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.