CLINICAL REPORT

Simplied technique for the prosthodontic rehabilitation of a

patient with a segmental mandibulectomy with a hollow cast
partial dental prosthesis: A clinical report
Amar Bhochhibhoya, MDS,a Pranay Shakya, MDS,b Suraj Mathema, MDS,c and Brijesh Maskey, MDSd
Surgical treatment of odontoABSTRACT
genic tumors often requires
Rehabilitating patients with a mandibulectomy defect is a challenging task as such surgical remandibular resection that may
sections may result in discontinuity defects that pose functional, esthetic, and psychological
cause
morphological
and
problems. A decreased denture-bearing area, increased interarch space, and lever action in such
functional decits, which lead
maxillofacial defects may cause problems with regard to retention, stability, and support of the
to numerous problems associprosthesis. Reducing the weight of the prosthesis helps to decrease the lever action and load on the
residual alveolar ridge. This clinical report describes how a patient with a posterior segmental
ated with mastication, speech,
mandibulectomy was rehabilitated with a hollow cast partial dental prosthesis using a simplied
and deglutition.1,2 In addition,
technique
with expanded polystyrene. (J Prosthet Dent 2016;116:144-146)
it may cause considerable
3
esthetic and social problems.
dental prosthesis using Thermocol. Reducing the
The degree of functional disability and cosmetic disgweight of the prosthesis decreases the leverage action
urement depends upon the location and extent of surand load on the residual alveolar ridges. Such weight
gical resection.4 Prosthodontic treatment may restore
reduction has been achieved using a solid 3-dimensional
facial esthetics and oral function for such patients. The
spacer of dental stone, cellophane-wrapped asbestos,
extent of surgery determines the amount of rehabilitation
silicone putty, or modeling clay during the laboratory
needed for a given patient, and rehabilitation efforts may
procedures.6-8
include secondary surgical management, prosthodontic
5
treatment, speech therapy, and psychological care.
CLINICAL REPORT
Radical resection resulting in a discontinuity defect presents challenges to prosthetic rehabilitation because of
A 45-year-old woman was referred to the Department of
the obliteration of vestibular depth, reduction in stability
Prosthodontics and Maxillofacial Prosthetics, Peoples
for prostheses supported by soft tissue, and loss of loadDental College and Hospital, for prosthetic rehabilitation
bearing tissues available for support. The cost and lack of
after a segmental mandibulectomy. Radiographic and
surgical expertise make reconstructive surgery followed
histopathological evaluation revealed a follicular ameloby an implant-assisted prosthesis difcult. Sometimes
blastoma that involved the body and angle region of
patients are not prepared psychologically for additional
the mandible for which she had undergone a segmental
surgical interventions.
mandibulectomy 4 years previously. A reconstruction
This clinical report demonstrates a safe and predictwith bone grafting was not done, which precluded an
able prosthetic rehabilitation of a patient with a
implant-supported prosthesis, so a hollow cast partial
segmental mandibulectomy with a hollow cast partial
dental prosthesis was planned for this patient.

Assistant Professor, Department of Prosthodontics and Maxillofacial Prosthetics, Peoples Dental College and Hospital, Kathmandu, Nepal.
Assistant Professor, Department of Oral and Maxillofacial Surgery, Peoples Dental College and Hospital, Kathmandu, Nepal.
c
Professor, Department of Prosthodontics and Maxillofacial Prosthetics, Peoples Dental College and Hospital, Kathmandu, Nepal.
d
Assistant Professor, Department of Prosthodontics and Maxillofacial Prosthetics, Peoples Dental College and Hospital, Kathmandu, Nepal.
b

144

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145

Figure 1. Intraoral occlusal view.

Figure 2. Panoramic radiograph.

Figure 3. Survey and design.

Figure 4. Denitive impression.

Examination revealed an asymmetrical face with a

depression of the right cheek, an obliterated distolingual
sulcus on the defect side, and satisfactory occlusion on
the non-resected side (Fig. 1). A panoramic radiograph
revealed a segmental resection of the mandible extending
from the left lateral incisor to the right third molar,
involving the body and angle region, which indicated
Cantor and Curtis type III resection (Fig. 2).9
Maxillary and mandibular preliminary impressions
were made with irreversible hydrocolloid (Zelgan;
Dentsply Intl), and diagnostic casts were poured with
Type III dental stone (Kalstone; Kalabhai) and surveyed
(Fig. 3). Mouth preparation was done, and a denitive
mandibular impression was made in an acrylic resin,
custom impression tray (Rapid Repair; Dentsply Intl)
border molded with green modeling plastic impression
compound (DPI tracing stick; DPI). The denitive impression was made with light-body polyvinyl siloxane
(Elite HD+; Zhermack) (Fig. 4), and a denitive cast was
poured with Type IV dental stone (Kalarock; Kalabhai).
A wax occlusion rim (Modeling Wax; DPI) was adjusted
to achieve a tentative occlusal vertical dimension. After
facebow transfer and registration of the centric relation,

the casts were articulated in a semiadjustable articulator (A7 Plus-E; Bioart). The wax trial denture was
processed following conventional laboratory procedures
up to the wax elimination stage. During the packing
stage, expanded polystyrene (Thermocol; Nagmagic;
KKNag Pvt Ltd) was packed in the heat-polymerized
poly(methyl methacrylate) resin dough (Trevalon;
Densply Intl). The dimension of the expanded polystyrene was maintained such that the spacer occupied
the area between the shim of 2-mm thickness and the
teeth with 3 mm of denture base (Fig. 5).
During the insertion appointment, the patient was
instructed to masticate on the non-resected side and
maintain good oral hygiene (Fig. 6). Regular evaluation
was done every 6 months for relining to compensate
for tissue changes and to improve the tissue adaptation
of the prosthesis as has been suggested.10

Bhochhibhoya et al

DISCUSSION
A range of treatment options is available for prosthetic
rehabilitation of patients with segmental mandibulectomy. Although dental implant-supported prostheses
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Volume 116 Issue 1

Figure 5. Thermocol packing.

Figure 6. Hollow cast partial dental prosthesis delivery.

are widely used, neither the functional efcacy nor the

treatment success rates of implant prostheses have
been established in patients with mandibulectomy.5
Numerous articles are available related to the success
of conventional prostheses in such patients.2
Every effort should be made to reestablish a favorable
distribution of force to stabilize the prosthesis during
mastication and function. The design should follow
customary prosthodontic guidelines with some modications of these principles, which are determined on the
basis of evidence and greatly inuenced by the unique
residual tissue characteristics. The engagement of structures in the defect diminishes the counterproductive lever
forces; contributes to the support, stability, and retention
of the prosthesis, and may increase its success.11,12
Changes in tissue beneath a maxillofacial prosthesis
may be more rapid than in those beneath an ordinary
prosthesis.10 Therefore, the occlusion and denture adaptation must be reevaluated frequently.10
Reducing the weight of the prosthesis decreases
the lever action and load on the residual alveolar ridges.
Such weight reduction approaches have been achieved
using different solid 3-dimensional spacers, which are
removed later to provide a hollow denture base, during the
laboratory procedures.6,7 Because expanding polystyrene
is a light-weight material, it can be left in the denture
without compromising the integrity of the denture,
thereby avoiding the tedious effort of removing the spacer
material from the denture. This technique is simple to
execute and allows control of the spacer thickness.8

Lightweight hollow cast partial dental prostheses provide

comfort and sufcient function. This option is inexpensive
and is also minimally invasive.

SUMMARY
This clinical report described a safe and predictable prosthetic rehabilitation of a patient with a segmental mandibulectomy with hollow cast partial dental prosthesis.

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Corresponding author:
Dr Amar Bhochhibhoya
Peoples Dental College and Hospital
Nayabazar, Kathmandu
NEPAL
Email: amarbhochhibhoya@gmail.com
Acknowledgments
The authors thank Dr Smriti Narayan Thakur for contributions to the preparation
of the manuscript.
Copyright 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.

Bhochhibhoya et al