OBTURATOR

S
Assignment 1 . Removable prosthesis
Name : Fatima Wael Mahmoud
Id:5882
 INTRODUCTION
• 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

USES OF OBTURATORS

Provides a stable matrix for surgical packing

Reduces oral contamination
Speech is effective post-operatively
Permits deglutition
Reduces the psychological impact of surgery
Reduce the period of hospitalization
LIMITATIONS OF OBTURATORS
• Require insertion and removal
• Have to redo periodically due to growth
• Can be lost or damaged
• May be very uncomfortable
• Compliance is often poor
• Do not permanently correct the problem
• Many centers use only if surgery is not possible
 DESIGN OF PROSTHESIS
• Must apply the basic principles of support, retention and stability so as
to minimize the stress generated to the structures of the mouth.
• The location of the fulcrum line, retentive undercuts and potential for
indirect retention will be important factors in determining the prognosis.
• In general, the prosthesis will have a fulcrum line near the defect area.

If natural teeth or implants are present to

provide retention and support for the
prosthesis, the fulcrum line will pass between
the most posterior occlusal rests on each side
of the arch.
Retentive clasps placed into undercuts
adjacent to the defect will resist the downward
displacement of the prosthesis due to the
effects of gravity.
• Occlusal rests on the opposite side of the fulcrum
line from the defect will act as indirect retainers.
Long guide planes on the natural teeth will also
assist in prevention of rotational dislodgment of the
prosthesis.
 TYPES OF OBTURATORS
1) Based on phase of treatment :-
o Surgical obturators (immediate surgical obturators & delayed surgical
obturators)
o Interim obturators
o Definitive obturators

2) Based on the material used :-

o Metal obturators
o Resin obturators
o Silicone obturators
3) Based on area of restoration :-
o Palatal obturator
o Meatal obturators
Obturator on basis of phase of treatment

SURGICAL OBTURATOR
• 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
 CLINICAL CONSIDERATIONS
• 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 wound.
 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

DEFINITIVE OBTURATOR
A prosthesis that artificially replaces part or all
of the maxilla & the associated teeth lost due
to surgery or trauma :-GPT
Obturator on basis of area of restoration

PALATAL OBTURATOR
•Closes or occludes
opening caused by cleft
or fistula
•Used to facilitate
separation of oral &
nasal cavities for speech,
feeding, & swallowing &
hypernasality
PALATAL OBTURATORS
FABRICATION OF OBTURATOR
• Diagnosis & treatment planning – it is to determine the size,location &
extent of the obturator.
• Preliminary impression using alginate – care should be taken to record
the undercuts.The junction of graft & mucosa should be properly
recorded,as it is an important retentive feature.
• Fabrication of custom tray
PATIENT WITH ACQUIRED
PALATAL DEFECT

PRIMARY CAST
ARAMANY’s CLASS IV SECONDARY IMPRESSION
DESIGN
• Border moulding – the velo-pharyngeal extension can be recorded by asking
the patient to swallow.
• Final impression with elastic impression material – it can be made using
alginate or elastomeric impression materials.The tray should be positioned
properly & scar band area must be accurately reproduced.The elastic recoil or
purse string action seen in scar band tissues is responsible for retention of
obturator.If scar band is not effective,implants can be placed to improve
retention.
 TEETH ARRANGEMENT IN
METAL FRAME-WORK WITH WAX ARTICULATOR AFTER FACEBOW
OCCLUSAL RIM
TRANSFER
•Jaw relation – it is very challenging to record
the jaw relation for these patients.Acrylic
denture bases are preferred because it is
difficult to position other denture bases.
•Teeth arrangement – it should be done such
that balanced occlusion is obtained.
•Insertion & post-insertional management
AFTER WAX BOIL OUT

THE DEFECT FILLED WITH TABLE SALT

& PACKED WITH HEAT CURE RESIN
AFTER PROCESSING,THE SALT IS POURED OUT
TO OBTAIN A HOLLOW BULB OBTURATOR
 MEATAL OBTURATOR
• It is special type of obturator that extends up to nasal meatus.
• It establishes closure with nasal structures at a level posterior &
superior to posterior border of hard palate.
• The closure is established against the conchae & roof of nasal cavity.
• It separates oral & nasal cavities.
• Indicated in patients with extensive soft palate defects.
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.

PALATAL LIFT PROSTHESIS

• It is a special type of obturator,which is a definitive prosthesis with a
posterior extension.
• It is helpful in restoring palato-pharyngeal incompetence where soft
tissue musculature is compromised. e.g. myasthenia gravis,bulbar
poliomylitis & cerebral palsy.
• It is clubbed with obturator if needed.
ADVANTAGES OF PALATAL LIFT PROSTHESIS

• Minimized gag response

• Tongue physiology,swallowing, mastication & speech are not compromised
• Access to the nasopharynx for the obturator is facilitated
• The palatal lift portion can be added later as desired.

CONTRAINDICATIONS FOR PALATAL LIFT PROSTHESIS

• If adequate retention is not available for the basic prosthesis

• If the palate is not displaceable
• Un-cooperative patients
 REFERENCES
• Sheldon Winkler, Essentials of complete denture prosthodontics (2nd
edition)
• Stewart,Rudd,Kuebker, Clinical removable partial prosthodontics (2nd
edition)
• Nallaswamy, Textbook of prosthodontics (1st edition) chapter 36