Prosthetic rehabilitation of a maxillary defect caused by am
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A 40-year-old male patient, reported with an ulcerative growth on right maxilla. The CT scan revealed an expansile soft-tissue lesion arising in the right maxilla, causing thinning and erosion of the cortex with extension into the soft-tissue plane. The lesion showed minimal heterogeneous enhancement. Medially, the mass was extending into the osteomeatal complex and the right nasal cavity, causing deviation of the nasal septum toward the left. The mass was causing erosion of the hard palate and the medial wall of the maxillary sinus. The fat plane between the mass and the inferior turbinate was also lost. The fat plane between the mass and the surrounding muscles was maintained. The case was diagnosed as plexiform ameloblastoma after histopathological investigation.

A clear acrylic surgical obturator was fabricated. Surgical procedure was carried out, and 24 and 25 root stumps were also extracted along with the lesion. An immediate obturator was inserted after carrying out the necessary adjustments, and instructions were given to the patient. The relining of the obturator was done with soft liners, and necessary modifications were done at each regular interval. Satisfactory healing of the soft tissues took place. After 6 months, a definitive prosthesis was planned. A definitive prosthesis was planned with a cast metal framework as the defect resembled more near to Class 1 linear type of design according to the Aramany's classification. As per the linear design, RPI (R=Rest, P=Proximal Plate, I=I bar clasp) concept applied on 23 regions. The retentive arms and bracing arms are placed on the palatal and buccal surfaces of the 26 and 27 respectively. The occlusal rest on the distal of 26, mesial of 27 was planned. A primary impression with alginate was made and the cast was poured. A custom tray was fabricated on this cast for medium body impression. Mouth preparation was carried out as per the framework design, guide plane on the distal of 23, rests on 26 and 27, and cingulum rest on 23.

A sectional impression technique was followed to record the defect with putty addition silicone. Once the defect was recorded, the medium body impression was made with the custom tray. Closed bulb obturator was planned as per the Habib technique. The lid portion was packed first with heat-cured acrylic resin, a piece of tinfoil was placed over this portion, and the rest of the defect was packed and processed. The processed obturator was retrieved and the lid was separated along with the tin foil. The bulb was hollowed out from within an acrylic trimming bur, and the lid was sealed with self-cure acrylic resin. The finished final prosthesis was delivered to the patient with appropriate instructions. Acquired palatal defects may cause major difficulties with speech, swallowing, and mastication. In turn, these functional problems may affect the quality of life of patients. The patient reported improvements in prosthesis retention and stability after definitive prosthesis compared to the performance of the immediate obturator, and his masticatory and speech functions, and esthetics particularly the midface, improved. During the follow-up, soft debris was observed; as the patient was too anxious on the maintenance of oral hygiene, he was instructed for proper oral hygiene maintenance and the use of denture cleanser to avoid stains on the prosthesis.

Source: http://www.contempclindent.org/article.asp?issn=0976-237X;year=2020;volume=11;issue=1;spage=87;epage=90;aulast=Shivakumar
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