1. Fabrication of a tooth–borne mouthstick for a Quadriplegic By: J.E. Viljoen

2. Contents Patient history Background condition Possible treatment options Treatment option of choice Laboratory procedures

3. Patient History 12 Year old female Diagnosed with Guillian–Barré syndrome Permanent resident at Tygerberg hospital Quadriplegic

4. About Guillian-Barré syndrome It is a syndrome, not a disease There is no cure Attack directed at mayelin – insulation component of the nerves Affects 1 in 100 000 people No particular race, gender or age group Causes paralysis 75 – 90 % partial or total recovery 2

5. Condition and background information Needs appliance to facilitate use of a computer Quadriplegic – limited head movement Connected to respirator Weak masseter muscles Eruption of permanent dentition

6. Background Prosthesis was made by occupational therepist Prosthesis was retained by bite forces Prosthesis caused pain in Masseter muscles

7. Possible treatment options Tooth–borne oral device A telescopic oral device Extra–oral chin cap

8. Tooth–borne oral device

9. Advantages: No biting forces required Inexpensive to fabricate Simple to use Occlusal forces equally distributed Disadvantages: Length cannot be altered 3

10. Telescopic oral device

11. Advantages: Length of extending stick can be altered No biting forces required Patient is self-supporting Disadvantages: Heavy in mass Difficult to fabricate and use Expensive to fabricate Requires maintenance 2

12. Extra–oral chin cap

13. Advantages: Easy to communicate with Easy to keep clean Disadvantages: Uncomfortable for patient No independence Complicated to use 2

14. Most suitable treatment option  The tooth-borne device Reasons: Inexpensive Simple to use Easy to fabricate Not necessary to extend or retract the device

15. Laboratory procedures Special trays were fabricated and impressions taken and cast

16. Laboratory procedures continued Extra-oral mechanical parts designed, then manufactured by engineering company Parts made from aluminium Extra–oral rod has magnetic tip Various tips made to accommodate patient Tip snaps in position

17. Laboratory procedures continued Two-ply gum-guard material applied to model

18. Laboratory procedures continued Gum–guard trimmed to deepest part of sulcus

19. Laboratory procedures continued Special dentarum screw-sleeves used to secure mechanical part in position on gum-guard

20. Laboratory procedures continued Orthodontic acrylic was applied to gum–guard Polished

21. Finished product

22. Final placement

23. Acknowledgments Dr Van Zyl Miss Nortjé Mr Steyn Mrs Wright

24. References: 1.A.J.Cloran. Telescopic mouth instruments for severely handicapped patients. Journal of Prosthetic Dentistry. 1974; 32(4): 435-438. 2.Hentschke, P. (2002) Guillian-Barré syndrome. (Web document). Available: http://www.medweb.pc.edu/students/med2003/ miller1/guillain.html 3.J.Smokler. Mouthstick prosthesis for a patient with arthrogryposis multiplex congenita. Journal of Prosthetic Dentistry. 1979; 42(3): 316-321.