engleski

Implanto-prosthodontic complex rehabilitation of a disabled patient with cerebral palsy

Case Presentation: Cerebral ppalsy (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. Patient who reffered to a dental office was normally intelligent. He could not control limb muscles and hands, and therefore had insufficient oral hygiene. He had involuntary head 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. He first received calculus, plaque and caries removal treatment, endodontic treatment and fillings together with the instructions on how to maintain proper oral hygiene. After his oral hygiene improved sufficiently we proceeded with an implant-prosthodontic rehabilitation. After analysis of the casts mounted in the articulator (S.A.M. 2P, Germany) we established a treatment plan. Implants (MIS, C1, Israel) were inserted in posterior alveolar ridges. Due to a small amount of available bone width, a split ridge technique was made and artificial bone (Bio Oss) soaked in I-PRF was placed with the APRF membrane and sutured (Fig. 2). Implants were left submerged and six months later healing abutments were screwed. Cast post and cores were made and cemented (some teeth had caries below gingival margin and he had hypersalivation). Teeth preparations were finished. Final impressions were obtained with transfer abutments and an open tray technique. Jaw relationship was determined and casts were transfered into the S.A.M. articulator. Due to difficulties in obtaining mandibular impression (saliva, tremor) we obtained 3 mandibular impressions and 3 casts. First the maxillary FPD was finished and cemented. After that jaw relationship was re-checked and the left side mandibular FPD was finished and cemented. After that frontal and right side mandibular FPD was finished and in the end implant retained FPD. All clinical steps were difficult to perform due to patient's tremor and involuntary continuous head movements. A year later patient had no complications and maintained satisfactory oral hygiene.

disabled patient ; cerebral palsy ; implanto-prosthodontic oral rehabilitation

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