Nasolabial morphological changes in patients with unilateral cleft lip and palate using a Korat-modified nasoalveolar moulding appliance with primary correction.

OBJECTIVE: The objective of this study is to measure the morphological changes of the nose and lip in patients with unilateral cleft lip and palate before and after cheiloplasty with primary rhinoplasty (primary correction) in conjunction with Korat-NAM usage. DESIGN: Longitudinal cohort study. SETTING: Cleft Center Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand. SUBJECTS: Twenty-six patients with unilateral cleft lip and palate. INTERVENTIONS: Control group: only active obturator before primary correction. Experimental group: an active obturator and Korat-NAM I before primary correction. A customized endotracheal tube was retained in the nostril for 3 weeks before switching to Korat-NAM II for 1 year. MAIN OUTCOME MEASURES: Six measurements comprising nostril rim length, nostril height, nostril sill width, columella angle, vertical lip height, and horizontal lip length were measured from the patients' photographs. All measurements, except the columella angle, were reported as the cleft side/non-cleft side value ratio. Measurements were taken at the initial appointment, immediately before, 3 weeks after, and 1 year after primary correction. RESULTS: Nostril rim length ratio, nostril height ratio, nostril sill width ratio, columella angle on the cleft side, and vertical lip height ratio were improved using Korat-NAM before and 3 weeks after primary correction. Nostril rim length and height ratios were significantly better than the control group. CONCLUSIONS: Korat-NAM improved nose and lip morphology before primary correction. An overcorrection improved the nose and lip morphology on the cleft side. The nostril rim length and vertical lip height on the cleft side also improved with Korat-NAM II 1 year after primary correction.

Full digital workflow of a 2-piece obturator with polyetherketoneketone in a patient with maxillectomy and trismus: A clinical and laboratory report.

The computer-aided design and computer-assisted manufacturing of a 2-piece definitive palatal obturator 3D printed from polyetherketoneketone and 2 acrylic resins with a fully digital workflow are presented for a patient who was diagnosed with adenoid cystic carcinoma and who developed severely limited mouth opening after surgery and radiotherapy. The 18-month follow-up period revealed satisfactory function, tissue compatibility, retention, and esthetics for this patient with a maxillectomy and severe trismus.

Influence of different designs of bulb support structures on the accuracy and weight of 3D printed maxillary obturators. An in vitro study.

STATEMENT OF PROBLEM: Evidence is lacking on the influence of different designs of bulb support structures on the accuracy of 3-dimensional (3D) printed obturators. PURPOSE: The purpose of this in vitro study was to evaluate the influence of various infill designs (hollow, honeycomb, and gyroid) for the bulb of an obturator on the accuracy and weight of digital light projection (DLP) 3D printed maxillary obturators. MATERIAL AND METHODS: A maxillary obturator was virtually designed and used to obtain 3 digital reference files which were defined based on the design of the infill support structure within the bulb: hollow, honeycomb, and gyroid. The resultant standard tessellation language (STL) files were used to fabricate the obturators using a DLP 3D-printer in FREEPRINT denture resin material (n=10 per each group design). The fitting surfaces of all printed specimens (n=30) were digitized using a laboratory scanner, and the scan STL files were exported to the Geomagic control X program for dimensional accuracy analysis (trueness and precision) using the digital subtraction technique. One-way analysis of variance (ANOVA) was used for analysis (α=.05) RESULTS: Quantitative analysis revealed no significant difference in root mean square estimate (RMSE) values among the test groups for trueness (P=.326) and precision (P=.140). Hollow bulb design was significantly lighter in weight than both honeycomb and gyroid infill designs (P<.001). Colormaps revealed increased areas of negative deviation around the circumference of the bulb wall in the hollow design compared with both the gyroid and honeycomb groups and the close surface matching of fitting surfaces in the 3 groups. CONCLUSIONS: The lack of significant difference in accuracy among the tested groups and the significantly lighter hollow design obturator compared with honeycomb and gyroid designs favors the selection of the hollow bulb design in the digital fabrication of maxillary obturators.

Tissue surface adaptation and retention of digital obturator after one year of use.

BACKGROUND: Effect of aging on tissue adaptability and retention of digital obturator is still under investigation. METHODS: A maxillary Armany (class I) epoxy reference model was scanned to fabricate digital obturator fabricated from milled Co-Cr framework and 3D printed bulb. A color map of the scanned reference and digital obturator was made using Geomagic software to evaluate the accuracy of fit before and after cyclic loading using ROBOTA chewing simulator at 37,500, 75,000 and 150,000 cycles to simulate clinically 3-, 6- and 12-months chewing condition. Insertion-removal condition simulating the placement and removal of the obturator was done using repeated 360, 720 and 1440 cycles and retention was evaluated before and after the repeated cycles. Data were collected, tabulated and statistically analyzed using Statistical Package for Social Sciences (IBM SPSS Statistics 26). Student t-test and multi variable ANOVA test were used to detect significance. P-value < 0.05 was considered significant difference. RESULTS: For retention test: There was a significant difference between baseline and 3, 6 and12 months. For the tissue surface adaptation test: There was significant difference at all measured areas (P-value < 0.05) before and after application of load. CONCLUSION: digitally designed and fabricated obturator was highly retentive and has excellent tissue surface adaptation upon fabrication, After application of load; reduction of retention and lack of tissue adaptation were resulted. THE CLINICAL IMPLICATION: of this manuscript is that digital obturator can be used successfully with the shortcomings of loosening retention and adaptation afterwhile. So, clinical trials should investigate the clinical acceptance of these shortcomings.

Retention of implant retained obturator using two implant placement configurations for maxillectomy cases: in-vitro study.

BACKGROUND: Implant-retained obturators for maxillectomy cases have several advantages over traditional obturators but prosthetic design for specific conditions after maxillary resection has several challenges and the appropriate implant placement configuration is essential for improving retention and the stability of the implant-retained obturator. OBJECTIVES: The present study aimed to assess the retention force of using linear and nonlinear implant placement configurations using ball and socket attachment in implant-retained obturators at the initial retention and after simulation of six months of use. MATERIALS AND METHODS: Two identical epoxy resin maxillary models of a completely edentulous unilateral maxillary defect (Brown's class IIb) were used for implant placement, in the first model three implants were arranged with linear placement configuration, and in the second model three implants were arranged in nonlinear placement configuration. For proper sample sizing, 26 models and obturator were used. Two equal groups of obturators (13 for each group) were constructed, each with a different implant placement configuration. Both groups used the same attachment design (a non-splinted ball attachment). Using a cyclic loading machine that served as a dental insertion and removal simulator, each study group was subjected to 500 tension-compression cycles simulating 6 months of use. Using the universal testing machine, each obturator was removed at a speed of 50 mm/min for the crosshead. peak load to dislodgement was measured at the initial retention and after the simulations of six months of use. Data were analyzed using independent and paired t-tests while percent change was analyzed using the Mann Whitney U test. RESULTS: There were a statistically significant differences in retention between the nonlinear implant placement configuration for Brown's class IIb maxillectomy and the linear implant placement configuration at initial retention evaluation with p-value of < 0.0001 and after simulation of six months of usage with p-value of < 0.0001 Also, after simulation of 6 months of use group I lose - 24.87 (10.16) % of its retention while group II lose - 17.49 (7.78) %. CONCLUSIONS: Non-linear implant placement is more retentive at the initial retention and after simulation of six months of use than linear and loses less retention after usage.

Immediate rehabilitation of a palatal defected edentulous patient by implant-supported overdenture: a case report.

BACKGROUND: Immediate rehabilitation is a considerable therapeutic challenge but is necessary for edentulous patients with oronasal fistulas, especially those with inadequate residual bone and a history of radiotherapy. CASE PRESENTATION: We report a rare case of a 63-year-old patient who was missing the majority of his maxillary teeth and who had a defect due to palatal mucoepidermoid carcinoma resection. The patient also received radiotherapy twice within one year postoperatively. An implant-supported prosthesis with an obturator was fabricated immediately. CONCLUSION: This technique improved patients' oral function, enhanced the aesthetic effect, and increased their confidence.

Maxillary interim obturator prosthesis fabrication for a patient with limited mouth opening with a digital approach: A clinical report.

Squamous cell carcinoma is a common malignant condition affecting the oral cavity and may involve the surrounding maxillofacial regions. Treatment commonly involves resection of the tumor, followed by prosthetic rehabilitation of the resection defect. This clinical report presents a 62-year-old Asian male patient who had previously undergone surgical resection, resulting in a post-surgical Aramany Class II maxillary defect. The patient's medical history included severe trismus, characterized by restricted mouth opening, as well as a diagnosis of maxillary sinus verrucous squamous cell carcinoma. This report provides a comprehensive account of the rapid fabrication of an interim obturator using digitally assisted dentistry techniques.

Modified vestibuloplasty of the zygomaticoalveolar crest to gain intradefect support for an obturator prosthesis.

This clinical report details a novel surgical modification at the time of maxillectomy to improve obturator function. A vestibuloplasty and split thickness skin graft of the zygomaticoalveolar crest created a denture-bearing surface that, when engaged, provided support and stability for the obturator prosthesis. This report outlines the surgical and prosthodontic procedures and the results achieved.

Digital workflow and virtual validation of a 3D-printed definitive hollow obturator for a large palatal defect.

This clinical report describes how a hollow obturator prosthesis was designed and fabricated for an 82-year-old partially edentulous patient with a large palatal defect. Computer-aided design (CAD) was used to design, articulate, and align the mandibular denture with the obturator prosthesis. The prosthesis was printed, adjusted chairside, rescanned, and made hollow by using a CAD software program. The prosthesis was printed in resin with a dental 3D printer. Quantitative evaluations of clinical (prosthesis dimensions, rest, and occlusal vertical dimensions) and virtual (surface area, volume, weight, interpoint mismatches, spatial overlap) parameters found that the 3D-printed prosthesis required an additional 5% chairside modification. The greatest differences in volume (24.7% less) and weight (22.2% less) were observed when the modified obturator bulb was made hollow via CAD. Hollowing the bulb, therefore, reduced the spatial overlap in volume by 16.8%.

Microbial Analysis of Obturators During Maxillofacial Prosthodontic Treatment Over an 8-Year Period.

The aim of the study was to investigate the microbial colonization (by Candida species, anaerobic and facultative anaerobic bacteria) of maxillary obturators used for the restoration of maxillary defects, including during radiotherapy.Retrospective cohort study.Fifteen patients requiring a maxillary obturator prosthesis had swabs of their obturators and adjacent tissues taken at different stages of their treatment over a period of 8 years.Identification of microbial species from the swabs was carried out using randomly amplified polymorphic DNA polymerase chain reaction (RAPD PCR) analysis, checkerboard DNA-DNA hybridization, CHROMagar Candida chromogenic agar, and DNA sequencing.Candida species were detected in all patients and all patients developed mucositis and candidiasis during radiotherapy which was associated with an increase in colonization of surfaces with Candida spp., particularly C albicans. Microbial colonization increased during radiotherapy and as an obturator aged, and decreased following a reline, delivery of a new prosthesis, or antifungal treatment during radiotherapy.Microbial colonization of maxillary obturators was related to the stage of treatment, age of the obturator material, radiotherapy and antifungal medications, and antifungal treatment may be recommended if C albicans colonization of palatal tissues is greater than 105 colony-forming units per cm2 following the first week of radiotherapy.

Prosthetic rehabilitation after hemimaxillectomy: a case report.

Maxillofacial defects created by the surgical resection of a tumor negatively impact the mastication, phonation, swallowing, and psychological function of patients. A 68-year-old woman received a diagnosis of oral squamous cell carcinoma involving the hard palate. The hemimaxillectomy procedure for tumor resection created a defect on the left side of the palate. This case report describes the patient's cancer treatment from presurgical planning to final rehabilitation with a conventional obturator and subsequent follow-up care for 1 year. The rehabilitation strategy was satisfactory for the patient, reestablishing lost function and esthetics.

Effectiveness of prosthetic rehabilitation and quality of life of older edentulous head and neck cancer survivors following resection of the maxilla: a cross-sectional study.

PURPOSE: To evaluate the effectiveness of prosthetic rehabilitation, as well as the quality of life (QOL) of older edentulous maxillectomy patients. METHODS: Effectiveness of the complete denture obturator prosthesis and QOL of N = 44 older edentulous patients who had resection of the maxilla and were restored with a definitive prosthesis that was in use for a minimum of 1 year was assessed using three instruments: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), Head and Neck Cancer Module (QLQ-HN35), and Obturator Functioning Scale (OFS). Data analysis was performed by one-way analysis of variance (ANOVA) on ranks, Spearman rank-order correlation, and hierarchical multivariable rank regression at α = .05 level of significance. RESULTS: Participants' gender (P < .001), adjuvant treatment (P = .016), surgical approach (P = .017), size of the maxillary defect (P = .028), participants' prosthetic history (P = .047), and dental status of the mandible (P = .038) were significantly related to the self-reported effectiveness of the complete denture obturator prosthesis. Perceived functioning of the prosthesis (P = .001), participants' gender (P = .002), the American Society of Anesthesiologists (ASA) physical status (P = .027), and surgical approach (P = .039) were significant predictors of QOL. CONCLUSION: Restoration of the edentulous maxillectomy defect is challenging. An effective definitive complete denture obturator appeared to be the strongest predictor for advanced quality of life in older maxillectomy patients. The physical status of the older participants significantly affected the overall QOL, but did not influence the self-reported functioning of the complete denture obturator prosthesis.

Changes in Quality of Life After Secondary Closure of Palatal Defects: Prosthetic Obturation Versus Surgical Reconstruction.

BACKGROUND: The closure of palatal defects after tumor resection or irradiation is performed with either a prosthesis or autogenous tissue; however, there are no clear criteria regarding selection of the method. Thus, this study aimed to investigate the real-world situation and problems of palatal closure using prostheses, and examined patient opinion on how palatal closure using autogenous tissue improved their postoperative quality of life (QOL). METHODS: In 5 patients whose palatal defects resulted from treatment for head and neck cancer and were closed with a prosthesis, the palate was closed secondarily with autogenous tissue; a questionnaire on daily life was administered pre- and post-operatively. RESULTS: Functional improvements in terms of speech and eating were achieved in all and in 4 of 5 cases, respectively. In all cases, the QOL was better for palatal closure with autogenous tissue than with the prosthesis. CONCLUSIONS: As postoperative QOL was considered to be better when reconstructing the palate with autogenous tissue than with the prosthesis, we recommend to actively select autogenous tissue for palate reconstruction.

Quality of life in patients with soft palate resection: The relationship between reported functional prosthetic outcomes and the patient's psychological adjustment.

STATEMENT OF PROBLEM: Tumors of the soft palate and the adjacent tissues often create considerable soft palate defects that are challenging for the maxillofacial prosthodontist. Soft palate obturator prostheses can usually address functional and esthetic concerns; however, the effectiveness of the prosthetic rehabilitation in improving the patient's well-being and overall quality of life (QOL) has not been extensively researched. PURPOSE: The purpose of the present research was to evaluate the function of the prosthesis, to review the interrelation between sociodemographic, medical, and treatment (SMT) characteristics, QOL, and prosthesis functioning, and to analyze the role of the prosthesis in how the patient represents the illness and the psychological coping response. MATERIAL AND METHODS: Thirty-three patients who underwent resection of the soft palate and had been using a technically successful soft palate obturator prosthesis for at least 1 year were interviewed by means of 5 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), Head and Neck Cancer Module (QLQ-HN35), Obturator Functioning Scale (OFS), Illness Perceptions Questionnaire (IPQ-R), and Mental Adjustment to Cancer Scale (MAC). Data analysis was performed at α=.01. RESULTS: The QOL (r=-0.53, P=.001), personal control (r=-0.53, P=.001), negative adjustment to cancer (r=0.47, P=.005), treatment control (r=-0.55, P=.001), consequences (r=0.62, P<.001), and emotional representations (r=0.30, P=.009) were significantly related to prosthesis functioning. Better QOL was significantly related to prosthesis functioning (P=.006), age (P=.001), sex (P=.011), and type of soft palate defect (P=.009). The most important predictors of favorable soft palate obturator functioning were age (P<.001) and type of soft palate defect (P=.01). CONCLUSIONS: A patient-perceived effective soft palate obturator prosthesis was a significant predictor for advanced QOL, better adjustment to illness and illness-related disabilities, as well as the overall coping response to cancer.

A Systematic Review of Feeding Interventions for Infants with Cleft Palate.

OBJECTIVE: Various devices and techniques have been proposed to reduce feeding difficulties experienced by infants with cleft palate. The aim of this review is to identify and assess the scope and quality of evidence for these interventions. METHODS: A systematic review of published literature evaluating feeding interventions for infants with cleft palate (with or without cleft lip) from database inception to 2021 was conducted using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using a methodological index for nonrandomized studies, Cochrane, or a measurement tool to assess systematic reviews 2 instruments, according to study type. RESULTS: Fourteen studies met inclusion criteria, with the majority (71%) of studies consisting of second-level evidence. Included interventions were specialty bottles (21%), alternative feeding delivery systems (14%), obturators (14%), and educational programs (14%). Specialty bottles and palatal obturators did not appear to offer any substantial growth advantages compared to traditional bottles or no intervention, respectively. Designated education programs for the mothers of infants with clefts had a positive impact on infant growth. CONCLUSIONS: Overall evidence evaluating feeding interventions for infants with cleft palate was moderate to low. While it does not appear that specialized feeding delivery systems or palatal obturators significantly improve growth in infants with clefts compared to children without cleft conditions, education programs do appear to be beneficial.

Intraoral Digital Impression for Speech Aid/Obturator in Children: Report of 2 Cases.

Cleft patients may develop an abnormal opening (fistula) between the oral and the nasal cavities. Surgical repair minimizes the adverse effect on speech and feeding. However, an obturator prosthesis is a nonsurgical approach to help close the communication. The purpose of the case report presented is to show the clinical use of an intraoral digital impression in the fabrication of obturator/speech aid appliances in children with cleft lip and palate deformity. Minimal adjustments were needed, and patients and caregivers responded positively. Prostheses demonstrated good stability and retention at delivery. The use of digital technology seems to have several benefits as an alternative method for capturing impressions, especially in young children with cleft lip and palate deformity.

Implant-Supported Prosthetic Rehabilitation of a Patient With Squamous Cell Carcinoma: A Case Report.

Patients who have undergone maxillary resection procedures are rehabilitated with dental obturators or microvascular reconstruction. This case report describes implant-supported prosthetic rehabilitation of a patient who underwent maxillary resection because of squamous cell carcinoma. After maxillectomy surgery, the patient was rehabilitated using a surgical obturator for 1 week, followed by an interim obturator until the surgical field was completely healed. For definitive prosthesis, different treatment options were presented from which the patient selected an implant-supported maxillofacial prosthesis and a removable mandibular partial prosthesis. Under general anesthesia, 2 zygomatic implants and 4 conventional implants to the posterior maxilla were inserted. After a healing period, the bar-retained maxillofacial prosthesis and removable mandibular partial denture were fabricated. The patient was satisfied regarding function, esthetics, speech, and swallowing. No problems, except slight discoloration of the prosthesis, were noted at the 6-month follow-up. Implant-supported maxillofacial prostheses are a valuable treatment option to improve quality of life after maxillary resection.

CAD-CAM Hollow Obturator Prosthesis: A Technical Report.

An obturator with a hollow bulb can decrease the overall weight of the prosthesis, stress on the underlying tissues, and patient discomfort. Although many techniques and materials have been proposed in the literature for hollowing the obturator prosthesis, they are often time consuming and technique sensitive. This proposed technique used an open-source software program to hollow a digital design of a solid obturator base from a commercially available software in one single convenient step. The hollowing process allowed precise control of prosthesis thickness at the hollow space area for desirable hermetic seal and prosthesis strength.

Computer-Aided Design and Manufacture of Intraoral Splints: A Potential Role in Cleft Care.

BACKGROUND: Nasoalveolar molding is a nonsurgical modality for the treatment of cleft lip and palate that uses an intraoral splint to align the palatal shelves. Repeated impressions are needed for splint modification, each carrying risk of airway obstruction. Computer-aided design and manufacturing (CAD/CAM) has the ability to simplify the process. As a precursor to CAD/CAM splint fabrication, a proof-of-concept study was conducted to compare three-dimensional splints printed from alginate impressions versus digital scans. We hypothesized that intraoral digital scanning would compare favorably to alginate impressions for palate registration and subsequent splint manufacture, with decreased production times. METHODS: Alginate and digital impressions were taken from 25 healthy teenage volunteers. Digital impressions were performed with a commercially available intraoral scanner. Plaster casts made from alginate impressions were converted to Standard Triangle Language files. Patient-specific matched scans were evaluated for total surface area with the concordance correlation coefficient. Acrylic palatal splints were three-dimensionally printed from inverse digital molds. Subjective appliance fit was assessed using a five-point scale. RESULTS: A total of 23 participants were included. Most subjects preferred digital impression acquisition. Impression methods showed moderate agreement (concordance correlation coefficient 0.93). Subjects rated splints from digital impressions as having a more precise fit (4.4 versus 3.9). The digital approach decreased impression phase time by over 10-fold and overall production time by 28%. CONCLUSIONS: CAD/CAM has evolved extensively over the past two decades and is now commonplace in medicine. However, its utility in cleft patients has not been fully realized. This pilot study demonstrated that CAD/CAM technologies may prove useful in patients requiring intraoral splints.

Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic.

During the current pandemic scenario, maxillofacial rehabilitation specialists involved with supportive care in cancer must transform its practice to cope with COVID-19 and improve protocols that could quickly return the oral function of complex cancer patients who cannot wait for surgical complex rehabilitation. This includes the role of the maxillofacial prosthodontist for the rehabilitation of surgically treated patients with maxillary cancers by the means of filling obturator prostheses that are considered an optimal scientific-based strategy to reduce hospital stay with excellent pain control, oral function (speech, swallowing, mastication, and facial esthetics), psychologic and quality of life outcomes for the patients following intraoral cancer resection. Therefore, the aim of this commentary was to bring new lights to the strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic as well as to present a protocol for managing such cases.