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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 85-87

Instant cast for an immediate obturator


1 Department of Dental Surgery, Government Royapettah Hospital, Chennai, Tamil Nadu, India
2 Department of Prosthodontics and Crown and Bridge, Manipal College of Dental Sciences, Manipal, Karnataka, India

Date of Web Publication25-Jan-2018

Correspondence Address:
Dr. D Lingeshwar
Government Royapettah Hospital, Westcott Road, Opposite YMCA Grounds, Chennai - 600 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohr.ijohr_20_17

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  Abstract 


Obturators are constructed to prevent the oro-antral communication that is ensued in maxillary lesions postsurgery. Often, the postsurgical rehabilitation of patients with maxillary defects is not given adequate time, which results in hypernasality and compensatory articulation. To prevent such complications fabricating immediate obturators within the minimal time that is often allotted to the dentist will be of immense aid to the patient. Fabrication of cast for these immediate obturators is often elaborate and time consuming. This article highlights a unique technique of making a cast that is instant, precise, and economical for construction of immediate surgical obturator.

Keywords: Dental cast, immediate obturator, maxillary defect, surgical obturator


How to cite this article:
Lingeshwar D, Appadurai R, Gupta L, Sangeetha J M, Dilshad B. Instant cast for an immediate obturator. Indian J Oral Health Res 2017;3:85-7

How to cite this URL:
Lingeshwar D, Appadurai R, Gupta L, Sangeetha J M, Dilshad B. Instant cast for an immediate obturator. Indian J Oral Health Res [serial online] 2017 [cited 2019 Dec 14];3:85-7. Available from: http://www.ijohr.org/text.asp?2017/3/2/85/223925




  Introduction Top


Cysts and carcinoma involving the maxilla often need surgical resection of the involved site. The extension for surgical resection in a patient with cysts is often a challenge even after thorough planning with advanced diagnostic techniques, and on many occasions, the extension would be decided only on the day of surgery or on-table. This leaves a very little time for fabrication of an immediate obturator which is very essential for the patient postsurgically. The prime purpose of an obturator is to separate the oral cavity from nasal cavity and form a constraint against the oral mucosa to prevent leakage of air and fluid from nasal cavity. This reduces the articulatory imprecision, hypernasal speech, and nasal-oral air emission.[1] The traditional technique used for fabrication of cast involves the making of a cast and arbitrary trimming of it so as to construct an obturator. The disadvantages of doing so would be the time taken for such lengthy procedure, tedious process involved, and the roughness of the tissue surface of the obturator. It is at this situation that an instant cast would be helpful to obtain precise, immediate obturators even in these critical moments. The following case report will illustrate about the technique to overcome these limitations.


  Case Report Top


Technique adopted

A 37-year-old female patient with odontogenic keratocyst involving the roof of the oral cavity planned for surgical excision was referred to the Dental Department of Government Royapettah Hospital for the purpose of construction of immediate obturator on the day of surgery. The procedure followed for fabrication of immediate obturator is as described below:

  1. Impressions were made of the maxillary and mandibular arches with irreversible hydrocolloid (Tropocalgin, IDS DENMED Pvt Ltd., New Delhi, India) [Figure 1]
  2. The impressions are disinfected with 2% glutaraldehyde
  3. The surgical site was covered with Type II dental plaster so as to block out the areas that are to be excised during the surgery [Figure 2]
  4. Once the dental plaster is set, generous amount of separating medium is applied over the dental plaster
  5. Now, the Type III dental stone (Goldstone, ASIAN CHEMICALS, Rajkot, India) is poured over the set plaster and the remaining portions of the impression making sure there are no air inclusions and allow it to set according to manufacturer guidelines [Figure 3]
  6. The cast is then retrieved from the impression, and the two sections of the cast are separated, so as to obtain the working model and the preplanned resection segment [Figure 4]
  7. Once the working model is obtained, the extension of the surgical obturator can be planned precisely. The design is based on Aramany classification of postsurgical maxillectomy defects, Class III quadrilateral obturator design is employed [2]
  8. The abutments that can be used for retention are selected, and retentive “C” clasps are made using 21-gauge orthodontic wire (Konark, India)
  9. The base plate is then constructed using autopolymerising acrylic resin (DPI Cold Cure Pink; Dental Products of India, Mumbai, Maharashtra, India). The acrylic plate is then trimmed and polished. The obturator prosthesis is then inserted intraorally [Figure 5].
Figure 1: Maxillary impression of the odontogenic keratocyst

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Figure 2: Impression with the preplanned resection segment blocked out

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Figure 3: Retrieved cast

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Figure 4: Working model and the preplanned resection segment

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Figure 5: Obturator prosthesis intraorally

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  Discussion Top


The standard protocol in prosthetic reform for the maxillary defects are: surgical obturator or immediate obturator, interim obturator and definitive obturators given postsurgery. A surgical obturator or immediate obturator supports the soft tissues after surgery, prevents mobilization of tissue, and helps in mastication and speech. The surgical obturator is worn only for a week following surgery. Different obturator designs are followed such as solid bulb obturator, open and closed hollow obturators, inflatable obturators, and two-piece hollow obturator prostheses. Sullivan et al. (2002) reported speech intelligibility, speaking rate, and communication effectiveness results for 32 patients who had undergone partial surgical resection of the maxilla and surgical obturator with a wide range of defects involving the hard and soft palate.[3] Their results revealed that prosthodontic rehabilitation resulted in better articulation and improvement in hypernasality across a wide range of maxillary defects.[4] The method described in the article is advantageous because minimal time is required for fabrication, the technical ease, and is thrifty.


  Conclusion Top


This article emphasizes the exclusive technique wherein the prosthetic procedure is made simpler. Even though the primary obturator is temporary, it plays a major role in patient comfort and protecting the surgical site during the healing phase.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgments

We would like to thank our Department of General Surgery and Surgical Oncology of Government Royapettah Hospital for their valuable support and guidance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Omondi BI, Guthua SW, Awange DO, Odhiambo WA. Maxillary obturator prosthesis rehabilitation following maxillectomy for ameloblastoma: Case series of five patients. Int J Prosthodont 2004;17:464-8.  Back to cited text no. 1
[PUBMED]    
2.
Parr GR, Tharp GE, Rahn AO. Prosthodontic principles in the framework design of maxillary obturator prostheses 1989. J Prosthet Dent 2005;93:405-11.  Back to cited text no. 2
[PUBMED]    
3.
Sullivan M, Gaebler C, Beukelman D, Mahanna G, Marshall J, Lydiatt D, et al. Impact of palatal prosthodontic intervention on communication performance of patients' maxillectomy defects: A multilevel outcome study. Head Neck 2002;24:530-8.  Back to cited text no. 3
[PUBMED]    
4.
de Carvalho-Teles V, Pegoraro-Krook MI, Lauris JR. Speech evaluation with and without palatal obturator in patients submitted to maxillectomy. J Appl Oral Sci 2006;14:421-6.  Back to cited text no. 4
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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