Definitive ObturationTreatment concepts v Movement of the prosthesis v Tissue changes v Oral-nasal partition v Extension into the defect v Teeth v Implants v Weight v Bolus manipulation
Treatment concepts v Movement of the prosthesis The prosthesis will move significantly during function. The degree of movement varies and depends upon: v Number of teeth present and their location v Presence of implants and their distribution pattern v Size and the configuration of the defect, remaining palatal shelf area v Whether the patient is edentulous or partially edentulous
Treatment concepts Movement of the prosthesisThere will be significantmovement of theprosthesis in defectssuch as this one withlittle palatal shelfremaining and thedentition arranged in alinear configuration.
Movement of the prosthesisMovement of the prosthesis in and out of the defect will occurin such patients. Partial dentures can be designed to resist theforces of gravity but must allow the forces of occlusion toimpact the prosthesis into the defect, otherwise abutment teethwill be compromised.
Movement of the prosthesisThe premaxillary segment is present, there is significantpalatal shelf surface area and therefore considerablyless movement of the obturator prosthesis in a defectsuch as this one and the partial denture design problemmore conventional.
Movement of the ProsthesisThe obturator prosthesisfitted for this defect will movea great deal. The successfuluser must learn to balancethe prosthesis with thedorsum of the tongue.However, if the defect isfavorable with undercutslined with skin, the addition ofimplants on the unresectedside would significantlyreduce movement of theprosthesis and theprosthodontic prognosisdramatically improved.
Treatment concepts Tissue changesv The contours and configuration of thedefect change rapidly immediately aftersurgeryv The defect is usually well healed 3months following surgery.v Dimensional changes continue to occurfor at least a year after surgery secondaryto scar contraction and further organizationof the wound.
Tissue changesMost tissue changes occur during the first3 months after surgery. Flaps becomeless edematous and skin grafts organizeand become smooth.
Oral-nasal partitionv Obturators for acquired defects are coveringprostheses, primarily serving to reestablish the oral-nasal partition.v The obturator is extended into the defectprimarily to enhance retention, stability and supportfor the prosthesis.v Extensions in some areas may need to belengthened to prevent leakage of liquid into thenasal passage
Treatment concepts Extension into the defectThe degree of extension intothe defect is dependent uponthe requirements for retention,stability and support, thecharacter of the tissue liningthe defect and theconfiguration of the defect.Most edentulous patients are lacking retention, stabilityand support and the defect is aggressively engaged tofacilitate all three as shown by this complete dentureand obturator.
Treatment concepts TeethThe presence of teethenhances the prostheticprognosis. Every effortshould be made tomaintain and enhancethe longevity of teeth,unless their retentionwould compromise afuture implant site.
Treatment concepts TeethIn some instances teeth adjacent to the defectare splinted together in order to enhance theirload bearing capacity.
Treatment concepts Osseointegrated implants" The placement of osseointegrated implants dramaticallyimproves the function of obturator prostheses. Implants can beplaced in association with resection of the tumor or thereafter." The most desirable locations are the premaxilla and themaxillary tuberosity.
Treatment concepts Osseointegrated implantsMost implant bar designs must be implant assistedand must accommodate the multitude of axis ofrotation of the prosthesis generated during function.
Treatment concepts Osseointegrated implantsImplant should not be used to prevent movement ofthe prosthesis in a defect of this size and extent. Ifthey are used for this purpose there is a significantrisk of implant overload and eventual implant failure.
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.
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