Narendra.R et al /J. Pharm. Sci. & Res. Vol.

8(6), 2016, 461-463

Prosthodontic Rehabilitation of Cantor and Curtis

Class III Mandibular Defect Using Cast Partial
Denture :- A Case Report ”
Narendra.R MDSa, P.Sesha.Reddy MDSb, Sashideepth Reddy MDSc, Ashish.R.Jain* MDSd, S.Arunakumari MDSe,
a
Professor And HOD, Department of Prosthodontics, Goverment Dental College, RIMS, Kadapa, India.
b
Professor, Department of Prosthodontics, Goverment Dental College, RIMS, Kadapa, India.
c
Professor, Department of Prosthodontics, Goverment Dental College, RIMS, Kadapa, India.
d
Reasearch Scholar, Reader, Department of Prosthodontics, Saveetha Dental College and Hospitals,
Saveetha University, Chennai, India
e
Senior Lecturer, Department of Prosthodontics, Goverment Dental College, RIMS, Kadapa, India.

Abstract
Surgical removal of tumors in mandible leads to discontinuity of bone. Prosthetic rehabilitation is a successful alternative to
reconstructive surgeries. Mandibular resection leads to altered mandibular movements, disfigurement, difficult in swallowing,
impaired speech and articulation, and deviation of the mandible towards the resected site. Various options for oral
rehabilitation of patients with mandibular resection include maxillomandibular fixation, implant supported prosthesis,
removable mandibular guide flange prosthesis, Cast partial denture prosthesis and palatal based guidance restoration Cast
partial denture prosthesis for mandibular defects is a permanent solution to mandibular deviations, as 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.
Keywords:- Cast Partial Denture prosthesis, Hemi mandibulectomy, Prosthetic rehabilitation.

INTRODUCTION:- pseudo articulation of bone and soft tissues in

Restoration of form, function and esthetics in a patient who the region of the ascending ramus. (Fig. 1d)
has undergone hemi mandibulectomy is a valuable service Class V: Resection defect involves the symphysis and
rendered by a Prosthodontist . Restoration of esthetics parasymphysis region only, augmented to
provides patient with marked self confidence and Improves preserve bilateral temporomandibular
and restores normal occlusion to the patient. Loss of articulations. (Fig. 1e)
continuity of the mandible destroys the balance and Class VI: Similar to class V, except that the mandibular
symmetry of mandibular function, leading to altered continuity is not restored. (Fig. 1f)
mandibular movements and deviation of the residual
fragment towards the surgical site. In general, patients
suffering extensive soft tissue loss resulting from tight
wound closure, radiation therapy and those requiring a
classical neck dissection exhibit the most severe
mandibular deviation and dysfunction.1-4 Conversely
patients with mandibular resections resulting in little soft
tissue loss have less mandibular deviation. A classification
of mandibular defects has been described by Cantor and
Curtis. Although the classification system is suggested
primarily for edentulous patients, it is also applicable to
partially edentulous patients. This system classifies defects
based on remaining structures. 5,6,7

CANTOR AND CURTIS CLASSIFICATION 1 (Figure 1)

Class I: Mandibular resection involving alveolar defect
with preservation of mandibular continuity (Fig
1a)
Class II: Resection defects involve loss of mandibular
continuity distal to the canine area (Fig. 1b).
Class III: Resection defect involves loss up to the
mandibular midline region. (Fig. 1c).
Class IV: Resection defect involves the lateral aspect of
the mandible, but are augmented to maintain
Figure 1: Cantor and Curtis Classification

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All removable resection prosthesis framework designs

should be detected by basic prosthodontic design. These
include broad stress distribution, cross arch stabilization
using a rigid major connector stabilizing and retaining
components at locations within the arch to minimize
dislodgement and replacement of tooth position that
optimize prosthesis. By giving a cast partial denture
prosthesis, minimum tissue contact is present and
maximum function is restored.
.
CASE REPORT:
A 29 yrs old male reported to the department of
prosthodontics with Chief complaint of missing teeth in
lower left teeth region of the jaw. Past dental history
revealed that he was diagnosed as a case of Ameloblastoma
within the left mandible. The patient underwent an
extensive resection of whole of left mandible before three
years. Clinical examination revealed missing left mandible
from the midline to the condyle, along with part of anterior
mandible on the right side. Clinical examination revealed
severe deviation of the mandible towards the resected site
with lack of proper contact between maxillary and
mandibular teeth. An orthopantomogram (OPG) revealed
Titanium reconstruction plate was used to reconstruct and
give proper shape to left side of the mandible and to right
side of mandible till first premolar (Figure 2). An extraoral
examination showed an asymmetrical face, concave profile
and ovoid face [Figure 2]. Based on the clinical situation, a Figure 4: Arrangement of Artificial teeth In Occlusion
Cast partial removable partial denture was planned.

Figure 2: Preoperative OPG

Figure 5: Fabricated cast partial denture

Figure 3: Cast Partial Framework Figure 6: Intraoral View of Cast Partial Denture

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CLINICAL PROCEDURE seats were prepared to House the occlusal rest from which
The patient was evaluated for the fabrication of a Cast "Embrasure clasps" arise and provide the necessary
partial removable partial denture prosthesis. Impressions retention to the prosthesis. 11Duplication of Master cast was
were made and diagnostic casts were prepared. Surveying done after blockout procedure and refractory cast was
was done to assess the amount of undercuts on primary prepared so that the master cast was preserved while the
abutments and to assess the path of insertion and removal refractory cast contained the elevated platform as a result of
of the prosthesis. The removable partial denture includes planned blockout procedure making it easy for the
occlusal rest seats on all remaining three molars. On first technician to identify the area where the retentive arm and
molar the occlusal rest seat was prepared on distal marginal reciprocal arm supposed to come. The nail and bead minor
ridge and second molar and third molar on mesial marginal connector were used to support the denture bases which
ridge. The major connector was lingual bar and the minor had excess length as a result of complete mandible
connector supporting the occlusal rim was "meshwork" resection on left side.12
type and also "nail and bead" minor connector was
incorporated to support the occlusal rim which will be CONCLUSION:
replaced by denture bases with teeth at a later stage. The When the mandible is not stabilized following resection
direct retainer planned was embrasure clasp with step back and discontinuity defect results mandibular resection
design on first and second molar whereas simple circlet prosthesis should be provided to restore mastication within
clasp in third molar. After mouth preparation the the unique
impression were made using polyvinyl siloxane putty movement capabilities of the residual functioning
(virtual,Ivoclar vivident) and light bodied (virtual,Ivoclar mandible. Fabrication of cast partial denture is a good
vivident) impression material using putty wash / putty treatment option in rehabilitation of patients who have
relining technique. Cast were poured using type IV die undergone hemi mandibulectomy due to various reasons.
stone. On the master cast, surveying was done. "Planned
block out/shaped block out procedure Were carried out and REFERENCES:-
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