Modified surgical stent  for tuberoplasty in combination syndrome patients

Zanetti, Glauco Rangel; Zanetti, Liliane Scheidegger da Silva; Peçanha, Marcelo Massaroni; Borges Filho, Fausto Frizzera; Castro, Gabriela Cassaro de

Original Article

Modified surgical stent for tuberoplasty in combination syndrome patients

Guia cirúrgico modificado para tuberoplastia em pacientes com síndrome da combinação

Zanetti, Glauco Rangel; Zanetti, Liliane Scheidegger da Silva; Peçanha, Marcelo Massaroni; Borges Filho, Fausto Frizzera; Castro, Gabriela Cassaro de

Rev. odontol. UNESP, vol.39, n2, p.131-135, 2010

PDF

Downloads: 6

Abstract

According to the literature, patients who have complete maxillary dentures opposing mandibular anterior natural teeth may present the combination syndrome (CS). These patients could develop the typical signs of the CS such as: overgrowth of the maxillary tuberosities, severe anterior maxillary resorption, and extrusion of the lower anterior teeth. When surgical removal of changes in the maxillary posterior ridges is asked, the subsequent prosthodontic treatment to improve oral function and aesthetics will be easier. This paper aims to present an alternative technique for presurgical prosthetic planning and surgical stent fabrication for patients with CS needing tuberoplasty. The modified surgical stent proposed was fabricated after the determination of the occlusal plane and mounting of study casts on the articulator. Adoption of the proposed stent allows more accurate determination of excessive tissue and better visualization of the area to be removed during surgery.

Keywords

Complete dentures, bone resorption, removable partial denture.

Resumo

De acordo com a literatura, pacientes que utilizam próteses totais superiores ocluindo com dentes ântero-inferiores naturais podem apresentar a síndrome da combinação (SC). Estes pacientes podem desenvolver sinais típicos da SC como: aumento das tuberosidades maxilares, reabsorção severa na região anterior da maxila, e extrusão dos dentes anteriores inferiores. Quando a remoção cirúrgica de alterações em rebordo posterior de maxila é solicitada, o tratamento protético subseqüente para melhorar função e estética será facilitado. O objetivo deste artigo é apresentar uma técnica alternativa para o planejamento protético pré-cirúrgico e para confecção de guia cirúrgico em pacientes com SC necessitando de tuberoplastia. O guia cirúrgico modificado proposto foi confeccionado após a determinação do plano oclusal e montagem dos modelos de estudo em articulador. A adoção do guia proposto permite a determinação mais precisa da quantidade de tecido excedente e melhor visualização da área a ser removida durante a cirurgia.

Palavras-chave

Prótese total, reabsorção óssea, prótese parcial removível.

References

1. Adriens PA. Preservation of bony sites. Proceedings of the Third European Workshop on Periodontology: Implant Dentistry. 1999; 54: 266‑80.

2. Talgreen A. The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years. J Prosthet Dent. 2003; 89: 427-35.

3. Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent. 1972; 27: 140-50.

4. Saunders TR, Gillis RE, Desjardins RP. The maxillary complete denture opposing the mandibular bilateral distal-extension partial denture: treatment considerations. J Prosthet Dent. 1979; 41: 124-8.

5. The glossary of prosthodontic terms. J Prosthet Dent. 2005; 94: 10-92.

6. Jameson WS. The use of linear occlusion to treat a patient with combination syndrome: a clinical report. J Prosthet Dent. 2001; 85: 15-9.

7. Carlsson GE, Ragnarson N, Astrand P. Changes in height of the alveolar process in edentulous segments. A longitudinal clinical and radiographic study of full upper denture cases with residual lower anteriors. Odontol Tidskr. 1967; 75: 193-208.

8. Carlsson GE, Ragnarson N, Astrand P. Changes in height of the alveolar process in edentulous segments II. A longitudinal clinical and radiographic study over 5 years of full upper denture patients with residual lower anteriors. Sven Tandlak Tidskr. 1969; 62: 125-36.

9. Palmqvist S, Carlsson GE, Owall B. The combination syndrome: a literature review. J Prosthet Dent. 2003; 90: 270-5.

10. Taylor TD, Wiens J, Carr A. Evidence-based considerations for removable prosthodontic and dental implant occlusion. J Prosthet Dent. 2005; 94: 555-60.

11. Tolstunov L. Management of biomechanical complication of implant-supported restoration of a patient with combination syndrome: a case report. J Oral Maxillofac Surg. 2009; 67: 178-88.

12. Zarb GA, Bolender C. Tratamento protético para os pacientes edêntulos. São Paulo: Ed. Santos; 2006.

13. Shen K, Gongloff RK. Prevalence of the “combination syndrome” among denture patients. J Prosthet Dent. 1989; 62: 642-4.

14. Cabianca M. Combination syndrome: treatment with dental implants. Implant Dentistry. 2003; 12: 300-5.

15. Miloro M, Ghali GE, Larsen P, Waite PD. Peterson´s principles of oral and maxillofacial surgery. 2nd ed. New York: B C Decker; 2004.

16. Albuquerque B, Guimarães P, Sampaio N, Horta E, Vale P, Pestana P. Cirurgia para-protética. Rev Port Estomatol Med Dent Cir Maxilofac. 2007; 48: 229-35.

17. Thiel CP, Evans DB, Burnett RR. Combination syndrome associated with a mandibular implant-supported overdenture: a clinical report. J Prosthet Dent. 1996; 75: 107-13.

18. Markt JC. Fabrication of a surgical stent for bilateral tuberosity and mandibular alveolar reduction. J Prosthodont. 1999; 8: 264-7.

19. Barrett GD. A simplified surgical guide stent technique for the reduction of the impinging maxillary tuberosity. Compendium Contin Educ Dent. 1988; 9: 196-202.

20. Marzola C. Cirurgia pré-protética. 3a ed. São Paulo: Ed. Pancast; 2002.