CLINICAL CONFERENCE - PROSTHODONTICS 2
MAXILLOFACIAL
PROSTHODONTICS
TOPIC OUTLINE:
A. Obturators
A.1 Basic Concepts
A.2 Case Presentation
A.3 Problem-Solving
MAXILLOFACIAL PROSTHODONTICS
- is a branch of prosthodontics concerned
with the restoration and/or
replacement of the stomatognathic
and associated facial structures with
prosthesis that may or may not be
removed on a regular or elective basis
- is a specialty of dentistry which deals
with the rehabilitation of patients with
acquired and congenital defects of the
head and neck region
- It focuses on optimizing the
rudimentary functions of speech and
swallowing
- These functions are disrupted
because of congenital, organic,
traumatic, or surgical
abnormalities involving the oral
cavity and related anatomical
structures.
- Maxillofacial prosthesis may be:
1. Extraoral - Part of the facial or cranial
structure (eye, ear or nose) is missing
and a nonliving substitute or prosthesis
is used to rehabilitate the part
2. Intraoral - Refers to defects in and
involving the oral cavity, for which
prosthesis may be used to rehabilitate
the defective area
I. BASIC CONCEPTS:
ANATOMICAL AND PHYSIOLOGICAL
CONSIDERATIONS: NORMAL FUNCTION
Superior Aspect of the Oral Cavity
● Hard palate
- “Roof” of oral cavity and “floor”
of nasal cavity and maxillary
sinuses
- It separates the oral cavity from
nasal cavity
● Soft palate
- Dynamic separator of oral and
nasal cavity
Respiration
● Expiration
- Air passes from the lungs, through the
pharynx, and then through the
oropharynx
- Either the air then passes behind the
soft palate into the nasopharynx, the
nasal cavity, and out the nose, or the
soft palate elevates to block the
nasopharynx and the air passes out the
oral cavity
● Inspiration
- Air passes in the opposite direction,
through either the nasal or the oral
cavity
- For appropriate separation of these
cavities during speech, respiration, and
swallowing, the soft palate elevates in
the middle third to separate the
oropharynx and nasopharynx
Speech
● Soft palate elevates
● Pharyngeal wall moves anteriorly and
medially but less dramatic than
sphincteric movement
● Velopharyngeal closure is the
functional movement of soft palate and
pharyngeal wall during speech and
swallowing
○ Nasal sound: n, m, ng
○ All oral sounds require that air be
impounded in the oral cavity by
the elevation of the soft palate and
closure of the pharyngeal walls
Inferior Aspect of the Oral Cavity
- Includes the tongue, muscles, and
tissues of the floor of mouth, and the
mandible
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
CLINICAL CONFERENCE - PROSTHODONTICS 2

- These inferior structures act in concert

- Generally require
during speech
some form of
● Tongue - primary articulator
prosthesis
Mastication Class IV - Completed cleft of
● Tongue constantly moves the food the palate involving
bolus on the occlusal surfaces alveolar ridges as well
- Forms the food into a mass and as lip on both right
pushes the mass posteriorly and left sides
against the hard palate and into - Generally require
the oropharynx some form of
● Soft palate simultaneously elevates as prosthesis
the pharynx squeezes
- The pharyngeal squeeze pushes
the food into the esophagus 3. Central nervous system trauma
4. Head injuries and cerebrovascular
accidents
FUNCTIONAL DEFICITS OF SPEECH AND 5. Surgery
6. Neoplastic disease
SWALLOWING
7. Closure of the surgical site
1. Congenital defects
8. Velopharyngeal closure or defects in
2. Cleft palate
hard palate

Class I - Clefts involving the Prosthetic Considerations

soft palate only ● Facial form
- Of these four classes, - Altered facial contours in patients
the class I type are who received trauma or surgical
surgically correctable resection
and usually do not - It may take several months after an
require any prosthesis operation or trauma for the soft
tissues to reach a final, stable position
Class II - Clefts involving the
- These changes necessitate:
soft and hard palate
- Fabrication of interim
up to the incisive
prostheses and repeated
foramen
prosthesis adjustments to
- The soft palate can be
conform to soft tissue
surgically corrected if
changes
the cleft of the hard
palate is not
correctable; the
Loss of Vertical Opening and Altered
prosthetic assistance
is provided for it Mandibular Movements
Causes:
Class III - Clefts of the soft and ● Surgical resection
hard palate involve - trauma to oral cavity structure
the alveolar ridge and - resection of the posterior aspect of the
continuous with the hard palate
lip on one side

GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA

CLINICAL CONFERENCE - PROSTHODONTICS 2
- muscles of mastication (medial and
lateral muscles) are frequently detached
from the maxilla or partially resected.
Trismus
- Immediate result of muscular trauma
leading to decreased vertical opening
and range of motion of the mandible.
- Manual exercise is given to improve
range of motion and opening.
● Clinical significance:
- Oral hygiene, prosthetic treatment, and
manipulation of food bolus will be
difficult.
Processed Bases
- Soft tissue and bony undercuts exist
after an oral cavity surgery or
maxillectomy that may be used as
prosthetic-bearing surfaces
- Prosthetic-bearing surfaces are
important in achieving accurate occlusal
plane and centric position records.
- Using processed bases and denture
adhesive will aid in achieving accurate
records
● Clinical significance:
- Processed bases will allow the clinician
to judge prosthesis retention and
position of soft tissues supported by the
base.
Border Molding the Velopharyngeal Area:
Patient Movements
- An impression to restore missing tissues
of the soft palate and pharynx
- After placement of the impression
material, the patient is asked to swallow.
- The patient will then open and close the
mouth, move the mandible from side to
side, turn the head from side to side,
place the chin down to the chest, move
the head from side to side, and extend
the head backward
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
Border Molding Peripheries of Maxillary
Resections and Hard Palate Defects: Patient
Movements
- Border molding the posterior and lateral
area of a maxillectomy requires that the
patient go through head and mandible
movements similar to border molding the
velopharyngeal area.
- Swallowing is important to move the cut
edge of the soft palate
Testing the Prosthetic “Seal” between the Oral
Cavity and the Nasal Cavity
- Drinking liquids is the usual test for
prosthetic closure of an anatomical defect
in the soft or hard palate
● Patient should be in upright position
when swallowing
● Listening to speech sounds is the usual
way to test for appropriate separation of
airflow from the oral cavity and nasal
cavity
➔ Test for possible hypernasality, have the
patient say the word “beat.” Then, pinch
the patient’s nares closed and have him or
her say “beat”
○ If there is a difference in the sound
of the word “beat” with and
without pinching the nares, air is
inappropriately escaping around the
prosthesis periphery.
○ If the word “beat” sounds more like
“meat,” there is inappropriate air
escape.
➔ Test for hyponasality, have the patient say
the phrase, “Momma made lemon jam.”
○ If the phrase sounds more like
“Bobba, bade lebon jab.”, the air is
not allowed to escape from the oral
cavity through the nose.
○ Therefore, prosthesis may be too
large or overextended; however,
creating hyponasal speech with an
obturator is uncommon. It is more
likely that the obturator is
satisfactory, but that the patient
really is congested in the nasal
passages.
CLINICAL CONFERENCE - PROSTHODONTICS 2
Side note:
Ang paginom ng tubig anf kadalasang
ginagawa to test if may tamang prosthetic
closure sa cases na may defect sa soft or hard
palate. Same test kanina na naka-swallow pero
naka upright position ang patient. Test for
possible hypernasality. Hypernasality—excessive
nasal resonance on vowels and voiced oral
consonants. Hyponasality—too little or absent
resonance on nasal consonants and adjacent
vowels, especially /i/ and /u. So have the patient
say the word “beat”. Then pinch the patient’s
nares closed and say “beat”… (please refer the
slide)
OBTURATOR
- a maxillofacial prosthesis used to close a
congenital or acquired tissue opening,
primarily of the hard palate and/or
contiguous alveolar/soft tissue
structures (GPT7)
Uses of obturator
1. Provides a stable matrix for surgical
packing
2. Reduce oral contamination
3. Speech is effective post operatively
4. Permits deglutition
5. Reduce the psychological impact of
surgery
6. Reduce period of hospitalization
Limitation of obturator
a) Require insertion and removal
b) Have redo periodically due to growth
c) Can be lost or damaged
d) May be uncomfortable
e) Poor patient compliance
MAXILLARY OBTURATOR PROSTHESIS
- Required for patients who have
undergone tumor resection of the hard
palate for neoplasms that originate in
the paranasal sinuses or superior aspect
of the oral cavity
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
- The patient who undergoes maxillary
resection is rehabilitated in three
phases, namely:
o surgical obturator
o interim obturator, and
o definitive obturator.
1) Surgical obturator prosthesis
- aka immediate surgical prosthesis,
immediate temporary obturator,
surgical baseplate
- a temporary maxillofacial prosthesis
inserted during or immediately
following surgical or traumatic loss of a
portion or all of one or both maxillary
bones and contiguous alveolar
structures (i.e. gingival tissue, teeth).
- This prosthesis allows the patient to
take oral nutrition immediately
postoperatively
- Speech is generally quite normal with
this prosthesis
- This prosthesis will be in service for
approximately 5 to 10 days
- Frequent revisions of surgical obturators
are necessary during the ensuing
healing phase (approximately six
months).
- Further surgical revisions may
require fabrication of another
surgical obturator
❖ Goals:
a) to support the surgical packing placed in
the resection cavity created by removal
of the walls of the maxillary sinus
b) to restore continuity of the hard palate
❖ Fabrication:
o The patient must have a presurgical
dental examination, and a maxillary
cast must be made
o The clinician will also plan
treatment for the patient for
necessary preprosthetic surgery to
remove epuli, reduce pendulous
tuberosities, and relieve bony
undercuts
CLINICAL CONFERENCE - PROSTHODONTICS 2
o A baseplate with routine denture
extensions or an existing well-fitting
denture may be used for the
surgical obturator
o If the tumor is altering the normal
contours of the hard palate, the cast
should be altered to restore
appropriate palatal contour
o Edentulous surgical obturators must
be secured by circumzygomatic
wires, sutures, or bone screws
o Retentive holes for zygomatic wires
are placed bilaterally with a no. 8
round bur in the premolar area
through the prosthesis flanges.
o A single bone screw may be placed
through the vomer bone, through a
predrilled hole in the midpalate at
the junction of the premaxilla and
hard palate.
o Removal of the bone screw and
sutures is easily accomplished in an
outpatient setting
o Removal of zygomatic wires should
be done with the surgeon’s
assistance and usually requires an
operating room setting
2) Interim obturator
- Processed from the postsurgical master
cast. The interim obturator is delivered
when the surgical obturator is removed
- Fabricated either from a new
impression made from the patient or by
adjusting the immediate surgical
obturator by soft relining material.
- Will be used for 2 to 6 months
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
Goal:
- to restore deglutition and speech by
restoring palatal contours separating
the nasal cavity, maxillary sinus, and
nasopharynx from the oral cavity
- Retain and reline the existing denture
may be required before modifying the
surgical area
Relining:
● Use Denture adhesives
● The prosthesis is modified with an
intermediate denture liner to conform
to the periphery of the surgical site
● The bulb portion should be kept hollow
during the relining procedure to limit
the weight of the prosthesis
● An ideal material should have enough
body to support itself during the initial
impression procedure and for several
weeks
● As the patient heals, the periphery of
the surgical site will become smaller
and the prosthesis will become
overextended
3) Definitive obturator
- Prosthesis that artificially replaces part
or all of the maxilla and the associated
teeth lost due to surgery or trauma
- Fabricated when tissue healing and
contraction are complete
- Fabricated after 6 months or until the
tissues are stable
- Preliminary impression with irreversible
hydrocolloid
Fabrication:
● Preliminary cast should be blocked out
● Border molding the nonsurgical side
and making the final impression before
border molding the surgical site ensures
that the tray is reseated in a consistent
manner when the surgical site is
impressed
● To avoid overextension of the
compound, the clinician must look
CLINICAL CONFERENCE - PROSTHODONTICS 2
constantly to the anatomical least form
and landmarks of the surgical site
● There is commonly a soft tissue
undercut at the junction of the oral
mucosa and skin graft that lines the
maxillary cavity called a cicatricial line
or scar band
● Maxillary and mandibular processed
bases and denture adhesive are used
● Place the anterior teeth in an
end-to-end or reverse horizontal
articulatim situation
● Facial position of the anterior teeth may
be verified at the try-in appointment
● Final evaluation: pressure areas and
border extensions (best done with a
combination of pressure-indicating
paste and tissue-conditioning material)
● The patient should swallow and go
through all head and jaw movements
● A uniform, thin, functionally formed
coating of material remains with
obvious “show through” of the acrylic
resin in pressure areas
*Soft palate obturator prosthesis
- A soft palate obturator or speech aid
prosthesis is required for patients who
have a resection of their soft palate or
have a soft palate deficit from a cleft
palate
- When soft palate is resected, patients
will resume swallowing with minimal
discomfort, but if the resection is more
extensive, patients may not resume
normal swallowing immediately
because of additional surgical
involvement of the pharynx. In these
situations, the obturator’s major
function will be to restore speech
● A posterior extension is added to a
denture prosthesis to contact the
patient’s pharyngeal wall when it closes
during speech and swallowing
● Passavant’s ridge: Prominent muscular
ridge on the pharyngeal wall, present
when the patient says
“ahh”
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
o The inferior extent of the pharyngeal
extension should be at or slightly below
the inferior aspect of the pharyngeal
sphincter
o The overall height of the extension
should not be more than 1 cm
o Final impression for closure of the
nasopharynx in swallowing by asking
the patient to drink water
o Ideally, airflow in speech should be
appropriate
PROBLEM SOLVING/ TROUBLESHOOTING
Troubleshooting an Obturator Prosthesis
1. Lack of Retention
- Overextension of borders in an interim
prosthesis is the result of soft tissue
changes, and the prosthesis borders will
need to be relieved and relined.
- Adhesives are almost always required
for any edentulous obturator prosthesis.
- Patients should masticate as little as
possible on the defect side because this
tends to unseat the prosthesis.
2. Nasal Reflux
- Explain to the patient that the
prosthesis cannot function as a “cork in
a bottle,” and some reflux is to be
expected.
- An upright head position is required
during swallowing.
o Check the palatal contours with
pressure indicator paste. A
palatal form that is too low
constricts the tongue and
unseats the prosthesis. Check
the tissue adaptation at the
posteromedial and
posterolateral margins(at the
prosthesis/soft palate junction).
o Place petroleum jelly on the
prosthesis surface and
functionally disclose the area
 CLINICAL CONFERENCE - PROSTHODONTICS 2
with a viscous tissue
conditioner. If the tissue
conditioner material is thick and
successfully decreases reflux,
this area should be addressed
for a relining procedure.
- When the required relining area is only
1 to 2 cm and the remainder of the
obturator portion is well fitting, a
chairside relining should be considered.
- Cut finish lines to demarcate the area
indicated by the tissue conditioner.
These finish lines will confine the
relining material. An autopolymerizing
relining resin or a light-cured composite
resin material can be added and border
molded in the patient’s mouth.
3. Hypernasality
- When reflux has been minimized but
hypernasality exists, one should
consider that the velopharyngeal
closure may be compromised from
surgery.
- The soft palate may elevate, but there
may not be enough elevation to close
the nasopharynx.
- Clinician should attempt to add a
pharyngeal extension, as in the soft
palate obturator prosthesis, over the
inadequately functioning soft palate to
obturate the pharynx
II. TROUBLESHOOTING THE SOFT PALATE
OBTURATOR PROSTHESIS
1. Prosthesis Feels Too Long
- The patient complains that they “feel
the prosthesis in the back” of their
pharynx.
- The prosthesis should be disclosed with
the tissue-conditioning material
because these complaints signal an
overextended prosthesis.
- if patient continues to complain, it may
be necessary to reduce the entire
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
extension and make a new functional
impression.
2. Hypernasality
- for appropriate tissue contact in
swallowing using a tissue conditioner. If
a uniformly thin coating of material is
evidenced on the obturator and
hypernasality persists, the problem is
that there is greater pharyngeal wall
constriction in swallowing and limited
pharyngeal wall movement in speech.,
- pharyngeal constriction is almost always
more pronounced during swallowing
than the constriction during speech.
- It usually is not possible to add more
material to the obturator, or the patient
begins to complain of overextension
during swallowing.
- Increased “compensatory” pharyngeal
constriction during speech may be seen
as time passes. This compensatory
movement may increase and eventually
eliminate hypernasality,
TROUBLESHOOTING PROSTHESES FOR THE
PATIENT WITH AN EDENTULOUS
MANDIBULECTOMY
1. Unstable Mandibular Denture
- Stability of the base should be
evaluated with processed bases at the
time of maxillomandibular relationship
records before placement of wax rims.
- Overextension onto movable tissue will
unseat the prosthesis.
- Overextensions should be reduced
before making records.
- Unstable at the try-in-inappropriate
tooth position may be unseating the
prosthesis.
- Denture adhesive often is necessary.
2. Inability to Chew or Inability to Chew
beyond a Soft Diet
● Patients with partial mandibulectomies
often have impaired range of motion of
the tongue.
CLINICAL CONFERENCE - PROSTHODONTICS 2
- soft diet may be all that the
patient can accommodate
despite the insertion of
dentures.
- Hard food requires masticatory
power that the edentulous
mandibulectomy patient lacks.
CASE REPORT 1: OBTURATORS
PATIENT PROFILE:
Age: 65 years old
Sex: Female
Medical/Dental History:
● Born with a congenital cleft lip
and palate
● Cleft lip repaired during early
years; cleft palate not surgically
repaired
● Old denture wearer for seven
years
Figure 1.
The patient’s
denture.
Complaint of the patient:
● Poor retention of dentures,
leading to difficulty in speaking,
swallowing, and chewing
Intraoral Examination:
● Complete unilateral cleft
involving anterior alveolar
bone, hard palate, and soft
palate
Figure 2.
● (A) Cleft palate.
● (B) Edentulous mandibular ridge.
● (C) Pretreatment extraoral view.
Treatment Plan:
1. Impression Phase:
● Use appropriate stock
impression tray for primary
impression
● Employ impression compound
for primary impression
● Block undercuts in cleft area
with modeling wax
Figure 3.
The patient’s primary
impressions using an
Impression
Compound.
● Right Impression - Maxillary Arch
● Left Impression - Mandibular Arch
2. Custom Impression Trays:
● Fabricate custom trays using
auto-polymerized acrylic resin
old ● Conduct border molding with
green stick impression
compound
● Adapt type I modeling plastic in
the cleft area
● Record posterior extension by
instructing patient in head
movements
○ The patient was asked
to bend the head
forward slowly, touch
the chest, and then
move it backward.
● Capture lateral side movements
and phonation for complete
impression
○ The patient was asked
to do a side-to-side
movement.
○ The patient was also
asked to say ah phonate
repeatedly and
forcefully.
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
CLINICAL CONFERENCE - PROSTHODONTICS 2

○
The impression surface Figure 5.
was adjusted till the (A) Posttreatment photograph of the patient
patient was satisfied with dentures.
with the speech and (B) (B) Intraoral view with dentures.
comfort. (C) (C) Patient's dentures
3. Secondary Impressions:
● Utilize light-body elastomeric
impression material for detailed 6. Patient Education:
impressions ● Instruct on cleaning and
4. Jaw Relations and Try-On: maintaining complete dentures.
● Record jaw relations ● The patient was satisfied with
● Conduct a try-on to evaluate the aesthetics, speech,
speech, aesthetics, and swallowing, and chewing
swallowing capacity due to improved
○ The patient's speech retention and stability in the
was evaluated using new prosthesis. .
speech tests like 7. Follow-up:
perceptual analyses, ● The patient was recalled for one
resonance frequency week, one month, and six
analyses, and acoustic months to assess any difficulty
analyses. while using the complete
○ There was a marked dentures
improvement in speech.
○ The patient was asked CASE REPORT 2:
to drink water to check Rehabilitation of a Hemimaxillectomy patient
for regurgitation of with Surgical, Interim and Definitive Obturator
liquid during
swallowing. Age: 38 years old
○ The denture prevented Sex: Male
the regurgitation of
liquid during Chief complaint:
swallowing. Overgrowth in the right side of maxilla (7-8
months back).

Intraoral Examination:
Figure 4. Patient The lesion was seen extending from beyond the
Try-On. palatal surface of 17 up to the palatal surface of
14. Swelling had no odontogenic origin. The
tumor was located on a hard palate with a size
5. Final Prosthesis: of 2.9x2.5x1.4 cm.
● Invest and dewax waxed
dentures using conventional
techniques
● Deliver complete dentures with
attention to aesthetics and
function

GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA

CLINICAL CONFERENCE - PROSTHODONTICS 2
Extraoral Examination:
Patient had a square facial
form and a straight facial
profile. No extraoral
swelling or deviation was
seen.
Preoperative CT scan:
Diagnosis:
Mesenchymal Chondrosarcoma
Treatment Plan:
1. SURGICAL OBTURATOR
● Placed at the time of tumor resection in
the operating room
● The surgical obturator must terminate
short of skin graft-mucosal junction
Steps:
a. Diagnostic impressions of upper and
lower arch were made with irreversible
hydrocolloid impression material. The
impressions were poured into dental
stone.
b. The operating surgeon gave the marking
for surgical resection
c. The presurgical cast was trimmed and
ball end clasp were placed for retention
d. After completing the wax-up, the clear
heat cured surgical obturator was
obtained with conventional denture
processing
e. The tumor mass was resected, with
leaving a safety margin of healthy
tissues by the operating surgeon
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
f. On table relining was done with
autopolymerizing clear acrylic resin.
Thus the surgical obturator was inserted
immediately following the surgery.
g. After initial healing was completed, the
obturator was relined
h. Impression compounds followed by
tissue conditione rs were used.
i. Later it was processed with clear heat
cure acrylic resin.
j. After 1-1.5 months the patient was
recalled for the fabrication of interim
obturator.
2. INTERIM OBTURATOR
● Processed from the postsurgical master
cast.
● It is placed when the surgical dressing is
removed.
● Serves the patient for 4–6 months till
the maxillary defect heals and matures.
Steps:
a. A stock tray of appropriate size was
used to record the impression.
b. The undercuts in the medial wall were
blocked out with gauze lubricated with
petroleum jelly.
c. Floss was tied to gauze for easy
retrieval. The lateral wall of the defect
was first recorded with an impression
compound.
CLINICAL CONFERENCE - PROSTHODONTICS 2
d. Retention grooves were made into
compounds for interlocking.
e. Later a wash made with irreversible
hydrocolloid impression material
f. A hollow bulb obturator was processed
with clear heat cured acrylic resin.
g. Wrap around clasp was used to
improve retention. It was checked into
the patient's mouth and then delivered
3. DEFINITIVE OBTURATOR
● It was processed at least 3-4 months
after completing chemotherapy and
radiotherapy.
Steps:
a. A diagnostic cast was obtained for
surveying.
b. Framework design
c. Mouth preparation
d. Impression was made with vinyl
polysiloxane in a custom tray. (FIG 12)
e. The master cast was poured into die
stone and a cast partial denture
framework was fabricated over it.
(FIG13)
f. Complete palate as the major connector
was designed.
g. Direct retainer was planned on the right
first premolar and embrasure clasp
between the right first and second
molars.
GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA
h. Indirect retention provided with rests
on canine, lateral incisor
i. Central incisor provided with rest seat
and proximal plate.
j. Altered cast technique was used to
record the soft tissue. For which, a
custom tray was fabricated over the
master cast which contained the
framework. The lateral border of defect
was recorded with the impression
compound. Later retentive holes were
made into the compound. A wash was
made with a tissue conditioner.
k. The master cast was sectioned along
the hard tissue to provide retention
groves. The impression was seated on
the cast. It was reversed and beading
and boxing was done. Later it was
poured with dental stone.
l. A layer of hard wax (Cavex Set up Hard)
was adapted over the framework placed
on the obtained cast from altered cast
technique
m. Modelling wax was used for fabricating
wax rims. Jaw relation was recorded.
CLINICAL CONFERENCE - PROSTHODONTICS 2

x. Installation
y. Recall after a week

n. The record was transferred to the

articulator and mounted.
o. Following teeth selection, the teeth
setting was completed. The obturator
was tried in the patient's mouth.

p. Waxed up articulator was then References:

processed to obtain heat cured clear
hollow bulb obturator.
q. 1 mm spacer with modelling wax was
adapted over the defect area. 3-4 tissue
stops were made.
r. A thin layer of autopolymerizing acrylic
resin was adapted over the wax.
s. Later the shell was filled with salt and
closed with a lid made from
autopolymerizing resin.
t. The shell was removed. Two holes were
made into the shell for removing the
salt. The modelling wax was removed.
u. The heat cured resin adapted over the
defect area; the shell was then
positioned over it.
v. The heat cured resin was adapted over
the remainder cavity and the flask was
closed and clamps placed over it.
w. The processing was completed.
PROSTHODONTIC TREATMENT FOR
EDENTULOUS PATIENTS: COMPLETE DENTURES
AND IMPLANT-SUPPORTED PROSTHESES 12th
edition by Zarb-Bolender Copyright © 2004,
Mosby, Inc. All rights reserved
Roslan, Husniyati & Shahabudin, Saadiah.
(2018). Palatal obturator prosthesis: A clinical
case report. Cumhuriyet Dental Journal. 21.
55-60. 10.7126/cumudj.340121
Rehabilitation of a hemimaxillectomy patient
with surgical, interim and definitive obturator: A
case report. . The Journal of Prosthodontics and
Dental Materials (JPDM). (n.d.).
https://jpdm-ips-mnm.com/rehabilitation-of-a-
hemimaxillectomy-patient-with-surgical-interim
-and-definitive-obturator-a-case-report/?fbclid=
IwAR1lLATwWcZarZgKI6QRM5QDQQ3lZnmSyCd
Xolvg6CLtxsdMI6eypPTkHrQ

GROUP 4: DESTOR, EGENIAS, GAANO, ORENA, PATIU, PEREZ, POJ-AGAN, RATUITA