Obturators

1. Dr. Aamir Godil
Department of Proshodontics
M.A.R.D.C.

2. 2
Contents
Maxillofacial defects
Maxilla:
• Anatomical considerations
• Acquired defects
Obturators:
• Background
• Classification
• Types

3. Maxillofacial
Defects

4. Intraoral defects
Maxilla/ Mandible
Hard/ Soft Palate
Tongue, floor of
mouth, alveolus,
tonsillar area
Extraoral defects
Ear, nose, lips,
ocular defect
Midfacial defect
Genital defect
Combined defects
Any possible
combination of
intra & extraoral
defects
4

5. MAXILLOFACIAL
DEFECTS
CONGENITAL
CLEFT LIP
CLEFT PALATE
SYNDROMES
RETROGNATHISM
PROGNATHISM
ACQUIRED
TRAUMA
SURGERY
PATHOLOGY
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6. Maxilla
Anatomical Considerations

7. • Roof - Floor of the orbit.
• Lateral walls - Lateral walls of the maxillary sinuses and
are a part of the lacrimal system.
• Central portion - Maxillary sinus.
• Anteriorly, it comprises the midface supporting the nose
and anterior teeth. Overlying the posterior pterygoid
region of the maxilla is the cranial base.
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8. 8
Maxilla – Soft Tissue Anatomy

9. Maxilla
Acquired Defects

10. • Most occur due to surgical resection of tumours.
• Benign lesions require a smaller resection and are easy
to restore.
• Malignant tumours require extensive resection, which are
very difficult to restore.
• Other non-neoplastic lesions may also require surgical
resection in the course of treatment.
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11. • Defects are usually classified based on their extent.
• If both the maxillae are resected, the defect is considered
as total maxillectomy.
• Resection of one or a part of the maxilla or palate is
considered as partial maxillectomy.
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12. 12

13. • Divided into six different groups based on the relationship of the
defect area to the remaining abutment teeth.
• Represents a systematic means of describing maxillectomy patients
and potential framework designs for an obturator prosthesis.
• It only considers the defect in the horizontal plane and gives no
indication of the extent of the defect in the vertical axis.
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14. Class I:
• It is a unilateral defect
involving one half of the arch
and the adjacent palatine shelf.
• The defect extends to the
midline.
• Teeth are maintained on one
side of the arch.
• Most common.
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15. Class II:
• Unilateral defect involving one
side of the arch posterior to the
canine (teeth posterior to the
canine are absent).
• The central incisor and
sometimes all the anterior teeth
to the canine or premolar are
saved.
• This type of surgical resection
is favored more than the
classical maxillectomy.
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16. Class III:
• Defect involving the center of
the palatine shelves.
• Involves the central portion of
the hard palate and may involve
part of the soft palate.
• Does not involve the remaining
teeth.
• The design for these patients is
simple, and retention,
stabilization, and reciprocation
can be effectively planned.
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17. Class IV:
• Bilateral defect involving one
side of the arch along with the
entire premaxilla (all anteriors
along with the posteriors of one
side are missing).
• Defect crosses the midline and
involves both sides of the
maxillae.
• There are few teeth remaining
which lie in a straight line.
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18. Class V :
• Bilateral posterior defect.
• The surgical defect lies posterior
to the remaining abutment teeth.
• Labial stabilization may be
needed, and splinting of
remaining abutments is advisable.
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19. Class VI:
• Bilateral anterior defect, rare.
• Occurs mostly in trauma or in
congenital defects rather than
as a planned surgical
intervention.
• Cross-arch stabilization is
derived through a system of
cross-arch bars to provide wide
distribution of support and
retention from separated
abutment teeth.
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20. Obturators
Background

21. • An obturator (latin : obturare, to stop up) is a disc or plate, natural or
artificial, which closes an opening or defect of the maxilla as a result of a
cleft palate or partial or total removal of maxilla for a tumour mass.
(Chalian 1971).
• A maxillofacial prosthesis used to close a congenital or acquired tissue
opening, primarily of the hard palate and/or contiguous alveolar/soft tissue
structures. (GPT-7);
• That component of a prosthesis that fits into and closes a defect within the
oral cavity or other body defect. (GPT – 9)
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22. • Ambroise Parr was the first to use artificial
means to close a palatal defect during the
1500’s.
• Pierre Fauchard – Winged obturator for
enhanced retention.
• Delabarre (1820) – Hinged obturator.
• Claude Martin (1875) – Surgical obturator.
• KW Coffey (1984) – Inflatable balloon
obturator.
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23. • Historically, these prostheses were made of cloth, leather, wrought or cast
metal, vulcanite, porcelain, and acrylic resin.
• As time progressed, newer and better concepts of obturation evolved.
• Today most are made of medical-grade silicone rubber.
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24. • A comfortable, cosmetically acceptable prosthesis that restores the impaired
physiologic activities of speech, deglutition, and mastication.
• Design → Easily and swiftly placed and secured.
• Durable for a reasonable period of time, retain its polish and finish.
• Easy to clean and maintain.
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25. • To act as a framework over which tissues may be shaped by the surgeon
• To serve as a temporary prosthesis during the period of surgical correction
• Restore cosmetic appearance rapidly
• When surgical primary closure is contra-indicated
• When the patient’s age contraindicates surgery
• When the local avascular condition of the tissues contraindicates surgery
• When the patient is susceptible to recurrence of the original lesion which
produced the deformity
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26. 26
Closure of
defect
Enhance
postsurgical
healing
Surgical stent
or to hold
surgical pack
Reduce
postoperative
hemorrhage
Reshape or
recontour the
palate
Improve
function and
speech
Reduce flow of
exudates into
nasopharynx
Improve
esthetics
Boost patient
morale

27. Obturators
Classification

28. (Beumer, Curtis)
A. Based on phase of treatment:
1. Surgical obturators
2. Interim obturators
3. Definitive obturators
a. closed hollow bulb (one piece/two
piece)
b. open bulb
B. Based on material used:
1. Metal obturator
2. Silicone obturator
3. Resin obturator
C. Based on area of restoration:
1. Meatal obturator
2. Palatal obturator
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29. A. According to origin of
discrepancy:
• Congenital defect obturator
• Acquired defect obturator
B. According to location of
defect:
• Labial/Buccal reflex obturator
• Alveolar obturator
• Hard palate obturator
• Soft palate obturator
• Pharyngeal obturator
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30. 30
C. According to movement of
oral, nasal and pharyngeal
tissues adjacent to or
functioning against obturator:
• Static obturator
• Functional obturator
D. According to the type of
attachment to the prosthesis:
• Fixed obturator
• Hinged/movable obturator
• Detachable obturator

31. • Almost all acquired palatal defects are precipitated by
resection of neoplasms of the palate and paranasal sinuses.
• The extent of the resection is dependent on the size, location,
and potential behaviour of the tumour.
• Prosthodontic therapy can be divided into three phases of
treatment with each phase having different objectives.
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33. • A temporary maxillofacial prosthesis inserted during or immediately
following surgical or traumatic loss of a portion or all of one or both
maxillae and contiguous alveolar structures. – (GPT - 9)
• It is of two types –
1. Immediate surgical obturator (inserted during surgery)
2. Delayed surgical obturator (inserted 7-10 days after surgery)
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34. 34
• A clear acrylic plate is fabricated and inserted after surgery.
• Dentulous patient → retention is obtained with simple clasps.
• Edentulous patient → wired into alveolar ridge & zygomatic arch.
• The obturator is retained for 7-10 days post surgically.
• Replaced with an interim or definitive obturator after complete healing.
• Less commonly used because of invasive method of securing the prosthesis.

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Principles relative to the design -
• Should terminate short of the skin graft — mucosal junction.
• Simple, lightweight and inexpensive.
• Perforated with small dental bur in the interproximal extensions to allow
the prosthesis to be wired to the teeth.
• Normal palatal contours should be reproduced to facilitate postoperative
speech and deglutition.

36. Fabrication procedure:
• An alginate impression of maxilla → Casts are retrieved.
• Surgical outline is marked on the cast and any tumor bulk present is
reduced to normal contour.
▪ Prosthesis can be fabricated with auto polymerizing or heat polymerizing
resin.
• Heat processed is not needed since it is only for 7-10 days.
• Composite resins are convenient but quite brittle (fracture with placement
of wires or screws). 36

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Immediate surgical obturator for completely edentulous patient

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Immediate surgical obturator for completely dentulous patient

39. • Given 7-10 days post surgically.
• Treatment of choice in edentulous patients with extensive defect.
• An impression is made after the packing is removed.
• The procedure must be carefully done when the area is raw and
tender. Prosthesis is made as described previously.
• As healing progresses, posterior occlusal ramps are established
since posterior occlusion helps the patient retain the prosthesis in
position.
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40. • Diagnostic casts are made prior to surgery. Post surgically, the surgeon
outlines the surgical margins on the cast. Prosthesis is made and on the day
the packing is removed, the prosthesis is delivered and adjustments are
made.
• After initial healing and removal of the pack the immediate obturator is
usually discarded and replaced by transitional prosthesis having a definite
bulbous extension and occasionally artificial anterior teeth.
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41. 41
Intraoral view of the defect 1 week
after surgery.
Immediate Surgical Obturator. Alginate Impression.
Maxillary cast. Modelling wax adapted in the defect
for the fabrication of open lid
obturator.

42. 42
Open Lid Delayed Surgical
Obturator.
Relined with tissue conditioning
material.
Intraoral view of the Defect
after 2 months.
Intraoral- Delayed Surgical
Obturator.

44. • A prosthesis that is made several weeks or months following surgical
resection of a portion of one or both maxillae. It frequently includes
replacement of teeth in defect area. It replaces the surgical obturator that
is placed immediately following the resection and may be subsequently
replaced with a definitive obturator. – (GPT-9)
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45. 45
Open Lid Interim Obturator. Intraoral View of Interim Obturator.

46. • Baseplate used for surgical obturator can be border molded and relined on remaining
hard palate.
• The prosthesis is seated with each increment of material and impression is made to
capture a few mm at a time. This incremental shaping creates a hollow, light prosthesis.
Technique:
• Patient movements, speech and swallowing are evaluated during border molding.
• Exaggerated head movements, turning right to left with neck flexed and extended.
• The mouth should be opened and closed, mandible moved laterally and asked to
swallow.
• Peripheries of bulb portion will be 2-3 cm in height.
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47. • Superior area of defect contracts between visits and creates a dislodging
force on the prosthesis.
• Inferior aspect should be at the level of original hard palate and soft
palate junction. If it extends below the palatal plane then:
1. Space required for tongue function is violated. Prosthesis is dislodged
into the defect by the tongue.
2. The injured soft palate junction will contract and elevate back to the
level of hard palate very rapidly over next two weeks and result in
irritation of the tissues.
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48. • Hypernasal speech occurs due to loss of air form oral cavity into nasal cavity. As the
prosthesis periphery is sealed, air loss will diminish and speech becomes normal.
• Insertion: After impression is made with a reliner, it is then flasked and the prosthesis
is fabricated.
• Given on same day otherwise tissue edema will occur and the defect will change
rapidly after removal of the packing.
• Delivery should include a functional impression with tissue conditioner since it allows
better assessment of functional movement.
• Requires several revisions after surgery. Over extensions may occur due to tissue
changes and will require correction.
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50. • A prosthesis that artificially replaces part or all of the maxilla and the
associated teeth lost due to surgery or trauma. (GPT – 9)
• Fabricated 3-4 months post surgery.
• Timings will depend on the defect size, healing prognosis, tumor control,
the effectiveness of the present obturator and the presence/absence of the
teeth.
• Indicated after surgical site is healed and dimensionally stable and the
patient is prepared physically and emotionally for restorative care.
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51. Reasons for new prosthesis:
• Periodic addition of interim lining material increases the bulk and
weight, and this temporary material may become rough and unhygienic.
• If anterior teeth are resected, addition can be of psychological benefit.
• If retention and stability are inadequate, occlusal contact on the defect
side may result in improvement.
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52. • Retention of complete denture in maxillary defects is compromised. Air
leakage, poor stability, reduced bearing surface will compromise
adhesion, cohesion and peripheral seal. The contours of the defects must
be used to maximize retention, stability and support.
• Maxillary obturator in edentulous patients will exhibit varying degree of
movement depending on amount of contour of remaining hard palate,
size, contour and lining mucosa of defect and availability of undercuts.
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53. Preliminary impression:
• Fistulas and undercuts are blocked with piece of cotton
or gauze tied with floss.
• An impression is made with alginate in a stock impression
tray. Interim prosthesis can also be used.
Final impression:
• Custom tray is made such that it extends 2-3 cm into the
cavity.
• Undercuts are to be blocked on cast while making custom
tray.
• This serves to stabilize and orient the tray to the defect.
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54. • Palatal margin is developed: Superior height of this extension
should terminate at junction of oral and respiratory mucosa.
• Soft palate is molded: All eccentric movements are performed to
account for movement of anterior border of ramus and coronoid
process of mandible.
• Impression is made with elastic impression material. If soft palate
exhibits elevation during speech and swallowing- a functional
impression is made with wax.
• Jaw relation records: Processed record bases are ideal.
• Vertical dimension: Conventional methods.
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55. • In the extreme trismus cases vertical dimension must be reduced to allow
the passage of food between denture and teeth.
• Centric relation: Recorded with soft wax/ ZOE paste/ Plaster.
• Graphic tracings are contraindicated, pressure on the defect side will
result in some displacement into the defect and compromise the accuracy
of the recording.
• Occlusal scheme: Non-anatomic posterior teeth are preferred.
• All records are verified at try in stage.
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56. 56
The resected hard palate,
alveolar bone, teeth, and soft
tissue on the right side.
Heat-processed hollow
bulb obturator.
Closely adapted obturator.

57. Short notes on:
1. Classify acquired defects of maxilla
2. Obturator
3. Indications and advantages of obturators for
maxillary defects
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