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Acquired Maxillary Defects
Part 1
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Etiology
1. Traumatic accidents as gun shot, sharp instruments or pencil, Suction disc or maxillary fractures.
2. Diseases as TB, Syphilis, Osteomylities.
3. Surgical resection for diseased area.
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Disabilities
1. Speech.
2. Appearance.
3. Mastication and swallowing.
4.Psychological.
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Rehabilitation of acquired defect
Surgical: indicated for
1. traumatic defects.
2. small defects.
3. non recurrence.
Prosthetic: indicated for
1. large defects of hard and/or soft palate.
2. Possible recurrence.
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Prosthetic Rehabilitation
Obturator
Obturator means
maxillofacial
prosthesis used to
close a congenital or
acquired tissue
opening in the maxilla
and associated
structures.
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Obturators
Surgical: At time of surgery.
Interim: 10 days to 4 weeks.
Definitive: 3 to 4 months or till complete
healing.
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Surgical Obturator
Types
A. Immediate surgical obturator:
Constructed before surgery and placed
immediately after surgery in the operating
surgical room (OR).
B. Delayed surgical Obturator:
Placement of the obturator 6 to 10 days
post surgically.
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A. Immediate Surgical Obturator
(ISO)
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Immediate Surgical Obturator
(ISO) Advantages and Benefits
A. Functional;
1. serves as matrix to support packing.
2. serves as a barrier between the oral cavity and the surgical packing.
3. permit patient to speech nearly normal.
5. Improve deglutition.
6. earlier removal of nasogastric tube.
7. prevents excessive contraction of the scar tissues.
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B- Hygienic:
1. Separation of the nasal cavity from oral
cavity give better hygiene.
2. reduce contamination of the wound.
3. keep the surgical pack in contact with
the wound.
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C- Psychological:
1. reduce the surgical trauma.
2. reduces the period of hospitalization.
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Basic Principles of the design
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Basic Principles of the design
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Basic Principles of the design
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Basic Principles of the design
Simple , light of weight, and inexpensive.
Normal palatal contour.
In dentulous patients the obturator should be perforated for wiring fixation with remaining teeth.
Wire in the fitting surface to hold the lining material.
Terminate short of skin- mucosal junction.
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Fabrication of ISO
Materials: Sponges.
Black Gutta-percha.
Tissue conditioning.
Light cured resins and
acrylic resin
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Impression procedures
Stock tray modification.
The impression should extended to soft palate.
Fast set hydrocolloid.
Patient set in upright position.
Accurate recording of vestibule in the affected side.
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Alteration of the cast
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Processing of
acrylic obturator 1. Adequate
thickness.
2.waxing with wire
retainer.
3. Processing with
transparent acrylic
resin
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Processing of acrylic obturator
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Procedures
Surgical room procedures
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B. Delayed Surgical Obturator
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B. Delayed Surgical Obturator
•It is inserted after 6 to 10
days post-surgically.
•In some cases the
immediate surgical (ISO)
can be utilized to
fabricate the new
restoration.
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Procedures of construction
After removal of the surgical packing, a modified metal stock
tray ( short flange in the defect side to avoid the damage of the
defect) with fast set hydrocolloid is used to make the impression
taking in mind that the medial undercut of the defect should be
blocked-out with Vaselinized gauze.
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Old denture may be used as immediate or
delayed surgical obturator
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Prosthetic consideration of the
design
The obturator depend on the wrought wire
Clasping for retention.
Acrylic resin base is practical for construction.
Anterior teeth should be included, and posterior
occlusion may be added to help the patient to
retain the denture.
It may be necessary to adjust the prosthesis by
self curing resin and then relined by tissue
conditioning material.
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2. Interim Obturation
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It is fabricated 2 to 6 weeks post surgically
( after initial healing occurs). The ISO can
be converted to interim obturator.
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In some cases the immediate surgical (ISO) can be
utilized to fabricate the new restoration
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The old denture can be relined by soft
liner to be used as interim obturator
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Retention means of interim
obturator
1. Buccal retaining
flange engage the
tissue and teeth
undercut in the
dentulous side.
2. WW clasps.
3. Open hallowed
interim Obturator.
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Thank U