Obturator Prosthesis Research Articles

Prosthetic Rehabilitation of a Patient after Hemimaxillectomy due to Squamous Cell Carcinoma in the Maxillary Sinus: Case Report

AbstractRehabilitation of uncontrolled diabetics with impairments due to acquired defects is complex. More significant defects are more challenging to treat than smaller ones, which can often be corrected surgically. When surgical reconstruction is not possible, the preferred treatment method for facial defects is prosthetic reconstruction. An obturator prosthesis is a standard and efficient method for treating such maxillary defects. This case report aims to evaluate patients' satisfaction with uncontrolled diabetes with improved speech, swallowing, and articulation, and achieving acceptable aesthetics after rehabilitation.This case report details the ultimate obturator prosthesis therapy for an elderly male patient who had a hemimaxillectomy because of squamous cell cancer of the maxillary air sinus. The patient had uncontrolled diabetes and mobility grade 1 of the remaining upper teeth. A gauze coated with Vaseline blocked a significant medial undercut in the defect. The primary, final impression, and jaw relationships were recorded to aid postoperative speech and deglutition. Normal palatal contours were replicated to ensure functional outcomes. The obturator portion was hollowed to reduce its weight and prevent unnecessary strain on the supporting teeth and tissues. The obturator was fabricated using heat-cured acrylic resin to allow future additions in the event of tooth extraction and relining.A well-made and constructed obturator for diabetic patients can offer high adaptability and functionality. Multidisciplinary planning is essential for effective dental care and functional rehabilitation, and avoiding oroantral communication. This will significantly improve the patient's quality of life.

Fabrication of Obturator Prosthesis by Using Digital Technology

Fabrication of Obturator Prosthesis by Using Digital Technology

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

Velo-palatal obturator prosthesis after maxillectomy following squamous cell carcinoma: a case report

Velo-palatal obturator prosthesis after maxillectomy following squamous cell carcinoma: a case report

Rehabilitation of Combined Hard and Soft Palate Defects with a Soft Relining Prosthesis: A Clinical Report.

It remains a significant challenge in prosthetic rehabilitation for combined hard and soft palate defects on account of two primary reasons. At first, conventional impressions can hardly get an accurate analogue and usually bring about a terrible experience for the patients. Secondly, conventional hard denture base resins used in obturator prostheses exhibit limitations in marginal sealing, undercut retention, and elastic buffering when in contact with the soft palate. This article presents a case where combined hard and soft palate defects were successfully and rapidly reconstructed by using digital intraoral impression technology and denture soft reline material.

REHABILITATION WITH OBTURATOR PROSTHESES IN PATIENTS AFTER MAXILLECTOMY: An integrative literature review

Maxillectomy is used for the removal of neoplastic tissues in the maxilla and adjacent regions. Defects in the maxilla resulting from this surgical approach generally lead to physical dysfunctions and compromise oral function, including problems with chewing, swallowing, and speech, as well as aesthetic impairments. To minimize the sequelae of maxillectomized patients, the fabrication of obturator prostheses is advocated to block communication between the oral and nasal cavities, enabling functional and aesthetic recovery. This study aims to present an integrative literature review on rehabilitation with obturator prostheses after maxillectomy. The literature search included PubMed, Medical Literature Analysis and Retrieval System Online, ScienceDirect, and the Scientific Electronic Library Online, using a combination of the MeSH terms "Palatal Obturators," "Oral Cancer," and "Oral Rehabilitation." Studies suggest that the greater the tissue destruction, the worse the prognosis, due to greater difficulty in sealing and retaining obturator prostheses, as well as aesthetically unfavorable outcomes. Modified prostheses have superior results in terms of retention, stability, and sealing compared to conventional ones. The use of obturator prostheses is considered an effective treatment option for patients undergoing maxillectomy, as it can restore chewing and speech functions, as well as acceptable aesthetics, contributing to an improvement in quality of life. The importance of the appropriate professional approach from the beginning of treatment is emphasized, considering long-term planning and follow-up ideally.

Dental Versus Zygomatic Implants in the Treatment of Maxillectomy: A Finite Element Analysis.

This study analyzed the stress distributions on zygomatic and dental implants placed in the zygomatic bone, supporting bones, and superstructures under occlusal loads after maxillary reconstruction with obturator prostheses. A total of 12 scenarios of 3-dimensional finite element models were constructed based on computerized tomography scans of a hemimaxillectomy patient. Two obturator prostheses were analyzed for each model. A total force of 600 N was applied from the palatal to buccal bones at an angle of 45°. The maximum and minimum principal stress values for bone and von Mises stress values for dental implants and prostheses were calculated. When zygomatic implants were applied to the defect area, the maximum principal stresses were similar in intensity to the other models; however, the minimum principal stress values were higher than in scenarios without zygomatic implants. In models that used zygomatic implants in the defect area, von Mises stress levels were significantly higher in zygomatic implants than in dental implants. In scenarios where the prosthesis was supported by tissue in the nondefect area, the maximum and minimum principal stress values on cortical bone were higher than in scenarios where implants were applied to defect and nondefect areas. In patients who lack an alveolar crest after maxillectomy, a custom bar-retained prosthesis placed on the dental implant should reduce stress on the zygomatic bone. The stress was higher on zygomatic implants without alveolar crest support than on dental implants.

Fully integrated additive manufacturing of an obturator prosthesis for an edentulous patient with a maxillectomy defect

Maxillary defects pose challenges for prosthodontists, especially when patients have no remaining teeth. This clinical report describes rehabilitation with a complete denture obturator fabricated in 2 visits for an edentulous patient after a maxillectomy. The obturator base and artificial teeth were digitally designed and merged into a 1-piece prosthesis. Following a virtual reduction, the integrated prosthesis and a gingival veneer were calculated and then printed and bonded together to complete the fabrication. Balanced occlusion was achieved with the assistance of a digital occlusion analyzer at the insertion visit. This approach avoided base-tooth assembly deviations and provided a prosthesis with good patient-reported outcomes at the 6-month follow-up.

Validation of the "obturator functioning scale" for Chinese-speaking patients with obturator prostheses after cancer-related maxillectomy

ObjectiveThe Obturator Functioning Scale (OFS) is a scale without formal measures of validity in any language. This study aimed to translate and adapt the OFS from English to Chinese and check its reliability and validity in Chinese-speaking patients with obturator prostheses after cancer-related maxillectomy. MethodsThe 15-item Chinese preversion of the OFS was completed by 133 patients in three tertiary stomatological hospitals. Of these, 41 completed it again one week after the first measurement. The patients also completed the Chinese version of the University of Washington quality of life scale (UW-QOL, Version 4). ResultsItem 12 ("upper lip feels numb") was deleted to achieve a better statistical fit. The 14-item Chinese version of the OFS (OFS-Ch) demonstrated high internal consistency (Cronbach's alpha = 0.908). The test-retest reliability coefficients for most items exceeded 0.90, indicating substantial reproducibility. Confirmatory factor analysis found that the scale consisted of three correlated factors: 1) eating (four items), 2) speech (five items), and 3) other problems (five items). This explained 70.2 % of the total variance using exploratory factor analysis. The scale was significantly convergent and discriminant and could validly discriminate between patients with Brown I and IId maxillary defects. ConclusionsOur results showed that the OFS-Ch scale is a valid tool for evaluating oral dysfunction and satisfaction with appearance for patients with the obturator prosthesis and identifying those at risk of poor obturator function in clinical settings.

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.

Dental versus zygomatic implants in the treatment of maxillectomy: a finite element analysis.

This study analyzed the stress distributions on zygomatic and dental implants placed in the zygomatic bone, supporting bones, and superstructures under occlusal loads after maxillary reconstruction with obturator prostheses. 12 scenarios of three-dimensional finite element models were constructed based on computed tomography scans of a patient who had hemimaxillectomy. Two obturator prostheses were analyzed for each model. A total force of 600 N was applied from the palatal to buccal bones at an angle of 45°. The maximum and minimum principal stress values for bone and also the von Misses stress values for dental implants and prostheses were calculated. When zygomatic implants were applied to the defect area, the maximum principal stresses were similar in intensity to the other models; however, the minimum principal stress values were higher than in scenarios without zygomatic implants. In models that used zygomatic implants in the defect area, von Misses stress levels were significantly higher in zygomatic implants than in dental implants. In scenarios where the prosthesis was supported by tissue in the non-defect area, the maximum and minimum principal stress values on cortical bone were higher than in scenarios where implants were applied to both defect and non-defect areas. In patients who lack an alveolar crest after maxillectomy, reduced stress on the zygomatic bone is expected if a custom bar-retained prosthesis is placed on the dental implant. The stress was higher on zygomatic implants without alveolar crest support than on dental implants.

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.

A fully digital approach to replacing an obturator prosthesis using a 3D printed closed hollow bulb: Α dental technique

The replacement of an obturator prosthesis using conventional methods has multiple issues. Standard tessellation language files generated from the superimposition of an accurate intraoral scanning of the maxillary defect and direct data acquisition of the existing hollow bulb obturator can facilitate the precise design of the prosthesis, requiring only minor adjustments. Rapid prototyping manufacturing techniques seem to ensure precise control of the integrity of the prosthetic component completion. The success of the technique is the simplicity and repeatability of designing and fabricating a retrievable and easily repairable obturator.

Guided placement of zygomatic implants in head and neck cancer patients: implant survival and patient outcomes at 1–3 years of follow-up

Zygomatic implants (ZI) are a valuable option for supporting an obturator prosthesis after maxillary resection. This study was performed to assess the clinical outcomes of a digitally validated guided technique for ZI placement, followed by immediate prosthetic obturation. The primary objective was to evaluate implant survival, while the secondary objective was to assess patient-reported quality of life post-rehabilitation. Twelve patients treated for head and neck cancer received a total of 36 ZI after ablative surgery. The mean duration of ZI follow-up was 30.1 months. The survival rate of ZI placed in non-irradiated patients was 100%, while it was 85% in irradiated patients. Patient-reported outcomes were evaluated using the Liverpool Oral Rehabilitation Questionnaire (LORQv3) and the University of Washington Quality of Life Questionnaire (UW-QOL v4). Most patients reported satisfactory outcomes in the oral function domain of the LORQv3 (mean score 17.7 ± 4.5; possible range 12–48, with lower scores indicating better outcomes). Regarding the UW-QOL v4, the swallowing and chewing domains had the highest scores (mean 97.5 ± 8.7 and 95.8 ± 14.4, respectively; maximum possible score of 100). In conclusion, this treatment approach improves function and quality of life after maxillary ablative surgery. However, irradiated patients showed a noticeable trend of higher implant failure, and this was influenced by tumour position and size impacting the radiation dose to the zygomatic bone.

Managing massive palatial defect secondary to palatoplasty failures: an in-depth analysis.

Massive palatal defects resulting from palatoplasty failures arising from cleft palate repair complications present ongoing challenges in clinical practice. The purpose of this review is to provide up-to-date insights into aetiology, risk factors, surgical techniques, and adjunctive therapies, aiming to enhance the understanding of such complex cases, and optimize patient outcomes. Primary palatoplasty has fistula recurrence rates ranging from 2.4% to 55%. Factors such as cleft width, surgical repair method, and patient characteristics, influence the likelihood of failure. Classifications such as the Pakistan Comprehensive Classification and Richardson's criteria aid in assessing defects. Surgical options range from local flaps and revision palatoplasty to regional flaps (e.g., buccinator myomucosal, facial artery-based flaps, tongue flaps, nasal septal flaps) to free microvascular flaps. Alternative approaches include obturator prostheses, and acellular dermal matrix has been used as an adjuvant to multiple repair techniques. Hyperbaric oxygen therapy has emerged as an adjunctive therapy to enhance tissue healing. This comprehensive review underscores the intricate challenges associated with massive palatal defects resulting from palatoplasty failures. The diverse range of surgical and nonsurgical options emphasizes the importance of patient-centric, individualized approaches. Practitioners, armed with evidence-based insights, can navigate these complexities, offering tailored interventions for improved patient outcomes.

Epidemiological profile of oral and maxillofacial prosthesis rehabilitated patients in the Brazilian National Cancer Institute: a cross-sectional study

Introduction: Maxillofacial prostheses represent a rehabilitative option for patients who underwent head and neck tumor resection. Objective: To describe the epidemiological profile of maxillofacial prostheses rehabilitated patients in an oncology reference center, from 2015 to 2020. Materials and methods: This is a retrospective, descriptive, observational study, based on secondary data. The maxillofacial prostheses were identified through the prosthesis laboratory records. The socio-demographic, clinical, and maxillofacial prosthesis data were collected from medical records and were descriptively analyzed according to the prosthesis types. Results: A total of 202 patients and 282 maxillofacial prostheses were identified. Obturator prostheses (37%) were the most frequent, and 2019 was the year with the largest production (54%). Males (55%), with 45 years, and incomplete primary education (32%) prevailed. Most tumors were carcinomas (43%), in the palate (40%), with 15.5 months of evolution, at stage III (25%) Surgery and surgery associated with radiotherapy were the most commonly used therapeutic modalities (40% each). At the last visit, most patients had complete remission of the disease (67%). Maxillofacial prostheses were mostly in acrylic resin (92%), with 9.5 months of use, and hygiene was considered satisfactory (87%). Most patients reported good adaptation (82%), satisfaction (76%), satisfactory hygiene (87%), and no adverse events (83%) or difficulties (69%) associated with its use. Conclusion: These data highlight the importance of oral and maxillofacial prostheses as an effective and accessible tool in the rehabilitation process and reinforce the need for a multidisciplinary team to work in oncology, with the dentist as an essential player in this context.

A Case report on remarkable healing by secondary intention in a hemi-maxillectomy patient rehabilitated with obturator prosthesis

A Case report on remarkable healing by secondary intention in a hemi-maxillectomy patient rehabilitated with obturator prosthesis

Extensive Partial Obturador Oropharyngeal in Class IV Aramany after Oral Adenocarcinoma

When a patient is interrupted by velopharyngeal closure or defects in the hard palate, air escapes inappropriately through the nose in nasal speech sounds. The obturator prosthesis with extension to the oropharynx is currently the best indication for maxillary defects, but it also represents a challenge for manufacturing and oral adaptation. The aim of this study was to report a clinical case of successful prosthetic rehabilitation of a 65-year-old woman who presented with a defect in the maxilla, soft palate, tonsil, and oropharynx after treatment for polymorphous low-grade adenocarcinoma. With her considerable loss of structure and tissue, she reported difficulties with impaired functions such as chewing, swallowing, and speaking and difficulty interacting with people. The oral rehabilitation was performed with an oropharyngeal obturator prosthesis with an extension to the oropharynx and a total mandibular denture. This case demonstrates that the rehabilitation with an oropharyngeal obturator prosthesis with an extension to the oropharynx and a total mandibular denture provides speech, chewing, and phonetics, directly interfering with her social life in the mutilated patient.

Obturator Prosthesis Rehabilitation: A Series of Three Cases

Obturator Prosthesis Rehabilitation: A Series of Three Cases