Transcript Fabrication of a tooth – borne mouthstick

Fabrication of a tooth–borne
mouthstick
for a Quadriplegic
By: J.E. Viljoen
Contents
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Patient history
Background condition
Possible treatment options
Treatment option of choice
Laboratory procedures
Patient History
• 12 Year old female
• Diagnosed with
Guillian–Barré
syndrome
• Permanent resident at
Tygerberg hospital
• Quadriplegic
About Guillian-Barré syndrome
• It is a syndrome, not a disease
• There is no cure
• Attack directed at mayelin – insulation component
of the nerves
• Affects 1 in 100 000 people
• No particular race, gender or age group
• Causes paralysis
• 75 – 90 % partial or total recovery2
Condition and background
information
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Needs appliance to facilitate
use of a computer
Quadriplegic – limited head
movement
Connected to respirator
Weak masseter muscles
Eruption of permanent
dentition
Background
• Prosthesis was made
by occupational
therepist
• Prosthesis was
retained by bite forces
• Prosthesis caused pain
in Masseter muscles
Possible treatment options
• Tooth–borne oral device
• A telescopic oral device
• Extra–oral chin cap
Tooth–borne oral device
Tooth–borne oral device
Advantages:
• No biting forces required
• Inexpensive to fabricate
• Simple to use
• Occlusal forces equally distributed
Disadvantages:
• Length cannot be altered3
Telescopic oral device
Telescopic oral device
Advantages:
• Length of extending stick can be altered
• No biting forces required
• Patient is self-supporting
Disadvantages:
• Heavy in mass
• Difficult to fabricate and use
• Expensive to fabricate
• Requires maintenance2
Extra–oral chin cap
Extra–oral chin cap
Advantages:
• Easy to communicate with
• Easy to keep clean
Disadvantages:
• Uncomfortable for patient
• No independence
• Complicated to use2
Most suitable treatment option
 The tooth-borne device
Reasons:
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Inexpensive
Simple to use
Easy to fabricate
Not necessary to extend or retract the device
Laboratory procedures
• Special trays were fabricated and impressions
taken and cast
Laboratory procedures continued
• Extra-oral mechanical parts
designed, then manufactured
by engineering company
• Parts made from aluminium
• Extra–oral rod has magnetic
tip
• Various tips made to
accommodate patient
• Tip snaps in position
Laboratory procedures continued
• Two-ply gum-guard material applied to model
Laboratory procedures continued
• Gum–guard trimmed to deepest part of sulcus
Laboratory procedures continued
• Special dentarum screw-sleeves used to secure
mechanical part in position on gum-guard
Laboratory procedures continued
• Orthodontic acrylic was applied to gum–guard
• Polished
Finished product
Final placement
Acknowledgments
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Dr Van Zyl
Miss Nortjé
Mr Steyn
Mrs Wright
References:
1. A.J.Cloran. Telescopic mouth instruments for
severely handicapped patients. Journal of
Prosthetic Dentistry. 1974; 32(4): 435-438.
2. Hentschke, P. (2002) Guillian-Barré syndrome.
(Web document). Available:
http://www.medweb.pc.edu/students/med2003/m
iller1/guillain.html
3. J.Smokler. Mouthstick prosthesis for a patient
with arthrogryposis multiplex congenita. Journal
of Prosthetic Dentistry. 1979; 42(3): 316-321.