Acquired Maxillary Defects

Part 1

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.

Disabilities

1. Speech.

2. Appearance.

3. Mastication and swallowing.

4.Psychological.

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.

Prosthetic Rehabilitation

Obturator

Obturator means

maxillofacial

prosthesis used to

close a congenital or

acquired tissue

opening in the maxilla

and associated

structures.

Obturators

Surgical: At time of surgery.

Interim: 10 days to 4 weeks.

Definitive: 3 to 4 months or till complete

healing.

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.

A. Immediate Surgical Obturator

(ISO)

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.

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.

C- Psychological:

1. reduce the surgical trauma.

2. reduces the period of hospitalization.

Basic Principles of the design

Basic Principles of the design

Basic Principles of the design

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.

Fabrication of ISO

Materials: Sponges.

Black Gutta-percha.

Tissue conditioning.

Light cured resins and

acrylic resin

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.

Alteration of the cast

Processing of

acrylic obturator 1. Adequate

thickness.

2.waxing with wire

retainer.

3. Processing with

transparent acrylic

resin

Processing of acrylic obturator

Procedures

Surgical room procedures

B. Delayed Surgical Obturator

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.

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.

Old denture may be used as immediate or

delayed surgical obturator

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.

2. Interim Obturation

It is fabricated 2 to 6 weeks post surgically

( after initial healing occurs). The ISO can

be converted to interim obturator.

In some cases the immediate surgical (ISO) can be

utilized to fabricate the new restoration

The old denture can be relined by soft

liner to be used as interim obturator

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.

Thank U