Maxillo facial prosthesis

Maxillofacial Prosthetics

:عميد كلية طب االسنان

محمد الدبيس.د1

2014

RITESH SHIWAKOTI

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

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

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

Intra-Oral

Extra-Oral

5

Indications of MFP

After surgical intervention.

After trauma.

Congenital defects.

Acquired defects.

6

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 -- mostly functional

Mandible

Maxilla

Extraoral -- cosmetic

Ear

Nose

Orbit

8

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.

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 Issues11

Dental Impression

Surgeon has

marked resection

for prosthodontic

planning.

12

Post surgical management.

After a surgery and even before it’s a team work for a

rehabilitation of a patient that includes:

1. Maxillofacial surgeon.

2. Prosthodontist

3. Orthodontist.

4. Phyciastrist.

5. Speech rehabilitation specialist.

6. Oncologist.

7. Plastic surgeon specialist

13

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

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

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 17

• 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.


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.

Congenital defects

Effects of cleft palate and lip

1. Speech – lack of valvopharyngeal closure leads to

escape of air through the nose (nasal speech)

2. Deglutition – greatly impede the feeding, regurgitation

and escape of fluids through the nose takes place .

3. Mastication – impaired due to escape of food through

the nasal cavity and due to missing teeth and

malocclusion .

19

Congenital defects

4. Esthetics – is effected seriously especially in cleft palate

and / or lip.

5. Deterioration of the general health

6. Psychological trauma .

7. Recurrent infection of the air ways and middle ear .

20

Congenital defects

Management of cleft lip and palate Include the following:

A. 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

B. Prosthetic restoration

o Feeding appliances.

o Simple palatal plate to close cleft.

o Speech aid obturator.

o Over denture.

C. Orthodontic

o To correct the malaligned teeth or expand the

maxillary arch.

22


Reason for early closure of cleft palate

1. To produce longer and more mobile soft palate

with better muscular development and

2. velopharyngeal closure.

3. To habilitate the patient for normal speech.

4. To allow undisturbed growth of maxilla.

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

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

1. It is a prosthesis inserted immediately after operation

2. Lasts 10-14 days after surgery

3. Material used, mostly acrylic

ADVANTAGES:

1. Maintain function (feeding, speech)

2. Promote healing

3. Restore esthetic

4. Act as stint (keep surgical pack and medication close to the wound)

5. Improve psychology of the patient

6. Prevent contamination of the wound

26

IMMEDIATE OBTURATOR

Construction:

o Impression/construction of the cast models.

o With the help of the surgeon determine the area to be

removed on the cast .

o The appliance is constructed as a plate to close the

operation site.

o Prepared cast is waxed, processed using either heat or

cold curing resin and wire clasps to retain the obturator.

27

IMMEDIATE OBTURATOR

o During operation eradication of the involved

area, and surgical cavity is filled with surgical

pack.

o We can say, it is simple plate with no teeth and

constructed before surgery to be inserted

immediately after surgery .

28

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


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


Function: helps in restoring

1. Speech.

2. Feeding.

3. Esthetics.

4. Prevent wound contamination.

31

Definitive Obturators

Definitive Obturator:

It is a final prosthetic management construction after

complete healing of the operation site .

32


Preparation of the mouth for obturator:

I. Extract hopeless teeth.

II. Periodontal therapy.

III. Restore carious teeth.

33


Types of obturators:

1. Hollow bulb (Closed).

2. Roofless (Open bulb).

34


Construction:

1. Select stock tray, modified with wax according to the

size and shape of the defect.

2. Partially, pack the defect with Vaseline gauze, then

do primary impression using alginate.

35


3. Under cuts are lift to help in retention. Gauze can

prevent broken pieces of alginate from escaping into

the defect.

4. Construct sp. Trays and do final impression using alginate

or rubber base impression material.

5. Outline the master cast to mark the bearing area,

blocking severe undercut, leaving small undercut area for obturator retention.

36

Premaxilla Preserved 37

Premaxilla Preserved

Cut through tooth socket

38

Mucosa Not Preserved

Rough edge uncomfortable for patient

39

Obturator

Restores oro-nasal partition.

At times can be added to prior

dentures.

40

Skin Grafting of Defect

Less pain while healing.

Less contracture of scar band which obscures

cancer surveillance.

Accomodates obturator better.

41

Maxillary Prosthesis

Articulates with scar

band.

Hollowed to be

lightweight.

42

Timing

Immediate (Intraoperative)

hold in packs

provide early function

Interim

Definitive

3 to 6 months

43

Maxillary Prosthesis

Can be made with a

reservoir to hold artificial

saliva.

44

Prosthetic Materials

Acrylics

Polyurethanes

Silicone Elastomers

Room-temperature vulcanizing

High-temperature vulcanizing

45

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

Skin graft preserves alveolar ridge for denture support

47

Postoperative Malocclusion

Deviates to surgical side.

48

Maxillary Ramp49

Maxillary Ramp 50

Adjunctive Preprosthetic Measures

Vestibuloplasty.

Lowering of Floor of Mouth.

Implants.

51

Vestibuloplasty52

Lowering the Floor of Mouth

Goal is to reposition mylohyoid muscle.

53

Lowering the Floor of Mouth

54

Edentulous Mandible55

Mental

Foramen

56

Implants57

Extraoral

Prostheses

58

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.

59

Extraoral

Prostheses --

Ear

60

Extraoral

Prostheses --

Ear

61

Extraoral Prostheses -- Ear

Tragus hides attachment.

62

Extraoral Prostheses -- Orbit

Skin graft provides base for prosthesis.

63

Extraoral Prostheses -- Orbit

Glasses help hide margin.

64

Extraoral Prostheses -- Nose

Skin graft provides base for prosthesis.

Alar tag undesirable.

65

Extraoral

Prostheses --

Nose

66

Extraoral

Prostheses --

Nose

67

Extraoral

Prostheses --

Nose

68

Extraoral

Prostheses --

Nose

69

Conclusion

Restore function and cosmesis.

Use techniques during surgery to aid prosthetic

management.

Consultation with maxillofacial prosthodontist for

optimal rehabilitation.

70

Maxillo facial prosthesis

Health & Medicine

Transcript of Maxillo facial prosthesis