Maxillofacial Prosthodontics

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This presentation is done by Dr. Abd Al Rahman Sabsoob. Hope you enjoy it !!

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Maxillofacial Prosthetics:

Maxillofacial Prosthetics عميد كلية طب الاسنان : د.محمد الدبيس 1 Hussam Al- Selami . Sadam Al Squor . Abdel Rahman Sabsoob . Thabet Alnaqeeb . Nooraldeen Al Mufti. Ali Nassar . Mahmood Zaitawi . 2013

History:

History Artificial facial parts found on Egyptian mummies long time ago. Ancient Chinese known to have made facial restorations. 1953 -- American Academy of Maxillofacial Prosthetics founded. 2

Overview:

Overview Maxillofacial prosthetics is a branch of prosthodontics in dentistry. Main aim is to restore the function and esthetics of an individual. Its also approve a psychological state of a patient after a trauma or surgery. 3

Maxillofacial Prosthetics:

Maxillofacial Prosthetics The art and science of anatomic, functional, or cosmetic reconstruction by means of nonliving substitutes of those regions in the maxilla, mandible, and face that are missing or defective because of surgical intervention, trauma, pathology, or developmental or congenital malformations. 4

Type of M.F.P:

Type of M.F.P Intra-Oral Extra-Oral 5

Indications of MFP:

Indications of MFP After surgical intervention. After trauma. Congenital defects. Acquired defects. 6

Prosthetic vs. Surgical Rehabilitation:

Prosthetic vs . Surgical Rehabilitation Individualized decision between patient and doctor. Removable prosthesis allows for cancer surveillance. Destruction amount. Malignancy recurrence. 7

Intraoral vs. Extraoral:

Intraoral vs. Extraoral Intraoral -- mostly functional Mandible Maxilla Extraoral -- cosmetic Ear Nose Orbit 8

Management of patient for MFP.:

Management of patient for MFP. Personal history of a patient should be obtained. Dental and medical history also should be obtained. Intra and external examination of a patient by a maxillofacial surgeon and prosthodontics should be done. 9

Management of patient for MFP.:

Management of patient for MFP. Patients risk assessment should be done. A surgeon should consulate with a dentist about a surgery so that there should be a team work. All surgical alterations should be demonstrated for a dentist on a cast and obturator should be made for a day of a surgery. 10

Psychosocial Issues:

Psychosocial Issues 11

Dental Impression:

Dental Impression Surgeon has marked resection for prosthodontic planning. 12

Post surgical management.:

Post surgical management. After a surgery and even before it’s a team work for a rehabilitation of a patient that includes: M axillofacial surgeon. Prosthodontics. Orthodontist. Phycastrist Speech rehabilitation specialist. Oncologist. Plastic surgeon specialist 13

Congenital defects:

Congenital defects Lip and palate development: Upper lip develop by coalescence of the premaxilla and maxillary growth centers on either sides to produce the complete lip. Fusion of the of the lip developing from growth centers commences around each nostril floor and spreads downwards towards the lower border of the lip uniting the premaxilla and maxillary process in each side. 14

Congenital defects:

Congenital defects Failure of this union will result in a cleft lip that varies from a notch on one side to complete bilateral cleft of the lip that may extend up to into each nostril. 15

Congenital defects:

Congenital defects The palate: Palate develops from the max. and premix. growth centers, union of the three segments commencing at the region of the nasal floor presented in full development by the nasal foramen. Union from this point proceeds backwards until both the hard and soft palates and uvula have united, and forwards along the of the future maxillary and premaxillary structures eventually. 16

Congenital defects:

Congenital defects Lack of fusion of the palatal shelves either completely or partially occurs during embryonic growth side. Failure of union of palatine processes at any stage will result in a cleft palate which may be pre-alveolar ( cleft lip ) or post alveolar ( cleft palate ) . Cleft palate between 6th – 9th wk. of the embryonic life. 17

Congenital defects:

Congenital defects Classification of cleft palate Pre-alveolar e.g. cleft lip Post alveolar any cleft from uvula up to incisive foramen. Alveolar cleft extending from uvula to alveolar ridge and lip either unilateral or bilateral. 18

Congenital defects:

Congenital defects Effects of cleft palate and lip Speech – lack of valvopharyngeal closure leads to escape of air through the nose (nasal speech) Deglutition – greatly impede the feeding, regurgitation and escape of fluids through the nose takes place . Mastication – impaired due to escape of food through the nasal cavity and due to missing teeth and malocclusion . 19

Congenital defects:

Congenital defects Esthetics – is effected seriously especially in cleft palate and / or lip. Deterioration of the general health Psychological trauma . Recurrent infection of the air ways and middle ear . 20

Congenital defects:

Congenital defects Management of cleft lip and palate Include the following: Surgical closure It is the treatment of choice for palatal cleft closure. It superior to prosthetic closure by obturator. If cleft involves the lip, it is advisable to repair it as early as possible (6 wks. after birth) to facilitate feeding and improve appearance. Surgical closure of palatal cleft is better to be done before the end of the second year of age. 21

Congenital defects:

Congenital defects Prosthetic restoration Feeding appliances. S imple palatal plate to close cleft. S peech aid obturator. O ver denture. Orthodontic To correct the malaligned teeth or expand the maxillary arch. 22

Congenital defects:

Congenital defects Reason for early closure of cleft palate To produce longer and more mobile soft palate with better muscular development and velopharyngeal closure. To habilitate the patient for normal speech. To allow undisturbed growth of maxilla. 23

ACQUIRED PALATAL DEFECTS :

ACQUIRED PALATAL DEFECTS DEFINITION : Lack of continuity of originally intact palatal structures through the whole or part of its length. Etiology : Surgical e.g. tumor removal. Traumatic fracture of maxilla. Pathological conditions e.g. osteomyelitis, T. B., and syphilis . 24

ACQUIRED PALATAL DEFECTS :

ACQUIRED PALATAL DEFECTS Prosthetic rehabilitation of acquired maxillary defect: The main priority for the patient with traumatic injury and traumatic surgery is to stabilize the patient and control immediate damage and/or defect. Three phases of prosthodontic treatment includes : Surgical procedures + Immediate obturator. Transitional obturator. Definitive obturator. 25

IMMEDIATE OBTURATOR :

IMMEDIATE OBTURATOR IMMEDIATE OBTURATOR It is a prosthesis inserted immediately after operation Lasts 10-14 days after surgery Material used, mostly acrylic ADVANTAGES : Maintain function (feeding, speech) Promote healing Restore esthetic Act as stint (keep surgical pack and medication close to the wound) Improve psychology of the patient Prevent contamination of the wound 26

IMMEDIATE OBTURATOR :

IMMEDIATE OBTURATOR Construction : Impression/construction of the cast models. With the help of the surgeon determine the area to be removed on the cast . The appliance is constructed as a plate to close the operation site. Prepared cast is waxed, processed using either heat or cold curing resin and wire clasps to retain the obturator . 27

IMMEDIATE OBTURATOR :

IMMEDIATE OBTURATOR During operation eradication of the involved area, and surgical cavity is filled with surgical pack. We can say, it is simple plate with no teeth and constructed before surgery to be inserted immediately after surgery . 28

Temporary Obturators :

Temporary Obturators Temporary/Transitional Obturator: Constructed few days after operation to help in restoring oro -nasal function. Carries teeth and stays 3-6 months. Making impression is complicated by presence of the wound and presence of the defect. 29

Temporary Obturators :

Temporary Obturators The defect is packed with gauze dipped in Vaseline to the level of the remaining tissue, then impression is taken with modified stock tray using elastic impression material. The steps of construction are the same as in immediate obturator . 30

Temporary Obturators :

Temporary Obturators Function : helps in restoring Speech. Feeding. Esthetics. Prevent wound contamination. 31

Definitive Obturators:

Definitive Obturator s Definitive Obturator : It is a final prosthetic management construction after complete healing of the operation site . 32

Definitive Obturators:

Definitive Obturator s Preparation of the mouth for obturator: Extract hopeless teeth. Periodontal therapy. Restore carious teeth. 33

Definitive Obturators:

Definitive Obturator s Types of obturators : Hollow bulb (Closed). Roofless (Open bulb). 34

Definitive Obturators:

Definitive Obturator s Construction: Select stock tray, modified with wax according to the size and shape of the defect. Partially, pack the defect with Vaseline gauze, then do primary impression using alginate. 35

Definitive Obturators:

Definitive Obturator s Under cuts are lift to help in retention. Gauze can prevent broken pieces of alginate from escaping into the defect. Construct sp. Trays and do final impression using alginate or rubber base impression material. Outline the master cast to mark the bearing area, blocking severe undercut, leaving small undercut area for obturator retention. 36

Premaxilla Preserved :

Premaxilla Preserved 37

Premaxilla Preserved:

Premaxilla Preserved Cut through tooth socket 38

Mucosa Not Preserved:

Mucosa Not Preserved Rough edge uncomfortable for patient 39

Obturator:

Obturator Restores oro -nasal partition. At times can be added to prior dentures. 40

Skin Grafting of Defect:

Skin Grafting of Defect Less pain while healing. Less contracture of scar band which obscures cancer surveillance. Accomodates obturator better. 41

Maxillary Prosthesis:

Maxillary Prosthesis Articulates with scar band. Hollowed to be lightweight. 42

Maxillary Prosthesis:

Maxillary Prosthesis Can be made with a reservoir to hold artificial saliva. 43

Timing:

Timing Immediate (Intraoperative) hold in packs provide early function Interim Definitive 3 to 6 months 44

Prosthetic Materials:

Prosthetic Materials Acrylics Polyurethanes Silicone Elastomers Room-temperature vulcanizing High-temperature vulcanizing 45

Mandible:

Mandible Mandibular reconstruction revolutionized by microvascular and plating techniques. Prosthetics mainly restore occlusion and occlusal surface. Implants able to restore high degree of function. 46

Mandible:

Mandible Skin graft preserves alveolar ridge for denture support 47

Postoperative Malocclusion :

Postoperative Malocclusion Deviates to surgical side 48

Maxillary Ramp:

Maxillary Ramp 49

Maxillary Ramp:

Maxillary Ramp 50

Guide Plane Prosthesis:

Guide Plane Prosthesis 51

Guide Plane Prosthesis:

Guide Plane Prosthesis 52

Adjunctive Preprosthetic Measures:

Adjunctive Preprosthetic Measures Vestibuloplasty . Lowering of Floor of Mouth. Implants. 53

Vestibuloplasty:

Vestibuloplasty 54

Lowering the Floor of Mouth:

Lowering the Floor of Mouth Goal is to reposition mylohyoid muscle. 55

Lowering the Floor of Mouth:

Lowering the Floor of Mouth 56

Edentulous Mandible:

Edentulous Mandible 57

Mental Foramen:

Mental Foramen 58

Implants:

Implants 59

Implants:

Implants Branemark in the 50’s studying bone temp during drilling. Found temp probes couldn’t be removed from bone without fracturing. Led to study of osseointegration . 60

Implants:

Implants Made of titanium. Have to be drilled at low speed. Oxide on metallic surface is dipole. Plasma proteins adhere. 61

Implants:

Implants Implant placed first -- closed primarily Abutment placed 4-6 mo later Appliance attached rigidly removable samarium-cobalt magnets 62

Implants:

Implants Factors that influence success material macrostructure microstructure implant bed surgical technique loading conditions 63

Implants:

Implants Implants can be placed in grafted fibula. 64

Implants:

Implants Want to avoid large step-off if possible. 65

Extraoral Prostheses:

Extraoral Prostheses 66

Extraoral Prostheses :

Extraoral Prostheses General Principles: Goal is cosmetic. Retained with : Adhesives. Implants. Skin grafting may help. Smooth edges. Extraoral Prostheses Ear: Retain tragus if possible to camouflage anterior border. 67

Extraoral Prostheses -- Ear:

Extraoral Prostheses -- Ear 68

Extraoral Prostheses -- Ear:

Extraoral Prostheses -- Ear 69

Extraoral Prostheses -- Ear:

Extraoral Prostheses -- Ear Tragus hides attachment. 70

Extraoral Prostheses -- Orbit:

Extraoral Prostheses -- Orbit Skin graft provides base for prosthesis. 71

Extraoral Prostheses -- Orbit:

Extraoral Prostheses -- Orbit Glasses help hide margin. 72

Extraoral Prostheses -- Nose:

Extraoral Prostheses -- Nose Skin graft provides base for prosthesis. Alar tag undesirable. 73

Extraoral Prostheses -- Nose:

Extraoral Prostheses -- Nose 74

Extraoral Prostheses -- Nose:

Extraoral Prostheses -- Nose 75

Extraoral Prostheses -- Nose:

Extraoral Prostheses -- Nose 76

Extraoral Prostheses -- Nose:

Extraoral Prostheses -- Nose 77

Conclusion:

Conclusion Restore function and cosmesis . Use techniques during surgery to aid prosthetic management. Consultation with maxillofacial prosthodontist for optimal rehabilitation. 78

PowerPoint Presentation:

THANK YOU 79