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Palatal defect can be repaired by reconstructive surgery and/or a dental prosthesis. We present prosthodontic rehabilitation of two partially edentulous patients, both with surgically induced palatal defect and explains how to achieve the goal for esthetics and phonetics. This also describes the fabrication of a hollow obturator by two piece method...
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Citations
... Individuals with maxillary defects often encounter significant challenges in performing everyday functions, with primary impairments observed in deglutition and Fig. 9: Post-operative extra-oral view of the patient speech, especially when dealing with substantial defects. 4 Successful rehabilitation through the use of an obturator serves as an effective approach, with the primary goal being the restoration of essential oral functions and aesthetics by separating the oral and nasal cavities. ...
The prosthodontic care for palatal defects is crucial for effectively closing oronasal communication in patients and enhancing various aspects of their oral health. This includes improving masticatory function, speech clarity, aesthetics, and overall comfort. Maxillary defects often arise as a result of surgical interventions for conditions like malformations, neoplasms, or traumatic injuries. In such cases, the primary objective of employing an obturator is to close the palatal defects that result from maxillectomy procedures, with the ultimate aim of enhancing both speech and masticatory function. This article presents a comprehensive case study highlighting the prosthetic rehabilitation of a maxillectomy defect resulting from osteosarcoma. The rehabilitation approach incorporates the use of a hollow bulb obturator, showcasing its transformative impact on the patient's masticatory function, speech clarity and aesthetics thus enhances the patient's quality of life.
... The advantage of nickel coating is its resistance to corrode in the intraoral environment, therefore increasing the life of the magnetic assembly. [7] Various means of auxiliary retention including spectacles, adhesives, buttons, implants and customised attachments have been previously cited in the literature. [8,9] Use of spectacles have the disadvantage of the added weight of the prosthesis, hence compromising the readiness to wear the prosthesis. ...
Loss of a sense organ, such as an eye in situations of orbital involvement, or any other bodily part, such as the maxilla or palate, might make one more dependent on others for care and affect how they perceive themselves in society. The prosthetic rehabilitation of large mid-facial defects is a challenging task due to the varied size and shape of the defect. Confluent maxillary and orbital abnormalities are best restored with prosthetic means by creating a comfortable, aesthetically pleasing prosthesis that allows for the restoration of speech, deglutition, and mastication. The retention of any prosthesis is must for it to be successful. The hollow orbital conformer described in this case presentation aids in reducing the weight of the prosthesis, thereby enhancing the retention of the prosthesis. This clinical case presentation highlights the aesthetic and functional rehabilitation using a combined obturator-orbital prosthesis connected using intraoral magnets.
... Obturator might get displaced superiorly along the defect due to the masticatory stress or tend to drop lacking occlusal contact. 5 This degree of movement varies according to the remaining number of natural teeth, their position, size and extent of the defect, the amount and configuration of the remaining palatal area, the height of the alveolar ridge, lining of the mucosal defect, and Compromised retention, stability and support are the common issues for rehabilitating patients who have had a maxillectomy. 6 The height and contour of the residual ridge, remaining natural teeth and preservation of alveolar bone adjacent to the defect are important restorative factors. ...
Congenital or acquired, intraoral or extraoral, traumas or carcinomas are known to produce psychological imbalances in patients with the least expectations of returning to their normal lives. Oral carcinomas are the fifth most common of all. The major goals of rehabilitation are such patients are to restore function, speech, swallowing, and aesthetics. However, there are many limitations in achieving these goals, an obturator prosthesis remains as the first line of choice in these maxillectomy patients.
... But it is still challenging and unpredictable if a defect is extensive because there is lack of supporting bone and tissue. 5 Implants have come forth as a good means to provide retention in obturators. But in case of mucormycosis it is not feasible as mucormycosis has very high recurrence rate so it may require repeated surgical debridement leading to repeated implant placement which increases price of the prosthesis and the patient has to undergo multiple surgeries, so conventional removable prosthesis remains the better option. ...
Mucormycosis is a fungal infection that was seldom seen, but it has currently become a bane due to COVID-19 infection, diabetes and, uncontrolled use of corticosteroids for its treatment. It is characterised by necrosis and is often fatal. Its management includes early diagnosis, control of the underlying diseases, and aggressive medical and surgical intervention which frequently results in a defect, making it difficult for the patient to live a normal life. Rehabilitation of the defect with an obturator can provide improved masticatory efficiency, speech, esthetic and also builds up self-confidence. This case report presents the prosthodontic management of maxillectomy defect post mucormycosis using one piece closed hollow bulb obturator prosthesis and also discussed a simple technique for its fabrication that allows us to control the weight and thickness of the prosthesis.
... Thus, the use of a total or partial obturator is an option to remedy such se-quelae and enable a better quality of life. Parameswari et al. (18) also concluded that prosthetic rehabilitation with an obturator restores the missing intraoral structures and acts as an anatomical barrier between the oral and nasal cavities, restoring function and esthetics. This study was conducted at the Cancer Hospital of Mato Grosso located in the city of Cuiabá, Brazil. ...
Background:
The aim of the present study was to identify the profile of cancer patients in need of rehabilitation with dental and/or oral-maxillofacial prostheses and evaluate possible reasons for not concluding the rehabilitation process.
Material and methods:
A retrospective observational study was conducted at the Dentistry Department of the Mato Grosso Cancer Hospital in the city of Cuiabá, Brazil, involving the analysis of the medical records of patients under care from April 2017 to November 2019.
Results:
The study population comprised 256 patients who met the inclusion criteria. A total of 30.90% of the patients were older adults, 65.6% were men, 70.3% had brown skin color, 27.3% were retired, 49.2% were married and 52% resided in municipalities in the state of Mato Grosso other than the capital. A total of 67.23% reported smoking and 53.9% reported alcohol consumption. The tumor was located in the head and neck region in 57.4%. The most frequent histological type was epidermoid carcinoma (55.1%). A total of 28.9% of cases were in disease stage IV. Most patients (60.2%) completed prosthetic rehabilitation, with a predominance of total prosthesis. The main reasons for not completing rehabilitation were the patient's death and weakness.
Conclusions:
Patients who started treatment in more advanced stages of cancer had a greater chance of not completing the prosthetic rehabilitation. The non-completion of treatment was directly related to death and the state of weakness. Key words:Cancer, dental prosthesis, epidemiology, maxillofacial prosthesis, oral rehabilitation.
... Maxillary complete denture along with a modified obturator restores oral functions and esthetics in patients with palatal defects. [7] This clinical case report explains in detail the prosthodontic rehabilitation of a midfacial defect and restored esthetics and improving the quality of life. ...
Midfacial defects are defined as congenital or acquired defects in the horizontal plane at the middle third of the face and communicate with intraoral maxillary defects. These defects lead to speaking difficulty, difficulty in saliva control and deglutition, mastication, and esthetics. Prosthetic rehabilitation of such defects with maxillofacial prosthesis is a challenging task. Maxillary defects with bilateral undercuts present are common. This case report explains to achieve retention by engaging the bilateral undercuts with the desired path of insertion and obtaining adequate retention of these prostheses. This clinical case report presents prosthetic rehabilitation of a mid-facial defect involving one orbit and the premaxilla region with the help of silicone orbital prostheses and magnets along with an expansion device. This dramatically improved the patient's speech, mastication, deglutition, esthetics, and self-confidence.
... to replace more than one element (70%), required the combination of prostheses (3.3%), total prosthesis (23.7%). Joo et al. 7 , cites in his research that patients undergoing oncological treatments may have several sequelae, impairing masticatory function, swallowing, aesthetics, so the use of total or partial obturator prosthesisis an alternative to remedy such sequelae and enable a better quality of life for the patient Parameswari et al. 19 also concluded in their research that prosthetic rehabilitation with obturator prosthesis restores the missing intraoral structures and acts as an anatomical barrier between the oral and nasal cavities, restoring function and aesthetics. ...
Purpose: This study aimed to identify the profile of cancer patients in need of rehabilitation with oral and/or buccomaxillofacial prostheses, as well as to evaluate the possible reasons for not concluding the rehabilitation.
Materials & Methods: This is a retrospective observational study carried out at the Dentistry Department of the Mato Grosso Cancer Hospital, Cuiabá, MT, Brazil, through the evaluation of the medical records of patients attended from April 2017 to November 2019.
Results: The study population comprised 256 patients who met the research inclusion criteria. It was found that 30.90% of the patients were elderly, 65.6% were men, 70.3% brown, 27.3% retired, 49.2% married and 52% coming from municipalities of the interior of the state of Mato Grosso. From the total of patients, 67.23% reported smoking and 53.9% alcohol consumption. As for the location of the tumor, 57.4% had it in the head and neck region, 55.1% of which were epidermoid carcinoma and in 28.9% of cases the disease stage was IV. Most of the patients (60.2%) completed prosthetic rehabilitation, with total prostheses predominating. The main reasons for not completing the rehabilitation were the patient's death and weakness.
Conclusions: Patients who started treatment in more advanced stages of cancer had a greater chance of not completing the prosthetic rehabilitation, and the incompletion of rehabilitation treatment was directly related to the patients’ death and the state of weakness.
Background: Over the last few years, there has been an increase in oncologic morbidity in the maxillofacial region. A significant increase in cases of cancer of the maxilla has been established. As a result of the surgical treatment of maxillary tumours, the barrier between the oral and nasal cavity is broken, which leads to serious speech disorders. Aim: The purpose of the literature review is to analyse data from different studies on the changes in speech after maxillectomy and the opportunities for its restoration with different types of dentures. Discussion: The opportunities for treatment of patients with maxillary defects include surgical restoration or obturator, as there are contradictory data on what are the optimal means of restoring speech. The predominant opinion is that the choice of treatment method depends on the size and the location of the defects, with most authors considering obturators the optimal means of treatment. Their role in the normalisation of speech function by restoring the barrier between the oral and nasal cavity is indisputably proven. Immediate prosthetics have been found to provide faster and easier recovery of speech. To preserve the achieved results, a three-stage method of treatment with surgical, temporary and definitive obturator is recommended, which restores not only speech but also normal articulation. Conclusion: Surgical treatment of cancer of the upper jaw causes defects differing in size, which seriously disturbs speech function. Depending on the size and location of the defect, specific prosthetic treatment methods are used, with different types of dentures being produced.
The commonly used prosthodontic materials are resins, ceramics, metals and silicones. A comprehensive review of literature was completed about the incorporation of nanomaterials in prosthetic dentistry using PubMed and Google Scholar databases. This was supplemented with a manual search of selected journals. English language articles in peer- reviewed journals were selected. Current literature reveals that incorporation of nanomaterials has significantly improved the properties of the prosthetic materials within the clinically acceptable ranges. There appears to be a need for a standardization for these in vitro studies carried out to evaluate their physical, mechanical and antimicrobial properties.
