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A straightforward modification of an immediate surgical obturator bulb
A straightforward modification of an immediate surgical obturator bulb Preeda Wansook, BSa and Theerathavaj Srithavaj, BS, MS, DDSb Faculty of Dentistry, Mahidol University, Bangkok, Thailand This article introduces clinical and laboratory techniques designed to change a surgical obturator into a transitional obturator in a single visit. The technique describes the procedures for relining and readjusting the nonbulb portion without interference from the bulb portion of the obturator prosthesis. After maxillectomy and/or conjunctive treatments, wound healing and scar contracture of the surgical site may lead to a loss of retention in a surgical obturator,1 requiring frequent relining of the prosthesis. This procedure for modifying a surgical obturator saves time and is beneficial in that the nonbulb portion can be assessed, adjusted, and relined without the interference of the bulb portion of the prosthesis.
A
PROCEDURE 1. Obtain the surgical obturator. Remove any bulb portion or overextended regions and clinically evaluate the obturator (Fig. 1A). 2. Use baseplate wax (Cavex Modelling Wax T T 100; Carvex, Haarlem, Holland) and soft tissue conditioning material (Coe-Comfort; GC Corp, Tokyo, Japan) to record the defect anatomy (Fig. 1B). 3. Pour the impression with Type III dental stone (Lafarge Prestia; Meiel, France) (Fig. 2A). After the stone sets, remove the obturator. 4. Make a 5 mm deep index in the dental stone in the center of the de-
B 1 A, Clinical evaluation of obturator plate after removal of bulb portion and overextended areas. B, Details of defect recorded by using tissue conditioning material and wax index. fect area with a carbide bur (SS White Burs Inc, Lakewood, NJ). 5. Fill the entire defect area with heavy body silicone material (Silagum Putty; DMG Chemical Pharmaceutical Factory GmbH, Hamburg, Germany). 6. Remove excess and reduce the silicone by 5 mm on all sides (Fig. 2B). Replace the silicone in the indexed stone. Reconfirm the plate thickness.
7. Apply separating medium (Tinfoil substitute; Factor II Inc, Lakeside, Ariz). 8. Mix autopolymerizing clear polymethylmethacrylate resin (Orthojet; Lang Dental Mfg, Wheeling, W Va) and pour over the area created for the new obturator. 9. Place the upper half of the flask. Process, trim, and polish the prosthe-
Dental Technician, Maxillofacial Prosthetic Service. Assistant Professor, Maxillofacial Prosthetic Service.
a
b
(J Prosthet Dent 2012;108:200-201)
The Journal of Prosthetic Dentistry
Wansook and Srithavaj
201
September 2012
A
B
C
D
2 A, Obturator poured with dental stone in conventional denture flask. B, Five mm of space created between silicone index and defect area. C, Final modified prosthesis. D, Obturator inserted intraorally. sis (Fig. 2C). Evaluate the prosthesis intraorally, reduce overcompression areas, polish, and insert the prosthesis (Fig. 2D).
REFERENCE 1. Jacob RF. Clinical management of the edentulous maxillectomy patient. In: Taylor TD (editor). Clinical maxillofacial prosthetics. Chicago: Quintessence; 2000. p. 85-7.
Corresponding author: Dr Theeratavaj Srithavaj Maxillofacial Prosthetic Service 6th Yothi Street Rajathevee, Bangkok 10400 THAILAND Fax: +6623548491 E-mail: [email protected] Copyright © 2012 by the Editorial Council for The Journal of Prosthetic Dentistry.
Wansook and Srithavaj
A
PROCEDURE 1. Obtain the surgical obturator. Remove any bulb portion or overextended regions and clinically evaluate the obturator (Fig. 1A). 2. Use baseplate wax (Cavex Modelling Wax T T 100; Carvex, Haarlem, Holland) and soft tissue conditioning material (Coe-Comfort; GC Corp, Tokyo, Japan) to record the defect anatomy (Fig. 1B). 3. Pour the impression with Type III dental stone (Lafarge Prestia; Meiel, France) (Fig. 2A). After the stone sets, remove the obturator. 4. Make a 5 mm deep index in the dental stone in the center of the de-
B 1 A, Clinical evaluation of obturator plate after removal of bulb portion and overextended areas. B, Details of defect recorded by using tissue conditioning material and wax index. fect area with a carbide bur (SS White Burs Inc, Lakewood, NJ). 5. Fill the entire defect area with heavy body silicone material (Silagum Putty; DMG Chemical Pharmaceutical Factory GmbH, Hamburg, Germany). 6. Remove excess and reduce the silicone by 5 mm on all sides (Fig. 2B). Replace the silicone in the indexed stone. Reconfirm the plate thickness.
7. Apply separating medium (Tinfoil substitute; Factor II Inc, Lakeside, Ariz). 8. Mix autopolymerizing clear polymethylmethacrylate resin (Orthojet; Lang Dental Mfg, Wheeling, W Va) and pour over the area created for the new obturator. 9. Place the upper half of the flask. Process, trim, and polish the prosthe-
Dental Technician, Maxillofacial Prosthetic Service. Assistant Professor, Maxillofacial Prosthetic Service.
a
b
(J Prosthet Dent 2012;108:200-201)
The Journal of Prosthetic Dentistry
Wansook and Srithavaj
201
September 2012
A
B
C
D
2 A, Obturator poured with dental stone in conventional denture flask. B, Five mm of space created between silicone index and defect area. C, Final modified prosthesis. D, Obturator inserted intraorally. sis (Fig. 2C). Evaluate the prosthesis intraorally, reduce overcompression areas, polish, and insert the prosthesis (Fig. 2D).
REFERENCE 1. Jacob RF. Clinical management of the edentulous maxillectomy patient. In: Taylor TD (editor). Clinical maxillofacial prosthetics. Chicago: Quintessence; 2000. p. 85-7.
Corresponding author: Dr Theeratavaj Srithavaj Maxillofacial Prosthetic Service 6th Yothi Street Rajathevee, Bangkok 10400 THAILAND Fax: +6623548491 E-mail: [email protected] Copyright © 2012 by the Editorial Council for The Journal of Prosthetic Dentistry.
Wansook and Srithavaj