If the “fusion” of maxillofacial prosthetic treatment and surgery for jaw defects can be routinely performed to restore function, one of the goals of the Japanese Academy of Maxillofacial Prosthetics will have been achieved. What is this “fusion”？ Let us try to define this goal based on the history of multidisciplinary cooperation.
The number of medical institutions working closely together in various forms of surgical and prosthetic treatment is increasing, thanks to the existence of the Japanese Academy of Maxillofacial Prosthetics, as well as insurance coverage for immediate surgical obturators （ISO） and bone anchored devices for wide edentulous areas. However, there are still issues that need to be resolved for “collaboration” and “medical team approach” to become “fusion”. Why has no clear strategy for functional restoration of maxillary and mandibular defects emerged？ Comprehensive satisfaction is still not provided in some cases. In the ideal case, the choice of the maxillofacial prosthesis and the bone anchored device for wide edentulous area should not be determined as a result of the surgery, but rather the selection of a donor of reconstructed bone should be made at the time of designing the reconstructive surgery, taking into consideration the tumor, the extent of jaw resection, the remaining teeth, and the occlusal condition. Reverse planning of treatment and functional recovery by digital simulation should also be considered. We believe that this is the essence of “fusion.”

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Patients with jaw defects due to tumors, trauma, or congenital diseases generally have more severe oral dysfunction and esthetic problems than normal patients. Prosthodontic treatment is essential in the majority of such cases to improve their quality of life. However, their oral functions may not improve with a dentomaxillary prosthesis installed in the oral environment where it is difficult to achieve support, bracing and retention, which are the requirements for a stable denture.
It is extremely important to improve and maintain the QOL of patients with jaw defects, therefore, it is necessary to provide a prosthesis that offers the best possible functional improvement. The postoperative oral environment is diverse, and the key points of each treatment for fabricating dentomaxillary prostheses are different.
This article outlines the trend of patients of our Department of Maxillofacial Prosthetics, our approach to prosthesis fabrication, oral environment problems for prosthesis fabrication after surgery, the types of retainer used for prostheses, and the postoperative oral functions. The integration with surgery and maxillofacial prosthetic treatment from a prosthetic standpoint is discussed from these perspectives.

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The aim of this research was to survey various denture retainers used for defective mandibles. The survey was conducted by retrospectively checking medical records and protocols. The retainer types and numbers were listed with regard to the type of mandibular defects such as marginal resection, or segmental resection with/without reconstruction. The results revealed that the most frequently used direct retainers were the wrought wire clasp following the Akers clasp regardless of the type of mandibular defect. The wire clasps were mostly located in the anterior teeth region whereas Akers clasps were applied in the posterior teeth region. The observation period of each retainer did not differ between the resection types, however, the Akers clasps functioned for longer in the marginal resection cases compared to the segmental resection cases. In the segmental resection cases, the number of indirect retainers did not differ but the ratio of the number of retainers to the number of remaining teeth was higher than that in the marginal resection cases. Since cases of mandibular reconstruction have increased, there is also a growing need for prostheses for defective jaws for improving oral function. This survey suggested important considerations for the ideal design of dentures for defective mandibles.

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