OBTURATOR

S
INTRODUCTION
 Obturator is a prosthesis used to
close a congenital or acquired
tissue opening,primarily of the hard
palate &/or contiguous alveolar
structures.Prosthetic restoration of
defect often includes use of a
surgical obturator,interim obturator
& definitive obturator.-GPT
USES OF OBTURATORS
 Provides a stable matrix for surgical
packing
 Reduces oral contamination
 Speech is effective post-operatively
 Permits deglutition
 Reduces the psychological impact of
surgery
 Reduce the period of hospitalization
LIMITATIONS OF
OBTURATORS
 Require insertion and removal
 Have to redo periodically due to growth
 Can be lost or damaged
 May be very uncomfortable
 Compliance is often poor
 Do not permanently correct the problem
 Many centers use only if surgery is not
possible
DESIGN OF PROSTHESIS
 Must apply the basic principles of support,
retention and stability so as to minimize the
stress generated to the structures of the
mouth.
 The location of the fulcrum line, retentive
undercuts and potential for indirect
retention will be important factors in
determining the prognosis.
 In general, the prosthesis will have a
fulcrum line near the defect area.
 If natural teeth or implants are present to
provide retention and support for the
prosthesis, the fulcrum line will pass
between the most posterior occlusal
rests on each side of the arch.
 Retentive clasps placed into undercuts
adjacent to the defect will resist the
downward displacement of the
prosthesis due to the effects of gravity.
 Occlusal rests on the opposite
side of the fulcrum line from the
defect will act as indirect
retainers. Long guide planes on
the natural teeth will also assist
in prevention of rotational
dislodgment of the prosthesis.
TYPES OF OBTURATORS
1) Based on phase of treatment :-
o Surgical obturators (immediate
surgical obturators & delayed
surgical obturators)
o Interim obturators
o Definitive obturators
2) Based on the material used :-
o Metal obturators
o Resin obturators
o Silicone obturators
3) Based on area of restoration :-
o Palatal obturator
o Meatal obturators
Obturator on basis of phase of treatment

SURGICAL
 A temporary prosthesis used to restore the
OBTURATOR
continuity of hard palate immediately after
surgery or traumatic loss of a portion or all of
the hard palate &/or contiguous alveolar
structures like gingival tissue,teeth.-GPT
 It is of two types :-
i. Immediate surgical obturator :- It is inserted at
time of surgery.
ii. Delayed surgical obturator :- It is inserted 7-10
after surgery
CLINICAL CONSIDERATIONS
 Surgical obturator is inserted on the day of
surgery.
 A preliminary cast is obtained before
surgery on which a mock surgery is
performed.
 A clear acrylic plate is fabricated & inserted
after surgery.
 If patient is dentulous,retention is obtained
with simple clasps.
 If the patient is edentulous,the
obturator is wired into alveolar ridge
& zygomatic arch.
 The obturator is retained for 3-4
months post surgically.
 It is replaced with an interim or
definitive obturator after complete
healing of the surgical wound.
INTERIM OBTURATOR
 A prosthesis that is made several weeks
or months following surgical resection of
a portion of one or both maxillae.It
frequently includes replacement of teeth
in defect area.This prosthesis when
used,replaces the surgical obturator that
is placed immediately following the
resection & may be subsequently
replaced with a definitive obturator.-GPT
DEFINITIVE OBTURATOR
 A prosthesis that
artificially replaces part or
all of the maxilla & the
associated teeth lost due
to surgery or trauma :-
GPT
Obturator on basis of area of restoration
PALATAL OBTURATOR
 Closes or occludes
opening caused by
cleft or fistula
 Used to facilitate
separation of oral &
nasal cavities for
speech, feeding, &
swallowing &
hypernasality
 PALATAL
OBTURATORS
FABRICATION OF OBTURATOR
 Diagnosis & treatment planning – it is to
determine the size,location & extent of the
obturator.
 Preliminary impression using alginate – care
should be taken to record the undercuts.The
junction of graft & mucosa should be
properly recorded,as it is an important
retentive feature.
 Fabrication of custom tray
PATIENT WITH ACQUIRED PRIMARY CAST
PALATAL DEFECT
ARAMANY’s CLASS IV SECONDARY IMPRESSION
DESIGN
 Border moulding – the velo-pharyngeal
extension can be recorded by asking the patient
to swallow.
 Final impression with elastic impression material
– it can be made using alginate or elastomeric
impression materials.The tray should be
positioned properly & scar band area must be
accurately reproduced.The elastic recoil or
purse string action seen in scar band tissues is
responsible for retention of obturator.If scar
band is not effective,implants can be placed to
improve retention.
METAL FRAME-WORK TEETH ARRANGEMENT IN
WITH WAX OCCLUSAL RIM ARTICULATOR AFTER
FACEBOW TRANSFER
 Jaw relation – it is very challenging to
record the jaw relation for these
patients.Acrylic denture bases are
preferred because it is difficult to
position other denture bases.
 Teeth arrangement – it should be done
such that balanced occlusion is
obtained.
 Insertion & post-insertional
management
AFTER WAX BOIL OUT
THE DEFECT FILLED WITH TABLE SALT
& PACKED WITH HEAT CURE RESIN
AFTER PROCESSING,THE SALT IS POURED OUT
TO OBTAIN A HOLLOW BULB OBTURATOR
MEATAL OBTURATOR
 It is special type of obturator that extends up to
nasal meatus.
 It establishes closure with nasal structures at a
level posterior & superior to posterior border of
hard palate.
 The closure is established against the conchae
& roof of nasal cavity.
 It separates oral & nasal cavities.
 Indicated in patients with extensive soft palate
defects.
DISADVANTAGES OF
MEATAL OBTURATORS
 Nasal air emission cannot
be controlled because it is
in an area where there is no
muscle function.
 Nasal resonance will be
altered.
PALATAL LIFT PROSTHESIS
 It is a special type of obturator,which is a
definitive prosthesis with a posterior
extension.
 It is helpful in restoring palato-pharyngeal
incompetence where soft tissue
musculature is compromised. e.g.
myasthenia gravis,bulbar poliomylitis &
cerebral palsy.
 It is clubbed with obturator if needed.
ADVANTAGES OF PALATAL
LIFT PROSTHESIS
 Minimized gag response
 Tongue physiology,swallowing,
mastication & speech are not
compromised
 Access to the nasopharynx for the
obturator is facilitated
 The palatal lift portion can be added
later as desired.
CONTRAINDICATIONS
FOR PALATAL LIFT
PROSTHESIS
 If adequate retention is not
available for the basic
prosthesis
 If the palate is not displaceable
 Un-cooperative patients
REFERENCES
 Sheldon Winkler, Essentials of complete
denture prosthodontics (2nd edition)
 Stewart,Rudd,Kuebker, Clinical removable
partial prosthodontics (2nd edition)
 Nallaswamy, Textbook of prosthodontics (1st
edition)
THANK
YOU