Retention in maxillo facial prosthesis./cosmetic dentistry course

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Retention in maxillo facial prosthesis./cosmetic dentistry course

  1. 1. RETENTION IN MAXILLO FACIAL PROSTHESIS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION www.indiandentalacademy.com
  3. 3. RETENTION IN MFP Intra oral prosthesis: Anatomic retention Mechanical retention Extra oral prosthesis: Anatomic retention Mechanical retention www.indiandentalacademy.com
  4. 4. www.indiandentalacademy.com
  5. 5. RETENTION IN MFP ANATOMIC MECHANICAL ADHESIVES IMPLANTS OCCLUSI ON www.indiandentalacademy.com
  6. 6. ANATOMIC RETENTION  Residual maxillary retention Teeth Alveolar ridge  Within the defect retention  Residual hard palate  Residual soft palate www.indiandentalacademy.com
  7. 7. Anterior nasal aperture Lateral scar band Floor of the orbit Lateral Pterygoid plate Nasal septum www.indiandentalacademy.com
  8. 8. Residual maxilla retention: Teeth: Alveolar ridge: • Utilization of the physical properties • Ridge size and shape • The palatal contour • premaxillary segment or the tuberosity www.indiandentalacademy.com
  9. 9. Within-the-defect retention:  Large defects contribute intrinsically to the retention of the obturator prosthesis www.indiandentalacademy.com
  10. 10.  There are intrinsic areas within and around the defect that can provide retention The residual soft palate The residual hard palate The anterior nasal aperture The lateral scar band www.indiandentalacademy.com
  11. 11. Residual soft palate: Extension of the obturator prosthesis on to the nasopharyngeal side of the soft palate will provide retention. www.indiandentalacademy.com
  12. 12. Residual hard palate:  Depending on the of the line of palatal resection  Undercut along this line into the nasal or paranasal cavity.  Engagement of the medial wall of the defect can increase retention. www.indiandentalacademy.com
  13. 13. Anterior nasal aperture: This can be entered unilaterally or bilaterally. www.indiandentalacademy.com
  14. 14. Lateral scar band: The skin superior to the junction tends to stretch creating an area above the scar band that can be engaged by the obturator prosthesis. This minimizes vertical displacement of the prosthesis www.indiandentalacademy.com
  15. 15. Retention is like a castle held together by proper Support and Stability.if any one fails the whole castle comes crumbling down…. www.indiandentalacademy.com
  16. 16. SUPPORT It is the resistance to movement of a prosthesis toward the tissue. The support available from the residual maxilla and from within the defect www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com
  18. 18. Within-the- defect support:  Positive support within the defect to prevent rotation of the prosthesis into it must be considered. This support can be achieved by contact of the prosthesis with any anatomic structure that provides a firm base. www.indiandentalacademy.com
  19. 19. the floor of the orbit, the bony structures of the Pterygoid plate, the anterior surface of the temporal bone The nasal septum www.indiandentalacademy.com
  20. 20. STABILITY  It is the resistance to prosthesis displacement by functional forces. www.indiandentalacademy.com
  21. 21. Residual maxilla stability: If natural teeth remain, the bracing components of the prosthesis framework can be used to minimize movement in all 3 directions. In edentulous patients, maximal extension into the mucobuccal fold www.indiandentalacademy.com
  22. 22. Within-the defect stability:  Maximal extension of the prosthesis in all lateral directions must be provided.  Maximum contact possible with the medial line of resection, the anterior and lateral walls of the defect, the pterygoid plates, and the residual softpalate must be established. www.indiandentalacademy.com
  23. 23. Occlusion:  The most important aspect of stability is occlusion. Maximal distribution of the occlusal force in centric and eccentric jaw positions is imperative to minimize the movement of the prosthesis and the resultant forces to individual structures. The patient with an acquired maxillary defect should not masticate over the defect. www.indiandentalacademy.com
  24. 24. MECHANICAL RETENTION Under this category, the operator has a myriad of devices and proven techniques to consider or use as the case demands. TEMPORARY PERMANENT www.indiandentalacademy.com
  25. 25. Temporary mechanical retention: www.indiandentalacademy.com
  26. 26. ORTHODONTIC BANDS AND PREWELDED BRACKETS TO RETAIN TEMPORARY PROSTHESIS www.indiandentalacademy.com
  27. 27. PERMANENT MECHANICAL RETENTION Cast clasps:  Most common method for retaining a prosthesis is using a cast metal clasp which enters a undercut. Properly designed clasp will provide stability, splinting, bilateral bracing, and reciprocation, as well as retention. www.indiandentalacademy.com
  28. 28. CAST CIRCUMFERENTIAL CLASP WROUGHT-CAST COMBINATION AKERS CLASP CAST ROACH-AKERS COMBINATION CLASP MANDIBULAR MOLAR RING CLASP www.indiandentalacademy.com
  29. 29. PRECISION ATTACHMENTS These prefabricated attachments can be placed into cast crowns for the best in esthetic and mechanical retention. www.indiandentalacademy.com
  30. 30. SEMIPRECISION ATTACHMENTS, CUSTOM MADE This attachment is formed in the wax pattern, using a specially shaped mandrel mounted on the parallelometer. www.indiandentalacademy.com
  31. 31. SNAP-ON ATTACHMENT It is a preformed precious- metal precision piece designed to retain and to stabilize a prosthesis. A Baker bar or Anderson bar is the rod connecting two abutment crowns, and the clip engages this rod. www.indiandentalacademy.com
  32. 32. BAKER SNAP-ON ATTACHMENTS SOLDERED TO THE CAST FRAMEWORK CROSS-ARCH SPLINTING USING 11-GAUGE BAR SNAP-ON ATTACHMENT www.indiandentalacademy.com
  33. 33. MAGNETS Magnets have been used since 1950 1970 rare earth magnets were used clinically for denture retention. www.indiandentalacademy.com
  34. 34. Magnetic systems used in dentistry www.indiandentalacademy.com
  35. 35. Closed Field Systems • Soft magnetic material is cemented to the root and a closed field magnet is set into the denture base www.indiandentalacademy.com
  36. 36. MAGNETS BAR ENGAGED IMPLANT FIXTURE TO PREVENT ROTATION OF BAR AND LOOSENING OF SCREW POSTERIOR SURFACE OF NASAL PROSTHESIS. NOTE: MAGNETIC ATTACHMENTS www.indiandentalacademy.com
  37. 37. BAR ENGAGING PROSTHESIS PROSTHESIS IN POSITION www.indiandentalacademy.com
  38. 38. Advantage of magnets  Have no moving parts to fatigue and break  Are self seating  require no paralleling  Transmit no damaging lateral forces to compromised abutments. Disadvantages of magnets: Possibility of corrosion if the capsule leaks or wears through www.indiandentalacademy.com
  39. 39. GATE TYPE OR SWING LOCK DEVICE This retentive aid helps gain partial retention for many loose or periodontally involved teeth. www.indiandentalacademy.com
  40. 40. AUXILIARY RETENTIVE DEVICES Buccal-lingual continuous clasp, Guide planes, Screws: they are specially made custom parts. Suction cups: Inflatable balloon suction cups are used for maxillary retention. www.indiandentalacademy.com
  41. 41. Spectacle retained www.indiandentalacademy.com
  42. 42. www.indiandentalacademy.com
  43. 43. ADHESIVES-Intra oral They enhance retention through optimizing interfacial force by (1) Increasing adhesive and cohesive properties and viscocity of the medium lying between the denture and its basal seal. (2) Eliminating void between the tissue surface of the prosthesis and the area on which it rests. www.indiandentalacademy.com
  44. 44.  Pastes  Liquid emulsions  Spray on  Double sided tape Adhesive used is a medical grade Disadvantage: frequent reapplication is necessary ADHESIVES-Extra oral www.indiandentalacademy.com
  45. 45. PROSTHESIS RETAINED WITH SKIN ADHESIVE www.indiandentalacademy.com
  46. 46. TISSUE CONDITIONERS They can increase retention of the prosthesis by engaging undercuts, which normally are difficult to cover. Relining is necessary www.indiandentalacademy.com
  47. 47. IMPLANTS www.indiandentalacademy.com
  48. 48. The retention provided by the implants makes it possible to fabricate large prosthesis that rests on movable tissues. Patient acceptance is significantly enhanced Help to fabricate thin margins in silicone which blend and move more effectively with the mobile peripheral tissues. www.indiandentalacademy.com
  49. 49. CT SCAN USED TO LOCATE POSSIBLE IMPLANT SITES STEREOLITHOGRAPHICALLY FABRICATED 3-D MODEL USED TO ASSESS IMPLANT SITES www.indiandentalacademy.com
  50. 50. • Skin and soft tissues overlying the proposed implant sites require careful examination. • The health of the soft tissues circumscribing the implants are easier to maintain if these tissues are thin (less than 5mm) and attached to the underlying periosteum. www.indiandentalacademy.com
  51. 51. SURGICAL PLACEMENT • Craniofacial implant fixtures are fabricated from pure titanium. • Available in 3 or 5mm lengths and 5mm diameter flange. • 2- stage surgical procedure, is employed. www.indiandentalacademy.com
  52. 52. AURICULAR DEFECT WAX SCULPTING FITTED TO IDENTIFY PROPER IMPLANT PLACEMENT SURGICAL TEMPLATE www.indiandentalacademy.com
  53. 53. FLAP REFLECTED TEMPLATE USED TO LOCATE PROPER IMPLANT POSITIONS www.indiandentalacademy.com
  54. 54. MASTOID EXPOSED AND SITES PREPARED FOR 3 IMPLANTS IMPLANT FIXTURES PLACED INTO PREPARED SITES WOUND CLOSED I N 3 LAYERS www.indiandentalacademy.com
  55. 55. Second surgical stage • Second surgical stage is performed 3 to 4 months after the first stage. www.indiandentalacademy.com
  56. 56. IMPLANTS BEING EXPOSED TISSUES FLAP IS THINNED AND PERFORATED OVER IMPLANT SITES ABUTMENT CYLINDERS ATTACHED www.indiandentalacademy.com
  57. 57. HEALING CAPS SECURED PRESSURE DRESSING APPLIED www.indiandentalacademy.com
  58. 58. ONE WEEK LATER, PRESSURE DRESSING REMOVED SITES HEALED 4 WEEK FOLLOWING EXPOSURE www.indiandentalacademy.com
  59. 59. SILICONE TEMPLATE FABRICATED AS AN AID TO FABRICATE RETENTION BAR www.indiandentalacademy.com
  60. 60. FIT OF BAR IS VERIFIED ON PATIENT www.indiandentalacademy.com
  61. 61. ACRYLIC RESIN SUBSTRUCTURE TO BE EMBEDDED WITHIN SILICONE PROSTHESIS PLASTIC SUBSTRUCTURE CONTAINS RETENTIVE ELEMENTS www.indiandentalacademy.com
  62. 62. OSSEOINTEGRATED IMPLANTS WERE REQUIRED TO RETAIN THIS LARGE ORBITAL PROSTHESIS www.indiandentalacademy.com
  63. 63. THESE IMPLANTS EXIT THROUGH MOBILE LIP TISSUES, INCREASING RISK OF PERIIMPLANTITIS THESE IMPLANTS ARE POSITIONED TOO FAR POSTERIORLY, MAKING ACCESS FOR HYGIENE DIFFICULT www.indiandentalacademy.com
  64. 64. BAR-CLIP DESIGN BARS WITH VERTICAL AND HORIZONTAL COMPONENTS POSTERIOR SURFACE OF NASAL PROSTHESIS. CLIPS ARE EMBEDDED IN ACRYLIC RESIN SUBSTRUCTURE WITHIN PROSTHESIS www.indiandentalacademy.com
  65. 65. BAR ENGAGING PROSTHESIS COMPLETED PROSTHESIS IN POSITION www.indiandentalacademy.com
  66. 66. Conclusion…. www.indiandentalacademy.com
  67. 67. References 1 1.Sudarat kiat-annuay,Lawrence Gettlemanet et al. Effect of adhesive retention of maxillofacial prostheses.J Prosthet Dent 2001;85:438-41 2. Mark A.Pigno and Jeff J.Funk. Augmentation of obturator retention by extention into the nasal aperture.J Prosthet Dent 2001;85;349-51 3. James C.Lemon,Jack W.Martin. Technique for magnet replacement in silicone facial prostheses.J Prosthet Dent 1995;73:166-8 www.indiandentalacademy.com
  68. 68. • 4. Ikuya watanabe,yasuhiroTanaka et al. Application of cast magnetic attachments to sectional complete dentures for patient with microstomia. J Prosthet Dent2002;88:573-77 • 5. Jafferey E.Rubenstein. Attachments used for implant supported facial prostheses. J Prosthet Dent 1995;73:262-6 • 6. Yuki Kokubo and Shunji Fukushima. Magnetic attachments for esthetic management of an overdenture. J Prosthet Dent 2002;88:354-5 www.indiandentalacademy.com
  69. 69. Acknowledgement • Dr.K.R.Kashinath (Prof and Head) • Dr.Vibha Shetty (Prof) • Dr.Harish P.V (Associate Professor) • Dr.Vahini Reddy (Associate Professor) www.indiandentalacademy.com
  70. 70. www.indiandentalacademy.com

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