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PROSTHESIS
DR RITESH SHIWAKOTI
1
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.
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Maxillofacial Prosthetics
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Intra-Oral
Extra-Oral
Type of M.F.P
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After surgical intervention.
Indications of MFP
After trauma.
Congenital defects.
Acquired defects.
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Prosthetic vs. Surgical Rehabilitation
Destruction amount.
Malignancy recurrence.
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Intraoral vs. Extraoral
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Management of patient for MFP.
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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.
11
Dental Impression
Surgeon has
marked
resection for
prosthodontic
planning.
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Post surgical management.
After a surgery and even before it’s a team work for a
rehabilitation of a patient that includes:
1. Maxillofacial surgeon.
2. Prosthodontics.
3. Orthodontist.
4. Phyciastrist.
5. Speech rehabilitation specialist.
6. Oncologist.
7. Plastic surgeon specialist
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Congenital defects
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Congenital defects
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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.
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Congenital defects
• Lack of fusion of the palatal shelves either completely
or partially occurs during embryonic growth side.
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Congenital defects
18
Congenital defects
19
Congenital defects
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Congenital defects
C. Orthodontic
oTo correct the malaligned teeth or expand the
maxillary arch.
22
Congenital defects
Reason for early closure of cleft palate
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 .
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ACQUIRED PALATAL
DEFECTS
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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.
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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.
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Temporary Obturators
Function: helps in restoring
1. Speech.
2. Feeding.
3. Esthetics.
4. Prevent wound contamination.
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Definitive Obturators
Definitive Obturator:
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Definitive Obturators
Preparation of the mouth for obturator:
I. Extract hopeless teeth.
II. Periodontal therapy.
III. Restore carious teeth.
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Definitive Obturators
Types of obturators:
1. Hollow bulb (Closed).
2. Roofless (Open bulb).
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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.
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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.
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Premaxilla Preserved
37
Premaxilla Preserved
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Skin Grafting of Defect
Less pain while healing.
Less contracture of scar band which obscures
cancer surveillance.
Accomodates obturator better.
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Maxillary Prosthesis
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Timing
Immediate (Intraoperative)
◦ hold in packs
◦ provide early function
Interim
Definitive
◦ 3 to 6 months
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Maxillary Prosthesis
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Prosthetic Materials
Acrylics
Polyurethanes
Silicone Elastomers
◦ Room-temperature vulcanizing
◦ High-temperature vulcanizing
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Mandible
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Mandible
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Maxillary Ramp
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Adjunctive Preprosthetic Measures
Vestibuloplasty.
Lowering of Floor of Mouth.
Implants.
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Vestibuloplasty
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Lowering the Floor of Mouth
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Edentulous Mandible
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Mental
Foramen
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Implants
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Extraoral Prostheses
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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.
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Extraoral
Prostheses --
Ear
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Extraoral
Prostheses --
Ear
61
Extraoral Prostheses -- Ear
66
Extraoral
Prostheses --
Nose
67
Extraoral
Prostheses --
Nose
68
Extraoral
Prostheses --
Nose
69
Conclusion
Restore function and cosmesis.
Use techniques during surgery to aid prosthetic
management.
Consultation with maxillofacial prosthodontist for
optimal rehabilitation.
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