prosthecdesignofan* obturator*with*orthodon(c*retainer ... advance/journals/ympr/guzman.pdf ·...

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INTRODUCTION Since the pa3ent underwent hemimaxilectomy surgery 8 years ago because of an Ossifiying Fibroma 3 (Fig. 13), she has an Aramany class I osseal defect 3 (Fig. 4). Once the permanent den33on was complete, the pa3ent underwent orthodon3c treatment for compensa3ng the occlusion of the remaining teeth (Fig. 5, 6). AOer the orthodon3c treatment was concluded, it was necessary to place a retainer, which could not be enamelbonded because it would avoid the obturator to be placed in a passive way. As a result, it became necessary to develop an obturator who included the retainer. CASE REPORT The obturator was designed including a thick wire (0.40 in) for making the part of the retainer in the dentate arch (Fig. 7, 8), the thick of the wire was picked up aVending the durability and func3on needs of the obturator, since in this kind of pa3ents, it is complicated and painful to make an impression. In order to give an extra reten3on to the obturator, aOer the loop, the wire of the retainer was contoured following the ves3bular convexity of the posterior teeth. In the anterior segment, it was made like a conven3onal retainer. The obturator’s occlusion is in group func3on for providing stability in every movement of the mandible (Fig. 9, 10). This design will be useful un3l the pa3ent concludes her growing stage with a good prognosis in order to give the pa3ent the opportunity of having a normal life according to her age. DISCUSSION A bonded retainer should not be used in this case, that is why the idea of adding it to the obturator was the key, making the elabora3on challenging. This design is useful because it can be repeated and adapted to other oncologic pa3ents during the growing stage. AKNOWLEDGEMENTS The final result was successful once it achieved to combine an obturator with an orthodon3c retainer that gives the pa3ent back mas3catory func3on, phona3on and support to the soO 3ssues, while it maintains the teeth posi3on, allowing the pa3ent to be socially and familiarly accepted. (Fig. 11 – 14). Prosthe(c Design of an Obturator with Orthodon(c Retainer: A Case Report Rosa de M. GUZMÁN*, Norma E. GUZMÁN, Blanca E. ESTRADA Benemérita Universidad Autónoma de Puebla, Master Program in Oral Rehabilita(on. Puebla, México. [email protected] ABSTRACT An obturator was designed for restoring the edentulous hemimaxillar and retaining the natural teeth posi3on aOer orthodon3cs of a 15 year old female with leO hemimaxillectomy because of an Ossifying Fibroma 1,2 , who underwent orthodon3c treatment for achieving an appropriate occlusion of the remaining teeth. The final result was a successful obturator with orthodon3c retainer that gave the pa3ent back mas3catory func3on, phona3on and esthe3cs, and avoided movements of the already posi3oned teeth. REFERENCES: 1. Mintz, Sheldon, Velez, Ines; “Central ossifying fibroma: An analysis of 20 cases and review of the literature”; Quintessence Interna3onal; Mar2007, Vol. 38 Issue 3. Journal of Oral Rehabilita3on; 2005; No. 32. 2. R. Mesquita, S. Catanhede, M. Sousa, N. Soares; “Prolifera3ve ac3vity in peripheral ossifying fibroma and ossifying fibroma”; Journal of Oral Pathology & Medicine; 1998; Vol. 27. 3. Silvia Pérez García, Leonardo Berini Aytes, Cosme Gay Escoda; “Fibroma Osificante Maxilar: Presentación de un caso y revisión de la literatura”; Medicina Oral, Patología Oral, Cirugía Bucal ; 2004; Vol. 9; No. 4. 4. Roesch, R.L., Sierra, F.M., Estrada E.B.E., Fernández, T.R.; “Importancia clínica de un obturador Quirúrgico. Reporte de un caso”; Oral; Año 8, No. 24. 5. S. Koyama, K. Sasaki, T. Inai, M. Watanabe; “Effects of defect configura3on, size, and remaining teeth on mas3catory func3on in postmaxillectomy pa3ents”; Journal of Oral Rehabilita3on; 2005 Vol. 32. 6. Prosthe3c Rehabilita3on by Keith Thomas, P. 234242. Fig. 4 Fig. 6 Fig. 1 Fig. 2 Fig. 3 Fig. 5 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 7 Fig. 8

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INTRODUCTION  

Since   the   pa3ent   underwent   hemimaxilectomy   surgery   8   years   ago  because  of  an  Ossifiying  Fibroma3(Fig.  1-­‐3),  she  has  an  Aramany  class  I  osseal   defect3(Fig.   4).   Once   the   permanent   den33on  was   complete,  the   pa3ent   underwent   orthodon3c   treatment   for   compensa3ng   the  occlusion   of   the   remaining   teeth   (Fig.   5,   6).   AOer   the   orthodon3c  treatment  was  concluded,  it  was  necessary  to  place  a  retainer,  which  could  not  be  enamel-­‐bonded  because  it  would  avoid  the  obturator  to  be  placed  in  a  passive  way.  As  a  result,  it  became  necessary  to  develop  an  obturator  who  included  the  retainer.  

CASE  REPORT  

The  obturator  was  designed    including  a  thick  wire  (0.40  in)  for  making  the  part  of  the  retainer   in  the  dentate  arch  (Fig.  7,  8),  the  thick  of  the  wire  was  picked  up  aVending  the  durability  and   func3on  needs  of   the  obturator,  since  in  this  kind  of  pa3ents,  it  is  complicated  and  painful  to  make  an  impression.    

In  order  to  give  an  extra  reten3on  to  the  obturator,  aOer  the  loop,  the  wire  of  the  retainer  was  contoured  following  the  ves3bular  convexity  of  the   posterior   teeth.   In   the   anterior   segment,   it   was   made   like   a  conven3onal  retainer.  

The  obturator’s  occlusion   is   in  group   func3on   for  providing   stability   in  every    movement  of  the  mandible  (Fig.  9,  10).  

This  design  will  be  useful  un3l  the  pa3ent  concludes  her  growing  stage  with   a   good  prognosis   in   order   to   give   the  pa3ent   the  opportunity  of  having  a  normal  life  according  to  her  age.  

DISCUSSION  

A  bonded  retainer  should  not  be  used  in  this  case,  that  is  why  the  idea  of  adding   it   to   the   obturator   was   the   key,   making   the   elabora3on  challenging.  

This   design   is   useful   because   it   can  be   repeated   and   adapted   to   other  oncologic  pa3ents  during  the  growing  stage.    

AKNOWLEDGEMENTS  

The   final   result   was   successful   once   it   achieved   to   combine   an  obturator   with   an   orthodon3c   retainer   that   gives   the   pa3ent   back  mas3catory  func3on,  phona3on  and  support  to  the  soO  3ssues,  while  it  maintains  the  teeth  posi3on,  allowing  the  pa3ent  to  be  socially  and  familiarly  accepted.  (Fig.  11  –  14).  

Prosthe(c  Design  of  an  Obturator  with  Orthodon(c  Retainer:  A  Case  Report  Rosa  de  M.  GUZMÁN*,  Norma  E.  GUZMÁN,  Blanca  E.  ESTRADA  

Benemérita  Universidad  Autónoma  de  Puebla,  Master  Program  in  Oral  Rehabilita(on.  Puebla,  México.    

 [email protected]  ABSTRACT  

An  obturator  was  designed  for  restoring  the  edentulous  hemimaxillar  and  retaining  the  natural  teeth  posi3on  aOer  orthodon3cs  of  a  15  year  old   female   with   leO   hemimaxillectomy   because   of   an   Ossifying  Fibroma1,2,   who   underwent   orthodon3c   treatment   for   achieving   an  appropriate   occlusion   of   the   remaining   teeth.   The   final   result   was   a  successful   obturator   with   orthodon3c   retainer   that   gave   the   pa3ent  back   mas3catory   func3on,   phona3on   and   esthe3cs,   and   avoided  movements  of  the  already  posi3oned  teeth.  

REFERENCES:  1.  Mintz,  Sheldon,  Velez,  Ines;  “Central  ossifying  fibroma:  An  analysis  of  20  cases  and  review  of  the  literature”;  Quintessence  Interna3onal;  Mar2007,  Vol.  38  Issue  3.    

 Journal  of  Oral  Rehabilita3on;  2005;  No.  32.          2.  R.  Mesquita,  S.  Catanhede,  M.  Sousa,  N.  Soares;  “Prolifera3ve  ac3vity  in  peripheral  ossifying  fibroma  and  ossifying  fibroma”;  Journal  of  Oral  Pathology  &  Medicine;  1998;  Vol.  27.  3.  Silvia  Pérez  García,  Leonardo  Berini  Aytes,  Cosme  Gay  Escoda;  “Fibroma  Osificante  Maxilar:  Presentación  de  un  caso  y  revisión  de  la    literatura”;  Medicina  Oral,  Patología  Oral,  Cirugía  Bucal  ;  2004;  Vol.  9;  No.  4.  

4.  Roesch,  R.L.,  Sierra,  F.M.,  Estrada  E.B.E.,  Fernández,  T.R.;  “Importancia  clínica  de  un  obturador  Quirúrgico.  Reporte  de  un  caso”;    Oral;  Año  8,  No.  24.  5.  S.  Koyama,  K.  Sasaki,  T.  Inai,  M.  Watanabe;  “Effects  of  defect  configura3on,  size,  and  remaining  teeth  on  mas3catory  func3on  in  post-­‐maxillectomy  pa3ents”;    Journal  of  Oral  Rehabilita3on;  2005  Vol.  32.    6.  Prosthe3c  Rehabilita3on  by  Keith  Thomas,  P.  234-­‐242.  

     

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Fig.  1     Fig.  2    

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Fig.  9   Fig.  10  

Fig.  11   Fig.  12  

Fig.  13   Fig.  14  

Fig.  7   Fig.  8