Maxillary Obturator Prosthesis Research Articles

Comparison of Retention of Clasps Fabricated with Cast Cobalt Chromium and Acetal Resin in Maxillary Obturator Prosthesis: An In Vitro Study

Comparison of Retention of Clasps Fabricated with Cast Cobalt Chromium and Acetal Resin in Maxillary Obturator Prosthesis: An In Vitro Study

Quality of life in oncologic patients after maxillectomy operations: clinical case series on different rehabilitation protocols.

The study's purpose was to compare the quality of life (QoL) in oncologic patients treated with different rehabilitation protocols following maxillary tumor resections. The patients were divided into three groups. Group A: 18 Patients with maxillary obturator prosthesis. Group B: 17 Patients with simultaneous autologous tissue reconstruction. Group C: 12 Patients with prosthesis on zygomatic implants. The post-operative QoL was compared using standard questionnaires, investigating items like pain, mood, social relations, and specific functions that could potentially compromise the post-operative QoL. A secondary analysis compared reconstructed vs. non-reconstructed patients. Most questionnaire items did not show significant differences among groups. Statistically significant outcomes were found in two parameters (social contact and sexuality), in which patients treated with zygomatic implants had the best satisfaction, and patients with obturator prostheses showed the lowest satisfaction. Patients belonging to the non-reconstructed group showed better moods than those in the reconstructed group, while taste problem complaints and pain were lower in the reconstructed group. Although the type of reconstruction procedure depends on the type of maxillectomy to be performed and on the general health situation of each patient, the impact of the rehabilitation protocol on the patients' QoL should be accounted for when planning the treatment.

Fabricating 2 piece closed hollow obturator with elastomeric impression material: An innovative dental technique

Maxillectomy defects are the most common results in oro-nasal communication, which leads to an expected change in speech tone, difficulty in mastication, and deglutition. These affect the quality of life of the patient and also impact them psychosocially in a long run. The most common management of maxillectomy patients for both complete and partial is by maxillary obturator prosthesis. To reduce the weight of the obturators various procedures of hollowing are present in literature. In this article, we will discuss an alternate and innovative laboratory technique for the fabrication of closed hollow obturator which will reduce the time of both dental technicians and clinicians.

Prevalence of Possible Dementia in Patients with Maxillofacial Defects and Difficulty of Inserting Obturator in Maxillectomy Patients: Toward Better Provision of Supportive Care.

As society ages, it is important to understand the prevalence of dementia and the difficulties of inserting prostheses in patients with maxillofacial defects in order to clarify issues in supportive care. We screened 183 patients for dementia using the revised Hasegawa's dementia scale (HDS-R) at the Clinic for Maxillofacial prosthetics, Tokyo Medical and Dental University, and investigated age and sex differences in HDS-R score. We asked 47 of the 183 participants about the difficulty of inserting a maxillofacial obturator prosthesis and collected subjective comments, information about the prosthesis, and data from five assessments. Multiple regression analysis was used to reveal factors associated with insertion difficulty. Overall, 8.7% of the participants were judged to have possible dementia. Men were more likely than women to have possible dementia, and the risk increased with age. Of the 47 participants, 26 reported difficulty inserting their prosthesis, 12 of whom attributed it to their oral defect. Fourteen patients advised following doctor's instructions to practice insertion in order to become accustomed to it. A lower HDS-R score had a significant impact on insertion difficulty. Cognitive function and difficulty inserting maxillary obturator prostheses should be considered in the provision of continuous supportive care to patients with maxillary defects.

Hollowing of Obturators for Post-Mucormycosis Maxillary Defects: Technique Based Case Series

Post COVID-19 extensive use of steroids led to mucormycosis induced invasive sinusitis in many patients. Location and extent of the fungal infection decides the amount of maxillectomy to be performed. Post surgical rehabilitation with an obturator is required to restore function of mastication deglutition and speech. Large size of the defect and missing teeth on defect side compromise the retention of obturator and at the same time make them heavy and uncomfortable. This case series describes prosthodontic management of four casestwo partially and two completely edentulous patients operated for mucormycosis with healed palatal defects unilaterally with chief complains of inability to speak and eat. All the defects were treated with a hollow maxillary obturator prosthesis fabricated using different designs and hollowing techniques. All the patients were treated with single piece definitive hollow obturator prosthesis using different fabrication techniques aimed at reducing the weight and thus enhancing patient comfort and function. A single-piece obturator prostheses reduce the chances of plaque or bacterial accumulation to a minimal amount. This helps in maintenance of better hygiene by the patient as compared to a two-piece obturator prosthesis.

Rehabilitation of the patient with a partial maxillectomy defect with an interim hollow bulb obturator

Maxillary obturator prosthesis is usually preferred for patient going through partial or total maxillectomy. The heavy weight of the obturator prosthesis is usually a major concern to the prosthodontist as it may cause inconvenience with masticatory function. The maxillary defect may be congenital or acquired; hence, the latter often leads to patients encountering an array of physical and psychological distress. Rehabilitation of such patients is often challenging due to the extent of the defect area. Achieving adequate retention is of utmost importance as it reinforces the obturator musculoskeletal coordination. The processing technique described in this case report is the lost salt technique using a single-step flasking procedure which was customized accordingly with heat-cure acrylic resin as stops on the flask to accommodate the closed hollow obturator prosthesis as a single unit. This article describes the management of a patient who had undergone partial hemimaxillectomy secondary to mucoepidermoid cell carcinoma rehabilitated with hollow obturator prosthesis.

A Clinical Evaluation of Implant-Supported Maxillary Obturator Prostheses: An Original Study.

Introduction:Rehabilitation after the maxillectomy is challenging to the clinician and the patient. Since the invention of the implants, the rehabilitation has changed the treatment strategies. Hence in our study, we evaluated the maxillary obturator that is implant supported.Materials and Methods:We piloted a retrospective analysis of the patients who received the maxillary obturator prosthesis with implant support from the department records from 2010 to 2020. We finalized 50 subjects who fit the criteria and evaluated clinically for various parameters. The comparison of these parameters was done using the Chi-square tests deliberating P < 0.05 as significant.Results:We observed that the implant survival was 94%. There was significant variation for the implant bone height (P = 0.001) and the implant threads exposed (P = 0.044) for the posterior and the anterior regions.Conclusion:The implant-supported maxillary obturator prosthesis has been shown to perform clinically satisfactorily. The success of the implant-supported maxillary obturator is dependent on the time of the placement, load applied, the radiation regime, and the patient follow-up.

On the issue of hygienic maintenance of post-resection maxillary obturator prostheses (literature review)

Based on literature data, this article reviews a range of problems associated with hygienic care after obturation prostheses and the oral cavity after combined treatment of malignant neoplasms. At the present time, replacing prosthetic care after maxillary resection due to malignant neoplasms using obturator prostheses is the main method for rehabilitation of oncological patients. Such methods as dental prosthetic care based on dental implants and removable dentures for elimination of partial and complete edentulism is impossible in such conditions. A defect in the maxilla, an oronasal fistula, post-operative and post-radiation jaw contracture as well as hyposalivation, impair the hygiene of the oral cavity. Acrylic plastics used for production of obturator prostheses have such substantial flaws leading to development of inflammation and progression of atrophy in the supporting tissues of the basal seat. This reduces short-term and long-term efficacy of orthopaedic dental rehabilitation procedures after replacing dental prosthetics. A conclusion has been drawn on the necessity of development and practical introduction of a special complex of dental hygienic procedures — professional and individual — adapted for oncological patients that would be implemented within the framework of dynamic dispensary observation in the setting of a dental polyclinic.

Microbial Analysis of Obturators During Maxillofacial Prosthodontic Treatment Over an 8-Year Period.

The aim of the study was to investigate the microbial colonization (by Candida species, anaerobic and facultative anaerobic bacteria) of maxillary obturators used for the restoration of maxillary defects, including during radiotherapy. Retrospective cohort study. Fifteen patients requiring a maxillary obturator prosthesis had swabs of their obturators and adjacent tissues taken at different stages of their treatment over a period of 8 years. Identification of microbial species from the swabs was carried out using randomly amplified polymorphic DNA polymerase chain reaction (RAPD PCR) analysis, checkerboard DNA–DNA hybridization, CHROMagar Candida chromogenic agar, and DNA sequencing. Candida species were detected in all patients and all patients developed mucositis and candidiasis during radiotherapy which was associated with an increase in colonization of surfaces with Candida spp ., particularly C albicans. Microbial colonization increased during radiotherapy and as an obturator aged, and decreased following a reline, delivery of a new prosthesis, or antifungal treatment during radiotherapy. Microbial colonization of maxillary obturators was related to the stage of treatment, age of the obturator material, radiotherapy and antifungal medications, and antifungal treatment may be recommended if C albicans colonization of palatal tissues is greater than 105 colony-forming units per cm2 following the first week of radiotherapy.

PROSTHETIC REHABILITATION OF A MAXILLECTOMY PATIENT WITH A TITANIUM CLOSED HOLLOW BULB OBTURATOR USING LOST WAX BOLUS TECHNIQUE - A CASE REPORT

Maxillary intraoral defects due to surgical resection create an open link between the oral and nasal cavities causing difficulty in deglutition, speech, and an unaesthetic appearance . Maxillary obturator prosthesis is a more frequent treatment modality than surgical reconstruction for maxillectomy in patients suffering from oral cancer. The obturators often become heavy and hence are hollowed out in the defect portion to reduce its weight as a standard practice. This case report describes the prosthetic rehabilitation of a maxillectomy patient with a titanium cast hollow obturator using lost wax bolus technique.

Digital fabrication of a maxillary obturator prosthesis by using a 3-dimensionally–printed polyetheretherketone framework

The digital fabrication of a maxillary obturator with a 3D-printed polyetheretherketone (PEEK) framework is described. Digital oral data were scanned for the computer-aided design (CAD) of the framework and the 3D printing of a preliminary resin cast. The framework was accurately printed from a PEEK filament material. A secondary impression was made to fabricate the definitive cast. The PEEK framework exhibited precise fit, excellent retention, and reduced weight compared with a typical metal framework.

Occlusion in obturators: A literature review

Maxillary Inadequacies originate due to various aetiologies. Prosthetic restoration of the defect often includes use of a surgical obturator, interim obturator and definitive obturator. Prosthetic design has been discussed by many authors. A search of dental literature through April 2020 was undertaken by use of PubMed. The focus of the search was on occlusion concepts and schemes incorporated in the designing of a maxillary obturator prosthesis for partially edentulous hemimaxillectomy patients. In addition, some common textbooks on removable and maxillofacial prosthodontics were scrutinised for additional documentation. The significance of occlusion should be emphasized in the support of maxillary obturator prostheses. Till date there is no literature review on the the array of concepts of occlusion incorporated in maxillary obturator fabrication. Keywords: Occlusal schemes, Maxillary obturators, Occlusal concepts in Definitive obturators.

Two-step fabrication of an obturator prosthesis for a large maxillary defect with digital speech analysis: A case report

This report describes the prosthetic rehabilitation of a patient with a large maxillary defect. It is often risky and difficult to take an impression of a large defect in a single-step procedure. In this study, we present a clinical technique where the maxillary obturator prosthesis was fabricated by combining two methods: conventional processing using an impression followed by relining of the obturator part to improve retention and support of the prosthesis. This report also describes how digital speech analysis using formants of five vowels can be utilized during the relining and adjustment step, resulting in improved patient satisfaction and comfort. (Int J Maxillofac Prosthetics 2020;3:32-36)

Oral Health-Related Quality of Life (OHRQoL) in Patients with Definitive Maxillary Obturator Prostheses: A Prospective Study

Aim: To assess the impact of definitive maxillary obturator prostheses on oral health-related quality of life (OHRQol). Materials and Methods: A presented prospective study comprising 50 patients with maxillectomy defects was selected for the study. Patients with any active or persistent lesion in relation to the defect site, restrictive mouth opening along with poor general health were excluded from the study. All the patients were rehabilitated with definitive maxillary obturator prostheses, respectively. These patients were subjected for assessment of OHRQol and obturator prostheses functioning. These assessments were done using three scales OHIP-Edent-19, obturator functioning scale (OFS-15) and a novel scale—maxillofacial prosthesis performance scale (MFPPS). The assessment was done on all the patients after 2 weeks and 3 months of prosthesis function. The data were tabulated and analysed using paired sample t-test and the Wilcoxon signed rank test for paired groups and unpaired sample t-test for independent groups. Results: The scores of OHIP-Edent, OFS and MFPPS for definitive maxillary obturator prostheses after 2 weeks were 37.56, 30.48 and 20.50. The scores of OHIP-Edent, OFS and MFPPS for definitive maxillary obturator prostheses after 3 months were 30.30, 24.26 and 16.10, respectively. Conclusion: Mean differences of OHIP-Edent (7.260), OFS (6.220) and MFPPS (4.400) were observed after 2 weeks and 3 months of obturator prosthesis function. These findings show significant improvements of prosthesis in terms of functional, physical, psychological and social parameters after long-term follow-up (3 months).

Integration of intraoral scanning and conventional processing to fabricate a definitive obturator: A dental technique

Clinical challenges occur when treating patients with maxillofacial defects with digital technology. This report describes a technique that combines intraoral scanning to fabricate a milled record base along with the conventional processing to fabricate a definitive maxillary obturator prosthesis.

Treatment Outcomes of Implant-Supported Maxillary Obturator Prostheses in Patients with Maxillary Defects: A Systematic Review.

To systematically review the current evidence on clinical and patient-reported outcomes of implant-supported palatal obturator prostheses. An electronic search of the PubMed, Web of Science, and Cochrane databases was carried out in June 2019. The titles and abstracts of all articles were screened by two independent reviewers. The references of the subsequently selected studies were further screened for potential articles. Assessment of the selected full texts was performed independently according to established inclusion and exclusion criteria. The quality of the selected studies was determined using the Newcastle-Ottawa scale. Interrater agreement on study selection was calculated using Cohen kappa statistic. The search yielded a total of 2,797 records. Ten studies were selected for data extraction, with a Cohen kappa value of 0.856. Five studies were prospective, and five were retrospective. The survival rates for conventional implants ranged from 21.42% to 100%, whereas for zygomatic implants, the survival rates varied from 30% to 100%. Four studies reported prosthodontic complications, with screw loosening being the most common. Patient quality of life (QoL) was analyzed in six studies. In spite of the limitations of the present review, it can be concluded that the clinical outcomes are acceptable in terms of survival rates, implant and prosthodontic complications, and QoL associated with implant-supported maxillary obturator prostheses. QoL of implant-supported prostheses in these patients are acceptable. The general study design was not homogenous between studies.

PEEK Maxillary Obturator Prosthesis Fabrication Using Intraoral Scanning, 3D Printing, and CAD/CAM.

This report presents a digital technique for the fabrication of a two-piece hollow bulb maxillary obturator prosthesis. The procedure described resulted in an accurate prosthesis while avoiding the discomfort associated with analog impressions. The manipulation of a routine postoperative CT scan in conjunction with a 3D printer allowed for the fabrication of a 3D-printed anatomical cast, from which the two-piece hollow bulb obturator was fabricated. The obturator prosthesis framework was digitally designed and milled from a modified PEEK material, resulting in a lightweight prosthesis with excellent biocompatibility. The clinical and laboratory steps involved are described.

Definitive maxillary obturator prosthesis: Timelines for fabrication and follow-up.

A definitive maxillary obturator prosthesis can be used to rehabilitate a maxillary defect with the aim of improving speech, deglutition, and elimination of oronasal regurgitation. The aims of this study were (1) to determine the time required to fabricate a definitive maxillary obturator prosthesis and (2) to compare the fabrication and follow-up times between a patient's first and second definitive maxillary obturator prosthesis. A retrospective review was completed of patients that had maxillary definitive obturators fabricated following head and neck surgery from 2002 to 2018 (n=173). Demographics, clinical data, date of surgery, start date of fabrication, follow-up dates, and prosthesis follow-up data were collected. The median time to delivery of the patient's first definitive maxillary obturator prosthesis from the date of surgery was 7.7 months for nonradiated patients and 9.6 months for radiated patients (P ≤ .05). Additionally, there was a significant difference in the median number of appointments to fabricate the 1st definitive maxillary obturator prosthesis as compared to the 2nd prosthesis (6vs 5; P ≤ .05). Fabrication timelines differed based on history of radiotherapy and patient experience. This data is helpful to set expectations for patients and practitioners regarding the process for prosthesis fabrication and follow-up.

The use of optical scanner for the fabrication of maxillary obturator prostheses.

Maxillectomy following tumors or, more rarely, traumatic injuries may result in maxillary defects that may determine physical dysfunctions and functional impairment of speech and swallowing. The aim of our study was to present our experience in the management of post-maxillectomy patients by the use of obturator prostheses that were obtained by 3D digital casts via an intraoral scanner. Patients with maxillary defects following maxillary and/or palatal resection or maxillary traumatic avulsion were selected for this clinical study between 2015 and 2018. Five to 6months after surgery, a definitive obturator prosthesis was fabricated thanks to an intraoral scanner. The following parameters of clinical outcome were considered: the absence of fluid leakage, the recovery of phonation, the recovery of swallowing, and personal satisfaction. Twenty-eight patients (20 males, 8 females) fulfilled the inclusion criteria and were included in the study. Most patients had a maxillary and/or palatal defect because of a malignant tumor. On the whole, 93% of patients reported a complete absence of fluid leakage between maxillary sinuses or nasal fossa and oral cavity; most patients reported a good or complete recovery of phonation and swallowing. Digital technology for the fabrication of maxillary obturator prosthesis may be effective and useful. The reduced laboratory working time, the avoidance of the risk of aspiration of impression materials, and the overcome of the difficulties associated with whole tissue undercut impression are just some of the most important advantages that have been encountered thanks to this promising technology.

LATE DIAGNOSIS OF INTRAORAL SALIVARY GLAND CARCINOMA

A 58-year-old female patient was referred because of a palatal nodular lesion. The patient reported that the lesion began 4 years ago, and she was attended by 5 different dentists without definitive diagnosis. Given its exacerbated growth in the last months, she sought care again, and then she was referred to our center. Clinical oral examination revealed an extensive nodular lesion located on the hard palate measuring 4 × 3 cm with well-defined limits, smooth surface, and pain with palpation. Our diagnostic hypotheses were pleomorphic adenoma and adenoid cystic carcinoma (ACC). Incisional biopsy was performed, and based on histopathologic and immunohistochemical findings, the diagnosis of ACC was established. Partial maxillectomy and rehabilitation with maxillary obturator prosthesis were performed. Currently, the patient is undergoing dental and psychological care in our center.