Subtotal Maxillectomy Case Report

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PRECISION ATTACHMENTS: AN EFFICIENT WAY TO ESTHETICALLY MEET THE MAXILLOFACIAL CHALLENGE- A CASE REPORT Abstract: Prosthetic rehabilitation with an obturator for a total or subtotal maxillectomy patient is a challenging task, as there is minimal or no residual maxillary structures to provide support, retention, and stability to the prosthesis. This clinical report describes the prosthodontic management of a patient who underwent hemimaxillectomy due to ameloblastic fibroma, with the use of precision attachments, compensating for the lost retention and support. This technique utilizes the natural teeth remaining, for support, stability and retention of the prosthesis in a more efficient way. This technique could provide efficient function and…show more content…
Past dental history revealed gradually enlarging painless swelling in the hard palate region on the right side noticed before 18 months. Later on she was diagnosed as a case of ameloblastic fibroma and subtotal maxillectomy of right side was performed 15 months back. Extraoral examination revealed gross asymmetry of the face due to mid facial defect on the right side and upward deviation of the lip line towards the right side producing an unesthetic appearance. Intraoral examination revealed an Aramany class I defect on the right side involving the entire alveolar process and hard palate on the right side and part of soft palate. 13 As a prosthetic protocol, immediate surgical obturator & an interim obturator was fabricated and inserted. For definitive obturator study casts were obtained, surveyed & diagnostic mounting done and a definitive obturator was planned. The treatment options were explained to the patient and an attachment retained cast obturator prosthesis was planned. The other options included a cast clasp retained obturator prosthesis with gingivally approaching clasp on tooth 21 and wire clasp retained acrylic hollow bulb obturator…show more content…
Ambrose Pare was the first one to have documented and illustrated the fabrication of the first obturator prosthesis in 1530 A.D. innumerable advances followed in the field with the noteworthy contributions of Fauchard, , Suersen and Ackerman, however, a classification system for maxillofacial defects was not published till 1978. 14 Dr. Mohammed Aramany 1st published a classification system14 for maxillofacial defects. Based on different combinations of remaining teeth and surgical defects, he classified the defects in 6 categories. On the basis of this classification a primary obturator framework design could be laid down which were clinically and scientifically acceptable, on the basis of these categories. The present case was a class I aramany’s defect. The framework design for a class I defect requires rest on the most anterior abutment and a mesio occlusal rest on the most posterior tooth along with a disto occlusal rest on the adjacent posterior tooth to prevent drifiting and periodontal damage of the most posterior tooth. Retention is aichieved with the help of direct retainers in the form of I bar clasp on the most anterior teeth, and embrasure clasps on premolars and molars. Indirect retainers are placed perpendicular to the fulcrum line running between the most anterior and most posterior abutments, which is usually the canine or the premolar

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