Guide Flange Prosthesis Research Articles

Management of hemimandibulectomy using guide flange

Patients with mandibular deviation following surgical hemi/segmental/subtotal mandibulectomy for a variety of reasons (squamous cell carcinoma being the most common cause) are administered a guide flange. The physician must wait for the lesion to heal, the graft to heal, or the radiotherapy effects to subside before proceeding with planned procedures like secondary osseous grafting. A definitive prosthesis cannot be planned until the graft has healed. The patient has to receive a prosthesis during this period of time in order to correct mandibular deviation caused by a unilateral muscle pull. Furthermore, if bone grafting fails or the patient refuses a second operation, there are situations in which a definitive prosthesis must be postponed. This report describes the fabrication of such a mandibular guide flange prosthesis.

Mandibular guiding flange prosthesis to guide mandibular deviation following partial mandibulectomy and partial maxillectomy for squamous cell carcinoma: A case report.

Squamous cell carcinoma is one of the most prevalent cancers affecting the oral cavity. Rehabilitation following surgical treatment requires a multidisciplinary approach and care. Multiple disabilities such as dysarthria, dysphagia, unesthetic appearance, and psychosocial disorders following the surgery for carcinoma can greatly impact the quality of life of such patients, thereby necessitating multidisciplinary intervention. The clinician has to wait for the healing of the lesion and the effects of radiotherapy to be dwindled in case a secondary osseous grafting is planned. During this time lag until a more definitive prosthesis is planned, an interim prosthesis is must to correct the mandibular deviation due to the unilateral muscular pull. This case presentation describes the utilization of guiding flange prosthesis (GFP) as an interim modality for the establishment of a stable and functional maxillomandibular relationship following combined ipsilateral partial mandibulectomy and maxillectomy.

Clinical Evaluation of Masticatory Performance of Pre and Post-mandibular Guidance Therapy in Hemi-mandibulectomy Patients: A Quasi-experimental Study

Introduction: Surgical removal of the lower jaw is the most common cause of mandibular deviation due to benign or malignant neoplasms. The Palatal Guide Flange Prosthesis (PGFP) is a recommended corrective appliance to reduce this clinical manifestation. The primary goals of rehabilitation with PGFP are to train the mandibular muscles and restore a healthy occlusal relationship so that the patient can effectively control their mouth opening and closing movements. In the present article, the Masticatory Performance (MP) of patients who had undergone hemi-mandibulectomy surgery was evaluated both before and after receiving an interim PGFP. Aim: To clinically evaluate MP pre- and post-mandibular guidance therapy in hemi-mandibulectomy patients. Materials and Methods: A quasi-experimental study was conducted on patients selected from the Outpatient Department of the Department of Prosthodontics at Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India, from January 2021 to July 2022, and were included as the sample size for the study. A total of 10 samples were selected. The study design was quasi-experimental. All cancer patients had lost their mandibular continuity and showed mandibular deviation toward the affected side. PGFPs were fabricated using Heat Cure Acrylic Resin (DPI) for each participant (n=10). Corn flakes (Kellogg’s) were given to the participants to chew, and the samples were sieved using a US standard 8-mesh sieve and collected at three different time intervals: T0 (preprosthesis), T1 (8th week), and T2 (16th week post-prosthesis). Data were entered into Microsoft Excel Version 13 and analysed using IBM Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive and inferential statistics were used, including mean and standard deviation for continuous variables and frequency analysis for categorical variables. For categorical variables, a Chi-square proportion test was utilised, and MP was evaluated between T0-T1 and T0-T2. We utilised a 95% confidence interval and a p-value of less than 0.05. Results: When comparing the MP between T0, T1 and T2 time intervals, it was found that the difference in mean MP was statistically significant (p<0.05), with MP increasing from 26.2% to 43% to 61.2%, respectively. Conclusion: The occlusion restored with the guide flange prosthesis, along with continuous use over a longer period, helped correct the deviated mandible and, in turn, improved the MP.

Guide Flange Prosthesis: A Case Report

This article introduces the concept of guide flange prosthesis as a rehabilitative solution for patients undergoing hemi-mandibulectomy due to oral squamous cell carcinoma (OSCC). OSCC is a prevalent malignancy, particularly in India, necessitating surgical resection that often leads to functional impairments and aesthetic challenges. Mandibular continuity loss results in issues like mandibular deviation, occlusal plane rotation, and cosmetic disfigurement. The guide flange prosthesis, discussed through a case report of a 45-year-old male post-hemi-mandibulectomy, aims to stabilize the remaining mandibular segment, reduce deviation, and enhance chewing function. The article emphasizes the importance of comprehensive rehabilitation, especially when dental implants may be contra-indicated due to radiotherapy. The case involves the fabrication process of the prosthesis using perforated partial impression trays, irreversible hydrocolloid, and a stainless steel orthodontic wire substructure. The patient's successful adaptation to the guide flange prosthesis, providing stability and improved mastication, highlights its significance in the post-resection phase. The article also discusses the prevalence of oral cancers in India, surgical interventions, and the role of innovative approaches like guide flange prostheses in addressing the challenges of oral cancer reconstruction. Overall, the integration of surgical techniques and prosthetic interventions offers hope for enhanced outcomes in the complex landscape of oral cancer rehabilitation.

Management of hemi-mandibulectomy patient with prosthetic devices

The success in rehabilitating a patient with hemi-mandibulectomy depends upon the nature and extent of the surgical defect, treatment plan, type of prosthesis, and patient co-operation. The management becomes more challenging when the prosthetic reconstruction has been delayed. The scar tissue forms and the soft tissue becomes stiff, causing severe deviation in the mandible towards the resected side. This case report presents a58year old male patient who underwent a mandibular resection surgery after he was diagnosed with buccal mucosa carcinoma. The patient had mandibular deviation and deranged occlusion making his speech, mastication and esthetics compromised.: The patient was provided with a cast guide flange prosthesis in the beginning as a training device to prevent the scar contracture and increase the mandibular movement towards healthy side to increase the intercuspation. After few months of training, when the deviation was reduced, flexible maxillary and mandibular partial dentures were fabricated with double occlusion in the maxillary denture to increase the masticatory efficiency of the patient.This case report attempts to formulate a treatment plan whereby the patient's discomfort could be minimized. The treatment starts with the fabrication of a removable guide flange as a physical therapy device to reduce the mandibular deviation followed by provision of a maxillary denture with double occlusion to obtain maximum intercuspation.The mandibulectomy patient is difficult to manage because a prosthodontist is limited in his ability to provide a reasonable and practical prosthesis. However, if the patients recognize the limitations of their rehabilitation, they would be more appreciative of the prosthodontic therapy that enhances their rehabilitative progress.

Guide Flange Prosthesis: A Case Report

Patients who have undergone surgical hemi/segmental/subtotal mandibulectomy for various reasons with resulting mandibular deviation are given a guide flange. If secondary osseous grafting is planned, the doctor must wait for the graft, lesion, or radiotherapeutic effects to resolve. A definitive prosthesis can be planned only when the graft has been healed. During this time lag, the patient must be fitted with a prosthesis to rectify mandibular deviation caused by unilateral muscle strain. Furthermore, in some circumstances, a definitive prosthesis must be postponed due to bone grafting failure or the patient's unwillingness to undergo a second surgery. This clinical case report shows a mandibular guide flange prosthesis fabricated for a patient.

Decision making in the fabrication of mandibular guide flange prosthesis: A case series.

Decision making in the fabrication of mandibular guide flange prosthesis: A case series.

Early prosthetic management of mandible using interim guidance appliances in hemimandibulectomy patients

Mandible is the most common site for intraoral tumors which often requires resection of large portions of the mandible depending upon the location and extent of the tumor leading to various complications such as deviation of the mandible toward the resected side and facial disfigurement. Early prosthodontic intervention during the healing period helps in training the muscles and establish an acceptable occlusal relation using guide flange prosthesis (GFP). This article aims to describe the case reports of early prosthodontic management of two patients who underwent partial resection of the mandible due to squamous cell carcinoma using two different GFP: palatal ramp prosthesis and mandibular buccal GFP using an innovative approach. Prosthodontic intervention by guidance therapy serves the purpose of reducing mandibular deviation, preventing extrusion of maxillary teeth, and improving masticatory efficiency. Guidance appliances are the simplest and most commonly used treatment modality in restoring the form and function of the mandible.

Oral Rehabilitation of Segmental Mandibulectomy with Extensive Fibrosis- A Daunting Obstacle for the Maxillofacial Prosthodontist

The fifth most frequent malignancy worldwide is head and neck cancer. Following surgical removal of lesions of the oral cavity, mandibular resection can result in undesirable effects, such as altered mandibular movements, disfigurement, dysphagia, impaired speech, and deviation of the mandible in the direction of the resected site. After a marginal or segmental mandibulectomy, prompt rehabilitation is preferred since aesthetic and functional deficiencies impair a patient’s quality of life. The contribution of maxillofacial prosthodontists safeguards the prosthetic viability, driven by a prosthetic proposed plan. Maxillofacial prosthodontists should be included from the start, and they play a crucial and directing role in this procedure. This article specifies the treatment of a 52-yearold male patient with extensive fibrosis who had a reduced mouth opening as a result of right side segmental mandibulectomy. The mandible was difficult to manipulate into occlusion due to considerable fibrosis that had formed over time, thus a guiding flange prosthesis was not employed in this case. To address the patient’s inability to chew food, a double occlusion table was designed using the remaining maxillary teeth. A 3-month follow-up was performed, as well as the Oral Health Impact Profile-14 (OHIP-14) was done prior to and following the treatment.

Prevention and treatment of maxillo-mandibular disorders following an interrupted mandibulectomy: The role of guide flange prosthesis

Ameloblastoma is an odontogenic epithelial tumor without induction of odontogenic ectomesenchyme. Although classified as a benign tumor, ameloblastoma can be very extensive and may involve an invasion of the immediate surrounding structures with a high potential for recurrence [1].

Prosthetic management of a Hemi-mandibulectomy patient with Definitive Removable Prosthesis - A case report

The loss of continuity of the lower jaw following surgical excision of tumor results in deviation of remaining mandibular segment toward the resected side. Swallowing, speech, mastication, and mandibular movements are adversely affected by mandibular surgery. Prosthetic rehabilitation plays a major role in these patients, by fabricating the whole array of prostheses to meet specific patient needs. This case report describes about the patient diagnosed with squamous cell carcinoma of alveolus on the left side. The patient had undergone hemimandibulectomy followed by soft tissue reconstruction. As a result, mandible deviated to the affected side with trismus due to scar contraction. Second surgery was planned to remove the scar tissue and to improve mouth opening. Few days following second surgery, guiding flange prosthesis was fabricated to reduce the deviation and to guide the mandible close to occlusion. After three months, a removable cast partial prosthesis was fabricated, for the defect side which was supported by a wing to compensate for lack of underlying structures. It is imperative to provide such patients with guiding flange prosthesis three to four weeks after surgical management to guide mandible to occlusion and minimize the mandibular deviation. Failure to do so will complicate the occlusion. Subsequently patient can be rehabilitated with removable prosthesis to restore the function

Definitive guiding flange prosthesis for management of hemimandibulectomy: A case report

Management of segmental mandibulectomy defects present a major challenge to the rehabilitation team. Mandibular discontinuity obliterates the equilibrium and mandibular function’s symmetry, which leads to altered mandibular movements, facial disFigurement, incomprehensible swallowing, impaired speech and deviation of the remaining fragment towards the surgical side. While opening the mouth, this deviation intensifies, leading to the opening and closing in the angular pathway. A definitive mandibular guiding flange prosthesis on the resected side can be used productively to stabilize the occlusion and correct the deviation. A new prospective for treating segmental mandibulectomy patients by using only one device both for Physiotherapy and Mastication. Keywords: flange prosthesis; mandibular defects; mandibular resection; hemimandibulectomy.

Prosthetic Rehabilitation of a Hemimandibulectomy Case by Non-Surgical Approach- A Case Report

Hemimandibulectomy can have several consequences such as disoriented masticatory cycle, eccentric occlusion, distorted speech and facial disfigurement depending on the severity of the defect. It is challenging for the prosthodontist to rehabilitate the patients in whom osseous reconstruction has not been carried out. This clinical report describes the Prosthetic management of a patient who had undergone hemimandibulectomy due to moderately differentiated squamous cell carcinoma involving left buccal mucosa, gingivobuccal sulcus and retromolar trigone. A non- surgical approach was carried out to rehabilitate this patient, which included the fabrication of a maxillary guide flange prosthesis for correction of the frontal plane rotation and a twin occlusion prosthesis for ease of mastication. The appearance of the patient was improved drastically by the fabrication of an extraoral prosthesis.

Prosthetic Management of Segmentally Resected Mandible and Partial Glossectomy: A Case Report

The balance and symmetry of mandibular function gets destroyed by the loss of continuity of the mandible, which deviates the residual fragment towards the resected side thereby altering the mandibular movements. Physical therapy in combination with prosthodontic treatment can be used to reduce the mandibular deviation and hence it improves the masticatory efficiency. Many prosthetic methods are discovered to minimize deviation and provide masticatory efficiency. Some of these methods are mandibular guide flange prosthesis, implant supported prosthesis and palatal guidance restoration. Contact of Tongue with palate is important for the production of normal speech, also the proper place of the tongue during certain sounds is important. In partial glossectomy conditions, tongue to palate articulation gets affected during speech and patient faces difficulty to pronounce certain sounds. For the rehabilitation of such patient thorough knowledge of the production of different sounds can be useful for diagnosis and treatment planning.

Mandibular guidance prosthesis: Conventional and innovative approach: A case series.

Surgical resection of the lower jaw due to the presence of a benign or malignant tumor is the most frequent cause of mandibular deviation. Location and extent of the tumor decide the surgical modality of mandibulectomy to be performed. The clinician must wait for an adequate span of time for completion of the healing and acceptance of the osseous graft before considering a definitive prosthesis. During the inceptive healing period, prosthodontic intervention is of utmost priority for preventing the mandibular deviation. A corrective appliance termed “guide flange prosthesis (GFP)” is indicated to limit this clinical manifestation. The basic intention of rehabilitation is to train the mandibular muscles and to re-establish an acceptable occlusal relationship so that the patient can adequately control the opening and closing movements. This case series describes early prosthodontic management of three patients who had undergone hemimandibulectomy, with different techniques of fabrication of a GFP. The three techniques described consist of two conventional methods of fabrication while the third technique is a new innovative approach.

Prosthesis for mandibular guidance therapy – A case series

This article shows the importance of an intra-oral guiding flange prosthesis in patients who have undergone resection of mandible due to an underlying pathology. The case series show how the use of a guidance prosthesis can re-educate the mandibular muscles and re-establish an occlusal relationship for the resected mandible. Fabrication of a Guiding flange prosthesis was done for patient’s reporting to the department of Prosthodontics, with a significant deviation of mandible causing a deranged occlusion. Utilisation of various intra-oral prosthesis designs to overcome the deranged forces of the mandibular muscles have been shown. Basic designs used for fabricating the guidance prosthesis were buccal-based (maxillary based), palatal-based (maxillary based) and mandibular-based guidance. The re-establishment of the occlusal relationship was successful with the use, of any of the basic designs, of a guiding prosthesis. The patients could maintain a healthy occlusal relationship even after cessation of the therapy. This case series gives an insight as to how a Guidance prosthesis can be utilized either on an interim basis or as a part of definitive treatment too, although the success depends on the nature of surgical defect, patient's cooperation and early physiotherapy program. Keywords: Guiding flange, Mandibular defect, Occlusal correction

Rehabilitating Occlusion with a Guiding Flange Prosthesis in a Patient with Mandibular Resection: A Case Report

Defects with the discontinuity of the mandible following a segmental mandibulectomy present a majorchallenge for rehabilitation. These challenges include correction of deranged mandibular movements,disfigurement, and esthetics, correction of functional difficulty seen during swallowing,speech andarticulation, and also of surgical side deviation of the remainder mandibular structure. The following casereport elaborates on the prosthodontic rehabilitation of a patient with the help of a device named «GuideFlange Prosthesis»which isindicated to correct such manifestations seen after hemimandibulectomy

An innovative technique for the fabrication of fixed removable guide flange prosthesis for lateral mandibular resection

Rehabilitation of patients with a severe mandibular defect is challenging to prosthodontists. The esthetic and functional rehabilitation of patients with lateral mandibular resection is difficult due to the lack of supporting tissues for the prosthesis. The mandibular deviation furthermore results in facial asymmetry and unstable occlusion. This case report describes an innovative technique to rehabilitate a patient with lateral mandibular resection using customized access post attachment system to retain guide flange prosthesis for reducing mandibular deviation.

Guide flange prosthesis for the management of deviation following hemimandibulectomy: A case report

Guide flange prosthesis for the management of deviation following hemimandibulectomy: A case report

Prosthetic rehabilitation of hemi-mandibulectomy Patient with a definitive prosthesis -a case report

“Often the loss reveals the value of things”. Surgical removal of odontogenic tumors in the posterior region of mandible leads to discontinuity of mandible. Prosthetic rehabilitation is a successful treatment modality to reconstructive surgeries. Mandibular resection leads to deviated mandibular movements, disfigurement, facial profile asymmetry, dysphagia, impaired speech and, deviation of the mandible towards the surgical site. Treatment modality for oral rehabilitation of patients with mandibular resection includes maxillomandibular fixation, implant-supported prosthesis, removable mandibular guide flange prosthesis, and twin occlusion prosthesis. One of the treatment options for the mandibular defect is Cast partial denture prosthesis, whereas surgical reconstruction by implants and grafts is always not feasible in every patient. This clinical report describes rehabilitation of Cantor and Curtis class III mandibular defect using cast partial denture prosthesis following hemi mandibulectomy.