Thomas A. Curtis

A comparison of masticatory function in patients with or without reconstruction of the mandible

The functional benefits of mandibular reconstruction following a composite resection remain unclear. Although microvascular surgical techniques have dramatically increased the predictability of bone and soft‐tissue reconstruction towards presurgical anatomic norms, the specific factors responsible for improved function remain controversial. Objective measures of masticatory function need to be more clearly determined before the predictability and efficacy of reconstructive approaches is established.

Prosthetic management of edentulous mandibulectomy patients. Part I. Anatomic, physiologic, and psychologic considerations

Abstract Part I of this series of articles dealing with the prosthetic treatment of mandibulectomy patients presents some general physiologic considerations pertinent to mandibulectomy patients discussed in terms of functional adaptability to surgical insult. Deglutition, speech, mandibular movement and mastication, saliva control, respiration, and psychosocial factors are characterized. A classification of mandibulectomy patients is suggested, and the anatomic and physiologic oral conditions of the patients in each group are described. Part II will present a step-by-step discussion of clinical procedures specifically designed for the anatomic and physiologic alterations of these patients. Part III will present an evaluation of these suggested procedures by means of a clinical research study of 30 mandibulectomy patients.

Maxillary speech prostheses for mandibular surgical defects

Abstract Speech distortion is one of the debilitating consequences of radical surgery of the tongue, floor of the mouth, and mandible. The major cause of this speech impairment is restricted motion of the tongue and lack of lingual-palatal contact. Since contact between the tongue and the posterior part of the palate is anatomically impossible, a prosthesis is functionally formed to lower the palatal vault. The sounds “k” and “g” require this palatal contact. A series of test words beginning with these consonants was, therefore, used to evaluate possible speech improvement. The results indicated significant improvement in speech intelligibility for those patients with severely restricted tongues with the use of the prosthesis.

Incidence of various classes of removable partial dentures

The purpose of a classification for removable partial dentures (RPDs) is to simplify identification and enhance its teaching. A classification also allows a longitudinal comparison of various classes of RPDs to determine whether the teaching of RPD design is consistent with the relative frequencies of RPD use. This study surveyed the types of removable partial dentures being fabricated in a regional dental laboratory and compared these findings with data from previous studies. Results indicate that mandibular RPDs are more common than maxillary RPDs and the class I mandibular RPD is the most common type of RPD for either dental arch. A palatal strap was the most frequently used maxillary major connector and a lingual bar was used three times more often than a lingual plate in the mandibular arch. Cast circumferential clasps were used twice as often as RPI clasp designs. The percentage of Kennedy class I RPDs was 40%, class II 33%, class III 18%, and class IV 9%. Comparisons with a previous study indicate the percentage of Kennedy class II has increased, whereas class I, class III and class IV RPDs have not changed significantly. Findings of the study indicate that the frequency of use of the various types of RPDs have changed in the past 30 years.

Psychosocial aspects of maxillofacial rehabilitation. Part I. The effect of primary cancer treatment

Abstract One-hundred thirty-nine patients at the University of California Maxillofacial Rehabilitation Clinic were given a psychosocial questionnaire. The items of the questionnaire covered a variety of significant areas and were tabulated by computer. The results helped to define this patient population in terms of social stability, income and occupation, drinking and smoking habits, age, sex, and educational background. Aspects of the patients self-imge before and after his primary cancer treatment were presented.

Prosthetic management of edentulous mandibulectomy patients. Part II. Clinical procedures

Abstract This article is concerned with prosthetic principles relevant to the postsurgical conditions of radical mandibular surgery, and it demonstrates clinical procedures designed especially for these problems. Clinical observations concerning the value of this prosthetic technique have been made. A controlled clinical study of 30 mandibulectomy patients was undertaken in order to make an objective assessment of the procedures. The results will be discussed in Part III of this series.

Autogenous bone graft procedures for atrophic edentulous mandibles

Using a joint oral surgery-prosthodontic team approach, five patients with extreme atrophy of the edentulous mandible were selected for augmentation of the mandible with autogenous bone grafts from the crest of the ilium. All were wearing restorations considered adequate, but they had difficulty tolerating the lower dentures. An extraoral submandibular surgical approach was employed with few postoperative complications. Sulcus extension procedures were unnecessary after surgery, and four of the five patients received lower prostheses in approximately 3 months. The oral surgeon, the prosthodontist, and the five patients considered the results successful.

Complete denture prosthodontics for the radiation patient

The increased use of radiation therapy for the control of oral cancer necessitates that all dentists concerned with the rehabilitation of oral cancer patients be familiar with this treatment modality. Radiologic equipment, the rationale for their use, and the sequelae to oral treatment are discussed. Misconceptions have developed concerning the advisability of prescribing complete dentures following radiation therapy. However, clinical experience in the Maxillofacial Unit at the University of California, San Francisco, indicates that most radiation patients can wear complete dentures. The need to follow sound prosthodontic techniques is advocated, along with a few modifications related specifically to the radiation patient. Patient cooperation and meticulous care during and following the placement of dentures are stressed to minimize the risk of tissue necrosis and to preserve the well-being of the patient.

Physical problems in obtaining records of the maxillofacial patient

The maxillofacial prosthodontist has the dilemma of obtaining jaw relation records with structures that have been altered anatomically and/or physiologically. In the maxillae, problems associated with stability of the recording base require the prosthodontist to equalize pressure as best he can in obtaining jaw records. The maxillofacial prosthodontist is faced with the additional problem of altered mandibular movements. Five patients with lateral resections of the mandible were tested in a pilot study. These patients could not make protrusive or repeatable lateral movements. Anatomic correlations, especially the unilateral action of the mylohyoid muscle, may account for this pattern of abnormal mandibular movements. This study will continue.

Treatment planning for intraoral maxillofacial prosthetics for cancer patients

Abstract A preliminary study was made on 50 oral cancer patients. These patients were arbitrarily divided into “maxillary” and “mandibular” tumor groups, according to the proximity of the tumor site. These groups were compared with a matched control group of dental patients. This preliminary study suggested that there are differences between the two oral cancer groups, and these differences affect prosthetic treatment. Preponderantly, the tumors found in the mandibular cancer group were squamous cell carcinomas, while the maxillary cancer patients demonstrated more variation in tumor type. Patients in the maxillary tumor group were in a higher socioeconomic level, appeared more stable, and developed greater motivation for treatment. The maxillary tumor group of patients had more teeth present and the teeth were in better condition; these individuals offered a better prosthetic prognosis. The theory of excessive smoking and drinking in association with oral cancer patients is primarily confirmed in individuals with cancer approximating the mandible. Factors of which the prosthodontist should be aware are enumerated in the hope that he will consider the defect and prosthesis as part of the whole individual and not as a separate entity. In this manner, more successful prosthetic rehabilitation can be accomplished.