Maxillofacial Prosthodontics Flashcards
Define Maxillofacial prosthodontics and its types
Maxillofacial prosthodontics is a branch of prosthodontics concerned with the restoration and/or replacement of the stomatognathic and associated facial structures with prosthesis that may or may not be removed on a regular or elective basis.
Maxillofacial prosthesis may be:
- Extraoral: Part of the facial or cranial structure (eye, ear or nose) is missing and a nonliving substitute or prosthesis is used to rehabilitate the part.
- Intraoral: Refers to defects in and involving the oral cavity, for which prosthesis may be used to rehabilitate the defective area.
What’s obturator and its types2
What can maxiloectory cause
Obturator is a prosthesis used to close a congenital or acquired tissue opening, primarily of the hard palate and or contiguous alveolar structures. Prosthetic restoration of the defect often includes use of a surgical obturator, interim obturator and definitive obturator
One of the most common surgical defects in the oral cavity is the defect caused by maxillectomy. This defect leads to problems in speech, mastication and deglutition unless a surgical / prosthetic reconstruction is carried out.
What are functions of Obturators?
- Feeding purpose.
- Maintains the wound/defective area clean.
- Enhances the healing of traumatic or post surgical defects.
- Helps to reshape/reconstruct the palatal contour and/ or soft palate.
- Improves speech.
- It can be used as a stent to hold dressings or packs post surgically in maxillary resections.
What are indications of Obturators?
- To serve as a temporary prosthesis during the period of surgical correction.
- To restore patient’s cosmetic appearance rapidly for social contacts.
- To provide for an inability to meet the expenses of surgery.
- When the patient’s age contraindicates surgery.
- When the size and the extent of the deformity contraindicates surgery.
- When the local avascular condition of the tissue contraindicates surgery.
- When the patient is susceptible to recurrence of the original lesion which produced the deformity.
What’s a surgical abturature?
This prosthesis is limited to the restoration of palatal integrity and the reproduction of palatal contours. Obturation may be accomplished with the placement of an immediate surgical obturator 6 to 10 days postsurgically.
The immediate temporary obturator is a base plate type appliance which is fabricated from the preoperative impression cast and inserted at the time of resection of maxilla in the operating room. If the extent of surgery is in question, it may be necessary to fabricate two or more prosthesis for more eventualities.
What does surgical obturature help with?
a. Restoring and maintaining the lost height of the middle 3rd of the face.
b. The prosthesis provides a matrix on which the surgical packing can be placed.
c. It reduces oral contamination and thus reduces the incidence of local infection.
d. The prosthesis permits deglutition, thus the nasogastric tube can be removed at an earlier date.
e. The prosthesis enables the patient to speak more effectively post operatively by reproducing normal palatal contours and by covering the defect.
f. The prosthesis reduces the psychological impact of surgery by making the post-operative course easier to bare.
Principles of design for immediate surgical obturator
- The obturator should terminate short of the skin graft.
- The prosthesis should be simple and lightweight.
- Normal palatal contours should be reproduced to facilitate post operative speech and deglutition.
- Posterior occlusion should not be established on the defect side until the surgical wound is well organized.
- In some patients the existing denture may be adapted for use as an immediate surgical obturator.
What’s temporary obturator used for?
The temporary obturator must serve the patient from the time the surgical obturator and pack are removed (approx 10 days post surgical) until the healing is sufficiently stabilized to warrant a definitive prosthesis.
Initially the surgical obturator is relined with soft liner. If this modified obturator cannot be worn due to gross changes in the healing tissues, then a new prosthesis is fabricated.
fabricated from the post surgical impression cast which replicates the palate and ridge and absence of teeth. The closed bulb extending into the defect area is hollow. The new prosthesis should also be lined with soft liner and worn till a definitive obturator is fabricated after complete healing of the surgical defect.
What’s definitive obturator? Timing depends on what? (5). Whets the design?
Three to four months after surgery consideration may be given to the fabrication of a definitive obturator. The timing will vary depending on the size of the defect, the progress of healing and the prognosis for malignancy control, the effectiveness of the present obturator and the presence or absence of teeth. The permanent obturator is fabricated from the postsurgical maxillary cast. This obturator with a hollow bulb replicates the palate, ridge and teeth.
What are general consideration of obturator bull design?
- A bulb is not necessary with a central palatal defect of small to average size where healthy ridges exist.
- It is not necessary in surgical or immediate temporary prosthesis.
- It should be hollow to aid speech resonance, to lighten the weight on the unsupported side, possibly to provide facial esthetics, and to act as a foundation for a combination extraoral prosthesis in communication with the intraoral extension.
- It should not be so high as to cause the eye to move during mastication.
- It should always be closed superiorly.
- It should not be so large as to interfere with insertion if the mouth opening is restricted.
What are special consideration in treatment before primary impression?
The intraoral defect should be carefully observed. The severe undercuts and small perforations which may cause accidental intrusion of the impression material into the nasal – maxillary sinus cavity should be noted. Such areas should be packed out with a lubricated cotton or gauze to which a piece of dental floss has been tied. The defect may also require some special addition or correction to the impression tray. This is easily done with wax or stick compound added to build up the tray, in order to capture the needed anatomy.
Write the steps from primary impression till jaw relation in obturator treatment?
The primary impression is made in irreversible hydrocolloid impression material. The custom tray is then fabricated which is designed to fit the cast obtained from this primary impression.
A final impression now is made with a rubber base material.
This is boxed, poured, trimmed and the periphery is outlined with a pencil.
The temporary record base should not use all the retentive areas so that it can be withdrawn from the stone working cast easily.
Write treatment of Obturators from jaw relation till end treatment?
During jaw relation record the procedure. The denture base should be stabilized with denture adhesive. Jaw relation is completed in the conventional manner followed by wax try-in. The waxed up denture is flasked and dewaxed. Finally during the laboratory procedure, a layer of acrylic in dough stage should be packed to the walls of the defect. The center space is filled with salt and an acrylic lid is placed over which acrylic is packed as for a conventional denture. The obturator is cured and retrieved. A small perforation is made in cured bulb of the oburator and salt is flushed out using water in a syringe and the perforation is sealed with autopolymerizing resin.
What are cause of cleft palate?
The causes of cleft palate are not entirely clear. The causes may be due to infectious diseases of the mother, mechanical interference with local blood supply in the fetus, malnutrition in the mother or any of the several changes in intrauterine environment.
What’s classification of cleft palate? And now each type is treated?
Class I: Clefts involving the soft palate only.
Class II: Clefts involving the soft and hard palate upto the incisive foramen.
Class III: Clefts of the soft and hard palate involving the alveolar ridge and continuous with the lip on one side.
Class IV: Completed cleft of the palate involving alveolar ridges as well as lip on both right and left sides.
Of these four classes, the clefts of class I type are surgically correctable and usually do not require any pros-thesis. In the class II type, the soft palate can be surgically corrected if the cleft of the hard palate is not correctable; the prosthetic assistance is provided for it. The class III and class IV generally require some form of prosthesis.
