The use of cone beam computed tomography and three dimensional printing technology in the restoration of a maxillectomy patient using a dental implant retained obturator

Abstract

This case report presents an alternative method for fabricating an obturator for patients that develop xerostomia and mild trismus following radiation to the Head and Neck region. Multiple initial impression stages are avoided leading to less irritation to soft tissues and less discomfort to the patient. A 69-year-old male patient was referred to our dental practice by the Maxillofacial Surgery Department of the local General Hospital. The patient had undergone a right maxillectomy for removal of a Squamous Cell Carcinoma 2 weeks prior. Four endosseous dental implants were placed in the remaining upper jaw and 2 implants were inserted into the canine region of his edentulous mandible 3 weeks after ablative surgery. Five months following completion of radiotherapy and chemotherapy, a cone beam computed tomography of the maxilla was obtained, and a three dimensional model was constructed using an appropriate resin. Using the model as the detailed primary cast, a custom acrylic special tray was fabricated for the final impression of the remaining maxilla and the maxillary defect. An implant retained maxillary obturator and an implant retained mandibular overdenture were constructed to restore patient's speech, mastication and deglutition. The method presented here can limit the impression stages needed for construction of a maxillary obturator prosthesis to a single impression procedure advocating a partial digital workflow process. This can be very beneficial to the patient suffering from postradiation side-effects such as trismus, mucositis, and xerostomia.

Reconstruction of Orbital Walls With 3D Printed Patient Specific Implant Using PEEK: A Case Report

“…Most distinctly, PEEK has shown an evidence-based success in managing disk diseases of the cervical vertebrae. In addition, PEEK has been constituted as a surrogate for autogenous bone grafts in different vertebral problems [11][12][13]. Moreover, in order to achieve an accurate restoration of the defect, the dimensions should be measured with an accurate method.…”

A modified technique for fabrication of custom-made afterload brachytherapy appliance

“…Cone beam computed tomography has now replaced the standard computed tomography (CT) in imaging and planning craniofacial defect reconstruction, and measurements were very accurate as compared to physical measurements. [12] But still, standard external beam radiation therapy is based on the assessment of target volumes to irradiate and organs at risk to protect in 3D-CT simulation plus multimodal images (e.g., positron emission tomography/CT, magnetic resonance imaging). [3] Brachytherapy is applied through carriers.…”

Rehabilitation of a maxillectomy patient using intraoral scanning impression technology and a computer-aided design/computer-aided manufacturing fabricated obturator prosthesis: A clinical report

“…In recent years, the shift from analog to digital impression taking has also been implemented into maxillofacial rehabilitation of oncology patients. [111213] The combined use of cone beam computed tomography and three-dimensional (3D) printing has led to a reduction in the number of impression appointments needed for the construction of an obturator prosthesis. [11] The accuracy of this technique compared to traditional impression procedures has been investigated with favorable results.…”

“…[111213] The combined use of cone beam computed tomography and three-dimensional (3D) printing has led to a reduction in the number of impression appointments needed for the construction of an obturator prosthesis. [11] The accuracy of this technique compared to traditional impression procedures has been investigated with favorable results. [12] Intraoral digital impression techniques have gained in popularity, and their use in fixed and removable prosthodontics has increased.…”