MANAGEMENT OF INTRAORAL DEFECTS

Hello!

I am Dr. B. Devi Parameswari,M.D.S

drdeviparameswari@gmail.com

MAHER ( Meenakshi Academy Of

Higher Education and Research)

GOD - creates,

MAN – DESTRUCTS,

MAXILLOFACIAL PROSTHODONTIST

recreates

A. MANDIBLE
I. MANDIBULAR DEFECTS

CANTOR CURTIS CLASSIFICATION

CLASS 1

PORTION OF ALVEOLAR PROCESS AND BODY OF MANDIBLE

LINGUAL AND BUCCAL SULCUS MUCOSA

BASE OF TONGUE AND MYLOHYOID

SUBLINGUAL AND SUBMAXILLARY GLANDS

CLASS 2

Condyle, ramus and body of mandible distal to cuspid

Palatoglossal, pterygoid, masseter, external pterygoid

Hypoglossal ,lingual, and inferior alveolar nerves

CLASS 3

CLASS 2 + ANTERIOR PORTION OF THE MANDIBLE

CLASS 4

CLASS 1,2,3 BONE AND SPLIT THICKNESS SKIN OR PEDICLE GRAFT

CLASS 5

ANTERIOR PORTION OF THE MANDIBLE WITH SURGICAL RECONSTRUCTION

CLASS 6

Similar to class V, but continuity of the mandible has not been restored surgically,

Each lateral fragment moves independently

Poor prognosis

Denture not advised

II. FACTORS AFFECTING MANDIBULECTOMY PATIENTS

 LOCATION AND EXTENT OF MANDIBULAR DEFECT

 PRESENCE OF REMAINING NATURAL TEETH
 DEGREE OF POST MANDIBULECTOMY ROTATION AND DEVIATION
  COMPROMISE OF VESTIBULAR EXTENSIONS
 AVAILABLE MOUTH OPENING
 FUNCTIONAL LIMITATION OF TONGUE
 SKIN GRAFTING
 ALTERED ANATOMIC RELATIONSHIP

III. TREATMENT PLAN

EXERCISE REGIMEN

RECONSTRUCTION- SURGICAL

TREATMENT PLANNING

DESIGNING OF PROSTHESIS

Major connector
Minor connector

Occlusal rest

Retention

Ribbon rests – parallel to axis of rotational

Retainers – buccal on molar and labial on cuspids placed at height of contour

Occlusion – only centric

greater chance of prosthesis dislodgement caused by lack of support under anterior extension.

Indirect retention -long mesial rests on the 2nd Molars

Minor connector – relieve distal aspect and proximal plate

Altered cast impression

Thermoplastic impression waxes

Implantsupported prosthesis

B. MAXILLARY DEFECTS

1. MAXILLA BONE

ANATOMY

2. FUNCTION OF HARD AND SOFT PALATE

SPEECH

SWALLOWING

RESPIRATION

3. IMPAIRMENT OF FUNCTION

1. HYPERNASAL OR HYPONASAL SPEECH

2. NASAL REGURGITATION

3. ESTHETICS
CLASSIFICATION OF MAXILLARY DEFECTS

- FOR SURGICAL PURPOSE

- FOR RESTORATIVE PURPOSE

 BASED ON ETIOLOGY
 Based on phase of treatment
 BASED ON MATERIAL USED

CLASSIFICATION OF MAXILLOFACIAL DEFECTS

CLASSIFICATION NEEDED FOR SURGICAL PURPOSE

1. Spiroclassification (1984)

2. Liverpool classification (2000)

3. Cordeiro’s classification

4. Okay’s classification(2001)

5. Durrani classification (2013)

FOR RESTORATIVE PURPOSE

Aramany’s classification(1987)

ARAMANY CLASSIFICATION

CONGENITAL
TREATMENT OPTIONS

FOR CONGENITAL DEFECTS

FOR ACQUIRED DEFECTS

CONGENITAL PALATAL DEFECTS

ROLE OF PROSTHODONTIST

PRESURGICAL NASO ALVEOLAR MOLDING (PNAM)

GOAL OF TREATMENT

DEFICIENT TISSUES – to be expanded

MALPOSITIONED STRUCTURES – to be repositioned

PRESURGICAL NASOALVEOLAR MOLDING (PNAM)

RETENTIVE TAPING

Unilateral clefts PNAM

Recent Advances: CAD

IMMEDIATE SURGICAL OBTURATOR

A temporary prosthesis used to restore the continuity of hard palate immediately after surgery or
traumatic loss

SURGICAL OBTURATOR

DEFINITIVE OBTURATOR

HOLLOW BULB TWO PIECE OBTURATOR

CLINICAL CASE

IMPRESSION

TWO PIECE OBTURATOR

PIECE I - HOLLOW BULB

PIECE II - OBTURATOR

PRINCIPLES OF DESIGNING

Based on aramany classification

RETENTION
ANATOMIC UNDERCUT

IMPLANTS

ZYGOMATIC IMPLANTS
 ENDOSTEAL IMPLANTS

RECENT ADVANCES

PEEK(polyetheretherketone)

CAD CAM milled PEEK

White , translucent, rigid material with thermal stability

Resistant to hydrolysis,

Non toxic

Biocompatible

SOFT PALATE DEFECTS

 PALATAL INSUFFICIENCY
 PALATAL INADEQUACY
 PALATAL INCOMPETENCE

MEATUS OBTURATOR

SPEECH BULB PROSTHESIS

PALATAL LIFT PROSTHESIS