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EFFICIENCY OF PROSTHETIC TREATMENT WITHPOST RESECTION PROSTHESES WITH SOLIDSUBSTITUTE PART

Ivan Gerdzhikov1, Mariana Dimova2, Tihomir Georgiev3

1) Department of Prosthetic dentistry, Faculty of Dental Medicine, MedicalUniversity -Sofia, Bulgaria2) Department of Prosthetic dentistry, Faculty of Dental Medicine, MedicalUniversity-Sofia, Bulgaria3) Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine,Medical University-Varna, Bulgaria

Journal of IMAB - Annual Proceeding (Scientific Papers) 2016, vol. 22, issue 3Journal of IMABISSN: 1312-773Xhttp://www.journal-imab-bg.org

ABSTRACTAim: The aim of this study is to track the effective-

ness of prosthetic treatment with post resection dentureswith solid substitute part and their role in the restorationof damaged functions.

Materials and methods: The study included 14 pa-tients (9 men and 5 women) with different size and loca-tion of defects in the upper jaw treated in the period 2010-2016 with post resection prostheses with a solid substitutepart.

The impressions were taken with irreversible hydro-colloid impression material. The prostheses were com-pleted by heat-curing acrylic with low quantity residualmonomer.

The effectiveness of prosthetics was evaluated bythe method of Mihaylov for both oral-nasal examinationof the pressure with the device “Oronasopneumotest.”

For objectifying and assess the occlusal-articulationratios was held computerized occlusal analysis with the sys-tem T-SCAN 8.

Results: The results showed successful obturationand sealing of defects in all patients.

It was found satisfactory recovery of the speakingfunction and normalization of occlusal-articulation ratios.

Conclusion: The prosthetic treatment with post re-section prostheses with a solid substitute part allows suc-cessful recovery of the lost speech and chewing functions,helping to restore self esteem and social rehabilitation ofpatients.

Key words: palatal defects, maxillary resection, ob-turator, post resection prostheses.

Damage in the maxillofacial area, occurring aftermaxillary resection, inflicts serious aesthetical changes,mental problems and functional disabilities in respect ofimpaired mastication, swallowing, speech and breathing [1,2]. A common opinion [3, 4, 5, 6] is that the degree of func-tional damage depends on the size and location of the de-fect. This is also confirmed by a research of Usui et al. [7, 8],

who discovered lesser functional impairment in patientswith smaller defects, a greater number of intact teeth andmouth opening greater than 20mm. Analogous is Devlin etBarker [9] position, who found that the localization of thedefect, it’s size, and the condition of the remaining denti-tion are crucial for determining the degree of functionaldamage and for the prognosis the treatment.

Prosthetic methods of treatment are of prime impor-tance in complex treatment and rehabilitation in patientswith maxillary resection (10, 11). According to the volumeof the maxillofacial area engaged, treatment has its specif-ics, with respect to the degree of disability [12].

Scientific literature describes a multitude of methodsand modifications for treatment of patients with maxillaryresection [13, 14, 15]. Some of these advocate treatmentwith closed obturators and others prefer hollow bulbobturators [16, 17]. Whatever the clinical approach, the mainpoint of the treatment is to restore the masticatory function[18, 19]. For its improvement and for heightening of themasticatory function Umino et al. [20] suggest restoring ofthe occlusal contacts of first and second molars. Throughvideofluoroscopic analysis Yonthcev et al. [5] visualize theleading role of these molars in the masticatory cycle alongwith the negligible contribution of incisors and the teeth onthe side of the defect. In a similar research before and afterprosthetic treatment of patients with single-sided defectsXing et al. [21] found a 59,98% raise in masticatory effec-tiveness one month after the end of treatment. Similar re-sults were obtained by Vergo et Chapman [4], who improvenutrition by distributing the masticatory stress.

MATERIALS AND METHODSWith the method applied, a prosthetic rehabilitation

of 14 patients (9 men and 5 women) with oncologic opera-tions of the maxilla, treated between 2011 and 2016 withclosed post resection prostheses was carried out. The pas-sageway defects which occurred, were unilateral and en-gaged only the hard palate and the alveolar crest, with thenatural teeth preserved (Fig. 1).

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Fig. 1. Intraoral view of a patient with unilateral max-illary defect.

The prosthetic rehabilitation was carried out in 4clinical stages. In the first one we took impressions of bothjaws with irreversible hydrocolloid impression material andto avoid it’s free entry we tamponed the defects with gauze.In the second clinical stage we determined the vertical di-mension of occlusion and fixed the centric position withwax rims and light curing baseplates. After a successful clini-cal trial of the teeth in wax, the prostheses were finished inheat curing acrylic plastic with a low level of residualmonomer. The cleaned and polished closed obturators withsolid substitute part (Fig. 2a) were adjusted and articulatedin the last clinical stage (Fig. 2b).

Fig. 2. Closed obturator with solid substitute part (a),adjusted in the patient’s mouth (b).

Through Mihailov’s method of simultaneous oral andnasal cavity pressure measuring, we checked the effective-ness of the reached hermetization with the“Oronasopneumotest” gauge (Fig. 3) With one of the ductsthe air pressure in the mouth was gauged by the oral lightindicator and the other was fixed to the patient’s nostrils bya dough consistency silicone mass to affect the nasal lightindicator. With each of the patients a triple examination wasconducted, where a flashing of the respective indicator readpresence or lack of hermetization between the oral and thenasal cavity.

Fig. 3. “Oronasopneumotest” gauge

To objectify the obtained occlusal reflections, a com-puterized occlusal analysis with the T-SCAN 8 system wasconducted.

RESULTSThe obtained results indicated an optimal degree of

hermetization in all treated patients. The “Oronasopneumo-test” examination found a successfully created barrier be-tween the oral and nasal cavity. The achieved effectivenesswas a result of the implemented treatment method in whichforming of a closed substitute part provided good retentionand sufficient stability of the prostheses. Vital for the goodclinical results were the comparatively small diameter and

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the unilateral location of the defects, as well as the presenceof natural teeth.

Hermetization of postresection defects gave the op-portunity to normalize the speech, mastication and swal-lowing in all of the patients. To the extent possible, occlu-sal relations were restored and documented by a computer-ized occlusion analysis with the T-SCAN 8 system (Fig. 4).The effect of the conducted prosthetic rehabilitation wasrestored self-confidence and social activity of the patients.

Fig. 4. Computerized occlusal analysis with the T-SCAN 8 system

support, but also to relieve pain and result in ease of use[11]. One of the most crucial parts in the application of ob-turator prostheses is retention. [4]. The volume and con-figuration of the defect, positioning of the remaining softand hard tissues, and weight of the prosthesis are the ma-jor factors influencing the retention and stability of theprosthesis [8, 9].

In literature there is a multitude of methods for pro-duction of obturators, in which different materials and tech-niques are used [15]. Most authors recommend treatmentwith hollow bulb obturators, which reduces the volume andweight of the prostheses and aids their placement in thedefect. Their main disadvantages have to do with worsenedhygiene and risk of developing a bacterial infection. Toovercome this, we applied prosthetic treatment with postresection prostheses with solid substitute part. The obtainedresults indicated good retention and stability of the pros-theses, which ensured optimal hermetisation of the defects.The positive results were due to the comparatively smalldefects, taking up only the hard palate and the alveolarcrest, with remaining natural teeth of the upper jaw. Theapplied prosthetic treatment confirmed the statement, thatpost resection prostheses ensure the successful restorationof speech and masticatory function. The computerized oc-clusal analysis with the T-SCAN 8 system indicated nor-mal occluso-articulatory relations and confirmed the state-ment of Vergo et Chapman [4], that the even distributionof masticatory pressure significantly improves nutrition.

CONCLUSIONSThe most challenging part in rehabilitating the pa-

tient with maxillectomy is achieving adequate retentionand stability of the prosthesis. The prosthetic treatmentwith post resection prostheses with a solid substitute partallows successful recovery of the lost speech and chewingfunctions, helping to restore self esteem and social reha-bilitation of patients.

DISCUSSIONProsthetic treatment with post resection prostheses

is the most commonly used treatment method in patientswith maxillary resection [1, 2, 3]. Well-designed post re-section prostheses for maxillary defects were applied notonly to maintain durable and good retention, stability, and

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Address for correspondence:Dr. Ivan GerdzhikovDepartment of Prosthetic dentistry, Faculty of Dental Medicine, MedicalUniversity - Sofia1, St. George Sofiyski blvd., 1431 Sofia, Bulgaria.E-mail: ivan_ger1971@abv.bg

Please cite this article as: Gerdzhikov I, Dimova M, Georgiev T. Efficiency of prosthetic treatment with post resectionprostheses with solid substitute part. J of IMAB. 2016 Jul-Sep;22(3):1265-1268.DOI: http://dx.doi.org/10.5272/jimab.2016223.1265

Received: 21/05/2016; Published online: 12/08/2016