1. Reconstruction of the Mandible with a Fixed Implant Supported Prosthesis A. S. Jochelson In Partial Fulfilment of BTech: Dental Technology Department of Dental Sciences Tygerberg Campus CPUT 2007

2. CONTENTS Patient history Odontogenic myxomas Clinical history Technical history Reasons for choice of acrylic bridge Problems encountered Future treatment plan Conclusion References Acknowledgements

3. PATIENT HISTORY 25 year old female Rare non-capsulated benign tumour 1 Misdiagnosis, tumour became worse Panoramic radiograph and biopsy Odontogenic myxoma of the mesenchymal tissue 2 Fourth quadrant Referred to dental faculty, UWC, Tygerberg hospital

4. RADIOGRAPH OF ODONTOGENIC MYXOMA Faculty of Dentistry UWC Radiograph of the odontogenic myxoma

5. ODONTOGENIC MYXOMAS Odontogenic Myxoma, Thomas and Goldman, 1947 3 Slow growing, locally invasive lesion 2 Do not metastisise 4 Involves mandible 4 Patients between ages of 20 and 40 2 Reports show predilection to females 5 Presents as pain, diasthesia, ulcerations, tooth mobility 6 Initiates in dental papilla, follicles, or periodontal ligaments 2 Uni-or multioccular radiolucency, “soap bubble” appearance 3

6. CLINICAL HISTORY Treatment started in, 2005 20/04/2005, right hemi-mandibulectomy Fibula free flap, reconstruction of mandible 7 6 month healing period Stent fabricated, 4 externally hexed implants placed Healing abutments, March 2006 8

7. REMOVAL OF DISEASED BONE Faculty of Dentistry UWC

8. RADIOGRAPH OF MANDIBLE AFTER FIBULA FREE FLAP Faculty of Dentistry UWC

9. HEALING ABUTMENTS Faculty of Dentistry UWC

10. TECHNICAL HISTORY 24/04/2006, impressions taken, 2 treatment options Fixed acrylic bridge, fixed ceramic bridge 9 13/06/2006 to 15/08/2006, 3 substructures tried in None achieved a passive fit 17/08/2006, laser welded substructure tried in passive fit not achieved Set-up was done Acrylic bridge processed, polished, placed in patients mouth Temporary fixed appliance

11. REASONS FOR CHOICE OF APPLIANCE Lack of space, distortion, long span substructure Lower cost than fixed ceramic bridge 9 Manufacturing process less complicated and time consuming 10 No distortion, no firing cycles, creep of metal 11,12 Substructure, titanium screws can be re-used 10 Mandibular teeth not as visible

12. PROBLEMS ENCOUNTERED Metal substructure, no passivity Substructure sectioned, 3 parts Seated and joined, non-shrinkage acrylic

13. FUTURE TREATMENT PLAN Decided future treatment plan similar Submucosal abutments change to transmucosal abutments Advantage: implant abutment junction, gingival level Access for better oral hygiene Cementation, could achieve passive fit

14. CONCLUSION Predicted success rate high Success with previous treatment plan Previous student, acceptable results, no passivity May be overcome with future treatment plan Could not provide necessary treatment Case will be taken further, numerous improvements Patient satisfied and grateful

15. REFERENCES 1.Dezotti MSG, Azevedo BJ, Fontao FNGK, Capelozza ALA, Sant’ana E. Odontogenic Myxoma – A Case Report and Clinico – Radiographic Study of Seven Tumours. The Journal of Contemporary Dental Practice.2006; 7(1): 2. 2.Simon ENM, Merkx MAW, Stoelinga PWJ. Odontogenic Myxoma: a Clinico – pathological study of 33 cases. International Journal of Oral and Maxillofacial Surgery.2004: 1.

16. REFERENCES (Cont.) 3.Noffke CEE, Raubenheimer EJ, Chabikuli NJ, Michael. Odontogenic myxoma: review of the literature and report of 30 cases from South Africa. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2007; 104: 101 4.Spencer KR, Smith A. Odontogenic Myxoma: Case Report with Reconstructive Considerations. Australian Detnal Journal. 1998; 43(4): 1. 5.Slootweg PJ, Witkamp ??. Myxoma of the Jaws. An anylasis of 50 cases. Journal of maxillofacial Surgery. 1986; 14: 46-52

17. REFERENCES (Cont.) 6. Khogare S, Deshpande MD, Malik NA. Odontogenic Myxoma:A Case Study. International Journal Of Oral and Maxillofacial Surgery 2007;16: 107. 7. Smolka K, Kraehenbuehl M, Eggensperger N, Hallrmann W, Thoren H, Iizuka T, Smolka W. Fibula free flap reconstruction of the mandible in cancer patients: Evaluation of a combined surgical and prosthodontic treatment concept Oral Oncology 2007: 1-3, 5, 8, 9 8. Rosentiel SF, Land MF, Fujimoto J. Contoemporary fixed prosthodontics, 4th ed. Missouri, Mosby Inc. 2006: 426

18. REFERENCES (Cont.) 9.Pagniano R. Bridges, Advantages and Disadvantages of Fixed Bridges [online]. Available:http://www.dublindentalcare.gomaker.com/page/p age/1655218.htm#Bridges 10.Tipton P. Bridge Desgn: Full Arch Implant-supported Porcelain-fused-to-metal Bridgework. Dentistry South Africa. 2002; May/June:50-52 11.Hostede TM, Ercoli C, Hagan ME. Alternative complete-arch cement-retained implant-supported fixed partial denture, The Journal of Prosthetic Dentistry. 1999;82: 94-99 12.Bryant RA, Nicholls JI. Measurement of distortion of fixed partial dentures resulting fro degassing. Journal of prosthetic Dentistry. 1979; 42: 515

19. ACKNOWLEDGEMENTS Dr. Z Patel Ms. Z Norjte Mr. LA Steyn Mr. W Spencer