OBTURATORS FOR ACQUIRED MAXILLARY DEFECTS

OBTURATORS FOR ACQUIRED MAXILLARY
DEFECTS
Guided by:
Dr. U.M. Radke Dr. N.A. Pande Dr. S Deshmukh
HOD & Guide Professor Reader
Dr. T.K. Mowade Dr. R. Banerjee DR. A. Chandak
Reader Reader READER
Presented by:
Dr. Richa Sahai
II MDS

• INTRODUCTION
• HISTORICAL REVIEW
• OBJECTIVES
• MATERIALS USED FOR FABRICATION
• CLASSIFICATIONS
• INDICATIONS AND FUNCTIONS
• DESIGN
• PROSTHETIC MANAGEMENT
• INNOVATIVE TECHNIQUES
• RECENT ADVANCES
• REFERENCES
CONTENTS

INTRODUCTION
• Defects in the maxillary jaw can be congenital, developmental, acquired,
traumatic or surgical involving the oral cavity and related anatomic structure.
• Defects can cause disruption of articulation and airflow during speech
production and also nasal reflux during deglutition.
• These changes require the fabrication of prosthesis and also sometimes
repeated prosthesis adjustments to confirm to the soft tissue changes.
• In such situation an obturator is designed to close the opening between the
residual hard and / or soft palate and the pharynx. The prosthesis provided for
these patients are called as OBTURATORS

DEFINITION (GPT 9)
• obturare - close or to shut off.
1. A maxillofacial prosthesis used to close a congenital or acquired
tissue opening, primarily of the hard palate and/or contiguous
alveolar/soft tissue structures
2. That component of a prosthesis that fits into and closes a defect
within the oral cavity or other body defect;

Ideal
requirements
for maxillary
obturator
Help the patient to
carry out natural
functions such as
phonation,
deglutition, and
mastication
Should exhibit life-
like appearance to
aid function
Design of the
prosthesis - easily
and swiftly placed
and held in position
both comfortably
and securely Prosthesis should be
durable , retain its
polish and finish
Should be easy to
clean so as to
maintain hygiene.

Ambroise Pare (1517-1590) :
• In one type – The dry sponge was attached to the upper surface of the prosthesis
expanded when moist, and kept the obturator from falling off.
• In another type – A turnbuckle type of mechanism to hold the prosthesis in
place.
HISTORICAL REVIEW

Pierre Fouchard (1678-1761) :
William Morton (1869) has been known to treat palatal defect patients with a
gold plate to which the patients missing teeth were soldered.
Matalon V. & La Feunte H (1976) outlined a simplified technique for processing
a hollow obturator using sugar to occupy space during processing.
The sugar was then removed leaving the interior of the prosthesis hollow, latter
sealed by self curing resin.

Objectives
of maxillary
obturator
Restoration of
esthetics or
cosmetic
appearance of
the patient
Restoration of
function
Protection of
tissues
Therapeutic or
healing effect
Psychological
therapy.

To achieve all these objectives, the obturator should have adequate support,
retention and stability.
SUPPORT
It gives resistance to movement of the prosthesis towards tissue.
Residual maxilla Within the defect
-Residual teeth
-Alveolar ridge
-Hard palate
-Floor of the Orbit
-Pterygoid Plate or Temporal Bone
-Nasal Septum

RETENTION
Retention is the resistance to vertical displacement of the prosthesis.
Residual Maxilla Retention
a) Teeth
• If the defect is small and remaining teeth are stable- intra coronal retainers.
• If the defect is large and all teeth are weak- extra coronal retainers.
b) Alveolar Ridge
• A large ridge with a broad ridge rest and flat palate is more retentive than small
ridge with tapering ridge crest and high tapering palate.

Within the defect retention
a) Residual soft palate
• Provides posterior palatal seal and prevent ingress of food.
• Extension of the obturator prosthesis into nasopharyngeal side of soft palate
provides retention.
b) Residual Hard Palate
• Under-cuts along the line of palatal resection into nasal or paranasal cavity or
medial wall of defect can increase retention.
• Obturator extension into the undercut is best provided by a soft denture base
material.

c) Lateral Scar Band
• Formation of scar band is more prominent laterally and
postero–laterally as compared to scar band anterior to
premolar region.
• These act as good undercuts for retention.
d) Height of lateral wall
• Engaging lateral wall of defect provides indirect retention.
• Longer radius undergoes less vertical displacement than
shorter radius.

STABILITY
Resistance to prosthesis displacement by functional forces.
Residual Maxilla Stability Within the defect stability
1. Residual Maxilla Stability
• This is done by providing bracing components to the prosthesis frame work.
• Extending bracing inter-proximally will minimize rotational as well as antero-
posterior movement of the prosthesis.
2. Within the Defect Stability
Maximal extension of prosthesis in all lateral directions.

MULTIDISCIPLINARYAPPROACH
MAXILLOFACIAL TEAM
• PLASTIC SURGEON
• SPEECH THERAPIST
• RADIO-THERAPIST
• PROSTHODONTISTS
• ORTHODONTISTS
• ORAL SURGEONS
• DENTAL TECHNICIANS
• ENT SPECIALISTS
• PSYCHIATRISTS
• SOCIAL WORKERS
Dr. Mahmoud Ramadan. Maxillofacial Prosthodontics, 3rd Ed

Materials used for fabrication
Ideal physical and
mechanical properties
• High edge strength
• High elongation
• High tear strength
• Softness, compatible
to tissue
• Translucent
Ideal processing
characteristics
• Chemically inert
after processing
• Ease of intrinsic and
extrinsic coloring.
• Long working time
• No color change
after processing
• Reusable moulds
Ideal biological
properties
• Non allergic
• Cleansible with
disinfectants
• Color stability
• Inert to solvents and
skin adhesives
• Resistance to growth
of micro-oraganisms

Classification of materials
1. Impression phase materials
• Reversible hydrocolloid
• Irreversible hydrocolloid
• Elastomeric materials
• Tissue conditioners

2. Modelling phase materials
• Modelling clay – water based clay (stone like substance
after becoming hard)
• Plastolene – modelling clay with oil base
• Waxes

3. Fabrication phase materials
• Rigid
i. Denture bases - metallic
- non metallic
ii. Teeth - porcelain
- acrylic
- composite
iii. Wires - Orthodontic hard round stainless steel wire
- nickel titanium wire
• Flexible
i. Acrylic copolymer or PMMA (palamed polyderm)
ii. Vinyl polymer and copolymers (mediplast, realistic)
iii. Polyurethane elastomers – HTV Silicones , foaming silicones, siphenylene

1) According to origin of the discrepancy
FOR CONGENITAL DEFECT
• To close the opening of hard
palate.
• An obturator with a tail,
consisting of speech aid
prosthesis.
• An overlay denture or a
superimposed denture.
FOR ACQUIRED DEFECT
• Immediate temporary
obturator or surgical
obturator is a base plate type
of prosthesis.
• Interim obturator, temporary
obturator, treatment
obturator, or transitional
obturator.
• Permanent obturator or
definitive obturator.

2) According to location of the defect
1. Lateral or buccal obturator
2. Alveolar obturator
3. Hard palate obturator
4. Soft palate obturator
5. Palatal lift prosthesis or obturator:
6. Pharyngeal obturator or speech aid prosthesis:

3) According to the type of obturator attachment to the basic
maxillary prosthesis
Fixed: It is stationary and directed toward the Passavant's pad.
Hinged: Connected to the main maxillary prosthesis by means of a hinge.
Meatus: extends obliquely upward from the hard soft palate junction to occlude against the
turbinate and superior aspect of nasal cavity up to the nasal meatus.
Detachable obturator: The maxillary prosthesis and obturator parts are held together by
some attachment.
Magnetically retained obturator: Two portions are connected to each other with the
magnets.
Implant retained obturator

4) Depending on the material used
a. Metal obturator
b. Resin obturator
c. Silicon obturator.
5) Obturator for
a. Dentulous mouth
b. Edentulous mouth

7) Classification of obturator by Chalian
A. Obturators for congenital defects of palate
i. To close opening of hard palate for correct swallowing, feeding and
speech.
ii. Restores hard and soft palate which aid in speech.
B. Obturators for acquired defects of palate
i. Immediate temporary obturator
ii. Temporary obturator for false palate, false ridge – no teeth hollow bulb or
closed bulb.
iii. Permanent obturator- post surgical cast

C. Obturator for dentulous and edentulous
i. Procedure – two piece hollow obturator
ii. Procedure – one piece hollow obturator
iii. Snap on prosthesis for marginal defects
iv. Snap on prosthesis for anterior segmental defects
v. Snap on prosthesis for lateral segmental defects
vi. Edentulous maxilla with no palatal segment

IndicationsTo act as a
framework.
To serve as a
temporary
prosthesis .
When surgical
primary closure is
contraindicated
When patient's
age
contraindicates
surgery
When size and
extent of the
deformity
contraindicates
surgery
When local
avascular
condition of the
tissues
contraindicates
surgery
When a
patient is
susceptible to
the recurrence
of original
lesion.

FUNCTIONS OF AN OBTURATOR
• To close the defect.
• For feeding purpose.
• To keep the wound or defective area clean.
• As a stent to hold dressings or packs post surgically.
• To reduce the possibility of postoperative haemorrhage (Lang & Bruce 1967)
• Help to reshape and reconstruct the palatal contour and/or soft palate
• Improves speech or in some instances, makes speech possible
• Help in reducing the flow of exudates, saliva from the mouth into the nasopharynx.
• To improve the aesthetics
• To benefit the morale of the patient with maxillary defects.
• To improve function when deglutition and mastication are impaired.

Advantages of an obturator
• Separation of oral and nasal
cavities to allow adequate
deglutition and articulation
• Possible support of the orbital
contents.
• Support of the soft tissue to
restore the midfacial contour
• Requires little or no surgery
• Less recovery period
• An acceptable aesthetic result
Disadvantages of an
obturator
• It has to be removed daily, cleaned
and reinserted
• Retention may not be satisfactory
• Occasional need of reconstructing
a new prosthesis

Mohamed Aramany in 1978 classified obturators for maxillectomy patients who
are partially edentulous into seven groups. It takes into consideration only the
hard palate defects

• Miller (1972) stated that unilateral design required bilateral retention and stabilization on
the same abutment teeth.

OBTURATORS FOR ACQUIRED MAXILLARY DEFECTS

• An indirect retainer is positioned perpendicular to the fulcrum line.
• Guiding planes are located at the distal surface of the anterior tooth as well as
the molar tooth
• Retention on all the abutment teeth is located on the buccal surface and
stabilizing components are on the palatal surface.

Depending on the phase of treatment or prosthetic rehabilitation of
acquired hard palate defects :
• The prosthodontic therapy for patients with defects of the maxilla can be arbitrarily
divided into three phases of treatment (Beumer III et al 1979, Weins 1990)
 Immediate surgical obturator
 Transitional obturator
 Definitive obturator

SURGICAL OBTURATOR
• It 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 or contiguous alveolar structure. (GPT 9)
• Placed immediately after surgery or seven to ten days post surgically.
• Initially limited to restoration of palatal integrity and reproduction of palatal
contours.
• Two types according to Beumer & Curtis :

1. IMMEDIATE SURGICAL OBTURATOR
Immediate surgical obturator is a baseplate type of appliance which is constructed
from the preoperative impression cast and inserted at the time of resection of the
maxilla in the operating theatre.
ADVANTAGES
1. Prosthesis provides a matrix on which the surgical packing can be placed.
2. Reduces oral contamination of the wound thus reducing the incidence of local infection.
3. Improves quality of speech.
4. Permits deglutition
5. Reduces the period of hospitalization (cost reduced).

Basic principles to design an immediate surgical obturators
(BEUMER & CURTIS)
1. Should terminate short of the skin graft mucosal junction.
2. Should be simple, lightweight and inexpensive.
3. Prosthesis of dentulous patient must be perforate at interproximal extensions for wiring
to teeth during surgery.
4. Normal palatal contours should be reproduced to facilitate postoperative speech and
deglutition.
5. Posterior occlusion should not be established on the side of the defect until the surgical
wound is well organized.
6. Existing complete partial prosthesis may be adapted for use as an immediate surgical
obturator.

Surgical obturator in dentulous patient (Rahn &
boucher)
1. Alginate impression is made for maxillary arch.
2. The impression is border molded in the soft palate area.
3. Impression is poured in stone and resection decided by the
surgeon and sketched on the cast
4. Teeth removed in designated area
5. Retention is obtained by 18 gauge wrought wires or ball
type retainers.
6. Obturator is waxed up to two thickness of base plate wax.
7. Artificial anterior teeth placed if required.
8. Invested and heat cured for 9 hours.

• Dentulous patient with partial maxillectomy the fulcrum line is dependent on
the placement of the occlusal rest.
• As more teeth are retained on the defect site the fulcrum line shift posteriorly.
• As the fulcrum line shifts posteriorly the disto-lateral extension of the
obturator should be lengthened as this area offers the greatest mechanical
advantage.
• Indirect retainer should be placed anteriorly as possible from the fulcrum line.

Squamous cell carcinoma of
right maxilla (upper jaw)
invading bone
A surgical obturator wired
in place after tumor was
removed.
Revision of the surgical obturator
In edentulous patient the prosthesis retention can be with help of :
• Bone screw retention
• Suture retention
• Circum-zygomatic retention
• Use of existing denture

DELAYED SURGICAL OBTURATOR
• An alternative is to place the prosthesis 7-10 days post surgical.
• After initial healing and removal of the pack the immediate obturator is usually
discarded and replaced by transitional or temporary prosthesis having a definite
bulbous extension and occasionally artificial anterior teeth.

INTERIM OBTURATOR
Rahn & Boucher
This bridges the gap between the immediate surgical obturator and the definitive
prosthesis.
OBJECTIVES
• To maintain patient comfort
• To maintain palate junction until definitive prosthesis can be fabricated

Procedure :
1. Prosthesis processed in conventional manner.
2. The prosthesis is tried in the patients mouth.
3. The acrylic resin cavity on the palatal side of the obturator is filled with wax
until proper contour of the palate is established.
4. Thin layer of separating media placed over the wax and acrylic resin.
5. Plaster cast is poured & over the wax and extended onto the acrylic resin .
6. The wax is removed from the defect side and acrylic resin separating medium is
placed on the superior portion of the core.
7. Auto-polymerizing acrylic resin is sprinkled to a thickness of 1-2mm , the core is
invested and pressed into contact with prosthesis and held firmly till resin sets.
8. Excess acrylic resin is trimmed away and obturator is polished.

DEFINITIVE OBTURATOR
• Three to four months after surgery consideration may be given to construction of the
definitive obturator prosthesis.
• If Osseo-integrated implants are placed at the time of tumor resection, fabrication of the
prosthesis is delayed until the implant is exposed and the soft tissues around it has healed.

General impression making procedure for a definitive obturator
• Edentulous stock metal tray is selected.
• The undercuts and fistulas are blocked out with a gauze lubricated with
petroleum jelly.
• Tray adhesive is applied to the tray.
• Irreversible hydrocolloid impression material is mixed and loaded in the tray.
•Impression is made and a diagnostic cast is obtained.

• The undesired undercuts recorded in the cast are
blocked out with wax.
• Custom acrylic resin tray is made extending 2-3 cm
into the defect cavity.
• Relief of one thickness base plate wax is provided.
• Conventional border molding technique is advocated
using modeling plastic asking the patient to do all
eccentric movements.
• Several perforations are made for the exit of the
impression material with at least 3 perforations along
the medial palatal margin.

• The tray is painted with the adhesive.
• Elastic impression material is loaded on the tray, excess
secretions are wiped from the surface of the palate, material is
injected into the reasonable undercut areas and impression tray
seated into position.
• The lip and cheek are manipulated and patient is instructed to
perform movements of the mandible.
• After the material is set the impression is removed with a gentle
teasing action.

• The vertical dimension of occlusion is established in the customary manner
with the wax rim on the record base.
• In case of palatal defects stabilized baseplate is made and followed into the
defect area.
• At this stage, a wax lid is fitted over the defected area to leave it hollow and
provide the effect of a complete palate.
• The wax rim are reduced to the proper level, the arbitrary face bow is
obtained and centric jaw relation is recorded. Graphic centric relation records
produced by intra or extra oral devices are contra-indicated.
• The teeth are set to contours established by the wax rim.
• In edentulous patient non-anatomic posterior teeth are preferred and tried in
patients mouth.

Stress breaker concept
• Maxillofacial prosthetic patient has an added problem of movable basal seat.
• This can be provided by the combination clasp that Applegate described with one arm
consisting of a flexible wrought wire and the opposing arm consisting of a rigid cast
arm.
• A double or split-bar type of stress breaker on the posterior teeth or The truss bar
retainer can be used.
Swing-Lock partial denture framework design
concept (Javid & Dadmanesh)
A swing-lock design for clasp retention of the obturator
prosthesis by A “gate clasp” was first described by Ackerman in
1955 and swing-lock concept was introduced by Simmons in
1963

Schmaman (1992) described ”Foam impression technique” to overcome
the problems of withdrawal of maxillectomy defect impressions with or
without limited space as the result of trismus

• Snap on prosthesis for marginal defects.
• Snap on Prosthesis for Anterior segmental defect - The versatile snap-on
mechanism can also be adapted to provide trans-palatal splinting when the anterior
palatal defect is large. To minimize tilting, looseness, and occlusal stress on the
remaining teeth, a clip attachment is centrally placed to engage the palatal rod.
• Prosthesis for lateral segmental defects of edentulous maxilla with no
palatal opening - Often trial dentures are made to permit the patient to have a
positive experience of closure and centric stop for occlusion. Then, when facial
symmetry and patient comfort have been achieved, the final prosthesis is fabricated,
ChalianVA, Drane JB, Standish SM; Maxillofacial Prosthetics- Multidisciplinary Practice; Williams & Wilkins1971; 1-13,89-121; 133-158,358-424

BULB DESIGN OBTURATOR GIVEN BY CHALIAN
• THE CLOSED HOLLOW BULB DESIGN
1. Two piece hollow obturator
2. One piece hollow obturator
• THE OPEN BULB DESIGN

FABRICATION OF ONE PIECE HOLLOW BULB OBTURATOR
(According to Chalian and Barnett)
Procedure :
• Try the trial denture in the mouth and make necessary modifications.
• Boil out the wax in the conventional manner.
• Block out the undercut area in the cast of the defect.

• Relieve the entire defect area with one thickness of base plate wax.
• Place three stops in the wax which will be deep enough to reach the underlying
stone of the master cast.
• Place one thickness of base plate wax in the top half of the flask over the teeth
and palate area to form the top wall of the shim.

• Mix the auto-polymerizing acrylic resin and allow it to come to a dough
consistency.
• Contour a layer of dough consistency acrylic resin over the wax relief to make
hollow shim.
• Close the flask and allow the resin to cure for 15 min.
• Flush the wax from the acrylic resin shim with a steam of boiled water.

• Trim all the excess of acrylic resin from the shim.
• Replace the heat cure acrylic resin shim using 3 stops for correct positioning.
• At this stage see that there is at least one thickness base plate wax between the
shim and the cast.

• Mix the heat cure acrylic resin in the usual manner.
• Place a layer of acrylic resin in the bottom of the defect.
• Reinsert the processed acrylic resin shim over the still
soft acrylic resin mix in the defect.
• Add more acrylic resin to the top half of the flask and
packing is done.
• Cure the resin in the usual manner.
• De-flask it and trim and polish in usual manner.
Placement of acrylic resin shim and denture processing

FABRICATION OF TWO PIECE HOLLOW BULB OBTURATOR
1. Make an impression that includes the palatal defect to be obturated.
2. Pour a stone cast, separate and prepare key at the border of the cast.
3. Apply a suitable separating media to the stone surface.
4. Clay is sculpted to the palatal defect and missing alveolus.
5. Pour a plaster (plaster cap) over the clay, including the keys in the master cast.

- Remove the plaster cap when it sets, take out the clay and
discard it.
- Coat the tissue side of the plaster cap with a suitable
separating media.
- Apply thin layer of self cure acrylic resin to the defect (E)
and tissue surface of the plaster cap(F).
- Soft acrylic resin is added into the border of E and F and
into the border of D adjacent to E.
- Invert the plaster cap into the master cast.
- Check the key for the proper fit and allow the acrylic
resin to cure.
- Remove and finish the bulb in usual manner.
E F
D

ADVANTAGES OF HOLLOW BULB OBTURATOR
• Weight of prosthesis is reduced, and it is more comfortable and
efficient.
• Problems of retention are overcome
• Increases physiologic function.
• Decrease in pressure to the surrounding tissues aids in deglutition and
encourages the regeneration of tissue.
• Does not add to the self consciousness of wearing a denture.
• Does not cause excessive atrophy and physiologic changes in muscle
balance.

Techniques for hollowing an obturator
Classic technique is to grind out the interior of the bulb after processing
while monitoring the thickness of walls.
• Parel and La Fuente in 1979 – cellophane and sugar or salt to make hollow
obturators
• El Mahdy and Guelde in 1969 – used two flasks with interchangeable parts
• Worley and Kniejski in 1983 – used asbestos, a filler material that is absent
from the final prosthesis.
• Aaron Schneider in 1978 described a technique utilizing double investment
procedure processing and used crushed ice.
• Chalian, Barnett et al in 1972— used double flask technique.

1. SILICONE OBTURATOR PROSTHESIS
• Hahn, Wood and Carl, Vergo and Chapman (1980)
• Obturator part – silicone material
• Denture – Acrylic Resin.
• Adhesive attaches both parts.
Advantages :
• Flexible material-permits partial collapse of obturator  overcomes trismus
• Allows entry through a palatal fenestration to a larger cavity above.
• Enhances potential for retention by use of more severe, diveregent undercuts.
• It may gain additional support from the cavity, thus minimize both the leverage
and force applied to the residual ridge.
• Can be remade independently .
Innovative techniques

2. INFLATABLE OBTURATOR PROSTHESIS
• A.G.L. Payne & W.G. Welton (1965)
• It consists of a latex rubber balloon attached to a denture by means of a
silicone rubber former, into which is incorporated an air valve.
• The balloon is inflated with air to fill the surgical defect with this inflator.

3. Titanium and visible light – polymerized (VLP) resin obturator technique
• Described by I.C.Benington (1989)
ADVANTAGES : light and biocompatible framework and facilitates the task of adjustments
and reline chair side.

Open bulb obturator
• Reduces weight of the obturator.
• Improves speech .
• Facilitates hygiene .
• Easier to make.
• Receptacle for nasal secretions and food  remove & clean more often
• Difficulty in polishing internal surface
Shifman, A. (1983). A technique for the fabrication of the open obturator. The Journal of Prosthetic Dentistry, 50(3), 384–385. doi:10.1016/s0022-
3913(83)80098-5
An alternative is an obturator with removable lid given by
Arie Shifman 1983.
Thin and small lid can be made up of vacuum formed
thermoplastic resin sheets

Bengal Journal of Otolaryngology and Head Neck Surgery Vol. 25 No. 2 August, 2017

Prosthodontic rehabilitation of a patient with total avulsion of the maxilla
• Thin acrylic resin obturator record base is made first.
• With subsequent visits, an additional layer of functional impression material is placed in
the intaglio surface of the record base.
• Patients’ speech, swallowing are monitored with each addition aided by the use of
palatograms, until the contours and level of the palate produces satisfactory speech and
allow the patient to swallow comfortably.
• Teeth arrangement is done acc. to phonetics and neutral zone concept.

Spring retained surgical obturator for total maxillectomy patient
Patil PG, Parkhedkar RD. New spring retained surgical obturator for total maxillectomy patient. J Indian Prosthodont Soc 2009;9:33-5

Enhanced retention of a maxillofacial prosthetic obturator using Precision Attachments
Eur J Dent. 2012 Apr; 6(2): 212–217.

J. Kortes, H. Dehnad, A. N. T. Kotte, W. M. M. Fennis, A. J. W. P. Rosenberg: A novel digital workflow to manufacture personalized three-
dimensional-printed hollow surgical obturators after maxillectomy. Int. J. Oral Maxillofac. Surg. 2018
A novel digital workflow to manufacture personalized three-dimensional-printed
hollow surgical obturators after maxillectomy

Intraoral
retention
Anatomical Mechanical
Temporary
S.S Wire Claps
Preformed
Bands/Crow
ns
Permanent
Clasps
Precision
Attachment
Overlay/Swi
ng-Locks
Adhesives
Magnets Implants

Retention
Intraoral retention
Anatomical Mechanical Anatomical Mechanical
Temporary Permanent - Eye glasses
- S.S. wire - Clasps - Magnets
- Clasps - Precision attachment - Buttons
- Preformed - Overlay, Swing-lock - Adhesives
Bands/crowns - adhesives - Implants
etc. - Magnets etc.
- Implants etc.
Combination of above

Implants as a retentive aid in obturators
• Osseo-integrated implants may assist in retention, stability, and support of obturator
prostheses.
• Mastication is significantly improved, and speech and swallowing are made more
efficient. Thus, adaptation to the prosthesis is much easier for the patient.
• The overall survival rate for implants supporting maxillofacial prosthesis was reported to
be more than 95%.
• Dental implants can be used in both the defect and non-defect sides of the maxillary arch.
• If Osseo integrated implants have been placed at the time of tumor resection, the
fabrication of the definitive prosthesis is delayed until the implants are exposed and the
peripheral soft tissues around them have healed.
Ahmed Yaseen Alqutaibi, “Enhancing retention of maxillary obturators using dental implants,” Int J Contemp Dent Med Rev, vol. 2015,
Article ID: 010915, 2015.

Implant sites in maxillectomy patients :
1. The residual pre-maxillary segment
2. The maxillary tuberosity
3. Residual elements of the zygoma
Types of Osseo-integrated Implant Used in Maxillectomy Patients
1. Conventional implants
2. Mini dental implants
3. Zygomatic implants.
Attachment mechanism of the prosthesis to the implants.
1. Magnet attachment
2. Stud attachments- including ball locators, ERA attachments
3. Bar attachment

Conclusion:
• Obturators are one of the most commonly designed prosthesis in the day to
day practice.
• Since introduction, the obturators have undergone many modifications. The
knowledge of the basic principles aids in obtaining better support, retention
and stability for the prosthesis.
• There are, however, no hard and fast rules that a design should follow. The
basic designs should be modified as the clinical situations demand.

REFERENCES
1. Aaron Schmider: Method of fabricating a hollow obturator. J. Prosth. Dent 40:351, 1978.
2. Aramany M.A: Basic principles of obturator design for partially edentulous patients. Part
I : Classification, J. Prosth. Dent, 40:351, 1978.
3. Desjardins R.P. : Obturator prosthesis design for acquired maxillary defects. J. Prosthet
.Dent, 1978, 39; 424.
4. Matalon J.W. et al – A simplified method for making a hollow obturator. J. Prosht. Dent.
36:580-82, 1976.
5. Tanaka et al – a simplified method for fabricating a light weight obturator. J. Prosth.
Dent. 38:638-42, 1977.
6. Russell R. Wang – Refilling hollow obturator base using light activated resin J. Prosth.
Dent. 78:327, 1997.

7. Gregory R. Parr – Prosthodontic principles in the frame work design of
maxillary obturator prosthetics. J.PD 62:205, 1989.
8. Oscar E. – Rapid technique for constructing a hollow – bulb provisional
obturator. JPD 39:237, 1978.
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13.Benington IC. Light-cured hollow obturators. J Prosthet Dent 1989;62:322-5
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158,358-424

Thank You!
“THERE IS NO ELEVATOR IN REHABILITATION;
YOU HAVE TO SLOWLY TAKE THE STEPS
-N Parre

OBTURATORS FOR ACQUIRED MAXILLARY DEFECTS

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OBTURATORS FOR ACQUIRED MAXILLARY DEFECTS