quick and easy guide

1. Sara Zaky mohamed
Lecturer of removable prosthodontics

2.  Permanent prosthesis constructed
3-6 months after surgery
 Time of placement will depend on
 1- size of the defect
 2-progress of healing
 3-Prognoisisof the tumor
 4-Presnsce or absence of teeth

4.  Before stating of treatment
following points should be
considerd
 prognosis of the tumor
 General health of the patient
 Radiographs of present teeth
 Patient expectation

5.  1- movement of the obturator
Obturator will move during
function , degree of movement
depends on amount of missing
tissues , defect size and number of
missing teeth
Patients should be informed about
this problem

6.  Defect will keep changing
dimensionally for at least a year
after surgery in addition to scar
contraction and organization of the
wound
 Plus obturator movement which
will affect tissues
 Bases should be made of acrylic
resin to facilitate relining

7.  Main roll of maxillary obturator is
covering prosthesis

8.  Extension into the defect depends
on the remaining structures
 If the remaining structures fulfill
the requirements of stability and
support no need for excessive
extension in the defect
 Avoid extension superiorly in nasal
septum
Why ???
 Because it’s formed of
pseudostatrified columnar ciliated
epithelium which will not tolerate
stress

9.  Extension should better be along lateral margin of the defect to enhance retention
 Stress better tolerated by skin graft and oral mucosa

10.  Presence of teeth enhance the
prosthetic prognosis
 Obturator with presence teeth
should anticipates and
accommodate to the movement of
the prosthesis without exerting
more force on teeth

11.  Bulky areas should be hollowed to
decrease the weight of the
prosthesis
 Types of obturators
Hollow blub
Roofless

13.  It’s done as follow
 During packing a small cellophane
bag filled with sand is packed
within the bulb . After processing a
hole is drilled through the bulb
 After processing a hole is drilled
through the bulb and sand drained
away

15.  Prosthesis exhibit a degree of
rotation around an access during
function
 Movements varies according to
size of defect and presnce and
abscenece of teeth
 In edenulous patients with total
maxillectomy axis of rotation
located along the medial palatal
margin of the defect
 The portion of the obturator most
distant from axis will exhibit the
greatest degree of motion

17.  Smaller defects have less degree of movements as maxillary structures remain for
retention and support
 With anterior resection of maxilla axis of rotation is located along the posterior
margin of the defect

18.  In dentulous patients better prognosis
 Class II is the best due to increased remaining structures followed by class I and IV
 Diagmostic casts are surveyed to select the path of insertion ( often compound path of
insertion must be employed to use )
 Rigid major connectors is used
 Occlusal rests must direct forces along the long axis of teeth
 Guide planes designed to facilitate stability and bracing

20.  Retention should be within the physiological limits of the PL
 Bones surrounding the teeth close to the defect is questionable so it’s better to select
another abutment away from defect
 Due to lack of cross arch stabilization in most of cases , this partial denture obturator is
viewed as a uni-lateral partial denture double retention (lingual and buccal ) may be
considered to obtain cross tooth retention.

26.  clasping
 Retaining buccal flanges engaging
both tooth and tissue undercuts
 Maximum extension
 Undercuts in the defects
 Inter-maxillary spring
 Implants in intact side
 Magnets in the intact area
 Denture adhesives
 Swing lock attachment (dentulous
patients )