Lecturer, University Of the West Indies School Of Dentistry
Documentation and Description of the fabrication and use of Obturators made from Myerson Duracetal.
Rehabilitation of large resection defects of the Maxilla pose several challenges to Prosthodontists and patients alike. Difficulty arises in gaining support and retention for the prosthesis from tissues which can withstand the various forces in the oral cavity, while reducing the damage caused by the prosthesis itself. This is especially so in cases where the use of implants is contraindicated or not possible given the clinical situation. Traditionally Cobalt Chrome has been the materia of choice. These prostheses however can be bulky, unaesthetic and heavy. In the four cases presented, Myerson Duracetal was used for the fabrication of Obturator Prostheses in four (4) patients. The steps in fabrication are outlined. The patients' perception of function as assessed using the Obturator Function Scale4 (Table 1) is also presented. Despite technical challenges, Myerson Duracetal was successfully used in fabrication of light, stable, retentive, aesthetic prostheses which could be adapted to the evolving defects. Further updates will be added after the presentation of this topic as a poster at the 2017 Greater New York Dental Meeting
Abstract: Odontogenic tumours involving the maxilla or mandible are usually treated with surgical resection. To prevent recurrence, extensive surgical intervention might be carried out leaving the patient with anatomical defects. However, rehabilitation of such patients with an obturator can improve function, facial form and social acceptance. In this case, we have evaluated the different designs and techniques of fabrication of an obturator prosthesis used for the rehabilitation of a hemipalatomaxillectomy patient. A 40-year-old man presented with a loose fitting obturator prosthesis. He had undergone hemipalatomaxillectomy for the treatment of an ameloblastoma 2 years earlier and had been using an obturator prosthesis since then. Hollow-bulb obturator prostheses were fabricated using two different methods, the lost salt and open lid techniques. The obturator prosthesis fabricated with the lost salt technique weighed less than the patient's old obturator. But the obturator fabricated using the open lid technique did not only considerably reduce the weight of the prosthesis but also improved health, function, aesthetics, phonetics and quality of life in this hemipalatomaxillectomy patient.
Pub.: 05 Sep '14, Pinned: 26 Jun '17
Abstract: A digitally captured, designed, and fabricated facial prosthesis is presented as an alternative to customary maxillofacial prosthodontics fabrication techniques, where a facial moulage and patient cooperation may be difficult.
Pub.: 18 Apr '15, Pinned: 26 Jun '17
Abstract: Maxillary obturator prostheses with hollow metal obturators can be made of titanium to reduce weight. To prevent perforation of the hollow obturator during modifications, the obturator is slightly undersized and covered with a replaceable cap. This cap is made of a soft copolymer to facilitate uncomplicated modifications in the resection area and to improve function.
Pub.: 20 Nov '15, Pinned: 26 Jun '17
Abstract: Publication date: Available online 2 November 2015 Source:Tanta Dental Journal Author(s): M.M. Amer, H.A. Rashad, S. Abdallah Objectives The objective of this study was to analyze the stress distribution around dental implants for different designs of implant supported obturator in cases of midline maxillary defect using a 3-dimensional finite element analysis. Methods A model of edentulous patient with midline maxillectomy is transferred to digital (CAD) model using 3D coordinate measuring machine, Finite element models were formed using ABAQUS package, creating 3 models rehabilitated with different designs of implant retained obturator prostheses using different attachment types of dental implants in the alveolar bone on the unaffected side, three implants with ball& socket, magnet and bar & clips. A 100 N load was applied bilateral vertically and unilateral vertically and obliquely on the defect side, and von Mises stresses in the cortical bone around implants were evaluated and compared. Results All the models showed the highest stress values under oblique load that applied on the defect side around the most anterior implant, the ball & socket models exhibited the lowest stresses followed by the magnet then the bar & clips models which showed the highest stress values.
Pub.: 04 Nov '15, Pinned: 26 Jun '17
Abstract: This study surveyed non-United States maxillofacial prosthodontists (MFP) to determine their practice profile and rationale for pursuing an MFP career.Email addresses for the MFP were obtained from the International Society for Maxillofacial Rehabilitation, American Academy of Maxillofacial Prosthetics, and International Academy for Oral Facial Rehabilitation. Emails with a link to the electronic survey program were sent to each participant. Chi-square and Mann-Whitney-U tests were used to investigate the influence of formal MFP training on professional activities and type of treatments provided.One hundred twelve respondents (response rate 39%) from 33 nationalities returned the survey. The top three reasons for pursuing an MFP career were personal satisfaction, prosthodontics residency exposure, and mentorship. The predominant employment setting was affiliation with a university (77%). There were significant differences between respondents with and without formal MFP training regarding provision of surgical treatments (P = 0.021) and dental oncology (P = 0.017). Most treatments were done together with otolaryngology, oral surgery (68%) and head and neck surgery (61%). Practitioners not affiliated with a university spent significantly more time in clinical practice (P = 0.002), whereas respondents affiliated with universities spent significantly more time in teaching/training (P = 0.008) and funded research (P = 0.015).Personal satisfaction is the most important factor in a decision to choose an MFP career. Most of the MFPs work at a university and within a multidisciplinary setting. There were differences regarding type of treatments provided by respondents with and without formal MFP training.
Pub.: 30 Apr '17, Pinned: 26 Jun '17
Abstract: Patient perspectives on the treatment options for maxillary defects, which include free tissue transfers or obturator prostheses, may help eliminate current uncertainty as to the best choice of treatment plan.The purpose of this systematic review was to evaluate the quality of life (QoL) of patients with maxillary defects who had undergone restoration with obturator prostheses and/or free tissue transfers.A systematic search of Medline/PubMed and Web of Science databases for articles published before April 2015 was performed by 2 independent reviewers. A manual search of articles published from January 2005 to March 2015 was also conducted. Studies published in English that evaluated the QoL in patients with head and neck cancers were included. The Cohen kappa method was used to calculate inter-reviewer agreement.Ten studies were included. The University of Washington Head and Neck Questionnaire (UW-QOL) was most commonly used to measure QoL. The majority of maxillary defects were Class IIa-b. Two studies reported that the global QoL for patients with obturator prostheses is equivalent to or even better than that of other chronic disease populations. One study revealed no significant difference in QoL when the 2 treatment options were compared.The limited data indicate that the QoL of patients treated with obturator prostheses and that of patients free of tumors is similar. Well-designed clinical studies are necessary to draw definitive conclusions about how obturator prostheses compare with free tissue transfers in terms of affecting patient QoL.
Pub.: 21 Oct '15, Pinned: 26 Jun '17