The limited mobility of the patient’s left temporo-man-dibular joint and the occurrence of lesions of tumorous and fi bromatous hypertrophies within the area of the mouth orbicular muscle, were the reasons for the development of an individual therapeutic treatment procedure (fi g. 3).
The laboratory work for the prosthetic treatment procedure required to do an impression of the oral cavity condition by means of a gypsum model. The model is produced on the basic of the impressions taken with standard trays (full range trays) covering the entire denture bearing area with alginate mass in the patient’s mouth. In the case consid-ered, as the patient found it diffi cult to open her mouth, all the impressions were taken using partial trays; each direct and indirect procedure step required a lot of patience and cooperation of both the dentist and the patient.
metal denture veneered with ceramics on the tooth no. 11 with a support in the shape of a swallow tail on the tooth no. 13. Tooth no. 11 was grinded, the single-time two-layer impressions and wax occlusion register were taken.
After the patient had tried the metal frame on, the trans-fer impression with alginate mass was made and the colour selected (fi g. 4). The prosthetic bridge denture was fi xed on a glasionomer cement base (fi g. 5).
Discussion
The changes with in the mouth orbicular muscle after e.g. surgical operations, burns or due to general organism diseases such as scleroderma or neurofi bromatosis, con-sidered herein, are the remarkable diffi culty and impedi-ment in the dental treatimpedi-ments, sometimes even disabling any treatments. It is necessary to have patients keep their mouth open for long time while making dental operations, in particular prosthetic ones. With in 1991–1994 the good practice, in cases of burn scars or scleroderma cases, was to use the hyaluronidase ionophoresis as a supportive tool.
In the case considered herein, due to the complexity and genetic character of the disease, the method mentioned above was not used as the support before prosthetic proceeding.
Even though the access to denture bearing area was very diffi cult, particularly from do its palatal side, the patient’s determination and her cooperative attitude gave unexpect-edly successful results.
Conclusions
Neurofi bromatosis in the course of Recklinghausen disease is a severe overall organism disease, signifi cantly detrimenting and reducing the life comfort of people suf-fering from it. In the case of Recklinghausen disease the treatment is of symptomatic character. The main objective is to detect the disease as early as possible and remove the bigger size neurofi bromas, those making patient’s life particularly inconvenient. In case the lesions of hyper-trophic character are found in the brain or spinal core, the neuro-surgical treatment is required. Since the glioma of sight nerves can occur, it is necessary to undergo periodi-cal ophthamologiperiodi-cal control. About 15–20% of patients suffering from NF-1 disease confi rm to have epilepsy at-tacks of general tonic-clonic character, so then appropriate pharmacological treatment is needed [8, 9, 10]. On having set up the prosthetic restoration – the bridge, the patient was advised of the necessity to under go the periodical dental control and carrying out maintenance activities to avoid dental plaque, the latter being one of the causes of carietic defect occurrences. The patient was advised of the necessity to control and observe the stomathognatic system.
In particular, the pains in the head and neck areas and hy-perplastic reactions which require intense observation. In
Fig. 3. The oral cavity before treatment, visible damage of tooth 11 and lack of tooth 12
Ryc. 3. Widok jamy ustnej przed rozpoczęciem leczenia, widoczny uszkodzony ząb 11 oraz brak zęba 12
Fig. 4. Laboratory stage of the prepared prosthetic appliance without ceramics on segment casts
Ryc. 4. Faza laboratoryjna wykonania mostu protetycznego – przygotowany odlew szkieletu pracy przed pokryciem ceramiką
Fig. 5. The state after prosthetic treatment – prosthetic bridge fi xed in the oral cavity
Ryc. 5. Stan po zakończeniu leczenia protetycznego – most protetyczny po założeniu w jamie ustnej
Due to diffi cult access, and the patient’s request, it was decided to make the steady restoration of the lack-ing tooth no. 12. The treatment included maklack-ing a partial
case the disease develops in cranial nerve terminals III, V and VIII, and further penetrates the area of the temporo-mandibular joint, the dysfunction symptoms and pains can occur. There are certain diagnostic methods to provide a correct diagnosis, such as NMR, arthroscopy or thin-needle biopsy. If an examination confi rms neurofi broma penetration to the joint cavity, any attempts of pain treat-ment of the above treat-mentioned areas will be unsuccessful.
In case the histopathological tests confi rm the penetration then a surgical operation is necessary [10].
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R O C Z N I K I P O M O R S K I E J A K A D E M I I M E D Y C Z N E J W S Z C Z E C I N I E 2007, 53, 2, 87–91
JUSTYNA POL, JADWIGA BUCZKOWSKA-RADLIŃSKA1, AGNIESZKA BIŃCZAK-KULETA2, MATYLDA TRUSEWICZ1