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.     

Prosthetic Rehabilitation of a Maxillectomy with a Two‐Piece Hollow Bulb Obturator. A Clinical Report

Extensive bilateral midfacial defects involving the upper jaw, palate, and sinus present a formidable reconstructive challenge. A combination of total and subtotal maxillectomy is, in general, a rare surgical procedure that affects the cosmetic, functional, and psychological aspects of a patient's life. Prosthetic restoration has become the preferred method for the rehabilitation of such conditions. The use of magnets is an efficient means of providing combined prostheses with retention, quality, and stability. This clinical report describes the rehabilitation of a total and subtotal maxillectomy patient with a two‐piece hollow bulb obturator retained with the help of magnets and a retention clasp.     

Preschool and School Phases of Postmaxillectomy Prosthetic Rehabilitation in a Child: A Clinical Report

This report describes the postmaxillectomy prosthetic rehabilitation of a child with maxillary chondrosarcoma over an 8‐year period. Specifically, it (1) describes the planning and rehabilitation procedures carried out during the period from before the operation to the time when the patient started elementary school and (2) reports the results of evaluations of the patient's oral and psychosocial function conducted during the school phase. The prosthetic treatment plan was separated into two phases (the preschool and school phases) and was started prior to surgery, when an immediate surgical obturator was designed by the surgeons. After the operation, it was considered important to provide the patient and her mother with training regarding how the defect should be cleaned, trismus prevention, and how the prosthesis should be fitted. In addition, esthetic improvements and the ability to speak clearly were also targeted during treatment planning. After surgery, obturators were fabricated in a conventional manner and fitted at the ages of 2, 4, 6, 8, and 10 years. The patient's oral function during the use of the obturators was evaluated objectively. Marked improvements in oral function were seen during both treatment phases. The patient's ability to perform psychosocial functions at school also improved during the use of the obturators.     

Early Prosthetic Management of Maxillectomy,Hemimandibulectomy Patient with a Lateral Mid Facial Defect: A Case Report

Maxillofacial prostheses for acquired defects have become more complex and sophisticated with advances in surgical, physical, and rehabilitative dentistry, but before planning, orofacial structures must be analyzed as to the specific cause and the consequent objectives of rehabilitation. Also retention of facial prostheses is very much challenging. Hence, we are presenting the fabrication of an interim prosthesis obturator and cheek prosthesis to restore the speech, help in deglutition and prevent drooling of saliva.     

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.     

上颌骨切除术临床分型的探讨

目的　探讨上颌骨切除术临床分型的意义。方法　回顾性分析施行上颌骨切除术治疗肿瘤病例 2 74例 ,根据肿瘤原发部位和侵犯范围将上颌骨切除术分为 4种临床类型 ,分别进行治疗并观察治疗效果。结果　 2 74例中 ,采用Ⅰ型上颌骨切除术 16 1例 ,Ⅱ型上颌骨切除术 5 8例 ,Ⅲ型上颌骨切除术 34例 ,Ⅳ型上颌骨切除术 2 1例。其中采用Ⅲ型和Ⅳ型上颌骨切除术18例 ,同时施行颈淋巴结清扫术 15例和 (或 )眼眶内容物清除术 3例。结论　将上颌骨切除术分成 4种临床类型是一种实用、易于表达手术切除范围的方法 ,并有助于对治疗效果的评价。     

Use of Orbital Conformer to Improve Speech in Patients with Confluent Maxillectomy and Orbital Defects

The basic objective in prosthetic restoration of confluent maxillary and orbital defects is to achieve a comfortable, cosmetically acceptable prosthesis that restores speech, deglutition, and mastication. It is a challenging task complicated by the size and shape of the defects. The maxillary obturator prosthesis often satisfies the objective of adequate deglutition; however, orbital defects that are not obturated in the medial, septal, or posterior walls allow air to escape, negatively impacting phonation. This article describes a technique to achieve favorable prosthetic rehabilitation in a patient with a maxillectomy and ipsilateral orbital exenteration. The prosthetic components include maxillary obturator, orbital conformer, and orbital prosthesis connected using rigid magnetic attachments.     

An Alternative Procedure for Fabricating a Hollow Interim Obturator for a Partial Maxillectomy Patient

A technique is described for fabricating an interim obturator for a partial maxillectomy patient. This technique enables the immediate and easy chairside fabrication of a lightweight hollow-type interim obturator when a preoperative cast is not available. After a master cast is formed, two duplicate casts are made from the master cast. One portion of the obturator is fabricated on a duplicate cast with a corrected defect, and the other portion of the prosthetic base is made on the second duplicate cast with a corrected alveolar ridge. These two portions are connected and adjusted in the patient's oral cavity. This technique is beneficial because it helps patients maintain good esthetics and their ability to speak, swallow, and chew just after surgery.     

A Prosthetic Alternative for Severely Angled Implants Beneath a Maxillary Overdenture: A Clinical Report

Implant‐retained overdentures have been shown to be a predictable, accepted option and represent a viable and cost‐effective treatment; however, patients with severe lack of bone volume and anatomical limitations are often a contraindication to the placement of osseointegrated implants without prior surgical procedures. In these situations, the placement of angled implants may offer a simple solution. This clinical report describes a case of dental rehabilitation using angled implants for a patient with a severely resorbed edentulous maxilla. The inclination has been solved by making a bar on the right side and individual pillars on the left side so as to obtain a functional and esthetic prosthetic result.     

An Innovative Three Part Prosthetic Rehabilitation of Class-1V Facial Defect

Loss of maxillo facial structures due to neoplasm, trauma and accidents gives inconsolable mental, physical and psychological agony to a person’s dignified life in his living society. Surgical reconstruction was not feasible for all cases and certain cases needs prosthetic rehabilitation. In this clinical case report, an innovative, simple three part maxillo orbital prosthesis fabrication using magnets was explained.     

Simplified Approach for Prosthetic Rehabilitation of an Enucleated Ophthalmic Socket

Physical defects that compromise appearance or function, prevents an individual from leading a normal life, prompt the individual to seek treatment that will reinstate an acceptable normalcy. The disfigurement associated with loss of an eye can cause significant physical and emotional problems. The role of maxillofacial prosthodontists in fabricating an ocular prosthesis with acceptable esthetics and restoring normal appearance is essential. This article presents simplified impression technique and fabrication of ocular prosthesis.     

Prosthetic Rehabilitation of a Cleidocranial Dysplasia Patient with Vertical Maxillofacial Deficiency: A Clinical Report

Cleidocranial dysplasia (CCD) is a rare congenital disorder characterized by skeletal and dental anomalies. This clinical report describes the prosthodontic approach to treating a CCD patient who presented with decreased facial height and relative mandibular protrusion due to maxillary hypoplasia after orthodontic treatment. Functional and esthetic rehabilitation was achieved using telescopic detachable prostheses in the maxilla and osseointegrated implants and metal‐ceramic fixed dental prostheses in the mandible. These treatment approaches precluded the need for orthognathic surgical correction and presented a favorable prognosis during the 5‐year observation period.     

Prosthetic Rehabilitation of an Orbital Defect: A Case Report

Mutilation of a portion of a face can cause a heavy impact on the self image and personality of an individual. Surgical removal of an eye is a severe handicap to a patient because the most important sensory organ of communication is lost. Depending on the severity of the defect Ocular/Orbital prosthesis are required in these patients for rehabilitation. This case report details the clinical management of a patient following enbloc removal of an eye. Fabrication of a sectional two piece orbital prosthesis has been detailed. The importance of meticulous treatment planning to tackle the challenges faced in fabricating an orbital prosthesis is explained with relevant literature.     

Prosthetic Rehabilitation of an Edentulous Patient with Microstomia Using Both Digital and Conventional Techniques: A Clinical Report

This clinical report describes prosthetic rehabilitation applied to an edentulous patient with microstomia. Intraoral scanning was used for preliminary impressions, edentulous models were printed using a 3D printer, custom 2‐piece impression trays for definitive impressions were made, and a 2‐piece collapsible maxillary and a conventional mandibular denture were fabricated. Intraoral scanning is a useful alternative to conventional impression techniques and can be used safely in patients with microstomia for preliminary impressions.     

Prosthetic Rehabilitation of Ocular Defect Using Digital Photography: A Case Report

The fundamental objective in restoring a congenital as well as acquired defect of eye with an ocular prosthesis is to enable the patient to cope better with the difficult process of rehabilitation after an enucleation or evisceration. A cosmetically acceptable prosthesis is that reproduces the color, form and orientation of iris and allows the patient to return to accustomed lifestyle. A sequence of steps for construction of custom-made ocular prostheses is outlined in this case report using the advantages of digital imaging technique.     

Prosthetic Improvement of Pronounced Buccally Positioned Zygomatic Implants: A Clinical Report

This report presents a prosthetic technique for the improvement of surgically positioned, buccally placed zygomatic implants with the use of custom abutments for improved retention screw position and an esthetic implant reconstruction. The patient presented four zygomatic implants with pronounced buccal inclination. The anterior implants were inclined toward the location where the anterior artificial teeth should be placed during rehabilitation. As the manufacturer does not provide angulated abutments, we attempted the waxing and overcasting of a prosthetic abutment, repositioning the access holes of the prosthetic screws to a more palatal position. This clinical report demonstrates that abutment customization could be an interesting way to relocate the access holes of the prosthetic screws in cases of zygomatic implants with pronounced buccal inclination.     

A hollow definitive obturator fabrication technique for management of partial maxillectomy

Maxillary obturator prosthesis is the most frequent treatment option for management of partial or total maxillectomy. Heavy weight of the obturators is often a dislocating factor. Hollowing the prosthesis to reduce its weight is the well established fact. The alternate technique to hollow-out the prosthesis has been described in this article which is a variation of previously described processing techniques. A pre-shaped wax-bolus was incorporated inside the flasks during packing of the heat-polymerized acrylic resin to automatically create the hollow space. The processing technique described is a single step flasking procedure to construct a closed-hollow-obturator prosthesis as a single unit. To best understand the technique, this article describes management of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma rehabilitated with a hollow-obturator prosthesis.     

Period between Completion of Radiation Therapy and Prosthetic Rehabilitation in Edentulous Patients: A Retrospective Study

PURPOSE: The primary purposes of this study were: (1) to describe the number and types of complications patients had before and after insertion of a removable prosthesis (i.e., denture) following radiation therapy to the head and neck and (2) to investigate whether the time between radiation therapy and denture insertion might contribute to those complications. MATERIALS AND METHODS: This research evaluated edentulous patients and those who were rendered edentulous as a result of their cancer treatment. After obtaining institutional approval following HIPAA regulations, a total of 349 charts were identified: 152 patients from Houston Veterans Administration Medical Center (HVAMC) and 197 patients from M. D. Anderson Cancer Center (MDACC). A total of 190 patients met the inclusion criteria with data available for review. RESULTS: No significant differences were found in any of the comparisons made, except when comparing complications that occurred after the dentures were inserted and the amount of time it took for prosthetic rehabilitation. The majority of patients had no complications. The patients who received their dentures in 180 days or less had the same number of complications when compared with those patients who received their dentures in 181 to 365 days and those who had to wait longer than a year for prosthetic rehabilitation. Patients with more pre-insertion complications tended to have delayed prosthetic rehabilitation. Those patients who had complications both before and after denture insertion tended to have bilateral dosing of their radiation treatment. Patients who had received radiation therapy were 1.7 times more likely to have post-prosthesis insertion complications. The majority of patients who experienced complications before and after denture insertion had greater than 5000 cGy. CONCLUSIONS: The numbers of complications reviewed in this retrospective analysis were considerably fewer than the number expected. There appears to be no difference in the number of pre- and post-insertion complications as a function of the time delay from oral surgical procedure to start of radiation treatment (10 to 21 days vs. 22 days or more).     

Two‐Piece Hollow Bulb Obturator for Postsurgical Partial Maxillectomy Defect in a Young Patient Revamping Lost Malar Prominence: A Clinical Report

The most frequent type of treatment for patients diagnosed with a malignant neoplasia of the oral cavity is surgical resection of the tumor. Ablative surgery may be followed by a reconstructive phase, in which the surgeon may choose between local flaps, nonvascularized bone grafts or free vascularized flaps to close the surgical site, depending on the general conditions of the patient. Esthetic and functional results are challenging to achieve for the prosthodontist, as variable amount of hard and soft tissues are removed. This report describes the fabrication of a two‐piece hollow obturator for a 19‐year‐old patient who underwent wide surgical excision of the osteosarcoma of the maxilla and was rehabilitated to function. In this case, the surgical site was covered with submental flap, and the second piece of the obturator provided fullness to the lost malar prominence.