Dental Prosthetic Rehabilitation of a Tumor Patient After Radiotherapy and Mandibular Resection

Volume 2 - Issue 1

Soo Jeong Portscher Kim*, Hans Christoph Lauer and Silvia Brandt

Received: February 06, 2019;   Published: February 13,2019

DOI: 10.32474/SCSOAJ.2019.02.000129

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Abstract

Background: Many patients with a history of head-and-neck tumors present with hard- and soft-tissue defects resulting from their disease and treatment that will preclude any dental prosthetic rehabilitation without the use of implants.

Case Report: A 57-year-old male patient with a history of tonsil and piriform sinus carcinoma sought prosthetic rehabilitation after successful radio-/chemotherapy and local mandibular resection. His dentition was severely reduced, consisting of inadequate crown restorations in the maxillary anterior segment and the mandibular right canine. The treatment decision was to rehabilitate the maxilla conventionally and the locally resected mandible with an implant-supported telescopic denture after extraction of tooth 43. Four implants were placed (32, 33, 42, 43) and allowed to osseointegrate submerged for 3 months, followed by surgical exposure, tightening abutments, and cementing conical crowns that served as primary telescopes. The secondary telescopes consisted of electroplated copings which were intraorally bonded to the tertiary structure, thus ensuring a perfect fit of the denture.

Conclusion: Other options for denture retention were contraindicated: ball or Locator attachments because of the existing xerostomia and pain from the resection-related scar tissue, and a bar due to its higher demands on self-performed oral hygiene and very high requirements for extending the superstructure in the event of an implant loss. The telescopic denture we provided has none of these drawbacks, nor does it require any extensive cantilever saddles because the masticatory loads are largely absorbed by the implants with almost no force transmission to the mucosa. The only treatment-related complication was a bony dehiscence, which was successfully managed by slightly reducing the bone and harvesting two connective-tissue grafts from the palate to close the perforation. After one year, the denture continues to be intact and functional. The patient reported a short period of adaptation followed by excellently restored function and greatly improved phonetics.

Keywords: head-and-neck tumors; radiotherapy; mandibular resection; prosthetic rehabilitation; telescopic denture

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