2. Palatal Obturators Scott Culpepper, DDS Kings County Hospital

4.  Surgical resection, as in SCCa  Used in cleft lip and palate cases  Traumatic injury to the palate

5.  Function o Used in speech o Prevent nasal regurgitation that occurs during feeding o Often used as a therapy for cleft lip and palate, or for treatment of resected neoplasms. o Includes any missing teeth to provide occlusion and esthetics

6. o In some cases, a palatal obturator can be gradually downsized, so that tissues can gradually strengthen over time and compensate for the decreasing size of the obturator. o They can be simple or complex, and reflect a whole area of practice. o May involve o Dentists, Oral Surgeons o Plastic surgeons o Oral & Maxillofacial Prosthodontists o Speech therapists o Oncologists

7. o Palatal plate (most common)

9.  Placed by plastic surgeons, for babies with complete clefts of lip and palate.  Surgical placement, designed to bring two pieces of cleft palate together and to make lip repair easier

12.  Ideally, obturator is planned prior to surgery, or consistent with planned closure of cleft lip and palate.  Depends of extent of surgery, and subsequent surgeries  Eventual closure of fistula?  Additional resection of carcinoma?

13.  Modification Obturator: very short term, used for immediate blockage and seal of fistula. May be made chairside.

14. Interim Obturator: used when no further surgical procedures are planned. Great part of surgical treatment planning.  Preoperative impressions, bite registrations and tooth set-up.  Placed and relined in the OR, for immediate use post- operatively.  Requires constant revision as tissues heal.

16.  Male pt, complaining of existing obturator that does not fit.  Ca treatments, still ongoing, tissues are continuously changing and Ca is probably out of control at this point.  Pt. did not receive radiation b/c proximity to brain, surgical resections have also stopped at this point.  How do you get retention?

23.  An oral and maxillofacial prosthodontist  Presurgical treatment planning, there appeared to have been some in this case  Prosthesis would ultimately have 2 parts that lock together: extraoral+intraoral  Retentively engaging all involved tissues makes a heavy prosthesis, and seems uncomfortable for pt.  Is there another way?

24.  Definitive Obturator  Used when surgical rehabilitation is not possible.  Long-term use after tissues have fully healed and matured.  May also be implant supported

28.  This was an appropriate case  Isolated defect  No further surgery planned  Mature and healthy tissues  Not a far stretch from conventional dental prosthesis  Retention is mostly gained from the fistula or defect itself, rather than by conventional means

29.  Etiquette: If you’re conversing w/a patient, make sure they have old obturator in, so they can answer you….. Get all concerns, complaints, questions up front.  Sell implants: Conventional prosthesis may not have enough retention. Understand that from the start.  Prepare the patient:  Estimated number of appts.  Some discomfort, irritation while working to record the tissues of the fistula. Gagging, sneezing.

30.  Stock tray w/adhesive, lots of alginate  Additional alginate to add to fistula  Record opposing dentition if any  Mark Midline, lab may not be able to tell  Order custom tray

31.  Border molding  Master impression, can also be multi-phase  This is the hardest for the patient  Order an occlusal rim on a record base where fistula tissues have been blocked out  You need to try in rims several times, no need to engage fistula every time during this phase

32.  Make the record base so you can try it in repeatedly w/o trauma.  Establish VDO, check phonetics, occlusal plane, etc.  Tooth selection, wax try-in etc.

33.  Need time.  Most adjustment is in area of fistula.  Go easy with try-ins, often the patient is better at placing it than we are.  Final polish.  Implant retention is always an option, even after delivery.