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Table of Contents   
SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 1  |  Page : 161-163
Comparison of obturator design for acquired maxillary defect in completely edentulous patients


1 Department of Prosthodontics, SRM Dental College, Ramapuram, Tamil Nadu, India
2 Government Dental College, Chennai, Tamil Nadu, India

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Date of Submission16-Jun-2009
Date of Decision25-Mar-2010
Date of Acceptance24-Apr-2010
Date of Web Publication25-Apr-2011
 

   Abstract 

The most challenging and appreciated area in the field of Prosthodontics is the rehabilitation of maxillary defects. Tumors of the head and neck are the common cause for acquired maxillofacial defects. Surgical consequences predispose the patient to hypernasal speech, fluid leakage into nasal cavity, impaired masticatory function, and cosmetic deformity. The Prosthodontists play a significant role in the intervention and improve the quality of life of such patients. The current article describes two clinical case reports of completely edentulous patients with acquired maxillary defects.

Keywords: Rehabilitation, obturator, maxillary defects

How to cite this article:
Ahila S C, Anitha K V, Thulasingam C. Comparison of obturator design for acquired maxillary defect in completely edentulous patients. Indian J Dent Res 2011;22:161-3

How to cite this URL:
Ahila S C, Anitha K V, Thulasingam C. Comparison of obturator design for acquired maxillary defect in completely edentulous patients. Indian J Dent Res [serial online] 2011 [cited 2014 Apr 24];22:161-3. Available from: http://www.ijdr.in/text.asp?2011/22/1/161/79987
Maxillary defects are created by surgical treatment of benign or malignant neoplasms, congenital malformation, and by trauma. The size and location of the defects influence the degree of impairment. Such patients present difficulty in speech, mastication, swallowing, and poor esthetics. [1] To overcome such problems, obturator prostheses are provided. [2] An obturator is a maxillofacial prosthesis used to close a congenital or acquired tissue opening, primarily of hard palate and/or contiguous alwveolar or soft tissue structures. [3]

Patients with acquired maxillary defects differ from those with congenital defects because of the abrupt alteration in physiologic processes associated with surgical resection of the maxillae. [4] Subsequently they create oronasal and oroantral communication leading to difficulties in mastication, hypernasal speech, fluid leakage, and various degrees of cosmetic deformity. This effect diminishes the patient's quality of life and self-esteem. [5] However, definitive prosthodontic treatment will restore the patient to a normal or near normal level of function.


   Case Reports Top


Case 1

A 70-year-old male patient reported to the Department of Prosthodontics, Government Dental College, Chennai, after a year of surgical removal of adenoid cystic carcinoma in the right side of the maxilla with a complaint of leakage of fluid through the nose, nasal twang, difficulty in speech, and swallowing [Figure 1].
Figure 1: Preoperative view

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On examination, a defect was seen on the right side of the palatal process of the maxilla without any soft tissue undercut with dripping of fluid through the nose. The patient was completely edentulous.

Treatment plan

The patient reported a year after the surgery; hence a definitive single-piece obturator was planned. Initially, a primary impression was made with impression compound in a stock tray and a primary cast was made. A special tray was fabricated with self-curing acrylic resin, and border molding was done with a low-fusing compound. Tissues were molded starting from the unaffected side and then proceeding toward the defective side. Posterior palatal seal was recorded. A final impression was made with polyvinyl siloxane monophase material. A permanent denture base with a hollow bulb was fabricated using heat cure acrylic resin. The hollow bulb was tried in the patient's mouth and pressure-indicating paste was streaked on the bulb to check for over extensions. An occlusal rim was made over the permanent denture base. Facebow transfer was done using a spring bow of Hanau Wide-view semi-adjustable articulator and the maxillomandibular relationship was recorded. The teeth were arranged in balanced occlusion. After the try-in, it was processed and inserted [Figure 2].
Figure 2: Final denture

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Case 2

A 74-year-old patient reported to the Department of Prosthodontics, Government Dental College, Chennai, after 5 years of surgical removal of mucoepidermoid carcinoma in the midpalatal area with a complaint of leakage of fluid through the nose and difficulty in swallowing and speech. On examination, a defect was seen in the midpalatal area, which extended to the inferior nasal concha. More soft tissue undercut was present. All other areas were normal. The patient was completely edentulous [Figure 3].
Figure 3: Preoperative view

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Treatment plan

A definitive two-piece obturator was planned for the patient. Before impression, all the undercuts were blocked with gauze and the impression was made with Addition silicone putty material. A cast was prepared and a special tray was fabricated. Border molding was done using a low-fusing compound. A secondary impression was made with monophase impression material. Impression was poured twice and two master casts were obtained; one for the fabrication of the hollow bulb and the other for the denture fabrication.

Hollow bulb fabrication

The undercuts were blocked out with plaster. First a thin shim was fabricated and encapsulated in heat-cured acrylic resin. The lid was fabricated and attached with the bulb. The bulb was tried in the patient's mouth. A magnet was attached on the lid portion and coated with self-curing resin to avoid exposure to fluids. The remaining steps were similar to those for a single-piece obturator [Figure 4].
Figure 4: Final denture

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   Discussion Top


Maxillary defects result in a communication between the oral and nasal cavities that causes difficulty in swallowing, nasal reflux, unintelligible speech, and unesthetic appearance. All these difficulties affect the patient psychologically. The Prosthodontists play a major role in rehabilitation of such defects.

The prosthesis being located in the maxilla, the retention is affected by naturally existing gravitational force acting on it. Hence, light-weight prosthesis (hollow bulb) will not only combat this problem but also enhance the resonance of speech. [6]

Leaving the hollow bulb open at the top may create difficulty for the patient in its maintenance and collection of nasal secretions and accumulation of food particles causing a foul odor. Hence, closed hollow bulb prosthesis was preferred. [7]

Single-piece hollow obturator is more hygienic, esthetic, and simple to fabricate. If the defect is large with more soft tissue undercuts, then a two-piece obturator is preferred. [8],[9] The differences between case 1 and case 2 are that in the case 1, the defect size was small and soft tissue undercut was absent, so a single-piece obturator was fabricated and in case 2, a large defect and soft tissue undercut were present, hence, a two-piece obturator was constructed.

The two components were retained with the help of rare earth magnets. Rare earth magnets have been used in dentistry as early as 1960s. In a two-piece obturator, the Neodymium-iron-boron magnets were coated with a layer of resin to withstand the corrosiveness of saliva, and thus no ill effects on the oral tissues. Magnetism has been found to be constant during the entire life of the magnet in use. Magnetic attraction allows easy insertion of a denture. [10],[11]


   Conclusion Top


Successful Prosthetic rehabilitation of partial maxillary defect is a challenge that requires multidisciplinary approach. Successful obturation depends on the volume of the defect and the positioning of the remaining hard and soft tissues. The weight of the prosthesis may act as a dislodging force therefore it must be light weight being easily cleanable to give a better postoperative life. So acquired maxillary defects can be restored close to normal function and appearance.


   Acknowledgment Top


I express my heartfelt thanks to my teachers Dr. (Late) R. Julian, Dr. K.G.A. Nasser & Dr. E. Subramaniam for their help, support, and guidance in the completion of this endeavor.

 
   References Top

1.Keyf F. Obturator prostheses for hemimaxillectomy patients. J Oral Rehabil 2001; 28:821-9.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Ahmed B, Hussain M, Yazdania N. Hollow bulb obturator: A blessing for maxillectomy patients - A case report. Pak Oral Dental J 2007; 27:127-8.  Back to cited text no. 2
    
3.The Glossary of Prosthodontic terms. J Prosthet Dent 2005; 94:10-92.   Back to cited text no. 3
    
4.Yontchev E, Karlsson S, Lith A, Almqvist SA, Lindblad P, Engstrom B. Orofacial functions in patients with congenital and acquired maxillary defects: A fluoroscopic study. J Oral Rehabil 1991 18:483-9.  Back to cited text no. 4
    
5.Sharma AB, Beumer J 3 rd . Reconstruction of maxillary defects: The case for prosthetic rehabilitation. J Oral Maxillofac Surg 2005; 63:1770-3.  Back to cited text no. 5
    
6.Schwartzman B, Caputo AA, Beumer J. Gravity induced stresses by an obturator prostheses. J Prosthet Dent 1990; 64:466-8.  Back to cited text no. 6
[PUBMED]    
7.Taylor TD. Clinical maxillofacial prosthetics. Univ. of Connecticut, Farmington Quintessence Publishing Co. Inc; 2000. p. 100-18.  Back to cited text no. 7
    
8.Chalian VA, Barnett MO. A new technique for constructing a one-piece hollow obturator after partial maxillectomy. J Prosthet Dent 1972; 28:448-53.  Back to cited text no. 8
[PUBMED]    
9.Chandra TS, Sholapurkar A, Joseph RM, Aparna IN, Pai KM. Prosthetic rehabilitation of a complete bilateral maxillectomy patient using a simple magnetically connected hollow obturator: A case report. J Contemp Dent Pract 2008; 9:70-6.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Javid N. The use of magnets in a maxillofacial prosthesis. J Prosthet Dent 1971; 25:334-41.  Back to cited text no. 10
[PUBMED]    
11.Federick DR. A magnetically retained interim maxillary obturator. J Prosthet Dent 1976; 6:671-5.  Back to cited text no. 11
    

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Correspondence Address:
S C Ahila
Department of Prosthodontics, SRM Dental College, Ramapuram, Tamil Nadu
India
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DOI: 10.4103/0970-9290.79987

PMID: 21525697

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
    Case Reports
    Discussion
    Conclusion
    Acknowledgment
    References
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