Rehabilitating mandibulectomy defects: a review of prosthetic solutions with case series

Prosthetic rehabilitation of mandibular defects is challenging for prosthodontists. Prosthetic treatment strategies require a detailed clinical evaluation of the patient. The first consideration is the mandibular continuity as the residual mandible deviates toward the site of the defect in segmental mandibulectomy without rigid reconstruction. In this condition, the initial prosthetic intervention often focuses on mandibular guidance therapy using interim appliances to re-educate muscles and re-establish acceptable occlusal relationships. Definitive restorations include conventional removable dentures and implant-supported prostheses, which are widely recognised as the gold standard for functional and dental rehabilitation following mandibular reconstruction. When implant placement is not medically indicated or preferred by the patient, complete dentures or removable partial dentures are the minimally invasive restorative options. Implant-supported prostheses are primarily divided into two categories: fixed prostheses and overdentures. Within each category, prostheses have different designs, which vary in the material used and the mechanism of retention. Implant-supported prostheses were designed considering several patient-specific factors, such as the number of implants, implant position, inter-jaw relationship, surrounding tissues, hygiene, and patient expectations. Considering these factors, a prosthetic reconstruction that restores mandibular integrity both functionally and aesthetically can be fabricated. Furthermore, the current use of computer-aided design and computer-aided manufacturing to design and fabricate these prostheses offers multiple advantages, including increased precision, a preview of the final prostheses, reduced fabrication time, and a wider range of material choices. This article provides information on the aetiology and classification of mandibular defects, reviews the management of the prostheses, and presents seven cases that describe different prosthetic treatment solutions and outcomes for such defects.