MAXILLOFACIAL PROSTHESIS

DR RITESH SHIWAKOTI

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 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.

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 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.

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 Maxillofacial Prosthetics

 Theart 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.

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 Intra-Oral

 Extra-Oral

Type of M.F.P
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After surgical intervention.

Indications
After
trauma. of MFP
Congenital defects.

Acquired defects.

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Prosthetic vs. Surgical Rehabilitation

 Individualized decision between patient and

doctor.

 Removable prosthesis allows for cancer

surveillance.

 Destruction amount.

 Malignancy recurrence.
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 Intraoral vs. Extraoral

 Intraoral -- mostly functional

◦ Mandible
◦ Maxilla
 Extraoral -- cosmetic
◦ Ear
◦ Nose
◦ Orbit

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 Management of patient for MFP.

 Personal history of a patient should be obtained.

 Dental and medical history also should be obtained.

 Intraand external examination of a patient by a

maxillofacial surgeon and prosthodontics should be
done.

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 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.

Management of patient for

MFP.
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Psychosocial Issues

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 Dental Impression
 Surgeon has
marked
resection for
prosthodontic
planning.

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 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. Prosthodontics.
3. Orthodontist.
4. Phyciastrist.
5. Speech rehabilitation specialist.
6. Oncologist.
7. Plastic surgeon specialist
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 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.

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 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.

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 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.

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 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.

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 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.
 

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 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 .

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 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 .

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 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.
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 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.

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Congenital defects
 
 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.

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 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 .

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 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.
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 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
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6. Prevent contamination of the wound 
 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.

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 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 .
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 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.

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 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.

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

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 Definitive Obturators

 Definitive Obturator:

 It is a final prosthetic management construction

after complete healing of the operation site .

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

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Definitive Obturators

 Types of obturators:
1. Hollow bulb (Closed).
2. Roofless (Open bulb).
 

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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.

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 Definitive Obturators
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.

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Premaxilla Preserved

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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.

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

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Maxillary Prosthesis

 Articulates with scar

band.
 Hollowed to be
lightweight.

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Timing

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

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Maxillary Prosthesis

 Can be made with a

reservoir to hold
artificial saliva.

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Prosthetic Materials

 Acrylics
 Polyurethanes
 SiliconeElastomers
◦ Room-temperature vulcanizing
◦ High-temperature vulcanizing

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Mandible

 Mandibular reconstruction revolutionized by

microvascular and plating techniques.
 Prosthetics mainly restore occlusion and occlusal
surface.
 Implants able to restore high degree of function.

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Mandible

 Skin
graft preserves alveolar ridge for denture
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Postoperative Malocclusion

 Deviates to surgical side.

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Maxillary Ramp

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Maxillary Ramp

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Adjunctive Preprosthetic Measures

 Vestibuloplasty.
 Lowering of Floor of Mouth.
 Implants.

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Vestibuloplasty

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Lowering the Floor of Mouth

 Goal is to reposition mylohyoid muscle.

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Lowering the Floor of Mouth

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Edentulous Mandible

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 Mental
Foramen

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Implants

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Extraoral Prostheses

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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.
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Extraoral
Prostheses -- Ear

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Extraoral
Prostheses -- Ear

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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

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Extraoral
Prostheses -- Nose

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Extraoral
Prostheses -- Nose

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Extraoral
Prostheses -- Nose

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

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