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*M.D.S, Professor and Head, **Post Graduate Student, Department of Prosthodontics, Darshan Dental
College, Udaipur, Rajasthan, India. Email: drsuresh72@gmail.com
Abstract:
Figure 2 Patient in effort of smiling. Figure 5 Neutral zone complete dentures in situ while
patient tried to contract his facial muscle to show his teeth
patient was educated about oral and denture hygiene maxillary denture showed patients lack of coordinated
maintenance.[ Fig 5] motor skills Dysmetria and Dyssynergia, in managing
Modification of removable prosthesis to prevent epulis has dentures.
been suggested by various authors. Steven J. Larsen et al5 Extra oral examination revels symmetrical facial
recommended additional thickness of denture borders to profile with competent lip and loss of cheek support, with
provide support for affected side to improve speech and tremors of head at movement and also at rest. Intra oral
esthetics for patients suffering from unilateral facial examination revealed completely edentulous upper and
paralysis. lower arch. Maxillary and Mandibular ridges were smooth
CASE 2 & well-formed covered with firm mucosa , palatal vault
Complete denture patient suffering from cerebral was shallow U shaped with House Class 1 hard and soft
ataxia palate relation. Tremors were evident on tongue and
Ataxia means “without order” or Loss of mandible.
coordination. “Ataxia is a condition in which there is gait The patient’s chief complaint was impaired
impairment, unclear speech ,visual blurring, hand in mastication due to inadequate retention and stability of her
coordination, tremors with movement resulting from existing dentures. Approach for complete denture
involvement of cerebellum & its afferent & efferent treatment started with proper education and training for
pathway including spino cerebellar pathway & fronto – removal and insertion of dentures, non anatomic teeth as
ponto cerebellar pathway.” occlusal scheme, high strength heat cure resin as denture
Signs and symptoms may include: Poor base material with metal mesh reinforcement.
coordination –patient may show unsteady walk and Because of intentional tremors, while making
tendency to stumble, difficulty with fine-motor tasks such impression patient was seated in upright position and head
as eating, writing or buttoning a shirt, change in speech, was properly supported and care was taken to steady the
abnormal eye movements, difficulty swallowing. mouth in head supported position. Standard protocol for
Intentional Tremor – is most prominent during voluntary primary and secondary impressions were followed, but
movement toward target and it is less at rest. Finger –nose ensured upright position with head support while making
test is positive is typical feature of hereditary ataxia, impressions. Medium body polyether material was selected
Cerebellar ataxic gait is broad based gait in which the for final impression because of viscosity and good control.
speed and length of strides varies irregularly from step to Denture base and occlusal rims are prepared, maxillary and
step, as in alcoholic (posture is erect but feet are separated), mandibular occlusal plane were adjusted according to
1ystagmus-involuntary movements of the eyes, aesthetics and phonetics.
Titubation - nodding of head anterior posterior direction, Due to unstable mandible, there were difficulties in
Dyssynergia - small,jerky, clumsy movements, recording resting position and centric relation of mandible.
Dysmetria- inability to arrest the movements at desire It was challenging task to record accurate jaw relations.
point, Dysarthria - slow , slurry , irregular, scanning type Patient was repeatedly asked to swallow and relax and most
speech. 6,7,8,9 consistent measurements were considered for vertical
relations.
A 62 years old women was referred to Department Dawson’s bimanual manipulation10 was used to
of prosthdontics, Darshan dental college, Udaipur with a record centric jaw relation. Centric jaw relation was
complain of missing teeth and desires to get them replaced. recorded at supine position, at this position patient was
Patient gave medical history that she was suffering from more relaxed, tendency for protrusion is prevented and it is
cerebral ataxia since 8 years and patient was easy for operator to stabilize and guide the
psychologically depressed as she was unable to eat with mandible.Patient’s head was cradled between ribcage and
previous dentures.(Fig. 6) forearm and was stabilized with firm grip to manipulate
Examination reveals patient walk was affected, mandible.(fig 7) Thumbs were encircled symphysis region
patient had reeling gait with severe tremors and titubation, to form C and mandible was manipulated in centric
patient had slow slurred scanning type of speech, nose – position (Fig 8 and Fig 9). Midline was marked with help
finger test was positive which reveals intentional tremors - of assistant. On repeated guidance, centric closure was
Dyssynegia sign was present. confirmed and centric relation was recorded using nick and
Past denture history revealed patient was treated notch technique using elastomeric bite registration paste.
with complete dentures, but she complained unable to wear Anterior teeth arrangement was done according to
dentures and difficulty in mastication. Inability to wear and patient aesthetic needs and non-anatomic teeth were
remove dentures, difficulty in mastication, broken selected to develop occlusal scheme. After final evaluation
of wax denture, processing is done using high strength acoustic neurinoma: A clinical report :Hercules C.
acrylic resin, maxillary denture was reinforced with metal Karkazis, J Prosthet Dent 2002;87:419-22.
mesh and mandibular with incorporating stainless steel 2. Management of patients with myasthenia gravis
wire (Fig 10). who requires maxillary dentures :William K.
At denture insertion appointment patient was Bottomley et al; J Prosthet Dent 1977;38:609-14
encouraged and trained to hold dentures, insertion and 3. The neutral zone in complete dentures :Victor E.
removal of dentures and denture hygiene manoeuvres(Fig Beresin, DDS, and Frank J. Schiesser, DDS J
11). Patient’s progress was monitored at regular recall Prosthet Dent 1976;36:357-67
appointments. 4. Using the neutral zone to obtain
maxillomandibular relationship records for
Discussion: complete denture patients :Stephen G. Alfano,
Neuromuscular disorders are common among DDS, LCDR, USNR, and Richard J. Leupold,
aged population and it is important to recognise clinical DDS, CAPT, USN J Prosthet Dent 2001;85:621-3
manifestations of these disorders and derive treatment 5. Prosthetic support for unilateral facial paralysis :
planning, which otherwise might lead to failure of Steven J Larsen,John F carter, Hratch A.
treatment. Aim of this article was to describe Abrahamian ; J Prosthet Dent 1976;35:192-201
manifestations of Neurological disorders and its influence 6. William R. Laney .Oral manifestation of systemic
on various stages of complete denture construction. disease. William R. Laney and Joseph Gibilisco,
Complete denture prosthesis in patients who In. Diagnosis and treatment in prosthodontics,
suffer from neurological disorders is complicated by Philidelphia, Lea and Febiger,1983 : page no 73-
several problems. 111
Advanced age; Most patients are elderly, loss 7. Roger N. Rosenberg. Ataxic Disorders. In, T.R
of oral sensitivity, degenerative changes in Harrison volume 2. Principles of internal
supporting structures are contributory to poor Medicine, 15th International Edition. New Delhi,
prognosis. Mc Graw Hill company, 2003; page no 2406.
Impaired neuromuscular balance affecting 8. Richard k. Olney, Michael J. Weakness, Myelgia,
denture stability. Disorders of Movment, and Imbalance. In, T.R
Tremors, lack of coordination and unstable Harrison volume 1. Principles of internal
jaw position require different skill while Medicine, 15th International Edition. New Delhi,
recording impressions and jaw relations. Mc Graw Hill company, 2003; page no 119.
Uncontrolled tremors of mandible and tongue 9. Arupkumar kundu. Short cases cerebellar
may lead to prosthesis instability. disorders In, Arupkumar kundu Bad side clinics
Dysmetria may lead to accidental falling of in Medicine part 1,5th Edition, Kolkata, Academic
dentures while insertion and removal of publisher, 2006; page no 284-288.
dentures. 10. Determining centric relation. In, Peter E.
Dawson,functional occlusion ; from TMJ to smile
Conclusion: design. Missouri, 2007 ;page no 75-84.
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