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An implant-retained obturator – a case study James Puryer Claire Forbes-Haley Dental Update 2024 44:5, 707-709.
Authors
JamesPuryer
BDS DPDS MFDS RCS(Eng) MDFTEd MSc FHEA
Clinical Lecturer (Restorative), School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK (James.Puryer@bristol.ac.uk)
This case describes the oral rehabilitation of a patient following maxillary hemi-section due to squamous cell carcinoma of the palate. Planned treatment was construction of a maxillary implant-supported obturator. Two dental implants were placed in his maxilla to aid the support and retention of an obturator. However, owing to bone availability, their angulation was suboptimal and compromised the retention of the obturator. This case describes alternative implant attachments to aid the retention and stability of implant-retained dentures constructed in cases with suboptimal implant placement.
CPD/Clinical Relevance: This case highlights the importance of careful planning for implant placement, and reinforces the need to plan the prostheses before implant surgery. This case highlights possible difficulties that can arise if implants are non-ideally angulated, and how to adapt restorations to manage such difficulties in cases with maxillary removable prostheses.
Article
An obturator is a device constructed for occluding a cavity, usually in a patient's hard or soft palate. Palatal defects can either be congenital, ie cleft palate, or they may be acquired; as a result of trauma or surgical excision. The resultant oronasal communication and altered anatomy may leave a patient with functional problems including:
All of these problems can affect the mental and physical wellbeing of patients, and the provision of a successful obturator for patients can have a significant effect on their quality of life.1 Obturators can be supported and retained by the patient's remaining hard and soft tissues but, whilst the presence of some remaining teeth can facilitate the prosthodontic rehabilitation of maxillectomy patients, for those patients that are edentulous the treatment may be more challenging.2 The difficulty in managing these cases is not only dependent upon the number of natural teeth remaining, but the size and classification of the defect, presence or lack of undercut within the oral cavity/defect, decreased muscular control and reduced sensation. Increasingly, dental implants are being used to aid support and retention, and the overall survival rate for implants supporting maxillofacial prostheses has been reported to be as high as 96.1%.3
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