The most challenging and appreciated area in the field of Prosthodontics is the rehabilitation of maxillary defects. Tumors of the head and neck are the common cause for acquired maxillofacial defects. Surgical consequences predispose the patient to hypernasal speech, fluid leakage into nasal cavity, impaired masticatory function, and cosmetic deformity. The Prosthodontists play a significant role in the intervention and improve the quality of life of such patients. The current article describes two clinical case reports of completely edentulous patients with acquired maxillary defects.
Restoration of acquired maxillary defect with an obturator prosthesis is a well evident approach in rehabilitation of maxillofacial defects. 1 Obturator therapy enhances the phonetics, aesthetics, swallowing and mastication, and occludes the oral and nasal cavity, thereby escalating the quality of life of patients. 2 Intraoral scenario of a maxillectomy state is much incomparable to that of a normal partial edentulous situation. 3 The prosthesis has to depend principally on the remaining hard and soft tissues for retention, stability and support. Nevertheless, a heterogeneous pattern of force gets transmitted when the patient performs any oral function. Altogether, more dislodging and rotational force get activated when the defect is huge and normal residual structures are less. 4,5 The size and configuration of the maxillectomy defect is one of the significant factors determining the prognosis of treatment.Lightweight hollow prostheses are fabricated when the defect size is large in order to improve the retention, stability, speech resonance and comfort of the patients. 6 A definitive closed hollow bulb obturator is the preferred mode of therapy proximately 6 months after
Aim:The aim of the study was to evaluate the osseo-integration and soft tissue status of the endosseous implants placed in immediate extraction socket.Methodology:Seven patients (4 males and 3 females) aged 20-30 years were selected for the study. Nine implants were placed in seven patients in the maxillary arch. All the patients were clinically αnd thoroughly examined. Under local anesthesia, the indicated tooth was extracted. The extracted socket was prepared using standard drills with palatal wall as guide. The longest and widest implants were placed (Hi-Tec Implants). All implants showed good primary stability. The implants used in the study were tapered design endosseous implants with Threaded implants (TI) unit plasma-sprayed surface. Surgical re-entry (secondary surgery) was performed to remove the healing cap after 6 months for supra crestal fabrication. All patients were reviewed periodically at 3rd and 6th month interval and the following clinical parameters including modified plaque index (mPlI), modified bleeding index (mBI), probing depth (PD), attachment level (AL), and distance between the implant shoulder and mucosal margin (DIM), distance between the implant shoulder and first bone-implant contact, and Clinical Mobility Index were recorded. The results were computed and subjected to statistical evaluation.Results:The mPlI, mBI, PD, AL, and DIM were evaluated around the implants at baseline, 3rd and 6th month intervals and analyzed statistically by Friedman T-test. The results of the above were shown to be statistically non-significant. The distance between the implant shoulder and first bone implant contact was evaluated around the implants at base line, 3rd and 6th month intervals. The results proved to be statistically significant (0.01) implying that there was a bone apposition around the implants.Conclusion:During the course of the study, soft tissue status around implants was found to be healthy. Osseointegration as assessed by clinical and radiographic findings was found to be sound.
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