the fabrication of an obturator for a hemi-maxillectomy
TRANSCRIPT
Cape Peninsula University of TechnologyDigital Knowledge
Tygerberg Dental Sciences Faculty of Health & Wellness Sciences
1-1-2003
The fabrication of an obturator for a hemi-maxillectomy patient with mixed dentionSheenah Van ReenenPeninsula Technikon
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Recommended CitationVan Reenen, Sheenah, "The fabrication of an obturator for a hemi-maxillectomy patient with mixed dention" (2003). Tygerberg DentalSciences. Paper 32.http://dk.cput.ac.za/tygerberg_ds/32
Van Reenen, S.
Stu. No.: 200000 327
Course: Btech DenTech
Subject: Research Methodology
The fabrication of an obturator
for a hemi-maxillectomy patient with mixed dention.
Lecturer: Mr Steyn
Due date: 06/10/2002
Contents
• Keywords 1
• Summary 1
• Introduction 2
• Purpose of study 3
• Clinical treatment options 3
• Technical treatment options 3-4
• Treatment option of choice 4
• Laboratory procedures 5
• Conclusion 6
• References 7
The fabrication of an obturator
for a hemi-maxillectomy patient with mixed dentition.
S. Van Reenen, BTech DenTech. Department of Dental Services, Peninsula
Technikon, Bellville, South Africa.
Keywords: hemi-maxillectomy; defect; obturator
Summary
This is a study of a patient with a maxillary defect as a result of a hemi-maxillectomy.
Various options are available to aid such patients in restoring and improving functions
such as mastication, speech as well as improving aesthetics. This literature contains
the procedures followed in choosing the most suitable option for this patient, as well
as the satisfying results.
Introduction
The patient is an eleven year old male. He was diagnosed with osteosarcoma at the
age of nine. This is cancer of the bone. It is a malignant bone tumour and is usually
found in male children and adolescents.1 In June 2002 the patient started receiving
chemotherapy. A hemi-maxillectomy was performed in October 2002 to remove the
infected bone.2 Part of the maxillary alveolar ridge and hard palate was removed
resulting in a maxillary defect (see figure 1). The patient received post-operative
chemotherapy for a further two months. He wore a maxillary acrylic baseplate (see
figure 2) to cover the defect, preventing food and fluids entering the nasal cavity. The
patient fully recovered from the cancer and no further treatment or therapy was
needed.
Fig. 1 Maxillary defect as a result of Fig. 2 Maxillary baseplate worn by
the hemi-maxillectomy. the patient.
Purpose of study
Due to the removal of infected bone, some of the patient’s permanent teeth will not be
able to erupt. This negatively affects the masticatory functions, speech and aesthetics
of the patient. The patient was referred to Tygerberg Hospital in an attempt to restore
and improve these functions by means of some kind of treatment.
Clinical treatment options
The bone that was removed during the hemi-maxillectomy can be replaced by doing a
bone graft.1
Healthy bone would be removed from the patient’s fibula and grafted to
the maxilla. A bone graft would be more advantageous between ages 17 and 18 when
the patient has fully developed. If a bone graft is done at this stage the chances are
great that bone augmentation will not be successful and another one would have to be
done at a later stage.
If however, a bone graft is done and bone augmentation is successful, implants could
then be inserted into this bone.3
Technical treatment options
If a bone graft is done and implants are inserted, crowns could be fabricated that
would be placed onto the implants.
An obturator could be fabricated to cover the defect as well as replace the missing
teeth.
All of these options have their advantages and disadvantages. If a bone graft is done,
implants are inserted and crowns are place it would have the following advantages
and disadvantages:
Advantages: It restores functions such as mastication and speech. It improves the
aesthetics of the patient. It is a permanent treatment (will not have to be replaced as
often as an obturator).
Disadvantages: It is a very long procedure as time is required for two or even more
operations as well as healing of the wounds. It is a very expensive procedure (surgery
cost alone would be ± R16 000).
Treatment option of choice
An obturator (see figure 3) was the option most suitable and the option of choice at
this stage. It also has its advantages and disadvantages.
Advantages: It restores functions such as mastication and speech. It improves the
aesthetics of the patient. It is easy to alter and adjust to provide space for permanent
teeth. It is more affordable to fabricate this appliance (± R632). The appliance is easy
to maintain.
Disadvantage: This appliance wears easily and will have to be replaced until more
permanent treatment can be applied.
Fig. 3 Obturator-most suitable
treatment option.
Laboratory procedures
The following laboratory procedures were followed in the fabrication of the obturator:
Primary impressions were taken of the patient’s maxilla and mandible. Primary
models were cast and special trays were fabricated using light-cure material (see
figure 4). Final impressions were taken of the patient’s maxilla and mandible using
the special trays. Final models were cast and a maxillary record block was fabricated
(see figure 5). The record block was used to record the bite registration of the patient.
A set-up and wax-up was done, replacing the left central and molars and the teeth in
the right quadrant of the maxilla. A try-in was done to check if everything was correct
and in place. Two single arm clasps were added to the set-up for extra retention. The
wax-up was flasked and processed in the conventional manner. The final step of the
laboratory procedures was to finish and polish the denture. The denture was ready for
placement (see figure 6).
Fig. 4 Primary models and Fig. 5 Final models and
special trays. record blocks.
Fig. 6 Prosthesis ready for placement.
Conclusion
Osteosarcoma is a kind of cancer that can cause major permanent effects as can be
seen in this case. Like this patient there are many other people with maxillary defects
as a result of a hemi-maxillectomy. There is no need for them to give up on life as
there are several treatment options available that could restore and improve functions
such as mastication etc. An obturator was temporary treatment for this patient and on
the placement of this appliance the patient was very satisfied and delighted (see figure
7). This appliance aided in the improvement of his mastication, speech and aesthetics.
Fig. 7 Patient with final
prosthesis.
References
1) Oxford Concise Medical Dictionary. 5th ed. Oxford: Oxford University Press.
1998: 280, 337, 472.
2) Dorland’s Illustrated Medical Dictionary. 29th ed. Philladelphia: W. B. Saunders
Company. 2000: 800.
3) M. Nevins & J. T. Mellonig. Implant Therapy: Clinical Approaches and Evidence
of success. Vol. 2. Chicago: Quintessence Publishing Co; Inc. 1998: 50, 120, 204,
212.
4) B. Shipman. Evaluation of occlusal force in patients with obturator defects.
The Journal of Prosthetic Dentistry. 1987; 57: 81- 84.
5) H. Heidl, A. Shor. Maxillary Rehabilitation with a Fixed Implant-Supported
Prosthesis: Design and Technical Steps. Quintessence of Dental Technology.
2003; 26: 187-198.