Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"

Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

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Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Important Notice

Year : 2010 | Month : October | Volume : 4 | Issue : 5 | Page : 3266 - 3270

Mandibular Guide Flange Prosthesis Following Mandibular Resection: A Clinical Report


MDS, Senior Lecturer, Dept. of Prosthodontics Chhattisgarh Dental College and Research Institute Rajnandgaon

Correspondence Address :
Dr. Shailendra Kumar Sahu
MDS, Senior Lecturer, Dept. of Prosthodontics
Chhattisgarh Dental College and Research Institute
Phone No. +919993860122


Loss of the continuity of the mandible destroys the balance and the symmetry of mandibular function, leading to altered mandibular movements and deviation of the residual fragment towards the surgical side. This clinical report gives a brief review of resection guidance prosthesis and describes the fabrication of an acrylic guidance flange prosthesis. Successful intercuspal position was accomplished through the use of the guidance appliance, combined with physiotherapy in a patient who underwent a hemisection of the mandible, subsequent to treatment for an ameloblastoma.


Mandibular guidance therapy, Guide flange prosthesis, hemimandibulectomy

Surgical treatment for neoplastic lesions of the oral cavity often requires resection involving the mandible, floor of the mouth, tongue and also the palate.(1),(2) While the surgical restoration of the mandibular resections has advanced dramatically with free-flap techniques, oral function and patient perceptions of function, as well as treatment outcomes, often indicate significant impairment.

In patients who have undergone mandibular resection, the remaining mandibular segment will retrude and deviate towards the surgical side, at the vertical dimension of rest. Upon opening the mouth, this deviation increases, leading to the opening and closing of the angular pathway. Loss of the proprioceptive sense of occlusion leads to the uncoordinated, less precise movement of the mandible. The absence of the muscle of mastication on the surgical side results in a significant rotation of the mandible upon forceful closure. When viewed from the frontal plane, the teeth on the surgical side of the mandible move away from the maxillary teeth after the initial contact on the nonsurgical side has been established. As the force of closure is increased, the remaining mandible rotates through the frontal plane. Hence the term ‘frontal plane rotation’.(1) This factor, with the addition of impaired tongue function, may totally compromise mastication.

The severity and permanence of mandibular deviation is highly variable and is dependent upon a number of complex factors such as the amount of soft and hard tissue resected, the method of closure and so forth. Patients who are closed with a myocutaneous or free flap soon attain an acceptable interocclusal relationship with adjunctive therapy, while some patients who are closed primarily, are never able to achieve an appropriate and a stable interocclusal relationship.(1),(2)

The literature shows the varying basic design of prostheses that can be mandibular based or palatal based, anchored on natural teeth or the denture flange, have been employed to reduce or minimize mandibular deviation.(3)

Review Of Literature
Robinson et al. (1964) (4) suggested that if the mandible can be manipulated into an acceptable maxillomandibular relationship, but lacks motor control to bring the mandible into occlusion, a cast mandibular resection restoration is appropriate. They further stated that fabrication of a provisional guide plane facilitates the fabrication of a definitive restoration. Dorsey J. Moore et al. (1976) (5) described a technique which combines crowns with a maxillary prosthesis to guide the mandible into a functional occlusion.

Mohamed A. Aramany et al. (1977) (6) reported 14 patients who were treated by the use of immediate intermaxillary fixation after segmental resection of the mandible to eradicate cancerous lesions. They claimed that the use of intermaxillary fixation during the first 6 postoperative weeks reduces the degree of deviation. Fattore et al. (1988) (7) advocated a two piece gunning splint, both for intermaxillary fixation and as a guidance appliance for an edentulous patient, following hemisection of the mandible. Hasanreisoglu et al. (1992)(8) suggested that for dentate patients, palatal guide ramps or mandibular guide flange prostheses are indicated.

Beumer et al. (1996) (1) reported that if the mandible can be manipulated comfortably into an acceptable occlusion position, a cast metal guidance ramp will be appropriate. If some resistance is encountered in positioning the mandible, a guidance ramp of acrylic resin is suggested, as this material can be periodically adjusted as an improved relationship is obtained. They further stated that mandibular guidance therapy begins when the immediate post surgical sequelae have subsided, usually at about two weeks after surgery. Initially, the patient should be placed on an exercise program.

Nasrin Sahin et al. (2005) (9) described the fabrication of a cast metal guidance prosthesis with supporting flanges and retentive flanges for a patient, following a segmental mandibulectomy and claimed that the patient was able to achieve a functional intercuspal position after the insertion of the prosthesis. Joshi et al (2008) (10) described the fabrication of a mandibular guide flange prosthesis and suggested that a removable prosthesis is an effective alternative for most patients with mandibular defects, considering the poor prognosis, difficulty in decision making for the use of the implant and economic feasibility. Prencipe MA et al (2009) (11) described a technique by which only 1 mandibular prosthesis can be used both for physiotherapy and eating, by simply inserting and removing the guide flange. Two precision attachments were inserted into buccal surface of the denture base with their patrix and the corresponding matrixes were inserted into the transparent guide flange.

Mandibular resection prostheses should be provided to restore the mastication within the unique movement capabilities of the residual function in the mandible. A common feature among all removable resection prosthesis is that all framework designs should be detected by a basic prosthodontic design. These include broad stress distribution, cross arch stabilization by using a rigid major connector, stabilizing and retaining components at locations within the arch to minimize the dislodgement and the replacement of the tooth positions which optimize the prostheses. Stability and function needs modification to these principles, that are determined on an evidence basis and greatly influenced by unique residual tissue characteristics and mandibular movement dynamics.

Case Report

A 30 year old female reported to the Dental Prosthesis Service with a chief complaint of difficulty in mastication and speech. She had a unilateral discontinuity mandibular defect on the right side due to surgery for ameloblastoma. The surgery was performed 20 days back and reconstruction was done with muscle graft. No intermaxillary fixation was applied at the time of surgery. The patient was not financially sound.

Extraoral examination showed facial asymmetry with mandibular deviation to the right side. Clinical examination revealed severe deviation of the mandible towards the resected side, with lack of proper contact between the maxillary and the mandibular teeth. Intra oral examination showed missing teeth 43, 44, 45, 46, 47 and 48 (Table/Fig 1). The mandibular defect was classified as Cantor and Curtis Class IV i.e. resection of the lateral portion of the mandible with subsequent augmentation to restore form and function(12).

(Table/Fig 1): Pre-operative intraoral view showing mandibular deviation towards resected side.

The patient was evaluated for the guide flange prosthesis. It was noted that the patient’s mandible could be manually placed into the centric occlusion without excessive force. A mandibular based acrylic resection prosthesis with a buccal guiding flange was planned.

A maxillary and mandibular impression was made by using irreversible hydrocolloid. (Table/Fig 2). The casts were poured with Type III dental stone. A maxillomandibular record was made by manually assisting the mandible into the centric occlusion. The maxillary and mandibular cast was mounted on a three point articulator.

(Table/Fig 2): Impression made using Irreversible hydrocolloid.

The mandibular resection prosthesis was fabricated on the non defect (left) side. The design (Table/Fig 3) included the guidance flange on the buccal side and the supporting flange on the lingual side. The retention was provided by the interdental clasp, engaging the premolars and the molars. The guide flange extended superiorly and diagonally on the buccal surface of the molars and the premolars, allowing the normal horizontal and vertical overlap of the left maxillary teeth. The guide flange was sufficiently blocked out, so that it would not traumatize the left maxillary teeth and the gingiva when the patient closed her mouth. The prosthesis was finished, evaluated and inserted intraorally. (Table/Fig 4)

(Table/Fig 3): Design of Guide Flange Prosthesis

The guide flange provided a mechanical system which prevented the mandible from turning towards the resected side. The patient was advised to use the guide flange device throughout the day, except at night and during meals.

(Table/Fig 4): Intraoral view of the patient with the Guide flange prosthesis.

Physiotherapy was suggested to assist the patient in improving the symmetrical arc of closure and in finding the centric occlusion position without guiding the mandible manually. The exercise consisted of the simple opening and closing of the mandible with and without the appliance. These movements tend to loosen scar contracture, reduce trismus and reprogram the remaining musculature to close the mandible into the centric occlusion. When prosthetic therapy is combined with a well organized exercise program, improved results can be achieved.

(Table/Fig 5): Intraoral view of the patient with the Interim removable partial denture.

Three days after insertion of the prosthesis, the patient was able to achieve a functional intercuspal position without manual manipulation. After one week, the patient was evaluated for the insertion of the interim removable partial denture. The interim removable partial denture was fabricated for the patient with heat cure acrylic by utilizing the wrought wire clasp and by engaging the premolars and the molars to get retention. This prosthesis helped her to get accustomed to close the mandible into the correct intercuspal position without the use of any external aid. (Table/Fig 5)

In such patients, definitive partial denture restorations are deferred until an acceptable maxillomandibular relationship is obtained or an end point in mandibular guidance therapy is reached. Guidance prosthesis and interim removable partial denture serve as training appliances till a cast partial denture can be fabricated for the patient. Within 3 weeks, the mandible was guided to the correct occlusal position.


Rehabilitation is an essential phase of cancer care and should be considered from the time of diagnosis in a complete and comprehensive treatment plan. The primary objective of rehabilitation is the restoration of appearance and function. Mandibular resection, as a consequence of surgical treatment of the tumour, will clinically result in facial asymmetry and malocclusion. The residual mandible deviates medially and superiorly and it will be more or less evident, depending on the location and the extension of the resection, the amount of soft tissue and innervations which are involved and the presence of the remaining natural teeth. A corrective device named ‘guide flange prosthesis’ is indicated to limit that clinical manifestation and to restore mandibular function.

This clinical report illustrates the prosthetic management of a patient who underwent mandibular resection due to surgery for ameloblastoma. The literature shows various types of cast metal guidance prostheses which are effective in managing the mandibular deviation. But such appliances are complex, the technique is sensitive and costly and they require a number of patient visits. The acrylic guide flange prosthesis which is presented here is a simple and cost effective method for managing the mandibular deviation. The number of patient visits is also less as compared to the cast metal guidance prosthesis. The other advantage is its ease of adjustability.

The success of mandibular guidance therapy depends on the early beginning, the nature of the surgical defect and the patient’s cooperation. Mandibular guidance therapy begins when the immediate postsurgical sequelae have subsided, usually within 2 to 3 weeks after surgery. This sort of therapy is most successful in patients whose resection involves only bone structures and minimally the tongue, the floor of the mouth and contiguous soft tissues. The presence of the teeth in both the arches is important for the effective guidance and the reprogramming of the mandibular movements. The patient in this clinical report retained all her teeth, except those on the defect site. Therefore, the patient had a better proprioceptive sense and was able to achieve the functional position after the insertion of the prosthesis.

The main purpose is to re-educate the mandibular muscles to re-establish an acceptable occlusal relationship (physiotherapeutic function) for the residual hemimandible, so that the patient can control the opening and closing of the mandibular movements adequately and repeatedly. This is the beginning of an accomplished prosthetic rehabilitation by using a removable prosthesis, by which artificial teeth could warrant a stable occlusion. For better results, the prosthetic management can be combined with an exercise program that can be started 2 weeks after the surgery. On opening completely, the mandible can be displaced by hand as forcefully as possible towards the nonsurgical side. These movements tend to lessen scar contracture, reduce trismus, and improve maxillomandibular relationships.


Because mandibular guidance therapy is most successful in patients whose resection involve only bony structures with minimal loss of soft tissue and no radical neck dissection or radiation therapy, the patients who are treated for ameloblastoma are ideal candidates for the use of a mandibular guidance therapy. For better results, the prosthetic management should be combined with an exercise program.

Key Message

In patients who have undergone mandibular resection, correct intercuspal position can be accomplished with the early use of Guide flange prosthesis combined with physiotherapy.


Beumer. J III, Curtis T.A, Marunick MT. Maxillofacial Rehabilitation. Prosthodontic and surgical consideration. St. Louis : Ishiyaku. Euro America. 1996. p. 113 –224.
Taylor TD. Clinical maxillofacial prosthetics. Quintessence Publishing Co, Illinois, 1997. p. 171-188.
Schneider RL, Taylor TD. Mandibular resection guidance prostheses: A literature review. J Prosthet Dent 1986:55:84–86
Robinson JE, Rubright W.C. Use of a guide plane for maintaining the residual fragment in partial or hemimandibulectomy. J Prosthet Dent 1964;14:992 -9.
Moore DJ, Mitchell DL. Rehabilitating dentulous hemimandibulectomy patients. J Prosthet Dent 1976:35:202–6
Aramany MA, Myers EN. Intermaxillary fixation following mandibular resection. J Prosthet Dent 1977:37:437–44
Fattore L, Marchmont – Robinson H, Crinzi RA, Edmonds DC. Use of a two piece Gunning splint as a Mandibular guide appliance for a patient treated for Ameloblastoma. Oral Surgery Oral Med Oral Patho. 1988;66:662-5.
Hasanreisoglu U, Uçtasli S, Gurbuz A. Mandibular guidance prosthesis following resection procedures: Three case reports. Eur J Prosthodont Rest Dent 1992;1:69-72.
Sahin N, Hekimoğlu C, Aslan Y. The fabrication of cast metal guidance flange prostheses for a patient with segmental mandibulectomy: a clinical report. J Prosthet Dent. 2005;93:217-20.
Joshi PR, Saini GS, Shetty P, Bhat SG. Prosthetic rehabilitation following segmental mandibulectomy. Journal of Indian Prosthodontic Sosiety. 2008;8:108-11.
Prencipe MA, Durval E, De Salvador A, Tatini C, Branchi Roberto. Removable Partial Prosthesis (RPP) with acrylic resin flange for the mandibular guidance therapy. J Maxillofac Oral Surg. 2009;8:19–21
Cantor R, Curtis TA. Prosthetic management of edentulous mandibulectomy patients. Part 1 Anatomic, physiologic and psycologic considerations. J Prosthet Dent. 1971;25:446-57.

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