Removable Partial Prosthesis (RPP) with acrylic resin flange for the mandibular guidance therapy.

OBJECTIVES: Patients undergoing hemimandibulectomy suffer from mandibular deviation. The purpose of this article is to describe a new therapeutic possibility for the prosthetic management of these patients using only one device both for physiotherapy and eating. METHODS: A 56-year-old man's pre-existing mandibular removable partial prosthesis was modified to use as a partial prosthesis as a device to correct mandibular deviation. In fact, two precision attachments patrix were inserted into buccal surface of partial prosthesis base and corresponding matrix were inserted into a transparent acrylic resin guide-flange. RESULTS: In this way the patient can use only one prosthesis both for physiotherapy and eating simply inserting and removing the guide flange. The transparent resin employ is important for the day by day use. CONCLUSION: This technique permits to use only one device both for mechanical correction of mandibular deviation and masticatory function while literature shows that two different devices are usually used in patients with mandibular deviation to satisfy both these functions.

Prosthetic management of neuromuscular rehabilitation in hemimandibulectomy patients. A case report.

The radio-surgical treatments for carcinomas involving the oral cavity are often destructive in order to limit as much as possible the high rate of recidivism. The outcome of the combined treatment is represented by lesions on hard and soft healthy tissues besides naturally by a more or less important mandibular deviation depending on greater or lesser quantity of basal bone excised. In some cases it is possible to surgically restore the defective mandible through bone grafting; this means a quite perfect restitutio ad integrum of the mandibular arch; instead, in other cases, because of bone and soft tissue biology, general healthy state and age of the patient prosthetic management would be better as it is less invasive even if less resolutive. For a right tonsillar cavity carcinoma the patient, T. F., female, 73-year old, had undergone radical neck dissection and hemisection of the homolateral mandible. A guide-device was realized for "guiding" the residual mandible into the physiological centric occlusion position, and then a removable partial denture was realized as a definitive prosthesis. After 3 months therapy the patient was easily able to spontaneously reposition the hemimandible itself, also with considerable improvement of the masticatory function. Neuromuscular re-education of hemimandibulectomy patients via the use of a guide flange on a removable prosthesis applied to the residual mandible represents a fundamental condition for permanent prosthetic rehabilitation.

The patient with xerostomia: medical therapy, prosthetic therapy.

The condition of xerostomia has significant consequences on both the hard and the soft components of the oral cavity, and can compromise functionality. Furthermore, this clinical complication produces negative changes in eating habits, frequently causing the loss of several kilograms of body weight. This article aims to provide as complete as possible an overview of therapeutic possibilities. Alongside medical therapy, the article will report on an experimental treatment designed for patients who are scheduled for radiation therapy to an area including a major salivary gland (in particular the parotid gland). The treatment consists in autologous transplantation of a portion of glandular tissue to a site outside the irradiated area. Lastly, a particular method for prosthetic rehabilitation, the so-called "reservoir" denture, is presented. A complete denture is produced with conventional techniques but has a small container for artificial saliva. For mandibular dentures the container is sub-divided into 3 inter-communicating chambers and is situated in the lingual flange; for maxillary dentures, a single chamber is situated in the palatine concavity. In our opinion, the mandibular reservoir denture presented here has better characteristics than other devices that have been reported in the international literature.

Cancer of the head and neck: general principles of radiobiology, radiotherapy and chemotherapy. Radiation damage.

The overall incidence of tumours of the head and neck area versus tumours of other areas is 10%; in other words, 1 neoplastic lesion out of 10 affecting the human body is in this area. The relative frequency places malignant tumours of the larynx in 1(st) place with 25-30%. This data relates only to the areas of competence of the dentist and ENT specialist, and thus indicates that it is now becoming increasingly frequent for the dentist to be faced with treating a cancer patient. At the same time, it is not possible to consider as "dental cancer patients" only those patients whose disease involves an anatomic structure of the oral cavity as such. Pa-tients with tumours involving any of the anatomic structures of the head and neck area (pharynx, larynx, lip, oral cavity, pa-ranasal sinuses, nasal fossae, salivary glands) must also be included. This article provides information on the epidemiology of tumours of the head and neck, the theoretical foundations of radiobiology, radiotherapy and chemotherapy, and possibilities for integration among the different possible treatment methods, i.e. radiotherapy, surgery, and chemotherapy. It looks at the most recent developments in these methods for patients with cancer of the head and neck, including the diagnostic protocol (clinical and instrumental). Lastly, irradiation damage to this anatomical area is analysed in terms of acute and delayed manifestations.

[Prosthetic rehabilitation in a patient with systemic scleroderma]. / Riabilitazione protesica in paziente sclerodermico.

A 49-year-old patient with systemic scleroderma was referred to the Department of Dental prostheses for the Degree in Dentistry and Dental Prostheses at Florence University because he was unable to wear his existing complete dentures. The upper denture was not correct owing to the position of the artificial teeth and the short base, and the lower denture caused pain when used. A complete new dental prosthesis was therefore required to overcome the difficulties caused by this systemic disease. Scleroderma is a progressive disease that causes the anelasticity of the mesenchymal tissues owing to post-inflammatory fibrotic and degenerative alterations of unknown etiology. Important changes also occur in the mouth: difficulty opening the mouth, hypo- or non-extendibility of the soft perioral tissues. The construction of the complete upper and lower dentures posed a series of major technical problems compared to a patient not suffering from this pathology. The first core, the rimming of the individual core holder, calculating the vertical dimension and the assembly of the front teeth were all phases that required technical modifications and special care, so that the techniques of our School could be adapted to this particular case. The cosmetic and functional result was undoubtedly good. The patient has been wearing these dental prostheses for five years with satisfaction.