Specific phenomenon affect the prognosis of an obturator prosthesis, including the tissue changes in the postoperative period, the degree movement of the prosthesis, the extension into and utilization of the defect by the obturator portion of the prosthesis, the availability of teeth and implants to provide retention and stability, and the impact of the weight of the prosthesis.  These factors are important to consider when designing the prosthesis and are discussed in detail in this program.

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Maxillofacial Prosthetics – Definitive Obturation Treatment Concepts — Course Transcript

  • 1. Definitive Obturation Treatment Concepts This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission. John Beumer III, DDS,MS Distinguished professor emeritus UCLA School of Dentistry
  • 2. Definitive Obturation Treatment concepts Movement of the prosthesis Tissue changes Oral-nasal partition Extension into the defect Teeth Implants Weight Bolus manipulation
  • 3. Treatment concepts Movement of the prosthesis The prosthesis will move significantly during function. The degree of movement varies and depends upon: Number of teeth present and their location Presence of implants and their distribution pattern Size and the configuration of the defect, remaining palatal shelf area Whether the patient is edentulous or partially edentulous
  • 4. Treatment concepts Movement of the prosthesis There will be significant movement of the prosthesis in defects such as this one with little palatal shelf remaining and the dentition arranged in a linear configuration.
  • 5. Movement of the prosthesis Movement of the prosthesis in and out of the defect will occur in such patients. Partial dentures can be designed to resist the forces of gravity but must allow the forces of occlusion to impact the prosthesis into the defect, otherwise abutment teeth will be compromised.
  • 6. Movement of the prosthesis The premaxillary segment is present, there is significant palatal shelf surface area and therefore considerably less movement of the obturator prosthesis in a defect such as this one and the partial denture design problem more conventional.
  • 7. Movement of the Prosthesis The obturator prosthesis fitted for this defect will move a great deal. The successful user must learn to balance the prosthesis with the dorsum of the tongue. However, if the defect is favorable with undercuts lined with skin, the addition of implants on the unresected side would significantly reduce movement of the prosthesis and the prosthodontic prognosis dramatically improved.
  • 8. Treatment concepts Tissue changes The contours and configuration of the defect change rapidly immediately after surgery The defect is usually well healed 3 months following surgery. Dimensional changes continue to occur for at least a year after surgery secondary to scar contraction and further organization of the wound.
  • 9. Tissue changes Most tissue changes occur during the first 3 months after surgery. Flaps become less edematous and skin grafts organize and become smooth.
  • 10. Tissue changes Most tissue changes occur during the first 3 months after surgery. Flaps become less edematous and skin grafts organize and become smooth.
  • 11. Treatment concepts Oral-nasal partition
  • 12. Oral-nasal partition Obturators for acquired defects are covering prostheses, primarily serving to reestablish the oral-nasal partition. The obturator is extended into the defect primarily to enhance retention, stability and support for the prosthesis. Extensions in some areas may need to be lengthened to prevent leakage of liquid into the nasal passage
  • 13. Treatment concepts Extension into the defect The degree of extension into the defect is dependent upon the requirements for retention, stability and support, the character of the tissue lining the defect and the configuration of the defect. Most edentulous patients are lacking retention, stability and support and the defect is aggressively engaged to facilitate all three as shown by this complete denture and obturator.
  • 14. Treatment concepts Teeth The presence of teeth enhances the prosthetic prognosis. Every effort should be made to maintain and enhance the longevity of teeth, unless their retention would compromise a future implant site.
  • 15. Treatment concepts Teeth In some instances teeth adjacent to the defect are splinted together in order to enhance their load bearing capacity.
  • 16. Treatment concepts Osseointegrated implants The placement of osseointegrated implants dramatically improves the function of obturator prostheses. Implants can be placed in association with resection of the tumor or thereafter. The most desirable locations are the premaxilla and the maxillary tuberosity .
  • 17. Treatment concepts Osseointegrated implants Most implant bar designs must be implant assisted and must accommodate the multitude of axis of rotation of the prosthesis generated during function.
  • 18. Treatment concepts Osseointegrated implants Implant should not be used to prevent movement of the prosthesis in a defect of this size and extent. If they are used for this purpose there is a significant risk of implant overload and eventual implant failure.
  • 19. Treatment concepts Weight Bulky areas should be hollowed to reduce weight so that teeth, implants and supporting tissues are not stressed unnecessarily. The superior surface can be either closed or left open. Speech is not effected whether the top is left open or is closed.
  • 20. Visit ffofr.org for hundreds of additional lectures on Complete Dentures, Implant Dentistry, Removable Partial Dentures, Esthetic Dentistry and Maxillofacial Prosthetics. The lectures are free. Our objective is to create the best and most comprehensive online programs of instruction in Prosthodontics