Dr Hamide Norouzi ,Prosthodontist,TUMS

1. Removable Partial
DentureConsiderations in
Maxillofacial Prosthetics
Dr Hamide Norouzi ,Prosthodontist

2. Maxillofacial
Classification
MaxillofacialDefects
Acquired
Congenital
Developmental

3. Acquired
Defects
Result of trauma or disease
May result from removal of hard and/or
soft palate for example in removal of a
squamous cell carcinoma

6. Congenital
Defects
 Present from birth
Most commonly include cleft defects of the
palate that may include the pre-maxillary
alveolus

7. Developmental
Defects
Defects that occur because of some
genetic predisposition that is expressed
during growth and development.

9. Maxillofacial
Classification
 According to type of Prosthesis under
consideration
 Extraoral
 Intraoral
 Interim
 Definitive

10. Timing of
Dental and
Maxillofacial
Prosthetic
Care for
Acquired
Defects
Preoperative and Intraoperative care
Interim Care
Potential Complications
Defect and Oral Hygiene
DefinitiveCare

11. Preoperative
and
Intraoperative
Care
 Planning of prosthetic treatment for acquired
oral defects should start before surgery.
 The patient should be examined by the
Prosthodontist before surgery
 The dental objectives are to remove potential
dental postoperative complications, to plan for
the subsequent prosthetic treatment, and to
make recommendations for surgical site
preparation that improve structural integrity.

13.  Patient benefits from such a consultation include
development of patient-doctor relationship, to
discuss functional deficits associated with the
surgical procedure and to how and what extent the
stages of prosthetic manage will address them.
 Benefits from a Prosthesis standpoint is that
strategically important teeth for definitive and/or
interim prosthesis use can be discussed with the
surgical team and treatment planned accordingly.
 Impressions are made for both arches to provide a
record of the existing conditions and occlusion to
allow fabrication of the immediate or interim
prosthesis.

15. InterimCare
 Typically maxillary acquired defects results in
oral communication with nose and/or maxillary
sinus,The objective of this interim obturator
prosthesis is to separate the oral and nasal
cavities by obturating the communication.

19. Commonly encountered problems with
the interim prosthesis:
 Tissue trauma and associated discomfort
 inadequate retention
 incomplete obturation
 Tissue effects of chemotherapy and radiation
therapy
Potential
Complications

20.  During the immediate postoperative healing
stage, the surgical defect will undergo a change
in dimension that affects the prosthesis fit and
seal. If space is created with the change,
speech will be altered (increase in nasality) and
nasal reflux with swallowing will occur.

21. Defect and
Oral Hygiene
 Patients are advised to clean the defect of food
debris and mucous secretions routinely
 Defect hygiene will allow quick healing and
improve the ability to adequately fit a
prosthesis
 Common defect hygiene practices include:
 Lavage procedures
 Rinsing of the defect using a bulb syringe
 Manual cleaning procedures

22. For some patients definitive prostheses are
delayed due to;
 General health concerns,
 Questionable tumor prognosis or control
 Failure of patient to reach to a level of oral and/or
defect hygiene
DefinitiveCare

24. Design
Considerations
for Intraoral
Prosthesis
 Typical goals of treatment consist of a well-supported
prosthesis that is acceptable in appearance and
exhibits minimal movement under function, thereby
preserving maximum amount of supporting tissue.
 Strategy to achieving goals
-Maximum coverage of edentulous ridge within
movement capacity of muscular attachments
-Maximum engagement of remaining teeth to control
retention
-Placement of artificial teeth to facilitate maintenance of
tooth-tissue contact during normal functional contacts.

25. Surgical
Preservation
for Prosthesis
Benefit
Maxillary Defects
 Primary prosthetic objectives include
restoration of physical separation of the oral
and nasal cavities in a manner that restores
mastication, deglutition, speech and facial
contour to as near state as possible.

26. Maxillary
defect
Classification
Class I – Midline resection Class II – Unilateral resection

27. Classification
Class III –Central resection Class IV – Bilateral
anteroposterior resection

28. Classification
ClassV – Bilateral posterior
resection
ClassVI – Anterior resection

29.  The basic principle of placing support,
stabilization, and retention immediately
adjacent to and as far from the defect as
possible acts to distribute the tooth effect on
prosthesis performance to the greatest
mechanical advantage.
 Because the teeth adjacent to the anterior
resection margin are often incisors, it may be
necessary to consider splinting them to
improve the long-term prognosis

30.  it is often necessary to incorporate an
embrasure clasp to provide maximum
retention and stabilization
 When possible, the palatal surfaces of the
maxillary teeth should be surveyed to
determine whether guide-plane surfaces can
be produced to impart a stabilizing effect

31. Maxillary
Prosthesis
Obturator Prosthesis
SpeechAid Prosthesis
Palatal Lift Prosthesis
Palatal Augmentation Prosthesis

32. Obturator
Prosthesis
Restores separation of oral and adjacent
cavities following surgical resection of
tumors of the nasal and paranasal
regions.

35. SpeechAid
Prostheses
 They are functionally shaped to the
palatopharyngeal musculature to restore or
compensate for areas of the soft palate that
are deficient because of surgery or anomaly.
 Consists of a palatal component, which
contacts the teeth to provide stability and
anchorage for retention; a palatal extension,
which crosses the residual soft palate; and a
pharyngeal component, which fills the
palatopharyngeal port during muscular
function, serving to restore the speech valve of
the palatopharyngeal region.

37. Palatal Lift
Prostheses
 It positions a flaccid soft palate posteriorly and
superiorly to narrow the palatopharyngeal opening
for the purpose of improving oral air pressure and
therefore speech
 Patients who exhibit a structurally normal soft
palate and pharyngeal port can demonstrate
hypernasal speech caused by paralysis of the
regional musculature.
 This condition is referred to as palatopharyngeal
incompetence because the failure lies in function,
not in anatomic deficiency.

38. Palatal
Augmentation
Prostheses
 When surgical resection involving the tongue
and/or floor of the mouth limits tongue mobility, it
affects both speech and deglutition.
 With tongue mobility limitations, the contour of
the palate can be augmented by a prosthesis to
modify the “Space of Donder” to allow food
manipulation to be more easily transferred
posteriorly into the oropharynx.
 The space between the dorsum of the tongue and
the hard palate when the mandible is in rest
position after the expiratory cycle of respiration

39. Mandibular Defects
 Primary prosthetic objectives for mandibular
defects are to restore mastication and
cosmesis by the replacement of teeth

40. Mandibular
Prostheses
Type I Resection:
In a type I resection of the mandible, the
inferior border is intact and normal
movements can be expected to occur

42.  Anterior marginal resections sometimes
include part of the anterior tongue and floor of
the mouth.With loss of normal tongue
function, the remaining teeth are no longer
retained in a neutral zone, and as a result, they
often collapse lingually because of lip pressure.
If this occurs, the use of a labial bar major
connector may be necessary.
 Corrected cast impression procedures provide
a major advantage for fabrication of removable
partial dentures in partial mandibulectomy
patients.

43. Type II Resection:
In the type II resection, the mandible is
often resected in the region of the second
premolar and first molar. If no other teeth
in the arch are missing, a prosthesis
usually is not indicated

45.  Framework design should be similar to a
Kennedy Class II design, with extension into the
vestibular areas of the resection.This area
would be considered non functional and should
not be required to support mastication
 When the remaining teeth are in a straight line,
a Swing-Lock major connector design (Swing-
Lock, Inc, Milford,TX) may be used to take
advantage of as many buccal and/or labial
undercuts as possible.

48. Class III Resection:
A type III resection produces a defect to
the midline or farther toward the intact
side, leaving half or less of the mandible
remaining
Alternating buccal and lingual retention in
a rigid design or the Swing-Lock design
should be considered.

49. Type IV Resection:
A type IV resection would use the same
design concepts as type II or III resections
with the corresponding edentulous areas

50. TypeV Resection:
the anterior or posterior denture-bearing
area of the mandible has been surgically
reconstructed, the removable partial denture
design is similar to the type I resection design
The principal difference between a typeV resected
mandible and the intact mandible with the same
tooth loss pattern lies in the management of soft
tissue at the graft site.

51. Mandibular
Guide Flange
Prosthesis
 in a discontinuity defect, the movement of the
residual mandibular segment is an uncoordinated
action dictated by two features:
 The first is the remaining unilateral muscular
activity (diagonal movement on "closure" )
 The second is that the surgical environment will
change as healing progresses, and patient efforts
to train movement
 To facilitate training of the mandibular segment to
maintain a more midline closure pattern, clinicians
have used a guide flange prosthesis.

53. Thank you