Maxillofacial Obturator

A dental prosthesis achieved with the help of a palatal obturator solves the purpose of an oronasal fistula. The palatal obturators are temporary prosthetics used to repair soft or hard palate abnormalities that could impair speech output or induce nasal regurgitation while eating.

Palatal obturators help in speech therapy by addressing compensatory articulation resulting from the cleft palate, which is used to adjust for hypernasality. A palatal obturator with a detachable plastic roof of the mouth helps with speech, eating, and appropriate air movement, which it achieves by covering fistulas in the roof of the mouth that may form a nasal cavity.

Dental obturators have two benefits: they improve oral aesthetics while restoring normal speech.

A surgical technique called a maxillectomy/palatectomy removes all or a portion of the hard or soft palate. Speaking, chewing, and swallowing are all nearly difficult with the resulting deformity because of maxillary defect, and it also leaves it impossible to use typical denture appliances.

A maxillectomy/palatectomy prosthesis, often known as an “obturator,” corrects the surgical error and facilitates speech, chewing, and swallowing. It fills the gap caused by the surgery and restores missing tissues and teeth artificially.

The following are a few aspects of prosthodontic treatment-

hygiene maintenance and patient education/counseling; dietary counseling; physical therapy (oral and physical); and the creation of prosthodontic appliances.

Functions of an Obturator

The Obturator performs the following tasks:

1. An obturator can heal traumatic or post-surgical defects and clean the wound. 
2. It can also be used to reshape or repair the defect.
3. It can rectify lip and cheek posture and sometimes make speech possible.
4. Improve deglutition and mastication skills when there are impairments.
5. It lessens the exudate flow in the mouth

Obturators are typically fabricated and installed in three ways:

1. Immediate

It is possible to implant a prosthetic during surgery.

2. Transitional

After 10–14 days following surgery, the removal of any immediate prostheses or surgical bandages is done. Then, until complete healing, the transitional prosthesis is positioned and adjusted. This stage could last for two to 24 months.

3. Definitive

Fixed prostheses (crowns) and/or removable prostheses may be used in definitive therapy.

Prosthetic Rehabilitation

Patients undergoing head and neck cancer treatment may benefit from having their teeth replaced. To restore function and enhance aesthetics, prosthetic devices can replace hard and soft tissue. A maxillary obturator, a mandibular resection prosthesis, and/or a palatal augmentation prosthesis are a few examples of medically essential maxillofacial prostheses that may be supported or held by dental implants, the remaining edentulous alveolus, or natural teeth in some circumstances. Before creating a plan for prosthetic rehabilitation, it is important to assess the general health of the mouth. The prosthesis should then be carefully created and cared for to reduce mucosal stress and irritation while maximizing speaking, chewing, and swallowing functions. Such prosthetic therapy can improve nutrition and restore a sense of normalcy while restoring both shape and function.

Obturator Types

Surgical, interim, and final obturators are the three types of obturators that are available. The placement of a surgical obturator requires surgery, and this obturator is intended to restore the missing structural elements of the maxillary arch, such as the plates and associated dentoalveolar tissues.

After the initial postoperative healing time, the Interim Obturator is a substitute for the Surgical Obturator. The prosthesis is subjected to numerous changes throughout this stage. In addition, prosthetic teeth are commonly inserted to improve oral functions and support nutrient intake.

To maximize oral functioning potential, definitive obturators include replacing the functional teeth. In addition, the phase can shape the visual structure and appearance.

Interim Obturators

A surgical obturator is made using the methodology of fabricating an immediate prosthesis by taking initial impressions and altering the cast as directed by the head and neck surgeon as to the planned resection for cancers of the maxilla, hard, and occasionally soft palate when immediate microvascular free-flap reconstruction is not indicated. The surgical obturator can be wired to the remaining teeth or wrought-wire clasping devices, depending on the degree of the resection.

Throughout the first stage of healing, interim obturators are worn. Radiation therapy, chemotherapy, and a person’s capacity for healing influence interim obturators and healing duration. The interim obturator will be repeatedly changed throughout the healing process to account for tissue changes. When healing has stabilized after 6 to 12 months, an assessment is done to determine whether a definitive prosthesis should be created.

Definitive Maxillary Obturators

Definitive maxillary obturators are made using a traditional removable prosthodontic technique. Casts for diagnostic purposes are initially imprinted. On the diagnostic cast, a framework design is planned using the remaining teeth for retention and stability of the prosthesis if the residual dentition is sufficient for supporting a removable partial denture obturator prosthesis. Additionally, retainer bars and plates will be made to cover as much surface area as possible.

The complete denture obturator prosthesis is made using the same techniques as traditional complete denture prostheses, except that a distinct design must be impressed onto the obturator bulb.

Initial impressions are created using gauze to block off the resection area and then an alginate impression. On the initial cast, a unique tray is made. A robust substance that will capture the resection area but is viscous enough to prevent leakage into undesirable areas should be used to make a definitive impression on the bespoke tray after it has been border molded. Next, the master cast in Type IV dental stone will be poured using this impression. After that, the master cast will be used to create the occlusal rims. During the records visit, the occlusal rim will be used to record the midline, the vertical dimension of occlusion, the anterior teeth line parallel to the interpupillary line, and the occlusal line parallels to the ala tragus line.

Global Over-view

The obturator has helped people with maxillary abnormalities to regain masticatory function and enhance their speech and attractiveness. The obturator’s primary function is to repair palate abnormalities left over during maxillectomy while enhancing the patients’ aesthetic appeal, comfort, and function. In a study published in the National Journal of Maxillofacial Surgery 2020, maxillectomy defects were found to be more common in men (81.81%) than in women (18.18%), with a left-sided prevalence of 68.18% and a right-sided prevalence of 31.81%. Additionally, growing older is a factor that is linked to worsening health and an increased risk of developing cancer.

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