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1.
J Med Life ; 14(3): 383-389, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34377205

RESUMO

Prosthetic rehabilitation of a partial or total maxillectomy with an obturator is the most acceptable treatment option. The hollowing of the obturator prosthesis is beneficial as it reduces the stresses over the underlying and surrounding tissues. A simple technique of fabricating a hollow bulb obturator has been discussed in this article. At the step of the packing of a denture, the hollow wax pattern of the defect area is formed with modeling wax. This hollow wax pattern is filled with water and is allowed to freeze to form an ice block. This ice block is removed from the wax pattern and is interposed between two layers for heat-cured acrylic resin and is then cured. After processing the denture, the water is retrieved by making a small hole in denture base, which is packed after hollowing with a cold cure acrylic resin. A lightweight prosthesis with a uniform thickness was achieved with a readily available and easily retrievable material, i.e., ice.


Assuntos
Membros Artificiais , Obturadores Palatinos , Humanos , Implantação de Prótese
2.
J Indian Prosthodont Soc ; 21(3): 249-255, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34380811

RESUMO

Aim: To compare speech intelligibility (SI), nasal resonance, and swallowing ability in maxillectomy patients with a customized obturator to the conventional obturator. Settings and Design: Non-randomized controlled study. Materials and Methods: Forty-eight maxillectomy patients were recruited and assessment of SI, nasal resonance, and swallowing ability was done at three situations: without obturator, with conventional obturator, and with customized obturator. Recordings of unrehearsed conversation, counting from number 1-20 and four sets of Chapel Hill Multilingual Intelligibility Test in the Hindi language were used to assess SI and nasal resonance. SI was evaluated by untrained listeners and graded according to a 6-point scale. Nasal resonance was evaluated by speech pathologists on a 7-point scale of severity. Swallowing ability was evaluated by water drinking test. Statistical Analysis Used: One-way ANOVA, Post hoc Bonferroni and Chi square test. Results: SI and nasal resonance showed a statistically significant difference between any two groups (P < 0.001). Water drinking time was significantly different between without obturator and with customized obturator (P < 0.001), but the difference was not statistically significant between without obturator and with obturator (P < 0.004). Conclusion: SI, nasal resonance, and swallowing ability improved with customized obturator in comparison to the conventional obturator.


Assuntos
Deglutição , Inteligibilidade da Fala , Ingestão de Líquidos , Humanos , Nariz , Obturadores Palatinos
3.
Rev. Soc. Odontol. La Plata ; 31(60): 7-12, jul. 2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1284434

RESUMO

Objetivo: Describir el plan de tratamiento completo para el manejo de pacientes con fisura labio alvéolo palatina (F.L.A.P.), basado en nuestra experiencia clínica de más de 40 años. Casos clínicos: En nuestro protocolo consideramos fundamental el tratamiento ortopédico, teniendo en cuenta los tiempos de crecimiento y desarrollo del maxilar superior de cada paciente, para luego aplicar las técnicas quirúrgicas en un maxilar armónico, con un éxito más predecible. Se describirá una serie de casos clínicos con seguimiento de pacientes. Conclusión: Con este protocolo que pregonamos desde hace muchos años, nos diferenciamos principalmente de otras propuestas por considerar los tiempos biológicos de cada paciente en cuanto a crecimiento y desarrollo, y no por basarnos en tiempos quirúrgicos preestablecidos. Aplicando este protocolo obtenemos resultados predecibles que entendemos que solo son posibles de evaluar, al realizar el seguimiento del paciente hasta completar su desarrollo (AU)


Objective: To describe the comprehensive treatment plan aimed at managing patients with cleft lip and palate (CLP) on the basis of our more than forty years of clinical experience. Case reports: e orthopedic treatment is deemed fundamental in the present protocol, which takes into account the maxilla growth and development periods of each individual patient, to later perform a surgical technique in a harmonized maxilla, with a more predictable success. Clinical cases with the patient follow-up shall be described. Conclusion: e main difference between the present protocol that has been held for many years and others proposed approaches mainly lies in considering the unique growth and developmental biological stages of each patient and not in drawing on pre-established surgical timing. When applying this protocol, predictable results are achieved and they are only meant possible to be assessed during the thorough patient follow-up (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Obturadores Palatinos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Ortopedia/métodos , Equipe de Assistência ao Paciente , Periósteo/cirurgia , Desenvolvimento Maxilofacial
4.
Arch. health invest ; 10(7): 1150-1155, July 2021. ilus
Artigo em Português | BBO - Odontologia | ID: biblio-1344592

RESUMO

A prótese obturadora constitui o principal método para a reabilitação de grandes defeitos maxilares. Tem como objetivo fechar o defeito, separar a cavidade oral da cavidade nasal, prevenir a fala anasalada e a regurgitação nasal de alimentos e líquidos e dar sustentação ao perfil facial. Este artigo visa relatar um caso de reabilitação com prótese obturadora maxilar após maxilectomia parcial. Paciente do gênero feminino, 72 anos, diagnosticada com carcinoma adenoide cístico na região de palato, foi submetida a maxilectomia parcial que resultou em extenso defeito maxilar e comunicação bucosinusal. Após anamnese, exames extra, intraorais e radiográfico, foi planejado para o período cicatricial e de uso da sonda nasogástrica, a confecção de uma placa obturadora para melhorar a deglutição e fala. Em seguida, confecção de uma prótese total obturadora superior e prótese parcial removível inferior. A placa obturadora foi confeccionada e utilizada até a remoção da sonda e instalação das próteses. Após moldagem das duas arcadas, foram obtidos modelos funcionais que foram montados em articulador após os ajustes dos planos de orientação e registro das relações intermaxilares. Foram realizadas provas estéticas e funcionais dos dentes artificiais e ajustes necessários. Posteriormente à acrilização, as próteses foram instaladas e o ajuste oclusal executado. Para obter retenção e estabilidade satisfatórias durante a utilização da prótese obturadora superior foi sugerido o uso de adesivo para dentadura. Três proservações foram realizadas. A prótese obturadora reabilitou a estética, fonética, função mastigatória e deglutição restabelecendo a autoestima e a ressocialização da paciente(AU)


The obturator prosthesis is the main method for the rehabilitation of large maxillary defects. With the purpose to closethe defect, separate the oral cavity from the nasal cavity, prevent hypernasal speech, nasal regurgitation of food and liquids and provide support for the facial profile. This article aims to report a case of rehabilitation with maxillary obturator prosthesis after partial maxillectomy. A 72-year-old female patient, diagnosed with adenoid cystic carcinoma in the palate region, underwent partial maxillectomy that resulted in extensive maxillary defect and bucco-sinus communication. After anamnesis, extra, intraoral and radiographic exams, the construction of a palatal plate was planned to be used with the nasogastric tube and during the healing process, to improve swallowing and speech. Then, the manufacture of a maxillary obturator prosthesis and a lower removable partial prosthesis. The palatal plate was made and used until the tube was removed and the insertion of the prostheses. After the impressions, master casts were made and mounted on an articulator after adjustment of wax occlusion rims and registration of the maxillo-mandibular relations. Functional elements of speech, occlusion, and appearance were evaluated during the try-in of the provisional set-up and adjusts were made.After the acrylization, the prostheses were inserted and the occlusal adjustment performed. To obtain satisfactory retention and stability when using the maxillary obturator prosthesis, it was suggested to use denture adhesive. Three post-insertions visits were carried out. The obturator prosthesis rehabilitated aesthetics, phonetics, masticatory function and swallowing, restoring the patient's self-esteem and improving social life(AU)


La prótesis obturadora es el método principal para la rehabilitación de grandes defectos maxilares. Tiene por objetivo cerrarel defecto, separar la cavidad bucal de la cavidad nasal, prevenir el habla nasal, la regurgitación nasal de alimentos y líquidos,dando apoyo al perfil facial. Este artículo tiene objetivo de reportar un caso de rehabilitación con prótesis obturadora maxilar tras maxilectomía parcial. Una paciente de 72 años, diagnosticada de carcinoma adenoide quístico en región del palato, fué sometida a maxilectomía parcial que resultó en extenso defecto maxilar y comunicación bucosinusal. Después de anamnesis, exámenes extra, intraorales y radiográficos, se planificó para el período de cicatrización y el uso de la sonda nasogástrica,la construcción de una placa obturadora para mejorar la deglución y el habla. Luego, la fabricación de una prótesis obturadora total superior y una prótesis parcial inferior removible. La placa obturadora se hizo y se utilizó hasta que se retiró la sonda y se instalaron las prótesis. Se realizón la impresión de ambos arcos, obtuvieron modelos funcionales que se montaron en articulador, tras ajustes de los planos de orientación y registro de relaciones intermaxilares. Se realizaron pruebas estéticas y funcionales en dientes artificiales y ajustes necesarios. Después de la acrilización se instalaron las prótesis y se realizó ajuste oclusal. Para obtener una retención y estabilidad satisfactoria al utilizar la prótesis obturadora superior, fue sugirió utilizar un adesivo para prótesis. Se realizaron tres proservaciones. La prótesis obturatriz rehabilitó estética, fonética, función masticatoria y deglución, devolviendo autoestima y resocialización al paciente(AU)


Assuntos
Humanos , Feminino , Idoso , Obturadores Palatinos , Carcinoma Adenoide Cístico , Prótese Parcial Removível , Resultado do Tratamento , Carcinoma Adenoide Cístico/cirurgia , Maxila/cirurgia , Prótese Maxilofacial
5.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33727288

RESUMO

Maxillectomy is done for a variety of disease conditions. Reconstruction following maxillectomy is done to restore the form and function. One of the important goals that are to be achieved in reconstruction is the separation of the oral and nasal cavities. In this article, we report the use of palatal flap by preserving the descending palatine artery during bilateral inferior partial maxillectomy, for separating the nasal cavity from the oral cavity. This technique eliminates the need for an obturator or another free or local flap for this purpose.


Assuntos
Neoplasias Maxilares , Procedimentos Cirúrgicos Reconstrutivos , Craniotomia , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Neoplasias Maxilares/cirurgia , Obturadores Palatinos , Retalhos Cirúrgicos
6.
Plast Reconstr Surg ; 147(3): 444-454, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33620939

RESUMO

BACKGROUND: Value-based health-care reform requires assessment of outcomes and costs of medical interventions. In cleft care, presurgical infant orthopedics is still being evaluated for clinical benefits and risks; however, the cost of these procedures has been largely ignored. This study uses robust accounting methods to quantify the cost of providing two types of presurgical infant orthopedics: Latham appliance treatment and nasoalveolar molding. METHODS: This is a prospective study of patients with nonsyndromic cleft lip and/or palate who underwent treatment with presurgical infant orthopedics from 2017 to 2019 at two academic centers. Costs were measured using time-driven activity-based costing. Personnel costs, facility costs (operating room, clinic, and inpatient ward), and equipment costs were included. Travel expenses were incorporated as an estimate of direct costs borne by the family, but indirect costs (e.g., time off from work) were not considered. RESULTS: Twenty-three patients were treated with Latham appliance treatment and 14 were treated with nasoalveolar molding. For Latham appliance treatment, average total cost was $7553 per patient ($1041 for personnel, $637 for equipment, $4871 for facility, and $1004 for travel over 6.5 visits). Unilateral and bilateral costs were $6891 and $8860, respectively. For nasoalveolar molding, average cost totaled $2541 ($364 for personnel, $151 for equipment, $300 for facility, and $1726 for travel over 13 visits); $2120 for unilateral and $3048 for bilateral treatment. CONCLUSIONS: The major difference in cost is attributable to operative placement of the Latham device. Travel cost for nasoalveolar molding is often higher because of frequent clinical encounters required. Future investigation should focus on whether outcomes achieved by presurgical infant orthopedics justify the $2100 to $8900 expenditure for these adjunctive procedures.


Assuntos
Fenda Labial/economia , Fenda Labial/terapia , Fissura Palatina/economia , Fissura Palatina/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Moldagem Nasoalveolar/instrumentação , Obturadores Palatinos/economia , Boston , Efeitos Psicossociais da Doença , Feminino , Seguimentos , Humanos , Lactente , Masculino , Moldagem Nasoalveolar/economia , Moldagem Nasoalveolar/métodos , North Carolina , Estudos Prospectivos
7.
J Surg Res ; 261: 173-178, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33444946

RESUMO

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.


Assuntos
Fissura Palatina/terapia , Desenho Assistido por Computador , Diagnóstico Bucal/métodos , Moldagem Nasoalveolar/instrumentação , Obturadores Palatinos , Adolescente , Alginatos , Voluntários Saudáveis , Humanos , Projetos Piloto , Contenções , Adulto Jovem
8.
Int J Oral Maxillofac Surg ; 50(9): 1156-1160, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33386202

RESUMO

The surgical removal of a maxillary tumour will result in an oronasal communication, which can negatively affect the patient's life and daily functions. Following maxillectomy, the defect can be treated with a prosthetic obturator or microvascular flap. However, the gold standard technique remains controversial. The aim of this study was to evaluate and compare quality of life (QoL) outcomes of submental island flap versus maxillary obturator reconstruction after partial maxillectomy. Sixty patients indicated for maxillectomy were allocated randomly to two equal-sized groups. Control group patients underwent reconstruction with a surgical obturator, while intervention group patients underwent submental island flap reconstruction. Patient QoL was evaluated at the 6-month follow-up using the University of Washington Quality of Life Questionnaire. Statistically significant differences in QoL were found between the two groups. Chewing (P = 0.034), swallowing (P < 0.001), speech (P = 0.009), taste (P = 0.04), mood (P = 0.01), and anxiety (P = 0.003) domains showed a statistically significant improvement in the submental group compared to the obturator group. However, the obturator group showed a greater improvement in appearance (P < 0.001). The masticatory function scores in the obturator group were significantly higher after obturator rehabilitation (P < 0.001). In conclusion, this study found that submental flap reconstruction provided better function and QoL than the obturator. This reconstruction was associated with less pain and better pronouncing of words, chewing, swallowing food, and psychosocial adjustment.


Assuntos
Neoplasias Maxilares , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Neoplasias Maxilares/cirurgia , Obturadores Palatinos , Qualidade de Vida , Retalhos Cirúrgicos , Inquéritos e Questionários
9.
J Craniofac Surg ; 32(5): 1794-1795, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33496518

RESUMO

ABSTRACT: Maxillary defects caused by surgical resection generate abnormal communication between the nasal and oral cavities, hindering proper eating and phonetics, and causing aesthetic damage. Prosthetic intervention is necessary to rehabilitate these patients, in order to block communication and allow correct speech and swallowing functions. This article reports the manufacture of an immediate palatal obturator prosthesis after hemimaxillectomy due to the surgical removal of an intraoral squamous cell carcinoma, which guaranteed better conditions for postoperative recovery, as well as better adaptation to the definitive prosthesis and the use of the prosthetic apparatus.


Assuntos
Carcinoma de Células Escamosas , Estética Dentária , Carcinoma de Células Escamosas/cirurgia , Humanos , Maxila , Boca , Obturadores Palatinos
10.
Cleft Palate Craniofac J ; 58(3): 386-390, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32808548

RESUMO

OBJECTIVE: The virtual cone beam computed tomography-derived 3-dimensional model was compared with the scanned conventional model used in the fabrication of a palatal obturator for a patient with a large palatal defect. DESIGN: A digitally derived 3-dimensional maxillary model incorporating the palatal defect was generated from the patient's existing cone beam computerized tomography data and compared with the scanned cast from the conventional impression for linear dimensions, area, and volume. The digitally derived cast was 3-dimensionally printed and the obturator fabricated using traditional techniques. Similarly, an obturator was fabricated from the conventional cast and the fit of both final obturator bulbs were compared in vivo. RESULTS: The digitally derived model produced more accurate volumes and surface areas within the defect. The defect margins and peripheries were overestimated which was reflected clinically. CONCLUSION: The digitally derived model provided advantages in the fabrication of the palatal obturator; however, further clinical research is required to refine consistency.


Assuntos
Obturadores Palatinos , Impressão Tridimensional , Tomografia Computadorizada de Feixe Cônico , Humanos , Maxila/diagnóstico por imagem , Palato/diagnóstico por imagem
11.
Support Care Cancer ; 29(1): 11-15, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856215

RESUMO

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.


Assuntos
COVID-19/epidemiologia , Procedimentos Clínicos/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Prótese Maxilofacial , Neoplasias Bucais/reabilitação , Obturadores Palatinos , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Procedimentos Clínicos/normas , Planejamento de Prótese Dentária/normas , Estética , Humanos , Reconstrução Mandibular/instrumentação , Reconstrução Mandibular/métodos , Reconstrução Mandibular/normas , Prótese Maxilofacial/estatística & dados numéricos , Neoplasias Bucais/cirurgia , Ortodontia/métodos , Ortodontia/organização & administração , Ortodontia/normas , Obturadores Palatinos/estatística & dados numéricos , Pandemias , Patologia Bucal/organização & administração , Patologia Bucal/normas , Qualidade de Vida , SARS-CoV-2 , Fluxo de Trabalho
12.
Gerodontology ; 38(2): 209-215, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33345389

RESUMO

AIM: To evaluate the stress on the surrounding structures of Aramany class I maxillectomy defect restored with different obturator prostheses. METHODS AND RESULTS: Definitive three-dimensional (3D) finite element (FE) model of Aramany class I defect rehabilitated with single- and two-piece closed bulb obturator prostheses was constructed based on patient computed tomography (CT) using a software. Unilateral defect restored with tripodal design single-piece closed bulb obturator was used as FE model 1- and two-piece magnet retained closed bulb obturators as FE model 2. Finite element analysis (FEA) with three different load (150 N, 200 N and 250 N) applications was used to calculate the equivalent von Mises stress. A least stress value of 62.28 MPa was observed in two-piece closed bulb design with 150 N force, and highest stress value of 104.15 MPa was observed in single-piece obturator with application of 250 N force. CONCLUSION: Minor difference in stress distribution pattern was observed between single-piece obturator and two-piece obturator, and stress value was comparatively lesser in two-piece than single-piece obturator. The stress pattern, distribution and numerical values increased with increase in magnitude of forces. More stress was observed on the lateral slopes of obturator closer to defect than in other areas of the obturator.


Assuntos
Maxila , Obturadores Palatinos , Análise de Elementos Finitos , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia
13.
Stomatologiia (Mosk) ; 99(5): 74-79, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33034181

RESUMO

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.


Assuntos
Maxila , Obturadores Palatinos , Humanos , Maxila/cirurgia
14.
PLoS One ; 15(10): e0241589, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33125441

RESUMO

Implant-retained custom-milled framework enhances the stability of palatal obturator prostheses. Therefore, to evaluate the mechanical response of implant-retained obturator prostheses with bar-clip attachment and milled bars, in three different materials under two load incidences were simulated. A maxilla model which Type IIb maxillary defect received five external hexagon implants (4.1 x 10 mm). An implant-supported palatal obturator prosthesis was simulated in three different materials: polyetheretherketone (PEEK), titanium (Ti:90%, Al:6%, V:4%) and Co-Cr (Co:60.6%, Cr:31.5%, Mo:6%) alloys. The model was imported into the analysis software and divided into a mesh composed of nodes and tetrahedral elements. Each material was assumed isotropic, elastic and homogeneous and all contacts were considered ideal. The bone was fixed and the load was applied in two different regions for each material: at the palatal face (cingulum area) of the central incisors (100 N magnitude at 45°); and at the occlusal surface of the first left molar (150 N magnitude normal to the surface). The microstrain and von-Mises stress were selected as criteria for analysis. The posterior load showed a higher strain concentration in the posterior peri-implant tissue, near the load application side for cortical and cancellous bone, regardless the simulated material. The anterior load showed a lower strain concentration with reduced magnitude and more implants involving in the load dissipation. The stress peak was calculated during posterior loading, which 77.7 MPa in the prosthetic screws and 2,686 µÎµ microstrain in the cortical bone. For bone tissue and bar, the material stiffness was inversely proportional to the calculated microstrain and stress. However, for the prosthetic screws and implants the PEEK showed higher stress concentration than the other materials. PEEK showed a promising behavior for the bone tissue and for the integrity of the bar and bar-clip attachments. However, the stress concentration in the prosthetic screws may represent an increase in failure risk. The use of Co-Cr alloy can reduce the stress in the prosthetic screw; however, it increases the bone strain; while the Titanium showed an intermediate behavior.


Assuntos
Materiais Dentários/química , Maxila/cirurgia , Obturadores Palatinos , Fenômenos Biomecânicos , Ligas de Cromo/química , Humanos , Cetonas/química , Teste de Materiais , Maxila/anatomia & histologia , Modelos Anatômicos , Polietilenoglicóis/química , Estresse Mecânico , Titânio/química
15.
J Oral Rehabil ; 47(9): 1171-1177, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32613633

RESUMO

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.


Assuntos
Implantes Dentários , Maxila , Estudos Transversais , Prótese Dentária Fixada por Implante , Humanos , Mastigação , Países Baixos , Obturadores Palatinos , Qualidade de Vida
16.
Spec Care Dentist ; 40(3): 315-319, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32396249

RESUMO

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.


Assuntos
Neoplasias Maxilares , Obturadores Palatinos , Seguimentos , Humanos , Maxila , Estudos Retrospectivos
17.
Oral Maxillofac Surg ; 24(2): 157-161, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32147758

RESUMO

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.


Assuntos
Implantes Dentários , Prótese Maxilofacial , Feminino , Humanos , Masculino , Maxila , Obturadores Palatinos
18.
J Prosthet Dent ; 124(6): 810-814, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32199640

RESUMO

Cysts, a common occurrence in the jaws, are managed with different conservative and radical approaches. Although surgical excision is usually the treatment of choice, it can result in an open defect that compromises the oronasal seal and affects the patient's quality of life by interfering with daily intake of nutrition. These defects vary in anatomic geometry and extent depending upon etiology and require a prosthodontic intervention in the intermediate phase until a definitive closure is executed. An unconventional obturator design with a helical spring incorporated into a flexible obturator is described to manage 2 patients with challenging anterior maxillary cysts.


Assuntos
Obturadores Palatinos , Qualidade de Vida , Humanos , Maxila/cirurgia
19.
BMC Pediatr ; 20(1): 103, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32126980

RESUMO

BACKGROUND: Robin sequence (RS) is characterized by mandibular micro- and retrognathia, glossoptosis, upper airway obstruction and optionally a cleft palate. With an incidence of 1:8000, it belongs to the so-called rare diseases; 30-50% of patients have RS as part of a syndrome. A comparatively well-studied treatment option is the Tuebingen Palatal Plate (TPP), which has proven effective in both, isolated and syndromic RS, but often requires multiple endoscopies for perfect fit and effectiveness. We report on a new method for fitting the TPP with only one session of nasopharyngeal endoscopy resulting in the plate being finished in one day. METHODS AND RESULTS: First, a prototype is produced, consisting of a traditional acrylic palatal part and a velar extension made of thermoplastic resin, usually measuring 10x40mm. Using polymerization, a scale is added to the posterior part of the extension to help with determining its optimal length during endoscopic evaluation. The extension is pre-bent in the dental laboratory to achieve an approximate shape. During endoscopy, the prototype can be adjusted to the infant's anatomy: first, the angulation is customized by controlled heating, bending and cooling of the thermoplastic spur. Second, the length of the spur is adapted by grinding its tip. Then the prototype is returned to the dental laboratory for completion; the final plate can be delivered to the patient on the same day. It acts by shifting the tongue into a more anterior position, thereby opening the airway and releasing upper airway obstruction, as well as by acting as a functional orthodontic appliance that stimulates mandibular growth through exerting pressure on the base of the tongue. CONCLUSIONS: With the thermoplastic spur presented here, a TPP can be produced within one day, requiring only one endoscopy. This approach may facilitate fabricating the TPP.


Assuntos
Obstrução das Vias Respiratórias , Obturadores Palatinos , Síndrome de Pierre Robin , Obstrução das Vias Respiratórias/terapia , Humanos , Lactente , Recém-Nascido , Mandíbula , Palato , Síndrome de Pierre Robin/terapia , Polissonografia
20.
Int. j. odontostomatol. (Print) ; 14(1): 67-72, mar. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1056503

RESUMO

ABSTRACT: There has been little discussion about the quality of life of patients with maxillary defects. This article evaluates the issues related to the condition. We performed a cross-sectional study of patients with maxillary defects from referral centers in Brazil. To avoid subject burden, a questionnaire was developed, based on questions from seven instruments, which dealt with domains and conclusions that were similar to those from other studies. The predictor variable was the patients' score for each question. The outcome measure was the presence of the best-ranked items on the questionnaire as the impact factor. Six experts assessed these items and suggested which questions to include or exclude. Patients scored each item according to its occurrence and importance. Descriptive statistics and the items' rank according to the impact factor were computed to determine whether there is a comprehensive instrument available. Thirteen patients and six professionals were included in this study. The patients' age ranged from 24 to 72 years (mean (standard deviation, SD), 50.41 (14.46) years). We obtained a 60-item instrument from the selected questionnaires and subject interviews. Only 12 (37.5 %) out of the 32 best-rated items were verified by the existing instruments, two (6.25 %) were suggested by professionals and 18 (56.25 %) were conclusions from other studies. To the best of our knowledge, this is the first study to provide many features related to the quality of life in patients with maxillary defects.


RESUMEN: Existe escasa discusión en la literatura sobre la calidad de vida de los pacientes con defectos maxilares. Este artículo evalúa los problemas relacionados con esta condición. Realizamos un estudio transversal de pacientes con defectos maxilares de centros de referencia en Brasil. Se desarrolló un cuestionario basado en preguntas de siete instrumentos, que trataba sobre dominios y conclusiones similares a las de otros estudios. La variable de estimación fue la puntuación de los pacientes para cada pregunta. La medida de resultado fue la presencia de los elementos mejor clasificados en el cuestionario como factor de impacto. Seis expertos evaluaron estos ítems y sugirieron qué preguntas incluir o excluir. Los pacientes puntuaron cada ítem según su ocurrencia e importancia. Se calcularon las estadísticas descriptivas y la clasificación de los ítems según el factor de impacto, para determinar si existe un instrumento completo. Trece pacientes y seis profesionales fueron incluidos en este estudio. La edad de los pacientes osciló entre 24 y 72 años [media (desviación estándar), 50,41 (14,46) años]. Obtuvimos un instrumento de 60 ítems de los cuestionarios y entrevistas de temas seleccionados. Solo 12 (37,5 %) de los 32 ítems mejor calificados se verificaron de acuerdo a los instrumentos existentes, dos (6,25 %) fueron sugeridos por profesionales y 18 (56,25 %) fueron conclusiones de otros estudios. De acuerdo a nuestro conocimiento, este es el primer estudio que proporciona características relacionadas con la calidad de vida en pacientes con defectos maxilares.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Doenças Maxilares/patologia , Doenças Maxilares/epidemiologia , Neoplasias Maxilares/patologia , Prótese Maxilofacial/classificação , Prótese Maxilofacial/normas , Obturadores Palatinos , Palato/cirurgia , Qualidade de Vida , Brasil , Neoplasias Maxilares/cirurgia , Estudos Transversais , Inquéritos e Questionários , Comissão de Ética , Análise de Dados
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