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Palatal Obturators Scott Culpepper, DDS Kings County Hospital

Palatal Obturators Scott Culpepper, DDS Kings County Hospital. Palatal Obturator : a prosthesis that occludes an opening such as an oronasal fistula. Surgical resection, as in SCCa Used in cleft lip and palate cases Traumatic injury to the palate. Function Used in speech

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Palatal Obturators Scott Culpepper, DDS Kings County Hospital

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  1. Palatal Obturators Scott Culpepper, DDS Kings County Hospital

  2. Palatal Obturator: a prosthesis that occludes an opening such as an oronasal fistula.

  3. Surgical resection, as in SCCa • Used in cleft lip and palate cases • Traumatic injury to the palate

  4. Function • Used in speech • Prevent nasal regurgitation that occurs during feeding • Often used as a therapy for cleft lip and palate, or for treatment of resectedneoplasms. • Includes any missing teeth to provide occlusion and esthetics

  5. In some cases, a palatal obturator can be gradually downsized, so that tissues can gradually strengthen over time and compensate for the decreasing size of the obturator. • They can be simple or complex, and reflect a whole area of practice. • May involve • Dentists, Oral Surgeons • Plastic surgeons • Oral & Maxillofacial Prosthodontists • Speech therapists • Oncologists

  6. Palatal plate (most common) Types

  7. Placed by plastic surgeons, for babies with complete clefts of lip and palate. • Surgical placement, designed to bring two pieces of cleft palate together and to make lip repair easier Latham Device

  8. Nasal Alveolar Type

  9. Ideally, obturator is planned prior to surgery, or consistent with planned closure of cleft lip and palate. • Depends of extent of surgery, and subsequent surgeries • Eventual closure of fistula? • Additional resection of carcinoma? Planning

  10. Modification Obturator: very short term, used for immediate blockage and seal of fistula. May be made chairside.

  11. Interim Obturator: used when no further surgical procedures are planned. Great part of surgical treatment planning. • Preoperative impressions, bite registrations and tooth set-up. • Placed and relined in the OR, for immediate use post-operatively. • Requires constant revision as tissues heal.

  12. Two cases

  13. Male pt, complaining of existing obturator that does not fit. Ca treatments, still ongoing, tissues are continuously changing and Ca is probably out of control at this point. Pt. did not receive radiation b/c proximity to brain, surgical resections have also stopped at this point. How do you get retention? Case #1: Interim

  14. An oral and maxillofacial prosthodontist Presurgical treatment planning, there appeared to have been some in this case Prosthesis would ultimately have 2 parts that lock together: extraoral+intraoral Retentively engaging all involved tissues makes a heavy prosthesis, and seems uncomfortable for pt. Is there another way? What would help

  15. Definitive Obturator • Used when surgical rehabilitation is not possible. • Long-term use after tissues have fully healed and matured. • May also be implant supported Second case: third type of obturator

  16. This was an appropriate case • Isolated defect • No further surgery planned • Mature and healthy tissues • Not a far stretch from conventional dental prosthesis • Retention is mostly gained from the fistula or defect itself, rather than by conventional means case selection

  17. Etiquette: If you’re conversing w/a patient, make sure they have old obturator in, so they can answer you….. Get all concerns, complaints, questions up front. • Sell implants: Conventional prosthesis may not have enough retention. Understand that from the start. • Prepare the patient: • Estimated number of appts. • Some discomfort, irritation while working to record the tissues of the fistula. Gagging, sneezing. Prepare your patients

  18. Stock tray w/adhesive, lots of alginate Additional alginate to add to fistula Record opposing dentition if any Mark Midline, lab may not be able to tell Order custom tray Preliminary Impressions

  19. Border molding Master impression, can also be multi-phase This is the hardest for the patient Order an occlusal rim on a record base where fistula tissues have been blocked out You need to try in rims several times, no need to engage fistula every time during this phase Custom tray

  20. Make the record base so you can try it in repeatedly w/o trauma. Establish VDO, check phonetics, occlusal plane, etc. Tooth selection, wax try-in etc. Occlusal rims

  21. Need time. Most adjustment is in area of fistula. Go easy with try-ins, often the patient is better at placing it than we are. Final polish. Implant retention is always an option, even after delivery. Delivery

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