Three-Dimensional Printing: A Novel Approach to the Creation of Obturator Prostheses Following Palatal Resection for Malignant Palate Tumors.

BACKGROUND: A subgroup of patients who have an oronasal fistula live in areas that have limited access to oral prosthetics. For these individuals, a temporary prosthesis, such as a palatal obturator, may be necessary in order to speak, eat, and breath properly. The creation of an obturator, which requires a highly trained prosthodontist, can take time and can be expensive. Through the current proof-of-concept study, there is an attempt to create a patient-specific palatal obturator through use of free and publicly available software, and a low-cost desktop 3-dimensional printer. The ascribed study may provide a means to increase global access to oral prosthetics if suitable biomaterials are developed. METHODS: Computerized tomography data were acquired from a patient who had an oronasal fistula. Through use of free software, these data were converted into a 3-dimensional image. The image was manipulated in order to isolate the patient's maxilla and was subsequently printed. The palatal obturator models were designed, and reformed, in correspondence with the maxilla model design. A final suitable obturator was determined and printed with 2 differing materials in order to better simulate a patient obturator. RESULTS: Creating a suitable palatal obturator for the specified patient model was possible with a low-cost printer and free software. CONCLUSIONS: With further development in biomaterials, it may be possible to design and create an oral prosthesis through use of low-cost 3-dimensional printing technology and freeware. This can empower individuals to attain good healthcare, even if they live in rural, developing, or underserviced areas.

Rehabilitación protésica en pacientes fisurados con fístula buconasal / Prosthetic rehabilitation in patients with cleft lip and buconasal fistula

La fisura labiopalatina consiste en la falta de fusión de los procesos palatinos y labial durante el desarrollo embrionario. Estos pacientes presentan una comunicación buconasal, alteraciones dentarias de forma, tamaño y posición, y un deficiente desarrollo del maxilar. Su tratamiento requiere un trabajo de equipo multidisciplinar, ya que afecta funciones básicas que comprometen su calidad de vida, como comer, hablar o relacionarse socialmente. Aunque la cirugía primaria soluciona mayormente esta anomalía, algunas veces persiste la comunicación entre las cavidades bucal y nasal, lo que se conoce como comunicación o fístula buconasal. Esto supone una mayor dificultad en el cierre quirúrgico, siendo a veces imposible de cerrar a través de la cirugía. En tales casos, la obturación de dicha fístula a través de una prótesis otorga una solución de bajo costo para el paciente y con resultados óptimos a corto y mediano plazo. El objetivo de este artículo es exponer casos de rehabilitación protésica en pacientes con fisura labiopalatina y fístula buconasal posterior al tratamiento quirúrgico.

Cleft lip and palate is the lack of fusion of the palatal and labial processes during embryonic development. Patients are characterised by the presence of buconasal communication, dental alterations, and poor development of the maxilla. Treatment requires multidisciplinary team work, due to the impact on basic functions such as eating, talking or interacting with other people, and even compromising their quality of life. Although primary surgery mostly solves this anomaly, sometimes communication between the oral and nasal cavity persists (called communication or buconasal fistula). This leads to greater difficulty to surgically close it, being impossible in some cases. In these cases, the closure using a prosthesis provides a low-cost solution for the patient, with an optimal result in the short and medium term. The aim of this article is to present cases of prosthetic rehabilitation in patients with cleft lip and buconasal fistula after surgical treatment.

Cast Titanium for Obturator Framework Construction in Maxillofacial Prosthodontics.

A 37 year old male presented with the complaint of a loose and bulky acrylic obturator prosthesis. He had previously tried to using a different acrylic obturator prostheses as well as both cobalt chromium and titanium framework obturators. The most successful previous prosthesis was a titanium based obturator which had performed well prior to a fractured clasp. Accordingly, following an exploration of the available surgical and prosthodontic treatment options, a further tooth borne partial maxillary obturator was provided successfully. The case highlights the relative merits and limitations of the use of cast titanium as a denture base material in partial denture and obturator construction.

Impact of obturation of palatal fistulae on speech quality and aerodynamic parameters in patients with cleft palates.

OBJECTIVES: The aim of this prospective study was to measure nasal and oral airflow during speech, before and after obturation. PATIENTS AND METHODS: Included were children aged 3-18 years with nonsyndromic clefts and palatal fistulae. The corpus used was: syllable /pi/; a sentence containing stop consonants and a nasal phoneme; and the description of a picture of a scene. Analysis criteria were: percentage of nasality; value of average flow for the explosion; perceived nasality and intelligibility; and tolerance of the proposed device. RESULTS: Only 5 children were included due to the observation of an increase in the percentage of nasality after obturation. The value of average flow for the explosion increased in all patients. A decrease in perceived nasality was noted in all but 1 patient. An improvement in intelligibility was observed in 3 out of the 5 children. The tolerance of the device was good. CONCLUSION: While the small number of patients studied does not permit firm conclusions concerning the efficiency of the obturation, the method described, as well as the introduction of 'speed of explosion' of stop consonants, offer new perspectives to prospectively study obturator effects on speech.

Prosthetic treatments for patients with oronasal communication.

The prosthetic treatments play a role in the rehabilitation of patients with congenital and acquired cleft palate. To prepare the surgical field and/or correct inevitable sequelae of the surgery, the rehabilitation with obturator prosthesis is an auxiliary or complementary treatment to surgical treatments. In cases where the surgical treatment is contraindicated, the prosthetic rehabilitation becomes a definitive treatment. The denture is planned and fabricated according to each patient. Therefore, the aim of this study was to discuss the prosthetic rehabilitation performed in patients with oronasal communication.

An implant-retained maxillary overdenture to obturate a patent oronasal communication: a case report.

This is a case report of dental prosthetic treatment of a 72-year-old patient with cleft palate with a persisting oral nasal communication in the anterior hard palate. The remaining teeth were extracted, and dental implants were surgically placed in the maxilla and mandible to retain removable overdentures. The maxillary complete overdenture had full palatal coverage as opposed to partial coverage. It was retained by 5 implants with low-profile light retentive retainers. The mandibular overdenture was retained with 4 implants of different diameters and brands. Apparent parameters for successful treatment of a removable maxillary overdenture are as follows: denture flanges, flat or lingualized occlusal scheme, light low-profile retainer retention, maximum implant positional spread with parallel placement, and a minimum of 4 rough-surfaced, long, wide implants placed in denser-type bone sites.

Prosthetic rehabilitation of orofacial donor site fistula following surgical reconstruction: a clinical report.

Orofacial defects can be either congenital or acquired. Rehabilitation of these patients can be done using a surgical and/or a prosthetic approach. In situations where surgical reconstruction is not possible, prosthetic management becomes the only option. This clinical report describes a simple, economical, and effective technique for the prosthetic rehabilitation of a patient with oro-cutaneous fistula due to donor site dehiscence following tumor defect reconstruction.

Speech intelligibility following maxillectomy with and without a prosthesis: an analysis of 54 cases.

To statistically evaluate the factors that influenced speech following maxillectomy, the speech intelligibility (SI) in 54 patients was measured with and without a prosthesis. The mean SI score without a prosthesis in all patients was 35.7 +/- 22.7% and that with a prosthesis was 84.9 +/- 12.7%. The results of the postmaxillectomy SI statistical analysis revealed that an oro-nasal communication was one of the factors that influenced SI without a prosthesis. The resection of the anterior portion of the soft palate was one of the factors that influenced SI with a prosthesis, which suggested that for some of these patients we should consider specific surgical treatment, aimed at the reconstruction in the deep defect extending to the intratemporal fossa. A new classification of maxillary defects has been proposed which will help to predict the grade of post-maxillectomy speech disorder following surgery.