J Dent Rehabil Appl Sci.  2023 Dec;39(4):229-236. 10.14368/jdras.2023.39.4.229.

Fabrication of implant-associated obturator after extraction of abutment teeth: a case report

• Jang KY
• Lee GJ

• KMID: 2550432
• DOI: http://doi.org/10.14368/jdras.2023.39.4.229

Abstract

Maxillary bone defects may follow surgical treatment of benign and malignant tumors, trauma, and infection. Palatal defects often lead to problems with swallowing and pronunciation from the leakage of air into the nasal cavity and sinus. Obturators have been commonly used to solve these problems, but long-term use of the device may cause irritation of the oral mucosa or damage to the abutment teeth. Utilizing implants in the edentulous area for the fabrication of the obturators has gained attention. This case report describes a patient, who had undergone partial resection of the maxilla due to adenocarcinoma, in need of a new obturator after losing abutment teeth after long-term use of the previous obturator. Implants were placed in strategic locations, and an implantretained maxillary obturator was fabricated, showing satisfactory results in the rehabilitation of multiple aspects, including palatal defect, masticatory function, swallowing, pronunciation, and aesthetics.

Keyword

implant; obturator; partial maxillectomy

Figure

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  Fig. 1 Panoramic radiograph before treatment. Maxillary lateral incisor and canine have severe secondary caries and mobility.

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  Fig. 2 Intraoral photograph before treatment. Rt. maxillary lateral incisor and canine were fractured due to severe secondary caries. Bridge of Rt. maxillary lateral incisor and canine was removed. (A) Frontal view, (B) Occlusal view.

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  Fig. 3 Intraoral photograph and old obturator photograph. Minor connector at Rt. maxillary first premolar and second premolar was fractured (Red circle). (A) Occlusal view, (B) Tissue surface of old obturator.

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  Fig. 4 Intraoral photograph and preliminary impression taking. Zirconia surveyed crown with cingulum rest was set on Rt. maxillary lateral incisor and canine. (A) Occlusal view, (B) Preliminary impression taking with alginate.

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  Fig. 5 Custom tray fabrication and fuctional impression taking. (A) Individual tray fabricated with 3D printer, (B) Border molding with modeling compound, (C) Functional impression taking with polysulfide rubber.

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  Fig. 6 Vertical dimension taking. The vertical dimension was measured based on the remaining abutment teeth. (A) Frontal view, (B) Left lateral view, (C) Occlusal view.

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  Fig. 7 Wax denture try-in. (A) Right lateral view, (B) Frontal view, (C) Left lateral view, (D) Occlusal view.

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  Fig. 8 Contact area checking before delivery. Pressure indicating agent was applied on the tissue surface of obturator. (A) Lateral surface, (B) Tissue surface.

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  Fig. 9 Hollow bulb area checking before delivery. Before adjustment, hollow was long and heavy (A), after adjustment, hollow was much shorter and lighter than before (B). (A) Before adjustment (tissue surface), (B) After adjustment (tissue surface).

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  Fig. 10 Obturator was delivered and checked. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 11 Obturator was checked after 3 months. (A) Right lateral view, (B) Frontal view, (C) Left lateral view, (D) Occlusal view.

Reference

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