OBTURATOR
SEMINAR- SHILPA P, III MDS
INTRODUCTION
“Obturare – to close or shut off”
HISTORICAL DEVELOPMENT
Ambrose Pare 1530
Pierre Fauchard
Nasopalatine prosthetic
reconstruction by Kingsley
HISTORICAL DEVELOPMENT
Maxillofacial prosthetic devices of Claude
Martin Nasopalatine prosthesis by Kazanjian
PARTIAL MAXILLARY ARCH DEFECTS
ARAMANY 1978
Liverpool classification by James S Brown, Richard J Shaw
Veau’s classification
BIOMECHANICS
Forces can be
• Vertical dislodging force
• Occlusal vertical force
• Torque or rotational force
• Lateral force
• Anterior posterior force.
BIOMECHANICS
The degree of movement will vary
• with the number and position of teeth that are
available for retention,
• the size and configuration of the defect,
• the amount and contour of the remaining palatal
shelf,
• height of the residual alveolar ridge,
• the size, contour, and lining mucosa of the defect and
the availability of undercuts
Retention Support Stability
Within the residual maxilla Within the residual maxilla Within the residual maxilla
Teeth Residual teeth bracing components of
Alveolar ridge the prosthesis frame work.
Alveolar ridge
Within the defect Residual hard palate
Within the defect
Residual soft palate
Within the defect Maximal extension of
Residual hard palate floor of the orbit, the prosthesis in all lateral
Lateral scar band the bony structures of directions must be
Height of lateral wall the pterygoid plate provided.
Anterior nasal aperature the anterior surface of Occlusion
the temporal bone near the Obturator size and
infratemporal fossa extension
The nasal septum may
be used if the defect
extends beyond the
midline.
RETENTION
Within the residual maxilla
Teeth
Alveolar ridge
Within the defect
Residual soft palate
Residual hard palate
Lateral scar band
Height of lateral wall
Anterior nasal aperature
Variance in vertical displacement
Within the residual maxilla
SUPPORT Residual teeth
Alveolar ridge
Residual hard palate
Within the defect
floor of the orbit,
the bony structures of the pterygoid plate
the anterior surface of the temporal bone near the
infratemporal fossa
The nasal septum may be used if the defect extends
beyond the midline.
STABILITY
Within the residual maxilla
bracing components of the prosthesis frame
work.
Within the defect
Maximal extension of the prosthesis in all
lateral directions must be provided.
Occlusion
Obturator size and extension
Surgical modification enhancing
prosthetic prognosis
• Hard palate
• Skin graft
• Retention of key teeth
• Palatal mucosa
• Soft palate
• Access to defect
• Placement of implants
CLASSIFICATION OF OBTURATORS
• According to origin of the discrepancy
• According to location of the defect
• According to the type of obturator attachment to
the basic maxillary prosthesis
• According to the physiologic movement of oral,
nasal, and pharyngeal tissues adjacent to or
functioning against the obturator
• Depending on the material used
CLASSIFICATION OF OBTURATORS
• Depending on the phase of treatment or prosthetic
rehabilitation of acquired hard palate defects
– Surgical obturator
• Immediate
• Delayed
– Transitional/interim/treatment/temporary
obturator
– Definitive/permanent obturator
SURGICAL OBTURATOR
Surgical obturator 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 and/or contiguous
alveolar structure
Types
• Immediate
• Delayed
Principles in surgical obturation
• terminate short of skin graft-mucosal junction
• simple, lightweight, and inexpensive
• Normal palatal and alveolar contours should be
reproduced
• Posterior occlusion should not be established on the
defect side
• The obturator for dentate patients should be
perforated at interproximal extensions
Fabrication of surgical obturator
INTERIM OBTURATORS
“The interim obturator prosthesis bridges the gap
between the immediate surgical obturator and the
definitive prosthesis’’.
• Chair side impression of surgical site 5-10days after
surgery
Open:
Patient complains of food, fluid and mucous
accumulations
Bad odor and altered taste sensation
Benefit to patient
Reduced weight, ease of fabrication; increased speech
intelligibility.
HOLLOW BULB OBTURATOR
Closed :
Prevent food and fluid collection
Reduce air space
Allows maximum extension
Fluid can be absorbed through porosity in the resin seal and it
can’t be cleaned (closed)
This creates a medium for growth of microorganisms.
HOLLOW BULB OBTURATOR
Several techniques are used for the fabrication of
hollow bulb obturator .
The commonly used ones are:
1.Two piece hollow obturator
2.One piece hollow obturator
FABRICATION OF ONE PIECE
HOLLOW BULB OBTURATOR
TWO PIECE HOLLOW BULB OBTURATOR
Alternative method for fabrication
of a closed hollow obturator
Glen, Donald,Santra. Alternative method for fabrication of a closed hollow obturator.
J Prosthet Dent 1986;55:485.
Simplified method of making hollow
obturator
Matalon V, La Fuente H. A simplified method for making a hollow obturator. J Prosthet Dent 1976;36:580-2.
A simplified technique for fabricating a
lightweight
obturator
• simple procedure that
utilizes polyurethane
foam for the core.
• efficient and
economical
Tanaka Y, Gold HO, Pruzansky S. A simplified technique for fabricating a
lightweight obturator. J Prosthet Dent 1977;38:638-42.
DEFINITIVE OBTURATOR
Designing of metal frameworks
Hollow obturator with removable lid
Mouth guard material- lid
Phankosol P, Martin JW. Hollow obturator with removable lid. J Prosthet Dent 1985;54:98-100.
Light-cured combination
obturator prosthesis.
Uses the combination of VLC denture base and indirect resilient relining
materials
Polyzois GL. Light-cured combination obturator prosthesis. J Prosthet Dent
1992;68:345-7.
INFLATABLE OBTURATOR
Payne, Welton. An inflatable obturator for use following maxillectomy. J.Pros Dent,
1965;15:175.
Magnets retaining maxillary
obturator prostheses
Boucher, Edwin: Prosthetic restoration of a maxilla And associated structures.J
Prosthet Dent 1966;16:154-60.
Implants retaining edentulous maxillary
obturator prostheses
Roumanas, Nishimura, Davi. Clinical evaluation of implants retaining edentulous
maxillary obturator prostheses.J Prosthet Dent 1997;77:184-90.
OBTURATION OF TOTAL SOFT PALATE DEFECTS
• Palatopharyngeal insufficiency
• Palatopharyngeal incompetence
• Palatopharyngeal inadequacy
Palatal obturator
Meatal obturator
TROUBLE SHOOTING OF OBTURATOR
• Leakage into the nose
• Hypernasal speech
CONCLUSION
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