/microbiología , Osteonecrosis/tratamiento farmacológico , Osteonecrosis/microbiología , Irrigación TerapéuticaRESUMEN
This report describes the prosthetic management of a fractured Dolder bar on a transmandibular implant system. The patient declined surgical removal of the implants. Therefore, to repair the superstructure, a cast Dolder bar was fabricated and luted onto the existing transmandibular implants. An implant-retained bar overdenture was then fabricated to rehabilitate the mandibular arch.
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Prótesis Dental de Soporte Implantado , Diseño de Dentadura , Anciano de 80 o más Años , Técnica de Impresión Dental , Fracaso de la Restauración Dental , Retención de Dentadura , Dentadura Completa Superior , Prótesis de Recubrimiento , Femenino , HumanosRESUMEN
Customized intraoral devices help the radiation oncologist minimize the adverse effects of radiation and maximize the tumor control rate by keeping the anatomic structures in a consistent position during each fraction of radiation treatment. This article illustrates the fabrication of a bolus-type positioning device for a combined intraoral/extraoral defect treated with proton radiation therapy.
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Terapia de Protones/instrumentación , Stents , Proceso Alveolar , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Diseño de Prótesis Dental , Humanos , Masculino , Neoplasias Mandibulares/radioterapia , Neoplasias Mandibulares/terapia , Persona de Mediana Edad , Terapia de Protones/métodosRESUMEN
This clinical report describes the fabrication of an implant-supported and magnet-retained combination oral-nasal prosthesis for a patient with a midline midfacial defect. The patient had undergone a total rhinectomy and partial maxillectomy as part of his cancer treatment. The nasal prosthesis was retained on the face by a magnet attached to the implant-supported maxillary denture, resulting in improved appearance and the recovery of speech, mastication, and swallowing functions.
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Prótesis Dental de Soporte Implantado , Maxilar/cirugía , Prótesis Maxilofacial , Nariz/cirugía , Prótesis Dental de Soporte Implantado/métodos , Humanos , Imanes , Masculino , Neoplasias Maxilares/rehabilitación , Neoplasias Maxilares/cirugía , Persona de Mediana Edad , Neoplasias Nasales/rehabilitación , Neoplasias Nasales/cirugía , Diseño de PrótesisRESUMEN
This clinical report presents the reconstruction of a maxillary arch with a cement retained implant supported fixed prosthesis using a monolithic zirconia generated by CAD/CAM system on eight osseointegrated implants. The prosthesis was copy milled from an interim prosthesis minimizing occlusal adjustments on the definitive prosthesis at the time of delivery. Monolithic zirconia provides high esthetics and reduces the number of metal alloys used in the oral cavity.
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This article introduces a procedure that allows the clinician to verify the 3-dimensional spatial orientations of implant analogs in the definitive cast for a cement-retained, implant-supported prosthesis with engaging abutments. Multiple interlocking puzzle pieces are used with engaging interim abutments to verify the accuracy of the impression.
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Implantes Dentales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Modelos Dentales , Resinas Acrílicas/química , Pilares Dentales , Cementos Dentales/química , Diseño de Implante Dental-Pilar , Técnica de Impresión Dental/instrumentación , Materiales Dentales/química , Humanos , Polimerizacion , Titanio/químicaRESUMEN
Injuries to the ear can result in partial or complete loss of the external ear. Resection of the external ear may be necessary secondary to malignant tumor or infection. This article discusses the diagnosis and management of acquired defects of the external ear. Because autogenous reconstruction is not always possible, both autogenous and prosthetic reconstruction are presented as well as the indications for both. This information should help guide the clinician in the decision-making process. In the hands of experienced clinicians, reconstruction of the external ear can result in an excellent outcome, with improved quality of life for the patient.
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Deformidades Adquiridas del Oído/cirugía , Oído Externo/lesiones , Oído Externo/cirugía , Procedimientos de Cirugía Plástica/métodos , Prótesis e Implantes , Cartílago/trasplante , Diseño Asistido por Computadora , Precisión de la Medición Dimensional , Neoplasias del Oído/cirugía , Oído Externo/anatomía & histología , Humanos , Diseño de Prótesis , Retención de la Prótesis/instrumentación , Elastómeros de Silicona , Trasplante de Piel , Colgajos QuirúrgicosRESUMEN
The transfer of composite tissue flaps by microvascular techniques has become the standard for reconstructing complex defects of the oral and maxillofacial regions. Despite advances in these techniques, sites reconstructed by free tissue transfer (free flaps) are often compromised by scarring, bulky tissue, and altered architecture. Dental rehabilitation is often impossible without endosseous implants to aid in stabilization and retention of prostheses. The most commonly used free flaps, however, have significant shortcomings with regard to implant placement, prosthetics, and maintenance. This article describes some site development and prosthetic techniques that can be applied to improve outcomes when dental implants are used in conjunction with free flap reconstruction.
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Implantes Dentales , Procedimientos Quirúrgicos Preprotésicos Orales/métodos , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Humanos , Microcirugia/métodos , Oseointegración/efectos de la radiación , Periodoncio/efectos de la radiación , Complicaciones Posoperatorias , Radioterapia/efectos adversos , Resultado del TratamientoRESUMEN
This clinical report presents the treatment of an unfavorable bilateral maxillary defect with the use of an extraoral device to hold an interim obturator in place during tissue healing and maturation.
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Retención de Prótesis Dentales/instrumentación , Procedimientos Quirúrgicos Orales/rehabilitación , Obturadores Palatinos , Anciano , Carcinoma de Células Escamosas/cirugía , Retención de Prótesis Dentales/métodos , Aparatos de Tracción Extraoral , Femenino , Humanos , Alambres para Ortodoncia , Neoplasias Palatinas/cirugíaRESUMEN
PURPOSE: The objective of this study was to determine changes in interdental papillae, alveolar bone loss, esthetics, and initial healing survival when 1-piece narrow-diameter implants were immediately loaded in sites with limited tooth-to-tooth spacing. MATERIALS AND METHODS: One-piece titanium alloy implants with a maximum diameter of 3.0 mm and a resorbable blast surface texture on a square-thread form were evaluated. Digital photographs were made at each clinical visit to assess soft tissue healing. Interproximal soft tissue fill of the embrasure was assessed with a modified Jemt index. Standardized radiographs were made at baseline (implant placement) and at 6 and 12 months postsurgery. Radiographic bone height was measured from a consistent landmark on the implant. A 1-sided t test was used to determine statistical differences of bone height. RESULTS: Thirty-one implants were placed in 17 subjects. One implant had clinical mobility and was removed, for an overall survival rate of 96.7%. Mean bone height on the day of placement and restoration was 2.33 + 0.73 mm above the first thread. Mean bone height was 1.75 +/- 0.78 mm at 6 months postrestoration and 1.63 +/- 0.81 mm at 12 months postrestoration. There was a statistically significant loss of bone support over the initial 6 months (0.58 mm; P < .01), with no significant progression thereafter (0.12 mm; NS). Complete fill of papillae was found in 92% of maxillary lateral incisor sites and 60% of mandibular incisor sites. CONCLUSION: The use of 1-piece narrow-diameter immediately loaded implants appears to be an effective prosthetic treatment for areas of limited space.