This document provides an overview of maxillofacial prosthetics. It discusses the history of artificial facial parts dating back to ancient Egypt and China. It defines maxillofacial prosthetics as reconstructing missing or defective regions of the maxilla, mandible, and face. The document outlines the types of maxillofacial prosthetics including intraoral and extraoral prosthetics. It also discusses indications, management of patients, and rehabilitation approaches for conditions like surgical defects, trauma, congenital defects, and acquired defects. Key aspects covered include immediate post-surgical obturators, transitional obturators, and definitive obturators.
This document provides an overview of maxillofacial prosthetics. It discusses the history of artificial facial parts dating back to ancient Egypt and China. It defines maxillofacial prosthetics as reconstructing missing or defective regions of the maxilla, mandible, and face. The document outlines the types of maxillofacial prosthetics including intraoral and extraoral prosthetics. It also discusses indications, management of patients, and rehabilitation approaches for conditions like surgical defects, trauma, congenital defects, and acquired defects. Key aspects covered include immediate post-surgical obturators, transitional obturators, and definitive obturators.
Original Description:
fabrication and case reports of pts. using various obturators
This document provides an overview of maxillofacial prosthetics. It discusses the history of artificial facial parts dating back to ancient Egypt and China. It defines maxillofacial prosthetics as reconstructing missing or defective regions of the maxilla, mandible, and face. The document outlines the types of maxillofacial prosthetics including intraoral and extraoral prosthetics. It also discusses indications, management of patients, and rehabilitation approaches for conditions like surgical defects, trauma, congenital defects, and acquired defects. Key aspects covered include immediate post-surgical obturators, transitional obturators, and definitive obturators.
This document provides an overview of maxillofacial prosthetics. It discusses the history of artificial facial parts dating back to ancient Egypt and China. It defines maxillofacial prosthetics as reconstructing missing or defective regions of the maxilla, mandible, and face. The document outlines the types of maxillofacial prosthetics including intraoral and extraoral prosthetics. It also discusses indications, management of patients, and rehabilitation approaches for conditions like surgical defects, trauma, congenital defects, and acquired defects. Key aspects covered include immediate post-surgical obturators, transitional obturators, and definitive obturators.
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Maxillofacial Prosthetics
: . 1 1. Hussam Al-Selami. 2. Sadam Al Squor. 3. Abdel Rahman Sabsoob. 4. Thabet Alnaqeeb. 5. Nooraldeen Al Mufti. 6. Ali Nassar. 7. Mahmood Zaitawi.
2013 History Artificial facial parts found on Egyptian mummies long time ago. Ancient Chinese known to have made facial restorations. 1953 -- American Academy of Maxillofacial Prosthetics founded. 2 Overview Maxillofacial prosthetics is a branch of prosthodontics in dentistry. Main aim is to restore the function and esthetics of an individual. Its also approve a psychological state of a patient after a trauma or surgery.
3 Maxillofacial Prosthetics The art and science of anatomic, functional, or cosmetic reconstruction by means of nonliving 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 malformations. 4 Type of M.F.P
Intra-Oral
Extra-Oral 5 Indications of MFP After surgical intervention.
After trauma.
Congenital defects.
Acquired defects. 6 Prosthetic vs. Surgical Rehabilitation Individualized decision between patient and doctor.
Removable prosthesis allows for cancer surveillance.
Destruction amount.
Malignancy recurrence. 7 Intraoral vs. Extraoral Intraoral -- mostly functional Mandible Maxilla Extraoral -- cosmetic Ear Nose Orbit 8 Management of patient for MFP. Personal history of a patient should be obtained.
Dental and medical history also should be obtained.
Intra and external examination of a patient by a maxillofacial surgeon and prosthodontics should be done.
9 Management of patient for MFP. Patients risk assessment should be done. A surgeon should consulate with a dentist about a surgery so that there should be a team work. All surgical alterations should be demonstrated for a dentist on a cast and obturator should be made for a day of a surgery.
10 Psychosocial Issues 11 Dental Impression Surgeon has marked resection for prosthodonti c planning. 12 Post surgical management. After a surgery and even before its a team work for a rehabilitation of a patient that includes:
Lip and palate development: Upper lip develop by coalescence of the premaxilla and maxillary growth centers on either sides to produce the complete lip. Fusion of the of the lip developing from growth centers commences around each nostril floor and spreads downwards towards the lower border of the lip uniting the premaxilla and maxillary process in each side.
14 Congenital defects
Failure of this union will result in a cleft lip that varies from a notch on one side to complete bilateral cleft of the lip that may extend up to into each nostril.
15 Congenital defects
The palate: Palate develops from the max. and premix. growth centers, union of the three segments commencing at the region of the nasal floor presented in full development by the nasal foramen. Union from this point proceeds backwards until both the hard and soft palates and uvula have united, and forwards along the of the future maxillary and premaxillary structures eventually. 16 Congenital defects Lack of fusion of the palatal shelves either completely or partially occurs during embryonic growth side.
Failure of union of palatine processes at any stage will result in a cleft palate which may be pre-alveolar ( cleft lip ) or post alveolar ( cleft palate ) .
Cleft palate between 6th 9th wk. of the embryonic life. 17 Congenital defects
Classification of cleft palate Pre-alveolar e.g. cleft lip Post alveolar any cleft from uvula up to incisive foramen. Alveolar cleft extending from uvula to alveolar ridge and lip either unilateral or bilateral.
18 Congenital defects
Effects of cleft palate and lip 1. Speech lack of valvopharyngeal closure leads to escape of air through the nose (nasal speech) 2. Deglutition greatly impede the feeding, regurgitation and escape of fluids through the nose takes place . 3. Mastication impaired due to escape of food through the nasal cavity and due to missing teeth and malocclusion . 19 Congenital defects 4. Esthetics is effected seriously especially in cleft palate and / or lip. 5. Deterioration of the general health 6. Psychological trauma . 7. Recurrent infection of the air ways and middle ear .
20 Congenital defects Management of cleft lip and palate Include the following: A. Surgical closure It is the treatment of choice for palatal cleft closure. It superior to prosthetic closure by obturator. If cleft involves the lip, it is advisable to repair it as early as possible (6 wks. after birth) to facilitate feeding and improve appearance. Surgical closure of palatal cleft is better to be done before the end of the second year of age.
21 Congenital defects B. Prosthetic restoration o Feeding appliances. o Simple palatal plate to close cleft. o Speech aid obturator. o Over denture.
C. Orthodontic o To correct the malaligned teeth or expand the maxillary arch.
22 Congenital defects
Reason for early closure of cleft palate
1. To produce longer and more mobile soft palate with better muscular development and 2. velopharyngeal closure. 3. To habilitate the patient for normal speech. 4. To allow undisturbed growth of maxilla.
23 ACQUIRED PALATAL DEFECTS
DEFINITION: Lack of continuity of originally intact palatal structures through the whole or part of its length. Etiology: Surgical e.g. tumor removal. Traumatic fracture of maxilla. Pathological conditions e.g. osteomyelitis, T. B., and syphilis .
24 ACQUIRED PALATAL DEFECTS
Prosthetic rehabilitation of acquired maxillary defect: The main priority for the patient with traumatic injury and traumatic surgery is to stabilize the patient and control immediate damage and/or defect. Three phases of prosthodontic treatment includes: Surgical procedures + Immediate obturator. Transitional obturator. Definitive obturator.
25 IMMEDIATE OBTURATOR IMMEDIATE OBTURATOR 1. It is a prosthesis inserted immediately after operation 2. Lasts 10-14 days after surgery 3. Material used, mostly acrylic ADVANTAGES: 1. Maintain function (feeding, speech) 2. Promote healing 3. Restore esthetic 4. Act as stint (keep surgical pack and medication close to the wound) 5. Improve psychology of the patient 6. Prevent contamination of the wound
26 IMMEDIATE OBTURATOR Construction: o Impression/construction of the cast models. o With the help of the surgeon determine the area to be removed on the cast . o The appliance is constructed as a plate to close the operation site. o Prepared cast is waxed, processed using either heat or cold curing resin and wire clasps to retain the obturator.
27 IMMEDIATE OBTURATOR o During operation eradication of the involved area, and surgical cavity is filled with surgical pack. o We can say, it is simple plate with no teeth and constructed before surgery to be inserted immediately after surgery .
28 Temporary Obturators Temporary/Transitional Obturator: Constructed few days after operation to help in restoring oro-nasal function. Carries teeth and stays 3-6 months. Making impression is complicated by presence of the wound and presence of the defect.
29 Temporary Obturators The defect is packed with gauze dipped in Vaseline to the level of the remaining tissue, then impression is taken with modified stock tray using elastic impression material. The steps of construction are the same as in immediate obturator.
34 Definitive Obturators Construction: 1. Select stock tray, modified with wax according to the size and shape of the defect. 2. Partially, pack the defect with Vaseline gauze, then do primary impression using alginate.
35 Definitive Obturators 3. Under cuts are lift to help in retention. Gauze can prevent broken pieces of alginate from escaping into the defect. 4. Construct sp. Trays and do final impression using alginate or rubber base impression material. 5. Outline the master cast to mark the bearing area, blocking severe undercut, leaving small undercut area for obturator retention. 36 Premaxilla Preserved
37 Premaxilla Preserved Cut through tooth socket 38 Mucosa Not Preserved Rough edge uncomfortable for patient 39 Obturator Restores oro-nasal partition. At times can be added to prior dentures. 40 Skin Grafting of Defect Less pain while healing. Less contracture of scar band which obscures cancer surveillance. Accomodates obturator better. 41 Maxillary Prosthesis Articulates with scar band. Hollowed to be lightweight. 42 Maxillary Prosthesis Can be made with a reservoir to hold artificial saliva. 43 Timing Immediate (Intraoperative) hold in packs provide early function Interim Definitive 3 to 6 months 44 Prosthetic Materials Acrylics Polyurethanes Silicone Elastomers Room-temperature vulcanizing High-temperature vulcanizing 45 Mandible Mandibular reconstruction revolutionized by microvascular and plating techniques. Prosthetics mainly restore occlusion and occlusal surface. Implants able to restore high degree of function. 46 Mandible Skin graft preserves alveolar ridge for denture support 47 Postoperative Malocclusion Deviates to surgical side 48 Maxillary Ramp 49 Maxillary Ramp 50 Guide Plane Prosthesis
51 Guide Plane Prosthesis
52 Adjunctive Preprosthetic Measures Vestibuloplasty. Lowering of Floor of Mouth. Implants. 53 Vestibuloplasty 54 Lowering the Floor of Mouth Goal is to reposition mylohyoid muscle. 55 Lowering the Floor of Mouth 56 Edentulous Mandible
57 Mental Foramen 58 Implants 59 Implants Branemark in the 50s studying bone temp during drilling. Found temp probes couldnt be removed from bone without fracturing. Led to study of osseointegration. 60 Implants Made of titanium. Have to be drilled at low speed. Oxide on metallic surface is dipole. Plasma proteins adhere. 61 Implants Implant placed first -- closed primarily Abutment placed 4-6 mo later Appliance attached rigidly removable samarium-cobalt magnets 62 Implants Factors that influence success material macrostructure microstructure implant bed surgical technique loading conditions 63 Implants Implants can be placed in grafted fibula. 64 Implants Want to avoid large step-off if possible. 65 Extraoral Prostheses 66 Extraoral Prostheses General Principles: Goal is cosmetic. Retained with : Adhesives. Implants. Skin grafting may help. Smooth edges. Extraoral Prostheses Ear: Retain tragus if possible to camouflage anterior border.
67 Extraoral Prostheses -- Ear 68 Extraoral Prostheses -- Ear 69 Extraoral Prostheses -- Ear Tragus hides attachment. 70 Extraoral Prostheses -- Orbit Skin graft provides base for prosthesis. 71 Extraoral Prostheses -- Orbit Glasses help hide margin. 72 Extraoral Prostheses -- Nose Skin graft provides base for prosthesis. Alar tag undesirable. 73 Extraoral Prostheses -- Nose 74 Extraoral Prostheses -- Nose 75 Extraoral Prostheses -- Nose 76 Extraoral Prostheses -- Nose 77 Conclusion Restore function and cosmesis. Use techniques during surgery to aid prosthetic management. Consultation with maxillofacial prosthodontist for optimal rehabilitation. 78 THANK YOU 79
