A maxillary lip prosthesis retained by an obturator with attachments: A clinical report

This article describes the prosthetic rehabilitation of small maxillary lip and maxilla defects with a lip prosthesis attached to an obturator. The definitive obturator prosthesis was designed with 3 plastic ball attachments on the labial surface that provided adequate retention for the lip prosthesis. The thin margin of the lip prosthesis ensured that it adapted well to functional movements.     

A custom made extraoral aid for retaining interim obturator in edentulous patients with bilateral maxillectomy: A report of four patients

It is a considerable challenge for a prosthodontist to rehabilitate and sustain the prosthesis in edentulous patients with bilateral maxillectomy. Compelling evidence is lacking with respect to the treatment outcome when the maxillary defects are closed surgically in comparison to their prosthetic rehabilitation. Four edentulous male patients, with bilateral maxillectomy defects were referred for prosthodontic intervention to meet their nutritional and speech issues. In the absence of intra oral supporting and retentive structures, it was decided to retain the obturator utilizing extraoral aid to address their functional needs. Customized headgear face‐bow retained obturators were adequately retentive and did serve its purpose well in all four patients. It also gave the liberty to alter retention and refine the prosthesis at will, provided access to the operated site for a quick evaluation of disease recurrence, and was economical to the patients. Considering the encouraging outcome experienced in this special category of individuals, it would be reasonable to believe that the headgear face‐bow assembly has an immense potential to function as a valuable, prudent, and a viable retentive aid for a non‐implant retained obturator in edentulous patients with extensive maxillary defect.     

Rehabilitation of a Bilateral Maxillectomy Patient with a Free Fibula Osteocutaneous Flap and with an Implant‐Retained Obturator: A Clinical Report

A 47‐year‐old man underwent surgical resection and reconstruction with a fibula osteocutaneous flap. After the surgery, a surgical obturator was placed and adjusted. After flap healing, a conventional obturator was fabricated with polymethyl methacrylate resin and retained by the anatomical undercuts around the reconstructed fibula bone flap and the posterior part of the defect. As the defect shape changed with time, a second conventional obturator was fabricated and fitted. No further recurrence of myoepithelioma was observed for 2 years, and the patient was satisfied with the obturator during mastication and speech; however, despite having no major complaints, the patient found it difficult to chew on the right side, and the obturator was displaced slightly downward when the mouth was opened wide and shifted when chewing hard and sticky food. Thus, an implant‐retained obturator was suggested to provide better retention and stability. Four dental implants were therefore placed into the fibula bone, although one did not osseointegrate because either primary stability was insufficient or overload was affected in the nonloaded implant environment and was replaced. After fitting custom abutments with a magnet, an implant‐retained obturator was placed, and the patient was satisfied with the outcome. During 3 years of follow‐up, no issues were noted with the implant bodies, abutments, obturator, or reconstructed site. The conventional obturator was displaced slightly downward when the patient opened his mouth wide, and it shifted when chewing hard and sticky food because there was limited fibula bone at the reconstruction site and more available posteriorly. For better retention and stability, the implant‐retained obturator was fabricated with a custom abutment and magnetic retention. The patient was satisfied with the results, as improved implant retention increased the stability of the prosthesis. This clinical report describes the rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap and an implant‐retained obturator. The patient's oral functions were improved when the prosthesis was stabilized by means of dental implants and custom abutments.     

计算机辅助设计与快速成形技术制作上颌骨缺损模型的临床应用初探

目的探寻利用计算机辅助设计（computer aided design，CAD）与快速成形技术制取上颌骨缺损模型的新方法，以弥补传统模型制取方法的不足。方法将12例上颌骨缺损患者的头部CT数据输入计算机，经Mimics 8．11软件和Geomagic 7．0软件处理后，得到缺损部位的三维影像数据，利用快速成形技术，获得缺损部位的树脂模型。根据树脂模型制作阻塞器，利用缺损部位的组织倒凹固位使阻塞器独立固定在缺损腔中。再行可摘义齿修复，将阻塞器和可摘义齿用磁性附着体连接。检查临床修复效果并用鼻音计测量5例患者阻塞器戴人前后的鼻音化率值。结果阻塞器和可摘义齿可分段戴人患者口内，两者固位、稳定等临床效果均较好。鼻音计测量结果显示，阻塞器戴人后患者的非鼻辅音语音样本的鼻音化率值降低，由戴人前的（46．53±13．86）％降为戴人后的（22．60±8．52）％，差异有统计学意义（P〈0．001）。结论利用CAD与快速成形技术制取上颌骨缺损部位模型是一种可行的方法。     

A modified technique to fabricate a complete hollow obturator for bilateral maxillectomy in a patient with mucormycosis—A technical 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. Conventional design has a few disadvantages; it needs modification many times to improve retention and psychological comfort of the patient. The article explains an easy technique in fabrication of an obturator. The conventional obturator design has a hollow antral part but usually a solid oral part, which adds to the weight of the prosthesis pressurizing the soft tissues in a maxillectomy, which affects the function and esthetics. This article demonstrates the hollowing of oral part, which bears the artificial teeth, and modifying the antral bulb, which covers the defect. It was designed considering the potential difficulties shared by the patient in wearing the single piece conventional hollow bulb design. This technique when followed was beneficial in reducing the weight of the prosthesis and enhancing retention, and allowed the patient to perform normal functional movements.     

一侧上颌骨缺损赝复体修复前后咀嚼效率的变化

目的探讨一侧上颌骨缺损患者赝复体修复后的咀嚼效率。方法以15名因一侧上颌骨缺损制作上颌中空式永久性赝复体修复的患者为研究对象。采用吸光光度法测定赝复体戴入前后的咀嚼效率。结果赝复体戴入前咀嚼效率平均值为0.340 abs,戴入后咀嚼效率（0.492 abs）明显提高,同戴入前相比差异有显著统计学意义（P〈0.01）。结论赝复体修复一侧上颌骨缺损显著提高患者的咀嚼效率。     

Fabrication of a Movable Obturator Following Maxillary Reconstruction with Slit‐Shaped Fenestration

Extensive maxillary resection has generally been reconstructed with free skin flaps. Because drooping of the transferred flap causes instability of the obturator prosthesis, maxillary reconstruction often incorporates a slit‐shaped oronasal fenestration. Although obturator prostheses for edentulous patients are stabilized with the help of oronasal slits, those for dentate patients are unstable because of flap mobility, resulting in a harmful lateral force exerted on the abutment teeth, causing dislodging of the denture. This report evaluates the benefits of a movable obturator prosthesis for a 60‐year‐old dentulous patient with maxillary sinus carcinoma. The patient underwent left‐sided total maxillectomy, and the defect was reconstructed with a slit‐shaped fenestration using a rectus abdominis flap. A conventional obturator prosthesis was inserted; however, drooping of the flap caused instability of the obturator, resulting in nasal regurgitation and fracture of the clasp. To solve this problem, we designed an obturator prosthesis with a movable connection consisting of a ball attachment (patrix) in the metal base and a socket (matrix) in the obturator, which acted as a stress breaker against the harmful force exerted by the flap. Application of this movable obturator prosthesis was a useful solution for a compromising situation created by the surgical procedure. No clinical disorders were observed at the 3‐year follow‐up.     

An Alternative Method for Constructing an Obturator Prosthesis for a Patient with a Bilateral Cleft Lip and Palate: A Clinical Report

The design of esthetic and effective dental prostheses for bilateral cleft lip and palate patients is a challenge for prosthodontists because the prostheses must serve more than one purpose. The goals to be attained by prosthetic intervention are preventing food and liquid leakage into the nose, improving speech intelligibility, a more esthetic appearance, and achieving the general satisfaction of the patient. The framework design of the obturator prosthesis is of great strategic importance for patients with a cleft lip and palate. The reduction in the mass of the obturator prosthesis increases stabilization and retention and also contributes to an easier adaptation to the prosthetic restoration. In this report, a 22-year-old woman was successfully treated with a fixed partial denture and a bar-retained obturator with palatal coverage.

CLINICAL SIGNIFICANCE

The design of an obturator prosthesis for cleft lip and palate patients is an important stage in terms of ensuring esthetic restoration and patient comfort. This article describes an esthetic and functional design for such a device using a fixed partial denture and a bar-retained obturator.     

Rehabilitation of a Maxillectomy Case with Telescopic Crowns: A Case Report

Prosthodontic rehabilitation of acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. Most of the times these goals are met by means of obturator prosthesis. Preservation of the remaining hard and soft tissues in such patients is very much essential in order to have a good retention, stability and support for the prosthesis. It is very much imperative to fabricate a prosthesis to provide proper function to the patient. Various techniques have been developed to enhance the retention and stability of the prosthesis, some of them being extension of the obturator bulb into the undercuts within the defect, use of magnets, implants etc. Telescopic crowns have been an adjunctive utility to prosthetic dentistry since a very long time. The biomechanics of telescopic crowns aid in providing a good retention and stability to the prosthesis. In the following clinical report a patient with a status of Subtotal Hemi Maxillectomy is presented in whom telescopic copings were incorporated into the cast hollow bulb obturator to enhance the retention and stability of the prosthesis.     

上颌骨缺损伴张口受限的磁性附着体分段式赝复体修复

目的探讨上颌骨缺损伴张口受限患者应用磁性附着体连接分段式赝复体修复的临床特点和疗效。方法选择15例上颌骨缺损患者,其中8例伴有张口受限。依据术后修复时间及张口情况分别选择磁附着体连接分段式赝复体和一体式中空赝复体进行修复,测定咀嚼效率、进行语音清晰度评价和临床效果评价。结果使用磁性附着体连接分段式赝复体可使上颌骨缺损伴张口受限病人提前进行修复,而且分段式赝复体摘戴方便,固位稳定,发音得到良好的改善,美观也有一定恢复。磁性附着体连接分段式赝复体咀嚼效率高于一体式中空赝复体(P<0.05),两类赝复体和语音清晰度评价没有差别(P>0.05)。结论上颌骨缺损伴张口受限患者,应用磁性附着体连接分段式赝复体修复能达到比较满意的效果。     

Mobility of the obturator prosthesis in hemimaxillectomy edentulous patients

In edentulous patients with maxillary defects, it is difficult to obtain sufficient retention, support, and stability of the obturator prosthesis, in addition, its mobility during various functions is considered to be large. A thorough understanding of the mobility of the obturator prosthesis is important to achieve successful results in the patient's oral rehabilitation. In this study, the ranges of movement of the obturator prostheses in three hemimaxillectomy edentulous patients were compared during tapping, chewing (biscuit), and opening and clenching jaw movements by simultaneously conducting three-dimensional measurements of three points that were established on the central incisor and the right and left first molars of the obturator prosthesis with a jaw movement tracking device having six degrees of freedom. This study indicates that the range of movement of the obturator prosthesis varied extensively from individual to individual. The ranges of movement were larger than those of normal complete dentures and differed considerably from each other when categorized according to the three functions and three measuring points in the patients.     

Magnet-retained facial prosthesis combined with an implant-supported edentulous maxillary obturator: a case report

The prosthetic rehabilitation of maxillofacial defects is especially challenging when the patient is edentulous. Although dental implants are used to enhance the retention and stability of both facial and maxillary prostheses, combining facial and maxillary prostheses is extremely difficult. This article describes the prosthetic treatment of an edentulous patient with a large maxillary and facial defect. After placing dental implants in the remaining maxilla, a maxillary obturator prosthesis supported by a milled bar attachment was fabricated. The facial prosthesis was retained by a magnetic attachment to the maxillary obturator prosthesis. As the obturator prosthesis was supported securely by this sturdy attachment, the facial prosthesis was stable during mastication and facial movement. The patient reported improvement in prosthesis retention and stability. Both the masticatory and the speech functions of the patient improved.     

Rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap

Rehabilitation of patients who have undergone bilateral maxillectomy is difficult because of extensive loss of bone and soft tissue. In this clinical report, prosthodontic rehabilitation of oral function in a bilateral maxillecitomy patient combined with a new fibular osteocutaneous flap, which was designed to have two oronasal slits for the retention of an obturator prosthesis, was described. A 58-year-old man with a maxillary alveolar carcinoma underwent bilateral maxillectomy. The defect was reconstructed using a vascularized fibular bone wrapped circumferentially with a peroneal flap, which was fixed with miniplates between the right malar prominence and cut edge of the left zygoma remaining two slits anterior and posterior to the graft. Two and half weeks after the surgery, a delayed surgical obturator was delivered and an obturator prosthesis was delivered 6 weeks after the surgery. This obturator prosthesis could be extended into the slits to engage the tissue undercuts, and was stable during use. Mastication, deglutition, articulation and the mid-facial profile of the patient were rehabilitated. After installation of the obturator prosthesis, relining of the prosthesis base was carried out alongside the healing process of the graft, and adjustment of occlusions and high-pressure spots was carried out. No clinical disorders were observed either in the grafted tissue or the obturator prosthesis with a 3-year prognosis. Newly designing a fibular osteocutaneous flap combined with tissue-borne obturator prosthesis is one successful approach to the restoration of oral function, and increases the patient's quality of life after bilateral maxillectomy.     

Light-cured combination obturator prosthesis.

A technique for the fabrication of an open combination (hard-resilient) obturator prosthesis with VLC materials for patients undergoing partially edentulous maxillectomy is described. VLC denture resins and resilient liners are an exciting innovation in prosthodontic treatment and offer the maxillofacial prosthodontist a wider choice of treatment modalities. The technique and the resultant obturator prosthesis have the following advantages: 1. The ease and rapidity of the technique saves time for both the patient and the maxillofacial prosthodontist by introducing the open obturator prosthesis at the earliest opportunity. 2. The combination open obturator prosthesis provides a stable record base for securing jaw relation records. 3. The thickness and resiliency of the obturator prosthesis can be managed more easily. Flexibility and resiliency can be modified by the thickness of the resilient liner or by adding a rigid scaffolding according to the clinical requirements. 4. Prostheses are easy to repair or modify by using increments of VLC hard or resilient materials. 5. The combination VLC obturator prosthesis provides stability, retention, and decreased weight and obduration of residual palatal defects. 6. The technique can be used for partially edentulous or edentulous patients after maxillary resection.     

单侧上颌骨缺损修复的临床体会

目的：通过单侧上颌骨缺损修复的临床实践,探讨其修复方法。方法：对１０８例单侧上颌骨缺损病例进行临床调查,从固位设计、基托设计、阻塞器设计及减小 力４个方面分别进行临床分析。结果：１０８例近期效果基本良好,２４例 ６个月至 ２年随访,２例基牙松动Ⅰ～Ⅱ°,１１例基托不密合,１５例能咀嚼一般食物,２２例基本恢复语言功能。结论：１ 固位设计应在保护基牙的情况下,尽量利用剩余牙承力,以加强平面固位作用。２．加大基托面积,利用组织倒凹辅助义齿固位。３采用低位中空阻塞器并减小 力,以利于义齿固位。     

Evaluation of obturator prostheses using vibration analysis

Obturator prostheses have been extensively used in the functional rehabilitation of maxillectomy patients. The purpose of this study was to evaluate in vitro the vibration movements of three types of obturator prostheses. Three types of bulbs were used: the solid type, the buccal flange type, and the hollow type. Modal analysis was performed to identify the better form. The three types of obturator prostheses were excited by a shaker, and the frequency response functions were recorded on an FFT analyzer to identify their modal shapes. In addition, transient response simulations were carried out, and decay rates of the resultant transient response waves were compared to evaluate the energy absorption after the obturator prosthesis had experienced an impact. The results showed that the modal shapes were closely similar, while the amplitudes at the rests and clasps of the hollow type bulb were the smallest. In the transient response simulation, the decay rates of the hollow type were significantly the highest (p < 0.01). In this study, modal analysis demonstrated that the hollow type obturator prosthesis showed the steepest vibration decay slope, indicating that it might be the best among the three types of bulbs for use in clinical treatments.     

Orofacial functions in patients with congenital and acquired maxillary defects: a fluoroscopic study

By means of videofluoroscopic recordings, chewing, swallowing and speech were monitored in nine patients with congenital and acquired maxillary defects. All of them were rehabilitated with a maxillary obturator prosthesis. The defective region was seldom used for chewing. No leakage between the obturator and surrounding tissue was observed, either for solids or for liquids. All of the prosthetic reconstructions were surprisingly stable during function. In the phonetic analysis, speech production was judged to be restored almost to normal. Videofluoroscopy may be valuable as a complement to other functional diagnostic procedures, and for the evaluation and improvement of rehabilitation with an obturator prosthesis.     

Two-Piece Denture-Obturator Prosthesis for a Patient with Severe Trismus: A New Approach

Prosthetic intervention with maxillary obturator prosthesis is necessary to restore the contours of resected palate and to recreate the functional separation of the oral cavity and sinus and nasal cavity. Trismus occurs most frequently in maxillectomy patient following surgical procedure. Absence of graft placement and healing by secondary intention always results in healing contracture and trismus. Trismus could also be a result of post radiation sclerosis and scarring of muscles. Two-piece denture-obturator prosthesis is an alternative management to conventional acrylic resin obturator prosthesis for the patient with severe trismus as patient could not insert a large prosthesis in the mouth. The use of flexible or resilient material affords the opportunity to engage in undercut areas, needed to help in the retention of the prosthesis, without causing trauma to the soft, often sensitive, and easily irritable tissues.     

Obturator prosthesis design for acquired maxillary defects.

Fabrication of obturator prostheses does not require a special ability to fabricate a prosthesis extension into a defect or an arbitrary extension of a prosthesis into a defect. Fabrication of an obturator prosthesis depends on the application of basic prosthodontic principles that are used in the treatment of patients without maxillary defects. Some principles must be modified because of the defect and the character and position of the remaining structures. The defect, in conjunction with the remaining structures, must be used to provide support, retention, and stability of an obturator prosthesis. If basic prosthodontic principles are applied the size and extension of the obturator will be determined, and the extensive variation so commonly seen in obturators will be minimized. Acceptable prosthodontic care for the patient with the acquired maxillary defect should include cautious prosthesis design combined with routine maintenance care to provide comfort, function, cosmetics, and minimal change to the compromised remaining structures.     

Oral rehabilitation of a patient with sub - total maxillectomy

This clinical report describes oral rehabilitation of a patient with sub-total maxillectomy with palatine process of maxilla and horizontal plate of palatine bone intact to retain the maxillary obturator. Clinical examination has been performed to know the amount of favorable undercuts to be used for retention of the obturator for better functional efficiency. Successful prosthetic reconstruction of hemimaxillectomy defect is a challenging procedure that requires multidisciplinary expertise to achieve acceptable functional speech and swallowing outcomes. This article describes the oral rehabilitation of a patient with sub-total maxillectomy with a maxillary obturator. Oral rehabilitation of sub-total maxillectomy patient is a challenging task. Obturation of the defect depends on volume of the defect, and positioning of remaining hard and soft tissues to be used to retain, stabilize, and support the prosthesis. A maxillary obturator for edentulous patient must provide for retention, stability, support, patient comfort, and cleanliness.