The purpose of this study was to investigate segmental resection of the mandibular bone by using the 3D finite element method. A 3D finite element model with mandibular bone resection was constructed. Mandibular reconstruction plates were inserted at the lower border of the mandibular bone and secured by screws. The analysis items were as follows: equivalent stress distribution of mandibular reconstruction plates, equivalent stress distribution of screws and equivalent stress value of screws. As a result, it was suggested that the size of defects of the jaw affected the mechanical effects of the plates and screws.
Purpose: This study aimed to explore the effects of oral hygiene instruction on maxillofacial prosthetic patients’ oral hygiene conditions with plaque control record （PCR）. Methods: Patients were divided into 3 groups. Group-1 included 38 maxillofacial prosthetic patients with continuous oral hygiene instruction by dental hygienists. Group-2 included 16 maxillofacial prosthetic patients who didn’t receive oral hygiene instruction. Group-3 included 35 non-maxillofacial defects patients with continuous oral hygiene instruction. Oral hygiene condition was calculated by O’Leary’s PCR. Patients’ age, residual teeth, occlusal supports, and occlusal units （OUs） were picked up as factors. Statistical analyses were performed using Kruskal-Wallis test, Steel-Dwass test, and Spearman’s rank correlation coefficient. Results: Group-3 patients had significantly more residual teeth, occlusal supports and OUs compared to Group-1 and Group-2, although there was no significant difference in age among all groups. There were significant differences in PCR scores among all groups, Group-2 showed the highest PCR scores, and Group-3 showed lower than Group-1. In only Group-1, significant correlations were found between PCR and residual teeth, and occlusal supports. Conclusions: Oral hygiene instruction and oral care could improve maxillofacial prosthetic patients’ oral hygiene conditions. However, it seems to be hard to reach the level of non-maxillofacial defects patients.
The patient was a 75-year-old male who underwent surgical resection due to left maxillary gingival carcinoma in 1990. A maxillary defect from the right central incisor tooth to the left second molar tooth and which extended to the soft palate was observed （HS classification: H6S1DXT4）. In 2008, the patient received a split type hollow obturator prosthesis with a magnetic attachment. In 2012, the patient re-visited this facility with the chief complaints of masticatory disorder, poor denture retention and instability, and requested a new maxillary prosthesis without a magnetic attachment. Therefore, improvement in denture retention and stability was attempted by modifying the hollow obturator in a new maxillary prosthesis. As a result, we devised a maxillary prosthesis with a cap mechanism where the interior can be washed. After insertion of the new maxillary prosthesis and dentures, a more hygienic state, satisfactory stability, and improved masticatory function were obtained with minimal adjustment.
Dental hygienists often hesitate to intervene for patients who are permanently damaged from an accident because of little information about oral hygiene management for them. Here, we report a case of oral hygiene management for 8 years in a patient with blindness and bilateral forearm amputation because of severe extensive burns who showed positive outcomes in oral health. A 48-year-old man who had blindness and had undergone bilateral forearm amputation with the Krukenberg procedure because of burns from an explosion was referred to our clinic for toothache in November 2010. As dental treatment was expected to be difficult because of cicatricial contracture, we prioritized intervention to manage and maintain oral hygiene. For the initial periodontal treatment, we set the goal of our oral hygiene instructions that the patient could realize his oral condition and learn the pointed usage of an electric toothbrush. With our instructions, the patient showed positive behavior modification for self-care. After the reassessment, we provided supportive periodontal therapy and followed up the patient every 3-6 months. In this case, the patient could understand the importance of self-care and practice through the intervention by dental hygienists. Effective follow-up for 8 years, provided by dental hygienists, contributed to positive outcomes in his oral health.