Fabrication of a closed hollow obturator

Fully integrated additive manufacturing of an obturator prosthesis for an edentulous patient with a maxillectomy defect

Maxillary defects pose challenges for prosthodontists, especially when patients have no remaining teeth. This clinical report describes rehabilitation with a complete denture obturator fabricated in 2 visits for an edentulous patient after a maxillectomy. The obturator base and artificial teeth were digitally designed and merged into a 1-piece prosthesis. Following a virtual reduction, the integrated prosthesis and a gingival veneer were calculated and then printed and bonded together to complete the fabrication. Balanced occlusion was achieved with the assistance of a digital occlusion analyzer at the insertion visit. This approach avoided base-tooth assembly deviations and provided a prosthesis with good patient-reported outcomes at the 6-month follow-up.

An integrated hollow bulb obturator prosthesis with a metal framework for a soft palate defect fabricated by multiple digital techniques

The digital workflow to fabricate an integrated hollow bulb obturator prosthesis with a metal framework for a patient with soft palate defect is described. The framework was digitally designed with an open lattice denture base connector to facilitate the assembly of the hollow bulb obturator and printed with titanium. A functional impression of the palatopharyngeal area was made, and an integrated 3-dimensional (3D) cast was obtained by aligning the data of the functional impression to the preliminary intraoral scan data. The hollow bulb obturator and a palatal cover were designed based on the integrated 3D cast and the framework design data and printed with light-polymerizing denture base resin. The printed framework, obturator, and palatal cover were assembled and bonded without a physical cast, and the definitive prosthesis exhibited good fit, retention, and stability.

Comparison of the weight of conventionally heat-processed hollow and solid obturators and 3D printed hollow obturators

STATEMENT OF PROBLEM

The weight of larger obturators places increased stress on the supportive teeth and bearing tissue and allows gravity to act as a dislodging factor affecting the stability and retention of the prosthesis. However, whether conventionally processed and 3-dimensionally (3D) printed hollow obturators have similar reduced weights compared with solid obturators is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the weight difference between conventionally heat-processed complete denture obturators with and without hollowing and 3D printed obturators with a hollow bulb.

MATERIAL AND METHODS

Obturators were fabricated as conventionally heat-processed solid obturators, conventionally heat-processed with a hollow obturator bulb, and 3D printed with a hollow obturator bulb. Nine obturator prostheses were fabricated for each type of Aramany Class I, Class II, and Class III defect. The weights of each of the 27 obturator prostheses were measured, and a statistical analysis was performed with exact versions of the Kruskal-Wallis test or Wilcoxon Rank Sum test (α=.05).

RESULTS

Conventionally heat-processed solid obturators were significantly heavier than the conventionally heat-processed hollow (P<.001) or the 3D printed hollow obturators (P<.001). No significant difference (P=.222) was found between the conventionally heat-processed hollow and 3D printed hollow obturators. The decrease in weight was proportional to the size of the defect with the Aramany Class I defect having the largest differences in weight between the different fabrication methods, followed by Class II, and then Class III with a much smaller defect.

CONCLUSIONS

Additive manufacturing could be a suitable alternative to conventional techniques for the fabrication of a closed hollow obturator because of the comparable weights.

PEEK versus Metallic Attachment-Retained Obturators for Patient Satisfaction: A Randomized Controlled Trial

Objective  The aim of the study was patients’ satisfaction evaluation and radiographic evaluation of the terminal abutments of attachment-retained maxillary obturators with metal framework versus milled polyetheretherketone (PEEK) framework in the management of maxillectomy cases.

Materials and Methods  Eighteen participants were randomly divided into three parallel groups ( n = 6). Participants of the PEEK group received attachment-retained obturators with milled PEEK framework, the metal group received an attachment-retained obturator with a metallic framework, and the conventional group received conventional clasp-retained obturators with a metallic framework (Control group). The evaluation included was radiographic evaluation and patients’ satisfaction in this study included two scales—”The Obturator Functioning Scale” and “The European Organization for Research and Treatment of Cancer Head and Neck 35” using one-way ANOVA test.

Results  Both PEEK and metal groups showed a statistically significant lower mean bone loss ( p <0.050) compared with the conventional group during all follow-up periods. There is no statistically significant difference between the PEEK and metal groups during all follow-up periods. Regarding patient satisfaction, both the PEEK and metal groups showed a statistically significant decrease score ( p <0.050) compared with the conventional group in various aspects of patients’ satisfaction scales as satisfaction with the look and difficulty of talking to the public, and noticeable clasps. In comparison, the PEEK group showed a statistically significant decrease score ( p <0.050) than the metal group with respect to satisfaction with the look along all follow-up periods.

Conclusions  PEEK attachment-retained maxillary definitive obturators could be considered a promising treatment modality for patients with acquired maxillary defects with regard to esthetics and satisfaction.

Shark Fin Titanium Hollow Bulb Obturator: A Treatment Concept

Restoring esthetics and function for patients with maxillectomy defects presents a complex challenge for the clinician. Obturator prostheses are subject to rotational forces during function, allowing movement into the defect. Gaining prosthesis support from endosseous implants can limit the amount of rotation. Xerostomia and impaired tissue healing caused by radiation therapy further complicates the treatment for such patients. Several resilient and rigid obturator design concepts are available for restoration of such defects. This clinical report describes a design concept used to treat a patient with a maxillectomy defect caused by tumor resection secondary to a squamous cell carcinoma.

Evaluation of water absorption properties and fabrication of hollow obturator model using 3D digital dentistry

Fluid accumulation in the hollow spaces of obturator is a continuing problem when fabricating hollow obturator prostheses using the conventional method. To address this problem, the three-dimensional (3D) digital technology was used to evaluate water absorption in the inner hollow obturator spaces. Solid and hollow obturator specimens were fabricated using a 3D printer with photocurable resin. Then, the hermeticity was examined by leak testing. These specimens were immersed in distilled water at 37°C. Each specimen was weighed every 24 h for 120 days, and weight changes between each group were compared. Water accumulation in the hollow obturator was not visually observed. Although water absorption was significantly higher in solid specimens, the weight increase rate was also significantly higher in hollow specimens. Applying a laminating 3D photo fabrication made the fabrication of a completely unified hollow obturator model possible.

Hollow Bulb One Piece Maxillary Definitive Obturator - A Simplified Approach

In maxillary defects, role of a prosthodontist is to rehabilitate the intra- and extra-oral structures and to endow with the normal function of mastication, speech, deglutition, and esthetics. Malignancies are common in the oral region and are treated usually through surgical intervention. Surgical intervention creates anatomical defects creating communication between oral and nasal cavity. Patients pose difficulties while performing normal functions such as swallowing and speaking, due to this communication. To overcome the problems encountered by the patient, obturators are fabricated. The main problem with rehabilitation of large defect is the weight of prosthesis; the prosthesis becomes very bulky and nonretentive due to its weight. Hollow obturators are fabricated to conquer this tribulation by different techniques. This case report describes a simplified method of fabrication of a definitive hollow bulb obturator for rehabilitation of a maxillary defect (Aramany's class I) by insertion of balloon.

Full Mouth Reconstruction of a Skeletal Class II Division 1 Patient with Adenoid Cystic Carcinoma Using an Interim Immediate Obturator and a Definitive Obturator

A 61-year-old female patient with adenoid cystic carcinoma (ACC) of the right maxilla and Angle class II division 1 malocclusion had received a subtotal maxillectomy in right side and used a conventional clasp-retained obturator. After implants placement, a maxillary interim immediate obturator (IIO) and then a definitive obturator using six endosseous implants were fabricated. During one-year follow-up, the patient was completely satisfied. Ideally, after implants placement in edentulous patients suffering from hemimaxillectomy, an implant-supported obturator (ISO) is designed in order to prevent nasal reflux and to improve speech and swallowing. However, in the following case, because of skeletal class II division 1 malocclusion and implants insertion in the premaxilla, using an ISO was impossible because it would cause excessive upper lip protrusion and lack of anterior teeth contact. Therefore, a five-unit implant-supported fixed partial denture (FPD) was fabricated in the maxillary anterior segment so that anterior teeth contacts were possible and the patient's normal lip support was achieved. A bar and three ball attachments were used in the maxillary posterior segment. A closed-hollow-bulb ISO was preferred. Conventional ISO in these patients results in several problems. Using a maxillary anterior FPD along with ISO caused satisfactory results in the current patient.

Lost wax-bolus technique to process closed hollow obturator with uniform wall thickness using single flasking procedure

INTRODUCTION

Maxillary obturator prosthesis is more frequent treatment modality than surgical reconstruction for maxillectomy in patients suffering from oral cancer. The obturators often become heavy and hence are hollowed out in the defect portion to reduce its weight as a standard practice.

MATERIALS AND METHODS

The processing technique described the incorporation of the preshaped "wax-bolus" during packing procedure of the Obturtor prosthesis and eliminated later by melting it once the curing procedure is completed.

RESULTS

This article is a single step procedure resulting into the closed-hollow obturator as single unit with uniform wall thickness around the hollow space ensuring the least possible weight of the hollow obturator.

CONCLUSION

This processing technique achieves predictable internal dimension of the hollow space providing uniform wall thickness of the obturator.

Split Hollow Bulb Obturator to Rehabilitate Maxillary Defect: A Case Report

The rehabilitation of a maxillectomy patient involves meticulous treatment planning and designing. Lack of retention and facial support and limited mouth opening are the major issues that lead to functional and psychological trauma in post-maxillectomy patients. The successful rehabilitation of a maxillary defect includes restoring the function, esthetics, and a complete obturation of the defect, enabling the patient to feed without nasal regurgitation. This case report describes the fabrication of an obturator with a modified design, namely a split-antral hollow bulb obturator and oral part that is retained with a ball attachment, for a patient with right-side acquired maxillary defect due to recurrent myxoma. The primary advantage of this modification is enhanced facial support and a self-retentive antral obturation that improved the quality of life of the patient after an extensive maxillectomy.

Sealing maxillary titanium obturators with removable flexible caps

Maxillary obturator prostheses with hollow metal obturators can be made of titanium to reduce weight. To prevent perforation of the hollow obturator during modifications, the obturator is slightly undersized and covered with a replaceable cap. This cap is made of a soft copolymer to facilitate uncomplicated modifications in the resection area and to improve function.

Fabrication of Closed Hollow Bulb Obturator Using Thermoplastic Resin Material

Purpose. Closed hollow bulb obturators are used for the rehabilitation of postmaxillectomy patients. However, the time consuming process, complexity of fabrication, water leakage, and discoloration are notable disadvantages of this technique. This paper describes a clinical report of fabricating closed hollow bulb obturator using a single flask and one time processing method for an acquired maxillary defect. Hard thermoplastic resin sheet has been used for the fabrication of hollow bulb part of the obturator. Method. After fabrication of master cast conventionally, bulb and lid part of the defect were formed separately and joined by autopolymerizing acrylic resin to form one sized smaller hollow body. During packing procedure, the defect area was loaded with heat polymerizing acrylic resin and then previously fabricated smaller hollow body was adapted over it. The whole area was then loaded with heat cure acrylic. Further processes were carried out conventionally. Conclusion. This technique uses single flask which reduces laboratory time and makes the procedure simple. The thickness of hollow bulb can be controlled and light weight closed hollow bulb prosthesis can be fabricated. It also minimizes the disadvantages of closed hollow bulb obturator such as water leakage, bacterial infection, and discoloration.

Rehabilitation of post surgical maxillectomy defects using interim obturators-a case series

Prosthetic rehabilitation of extensive maxillectomy defects are exigent given the difficulties faced due to loss of palatal bone,teeth and surrounding supporting tissues which help in retention, support and stability of the prosthesis. An interim maxillary obturator is a prosthesis which is made after surgical resection of a portion or all of one or both maxilla where initial healing is completed. Frequently many or all teeth in the defect area are replaced by this prosthesis. It plays a vital role in preventing the facial disfigurement and irritation to the surgical site thereby enhancing the healing and restores the functional capabilities such as speech, mastication, deglutition etc. To gain better retention and stability, preservation of the unaffected regions is needed which can be achieved by proper surgical planning and designing of the prosthesis. This case series describes rehabilitation of three extensive maxillectomy defects with hollow open and closed interim obturators.

Fabrication of a hollow bulb prosthesis for the rehabilitation of an acquired total maxillectomy defect

The prosthodontic rehabilitation of maxillary defects is a challenging and demanding task which requires careful pre-surgical and post-surgical planning. Maxillary defects can be congenital or acquired. Acquired defects include those following trauma or surgical treatment of benign or malignant neoplasms. A prosthodontist encounters problems such as absence of support, poor retention, and lack of prosthesis stability in treating these patients. The present case report describes a procedure to fabricate a definitive hollow bulb obturator prosthesis for the rehabilitation of a total maxillectomy defect.

Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: a clinical report

To treat a patient who needed a replacement for a maxillary obturator prosthesis, a new obturator prosthesis was fabricated from polyetheretherketone (PEEK), a material often used in medicine but seldom in dentistry. This material provided the patient with a better-adjusted, more functional, and lighter prosthesis.

A direct investment method of closed two-piece hollow bulb obturator

Maxillary defects occur due to surgical treatment of benign and malignant tumors, congenital malformation, and trauma. Prosthetic rehabilitation in such patients is influenced by the size and location of the defect. The most common of all intraoral defects are seen in the maxilla, in the form of an opening into the maxillary sinus and nasopharynx. These defects create disabilities in speech, deglutition, and mastication. The prosthesis which closes such an opening and recreates the functional separation of the oral cavity and sinus and nasal cavities is referred to as an obturator. Numerous techniques of hollow bulb fabrication have been mentioned in the literature from time to time. But there are only a few methods for bulb fabrication in two-piece obturator. This technique describes a direct investment method of waxed-up closed hollow bulb two-piece obturator.

Maxillofacial prosthodontic management of an ablative maxillary surgical defect using a combination of conventional obturator prosthesis and an early loading implant supported high-strength full ceramic fixed dental prosthesis

Prosthodontic rehabilitation of maxillary defects and early loading of endosseous implants has been widely published. The combination of the aforementioned treatment modalities are seldom reported in peer reviewed journals. This article describes the clinical presentation, management and prosthodontic rehabilitation of the maxillary defect of a patient. Clinical and scientific concerns are discussed.

A hollow definitive obturator fabrication technique for management of partial maxillectomy

Maxillary obturator prosthesis is the most frequent treatment option for management of partial or total maxillectomy. Heavy weight of the obturators is often a dislocating factor. Hollowing the prosthesis to reduce its weight is the well established fact. The alternate technique to hollow-out the prosthesis has been described in this article which is a variation of previously described processing techniques. A pre-shaped wax-bolus was incorporated inside the flasks during packing of the heat-polymerized acrylic resin to automatically create the hollow space. The processing technique described is a single step flasking procedure to construct a closed-hollow-obturator prosthesis as a single unit. To best understand the technique, this article describes management of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma rehabilitated with a hollow-obturator prosthesis.

Difference in water accumulation patterns between solid and closed hollow obturators under a thermal cycle

Water accumulation in the hollow space of a maxillary obturator is a continuing problem, and it is unclear whether the porosity of acrylic resin is involved in the mechanism. The purposes of the study were to evaluate the effect of a hollow space in the resin obturator on water sorption under a thermal cycle and to determine factors associated with water accumulation in the obturator. Twenty solid spheres (30-mm diameter) and 40 hemispheres (30-mm diameter, 1.5 mm thickness) were fabricated from heat-polymerized acrylic resin. Closed hollow specimens consisted of 2 hemispheres joined with autopolymerizing resin. Ten solid and 10 closed hollow specimens were immersed in distilled water, whereas the other specimens were stored at 100% relative humidity. Each specimen was thermocycled (5°C-37°C) with a dwell time of 12 hours and weighed every 12 hours for 180 days. Of the 20 closed hollow specimens, 16 showed no water accumulation (8 in distilled water, 8 at 100% humidity). The weight of these specimens became saturated by day 90, with increases from the initial weight of 1.41% at 5°C and 1.36% at 37°C. By day 180, the weights of the solid specimens had increased by 0.96% at 5°C and 0.94% at 37°C. Weight fluctuation associated with temperature was observed for both types of specimens and for all storage conditions. It is concluded that water accumulation inside a closed hollow obturator is not directly related to the water absorption properties of the acrylic resin but is related to thermal damage of the obturator.

Fabrication of a hollow obturator as a single unit for management of bilateral subtotal maxillectomy

Prosthetic rehabilitation with an obturator for a total or subtotal maxillectomy patient is a challenging task, as there are little or no residual maxillary structures to depend on for support, retention, and stability of the prosthesis. This clinical report describes the prosthodontic management of a patient operated on for a bilateral subtotal maxillectomy secondary to ameloblastoma of the palate with a closed hollow obturator. The processing technique described in this article to fabricate the hollow obturator is a variation of other well-known techniques. The variation comprises the use of a wax bolus to maintain a predictable internal dimension for a hollow obturator. This technique allows fabrication of a complete hollow obturator prosthesis as a single unit in heat-polymerized acrylic resin using a single-step flasking procedure.

An alternative method for constructing an obturator prosthesis for a patient with a bilateral cleft lip and palate: a clinical report

The design of esthetic and effective dental prostheses for bilateral cleft lip and palate patients is a challenge for prosthodontists because the prostheses must serve more than one purpose. The goals to be attained by prosthetic intervention are preventing food and liquid leakage into the nose, improving speech intelligibility, a more esthetic appearance, and achieving the general satisfaction of the patient. The framework design of the obturator prosthesis is of great strategic importance for patients with a cleft lip and palate. The reduction in the mass of the obturator prosthesis increases stabilization and retention and also contributes to an easier adaptation to the prosthetic restoration. In this report, a 22-year-old woman was successfully treated with a fixed partial denture and a bar-retained obturator with palatal coverage.

CLINICAL SIGNIFICANCE

The design of an obturator prosthesis for cleft lip and palate patients is an important stage in terms of ensuring esthetic restoration and patient comfort. This article describes an esthetic and functional design for such a device using a fixed partial denture and a bar-retained obturator.

Rehabilitation of a congenital palatal defect with a modified technique: a case report

Introduction

Constuction of the obturator prostheses and providing the patient's comfort with them are very difficult. Primary and the most important stage for these prostheses is to perform a proper impression.

Case Presentation

A 55-year-old edentulous Turkish female patient with a congenitally maxillary defect was rehabilitated with an open hollow obturator prosthesis. After the preliminary impression was completed, a metal frame suitable with the maxillary defect was constructed manually and used for making the impression of the defect area. After the first part of the obturator was finished, second part which separates nasal cavity and oral cavity was constructed by the aid of the bulb.

Conclusion

When constructing an obturator prosthesis, making a detailed impression from the defect area can be performed by the aid of a metal frame, and an intraorally shaped extension that separates oral cavity from nasal cavity might be more effective for adaptation of the prosthesis.