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–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

• 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:

• 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

• 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/miller1/guillain.html

3. J.Smokler. Mouthstick prosthesis for a patient with arthrogryposis multiplex congenita. Journal of Prosthetic Dentistry. 1979; 42(3): 316-321.