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Table of Contents   
SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 3  |  Page : 486-488
Two-piece hollow bulb obturator


Department of Prosthodontics, Thaimoogambigai Dental College and Hospital, Chennai, India

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Date of Submission09-Oct-2009
Date of Decision13-Apr-2010
Date of Acceptance22-Dec-2010
Date of Web Publication3-Nov-2011
 

   Abstract 

There are various types of obturator fabrication achievable by prosthodontist. Maxillectomy, which is a term used by head and neck surgeons and prosthodontists to describe the partial or total removal of the maxilla in patients suffering from benign or malignant neoplasms is a defect for which to provide an effective obturator is a difficult task for the maxillofacial prosthodontist. Multidisciplinary treatment planning is essential to achieve adequate retention and function for the prosthesis. Speech is often unintelligible as a result of the marked defects in articulation and nasal resonance. This paper describes how to achieve the goal for esthetics and phonetics and also describes the fabrication of a hollow obturator by two piece method, which is simple and maybe used as definitive obturator for maximum comfort of the patient.

Keywords: Maxillectomy, Ni-Cr attachments, two piece hollow bulb obturator

How to cite this article:
Elangovan S, Loibi E. Two-piece hollow bulb obturator. Indian J Dent Res 2011;22:486-8

How to cite this URL:
Elangovan S, Loibi E. Two-piece hollow bulb obturator. Indian J Dent Res [serial online] 2011 [cited 2018 Aug 18];22:486-8. Available from: http://www.ijdr.in/text.asp?2011/22/3/486/87077
An obturator is an artificial substitute which replaces the surgical or congenital defective areas. It serves in lieu of a Levin tube for various purposes, in congenital defective palatal contour and/or soft palate after surgical removing of the defective area in the oral cavity, improves speech and used to correct lip and cheek position. [1]

There are various case reports and studies of obturators available for congenital defects of the palate and for acquired defects of the oral cavity. The size of the maxillectomy defect is one of the main factors governing the prognosis for treatment. [2]

A hollow closed bulb obturator is one type of permanent obturator used for acquired defects or surgically operated areas. A hollow bulb design is not necessary when the defect is of small to average size where healthy ridges exist. The hollow bulb design is to aid speech resonance to lighten the weight on the unsupported side.

Advantage of two-piece hollow obturator is that it is more hygienic and easy to handle. A hollow bulb obturator allows fabrication of a light weight prosthesis, that is readily tolerated by the patient while effectively extending into the defective areas. [3] Hollow obturator reduces the weight, is hygienic, easy to fabricate, and increase speech intelligibility, and moreover a closed hollow obturator prevents fluid and food collection, reduces air space, and allows maximum extension as well as more comfort than single piece obturator. [4] whereas an open bulb is unhygienic, foul smelling and unpleasant for the patient.

A 63-year-old male patient was diagnosed with oro-facial cancer and underwent maxillectomy in Govnt. Medical College. After the surgery, the patient was given temporary obturator. He had no other relevant medical history. The patient reported to Dental College with the complaint of difficulty in eating and speaking and also appearance. After the healing period of 6-8 months, the patient was advised for a definitive obturator. A two-piece hollow bulb obturator was planned as the definitive prosthesis. Edentulous ridge and the remaining teeth were in good condition.


   Procedure Top


  • An impression is made of elastomeric impression material to fabricate the bulb, which has two surfaces, i.e., the tissue side and a hollow side [Figure 1] and [Figure 2].
  • Hollow bulb is fabricated using acrylic resin.
  • The bulb is then placed intra-orally and an over impression for the partial denture is made with the bulb intact [Figure 3].
  • Cast is then poured with dental stone [Figure 4].
  • Jaw relation and wax try-in are done as in a conventional method [Figure 5].
  • Ni-Cr attachments are fabricated which consists of male and female parts and are attached to the bulb.
  • The denture is then processed and the final prosthesis consists of two parts, the bulb and the partial denture [Figure 6].
Figure 1: Tissue side

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Figure 2: Hollow side

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Figure 3: Hollow bulb try-in

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Figure 4: Split master cast with hollow bulb

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Figure 5: Wax try-in

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Figure 6: Final prosthesis

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   Discussion Top


The primary goal of the treatment of maxillectomy defect is to give a prosthetic obturation which closes the defect and separates the oral cavity from the sino-nasal cavities. The size and location of the defects influence the degree of impairment and difficulty in prosthetic rehabilitation. [5] A pressure resistant seal of the obturator bulb against the mucosal lining if placed restores the speech and swallowing function. [6] It utilizes the remaining palate and the dentition for maximum support, stability, and retention of an obturator bulb. Patients with partial maxillectomy has a unilateral defect which replaces the residual tissue bearing area and remaining teeth are located on one side of the dental arch. The presence of teeth, the size, and configuration of the defect influenced the masticatory function of post-maxillectomy patients with obturator prostheses.

The obturator design is important to allocate the proportionate share of stress to be sustained by the abutment and the increase longevity of the prosthesis.

The obturators help patients with speech, swallowing, mastication, esthetics, and psychological well-being. The main goals in restoring a maxillary defect with a completely edentulous or partially dentate obturator are achieved to provide adequate retention, increased stability, and strong vertical support.

This paper provides a simple method of fabrication of a definitive obturator which is hygienic and easy to use by the patient.

The patient was fully satisfied with the final prosthesis, as his previous condition was maximally restored for comfort, function, and esthetics [Figure 7].
Figure 7: Post-operative

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   References Top

1.Chalian VA. Maxillofacial Prosthetics. Multidisciplinary Practice. Baltimore: The Williams and Wlkins Co.; 1971.   Back to cited text no. 1
    
2.Devlin H. Prosthetic rehabilitation of the edentulous patient requiring a partial maxillectomy. J Prosthet Dent 1992;67:223-7.  Back to cited text no. 2
    
3.Habib BH, Carl F. Driscoll. Fabrication of a closed hollow obturator. J Prosthet Dent 2004;91:383-5.  Back to cited text no. 3
    
4.McAndrew KS, Rothenberger S, Minsley GE. An innovative investment method for the fabrication of a closed hollow obturator prosthesis. J Prosthet Dent 1998;80:129-32.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Keyf F. Obturator prostheses for hemimaxillectomy patients. J Oral Rehabil 2001;28:821-9.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: A classification system of defects. J Prosthet Dent 2001;86:352-63.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Elangbam Loibi
Department of Prosthodontics, Thaimoogambigai Dental College and Hospital, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.87077

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]

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