Treatment
Before the resective surgery and the reconstruction, a fixed implant-supported mandibular prosthesis had been planned. However, due to the tissue sclerosis leading to mouth opening limitation and therefore a reduced prosthetic space, we decided to select a complete implant-supported bar-retained overdenture. Implant loading was performed 10 months after surgery with the placement of healing caps 5mm high and 3.5 diameter (according to the important thickness of the new mucosa). Implementation of the prosthesis started 3 weeks after loading.
To circumvent the mouth opening limitation, a small « custom-made » screw driver fabricated from the conventional screw driver (Zimmer®, Warsaw, Indiana) facilitates the screwing/unscrewing procedures of the implant parts. The second impression using polyethers allows to fabricate a custom-made impression tray perforated around the transfers (HLTE3 Zimmer®, Warsaw, Indiana). A plaster index allows to validate the model obtained from this impression.
The phonation test shows little relevance to determine the VOD in this patient, due to his partial ankyloglossia following the surgery. The VOD is determined according to esthetic factors and the balance of the medium stage of the face. The occlusal plane is determined according to the patient’s lower lip and corners of the mouth.
An esthetic and functional trial insertion of the mandibular prosthetic teeth mounted on wax is validated with the patient. The connecting bar and its counter-part located in the inner face of the prosthesis are machined in titanium according to the teeth arrangement. During the mouth trial insertion, the bar is adjusted and checked radiographically. Then the complete removable prosthesis is delivered, and the retention parts are placed.