Single-Step Fabrication of a New Maxillary
Obturator Prosthesis
Muhammad Waseem Ullah Khan1*, Asif Ali Shah2 and Aliya Fatima3
1Assistant Professor of Prosthodontics, Prosthodontics Department, Punjab Dental Hospital/de'Montmorency
College of Dentistry, Fort Road, Lahore, Pakistan
2Professor of Prosthodontics, Prosthodontics Department, Punjab Dental Hospital/de'Montmorency College of Dentistry, Fort Road, Lahore, Pakistan
3FCPS Resident, Prosthodontics Department, Punjab Dental Hospital/de'Montmorency College of Dentistry, Fort Road, Lahore, Pakistan
2Professor of Prosthodontics, Prosthodontics Department, Punjab Dental Hospital/de'Montmorency College of Dentistry, Fort Road, Lahore, Pakistan
3FCPS Resident, Prosthodontics Department, Punjab Dental Hospital/de'Montmorency College of Dentistry, Fort Road, Lahore, Pakistan
*Corresponding author: Dr. Muhammad Waseem Ullah Khan, Orthodontics Dental Centre, 5-B Gulberg II, Lahore, Pakistan, Tel: 03-334-844-939; E-mail: veritarian@yahoo.com
Received: November 28, 2014; Accepted: March 24, 2015; Published: April 10, 2015
Citation: Ullah Khan MW, Shah AA, Fatima A (2015) Single-Step Fabrication of a New Maxillary Obturator Prosthesis. J Dent Oral
Disord Ther 3(1): 1-4. DOI: http://dx.doi.org/10.15226/jdodt.2015.00136
Abstract
Patients with acquired maxillary defects suffer from disturbances
in mastication, speech and social activities. Obturator prostheses
eliminate these problems and allow the patients to function normally
in the society. A new maxillary obturator prosthesis was constructed
for an old obturator wearing patient using a pick-up impression
technique and bite registration with his previous prosthesis. The
obturator was inserted at the very next clinical visit saving the patient
from multiple appointments.
Keywords: Hemimaxillectomy; Obturator; Prosthesis
Keywords: Hemimaxillectomy; Obturator; Prosthesis
Introduction
Surgical procedures to eradicate carcinomas of head and
neck region usually leave behind large tissue defects and it
becomes a challenging task for the maxillofacial prosthodontist
to rehabilitate these patients to optimum function and esthetics
[1,2]. The patients having partial or complete maxillary resections
face a variety of difficulties including defective mastication,
swallowing, speech and social interaction [3,4].
The partially dentate maxillary defects are classified according to Aramany's classification and are treated successfully by taking support from the natural teeth [5,6]. Maximum number of remaining natural teeth or dental implants should be engaged in the obturator design to gain sufficient support, retention and stability for the prosthesis [4,7,8]. Unfortunately, in many cases the little amount and poor quality of residual bone available after resection and radiotherapy along with economic constraints of patients preclude the use of dental implants. In these cases the prosthodontist has to resort to conventional physical methods to maximize the support, retention and stability [9].
The present case report describes a simple, economic and reliable single step procedure for the construction of a new obturator prosthesis using the previous obturator as an The present case report describes a simple, economic and reliable single step procedure for the construction of a new obturator prosthesis using the previous obturator as an
The partially dentate maxillary defects are classified according to Aramany's classification and are treated successfully by taking support from the natural teeth [5,6]. Maximum number of remaining natural teeth or dental implants should be engaged in the obturator design to gain sufficient support, retention and stability for the prosthesis [4,7,8]. Unfortunately, in many cases the little amount and poor quality of residual bone available after resection and radiotherapy along with economic constraints of patients preclude the use of dental implants. In these cases the prosthodontist has to resort to conventional physical methods to maximize the support, retention and stability [9].
The present case report describes a simple, economic and reliable single step procedure for the construction of a new obturator prosthesis using the previous obturator as an The present case report describes a simple, economic and reliable single step procedure for the construction of a new obturator prosthesis using the previous obturator as an
Case Report
A 36 year old male patient presented to the outdoor of
Prosthodontics department, de'Montmorency College of
Dentistry / Punjab Dental Hospital, Lahore. The patient had
a history of Ameloblastoma in the right maxilla for which he
had undergone a hemimaxillectomy type of surgical resection
ten years ago. The patient had an Aramany Class I defect and
was using obturator prosthesis for the last ten years. His chief
complaints with the previous obturator were its looseness, foul
smell and unaesthetic appearance. The patient was a carpenter
by profession and medically and physically fit.
On extra oral examination there was a tissue contracture visible on the right side of face (Figure 1). On intra oral exam it was observed that the left maxillary quadrant was intact with all
On extra oral examination there was a tissue contracture visible on the right side of face (Figure 1). On intra oral exam it was observed that the left maxillary quadrant was intact with all
Figure 1: Frontal view.
the teeth present except left upper central incisor. The left upper
lateral incisor however was carious and required restoration
(Figure 2, 3). The mandible had a full component of natural teeth
and the oral hygiene was fair. The patient had normal mouth
opening and jaw movements. A mature maxillary Aramany Class
I defect on the right side was present with the loss of all teeth
from left upper central incisor to right upper third molar.
The defect had a communication with the nasal cavity and mild lateral undercuts were present (Figure 2). The previous obturator was an all acrylic ill fitting removable prosthesis. The support and retention was inadequate but it had stable occlusal contacts with the opposing dentition (Figure 3). The ten years old acrylic denture base showed signs of disintegration such as foul smell, discoloration and staining.
After thorough evaluation of the patient it was decided that new acrylic obturator prosthesis will be fabricated for him using his old obturator both as an impression tray and bite recording
The defect had a communication with the nasal cavity and mild lateral undercuts were present (Figure 2). The previous obturator was an all acrylic ill fitting removable prosthesis. The support and retention was inadequate but it had stable occlusal contacts with the opposing dentition (Figure 3). The ten years old acrylic denture base showed signs of disintegration such as foul smell, discoloration and staining.
After thorough evaluation of the patient it was decided that new acrylic obturator prosthesis will be fabricated for him using his old obturator both as an impression tray and bite recording
Figure 2: The defect.
Figure 3: Old prosthesis in situ.
Figure 4: Pick-up impression.
template. A cast partial framework and/or implant supported
prosthesis were not selected because of financial constraints of
the patient.
Technique
Figure 5: Frontal view with new obturator.
Figure 6: New obturator in-situ showing optimum retention.
Discussion
A maxillary obturator prosthesis was fabricated for a patient
with hemimaxillectomy defect. The patient was a satisfied old
obturator wearer but after ten years some tissue changes had
occurred making the previous obturator loose. The acrylic had
started disintegrating giving foul smell and poor appearance.
Financial constraints of the patients limited our treatment
options and precluded the selection of cast partial framework or
treatment with dental implants so a simple acrylic obturator was
planned for the patient.
A maxillary obturator prosthesis was fabricated for a patient with hemimaxillectomy defect. The patient was a satisfied old obturator wearer but after ten years some tissue changes had occurred making the previous obturator loose. The acrylic had started disintegrating giving foul smell and poor appearance. Financial constraints of the patients limited our treatment options and precluded the selection of cast partial framework or treatment with dental implants so a simple acrylic obturator was planned for the patient.
The pick-up impression was taken in irreversible hydrocolloid alginate impression material in a stock tray which recorded the rest of the arch and the remaining dentition. Bite record in the form on an occlusal wafer was recorded and used for mounting of the casts. These records were sufficient for the construction of a new obturator in the laboratory.
The pick-up impression was taken in irreversible hydrocolloid alginate impression material in a stock tray which recorded the rest of the arch and the remaining dentition. Bite record in the form on an occlusal wafer was recorded and used for mounting of the casts. These records were sufficient for the construction of a new obturator in the laboratory.
Most of the patients having maxillofacial defects limit their social contact. They also don't prefer frequent visits to the dentist. Therefore, short and simple procedures should be adopted in treating such patients to save them from multiple unnecessary visits to the clinic as described in this case.
A maxillary obturator prosthesis was fabricated for a patient with hemimaxillectomy defect. The patient was a satisfied old obturator wearer but after ten years some tissue changes had occurred making the previous obturator loose. The acrylic had started disintegrating giving foul smell and poor appearance. Financial constraints of the patients limited our treatment options and precluded the selection of cast partial framework or treatment with dental implants so a simple acrylic obturator was planned for the patient.
The pick-up impression was taken in irreversible hydrocolloid alginate impression material in a stock tray which recorded the rest of the arch and the remaining dentition. Bite record in the form on an occlusal wafer was recorded and used for mounting of the casts. These records were sufficient for the construction of a new obturator in the laboratory.
The pick-up impression was taken in irreversible hydrocolloid alginate impression material in a stock tray which recorded the rest of the arch and the remaining dentition. Bite record in the form on an occlusal wafer was recorded and used for mounting of the casts. These records were sufficient for the construction of a new obturator in the laboratory.
Most of the patients having maxillofacial defects limit their social contact. They also don't prefer frequent visits to the dentist. Therefore, short and simple procedures should be adopted in treating such patients to save them from multiple unnecessary visits to the clinic as described in this case.
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