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1.
Support Care Cancer ; 29(1): 11-15, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856215

RESUMEN

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.


Asunto(s)
/epidemiología , Vías Clínicas/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Prótesis Maxilofacial , Neoplasias de la Boca/rehabilitación , Obturadores Palatinos , Atención Ambulatoria/métodos , Atención Ambulatoria/organización & administración , Vías Clínicas/normas , Diseño de Prótesis Dental/normas , Estética , Humanos , Reconstrucción Mandibular/instrumentación , Reconstrucción Mandibular/métodos , Reconstrucción Mandibular/normas , Prótesis Maxilofacial/estadística & datos numéricos , Neoplasias de la Boca/cirugía , Ortodoncia/métodos , Ortodoncia/organización & administración , Ortodoncia/normas , Obturadores Palatinos/estadística & datos numéricos , Pandemias , Patología Bucal/organización & administración , Patología Bucal/normas , Calidad de Vida , Flujo de Trabajo
2.
Stomatologiia (Mosk) ; 99(5): 74-79, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33034181

RESUMEN

BACKGROUND: Due to the growth of oncological diseases of the maxillofacial region, there is an increasing need to improve methods of orthopedic treatment of post-resection defects of the upper jaw with modern designs of replacement prostheses. OBJECTIVE: Improving the quality of orthopedic treatment by creating an improved upper jaw resection prosthesis and justifying its use. MATERIAL AND METHODS: We studied the effectiveness of orthopedic treatment of post-resection defects of the upper jaw using the proposed replacement prosthesis with a pneumatic obturator. A special questionnaire was used to analyze the level of adaptation and maladaptation of patients. RESULTS: There was a significant decrease in complaints and adaptation time in the group of patients with a replacement prosthesis with a pneumatic obturator. CONCLUSION: The use of the proposed resection removable prosthesis helps to reduce the period of adaptation to the prosthesis, which indicates that it can be widely used in clinical practice.


Asunto(s)
Maxilar , Obturadores Palatinos , Humanos , Maxilar/cirugía
3.
J Oral Rehabil ; 47(9): 1171-1177, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32613633

RESUMEN

OBJECTIVE: The aim of this study was to compare masticatory performance and patient reported eating ability of maxillectomy patients with implant-supported obturators and patients with surgically reconstructed maxillae. METHODS: This cross-sectional study was conducted at the University of Alberta, Edmonton, Canada and at Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Eleven surgically reconstructed maxillectomy patients have been included at University of Alberta and nine implant-supported obturator patients at MUMC+. The mixing ability test (MAT) was used to measure masticatory performance. In addition, the oral health related quality of life (OHRQoL) was measured with shortened versions of the oral health impact profile (OHIP) questionnaire. Values of the implant-supported obturator group versus the surgical reconstruction group were compared with independent t-tests in case of normal distribution, otherwise the Mann-Whitney U test was applied. RESULTS: Patients with reconstructed maxillae and patients with implant-supported obturator prostheses had similar mean mixing ability indices (18.20 ± 2.38 resp. 18.66 ± 1.37; P = .614). The seven OHRQoL questions also showed no differences in masticatory ability between the two groups. CONCLUSION: With caution, the results of this study seem to confirm earlier results that implant-supported obturation is a good alternative to surgical reconstruction for all Class II maxillary defects. With both techniques, the masticatory performance is sufficiently restored, with careful planning being highly desirable.


Asunto(s)
Implantes Dentales , Maxilar , Estudios Transversales , Prótesis Dental de Soporte Implantado , Humanos , Masticación , Países Bajos , Obturadores Palatinos , Calidad de Vida
4.
Spec Care Dentist ; 40(3): 315-319, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32396249

RESUMEN

INTRODUCTION: A definitive maxillary obturator prosthesis can be used to rehabilitate a maxillary defect with the aim of improving speech, deglutition, and elimination of oronasal regurgitation. The aims of this study were (1) to determine the time required to fabricate a definitive maxillary obturator prosthesis and (2) to compare the fabrication and follow-up times between a patient's first and second definitive maxillary obturator prosthesis. MATERIALS AND METHODS: A retrospective review was completed of patients that had maxillary definitive obturators fabricated following head and neck surgery from 2002 to 2018 (n = 173). Demographics, clinical data, date of surgery, start date of fabrication, follow-up dates, and prosthesis follow-up data were collected. RESULTS: The median time to delivery of the patient's first definitive maxillary obturator prosthesis from the date of surgery was 7.7 months for nonradiated patients and 9.6 months for radiated patients (P ≤ .05). Additionally, there was a significant difference in the median number of appointments to fabricate the 1st definitive maxillary obturator prosthesis as compared to the 2nd prosthesis (6 vs 5; P ≤ .05). CONCLUSION: Fabrication timelines differed based on history of radiotherapy and patient experience. This data is helpful to set expectations for patients and practitioners regarding the process for prosthesis fabrication and follow-up.


Asunto(s)
Neoplasias Maxilares , Obturadores Palatinos , Estudios de Seguimiento , Humanos , Maxilar , Estudios Retrospectivos
5.
Oral Maxillofac Surg ; 24(2): 157-161, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32147758

RESUMEN

INTRODUCTION: Maxillectomy following tumors or, more rarely, traumatic injuries may result in maxillary defects that may determine physical dysfunctions and functional impairment of speech and swallowing. The aim of our study was to present our experience in the management of post-maxillectomy patients by the use of obturator prostheses that were obtained by 3D digital casts via an intraoral scanner. METHODS: Patients with maxillary defects following maxillary and/or palatal resection or maxillary traumatic avulsion were selected for this clinical study between 2015 and 2018. Five to 6 months after surgery, a definitive obturator prosthesis was fabricated thanks to an intraoral scanner. The following parameters of clinical outcome were considered: the absence of fluid leakage, the recovery of phonation, the recovery of swallowing, and personal satisfaction. RESULTS: Twenty-eight patients (20 males, 8 females) fulfilled the inclusion criteria and were included in the study. Most patients had a maxillary and/or palatal defect because of a malignant tumor. On the whole, 93% of patients reported a complete absence of fluid leakage between maxillary sinuses or nasal fossa and oral cavity; most patients reported a good or complete recovery of phonation and swallowing. CONCLUSIONS: Digital technology for the fabrication of maxillary obturator prosthesis may be effective and useful. The reduced laboratory working time, the avoidance of the risk of aspiration of impression materials, and the overcome of the difficulties associated with whole tissue undercut impression are just some of the most important advantages that have been encountered thanks to this promising technology.


Asunto(s)
Implantes Dentales , Prótesis Maxilofacial , Femenino , Humanos , Masculino , Maxilar , Obturadores Palatinos
6.
Rev. esp. cir. oral maxilofac ; 42(1): 20-24, ene.-mar. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-195294

RESUMEN

OBJETIVOS: Describir la prevalencia y localización de la anastomosis intraósea (AIO) del conducto alveolar superior posterior (CASP) con el conducto alveolar superior anterior (CASA) en pacientes portadores de fisura labiopalatina, comparando el lado afectado por la fisura labiopalatina de tipo transforamen incisivo unilateral (FLP) con el contralateral no portador de fisura labiopalatina (NF). MATERIAL y MÉTODO: Fueron evaluadas 1500 tomografías computadorizadas de haz cónico (TCHC) y de acuerdo con criterios de inclusión, 95 TCHC fueron seleccionadas para análisis (52 hombres, 43 mujeres, edad media 27 años). La muestra fue conformada por: 1) pacientes con FLP en el lado derecho y NF en el lado izquierdo; y 2) pacientes con FLP en el lado izquierdo y NF en el lado derecho. El análisis fue dividido en 4 etapas: 1) calibración intra e interexaminador; 2) evaluación de la presencia/ausencia de la AIO del CASP con CASA; 3) localización de la AIO del CASP con CASA, tomando como referencia las caras mesiales de los dientes (17/27), (16/26), (15/5) y (14/24); y 4) comparar la simetría/asimetría de localización comparando el lado portador de FLP con el contralateral NF. RESULTADOS: La prevalencia total de la AIO fue de 67,9 %. La prevalencia de la AIO en el lado portador de FLP fue 71,6 % y en el lado NF fue 64,2 % (Test de Fisher > 0,35). La localización de la AIO en el lado portador de FLP fue más prevalente en las áreas (15/25), (16/26) y en el lado NF fue en el área (14/24) (Test Chi-cuadrado < 0.03). La AIO es asimétrico en el 71,5 % (Test de Fisher < 0.03), cuando se compara el lado FLP con el contralateral NF. CONCLUSIONES: La prevalencia de la AIO fue mayor en el lado portador de FLP (71,6 %) comparado con el lado NF (64,2 %). La localización de AIO en el lado portador de FLP fue dislocado hacia distal a diferencia de su contralateral NF. La AIO fue asimétrica en 71,5 % de los casos. Esta información es relevante en procedimientos quirúrgicos que son realizados en pacientes con fisuras labiopalatinas, que tienen por objetivo corregir las discrepancias maxilomandibulares


OBJECTIVES: The purpose of this study was to examine the prevalence of intraosseous anastomosis (AIO) between the posterior superior alveolar canal (CASP) and the anterior superior alveolar canal (CASA) in patients with cleft lip and palate, comparing the side affected by unilateral incisive trans-forame fissure (FLP) with the contralateral side not affected by fissure (NF). Material and method: A total of 1500 Cone Beam Computed Tomography (TCHC) were evaluated and, according to inclusion criteria, 95 TCHC were selected for analysis (52 men, 43 women, average age 27 years). The sample consisted of 1) patients with FLP on the right side and NF on the left side; and 2) patients with FLP on the left side and NF on the right side. The analysis was divided into 4 steps: 1) Intra and inter-rater calibration; 2) evaluating presence or absence of AIO anastomose between the CASP with CASA; 3) Location of the AIO anastomose between the CASP with CASA, as reference to the mesial aspect of each tooth (17/27), (16/26), (15/25) and (14/24); 4) Evaluated symmetry/asymmetry the localization of AIO, comparing them side with FLP, with the contralateral side NF. RESULTS: The total prevalence of AIO was 67.9 %. The prevalence in FLP side was 71.6 %, and NF side was 64.2 % (Fisher's test > 0.35). The location of the AIO in the FLP side was more than prevalent in the areas of (15/25), (16/26) and on the NF side, it was in the area (14/24) (Chi-square test < 0.03). The AIO was 71.5% (Fisher's test > 0.03) asymmetric comparative of the FLP side with the contralateral NF. CONCLUSIONS: The prevalence of AIO was higher in FLP side (71.6 %) comparing the NF side (64.2 %). The location of AIO, in the FLP side was dislocated distally when compared with the contralateral side NF. The AIO was asymmetric in 71.5% of the cases. This information is relevant in surgical procedures that are performed in patients with cleft lip and palate, which aim to correct maxillomandibular discrepancies


Asunto(s)
Humanos , Fisura del Paladar/cirugía , Labio Leporino/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Arteria Maxilar/cirugía , Anastomosis Quirúrgica/métodos , Obturadores Palatinos , Implantación Dental/métodos , Tomografía Computarizada de Haz Cónico/métodos , Estudios Retrospectivos
7.
J Prosthet Dent ; 124(5): 616-622, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31959395

RESUMEN

STATEMENT OF PROBLEM: Oral rehabilitation after maxillectomy can be performed by prosthetic obturation or with a free fibula flap. Successful prosthetic obturation of large maxillectomy defects can be difficult, and masticatory function is at risk in these patients. Surgical reconstruction might provide adequate masticatory function, but the literature is lacking evidence regarding this topic. PURPOSE: The purpose of this pilot clinical study was to assess masticatory functions and health-related quality of life (HR-QoL) outcomes in patients after maxillectomy reconstructed by using the Rohner or the Alberta Reconstructive Technique and to compare outcomes with patients rehabilitated with an obturator prosthesis. MATERIAL AND METHODS: Mixing ability, maximum occlusal force, maximum mouth opening, and HR-QoL were assessed. Differences between the 2 groups were analyzed by using the Kruskal-Wallis tests for continuous variables and chi-squared tests for categorical variables. RESULTS: The reconstructed patients (n=11) showed better mixing ability, occlusal force (nonoperated side), and overall mean HR-QoL. The nonreconstructed group (n=13) did not differ from the reconstructed groups in terms of maximum mouth opening, overall mean occlusal force, occlusal force on the operated side, and most HR-QoL questionnaire domains. CONCLUSIONS: Maxillary reconstruction might be beneficial for masticatory performance in patients undergoing maxillectomy. A larger study is justified to support the possible benefit of the reconstruction of maxillary defects regarding mixing ability, occlusal force (nonoperated side), and HR-QoL.


Asunto(s)
Implantes Dentales , Procedimientos Quirúrgicos Reconstructivos , Peroné , Humanos , Maxilar/cirugía , Obturadores Palatinos , Proyectos Piloto , Calidad de Vida
8.
J Oral Sci ; 62(1): 122-124, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31996515

RESUMEN

Retainers are the most important component in the success of an obturator prosthesis. However, the optimal retainer design for a fully dentulous patient with palatal defect needs four widely separated retainers-resulting in unsatisfactory esthetics-and regulates engagement of deep undercuts of the defect cavity, which leads to an inadequate palatal seal. A new retainer-free obturator prosthesis that closes only the defect cavity and is retained by undercuts within the defect was designed and proved useful for problems caused by a clasp-retained obturator prosthesis for a fully dentulous patient with palatal defects.


Asunto(s)
Implantes Dentales , Obturadores Palatinos , Humanos , Maxilar , Diseño de Prótesis
9.
Clin Oral Implants Res ; 31(5): 405-416, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31944417

RESUMEN

OBJECTIVE: The aim of this cross-sectional study was to compare the masticatory performance and oral health-related quality of life (OHRQoL) of edentulous maxillectomy patients with and without implant-supported obturator prostheses. MATERIAL AND METHODS: Nineteen edentulous maxillectomy patients with completed prosthetic obturator treatment in the upper jaw participated in this study. In nine patients, the obturator prosthesis was supported by implants in the remaining bone of the midface and/or skull base to improve retention. Masticatory performance was measured objectively by the mixing ability test (MAT) and subjectively by three OHRQoL questionnaires: (a) the Oral Health Impact Profile for EDENTulous people (OHIP-EDENT), (b) the Obturator Function Scale (OFS), and (c) the Dutch Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3-NL). The independent t test and the Mann-Whitney U test were used to test for differences in outcomes of patients with and without implant-retention of their obturator prostheses. RESULTS: Patients with implant-supported obturator prostheses had significantly better masticatory and oral function, reported fewer chewing difficulties, and had less discomfort during food intake than did patients with a conventional obturator. CONCLUSION: Supporting prosthetic obturators after maxillectomy with implants improve oral functioning, chewing, and eating comfort. This treatment modality is a viable technique to improve the functionality of prosthetic rehabilitation in patients who have undergone maxillectomy.


Asunto(s)
Implantes Dentales , Calidad de Vida , Estudios Transversales , Prótesis Dental de Soporte Implantado , Humanos , Salud Bucal , Obturadores Palatinos
10.
J Dent ; 92: 103230, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31734257

RESUMEN

OBJECTIVES: To describe the correlation between changes in the surface area and depth of the face in individuals wearing an obturator compared with it not being in place, and self-reported Quality of Life in relation to appearance. METHODS: Difference images were created from stereophotogrammetry images recorded from research participants with and without their obturators in place. On the difference images of the face, surface areas and mean depths were calculated. Oral health impact profile questionnaires (OHIP-49) were completed. RESULTS: Data from 19 research participants were recorded. The mean size of the outlined area of the face when the obturators were present compared to when they were not was 1411 mm2 (SD ± 848). Similarly the mean depth differences ranged up to 6.14 mm. Although a proportion of the individuals reported effects in relation to their quality of life, there were no statistically significant relations between the surface areas and mean depths with the participants' responses to the quality of life questions. CONCLUSIONS: There are clear changes in facial tissues, both in relation to surface area and depths when obturators are worn compared to when they are not. There is no simple relationship between the extent of facial change with and without an obturator and quality of life around appearance. The determinants of changed quality of life in this group of patients require greater exploration.


Asunto(s)
Cara , Neoplasias de Cabeza y Cuello/cirugía , Obturadores Palatinos , Calidad de Vida , Humanos , Fotogrametría , Encuestas y Cuestionarios
11.
Artículo en Inglés | MEDLINE | ID: mdl-31562033

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the clinical outcomes of implant-retained obturator rehabilitation after maxillectomy, based on quality of life (QOL) and masticatory function. STUDY DESIGN: The present study included 12 patients who underwent dental implant surgery after maxillectomy. Oral health-related QOL and masticatory function before and after completion of implant-retained obturator rehabilitation were evaluated. RESULTS: Oral Health Impact Profile-Short Form (OHIP-14) scores showed significant differences in the domain for functional limitation (before, 4.08 ± 2.47; after, 1.33 ± 0.98; P < .01); physical pain (before, 2.75 ± 2.05; after, 0.42 ± 0.51; P < .01); physical disability (before, 3.24 ± 2.11; after, 1.33 ± 1.30; P < .01), psychological disability (before, 3.83 ± 2.48; after, 1.67 ± 2.50; P < .01); social disability (before, 2.17 ± 1.75; after, 1.08 ± 1.38; P < .05); handicap (before, 3.17 ± 1.90; after, 1.08 ± 1.00; P < .01); and total score (before, 22.41 ± 10.17; after, 8.83 ± 6.82; P < .01) Furthermore, masticatory function score was significantly higher after completing implant-retained obturator rehabilitation (before, 38.75 ± 22.97; after, 69.17 ± 21.41; P < .01). CONCLUSIONS: Implant-retained obturator rehabilitation contributed to improved masticatory function and oral health-related QOL after maxillectomy.


Asunto(s)
Implantes Dentales , Calidad de Vida , Prótesis Dental de Soporte Implantado , Humanos , Obturadores Palatinos , Encuestas y Cuestionarios
12.
J Prosthet Dent ; 123(4): 648-652, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31590982

RESUMEN

Conventional methods used for fabricating hollow obturator prostheses have numerous problems. The workflow presented in this article integrates 3D digital technologies into a functional protocol, enabling the fabrication of single-piece hollow prostheses with no joints by using an optical 3D scanner and a laminating molding device.


Asunto(s)
Obturadores Palatinos , Flujo de Trabajo , Impresión Tridimensional
13.
Int J Oral Maxillofac Surg ; 49(3): 392-396, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31515119

RESUMEN

Surgical reconstruction after a total maxillectomy remains challenging. The standard treatment is the microvascular free flap. In cases of surgical contraindication, oral rehabilitation is usually performed with a palatal obturator prosthesis (PAP). Acceptable anatomical and functional outcomes in terms of speech, mastication, aesthetic appearance, stability, and comfort are not often achieved with a PAP. This technical note describes a technique for reconstruction after total bilateral maxillectomy involving the implantation of a custom-made bone-anchored titanium prosthesis obtained by 3D printing. Good functional and anatomical outcomes were achieved with this technique. It combines the advantages of the obturator prosthesis (short duration of surgery and hospitalization, low morbidity) and free flap (aesthetic/anatomical reconstruction and irremovable comfortable functional rehabilitation). This technique constitutes a new therapeutic alternative for the restoration of large defects after total maxillectomy when free flaps are contraindicated.


Asunto(s)
Neoplasias Maxilares , Procedimientos Quirúrgicos Reconstructivos , Estética Dental , Humanos , Maxilar , Obturadores Palatinos , Titanio
14.
J Prosthet Dent ; 123(2): 355-363, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31307797

RESUMEN

STATEMENT OF PROBLEM: Prosthetic interventions at various stages help patients recover from esthetic and functional disabilities. However, little is known regarding their impact on patient quality of life (QOL) during various phases of treatment. PURPOSE: The purpose of this clinical study was to evaluate changes in the QOL and acoustic speech parameters of patients rehabilitated by using a prosthesis at various stages after undergoing maxillectomy. MATERIAL AND METHODS: A total of 30 consecutive patients who underwent maxillectomy resection and successfully completed all phases of rehabilitation with obturator prostheses were included. The study was conducted in 4 phases. In the preoperative phase, patients were evaluated for QOL and speech, and dental impressions were made. In the immediate postoperative phase, patients were rehabilitated with a delayed surgical obturator on the fifth postoperative day and were evaluated for QOL and speech on the 12th postoperative day. In the interim obturator phase, patients were rehabilitated with an interim maxillary obturator between the 12th and 15th postoperative days and were evaluated for QOL and speech after using the prosthesis for a minimum of 1 week. In the definitive phase, nonradiated patients were rehabilitated with a definitive prosthesis in the sixth week, and radiated patients were rehabilitated with a definitive prosthesis in the sixth month. The QOL and speech parameters of the patients were evaluated after 1 week. QOL evaluation in each phase was performed by using the EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires. Speech parameters, namely intensity, fundamental frequency, habitual frequency, jitter, shimmer, maximum phonation time, and the S/Z ratio, were measured by using acoustic speech software. The change in QOL over various phases of rehabilitation with an obturator was analyzed by using repeated measures analysis of variance, whereas changes in acoustic speech parameters were analyzed by using the Friedman test (α=.05). RESULTS: A statistically significant difference (P<.05) was observed in the physical function, role function, fatigue, nausea, vomiting, dyspnea, sleep, and appetite loss domains of the EORTC QLQ-C30 and in the speech, social eating, social contact, mouth opening, dry mouth, sticky saliva, use of painkillers, and feeding tube domains of the EORTC QLQ-H&N35. The analysis of speech parameters also revealed significant improvement in intensity, jitter, shimmer, maximum phonation time, and the S/Z ratio, suggesting improvement in speech with the use of different types of obturators. CONCLUSIONS: The overall QOL and speech of the patients showed increasing improvement with the use of surgical obturators, immediate obturators, and definitive obturators in that order. The disease symptoms and oral functions deteriorated in the immediate postoperative phase but improved steadily and approached the preoperative level with definitive obturator prostheses.


Asunto(s)
Neoplasias Maxilares , Calidad de Vida , Acústica , Estética Dental , Humanos , Obturadores Palatinos , Habla
15.
J Prosthet Dent ; 123(3): 531-534, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31307800

RESUMEN

To simulate the current oral status of patients, including maxillofacial defects, the digital method described uses a method based on multisource data. These include data recorded from scans made with and without wearing an obturator and data obtained by scanning the surgical or interim obturator. This method eliminates the need for preliminary impressions and complex border-molding steps during the process of creating a definitive obturator, thereby greatly simplifying the fabrication process.


Asunto(s)
Implantes Dentales , Obturadores Palatinos , Humanos , Boca
16.
J Prosthet Dent ; 123(1): 184-187, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31307801

RESUMEN

After ablative surgery, especially a total maxillectomy, an obturator is commonly used as a method of reconstruction. However, the loss of a palatal denture-bearing area and vestibular retentive undercuts leaves an anatomically deficient base on which to construct the definitive prosthesis. As a result, retention and stability is compromised. A solution to the retention problem is to construct an obturator that engages undercuts and scar bands. Engagement of all undercuts can lead to a prosthesis that is too cumbersome and difficult to insert, especially in a patient with scars after radiation. In this article, a technique for creating a 2-piece magnetic obturator that engages the nasal scar band is described.


Asunto(s)
Obturadores Palatinos , Implantación de Prótesis , Humanos , Maxilar
17.
Cleft Palate Craniofac J ; 57(4): 487-498, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31665902

RESUMEN

BACKGROUND: Maxillofacial prosthetics includes restoration of maxillary defects resulting from resection of palate and nasosinus neoplasms with obturator prostheses which may be colonized by microorganisms and function as a reservoir of infection. Patients with neoplasms commonly also require radiotherapy that can result in changes in saliva quality and quantity and changes in the oral microbial flora. The altered flora, in individuals immunocompromised from cancer therapy, increases their risk of prosthesis-related infections. OBJECTIVES: In this review article, we explore microbial biofilms, their main components, mechanisms of microbial adhesion, and stages of biofilm development. We also discuss the different materials that are used for manufacturing maxillary obturators, their characteristic features, and how these can affect microbial adhesion. Furthermore, we shed some light on the factors that affect microbial adhesion to the surface of maxillary obturators including tissue proteins, protein adsorption, and the acquired enamel pellicle. CONCLUSIONS: The conclusions drawn from this literature review are that it is imperative to minimize the risk of local and systemic infections in immunocompromised patients with cancer having maxillary defects. It is also important to determine the role of saliva in microbial adhesion to obturator materials as well as develop materials that have a longer life span with surface characteristics that promote less microbial adhesion than current materials.


Asunto(s)
Implantes Dentales , Neoplasias Maxilares , Biopelículas , Humanos , Maxilar , Obturadores Palatinos
18.
Braz. dent. sci ; 23(1): 1-8, 2020. ilus, tab
Artículo en Inglés | LILACS, BBO - Odontología | ID: biblio-1049266

RESUMEN

Background: Zinc oxide eugenol(ZOE) has long been the material of choice for obturating primary teeth,but it is resistant to resorption, might result in a deflected successor and has limited antibacterial efficacy. Curcuminpossessesanti-inflammatory and antimicrobialproperties which can be implied by its use as obturating material in primary teeth. Objective: To evaluate and compare the efficacy of Curcumin Gel mixed Endoflas powderand Zinc oxide eugenol as obturating materials in primary molars. Material and methods: A total of 30 primary molars indicated for pulpectomy were selected from 4-9-yearold children and divided into two equal groups based on the obturating material used. Group 1- Curcumin Gel mixed Endoflas powder(CGE) and Group 2- Zinc oxide eugenol(ZOE). The efficacy of these obturation materials was evaluatedboth clinically and radiographically. Follow-up was done after 1, 3 and 6months to evaluate clinical and radiographical success rates. The results were subjected to statistical analysis using SPSS software version 21 using chisquare test. Results: At the end of the 6th month follow-up,there was 93.3% clinical success in Group 1 compared with 86.6% success in Group 2. Whereas, radiographically success reported was 100% with Group 1 and 93.3% with Group 2. The difference in the radiographic success rate between the two Groups was statistically significant (P < 0.05). Conclusion: Based on the present study results, Curcumin Gel mixed Endoflas powder can be considered as an alternative obturation material for treating deciduous molars with extensive involvement of pulp and periradicular tissues.(AU)


Fundamentação: O óxido de zinco eugenol (OZE) há muito tempo é o material de escolha para a obturação de dentes decíduos, mas é resistente à reabsorção, podendo resultar em um dente permanente desviado e tem eficácia antibacteriana limitada. A curcumina possui propriedades anti-inflamatórias e antimicrobianas que podem indicar seu emprego como material obturador em dentes decíduos. Objetivo: Avaliar e comparar a eficácia da pasta de curcumina Endoflas e do óxido de zinco eugenol como materiais obturadores em molares decíduos. Material e métodos: Um total de 30 molares decíduos indicados para pulpectomia foram selecionados entre crianças de 4 a 9 anos e divididos em dois grupos iguais, com base no material obturador utilizado. Grupo 1 - pasta de curcumina Endoflas (CGE) e Grupo 2- óxido de zinco eugenol (ZOE). A eficácia desses materiais de obturação foi avaliada clinicamente e radiograficamente. O acompanhamento foi realizado após 1, 3 e 6 meses para avaliar as taxas de sucesso clínico e radiográfico. Os resultados foram submetidos à análise estatística no software SPSS versão 21, utilizando o teste quiquadrado. Resultados: No final do sexto mês de acompanhamento, houve 93,3% de sucesso clínico no Grupo 1 em comparação com 86,6% de sucesso no Grupo 2. Considerando que, o sucesso radiográfico relatado foi de 100% no Grupo 1 e 93,3% no Grupo 2. A diferença na taxa de sucesso radiográfico entre os dois grupos foi estatisticamente significante (P < 0,05). Conclusão: Com base nos resultados do presente estudo, a pasta de curcumina Endoflas pode ser considerada como um material de obturação alternativo para o tratamento de molares decíduos com amplo envolvimento de polpa e tecidos perirradiculares (AU)


Asunto(s)
Humanos , Masculino , Femenino , Niño , Obturadores Palatinos , Pulpectomía , Cemento de Óxido de Zinc-Eugenol , Curcuma , Antiinfecciosos
19.
Rev. Ciênc. Plur ; 6(1): 137-149, 2020. ilus
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1052873

RESUMEN

Introdução:Aenorme dificuldade de deglutição e fala apresentada em pacientes que sofreram maxilectomiatotal ou parcial por consequência de patologias bucais, afeta grande parte da população que realizou tal procedimento. A alternativa de minimizar o impacto causado pela sequela deixada após cirurgia em maxila está na confecção de um obturador palatino, que tem como objetivo obstruir a comunicação oronasal.Objetivo:Este trabalho objetivou descrever um relato de caso evidenciando o passo a passo clínico e laboratorial de uma prótese total obturadorae a satisfação do paciente com a mesma.Método:Paciente do gênero masculino, maxilectomizado há seisanos devido a presença de um CarcinomaAdenóideCístico foi reabilitado com prótese total obturadora superior e prótese total convencional inferior. A reabilitação superior seguiu os mesmos passos de uma prótesetotal convencional, com exceção da moldagem funcional, na qual foi feita a moldagem da comunicação bucosinusal com silicona de condensação antes da moldagem do selado periférico e moldagem funcional propriamente dita. Na etapa laboratorial, foi necessáriaa realização de três prensagens a fim de deixar a prótese oca na porção obturadora.Resultados:O tratamento restabeleceu a dimensão vertical perdida, proporcionou uma oclusão adequada, se mostrou melhor esteticamentee o paciente mostrou-se extremamente satisfeito com a reabilitação.Conclusões:Como conclusão, obteve-se uma prótese total obturadora superior com qualidades funcionais e estéticas satisfatórias. Ademais, ao comparar com a antiga, a novamostrou-se satisfatória de acordo com a percepção do usuário epossui um menor peso, favorecendo uma melhor retenção (AU).


Introduction:The enormous difficulty in swallowing and speaking presented in patients who underwent total or partial maxillectomy as a result of oral pathologies affects a large part of the population that performed this procedure. The alternative of minimizing the impact caused by the sequelae left after maxillary surgery is by making a palatal obturator, which aims to obstruct oronasal communication.Objective:This study aimed to describe a case report highlighting the clinical and laboratory step by step of a complete obturator prosthesis and patient satisfaction with it. Methods:A male patient who had been maxillectomized for 6 years due to the presence of a cystic adenoid carcinoma was rehabilitated with superior obturator total denture and inferior conventional total denture. The superior rehabilitation followed the same steps of a conventional total prosthesis, except for the functional molding, in which the bucosinusal communication with condensation silicon was molded before the peripheral sealing molding and the functional molding itself. In the laboratory stage, it was necessary to perform three presses in order to leave the hollow prosthesis in the obturator portion.Results:The treatment restored the lost vertical dimension, provided an adequate occlusion,was better aesthetically and the patient was extremely satisfied with the rehabilitation.Conclusions:In conclusion, a superior total obturator prosthesis with satisfactory functional and aesthetic qualities was obtained. Moreover, when compared to the old one, the new one was satisfactory according to the user's perception and has a lower weight, favoring a better retention (AU).


Introduccion: La enorme dificultad para tragar y hablarpresentada en pacientes que han sufrido una maxillectomía total o parcial como resultado de patologías orales afecta a gran parte de la población que realizó este procedimiento. La alternativa de minimizar el impacto causado por las secuelas que quedan después de la cirugía maxilar es hacer un obturador palatino, que tiene como objetivo obstruir la comunicación oronasal. Objetivo: Este estudio tuvo como objetivo describir un informe de caso que muestra la clínica y el laboratorio paso a paso de una prótesis obturadora completa y la satisfacción del paciente con ella. Método:Un paciente masculino que había sido maxillectomizado durante seis años debido a la presencia de un carcinoma adenoide quístico fue rehabilitado con una prótesis obturadora total superior y una prótesis total inferior convencional. La rehabilitación superior siguió los mismos pasos de una prótesis total convencional, excepto el moldeado funcional, en el cual la comunicación bucosinusal con silicio de condensación se moldeó antes del moldeado de sellado periférico y el moldeado funcional en sí. En la etapa de laboratorio, fue necesario realizar tres prensas para dejar la prótesis hueca en la porción del obturador. Resultados:El tratamiento restableció la dimensión vertical perdida, proporcionó una oclusión adecuada, fue mejor estéticamente y el paciente quedó extremadamente satisfecho con la rehabilitación. Conclusiones:Como conclusión, se obtuvo una prótesis obturadora superior con cualidades funcionales y estéticas satisfactorias. Además, en comparación con el anterior, el nuevo fue satisfactorio de acuerdo con la percepción del usuario y tiene un peso menor, lo que favorece una mejor retención (AU).


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Obturadores Palatinos , Cirugía Bucal/rehabilitación , Satisfacción del Paciente , Prótesis Maxilofacial , Rehabilitación Bucal , Brasil , Dentadura Completa
20.
Indian J Dent Res ; 31(5): 799-802, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33433523

RESUMEN

The majority of maxillary defects can be rehabilitated with pedicled flaps. However, when there are very large resections of the maxilla and flap success is questionable, then the defect may be obturated with a conventional hollow bulb clasp retained obturator or implant retained obturator prosthesis. However, inadequate retention, stability and support may be associated with the use of a conventional obturator and in case of recurrence the success of implant is questionable. A precision attachment becomes the silver lining. They have been used to retain obturator for some time. The use of precision attachments in a dentate maxillectomy patient can yield significant functional improvement while maintaining the obturator's aesthetic advantages. This clinical report describes the successful prosthetic rehabilitation of maxillary defects with an obturator retained using two different extracoronal resilient precision attachments. Attachment retained prosthesis provides a successful closure for the defect but also better esthetics, retention, better tolerability and better mastication and speech.


Asunto(s)
Estética Dental , Obturadores Palatinos , Humanos , Maxilar/cirugía , Habla , Colgajos Quirúrgicos
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