maxillofacial prosthesis

1. Maxillofacial Prosthetics
عميد كلية طب الاسنان :
د.محمد الدبيس
1
2014
RITESH SHIWAKOTI

2. 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

3. 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

4. Maxillofacial Prosthetics
 The art and science of anatomic, functional, or
4
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.

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

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

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

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

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

10. 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

11. Psychosocial Issues
11

12. Dental Impression
 Surgeon has
marked resection
for prosthodontic
planning.
12

13. 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

14. Congenital defects
Lip and palate development:
14
 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.

15. Congenital defects
15
 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.

16. Congenital defects
The palate:
16
 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.

17. 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.

18. Congenital defects 18
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.

19. 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

20. Congenital defects
20
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 .

21. 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

22. 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

23. Congenital defects 23
 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.

24. 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

25. 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

26. 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

27. IMMEDIATE OBTURATOR
Construction:
o Impression/construction of the cast models.
27
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.

28. 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

29. Temporary Obturators
29
 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.

30. 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

31. Temporary Obturators
 Function: helps in restoring
1. Speech.
2. Feeding.
3. Esthetics.
4. Prevent wound contamination.
31

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

33. Definitive Obturators
 Preparation of the mouth for obturator:
I. Extract hopeless teeth.
II. Periodontal therapy.
III. Restore carious teeth.
33

34. Definitive Obturators
 Types of obturators:
1. Hollow bulb (Closed).
2. Roofless (Open bulb).
34

35. Definitive Obturators
 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

36. Definitive Obturators
3. Under cuts are lift to help in retention. Gauze can
36
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.

37. Premaxilla Preserved 37

38. Premaxilla Preserved
 Cut through tooth socket
38

39. Mucosa Not Preserved
 Rough edge uncomfortable for patient
39

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

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

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

43. Timing
 Immediate (Intraoperative)
 hold in packs
 provide early function
 Interim
 Definitive
 3 to 6 months
43

44. Maxillary Prosthesis
 Can be made with a
reservoir to hold artificial
saliva.
44

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

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

47. Mandible
47
 Skin graft preserves alveolar ridge for denture support

48. Postoperative Malocclusion
 Deviates to surgical side.
48

49. Maxillary Ramp
49

50. Maxillary Ramp 50

51. Adjunctive Preprosthetic Measures
 Vestibuloplasty.
 Lowering of Floor of Mouth.
 Implants.
51

52. Vestibuloplasty
52

53. Lowering the Floor of Mouth
 Goal is to reposition mylohyoid muscle.
53

54. Lowering the Floor of Mouth
54

55. Edentulous Mandible
55

56. Mental
Foramen
56

57. Implants
57

58. Extraoral
Prostheses
58

59. 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

60. Extraoral
Prostheses --
Ear
60

61. Extraoral
Prostheses --
Ear
61

62. Extraoral Prostheses -- Ear
 Tragus hides attachment.
62

63. Extraoral Prostheses -- Orbit
 Skin graft provides base for prosthesis.
63

64. Extraoral Prostheses -- Orbit
 Glasses help hide margin.
64

65. Extraoral Prostheses -- Nose
 Skin graft provides base for prosthesis.
 Alar tag undesirable.
65

66. Extraoral
Prostheses --
Nose
66

67. Extraoral
Prostheses --
Nose
67

68. Extraoral
Prostheses --
Nose
68

69. Extraoral
Prostheses --
Nose
69

70. Conclusion
 Restore function and cosmesis.
 Use techniques during surgery to aid prosthetic
management.
 Consultation with maxillofacial prosthodontist for
optimal rehabilitation.
70