Definitive Obturator Research Articles

Prosthetic rehabilitation of hemi-maxillectomy patient with definitive obturator using precision attachment: A case report

Prosthetic rehabilitation of hemi-maxillectomy patient with definitive obturator using precision attachment: A case report

Impact of prosthodontic rehabilitation on psychological status and quality of life in maxillectomy patients of coronavirus disease 2019-associated mucormycosis at a tertiary care center: A prospective clinical study

Aims: The study was aimed to evaluate the effect of prosthodontic rehabilitation on psychological status (PS) and quality of life (QoL) in maxillectomy patients of coronavirus disease 2019-associated mucormycosis (CAM). Settings and Design: The study was designed as a prospective and clinical study. Materials and Methods: Twenty-four CAM patients undergoing maxillectomy and subsequent prosthetic rehabilitation were included. The treatment involved surgical, intermediate, and definitive obturator delivery at various phases of healing. PS was assessed using the Hospital Anxiety and Depression Scale (HADS), QOL using the European Organization for Research and Treatment of Cancer QoL Questionnaire-Head and Neck Module (EORTC QLQ-HandN35), and the functioning of obturator was assessed utilising the Obturator Functioning Scale (OFS) at various time points: before maxillectomy (T1), 2 weeks after maxillectomy (T2), 2 weeks upon usage of intermediate obturator (T3), just before delivery of definitive obturator (T4), and 12 weeks after the usage of definitive obturator (T5). Statistical Analysis Used: Data were analyzed using a social science statistical analysis program (Stata 14.0; StataCorp LLC, Texas, USA). The significance level was chosen <0.05. Shapiro–Wilk test was used to assess the normality of quantitative data. Student’s t-test was employed (α =0.05) to evaluate if the patient’s PS, QOL, and obturator function had changed over time. The Spearman correlation coefficient (α =0.05) was utilized to evaluate the correlation coefficient between PS, QOL, and obturator function seen at T3 and T5. Results: Out of 24 enrolled patients, nine were dropped out. HADS-anxiety score was the highest at T1 (18.6 ± 1.2) and HADS-depression score was the highest at T2 (18.8 ± 1.6). HADS scores decreased significantly (P = 0.001) after prosthetic rehabilitation. EORTC QLQ-HandN35 score was the highest at T2 (105.8 ± 29.5), with statistical significance (P = 0.001) after rehabilitation. OFS was the highest at T3 (51.9 ± 3.9) and lowest at T5 (25.4 ± 2.8). Conclusion: CAM and maxillectomy deliberately affects the PS and QOL. Prosthetic rehabilitation, psychological motivation, and education create greater improvement in PS and QOL. The progress in parameters showed an upward trend with good obturator quality over a period of time.

Fabrication of a definitive obturator for a patient with partial maxillectomy defect following post-covid mucormycosis: A case report

Mucormycosis was a rapidly progressing and life-threatening fungal infection. After surgery, we should anticipate seeing more individuals with orofacial abnormalities given the total number of cases and the orofacial region's primary involvement in the previous COVID-19 pandemic. Thus, in order to improve the quality of life for individuals suffering from mucormycosis, maxillofacial prosthetic rehabilitation is of paramount importance. Postoperative maxillary defects can be rehabilitated through surgical and prosthetic procedures. An obturator was utilized as a part of prosthetic management to facilitate efficient deglutition and articulation. It also provides support for the facial soft tissue to restore the midfacial contour in cases of palatal defects. This case report describes about the fabrication of a definitive palatal obturator for a patient with postsurgical maxillary defect wearing interim obturator made of polymethyl methacrylate (PMMA). Food impaction and irritation of the fitting surface over the tissue defect, resulting in erythema to the tissue surface and discomfort of using interim obturator. With the remaining teeth and tissues serving as support, the definitive obturator made of cobalt and chromium was made. With no degradation in the prosthesis, the follow-up showed satisfactory outcomes.

An innovative approach for lid design for rehabilitation of maxillary oncological defect using hollow bulb obturator

BackgroundPost Maxillectomy, prosthodontic treatment modalities include surgical obturator, interim obturator and followed by definitive obturator. The surgical and interim obturator serves the purpose of providing a matrix on which surgical packing can be placed, reduces the contamination during wound healing, facilitates speech and permits deglutition and lessens the psychological impact of surgery. Local drug delivery techniques at the surgical site and the fabricated prosthesis have an impact on the targeted tissue. ObjectivesTo design a hollow bulb obturator with a detachable lid with attachments in the palatal surface of the obturator and to facilitate local drug delivery. MethodsDuplication of patient's maxillectomy cast, pre-shaped plaster bolus was incorporated inside the defect space to create the hollow space. After which a wax pattern was fabricated and acrylized. Wax template of the lid design was made and acrylized incorporating pins. ResultThe weight of the prosthesis is reduced. Due to the lesser weight of the prosthesis retention and physiologic function increases. The decrease in pressure to the surrounding tissue aids in deglutition and encourages the regeneration of tissue. The fabricated lid appears stable and retentive, which can be easily removed and placed back according to the need. ConclusionLocal drug delivery techniques at the surgical site and the fabricated prosthesis has an impact on the targeted tissue.The ability of the drug to reach the appropriate anatomic region will always be important, and has been the subject of much research in the past 5 years. Modified hollow bulb of the obturator in this research can aid in local drug delivery in surgical and interim obturators avoiding the removal of the obturator as the whole.

Definitive Obturator Prosthesis Post Mandibular Dredging for Treatment Ameloblastoma Patient: A Case Report

Background: Ameloblastoma is an odontogenic tumor that can cause bone destruction in the mandible. Mandibular dredging is a conservative treatment that involves enucleation and curettage of tumor tissue to remove tumor tissue from the bone-tooth loss after mandibular dredging treatment results in reduced occlusion function and aesthetics. A definitive obturator prosthesis is helpful to restore occlusions and aesthetics.

Prosthetic Rehabilitation of Post Covid Mucormycosis of Maxilla with Definitive Obturator Prosthesis- A 24 Month Follow Up Case Report

The second wave of COVID-19 in April 2021 witnessed a new mutated variant of SARS-CoV2 known as B.1.617 resulting in Mucormycosis. Inhalation, ingestion, or contamination of ulcerated mucosa by fungal spores results in infection and cause Mucormycosis. Objective: To highlight how a complex case of oral mucormycosis can be misdiagnosed due to its similar clinical presentations with other periodontal diseases and benefits of prosthetic rehabilitation of surgical defects with definitive obturator which improves the quality of life by restoring oral function and aesthetics. Case report: A 35-year-old female reported with chief complaint of pain, pus and mobility in upper front teeth region of 2 months and swelling of mid-face. Darkening of skin, swelling with tenderness over bilateral malar- infraorbital regions with epiphora and blurred vision in right eye and discharge from right nostril. She had multiple abscess in attached gingiva in incisor and premolar region of maxilla having probing depths ≤ 4mm with mobility. Conclusion: A precise diagnosis is prerequisite to specific treatment of any disease. Treatment often requires an extensive surgical resection causing facial deformation, masticatory, swallowing and speech problems. It is important to rehabilitate these patients by correcting the defects with the help of obturators and improve their lifestyle.

FABRICATION OF CLOSED HOLLOW BULBOBTURATOR USING LOST SALT TECHNIQUE : A CASE REPORT

Obturator is given for patient with maxillary defect which occurred either due to trauma or congenitally. They are generally classified into three that is immediate ,interim and definitive obturator. Immediate obturator is the type of obturator that is given immediately after surgery. Fabrication of this type of obturator is done on pre-surgical cast. It is a base plate type of obturator. Interim obturator is the obturator given after surgery and before proper healing. This case report deals with the fabrication of definitive obturator, an obturator that is given after proper healing. Fabrication of obturator can be done in different ways. They differ in the mode of acrylisation. Acrylisation can be done by two methods, single piece and two piece type of Acrylisation. This case report describes the use of two piece type of acrylisation by lost salt technique.

Impact of Milled Peek versus Conventional Chrome Cobalt Framework on Retention of Definitive Obturators for Unilateral Total Maxillectomy Patients

Impact of Milled Peek versus Conventional Chrome Cobalt Framework on Retention of Definitive Obturators for Unilateral Total Maxillectomy Patients

Maxillary defects due to COVID-19 associated mucormycosis: Impact on quality of life after rehabilitation with an obturator

Aggressive surgical debridement including maxillectomy in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis of the maxilla alters facial appearance, function, and an individual's overall quality of life (QOL). These patients require rehabilitation of defects with obturators to help them recover from esthetic and functional disabilities and regain near-normal quality of life. Because COVID-19 associated with mucormycosis is a newer entity, less is known about the quality of life of these patients after rehabilitation with obturators. Hence, the effects of COVID-19 associated with mucormycosis, treatment, and rehabilitation need to be evaluated to assess QOL. The purpose of this clinical study was to assess the impact on QOL after rehabilitation with obturators for participants with COVID-19-associated mucormycosis who underwent maxillectomy. Oral health impact profile-14 (OHIP-14) and obturator functioning scale (OFS) questionnaires were administered to 26 participants with COVID-19-associated mucormycosis of the maxilla who underwent maxillectomy and required rehabilitation with obturators. Questionnaire responses were received on numerical Likert scales of 0 to 4 for OHIP-14 and 1 to 5 for OFS. The repeated measures analysis of variance (ANOVA) with pairwise post hoc Bonferroni tests were used to evaluate and compare mean scores of OHIP-14 and OFS at different preoperative and postoperative stages (α=.05). A total of 26 participants who underwent maxillectomy were provided with obturators. A higher mean ±standard deviation OHIP score was observed before rehabilitation at T1 (51.0 ±9.6) followed by 1 week after fabrication of the surgical obturator at T2 (18.6 ±16.4), and 1 week after fabrication of the interim obturator at T3 (4.7 ±8.2). The lower mean scores ±standard deviation were seen 1 week after the fabrication of definitive obturators at T4 (2.9 ±7.2). Comparison of the scores at T1, T2, T3, and T4 found significant difference (P≤.001). Similarly, higher mean ±standard deviation OFS scores were seen 1 week after rehabilitation with surgical obturators at T2 (27.3 ±12.6) and at least 1 week after fabrication with definitive obturators at T4 (15.7 ±5.6). A comparison of the scores at T2, T3, and T4 found significant differences (P≤.001). Considerable improvement was seen in QOL with the fabrication of surgical obturators in participants who had received maxillectomy/debridement for mucormycosis. This improvement had a linear relationship with the time elapsed and the consecutive fitting of the obturators with healing.

REHABILITATION OF MAXILLARY DEFECTS IN PARTIAL AND COMPLETE EDENTULOUS ARCHES WITH DEFINITIVE OBTURATORS-A CASE SERIES

Rehabilitation of hemimaxillectomy patients can be challenging. The most common problem with prosthetic treatment in such patients is in getting adequate retention, stability, and support. The size and location of the defect usually influences the amount of impairment and difficulty in prosthetic rehabilitation. The obturator prosthesis is commonly used as an effective means for rehabilitating hemimaxillectomy cases. In this case series prosthetic rehabilitation of a completely edentulous and partially edentulous patients with definitive obturators have been discussed.

Fabrication of a Closed Hollow Bulb Obturator for the Rehabilitation of an Acquired Partial Maxillectomy Defect Due to Mucormycosis

Patient affected from post-COVID mucormycosis often require local debridement or surgical resection resulting in maxillectomy. This is frequently quite extensive or bilateral and spares very little of the hard and soft tissues in the oral cavity. Both surgery and prosthetic rehabilitation are needed to rehabilitate such extensive defects. Once the patient has grown accustomed to the temporary prosthesis and effective healing has taken place, a definitive prosthesis is inserted for the patient. Definitive obturators require careful thought during design to ensure longevity and superior retention and stability. This article documents the prosthetic rehabilitation of a partial maxillectomy defect due to mucormycosis which resulted after COVID.

A Study on Speech Analysis in Acquired Maxillary Defect Patients Treated with Maxillary Obturator.

The aim of the present study was to assess the speech analysis in acquired maxillary defect patients treated with maxillary obturator. Total of 16 patients were considered in the study. The age group of these patients ranged from 40 to 75 years with a mean age of 59.5 years, irrespective of their gender. The surgical obturator was fabricated using self-cure acrylic. The surgical obturator was delivered immediately after surgery. After a healing period of about 2 weeks, the surgical obturator was replaced by an interim prosthesis. This was processed with the help of heat-cure polymethylmethacrylate. The total number of patients was divided into two groups, namely, (A) Definitive obturator group and (B) Interim obturator group. The speech intelligibility (SI), was analyzed. The mean scores for SI before prosthesis in definitive and interim groups were 19.13 ± 3.22 and 19.87 ± 1.72, respectively. This was increased after prosthesis insertion to 24.38 ± 1.30 and 22.37 ± 1.18, which further increased after adaptation period of 2 months to 28.75 ± 1.28 and 24.62 ± 1.59 in two groups. The present study concluded that speech was severely affected by maxillary resection and that rehabilitation with maxillary obturator was successful in restoring these aspects of speech.

Rehabilitation of post mucormycosis surgical defect using definitive obturator with cast metal framework- A case report

The recent outbreak of covid-19 disease has led to development of mucormycosis in immunocompromised individuals. Treatment options include antifungal drugs, surgical removal of infected tissues, and management of underlying metabolic disorders. Surgery typically includes the complete excision of the diseased region. These defects put the patient at risk for nasal twang, fluid leaks into the nasal cavity, and poor masticatory function. In such defects, the obturator prosthesis can create an oro-nasal seal. This case report describes the rehabilitation of post mucormycosis surgical defect using definitive obturator using cast metal framework.

OPPORTUNITIES FOR SPEECH RESTORATION IN PATIENTS WITH MAXILLECTOMY. LITERATURE REVIEW

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.

Combined digital–conventional workflow to fabricate a definitive obturator from an interim obturator for a patient with an anterior maxillectomy defect

An existing interim obturator can be reproduced as the definitive one using digital technology, with benefits for a patient with a maxillectomy. By digitally scanning the oral condition and the existing interim obturator, a definitive obturator, including a computer-aided designed and computer-aided manufactured metal framework, was fabricated and delivered to a patient with an anterior maxillectomy defect by following a combined digital and conventional workflow. This technique can hasten the adaptation of the patient to the new obturator and ensure a more comfortable and safer clinical procedure.

A definitive cast partial denture post partial maxillectomy defect due to mucormycosis: A case report

Maxillectomy performed in acquired lesions is often very extensive or bilateral, sparing very less hard and soft tissue in the oral cavity. These defects need both surgical and prosthetic rehabilitation. A definitive prosthesis is inserted after complete healing, when the patient is accustomed to the interim prosthesis. Definitive obturator warrants better retention and stability and needs a meticulous planning in design for long-term use. This article explains about cast partial denture as a definitive obturator for a post surgical defect due to mucormycosis.

Psychological Impact of Maxillectomy and Prosthodontic Rehabilitation and Role of Socio-demographic and Disease-related Variables

Abstract Background: The objectives of this study were to evaluate the psychological impact of maxillectomy and prosthodontic rehabilitation and to assess the role of various sociodemographic and disease-related variables on the psychological distress of patients. Materials and Methods: Thirty-nine patients who were referred for prosthodontic rehabilitation after maxillectomy were enrolled, of whom 36 completed the study. The Hospital Anxiety and Depression Scale (HADS) was used to assess and compare the psychological distress level after maxillectomy (T0) and 3 weeks after insertion of a definitive obturator (T1). The Obturator Functioning Scale was also used to assess the functioning of the obturator prosthesis. The means of anxiety and depression scores were also compared among different variables using one-way ANOVA. A probability level of P < 0.05 was considered statistically significant. Results: Anxiety and depression scores were significantly reduced at T1 compared to T0 (P < 0.001). The patients reported little or no difficulty with the obturator prosthesis. Among the sociodemographic variables, psychological distress was not affected by the patient’s age or marital status at any time point (P > 0.05); however, the female, illiterate, and unemployed patients had significantly higher HADS scores compared to the male, graduate, and employed patients (P < 0.05). Malignant tumors and large postsurgical defects had a significant impact on psychological distress compared to benign tumors and small defects (P < 0.05). Conclusion: Maxillectomy had a profound psychological impact. Prosthodontic rehabilitation after maxillectomy restored function and esthetics to near normalcy, and this helps to cope with psychological distress.

Recreating lost smile - A definitive obturator.

Recreating lost smile - A definitive obturator.

Definitive obturator rehabilitation on the maxilla defect post-tumor surgery

Background: Obturator is a prosthesis to replace tissue lost post tumor surgery in the maxilla called maxillectomy. Obturator is made of acrylic and consists of surgery, intermediate, and definitive obturator. Definitive obturator is made using Hollow bulb technique to be light and stable when used. In this case, a definitive obturator was made for a patient using intermediate obturator. Objectives: To inform that obturator can rehabilitate maxillary defect to restore the patient’s mastication, digestive, phonetic, aesthetic and psyche functions. Case report: A 28-year-old man came for postoperative cleft management. Diagnosis is Post OP Hemi maxillectomy Dextra. The procedure begins with impression to obtain study model and the making of individual tray. The next visit is grinding the remaining teeth for occlusal rest placement. Double impression is done to obtain working model and making the bite block. The third visit is bite block try-in on the patient and placed to working model for fixation on the articulator, followed by tooth color determination and laboratory instructions. The fourth visit is wax obturator try-in and checking occlusion, articulation, aesthetics and phonetics. The fifth visit is definitive obturator insertion and follow up. Conclusion: Definitive obturator can rehabilitate defects post maxillary tumor surgery.Keywords: Maxillary defect, definitive obturator, Hollow bulb technique

Post maxillectomy definitive rehabilitation in post-covid mucormycosis patients using conventional and 3D printed obturator: A twin case report

Abstract Maxillectomy is the surgical removal or resection of the maxilla or upper jaw bone. Maxillectomy may be total or partial. It is performed during surgical treatment of cancer and infections (bacterial. fungal) of the oral cavity, nasal cavity and maxillary sinuses. Patient affected from post-Covid mucormycosis require local debridement or surgical resection resulting in maxillectomy. After surgery, patient has difficulty in mastication, speech, and swallowing because of communication between oral and nasal cavity. This may also give rise to psychological challenges and social exclusion. The prosthodontic rehabilitation of such patient using obturator provide a separation between oral and nasal cavity and improve the quality of life of the patient. There are various techniques and materials used for fabrication of definitive obturator. This article discusses the prosthodontic rehabilitation after maxillectomy in post-covid mucormycosis patients using obturator by conventional and 3D printed techniques.