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Dr. Muaiycd. Maﬁtmoud. Buzayan, BD8 *
Maeinbant Maeaysia *
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Maxillofacial prosthetics :
*1‘ The art and science of anatomic. functional. or cosmetic reconstruction b_v
means of non-living substitutes of those regions in the maxilla. manclible_ and
face that are missing or defective because of surgical intervention. trauma.
pathology. or developmental or congenital malfonnations“
‘It The branch of prosthodontics concerned with the restoration and/ or
replacement of the stomatognatliic and craniofacial structures with prosthesis that
may/ may not be removed on a regular or elective basis.
Maxillofacial prosthesis :
Any prosthesis used to replace part / all of any stomatognathic and / or
((}loss; riy of Prostliodontic 'I‘enns- ed 8, J Piostlict dent 2005)
There are three types of maxi llofacial
I. Congenital : - e. g. cleft palate , cleft palate , cleft lip ,
missing ear , prognathism .
ll. Acquired : Accidents , surgery , pathology .
III. Developmental : Prognathism , Retrognathism .
Types of M. F.P
1 . Extra-Oral (Craniofacial )
2. lntra-Oral ( Stomatognathic )
Indications of MFP
1 . After surgical intervention.
2. After trauma.
3. Congenital defects.
4. Acquired defects.
Prosthetic vs. Surgical Rehabilitation
which one to choose?
That depends on the following factors:
1. Individualized decision between patient and
2. Removable prosthesis allows for cancer
3. Destruction amount.
4. Malignancy recurrence.
However, combined management would be
indicated for some cases
Indications of maxillofacial prosthesis :
1- When plastic surgery is contraindicated.
2- When recurrence of malignancy is expected , the
prosthetic restoration is preferred .
3- When radiotherapy is being instituted , radium appliance
and radium protector shield can be used .
4- Temporary Prosthesis can be used when plastic surgery
requires various steps .
5- When cleft palate is not repairable by surgery .
Contraindications of surgery in maxillofacial defects :
1- Advanced age of the patient :
This is specially true when the surgical treatment requires
2- Poor health :
When general health makes surgical procedures dangerous e. g.
cardio - vascular disease , heart disease and diabetes and also if
the general anaesthesia is contraindicated .
3- Very large deformity :
When anatomic parts of head and neck are not replaceable by
living tissues and if is not practical to attempt a grafting
4- Poor blood supply :
On postradiated tissues and due to unhealthy vascular condition
at the site of deformity .
5- Susceptibility to recurrence of malignant lesion .
6- Expenses of the operation
C raniofacial Structures
Nose, Ear, Eye and combinations
intra oral defects
The most common of intra oral defects are in the form of cleft or
opening in the palate. These defects may be congenital or acquired
Acquired defect is due to injuries ( gun shot) or surgical excision of
tumor. Congenital defect is due to malformation.
The maxillofacial appliance must meet certain
1- The appliance must be easily seated in place
comfortably and securely as mush as possible .
2- The appliance must be durable and easily cleaned .
3- The material used must be easily adjusted and
altered if needed .
Problems associated with maxillofacial defects
Deglutition and s‘all0‘ing
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Treatment of maxillary defects
1. Surgical treatment
2. Prosthetic Treatment
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Management ef patient fer MF P.
. Personal history of a patient should be obtained.
. Dental and medical history also should be obtained.
. Intra and external examination of a patient by a
maxillofacial surgeon and prosthodontics should be done.
. Patients risk assessment should be done.
. A surgeon should consulate with a dentist about a surgery
so that there should be a team work.
. All surgical alterations should be demonstrated for a
dentist on a cast and obturator should be made for a day
of a surgery.
Members of the maxillofacial team :
1- Plastic Surgeon :
2- Speech therapist :
3- Radiotherapist :
4- Dental specialists :
A. Prosthodontist :
B. Orthodontist :
C. Oral surgeon :
D. Dental technician :
E. Other dental specialists :
5- E. N.T. ( Ear, Nose & Throat) Specialist :
6- The psychiatrist :
Treatment plan :
Treatment should be mainly directed to:
1- To cure or control the disease and to prevent further disability . And
remains free of recurrence .
2- The objective of the total plan should contribute to the patient's well
being and acceptance by his society .
3- Arrangement for patient return at appropriate intervals to his dentist
for routine dental care and to his physician for regular health care
must be considered .
4- Maxillofacial prosthetic treatment is established — after final
evaluation of the physical and radiographic finding , analysis of study
casts full consideration of the patients needs for the device and
psychologic acceptance of it .
5- The patient should understand the limitations of the appliance and
the complications that may arise .
Objectives of maxillofacial prosthetics :
1 . Improve or restore the esthetics or cosmetic appearance of the
patient which is of prime importance for every body .
2. Improve or restore the functions that include :
A. Speech function in patients with cleft palate .
B. Nutritional function in patients with lost parts of the jaw .
C. Avoid the escape of food to the nasal cavity . In children with cleft palate
trying to overcome the feeding problem and help to maintain the child
general health .
3. Protect the tissues :
A. To protect the adjacent tissues as in the radium protective shield , also to
protect wound , stop
B. bleeding and carry medicaments after surgery . In contact sport mouth
guards are used to
C. protect the teeth against possible injuries .
4. Therapeutic or healing effect :
A. Placement of appliances such as the radium needle , carrier stents and
splints which are used to
B. aid and promote the healing process .
15.. Psychologic therapy :
To raise the morale of the patient which is very important for such type of
OBTURATOR : “Obturare — to stop up”
A maxillofacial prosthesis used to close a congenital / acquired tissue opening.
pri1naril_' of the hard palate and / or contiguous alveolar / soft tissue structures.
A inaxillofacial prosthesis used to close. cover or maintain the integrity of the oral
and nasal compartments resulting from a congenital. acquired or developmental
disease process. i. e.. cancer, cleft palate. osteoradionecrosis of the palate. The
prosthesis facilitates speech and deglutition by replacing those tissues lost due to the
disease process and can. as a result. reduce nasal regurgitation and liypemasal speech.
improve articulation. deglutition and mastication. An obturator prosthesis is classified
as surgical. interim or definitive and reflects the intervention time period used in the
ma. 'illofacial rehabilitation of the patient.
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keep the wound or defective area clean.
Enhance the healing of traumatic or post surgical defects.
The obturator can be used as a stem to hold dressing or packs post surgicall_v
Reshape or reconstruct the defect.
It also improves or makes speech possible.
Beneﬁt the morale of patients with maxillary defects.
When deglutition and mastication are impaired. it can be used to improve functions.
It reduces the flow of C. "l.1L'iillCS into the mouth.
It may serve for feeding purpose.
Tynes ef Qbturaters
( iihtummrs / ii! ‘/lL‘t lured Psi/ utal defects (/7( ls’! -[lZIlII71£I[lL'. po. ~:I. s'111g1c;1/)1
‘r Immediate temporaiy/ surgical obturator.
‘r Treatment/ T ransitiona 1/ Interim obtura tor.
i Definitive or permanent obturator.
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r A simple base plate type to correct the svallo'ing. feeding and speech.
r (RPD/ (f)verla_v denture) Obturators with a tail. consisting of a speech
appliance or a speech aid prosthesis. which restores soft and hard palate
defects and a velophaiyngeal extension that correct the speech.
‘r Overlay or superimposed denture without tail extension.
Tynes ef Qbturetetrst
} It is deﬁned as a temporary prosthesis used to restore the continuity of the hard palate
immediately after surgery or traumatic loss of a portion or all of the hard palate. The obturator
may be placed immediately after surger_v or seven to ten da_vs post surgically.
i It is a base plate type appliance which is constructed from the pre-operative impression cast
and inserted at the time of resection of the maxilla in the operating room.
2- Inter rim oblur. -n‘or. '
"i It was made following completion of initial healing following surgical resection
of a portion or all of one or both maxillae; frequently many or all teeth in the
defect area are replaced by this prosthesis. This prosthesis replaces the surgical
obturator which is usually inserted at or immediately following the resection. (one
‘r It is constructed from the postsurgical impression cast which has a false palate and
false ridge and generally has no teeth. The closed bulb emending into the defect
area is hollow.
3- Definitive obturator:
r A deﬁnitive obturator is made when it is deemed that further tissue changes or recurrence
of tumor are unlikely and a more permanent prosthetic rehabilitation can be acliieyed; it is
intended for long- term use.
I It is constructed from the postsurgical maxillary cast. This obturator has a false palate.
false ridge. teeth and closed bulb which is hollow.
Postsurgical Maxillary defects Classiﬁcation
in partially dentate
1978 Dr. Mohammed Aramany presented a system of classiﬁcation of poststugical
He divided the defects into six categories based on the relationship of the defect to the
remaining teeth and the frequency of occurrence.
Class I : most frequent defect. The resection is performed along the midline of maxilla.
the teeth are maintained on one side of the arch.
Class II : similar to Kennedy's RPD class II. The defect is unilateral. retaining the
anterior teeth on the contralateral side.
Class III : The defect occurs in the central portion of the hard palate and may
involve part of sott palate.
Class IV : The defect crosses the inidline and involves both sides of the
Class V : The defect is bilateral and lies posterior to the remaining abutment teeth.
Class VI : rare defect. The defect is lies anterior to the remaining abutment teeth.
due to trauma / may be a congenital defect.
Different ebturater bulb
The obturator’s bulb can be open/ close, and the closed bulb can be
hollow or non-hollow
General consiclieregtions concerning
A bulb is not necessary with a central palatal defect of small to average size where
healthy ridges exist.
. It is not necessary in the surgical or immediate temporary obturator.
. It should be hollow to aid speech resonance. to reduce the weight on the
unsupported side. possibly to provide facial aesthetics and to act as a foundation
for a combination of extraoral prostheses in communication with the intraoral
. It should not cause the eye to move during mastication.
. It should always be closed superiorly. mucous crusts. food accumulation
. It should not be so large as to interfere with insertion if the mouth opening is
OPEN / CLOSE OBTURATOR
Patient complains of food. fluid and mucous accumulations -'9 Bad odor and altered
Benefit to patient ""* Reduced wt ; ease of fabrication; increased speech intelligibility.
r Prevents food and ﬂuid collection
I Reduces air space
r Allows maximum extension
HOLLOW CLOSED BULB OBTURATOR
r The wt of the prosthesis i'cduced — comfortable and elficicnt.
r The lightness of prosthesis
° Improves retention
° Decreases the consciousness of wearing a denture.
i Decrease in pressure to the surrounding tissues aids in deglutition and encourages
regeneration of tissue.
FABRICATION OF ONE PIECE HOLLOW BULB OBTURATOR‘
1- Invest the denture in the ﬂask in the usual manner.
Construction of autopolymerizing acrylic resin shim
"r Relieve the entire defect area with one thickness of base plate wax.
P Place three stops iii the wax which will be deep enough to reach the underlying
stone of the master cast.
‘r Contour a layer of dough consistency acrylic resin over the wax relief
r Close the ﬂask. Allow the resin to cure for 15 rrrirr.
r Trim all the excess of acrylic resin from the shim.
r Replace the heat cure acrylic resin shim using 3 stops for correct positioning.
Placement of aci_'xlic resin shim and denture processing
Reinsert the processed acrylic resin shim over the still sort acrylic resin mix in the defect.
Add more acrylic resin to the top half of the ﬂask and packing is done.
Cure the resin in the usual manner.
Detlask it and trim and polish in usual manner
Ferces acting on Qbturaters
These forces can be:
Vertical dislodging force (Gravity)
Occlusal Vertical force
Torque or rotational force
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Primary surgical enhancements that can improve
prosthesis outcome are:
7 Maintain as much hard palate as possible
I Remove the inferior turbinatel to have space within the surgical defect for height of
the medial wall of obturator bulb)
I Skin graft the maxillar_ sinus walls