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Maxillofacial Prosthetics

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1. Hussam Al-Selami.2. Sadam Al Squor.3. Abdel Rahman Sabsoob.4. Thabet Alnaqeeb.

5. Nooraldeen Al Mufti.6. Ali Nassar.7. Mahmood Zaitawi.

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Overview Maxillofacial prosthetics is a branch

of prosthodontics in dentistry.

Main aim is to restore the function

and esthetics of an individual.

Its also approve a psychological

state of a patient after a trauma orsurgery.

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MaxillofacialProsthetics

The art and science of anatomic,

functional, or cosmetic reconstruction bymeans of nonliving substitutes of thoseregions in the maxilla, mandible, and

face that are missing or defectivebecause of surgical intervention, trauma,pathology, or developmental orcongenital malformations.

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IndicationsofMFP

After surgical intervention.

After trauma.

Congenital defects.

Acquired defects.

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Prostheticvs. SurgicalRehabilitation

Individualized decision between

patient and doctor.

Removable prosthesis allows forcancer surveillance.

Destruction amount.

Malignancy recurrence.

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Intraoral vs. Extraoral

Intraoral -- mostly functional

Mandible

Maxilla

Extraoral -- cosmetic

Ear

Nose

Orbit

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Management of patient for

MFP.

Patients risk assessment should be

done. A surgeon should consulate with a

dentist about a surgery so that thereshould be a team work.

All surgical alterations should bedemonstrated for a dentist on a castand obturator should be made for aday of a surgery.

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Psychosocial Issues 11

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Dental Impression

Surgeon has

markedresection forprosthodonti

c planning.

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Post surgical management.

After a surgery and even before its a team work for arehabilitation of a patient that includes:

1. Maxillofacial surgeon.

2. Prosthodontics.

3. Orthodontist.

4. Phycastrist

5. Speech rehabilitation specialist.

6. Oncologist.

7. Plastic surgeon specialist

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Congenital defects Lip and palate development:

Upper lip develop by coalescence of thepremaxilla and maxillary growth centers on either

sides to produce the complete lip.

Fusion of the of the lip developing from growthcenters commences around each nostril floor

and spreads downwards towards the lower

border of the lip uniting the premaxilla and

maxillary process in each side.

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Congenital defects

The palate:

Palate develops from the max. and premix.growth centers, union of the three segments

commencing at the region of the nasal floor

presented in full development by the nasal

foramen. Union from this point proceeds backwards until

both the hard and soft palates and uvula have

united, and forwards along the of the future

maxillary and premaxillary structures eventually.

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Congenital defects Lack of fusion of the palatal shelves either

completely or partially occurs during embryonic

growth side.

Failure of union of palatine processes at any

stage will result in a cleft palate which may be

pre-alveolar ( cleft lip ) or post alveolar ( cleftpalate ) .

Cleft palate between 6th9th wk. of the

embr onic life.

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Congenital defects

Classification of cleft palate

Pre-alveolar e.g. cleft lipPost alveolar any cleft from uvula up

to incisive foramen.

Alveolar cleft extending from uvulato alveolar ridge and lip either

unilateral or bilateral.

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Congenital defects

Effects of cleft palate and lip

1. Speechlack of valvopharyngeal closure leadsto escape of air through the nose (nasal speech)

2. Deglutitiongreatly impede the feeding,

regurgitation and escape of fluids through the

nose takes place .

3. Masticationimpaired due to escape of food

through the nasal cavity and due to missing

teeth and malocclusion .

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Congenital defects

4. Estheticsis effected seriously

especially in cleft palate and / or lip.5. Deterioration of the general health

6. Psychological trauma .

7. Recurrent infection of the air ways

and middle ear .

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Congenital defects

Management of cleft lip and palate Include the following:

A. Surgical closure

It is the treatment of choice for palatal cleft closure. Itsuperior to prosthetic closure by obturator.

If cleft involves the lip, it is advisable to repair it as early as

possible (6 wks. after birth) to facilitate feeding andimprove appearance.

Surgical closure of palatal cleft is better to be donebefore the end of the second year of age.

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Congenital defectsB. Prosthetic restoration

o Feeding appliances.

o Simple palatal plate to close cleft.

o Speech aid obturator.

o Over denture.

C. Orthodontic

o To correct the malaligned teeth or expand the maxillaryarch.

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Congenital defects

Reason for early closure of cleft palate

1. To produce longer and more mobile soft palate

with better muscular development and

2. velopharyngeal closure.

3. To habilitate the patient for normal speech.4. To allow undisturbed growth of maxilla.

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ACQUIRED PALATAL DEFECTS

Prosthetic rehabilitation of acquired maxillary defect:

The main priority for the patient with traumatic injury andtraumatic surgery is to stabilize the patient and controlimmediate damage and/or defect.

Three phases of prosthodontic treatment includes:

Surgical procedures + Immediate obturator.

Transitional obturator.

Definitive obturator.

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IMMEDIATE OBTURATOR

IMMEDIATE OBTURATOR

1. It is a prosthesis inserted immediately after operation

2. Lasts 10-14 days after surgery

3. Material used, mostly acrylic

ADVANTAGES:

1. Maintain function (feeding, speech)

2. Promote healing

3. Restore esthetic

4. Act as stint (keep surgical pack and medication close to the wound)

5. Improve psychology of the patient

6. Prevent contamination of the wound

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IMMEDIATE OBTURATOR

o During operation eradication of the

involved area, and surgical cavity isfilled with surgical pack.

o We can say, it is simple plate with no

teeth and constructed before surgeryto be inserted immediately after

surgery .

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Temporary Obturators

Temporary/Transitional Obturator:

Constructed few days after operationto help in restoring oro-nasal function.Carries teeth and stays 3-6 months.

Making impression is complicated bypresence of the wound and presenceof the defect.

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Temporary Obturators

The defect is packed with gauze

dipped in Vaseline to the level ofthe remaining tissue, then

impression is taken with modified

stock tray using elastic impression

material.

The steps of construction are the

same as in immediate obturator.

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Definitive Obturators

Definitive Obturator:

It is a final prosthetic managementconstruction after complete

healing of the operation site .

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Preparation of the mouth

for obturator:

I. Extract hopeless teeth.

II. Periodontal therapy.III. Restore carious teeth.

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Types of obturators:

1. Hollow bulb (Closed).

2. Roofless (Open bulb).

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Construction:

1. Select stock tray, modified with waxaccording to the size and shape ofthe defect.

2. Partially, pack the defect withVaseline gauze, then do primary

impression using alginate.

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3. Under cuts are lift to help in retention. Gauze

can prevent broken pieces of alginate from

escaping into the defect.

4. Construct sp. Trays and do final impression using

alginate or rubber base impression material.

5. Outline the master cast to mark the bearingarea, blocking severe undercut, leaving small

undercut area for obturator retention.

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Premaxilla Preserved

Cut through tooth socket

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Mucosa Not Preserved

Rough edge uncomfortable for patient

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Obturator

Restores oro-nasalpartition.

At times can be

added to priordentures.

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Skin Grafting of Defect

Less pain while healing.

Less contracture of scar band

which obscures cancersurveillance.

Accomodates obturator better.

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Maxillary Prosthesis

Articulates with scar

band.

Hollowed to belightweight.

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Maxillary Prosthesis

Can be madewith a reservoir

to hold artificial

saliva.

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Prosthetic Materials

Acrylics

Polyurethanes

Silicone Elastomers

Room-temperaturevulcanizing

High-temperature vulcanizing

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Mandible

Mandibular reconstructionrevolutionized by microvascular andplating techniques.

Prosthetics mainly restore occlusion andocclusal surface.

Implants able to restore high degree offunction.

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Mandible

Skin graft preserves alveolar ridge for denture support

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Postoperative Malocclusion

Deviates to surgical side

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Maxillary Ramp49

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Guide Plane Prosthesis

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Guide Plane Prosthesis

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Adjunctive Preprosthetic

Measures

Vestibuloplasty.

Lowering of Floor of Mouth.

Implants.

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Lowering the Floor of

Mouth

Goal is to reposition mylohyoid muscle.

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Lowering the Floor of

Mouth

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Edentulous Mandible

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Mental Foramen

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Implants59

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Implants

Branemark in the 50s studying

bone temp during drilling.Found temp probes couldnt be

removed from bone without

fracturing.

Led to study of osseointegration.

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Implants

Made of titanium.

Have to be drilled at low speed.

Oxide on metallic surface is

dipole.Plasma proteins adhere.

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Implants

Factors that influence success

materialmacrostructure

microstructure

implant bedsurgical technique

loading conditions

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Implants

Implants can be placed in graftedfibula.

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Implants

Want to avoid large step-off if

possible.

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Extraoral

Prostheses

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Extraoral Prostheses

General Principles:

Goal is cosmetic.

Retained with : Adhesives.

Implants.

Skin grafting may help.

Smooth edges.

Extraoral Prostheses Ear:

Retain tragus if possible to camouflage anterior

border.

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Extraoral

Prostheses -- Ear

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Extraoral

Prostheses -- Ear

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Extraoral Prostheses -- Ear

Tragus hides attachment.

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Extraoral Prostheses -- Orbit

Skin graft provides base for prosthesis.

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Extraoral Prostheses -- Orbit

Glasses help hide margin.

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Extraoral Prostheses -- Nose

Skin graft provides base for prosthesis.

Alar tag undesirable.

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Extraoral

Prostheses -- Nose

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Extraoral

Prostheses -- Nose

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Extraoral

Prostheses -- Nose

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Extraoral

Prostheses -- Nose

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Conclusion

Restore function and cosmesis.

Use techniques during surgery toaid prosthetic management.

Consultation with maxillofacial

prosthodontist for optimalrehabilitation.

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THANK YOU 79

Documents

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