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Fabrication of a tooth–borne mouthstick for a Quadriplegic

Fabrication of a tooth–borne mouthstick for a Quadriplegic. By: J.E. Viljoen. Contents. Patient history Background condition Possible treatment options Treatment option of choice Laboratory procedures. Patient History. 12 Year old female Diagnosed with Guillian–Barr é syndrome

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Fabrication of a tooth–borne mouthstick for a Quadriplegic

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  1. Fabrication of a tooth–borne mouthstickfor a Quadriplegic By: J.E. Viljoen

  2. Contents • Patient history • Background condition • Possible treatment options • Treatment option of choice • Laboratory procedures

  3. Patient History • 12 Year old female • Diagnosed with Guillian–Barré syndrome • Permanent resident at Tygerberg hospital • Quadriplegic

  4. 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

  5. Condition and background information • Needs appliance to facilitate use of a computer • Quadriplegic – limited head movement • Connected to respirator • Weak masseter muscles • Eruption of permanent dentition

  6. Background • Prosthesis was made by occupational therepist • Prosthesis was retained by bite forces • Prosthesis caused pain in Masseter muscles

  7. Possible treatment options • Tooth–borne oral device • A telescopic oral device • Extra–oral chin cap

  8. Tooth–borne oral device

  9. Tooth–borne oral device Advantages: • No biting forces required • Inexpensive to fabricate • Simple to use • Occlusal forces equally distributed Disadvantages: • Length cannot be altered3

  10. Telescopic oral device

  11. 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

  12. Extra–oral chin cap

  13. Extra–oral chin cap Advantages: • Easy to communicate with • Easy to keep clean Disadvantages: • Uncomfortable for patient • No independence • Complicated to use2

  14. Most suitable treatment option • The tooth-borne device Reasons: • Inexpensive • Simple to use • Easy to fabricate • Not necessary to extend or retract the device

  15. Laboratory procedures • Special trays were fabricated and impressions taken and cast

  16. 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

  17. Laboratory procedures continued • Two-ply gum-guard material applied to model

  18. Laboratory procedures continued • Gum–guard trimmed to deepest part of sulcus

  19. Laboratory procedures continued • Special dentarum screw-sleeves used to secure mechanical part in position on gum-guard

  20. Laboratory procedures continued • Orthodontic acrylic was applied to gum–guard • Polished

  21. Finished product

  22. Final placement

  23. Acknowledgments • Dr Van Zyl • Miss Nortjé • Mr Steyn • Mrs Wright

  24. References: • A.J.Cloran. Telescopic mouth instruments for severely handicapped patients. Journal ofProsthetic Dentistry. 1974; 32(4): 435-438. • Hentschke, P. (2002) Guillian-Barré syndrome. (Web document). Available: http://www.medweb.pc.edu/students/med2003/miller1/guillain.html • J.Smokler. Mouthstick prosthesis for a patient with arthrogryposis multiplex congenita. Journalof Prosthetic Dentistry. 1979; 42(3): 316-321.

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