Acquired maxillary defects copy removeable
- 2. Define: It is the lack of continuity of previous intact palatal structure through all or part of its length 2
- 3. •Acquired soft palatal defects. •Acquired hard palatal defects. 3
- 4. Function of velopharyngeal sphincter: to close naso-pharynx by contraction of posterior and lateral pharyngeal walls against soft palate. What is Passavant’s ridge or pad? 1. It is a horizontal cross roll on posterior pharyngeal wall which occur during speech and swallowing in cleft palate patient 2. It serves as a guide for proper placement of soft palate obturation prosthesis 4
- 5. Method of reconstruction: Denture fabrication Get a wire and extend it to defect Green compound molding by head tilting and swallowing Scrap(correcta wax impression) Replace be self cure acrylic 5
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- 14. Acquired soft palatal defects. •Acquired hard palatal defects. 14
- 15. Found in edentulous and fully dentate patients Etiology: 1. Benign or malignant tumors of palate and maxillary sinus. 2. Traumatic loss 3. Pathological condition eg: osteomylitis, syphilis. 15
- 16. Disabilities: i. Hyper nasal speech ii. Fluid leakage in nasal cavity iii. Impaired mastication iv. Cosmetic deformity 16
- 17. Class l Class ll Class lll Class iv Class v Class vi The classification of acquired hard palate defect was originally proposed by Armany .1978 as follows 17
- 18. Class l Class ll Class lll In classical maxillectomy resection, The dentition and the alveolar bone are removed along the midline In the classification The premaxilla on the defect side is maintained The defect Area is Located On the Central Portion of the palate And all the Dentition is preserved 18
- 19. Class iv Class v Class vi The defect includes the pre-maxilla on the no surgical side The anterior teeth are preserved, the posterior teeth ,hard palate ,portions of soft palate are resected. Anterior palatal defects ,the least frequently occurring class ,are caused by trauma more often than surgery 19
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- 22. Removal of a part or all maxilla. Can be done with inta oral/extra oral approach Extension of resection depends on: 1. Size 2. Location 3. Behavior of tumor 22
- 23. Complete(total)maxillectomy.(removal of 1 of 2 maxilla) Partial maxillectomy:(partial removal of a part of 1 maxilla) Total bilateral maxillectomy:(removal of upper jaw totally) 23
- 24. 8 steps for the modification. 24
- 25. 1. Safe as much of hard palate as possible 2. Try to retain the key teeth (canines) 3. Extract the tooth just adjacent to defect with trans-alveolar resection through distal portion of this socket improving bony support to tooth adjacent to defect. 25
- 26. 4. Save palatal mucosa to line palatal margin to defect which increases lateral stability of prosthesis. 5. If resection include anterior 2/3 of soft palate remove the remaining 1/3 (non functional) 6. Turbinates and bands of oral mucosa preventing the prosthesis from engaging key areas of defect should be removed 26
- 27. 7. Place Osseo-integrated implant if possible. 8.Line the cheek with a split thickness skin graft to:??? Decrease scar tissue formation Form a scar band at line of junction between skin graft and mucosa (pure string effect) Improves support, stability and retention of obturator 27
- 30. Reconstruction: Depends on: Etiology of defect Size of defect Types: Surgical construction Prosthetic rehabilitation
- 31. surgical construction: Using soft or hard tissue. Disadvantage: 1. Not morphologically well 2. Difficult to build prosthesis on it 3. Not used with aggressive tumors(fear of recurrences)
- 32. Prosthetic rehabilitation: Before surgery: 1. Examine the patient 2. Gain mounted diagnostic casts 3. X-ray 4. Prophylaxis by restoring carious teeth ,extraction of hopeless teeth.
- 33. Prosthetic rehabilitation: After surgery: 1. Surgical obturator(immediate obturator) 2. Temporary transitional obturator 3. Definitive obturator
- 34. •Advantages •Retention of surgical obturators •Steps of construction •Modification of cast
- 35. Obturation :latin word means (to close) Inserted during or immediately after surgery It is a plate of clear acryl Should be left 7-10 days post surgically
- 36. Advantages: 1. Holds surgical pack to ensure close adaptation of skin graft to raw surface of cheek 2. Decreases oral contamination of wound 3. Improves speech 4. Improves deglutition 5. Decreases psychological impact of surgery 6. Faster healing
- 37. Retention of surgical obturator: 1. Clasps on remaining teeth 2. Suturing with mucosa 3. Ligature to remaining teeth 4. Wired to available structure
- 38. Steps of construction: 1. Impression 2. Outlining the resection by surgeon 3. Modification of cast(explained next slide)*** 4. Planning for retention 5. Waxing up with no artificial teeth 6. Processing in clear acryl 7. Surgical defect is filled with surgical pack or tissue conditioner
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- 42. …steps of construction: Modification of cast: Remove teeth to be included in resection Maintain alveolar ridge Restore palatal contour
- 43. •Steps of construction •Differences with surgical obturators
- 44. Constructed after 10 days of surgery In most cases, the surgical obturator is only modified by tissue conditioner.
- 45. Steps of construction: 1. Wax rim is added to surgical obturator and jaw relation is made 2. An opposing impression ,then pour ,then mount to articulator 3. Denture teeth are set ..process in heat cure resin 4. Reline in patient mouth periodically
- 46. Differences with surgcal obturators: 1. Teeth 2. More accurate 3. Obturator portion
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- 49. 1. Intro 2. Types 3. Steps of construction
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- 53. Started after complete healing(3-6 months) Treatment concept: 1. Clasps on remaining teeth 2. Lateral extention into defect 3. Engaging undercut over the scar band on cheek
- 54. Types: 1. Hollow (bulb)obturator. 2. Roofless(open top) obturator.
- 56. 1.hollow (bulb) obturator: It is an RPD with obturator portion that is hollow. How to construct it? As RPD steps.
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- 61. Hollow /bulb obturator: How is it made hollow???? method 1 1. After packing 2. open a vent 3. start to scrap the obturator portion 4. Cover the vent with self cure acryl
- 62. Hollow /bulb obturator: How is it made hollow???? Method 2 1. Pack the defect walls, 2. fill it with a sugar bag. 3. complete packing . 4. cure… 5. after curing , 6. open a small hole 7. dissolve the sugar
- 64. Advantage: 1. Simple 2. Light in weight 3. Easily adjusted Disadvantage: 1. Accumulation of secretion 2. Added weight and odor 3. Need very well selected cases
- 65. Steps of construction. 1. Special tray and ZnO impression to non defect side. 2. Mold defect with green compound..correcta wax impression…flask..cure. 3. Jaw relation..teeth setting on final base plate..attach teeth with self cure resin. 4. Teeth are chosen to be flat.
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- 68. Dr. Osama Gaber