Maxillofacil prosthodontics/ dental education in india

Maxillofacial
Prosthodontics.
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Ragas dental college.

Dr M.
Vasanth
kumar
Dr .V
.Rangarajan
Dr
Azhagarasan
Dr Chitra
shankar
Dept of prosthodontics
Faculty

Introduction.
• What is Maxillofacial prosthetics ?
It is the art and science of anatomic,
functional, or cosmetic reconstruction by
means of non living substitutes of those
regions in the maxilla,mandible, and face
that are missing or defective because of
surgical intervention, trauma, pathology, or
developmental or congenital malformation.

Objectives of maxillofacial
prosthetics.
1) Restoration of Esthetics or Cosmetic
appearance of the patient.
2) Restoration of function.
3) Protection of tissues.
4) Therapeutic or healing effect.
5) Psychologic therapy.

Prosthetics Vs Plastic surgery.
• Maxillofacial prosthetist normally provides
appliances and devices to restore esthetics and
function to the patient who cannot be restored to
normal appearance or function by means of
plastic reconstruction
• Limitations for plastic surgery:
1. Advanced age of patient.
2. Poor health
3. Very large deformity
4. Poor blood supply on post-radiated tissue.
5. Systemic diseases.
6. Economic conditions.

Team approach.
1. Maxillofacial prosthodontist.
2. The surgeon.
3. The radiotherapist.
4. The speech therapist.
5. The psychiatrist.
6. The social worker.
7. Other dental specialists.

Diagnosis and treatment planning

Impression making

Materials used in maxillofacial
prosthetics.

Retention of prosthesis.
• Close evaluation of a case with the surgeon
before and during surgery helps in finding
means to create irregular defects for
enhancing anatomic retention

Retention in Intraoral prosthesis.
• Anatomic retention- By Teeth, Mucosal and
bony tissues.
Factors aiding in anatomic retention
– Anatomic undercuts –
– Large alveolar ridges
– High palatal vaults.
– Proper occlusion.
– Proper post dam
– Surface adhesion

Mechanical retention
• Temporary
– different clasps made of wrought wire.
– Preformed stainless steel bands or crowns
• Permanent mechanical retention
– Cast clasps.
– Precision attachments:Prefabricated and custom made.
– Snap on attachment
– Telescopic crowns and thimble crown.
– Gate type or swing lock devices
– Intermaxillary “george washington” springs
– Screws,Implants,Suction cups,Adhesives, Magnets and
occlusion.

Extraoral retention.
• Anatomic retention.
– Hard tissues act as a base against which to seat the
prosthesis.
– Soft tissues
• Mechanical retention.
– Magents
– Eyeglasses
– Snap buttons and straps
– adhesives

Intraoral prosthesis
• Obturators
– a prosthesis used to close a congenital or
acquired tissue opening ,primarily of the
hard palate and /or contiguous alveolar
structures.
– Prosthetic restorations of the defect often
includes use of a surgical obturator,
interim obturator, and definitive
obturator.

Functions of obturator
1) keeps the wound area clean and to enhance healing
2) To reshape or reconstruct the palatal contour/or soft
palate
3) Improves speech
4) Can be used to correct lip and cheek position
5) Improves mastication.
6) Reduces the flow of exudates in the mouth

Classification :-
Congenital Defects Acquired Defects
•Simple obturator
•Simple with Velopharyngeal extn..
•Overlay or a super imposed denture.
•Surgical obturator.
•Interim obturator
•Definitive obturator

Variants :-
• Inflatable obturator bulb.
• Magnets between bulb & denture.
• Hollow silicone obturator bulb.
• Rigid hollow bulb obturator.

Surgical obturator
• Facilitates oral function
immediately after surgery,
• Patient may regain speech
within a normal range .
• Wrought wire clasps are used .
• Constructed from preoperative
impression cast.
• It eliminates the need for the
nasogastric tube.
• It can serve as matrix for
surgical dressing.

Temporary obturator
• After 7-10 days ,the prosthesis is removed and
reprocessed with new acrylic resin.this becomes a
temporary obturator and serves for 4-6 months of
healing period.
• Periodic modifications with tissue conditioners
• Multiple wrought wire clasps are used
• Mastication on the surgical side are avoided
• Prosthetic teeth may be added to enhance
esthetics.

Definitive obturator.
• Constructed from the post surgical
maxillary cast.
• Has a false palate ,false ridge ,teeth ,and a
closed bulb which is hollow.

•Patient examination and preparation for impression making.

•Sectional impression of dentulous side.
•Compound impression on the defect side.
•Final impression.

•Master cast is poured.
•Jaw relation record established.
•Teeth setting is done.

•The obturator is retrieved.
•The roof is cut.

•The obturator is finished, trimmed and placed in the mouth

ADVANTAGES:
Lighter.
Minimal stress & Maximal comfort.
Motivates the patient to clean.
Simple.
Accurate.

Quality of retention depends on
• Muscular control.
• Size of surgical cavity
• availability of tissue undercut around the
cavity
• Direct and indirect retention provided by
any remaining teeth.

Retentive regions are
• Fibrous tissue scar bands in the buccal
sulcus.
• Rolled edge of the palatal remnants
• Base of the nasal mucosa of the nasal
septum.

Forces on Obturators
These forces can be
• Vertical dislodging force
• Occlusal vertical force
• Torque or rotational force
• Lateral force
• Anterior posterior force.

dislodging and rotational forces
The weight of the nasal extension of the
obturator exerts dislodging and rotational
forces on abutment teeth.
To resist these forces
-weight of the obturator be minimal
-direct retention
-extending the buccal wall of the
nasal extension superiorly.

Relation of the scar band to the
lateral portion of the obturator.
• Buccal scar band will
develop at height of
previous vestibule
where buccal mucosa
and skin graft in
surgical defect join.

Surgical considerations
• Efforts should be directed towards
conversion a potential class I maxillary
defect into a class II defect to provide a
superior prosthesis both functionally and
esthetically.

Recommendations to surgeon.
1. Preservation of the contra lateral anterior
teeth,if it does not compromise tumor
eradication.
2. If the palatal mucosa is not invaded by the
tumor,it is preserved and reflected to
cover the medial wall. this procedure
provides superior tissue quality coverage
for the nasal septum.

3. Preservation of the posterior hard plate on
the defect side if the tumor is situated
anteriorly or laterally.
4. Resection through the socket of the tooth
closest to the specimen allows for
maintenance of the proximal alveolar
bone adjacent to the abutment tooth.

Classification of Obturators
According to Origin of discrepancy :
- congenital
– acquired
According to Location of defect
According to physiological movement of the
surrounding tissue.
a. Static obturator
b. Functional obturator.

Factors to consider for superior
height of bulb.
1. If patients speech cannot be understood the bulb
should be extended upward.
2. With maxillary resection much of the bone
support for the cheek is removed.the obturator
bulb height will reestablish this contour.
3. According to brown (1968) height of the bulb
relates to the retention of the completed
obturator.
4. Amount of Mouth opening of the patient

Guiding flange

Speech aids
• These are prosthesis that are functionally
shaped to the velopharyngeal musculature
to restore or compensate for areas of the
soft palate that are deficient because of
surgery or congenital anomaly.

Palatal augmentation
• If a part of tongue is lost ,the ability of the
tongue to reach the palate for appropriate
speech and swallowing is compromised.
• The contour of palate can be augmented by
a prosthesis to fill the space of donder so
that a food bolus can be more easily moved
posteriorly into the oropharynx.

Reasons of eye loss.
• Cancer , e.g. Retinoblastoma.
• Trauma
• Congenital birth deficiency
• Blind painful eye

Evisceration
• The muscles that
control eye movement
remain attached to the
sclera.
• Evisceration generally
gives better movement
to the ocular prosthesis
(artificial eye).

This is a 7 year old child who
came to dept of prosthodontics
ragas dental college 4 weeks
after exenteration of the right
orbital contents. he is other wise
healthy and has normal vision in
left eye.

Type of surgery Prosthetic
rehabilitation by
Enucleation Ocular prosthesis
Evisceration Ocular prosthesis
Exenteration Orbital
prosthesis.
Types of eye surgery and their
corresponding prosthesis

• Ocular prosthesis
– An ocular prosthesis is an
artificial replacement for
the Bulb of the eye.
• Orbital prosthesis
– When the entire contents
of the orbitare removed-
the artificial replacement
is referred to as an orbital
prosthesis.

Eye as focus of attention
• The movement(black
lines) show how much
of the time an
observer’s eyes search
the eyes of the person
observed.

Aims/Advantages of eye
prosthesis
1. Comfort
2. Cosmetics- Restore facial contour.
3. Bony Orbital Wall, and Eyelid development.
4. To maintain the volume of the eye socket
5. Protects delicate tissues and maintains proper
humidity for Mucosa or orbital structures.
6. Provides a great psychological benefit in the
rehabilitation of the patient.
7. Quick and early adjustment to monocular vision.

acrylic v/s Silicone Prosthesis
Acrylic Medical grade
silicone
Artificial look More natural look
light heavy
affordable Expensive

Impression
• Areas for impression defined and boxed.
Length –from forehead down to
the top lip.
Breadth - from tragus to tragus.
• Impression procedure.
• Pouring the impression.

Eyeball component
• The eyeball component
is custom designed and
fabricated in acrylic, with
regard to size and
colour, to match the
contra lateral eye, as
closely as possible.

Eye alignment
• Eye must be in exactly the right position or the
prosthesis will look strange and unreal.
• Determining factors
-Inter-pupillary distance
-Back vertex alignment
-Horizontal alignment

• Sculpting
– Great care is taken during
carving of the prosthesis
so as to 'capture' the most
constant appearance.
– It is done with the patient
present .
• Color matching
• Finishing
• Eyelashes and eyebrows
are added

Spectacle considerations
• The frame should mask as
much of the margins as
possible .
• Patients with orbital defects
are advised to wear lightly
tinted glasses to help hide the
prosthetic margins and
disguise that there is no
movement in the prosthetic
eye.
• Hinge of the spectacle arm is
locked to prevent any
accidental opening .

Limitations
•It will take some time to adjust to using one
eye, but almost all patients learn to
compensate during the first year after surgery.
•The socket will grow with age and hence the
need for new prosthesis frequently.
•Since the extraocular muscles are not
attached to the prosthesis, it does not move as
a natural eye.
•Almost all patients learn to compensate during the
first year after surgery.

Ear prosthesis

Thank you
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Maxillofacil prosthodontics/ dental education in india

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