engleski

A complex implanto-prosthodontic rehabilitation of a patient with cerebral palsy

Cerebral palsy (CP) is a group of permanent movement disorders caused by abnormal development or damage to the parts of brain that control movement, balance, and posture. The most common problems include poor coordination, stiff/weak muscles, tremors, and involuntary movements. Our patient with CP was normally intelligent. He showed signs of physical impairment and could not control arm muscles and hands, and therefore had insufficient oral hygiene at baseline. He also had permanent head involuntary movements. All lateral teeth had been already extracted, his mouth was full of caries, plaque, calculus and gingivitis. He had Class III jaw relationship and no posterior antagonistic contacts (Fig. 1 and Fig.3 a, b).He first received calculus, plaque and caries removal treatment, endodontic treatment and fillings together with the instructions on how to maintain proper oral hygiene. As his oral hygiene improved sufficiently we proceeded with an implant- prosthodontic rehabilitation. After analysis of the casts mounted in an articulator (S.A.M. 2P, Germany) we established a treatment plan. Post and cores were made directly in mouth, casted and cemented (Glass-ionomer) (some teeth were destroyed below the gingival margin and the patient had hypersalivation). mplants (MIS, C1, Israel) were inserted in posterior alveolar ridges. Due to a small amount of available bone width, a split ridge technique was made, implants were placed together with artificial bone (Cerabone, Botiss dental GmbH, Germany) soaked in I-PRF, and covered with the A-PRF membrane and sutured (Fig. 2). Implants were left submerged. Six months later healing abutments were screwed and teeth preparations finished. Final impressions were obtained with transfer abutments and the open tray technique (Fig. 4 a, b). Jaw relationship was determined (Fig. 3 c, d, e) and casts transfered using a face bow into the S.A.M. articulator. Due to difficulties in obtaining mandibular impression (saliva, tremor) we obtained two mandibular impressions and 2 casts. The dental technician casted metal fixed partial dentures (FPD), which we checked in the mouth (Fig 5. a, b). After that the mandibular FPDs were first finished in ceramics (one mandibular cast served for the left side FPD and the other for the right side FPD). After cementation we obtained a single mandibular impression and final jaw vertical and horizontal relationship. The maxillary FPDs were finished in ceramics and cemented (Fig.6. a-d) with instruction about techniques how to maintain proper oral hygiene, which was sufficient at the 6 month clinical observation.

cerebral palsy ; implant rehabilitation ; prosthodontic rehabilitation

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