Surgical obturator duplicating original tissue-form restores esthetics and function in oral cancer

Oral cancer treatment primarily focused on the surgical removal of cancer tissues followed by surgical/prosthetic reconstruction. Restoration of the missing structures immediately after surgery shortens recovery time and allows patient to return to community as a functioning member. The most practiced surgical obturators are simple resin prosthetic bases without incorporation of the teeth. This article highlights a technique to fabricate a surgical obturator that duplicates patient’s original tissue form including teeth, alveolus and palatal tissues. The obturator is placed immediately after surgery and make patient feel unaware of surgical deformity. The obturator prosthesis fabricated with this technique supports soft tissues and minimizes the scar contracture. We have clinically tried this technique in 11 patients. Patients’ satisfaction level was recorded on visual analogue scale (VAS) and it ranges between 74% and 94% (with average of 87%). Four different prosthodontists have visually evaluated facial asymmetry of patients at 6 mo recall and their average perception on VAS varies between 71% and 93% (with average of 84%).     

New Technique to Fabricate an Immediate Surgical Obturator Restoring the Defect in Original Anatomical Form

The presence of oral cancer can necessitate the surgical removal of all or part of the maxilla, leaving the patient with a defect compromising the oral cavity's integrity and function. The immediate postoperative restoration of esthetics, deglutition, and speech shortens recovery time in the hospital and expedites the patient's return to the community as a functioning member. This article describes a simple technique to fabricate an immediate surgical obturator by restoring the patient's original dentition and facial and palatal tissue form. An immediate obturator fabricated with this technique supports soft tissues after surgery and minimizes scar contracture and disfigurement and thus may have a positive effect on the patient's psychology.     

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.     

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.     

A simple method of fabricating an interim obturator prosthesis by duplicating the existing teeth and palatal form

An interim obturator prosthesis is required for the restoration of speech, deglutition, and improvement of esthetics after maxillectomy. This article describes a simple method for fabricating the interim obturator prosthesis by duplicating the patient's teeth and palate. The interim obturator prosthesis fabricated by duplication of the presurgical appearance and contour may be more acceptable to the patient.     

An endosseous, implant-retained obturator for the rehabilitation of a recurrent central giant cell granuloma: a clinical report

The prosthodontic rehabilitation of a patient with a recurrent maxillary CGCG has been described. The patient's immense defect originally was rehabilitated with a scapular microvascular free flap, endosseous dental implants, and an ISP that became obsolete by virtue of the resection of recurrent disease and the subsequent need for velopharyngeal obturation. The patient was provided with a surgical obturator at the time of the resection of the recurrent CGCG. The surgical obturator thereafter was modified into an interim obturator to provide velopharyngeal competence while the soft tissues around the palatal defect healed. Finally, the construction of a bar-retained definitive obturator markedly improved the patient's speech, mastication, and deglutition.     

Prosthetic treatments for patients with oronasal communication

The prosthetic treatments play a role in the rehabilitation of patients with congenital and acquired cleft palate. To prepare the surgical field and/or correct inevitable sequelae of the surgery, the rehabilitation with obturator prosthesis is an auxiliary or complementary treatment to surgical treatments. In cases where the surgical treatment is contraindicated, the prosthetic rehabilitation becomes a definitive treatment. The denture is planned and fabricated according to each patient. Therefore, the aim of this study was to discuss the prosthetic rehabilitation performed in patients with oronasal communication.     

Evaluation of speech in patients with partial surgically acquired defects: pre and post prosthetic obturation

AIM: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for the patient. Such disabilities include inability to masticate, deglutition, and speech disturbance. Unfortunately, little is known about the nature of the speech disturbance and the influence of the class of surgical defects in this group of patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid and to examine the influence of the classes of surgical defects on speech intelligibility (SI). MATERIALS AND METHODS: Twelve patients aged between 18 and 60 years with surgically acquired partial maxillary defects were included in this study. The patients were given immediate surgical obturators six to ten days after surgery, which were then converted to interim obturators by relining with tissue conditioner. Interim prostheses were used for two to three months until healing and resorption were found satisfactory after which the definitive obturators were fabricated. The SI test described by Plank et al. and Wheeler et al. was employed in this study. There were significant improvements in the mean SI score from 59.8% without prosthetic obturation, to 89.2% following interim obturation, and 94.7% following definitive obturation (p<0.005). Nine patients (75%) had class I surgical defects, two patients (16.67%) had class II defects, while only one patient (8.33%) had a class VI surgical defect. None of the patients had class III, IV, or class V surgical defects. There was an improvement in the SI score from class I to class VI without obturation, after insertion of interim obturator, and after insertion of the definitive obturator. CONCLUSION: Results support the widely held view that the maxillary obturator is a useful speech rehabilitation aid. It also shows immediate, interim, and definitive obturators are all important in the speech rehabilitation of patients with surgically acquired maxillary defects. Moreover SI is affected by the class of defect.     

A modified copy technique for obturator prostheses

Prosthodontic rehabilitation of patients following intra-oral surgical resection is often challenging for both the clinician and patient. With a general increase in life expectancy, it is reasonable that a definitive obturator prosthesis will need to be replaced at least once in the lifetime of a patient. The ability of a patient to become accustomed to such a new prosthesis is often limited by their increased age, and diminished neuromuscular skills and limited tissue support following surgical resection. The purpose of this paper is to describe a duplicating technique for obturator prostheses that has been adapted from conventional complete denture prosthodontics.     

One step polymerizing technique for fabricating a hollow obturator

PurposeAlthough a closed hollow obturator is often applied to post maxillectomy patients, it has a few problems such as complexity of fabrication and water leakage to inside. A one step curing technique to fabricate a closed hollow obturator by constructing a small hollow bulb made by two thermoplastic resin sheets is described in the present report.MethodsIn the one step curing technique, after dewaxing the wax denture fabricated conventionally, one size smaller hollow body was fabricated with two thermoplastic resin sheets and set into the investment mold as a core. Then the circumferential part of obturator was cured by the pour type resin.This technique was used to fabricate an obturator prosthesis in a 60-year-old post-maxillectomy patient. The weight of this obturator was well controlled and the definitive prosthesis weighed 22 g. At a one year follow-up, the obturator fared well without any water leakage or breakage.ConclusionsThis technique allows the fabricator to control the thickness and weight of the obturator by the amount of relief provided by the hollow bulb. It also rectifies the disadvantages of the closed hollow obturator such as water leakage and complexity of fabrication.     

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.     

Oral rehabilitation after surgical removal of pleomorphic adenoma

Although tumors of minor salivary glands are rare, the pleomorphic adenoma is the most common pathology among the benign neoplasm and can be found with high prevalence in the junction between hard palate and soft palate. The treatment of choice for most of maxillary tumors is surgical through either a total or partial maxillectomy. However, surgical defects caused by such type of treatment lead to both clinical and psychologic disorders for the patient. The immediate oral rehabilitation using interim palate obturator after maxillectomy provides optimization on the healing process, recovers the stomatognathic functions after surgery, and avoids psychosocial sequelae for the patients. This clinical report aimed to present the rehabilitation with immediate palate obturator of a patient who underwent a partial maxillectomy due to a hard palate pleomorphic adenoma of minor salivary glands. We report the clinical importance of the prosthetic rehabilitation and the improvements on both quality of life and stomatognathic functions of this patient. It can be concluded that the immediate rehabilitation of the patient after partial maxillectomy by using an interim palate obturator was a great option and provided clinical benefits in the immediate postoperative period, improving the patient’s quality of life, allowing the patient’s reinsertion into society, and reducing the surgical treatment sequelae.     

A simplified technique for construction of an interim obturator for a bilateral total maxillectomy defect

PURPOSE: This report describes a simplified method for construction of an interim obturator for a huge maxillary defect. MATERIALS AND METHODS: A medical grade-silicone obturator was fabricated indirectly on a duplicate cast of the surgical defect for a patient with a bilateral total maxillectomy. This silicone obturator was attached to an acrylic plate by means of mushroom-like extension tags projecting from the fitting surface of the acrylic palatal plate. RESULTS: The obturator was well retained in the patient's mouth and markedly improved his ability to speak and swallow. CONCLUSION: This technique proved to be a simple, quick, and cost-effective method for construction of obturators for huge maxillary defects.     

A preplanned surgical obturator prosthesis for alternative resection lines in the anterior region

A technique is described that enables adaptation of a surgical obturator to accommodate anterior teeth that may or may not be resected with the lesion at surgery. This is designed and fabricated by placing additional clasps on the teeth in question and providing for a clasp on one of the anterior teeth that can be determined at the time of surgery, thereby allowing anterior retention of the obturator immediately postoperatively. This technique is cost-effective and useful, especially if no prosthodontist is available at the time of surgery to perform obturator modifications.     

A custom-made sealing screw cap for a closed, hollow obturator

This paper describes a closed, hollow obturator with a nondetachable screw cap to seal the access hole that also allows cleaning of the inside of the bulb. A small screw cap was fabricated from a cobalt-chromium alloy. This screw was screwed to the access hole prepared at the top of the hollow obturator and when removed allows the inside of the obturator to be cleaned through the access hole. At the end of the screw, a preformed cobalt-chromium wire was attached that works as the safety retention mechanism of the screw. This ensures the screw in not aspirated or swallowed if it becomes unscrewed and falls from the prosthesis during wear in the patient's mouth. This device enables the patient to clean the inside of the closed obturator at home.     

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.     

Upper lip prosthesis retained to a palatal obturator

In cases of total or partial maxillectomies, the prosthetic rehabilitation is an effective alternative to minimize the sequelae left by surgical resection. The present study reports a clinical case of a 52-year-old patient who underwent partial maxillectomy, with upper lip involvement. The oronasal communication, resultant from surgical resection, did not allow the patient to return to her normal social life. Besides, the upper lip partial resection damaged her face's aesthetics. The proposed treatment was the confection of an upper lip prosthesis retained by a palatal obturator. The prosthesis insertion restored the patient's facial aesthetics, contributing not only to function, but also to psychosocial adaptation.     

A hollow delayed surgical obturator for a bilateral subtotal maxillectomy patient: a clinical report

Effective obturation of the bilateral maxillectomy defect is a difficult task for the maxillofacial prosthodontist. Multidisciplinary treatment planning is essential to achieve adequate retention and function for the prosthesis. This clinical report describes an original technique of engaging the inner aspect of the nasal aperture to augment anterior retention of a hollow obturator in a bilateral subtotal maxillectomy defect. This method is simple to execute, and may be used chairside for a surgical, interim, and/or definitive obturator.     

Maxillary obturator prosthesis rehabilitation following maxillectomy for ameloblastoma: case series of five patients

PURPOSE: The purpose of this case report is to demonstrate the benefits and applicability of appropriate maxillofacial prosthetic rehabilitation following surgical resection of ameloblastoma of the maxilla in Kenya. MATERIALS AND METHODS: Five patients presenting with ameloblastoma of the maxilla over 3 years were studied with respect to histologic type, site of tumor, resultant surgical defect, and form of definitive obturator prosthesis. Impressions were taken using irreversible hydrocolloid and poured with dental stone. Immediate surgical obturators were fabricated from casts using clear autopolymerizing acrylic resin. One patient had bilateral partial maxillectomy, whereas the rest had unilateral partial maxillectomy. Immediate surgical obturators were fitted intraoperatively and held in place using Adams clasps on the remaining natural dentition for all patients, except the one who had undergone bilateral partial maxillectomy, whose surgical obturator was held loosely using circumzygomatic wires. After 6 to 8 weeks, surgical obturators and packing were withdrawn, and new impressions were taken to fabricate definitive obturators. Patients were reviewed every 2 weeks for 3 months, then once every 3 months per year for 3 years, and thereafter once per year. RESULTS: The immediate surgical obturators facilitated retention of the surgical packing, promoting healing with minimal postsurgical infection and scar contracture formation. This ensured the restoration of acceptable esthetics and maintenance of oral function at a reasonable level during the initial postoperative period. Definitive obturators restored esthetics, oral function, and ability to handle secretions to a satisfactory level. CONCLUSION: Satisfactory functional and esthetic results are achievable in patients with extensive acquired maxillary defects by means of obturator prostheses fabricated using readily available materials.