This document discusses considerations for maxillofacial prosthetics, including indications, goals, and types of obturators. It provides details on managing a partially dentate patient undergoing hemimaxillectomy. Key points addressed include: - Indications for maxillofacial prosthetics include when surgical reconstruction is contraindicated or as a temporary prosthesis during surgical correction. - Goals of maxillofacial prosthetics include being easily placed/removed, restoring lost function, and having a near-normal appearance. - A 56-year-old male requiring hemimaxillectomy would receive pre-operative dental management and impressions to aid in construction of a surgical obturator. -

1. RPD Consideration in
Maxillofacial
prosthodontics (II)
BY
DR AYESHA SADAF

2. Indications of maxillofacial prosthesis
 In situations when surgical reconstruction is contraindicated
a) Defect is too large to be closed by plastic surgeon
b) Extremes of age: too young or geriatric patients
c) Patient undergoing radiotherapy

3. Indications of MaxilloFacial
Prosthesis
 When the patient is susceptible to recurrence of the original lesion which
produced the deformity.
 To serve as a temporary prosthesis during the period of surgical correction;

5. GOALS OF MAXILLOFACIAL
PROSTHESIS
 Should be easily placed and removed
 Should fix the lost function
 The appearance should be close to normal
 Should be easily cleaned
 Should be long lasting and resistant
 Should not have dimensional changes
 Should be light and easy to fabricate

6. OBTURATOR
That component of a prosthesis that fits into and closes
a defect within the oral cavity or other body defect.
(GPT – 9)

7. FUNCTIONS OF OBTURATORS
ENHANCE POST
SURGICAL HEALING
CLOSURE OF DEFECT
REDUCE POST OPERATIVE
HEAMORRHAGE
RESHAPE AND RECONTOUR
THE PALATE
PSYCHOLOGICAL BENEFITS
IMPROVE ESTHETICS
HELP IN MASTICATION, SPEECH ,
DEGLUTITION

8. CLASSIFICATION OF OBTURATORS
BASED ON THE PHASE OF
TREATMENT
1. SURGICAL OBTURATORS
2. INTERIM OBTURATORS
3. DEFINITIVE OBTURATORS
a. closed hollow bulb obturators
b. open bulb
BASED ON MATERIAL
USED
1. METAL OBTURATOR
2. SILICONE OBTURATOR
3. RESIN OBTURATOR

9. CLINICAL MANAGEMENT OF A PARTIALLY
DENTATE MAXILLECTOMEY PATIENT
A 56 year old male patient was referred from maxillofacial surgery department to the
prosthodontic department of a tertiary care hospital. Patient had squamous cell carcinoma
involving the hard palate. Hemimaxillectomy was planned by the maxfacs surgeon. How will you
manage the patient prosthodontically

10. Pre-operative Considerations
Prosthodontist is concerned with the four objectives
1. PSYCHOLOGICAL SUPPORT OF THE PATIENT
2. PRE-OPERATIVE DENTAL MANAGEMENT.
4. SUGGESTIONS FOR THE SURGEONS
3. PRE-OPERATIVE IMPRESSIONS

11. PRE-OPERATIVE DENTAL
MANAGEMENT
1. ALL MAXILLARY TEETH THAT CAN BE
PRESERVED SHOULD BE PRESERVED
2. GROSS SCALING AND PROPHYLAXIS
3. CARIES EXCAVATION AND
PROVISIONAL RESTORATION
4. ENDODONTIC TREATMENT OF
NONVITAL /PULP EXPOSED TEETH

12. PRE-SURGICAL IMPRESSIONS
 TWO PRESURGICAL
IMPRESSIONS OF BOTH
MAXILLA AND MANDIBLE ARE
RECOMMENDED BEFORE
SURGERY
 ONE IMPRESSION WILL BE
FOR THE PATIENTS RECORD
 SECOND IMPRESSION
WILL BE FOR THE
CONSTRUCTION OF
SURGICAL OBTURATOR

13. SURGICAL ENHANCEMENT
& SUGGESTIONS FOR SURGEONS
 Preservation of as much alveolar bone as possible and hard palate
 Resection should be made through the socket of extracted tooth
 Preservation of as much teeth as possible
 Cover the denuded bone
 Interproximal cuts should be avoided

14. Retain as much ant max as possible

15. Incision through the socket
Palatal
incision
Bony cut

16. Considerations in Obturator Prosthesis
Design
SUPPORT
RETENTION
STABILITY

17. Considerations in Obturator Prosthesis Design
RESIDUAL
MAXILLAE
WITHIN
DEFECT RESIDUAL TEETH, ALVEOLAR
RIDGE, HARD PALATE
FLOOR OF THE
ORBIT, BONY
STRUCTURES OF
THE PTERYGOID
PLATE, ANT
SURFACE OF
TEMPORAL BONE
SUPPORT

18. Considerations in Obturator Prosthesis Design
SUPPORT FROM THE FLOOR OD THE ORBIT
SHOULD BE MINIMAL DUE TO ADDITIONAL WEIGHT
AND DIFFICULTY OF FABRICATION

19. Considerations in Obturator
Prosthesis Design
Retention is the resistance to vertical displacement of the prosthesis.
 Retention is provided by
A. Within the residual maxilla
B. Within the defect
A. Residual Maxilla Retention-is provided by teeth in a dentate patient.
 If the defect is small and remaining teeth are stable, intra coronal retainer can
be used.
 ii) If the defect is large and all teeth are weak, extra coronal retainers should
be used.

20. Considerations in Obturator Prosthesis
Design
 i) If the defect is small and remaining teeth are
stable, intra coronal retainer can be used.
 ii) If the defect is large and some or all teeth are
weak, extra coronal retainers should be used.

21. Considerations in Obturator Prosthesis Design
RETENTION WITH IN THE DEFECT
 The following structures should be considered for retention
within the defect.
a) Residual soft palate
b) Residual hard palate
c) Anterior nasal aperture
d) Lateral scar band
e) Height of lateral wall

22. Considerations in Obturator Prosthesis
Design
Residual Hard Palate
 Under cuts along the line of palatal resection into, nasal or para nasal
cavity or medial wall of defect can increase retention.
 Obturator extension into the undercut is best provided by a soft
denture base material.
 The extension shouldn’t contact the nasal septum or the turbinates

23. Considerations in Obturator Prosthesis
Design
Lateral Scar Band
 For adequate surgical closure, most maxillary resections are lined with
split – thickness skin graft along the anterior lateral and postero –
lateral walls of defects.
 This results in the formation of scar band which is more prominent in
laterally and postero – laterally as compared to scar band anterior to
premolar region.
 These act as good undercuts for retention.

24. It is advantageous to provide maximal bracing and to
extend this bracing interproximally when possible to
minimize rotational as well as anteroposterior movement
of the prosthesis.

26. STABILITY
 Movement of the prosthesis within the horizontal plane can be
anteroposterior, mediolateral, rotational, or a combination of any or all
of these directions. As with retention and support specific areas of the
residual maxilla, as well as the defect itself, must be considered in
minimizing the extent of these potential movements.
Residual maxilla
 If natural teeth remain, the bracing components of the prosthesis
framework can be used to minimize movement in all three directions.

27. It is advantageous to provide maximal bracing and to
extend this bracing interproximally when possible to
minimize rotational as well as anteroposterior movement
of the prosthesis.
STABILITY

28. Occlusion FOR STABILITY
 Occlusion is a very important aspect for stability of the prosthesis.
an unstable prosthesis is the result if the occlusal relationship fails to
maintain intimate contact of the prosthesis with the supporting and
the retentive structures.
 To minimize the movement of the prosthesis, maximum distribution
of occlusal forces is essential.
 Mastication over the defect should be avoided.

29. Purpose of the prosthetic dentition on defect side:
 Esthetic display
 Lip support
 Prevent opposing dentition from super-erupting
Occlusal scheme
 Centric only contact on the defect side is preferred.
 Lateral interferences should be removed.

30. ARMANI CLASSIFICATION FOR
MAXILLECTOMY DEFECTS