1. 13.Definitive Obturation
Treatment Concepts
John Beumer III, DDS,MS
Distinguished professor emeritus
UCLA School of Dentistry
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2. Definitive Obturation
Treatment concepts
v Movement of the prosthesis
v Tissue changes
v Oral-nasal partition
v Extension into the defect
v Teeth
v Implants
v Weight
v Bolus manipulation

3. Treatment concepts
v Movement of the prosthesis
The prosthesis will move significantly during
function. The degree of movement varies and
depends upon:
v Number of teeth present and their location
v Presence of implants and their distribution pattern
v Size and the configuration of the defect, remaining
palatal shelf area
v Whether the patient is edentulous or partially
edentulous

4. Treatment concepts
Movement of the prosthesis
There will be significant
movement of the
prosthesis in defects
such as this one with
little palatal shelf
remaining and the
dentition arranged in a
linear configuration.

5. Movement of the prosthesis
Movement of the prosthesis in and out of the defect will occur
in such patients. Partial dentures can be designed to resist the
forces of gravity but must allow the forces of occlusion to
impact the prosthesis into the defect, otherwise abutment teeth
will be compromised.

6. Movement of the prosthesis
The premaxillary segment is present, there is significant
palatal shelf surface area and therefore considerably
less movement of the obturator prosthesis in a defect
such as this one and the partial denture design problem
more conventional.

7. Movement of the Prosthesis
The obturator prosthesis
fitted for this defect will move
a great deal. The successful
user must learn to balance
the prosthesis with the
dorsum of the tongue.
However, if the defect is
favorable with undercuts
lined with skin, the addition of
implants on the unresected
side would significantly
reduce movement of the
prosthesis and the
prosthodontic prognosis
dramatically improved.

8. Treatment concepts
Tissue changes
v The contours and configuration of the
defect change rapidly immediately after
surgery
v The defect is usually well healed 3
months following surgery.
v Dimensional changes continue to occur
for at least a year after surgery secondary
to scar contraction and further organization
of the wound.

9. Tissue changes
Most tissue changes occur during the first
3 months after surgery. Flaps become
less edematous and skin grafts organize
and become smooth.

10. Treatment concepts
Oral-nasal partition

11. Oral-nasal partition
v Obturators for acquired defects are covering
prostheses, primarily serving to reestablish the oral-
nasal partition.
v The obturator is extended into the defect
primarily to enhance retention, stability and support
for the prosthesis.
v Extensions in some areas may need to be
lengthened to prevent leakage of liquid into the
nasal passage

12. Treatment concepts
Extension into the defect
The degree of extension into
the defect is dependent upon
the requirements for retention,
stability and support, the
character of the tissue lining
the defect and the
configuration of the defect.
Most edentulous patients are lacking retention, stability
and support and the defect is aggressively engaged to
facilitate all three as shown by this complete denture
and obturator.

13. Treatment concepts
Teeth
The presence of teeth
enhances the prosthetic
prognosis. Every effort
should be made to
maintain and enhance
the longevity of teeth,
unless their retention
would compromise a
future implant site.

14. Treatment concepts
Teeth
In some instances teeth adjacent to the defect
are splinted together in order to enhance their
load bearing capacity.

15. Treatment concepts
Osseointegrated implants
" The placement of osseointegrated implants dramatically
improves the function of obturator prostheses. Implants can be
placed in association with resection of the tumor or thereafter.
" The most desirable locations are the premaxilla and the
maxillary tuberosity.

16. Treatment concepts
Osseointegrated implants
Most implant bar designs must be implant assisted
and must accommodate the multitude of axis of
rotation of the prosthesis generated during function.

17. Treatment concepts
Osseointegrated implants
Implant should not be used to prevent movement of
the prosthesis in a defect of this size and extent. If
they are used for this purpose there is a significant
risk of implant overload and eventual implant failure.

18. Treatment concepts
Weight
" Bulky areas should be hollowed to reduce weight so that teeth,
implants and supporting tissues are not stressed unnecessarily.
" The superior surface can be either closed or left open.
" Speech is not effected whether the top is left open or is closed.

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