Impression and custom preparation; mandibular resection prosthesis

CPT4 code

Name of the Procedure:

Impression and Custom Preparation; Mandibular Resection Prosthesis

Summary

This procedure involves taking an impression of the lower jaw, which has been surgically altered due to conditions like cancer. The impression is then used to create a custom prosthesis that replaces the resected part of the mandible, helping restore function and appearance.

Purpose

This procedure addresses conditions that require a portion of the mandible (lower jaw) to be removed, such as oral cancer. The goal is to restore normal oral functions like chewing and speaking, and to improve facial appearance and quality of life.

Indications

Cancer that necessitates the resection of part of the mandible.
Severe trauma to the lower jaw.
Congenital defects affecting the mandible.
Osteoradionecrosis (bone death caused by radiation therapy).

Preparation

Pre-procedure consultations with the surgical team and a prosthodontist.
Diagnostic imaging (e.g., CT scans) to assess the extent of mandibular resection.
Fasting for a specific period if general anesthesia is to be used.
Adjustment or cessation of certain medications as advised by the healthcare provider.

Procedure Description

Impression:
- A dental impression material is used to create a mold of the oral structures, capturing the precise anatomy of the resected area.
Custom Preparation:
- The mold is sent to a dental laboratory where a custom prosthesis is fabricated. This involves designing and creating an artificial replacement tailored to fit the unique contours of the patient's mouth.
Fitting:
- The prosthesis is checked for fit and comfort. Adjustments are made as required to ensure proper alignment and functionality.
Tools and Equipment:
- Dental impression trays and materials.
- Dental laboratory equipment for prosthesis fabrication.
- Precision surgical instruments, if needed, during the fitting process.

Anesthesia:

Local or general anesthesia may be used during the impression-taking process if required.

Duration

The entire process, including impression, custom preparation, and fitting, may take several weeks to complete, with multiple appointments spread out over this period. Each session typically lasts 1-2 hours.

Setting

Typically performed in a combination of dental offices, specialized prosthodontic clinics, and hospital settings for certain stages.

Personnel

Oral and maxillofacial surgeons.
Prosthodontists.
Dental technicians.
Nurses and support staff.
Anesthesiologists (if general anesthesia is needed).

Risks and Complications

Discomfort or gagging during the impression process.
Infection at the site of prosthesis fitting.
Poor fit requiring adjustments.
Temporary difficulty with speech or chewing.
Damage to remaining teeth or oral tissues.

Benefits

Restored ability to chew and speak effectively.
Improved facial aesthetics and symmetry.
Enhanced quality of life and self-esteem.
Long-term solution if maintained properly.

Recovery

Mild discomfort and swelling post-fitting, usually managed with pain relief medications.
Soft diet for the initial days until the patient adapts to the prosthesis.
Follow-up appointments for adjustments and monitoring.
Good oral hygiene to prevent infections and ensure the longevity of the prosthesis.

Alternatives

Non-surgical options like modified dentures.
Bone grafting and reconstruction without prostheses.
Other dental appliances (e.g., bridges, partial dentures).

Pros and Cons:

Prosthesis provides a more permanent, stable solution compared to dentures.
However, the process is lengthy and involves multiple appointments.

Patient Experience

During the procedure, patients might feel some discomfort due to the materials used for impressions. After the fitting, pain and swelling are usually managed with medications. Patients might need time to adapt to the prosthesis and may experience some initial difficulties with speech and chewing. Comfort measures include prescribed analgesics and soft diets.