OBTURATOR

S
NIKHITA NARAYANAN
III MDS
• Introduction
• History
• Classification of maxillary defects
• Functions of obturators
• Pre operative evaluation
• Recommendations to surgeons
• Biomechanics
• Types of obturators
• Design considerations
• Impression Procedures
• Hollow bulb obturator
• Conclusion
• References
INTRODUCTION

•MAXILLOFACIAL PROSTHESIS:
• Any prosthesis used to replace part or all
of any stomatognathic and/or
craniofacial structures.
1. Maxillary Defect- I. Orbital. I. Orbito-Maxillary.
a)Hard Palate- II. Nasal. II. Naso-Maxillary
Surgical Obturator.Interim Obturator. III. Auricular.
Definitive Obturator IV. Mid-Facial.
b) Soft Palate-
Speech Appliance.Meatus Obturator.
Palatal Lift Prosthesis
2. Mandibular Defect-
Mandibular Resection Prosthesis.
Guide Flange Prosthesis
3. Glossectomy-
Tongue Prosthesis.
Palatal Augmentation.
4. Splints/Stents-
Surgical Splints, Bite Splints, TMJ
Appliances
• An obturator (latin: obturare, to stop up) is a
disc or plate, natural or artificial, which
closes an opening.
• OBTURARE = “TO CLOSE
• Obturator is a prosthesis used to close a
congenital or acquired tissue opening, primarily
of the hard palate &/or contiguous alveolar
structures. Prosthetic restoration of defect often
includes use of a surgical obturator, interim
obturator & definitive obturator.-GPT
 HISTORY
• ANCIENT EGYPT (3000 B.C)
• Mud, flax or sawdust was packed under the skin and
linen cloth was placed in the mouth to restore facial
cotours.
• Artificial eyes of earthenware, precious stones and
enameled bronze, copper and gold were placed in
shrunken sockets.
• earliest known application of engineering principles to
restore facial appearance and dental occlusion may be
attributed to Hippocrates
 EARLY PROSTHESIS

• Ambroise WAS FAMILIAR WITH PALATAL OBTURATOR AS EARLY 1537 to 15

Pare AS
Pare’s first obturator held in 39.
position with a sponge.

Pare’s second
Pare’s first obturator held Pare’sappliance, meant tomeant to
second appliance,
Pare’s first obturator
in position held
with a in position with a engage theengage
nasal the nasal with a button
undercut
sponge.
sponge. undercut with a button
Wolff
PIERRE FOUCHARD KINGSLEY
schlitsky(1385)

ARTIFICIAL PALATE

Fauchard's winged
obturator
WINGED OBTURATOR
Palatal lift prosthesis by Palatal Elevator Button fabricated
Sato by
Beder in 1968
CLASSIFICATION OF MAXILLARY
DEFFECTS
According to origin of the deffect
•CONGENITAL ACQUIRED
• Cleft palate Trauma
• Cleft lip Surgery
• Facial cleft Pathology
• Missing ear
•hemi facial
microsomia
ARAMANY CLASSIFICATION

•Dr. Mohammed aramany IN 1978

•Developing optimum obturator design
•Enhances communication among
prosthodontists
•6 designs
Classification by okay et al.
(2001)
Class I a
• Defects that involve the hard palate but
not the tooth –bearing alveolus.
• Prosthesis created for prosthetic
obturation were stable and well tolerated.
Class I b

• Defects that involved any portion of the

maxillary alveolus and dentition posterior to
the canines or that involved the premaxilla .
Class II

• Defects
-that involved any portion of the tooth-bearing
maxillary alveolus but included only 1 canine .
- anterior transverse palatectomy defects that
involved less than one half of the palatal
surface.
 Class III
• Defects that involved any portion of the tooth-
bearing maxillary alveolus and included both
canines,total palatectomy defects,and anterior
transverse palatectomy that involved more than
half of the palatal surface.
Subclass f and z
• F- defects involving inferior
orbital rim.
• Z – defects involving body of
the zygoma.

• The orbital floor and zygomatic

body play both functional and
cosmetic roles.

.
• Spiro et al (1997): a relatively simple classification in
which defects can be termed as “limited” or “subtotal”
on the basis of the number of maxillary “walls” involved
in the resection.

• Davison et al: reconstruction algorithm based on the

review of 108 patient treatments. They are divided into 2
broad categories as “complete” and “partial”.

• Brown : first to discuss a multi disciplinary (surgical and

prosthodontic) approach to palatomaxillary
reconstruction. based on both the vertical and
horizontal dimensions of a defect
FUNCTIONS OF OBTURATORS

 It can serve in lieu of a Levin tube for feeding purposes.

 It can be used to keep the wound or defective area clean

 It can enhance the healing of traumatic or postsurgical defects.

 It can help to reshape and reconstruct the palatal contour

and/or soft palate.

 It also improves speech or, in some instances, makes speech

possible.
 In the important area of esthetics, the obturator can be
used to correct lip and cheek position.
 It can benefit the morale of patients with maxillary defects.
 When deglutition and mastication are impaired, it can be
used to improve function.
 It reduces the flow of exudates into the mouth.
 The obturator can be used a a stent to hold dressings or
packs postsurgically in maxillary resections.
•Objectives
•Restoration of esthetics or cosmetic
appearance of the patient.
•Restoration of function.
•Protection of tissues.
•Therapeutic or healing effect.
•Psychologic therapy.
Preoperative evaluation
 Psychological support : the patient should be aware of
the potential physiologic and cosmetic deficiencies that
will result from his treatment and subsequent
prosthodontic management.
 Preoperative dental management.
 1. Temporary restoration of teeth with severe carious
lesions
 2. Removal of disesed or malposed teeth at the time
of the operation.
 3. Treatment for acute oral infections such as
necrotizing ulcerative gingivitis.
 Preoperative impressions:for diagnostic casts
and for fabrication of temporary obturator.
 Suggestions to the surgeon
 Recommendations to surgeons

1. Preservation of the contralateral anterior teeth, if it does

not compromise tumor eradication.
2.If the palatal mucosa is not invaded by the tumor, it is
preserved and reflected to cover the medial wall. this
procedure provides superior tissue quality coverage for the
nasal septum.
3.Preservation of the posterior hard plate on the defect side
if the tumor is situated anteriorly or laterally.
4.Resection through the socket of the tooth closest to the
specimen allows for maintenance of the proximal alveolar
bone adjacent to the abutment tooth.
Prognosis of obturator depends on:

• The size and curvature of the arch

• Quality of tissue covering the ridge and lining
the defect
• Abutment alignment that is curved instead of
linear
• Availability of teeth on defect side for
retention and support
 TYPES OF
OBTURATORS
1) Based on phase of treatment :-
oSurgical obturators (immediate
surgical obturators & delayed surgical
obturators)
oInterim obturators
oDefinitive obturators
2) Based on the material
used :-
oMetal obturators
oResin obturators
oSilicone obturators

3) Based on area of
restoration :-
oPalatal obturator
oMeatal obturators
4) According to physiological movement of the
surrounding tissue.
a.Static obturator
b.Functional obturator.

Obturators covering defects in the area from the

lips to the junction of the hard and soft palates
are static Obturators.
Those Obturators which provide closure in the
soft palate and pharyngeal areas are functional
Obturators.
• According to Location of defect:
i. labial or buccal obturator
ii. alveolar obturator
iii. hard palate obturator
iv. soft palate obturator
v. pharyngeal obturator

• According to the Type of to the basic

maxillary prosthesis attachment
1) Fixed obturator
2) Hinged or movable obturator
3) Detachable obturator.
OBTURATORS FOR AQUIRED
DEFECTS.
Surgical obturator
8
 A temporary prosthesis used to restore the
continuity of hard palate immediately after
surgery or traumatic loss of a portion or all
of the hard palate &/or contiguous alveolar
structures like gingival tissue,teeth.-GPT

 It is of two types :-
i. Immediate surgical obturator :- It is inserted
at time of surgery.
ii. Delayed surgical obturator :- It is inserted 7-
10 after surgery
• Surgical obturator is inserted on the day of
surgery.
•  A preliminary cast is obtained before surgery
on which a mock surgery is performed.
•  A clear acrylic plate is fabricated & inserted
after surgery.
•  If patient is dentulous,retention is obtained
with simple clasps.
• If the patient is edentulous,the obturator is
wired into alveolar ridge & zygomatic arch.
•  The obturator is retained for 3-4 months post
surgically.
•  It is replaced with an interim or definitive
obturator after complete healing of the surgical
INTERIM OBTURATOR

• A prosthesis that is made several weeks

or months following surgical resection of
a portion of one or both maxillae.It
frequently includes replacement of teeth
in defect area.This prosthesis when
used,replaces the surgical obturator that
is placed immediately following the
resection & may be subsequently
replaced with a definitive obturator.-GPT
• The defect is packed with gauze dipped in Vaseline to
the level of the remaining tissue, then impression is
taken with modified stock tray using elastic impression
material.

•  The steps of construction are the same as in

immediate obturator.
• Function: helps in restoring
1. Speech.
2. Feeding.
3. Esthetics.
4. Prevent wound contamination.
DEFINITIVE OBTURATOR

• A prosthesis that artificially replaces

part or all of the maxilla & the
associated teeth lost due to surgery or
trauma :-GPT
 Preparation of the mouth for
obturator:
I. Extract hopeless teeth.
II. Periodontal therapy.
III.Restore carious teeth.
• Types of obturators:
1.Hollow bulb (Closed).
2.Roofless (Open bulb).
 PALATAL OBTURATOR
• Closes or occludes opening caused by cleft or
fistula
•  Used to facilitate separation of oral & nasal
cavities for speech, feeding, & swallowing &
hypernasality
Speech aids

• These are prosthesis that are functionally

shaped to the velopharyngeal musculature to
restore or compensate for areas of the soft
palate that are deficient because of surgery
or congenital anomaly.
• Such prosthesis consists of following 3 parts
The palatal part ,which
provide stability and
anchorage for retention.
The palatal extension,which
crosses the residual soft
palate;
The pharyngeal part,which
fills the velopharyngeal
part during muscular
function
• Pediatric speech aid- made of materials that can be
easily modified as growth or orthodontic treatment
progresses.
• Adult speech aid- when velopharyngeal
insufficiency is a result of a cleft palate or palatal
surgery.
• Both of above are based on the principle of
posterior retention and anterior indirect retention.
Palatal lifts.
• Prosthesis which lift the flaccid palate posteriorly
and superiorly to narrow the Velopharyngeal
opening.
• Velopharyngeal incompetency; patients with
normal,intact anatomy but with hypernasality and
nasal emission of air.
• This condition results from a paralysis of the
activating muscles and soft tissues.
Palatal augmentation

• If a part of tongue is lost ,the ability of the tongue

to reach the palate for appropriate speech and
swallowing is compromised.
• The contour of palate can be augmented by a
prosthesis to fill the space of donder so that a food
bolus can be more easily moved posteriorly into
the oropharynx.
MEATAL OBTURATOR

• A meatal obturator is static.

• It extends obliquely upward from the hard-soft
palate junction to occlude against the turbinates
and the superior aspect of the nasal cavity.
• It may be preferable obturator when the cleft is
wide, few undercuts exist, and the patient has an
active gag reflex.
DISADVANTAGES OF MEATAL
OBTURATORS
• Nasal air emission cannot be controlled
because it is in an area where there is no
muscle function.

• Nasal resonance will be altered.

 Advantages of hollow bulb:

1. The weight of the prosthesis is reduced, making it more

comfortable and efficient.
2. The lightness of the prosthesis changes one of the
fundamental problems of retention and increases
physiologic function.
3. The decrease in pressure to the surrounding tissues aids
in deglutition and encourages the regeneration of tissue.
4. The light weight of the hollow bulb obturator does not add
to the self- consciousness of wearing a denture.
5. The lightness of the prosthesis does not cause
excessive atrophy and physiologic changes in muscle
balance.
General principles for the design
of obturator
1. The need for a rigid major connector;
2. Guide planes and other components that
facilitate stability and bracing;
3. A design that maximizes support;
4. Rests that place supporting forces along the long
axis of the abutment tooth;
5. Direct retainers that are passive at rest and
provide adequate resistance to dislodgment
without overloading the abutment teeth; and
6. Control of the occlusal plane that opposes the
defect, especially when it involves natural teeth.
Forces on Obturators

These forces can be

• Vertical dislodging force
• Occlusal vertical force
• Torque or rotational force
• Lateral force
• Anterior posterior force.
DESIGN CONSIDERATION OF
PROSTHESIS

•Retention
•Stability
•Support
•Fulcrum line near the defect area
Retention

• Retention is the resistance to vertical displacement

of the prosthesis.
• Retention Is obtained from
• Within the defect
• From the residual maxilla
• From the residual maxilla
• Remaining teeth
• if the defect is small and the remaining teeth stable,
intracoronal retainers might be considered.
• If the defect is large and some or all of the remaining
teeth are weak, extracoronal retainers should be used.
• If the remaining teeth are not parallel with the walls of
the defect, and if the palatal surfaces of the teeth are
not adequate, guiding planes may be provided to resist
vertical displacement of the obturator and
disengagement of the retentive clasp arms
• Alveolar ridge
• A large ridge with a broad ridge crest is more
retentive than is a small or tapering ridge crest.
• The broad, flat palate is more retentive than the
high tapering palate. The square arch form is more
conducive to retention than the tapering or ovoid
arch form. 
Within the deffect
Residual soft palate: provides a posterior palatal
seal. Extension of the obturator prosthesis onto the
nasopharyngeal side of the soft palate will help in
this purpose and will also provide retention.

Residual hard palate: Depending on the location of

the line of palatal resection, there will be varied
degrees of undercut along this line into the nasal or
paranasal cavity.
• Lateral scar band: A scar band results after
surgical resection at about the level of the
mucobuccal fold. Because of its lack of bone
support, the lateral scar band also tends to
stretch with continued use. This stretching
may necessitate sequential additions to the
prosthesis which may be limited by cosmetic
requirements and prosthesis size and weight
.

Height of lateral wall: the lateral wall of the defect

can be utilized for indirect retention.
A high lateral wall of an obturator will undergo less
vertical displacement with a given defect wall
flexure than will a shorter prosthesis lateral wall.
One way of overcoming retention problem is to
obtain accurate reproduction of undercut areas.
• Stability
• Stability is the resistance to prosthesis displacement by
functional forces.
• Residual maxilla stability
• If sound natural teeth remain, the bracing components of
the prosthesis framework can be used to minimize
movements.
• In edentulous patients, maximal extension of the prosthesis
into the mucobuccal fold, and especially the distobuccal
extension as the buccal flange approaches the hamular
notch, is important in minimizing movement within the
horizontal plane.
• Stability within the defect
• Maximal extension of the prosthesis in all lateral
directions must be provided.
• maximal contact with the medial line of resection, the
anterior and lateral walls of the defect, the pterygoid
plates, and the residual soft palate. Contact of the
obturator portion of the prosthesis with these structures
minimizes anteroposterior, mediolateral and rotational
movement of the prostheses.
Support
Support is the resistance to movement of a prosthesis towards
the tissue.
Residual maxilla
Teeth
Only sound teeth should be selected to provide support in the
remaining segment for a large prosthesis.

Alveolar ridge
The height and contour of the residual alveolar ridge and the depth of
the sulci are important for support in both the edentulous and the
dentulous patient.

Residual hard palate

The residual hard palate is an important structure for support of an
obturator prosthesis. The broad, flat palate is more conducive to
support than the high tapering palate.
• Within the defect
• This support can be achieved by contact of the prostheses
with any anatomic structures that provide a firm base.

• The exact structure depends on the size and extension of

the defect.

• In the acquired maxillary defects, the floor of the orbit, the

bony structures of the pterygoid plate and the anterior
surface of the temporal bone near the infratemporal fossa
are considered for positive support.

• The nasal septum may be used if the defect extends

beyond the midline.
BASIC OBTURATOR DESIGN DESCRIBED BY
ARAMANY
Linear design

Anterior teeth are not included in the design.

Support- located in a linear fashion.
Stability –palatal surface of
premolars, buccal surface of
molars.
Retention –buccal surface of
the premolar.
palatal surface of molars.
Tripodal

2 or 3 anterior teeth are splinted.

Retention –from labial surface of
anterior teeth with gate design
or an I bar on the central incisor;
-Buccal surface of the
molars
Stability –from molars palatally
Support – rest on the distal
surface of the first premolar
• Support- perpendicular to the fulcrum line rest is
placed
• Stability –from palatal surfaces of abutments
• Retention – from buccal surfaces of the abutment
teeth
•The design is based on quadrilateral configurations.
•Support is widely distributed on both premolars and molars.
•Retention is derived from the buccal surfaces and stabilization
from the palatal surfaces.
• The design is linear
• Support –on the center of all remaining teeth.
• Stability-palatal on the premolars;
buccal on the molars.
• Retention- mesially on the premolars.
palatally on the molars.
•Tripodal configuration
•Splinting of at least two terminal abutment teeth on each
side is suggested.
•I –bar clasps are placed bilaterally on the buccal surface of
the most distal teeth.
• Stabilization and support are located on the palatal
• 2 anterior teeth are splinted bilaterally and connected by a
transverse splint bar.
• A clip attachment may be used without an elaborate partial
framework.
• If the defect is large,or the remaining teeth are in less than
optimal condition,a quadrilateral configuration design is followed.
Impression procedures
• Before impressions
• Preoperative and postoperative oral anatomy
• Incomplete palatal closures
• Thick fibrous bands
• Perforations into the maxilla, nose, sinuses
• Position
• Supine to be used for preliminary impression for patients with
extensive surgical defects- provides more more visibility and access.
• Erect position to be used for final impression so that dependent
tissue do not become displaced from normal.
• All other positions usually induce gagging and so should be avoided.
• Place an airway in the nostrils and pack the throat
with gauze.

• Extreme undercuts blocked with petrolatum

impregnated gauze.

• Lubricate the lips with petrolatum to prevent

impression material from sticking to it.
Primary impression

Build the stock tray with wax in the defect area to

direct the impression material into the defect.
• Make an alginate impression and pour the cast.
• Fabricate individual acrylic resin impression tray.
• REVIEW OF IMPRESSION TECHNIQUES

• Schmaman and carr(1992)

• A foam impression technique for maxillary defects
• This technique overcomes the problems of
withdrawal of maxillectomy defect impression with
or without limited space as the result of trismus.
• Silastic foam material is used to make an impression
which expands inside the defect and is extremely
elastic to escape any deformation on removal.
• Luebke
• Use of sectional tray in patients with trismus.
• Beumer et al.
• In this method the impression is refined with
modeling plastic, a soft flowing wax, and an
elastic impression material to record the defect.
Procedure for construction of
obturator for edentulous mouth

• Before impressions
• Fistulas or smaller defects must be blocked
• Priliminary impression
• Construction of special tray
• Final impression
• Rubber base impression material
• Master cast
• Wax lid is fitted over the defect area
• Stabilized base plates
• Wax occlusal rims are attatched
• Records are obtained using denture
adhesives
• Teeth arrangement done
• Try in stage
• Processing the denture
HOLLOW BULB OBTURATOR

• A permanent obturator fabricated from postsurgical

master cast
• It contains
• False palate
• False ridge
• Teeth
• Closed bulb which is hollow
General considerations
concerning the bulb design

• A bulb is not necessary

• Small to average size defect
• Surgical or immediate temporary prosthesis

• Need of hollow
• To aid in speech resonance
• Light weight
• Provide facial esthetics
• It should not be high as to cause the eye to move
during mastication
• It should be one piece
• It should be closed superiorly always
• It should not be large as to interfere with insertion
if the mouth opening is restricted
Procedure for one piece hollow
obturator
RECENT ADVANCES

• IMPLANT RETAINED OBTURATORS

• THREE-DIMENSIONAL (3D) PRINTING
 IMPLANT RETAINED OBTURATOR

Pretreatment clinical situation following previous Surgical view of maxillary defect following
sub- total maxillectomy. placement of four zygomatic oncology
implants via an intra-oral approach.

Butterworth CJ. Immediately Loaded Zygomatic Implant Retained Maxillary Obturator used in the Management of a
Patient following Total Maxillectomy. Int J Head Neck Surg 2018;9(2):94-100.
New obturator prosthesis and clinical situation 9 months
following implant placement.
3D PRINTED DEFENITIVE OBTURATOR
PROSTHESIS

Tasopoulos T, Kouveliotis G, Polyzois G, Karathanasi V. Fabrication of a 3D Printing Definitive Obturator

Prosthesis: a Clinical Report. Acta Stomatol Croat. 2017;51(1):53–58. doi:10.15644/asc51/1/7
A 3Dprinting anatomical An invested wax pattern of An intraoral application
model of defect a of the hollow bulb.
hollow bulb

The final impression with Duplication of the

Fabrication of a working
the silicone hollow bulb
cast
master cast and the
in situ. silicone obturator.
 Directrelining of the definite
3D printing obturator
Fabrication of the prosthesis with RTV soft
transparent acrylic lining materials.
denture base from 3D
PRINTING

A 5 year- follow up of the maxillary 3D printing obturator

prosthesis
 TROUBLE SHOOTING OF
OBTURATOR
• Complaints of the patients are mainly due to
continued fibrosis of tissues bordering the
prosthesis
• Nasal reflux: inadequate surface contact
• Relining
• Hypernasal speech : defficient closure of soft
palate and pharynx
• Addition of pharyngeal bulb that passses
superior to the edge of the soft palate and
extend into the larynx
 Conclusion

• As a prosthodontist our aim should be to render the best

service possible to the patient in regard to the restoration
and continuity of the defect to its most natural form
• Basic knowledge of the technique, materials is the basic
requirements for any rehabilitation procedure.
• Maxillofacial prostheses restore several types of orofacial
defects as well as improve the patient’s quality of life.
• It is an ancient treatment modality that has developed over
centuries. The current situation is promising, and there are
positive expectations for the future.
Referances
Aramany MA. Basic principles of obturator design for
partially edentulous patients. Part I: classification. J
Prosthet Dent 1978;40: 554-7.

2. Rahn AO, Goldman BC, Parr CR. Prosthodontic

principles in the surgical planning for maxillary and
mandibular resection patients. J Prosthet Dent
1979;42:429-33.

3. Brown KE. Peripheral considerations in improving

obturator retention. J Prosthet Dent 1968;20: 176-80.
4. Beumer J, Curtis TA, .Firtell DN. maxillofacial rehabilitation.
St. Louis Mosby; 1979. p. 188-243.

5, Aramanv MA. Basic principles of obturator design for

partially edentulous patients. Part II: design principles. J
Prosthet Dent 1978;40:656-62.

6. Firtell DN, Grisius RI. Retention of obturator removable

partial dentures: a comparison of buccal and lingual
retention. J Prosthet Dent 1980;43:212-7.
7. Desjardins RP. Obturator prosthesis design for acquired
maxillary defects. J Prosthet Dent 1978;39:424-32.

8. Fiebiger GE, Rahn AO, Lundquist DO, Moise PK. Movement

abutments by removable partial denture frameworks with a
hemimaxillectomy obturator. J Prosthet Dent 1975,34:555-
60.

9. Stewart KL, Rudd KD, Kuebker WA. Clinical removable

partial prosthodontics. St. Louis: Mosby; 1983. p. 663.
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