J Dent Rehabil Appl Sci.  2019 Sep;35(3):191-198. 10.14368/jdras.2019.35.3.191.

Prosthetic rehabilitation for a maxillectomy patient using 3D printing assisted closed hollow bulb obturator: a case report

• Oh M
• Lee J
• Song YG

• KMID: 2463628
• DOI: http://doi.org/10.14368/jdras.2019.35.3.191

Abstract

This case report presents a closed hollow bulb obturator made by 3D printing for a maxillectomy patient. Final impression was taken according to the instructions and impression trays provided by the Magic dentureâ„¢ system. Vertical dimension, facial appearance, and retention had been checked with the try-in denture. The try-in denture was corrected and adjusted to fulfill the demand of the patients, then these were reflected to the final design of the denture. The defect area was designed as a closed hollow bulb shape to reduce the weight and to provide uniform thickness of the denture. The patient satisfied with the esthetics and function of the denture.

Keyword

obturator; maxillary defect; 3D printing; closed hollow bulb

MeSH Terms

Clothing
Dentures
Esthetics
Humans
Magic
Printing, Three-Dimensional*
Rehabilitation*
Vertical Dimension

Figure

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  Fig. 1 Intraoral view. Fully edentulous ridge with partial resection of the left premaxillary area.

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  Fig. 2 Extraoral view (A) and lateral view (B). Facial depression and scar contracture on the left nasal alar area and the left mouth angle were seen.

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  Fig. 3 Panoramic radiograph. Maxillary defect on the left sinus area was observed.

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  Fig. 4 Temporary obturator (A, B). Artificial teeth were exposed due to the scar contracture and the temporary obturator’s excessive lip support (C).

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  Fig. 5 Final impression of CAD-CAM obturator by the Magic denture system. 1st impression with heavy body PVS material (A). 2nd wash impression with light body PVS material (B). Vertical dimension determination and centric relation record with the Gothic arch tracing device (C, D).

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  Fig. 6 After the correction of the try-in denture’s vertical dimension (A), Lip support (B). Wash impression made with the try-in denture (C).

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  Fig. 7 STL file the bulb portion was not hollow (A). The bulb portion was redesigned in the shape of hollow bulb (B).

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  Fig. 8 Final obturator. Extraoral view with the obturator in place (A, B). Intra oral view (C). Hollow space inside the bulb portion of the CAD-CAM obturator (cross sectioned) (D).

Reference

References

1. Irish J, Sandhu N, Simpson C, Wood R, Gilbert R, Gullane P, Brown D, Goldstein D, Devins G, Barker E. Quality of life in patients with maxillectomy prostheses. Head Neck. 2009; 31:813–21. DOI: 10.1002/hed.21042. PMID: 19280665.

2. Keyf F. Obturator prosthesis for hemimaxillectomy patients. J Oral Rehabil. 2001; 28:821–9. DOI: 10.1111/j.1365-2842.2001.00754.x. PMID: 11580820.

3. Wang RR. Sectional prosthesis for total maxillectomy patients:a clinical report. J Prosthet Dent. 1997; 78:241–4. DOI: 10.1016/S0022-3913(97)70020-9. PMID: 9297638.

4. Buzayan MM. The hollow bulb obturator fabrication, where do we stand in 2017. Periodont Prosthodont. 2017; 3:10. DOI: 10.21767/2471-3082.100035.

5. Brown KE. Fabrication of a hollow-bulb obturator. J Prosthet Dent. 1969; 21:97–103. DOI: 10.1016/0022-3913(69)90035-3. PMID: 4881714.

6. Krishna CH, Babu JK, Fathima T, Reddy GV. Fabrication of a hollow bulb prosthesis for the rehabilitation of an acquired total maxillectomy defect. BMJ Case Rep. 2014; Mar. 26. 2014:pii:bcr2013201400. doi:10.1136/bcr-2013-201400. DOI: 10.1136/bcr-2013-201400. PMID: 24671313. PMCID: PMC3975568.

7. Dawood A, Marti Marti B, Sauret-Jackson V, Darwood A. 3D printing in dentistry. Br Dent J. 2015; 219:521–9. DOI: 10.1038/sj.bdj.2015.914. PMID: 26657435.

8. Tasopoulos T, Kouveliotis G, Polyzois G, Karathanasi V. Fabrication of a 3D printing definitive obturator prosthesis:a clinical report. Acta Stomatol Croat. 2017; 51:53–8. DOI: 10.15644/asc51/1/7. PMID: 28740271. PMCID: PMC5506255.

9. Kattadiyil MT, Jekki R, Goodacre CJ, Baba NZ. Comparison of treatment outcomes in digital and conventional complete removable dental prosthesis fabrications in a predoctoral setting. J Prosthet Dent. 2015; 114:818–25. DOI: 10.1016/j.prosdent.2015.08.001. PMID: 26412000.

10. Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head Neck. 2000; 22:17–26. DOI: 10.1002/(SICI)1097-0347(200001)22:1<17::AID-HED4>3.0.CO;2-2. PMID: 10585601.

11. Habib BH, Driscoll CF. Fabrication of a closed hollow obturator. J Prosthet Dent. 2004; 91:383–5. DOI: 10.1016/j.prosdent.2004.01.020. PMID: 15116041.

12. Sreeramulu B, Shalini K, Swapna B, Suman P, Venkata Ratana Kumar R. Alternative technique for fabrication of hollow bulb obturator for hemimaxillectomy patient - a case report. Int J Healthcare Biomed Res. 2014; 3:139–43.

13. Patil PG, Nimbalkar-Patil S. Lost wax-bolus technique to process closed hollow obturator with uniform wall thickness using single flasking procedure. J Indian Prosthodont Soc. 2017; 17:84–8. DOI: 10.4103/0972-4052.176538. PMID: 28216851. PMCID: PMC5308074.

14. Shrestha B, Hughes ER, Kumar Singh R, Suwal P, Parajuli PK, Shrestha P, Sharma A, Adhikari G. Fabrication of closed hollow bulb obturator using thermoplastic resin material. Case Rep Dent. 2015; 2015:504561. DOI: 10.1155/2015/504561. PMID: 26491575. PMCID: PMC4600497.

15. Ushijima M, Kamashita Y, Nishi Y, Nagaoka E. Changes in lip forms on three-dimensional images with alteration of lip support and/or occlusal vertical dimension in complete denture wearers. J Prosthodont Res. 2013; 57:113–21. DOI: 10.1016/j.jpor.2012.11.003. PMID: 23265952.

16. Kamashita Y, Kamada Y, Kawahata N, Nagaoka E. Influence of lip support on the soft-tissue profile of complete denture wearers. J Oral Rehabil. 2006; 33:102–9. DOI: 10.1111/j.1365-2842.2006.01575.x. PMID: 16457669.