Acquired Maxillary Defects

Dr. Abo Al-Mawaheb

Ebrahim
 Definitive Obturator For Dentulous
Patients
 Better prognosis prosthesis due to
presence of teeth
 Problems complicating RPD design
1. Multiple axis of
rotation
2. Compromised
support
3. Lack of cross
arch
stabilization
4. Long lever arms
5. Forces of
gravity
 Treatment Concepts
I. Location of the defect
A. The surgical resection
usually includes the
distal portion of the
maxilla
B. Rarely a distal
abutment remain and
extent of the resection
anteriorly varies
C. Kennedy class II P.D.
with extensive lever
arm is required
 Treatment Concepts

II. Movement of the prosthesis

A. With resection of the
maxilla mucosal and
bony support are
compromised
B. So, The defect must
be used to minimize
the movement to
reduce the stress on
the abutment teeth
 Treatment Concepts
III.Teeth
A. Preservation of the
remaining teeth is
important
B. P.D. design must anticipate
and accommodate to the
movements of the
prosthesis during function
C. Maximum retention,
stability and support must
be obtained from engaging
the defect
 Principles Of Obturator Design
 All the bio-mechanical principles
of RPD design should be followed
1. surveying of Diagnostic
casts to locate undercuts,
guiding planes and select
the path of insertion
2. Major connectors must be
rigid
3. Occlusal rest
4. Guide planes
5. The tooth adjacent to the anterior margin
of the defect must have a rest and a
retainer
 Principles Of Obturator Design
6. Since there is no cross
arch stabilization so this
PD viewed as a
unilateral partial
denture( class II
Kennedy)
 For this reason both
buccal and lingual
retentive arms are
considered to obtain
cross-tooth retention
and reciprocation
 Aramany Class I Design
 The design is tripodal or linear
 Tripodal design
1. cross-tooth retention
and reciprocation
2. Support are derived
from the central
incisor and the most
posterior abutment
tooth
1. Indirect retention is a rest on the
canine or on the distal surface of the
first premolar
 Aramany Class I Design
 The linear design
1. If the anterior
teeth are not
included in the
design
2. cross-tooth
retention and
reciprocation
 Aramany Class II Design
 The design is tripodal

 The triangle formed

by the fulcrum and
lines through the
anterior and posterior
teeth with the canine
as an apex serves as
a reference
 Aramany Class II Design
The design is tripodal

 As the triangle flatten

and diminish in area,
the stresses on the
posterior teeth
increase, leading to
more difficult
considerations of
retention and stress
distribution
 Aramany Class II Design
 The design is tripodal

 Support is derived
from the tooth next to
the defect and the
most posterior
abutment tooth
 cross-tooth retention
and reciprocation on
all abutments
 Aramany Class II Design
 The design is tripodal
 Indirect retention is
located on the
opposite side of the
defect
 Guiding planes are on
the proximal surfaces
of the second molar
and the tooth next to
the defect
 Liner and Tripodal Designs
 Based on this
principle
1. Class IV is the most
critical
2. Class I
3. Class II is the least
 Aramany Class III Design

 Dentulous patients
with partial
maxillectomy
defects
 Tooth supported
partial denture with
central obturator
 Conventional
clasping elements
are selected
 Aramany Class V Design
 Patients with bilateral
total maxillectomy
defects
 Splinting of the anterior
teeth is recommended
 Tripodal design
 Support is derived from
the splinted
components
 indirect retention is
located on the central
 Aramany Class VI Design
 Patients with surgical
resection of
premaxilla
 The defect is smaller
than the class V defect
 Defect is less stressful
to remaining posterior
teeth
 Full palatal coverage
and conventional
clasping to retain and
support the prosthesis
 Methods To Improve Retention
Of Definitive Obturator
1. Clasping
2. Undercuts in the defects
3. Engagement of the skin graft & the
scar band
4. Maximum extension against the
lateral wall of the defect ( in
dentulous & edentulous patient)
5. Swing-lock attachment
6. Buccal retaining flange
7. Flexible acrylic resin in the defect
9. Two piece sectional obturator
10.Denture adhesives and creams
11.Osseointegrated dental Implants in
the intact side
12.Attachments in the non-defective
side
13.Magnets in the intact side
14.Hollowing of the obturator

2 piece sectional obturator Hollowed Obturator

 Clasping Swing-lock attachment

Buccal retaining flange dental Implants

Hollowed Obturator
Any Question?