Journal of Dental Rehabilitation and Applied Science (구강회복응용과학지)

Korean Academy of Stomatognathic Function and Occlusion (대한턱관절교합학회)
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Prosthetic rehabilitation by obturator considering the biomechanics in partially edentulous patient after maxillectomy

상악골 절제술을 받은 부분 무치악 환자에서 생역학을 고려해 제작한 구개 폐색장치를 이용한 보철 수복 증례

  • Lee, Kang-Shin (Department of Prosthodontics, School of Dentistry and Institute of Oral Bio-Science, Jeonbuk National University) ;
  • Park, Ju-Mi (Department of Prosthodontics, School of Dentistry and Institute of Oral Bio-Science, Jeonbuk National University) ;
  • Ahn, Seung-Geun (Department of Prosthodontics, School of Dentistry and Institute of Oral Bio-Science, Jeonbuk National University) ;
  • Seo, Jae-Min (Department of Prosthodontics, School of Dentistry and Institute of Oral Bio-Science, Jeonbuk National University) ;
  • Park, Yeon-Hee (Department of Prosthodontics, School of Dentistry and Institute of Oral Bio-Science, Jeonbuk National University) ;
  • Lee, Jung-Jin (Department of Prosthodontics, School of Dentistry and Institute of Oral Bio-Science, Jeonbuk National University)
  • 이강신 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 박주미 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 안승근 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 서재민 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 박연희 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 이정진 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소)
  • Received : 2021.11.24
  • Accepted : 2021.12.14
  • Published : 2021.12.31
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Abstract

Patients who went through maxillectomy can have severely impaired swallowing, mastication, and pronunciation functions because of palatal defects. Leakage occurs through the nasal cavity while eating, chewing becomes difficult due to the loss of teeth and alveolar ridges, and oral and nasal passages are not separated, leading to hyper-nasal sound, and significantly reducing the quality of life. To prosthetically reconstruct the defect, the weight of the obturator should be reduced as much as possible to minimize dropout because of gravity, and the bulb of the obturator should be properly extended into the defect to get additional retention and stability. In this case of a partially edentulous patient who underwent additional maxillary resection because of tumor recurrence, a metal framework was designed by applying the basic design principles of removable partial dentures. An obturator with improved retention, stability, and support was fabricated through functional impressions. The patient was satisfied with the improved facial expression, mastication, swallowing, and pronunciation, and showed stable occlusion and oral hygiene management during the follow-up period.

상악골 절제술을 받은 환자는 구개부의 결손으로 인해 연하, 저작, 발음 기능이 심각하게 손상되는데, 식사 시 비강과 코를 통한 누출이 있게 되고, 치아 및 치조제의 소실로 저작이 어려워지며, 구강과 비강이 분리되지 않아 과비음이 발생하는 등 삶의 질이 현저히 저하된다. 결손부를 보철적으로 재건하기 위해서는 폐색장치의 무게를 최대한 줄여 중력에 의한 탈락을 최소화하고, 폐색장치의 bulb를 결손부 내로 적절히 연장시켜 부가적인 유지, 안정을 얻도록 해야 한다. 본 증례는 종양의 재발로 인해 추가적인 상악골 절제를 받은 부분 무치악 환자에서 가철성 국소의치의 기본적인 설계 원칙을 적용하여 금속 구조물을 디자인하고, 기능 인상을 통해 유지, 안정, 지지를 향상시킨 폐색장치를 제작하였다. 환자는 개선된 안모 및 저작, 연하, 발음 기능 향상에 만족하였고, 경과관찰 기간 동안 안정적인 교합 및 구강위생관리를 보여 이를 보고하는 바이다.

Keywords

References

  1. The Glossary of Prosthodontic Terms: Ninth Edition. J Prosthet Dent 2017;117(5S):e62.
  2. Marunick M. Hybrid gate design framework for the rehabilitation of the maxillectomy patient. J Prosthet Dent 2004;91:315-8. https://doi.org/10.1016/j.prosdent.2004.01.015
  3. Beumer J, Marunick MT, Esposito SJ. Maxillofacial rehabilitation: Prosthodontic and surgical management of cancer related, acquired, and congenital defects of the head and neck. 3rd ed. Illinois; Quintessence Pub.; 2011. p. 187-210.
  4. Desjardins RP. Obturator prosthesis design for acquired maxillary defect. J Prosthet Dent 1978;39:424-35. https://doi.org/10.1016/S0022-3913(78)80161-9
  5. Schwartzman B, Caputo AA, Beumer J. Gravityinduced stresses by an obturator prosthesis. J Prosthet Dent 1990;64:466-8. https://doi.org/10.1016/0022-3913(90)90045-E
  6. Firtell DN, Grisius RJ. Retention of obturatorremovable partial denture: A comparison of buccal and lingual retention. J Prosthet Dent 1980;43:212-7. https://doi.org/10.1016/0022-3913(80)90189-4
  7. Aramany MA. Basic principles of obturator design for partially edentulous patients. Part I: Classification. J Prosthet Dent 1978;40:554-7. https://doi.org/10.1016/0022-3913(78)90092-6
  8. Rosenstiel SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 5th ed. Amsterdam; Elsevier Inc.; 2017. p. 582-606.
  9. The council of professor of dental universities. Removable partial prosthodontics. Revision. Seoul; Dental Wisdom Pub.; 2019. p. 100-39, 256-65.
  10. King GE, Martin JW. Cast circumferential and wire clasps for obturator retention. J Prosthet Dent 1983;49:799-802. https://doi.org/10.1016/0022-3913(83)90352-9
  11. Lyons KM, Beumer J 3rd, Caputo AA. Abutment load transfer by removable partial denture obturator frameworks in different acquired maxillary defects. J Prosthet Dent 2005;94:281-8. https://doi.org/10.1016/j.prosdent.2005.06.005
  12. Berg T Jr, Caputo AA. Anterior rests for maxillary removable partial denture. J Prosthet Dent 1978;39:139-46. https://doi.org/10.1016/S0022-3913(78)80010-9
  13. The council of professor of dental universities. Prosthodontic treatment for edentulous patients. 2nd ed. Seoul; Dental Wisdom Pub.; 2014. p. 566-83.
  14. Gay WD, King GE. Applying basic prosthodontic principles in the edentulous maxillectomy patient. J Prosthet Dent 1980;43:433-5. https://doi.org/10.1016/0022-3913(80)90216-4
  15. Aramany MA. Basic principles of obturator design for partially edentulous patients. Part II: Design principles. J Prosthet Dent 1978;40:656-62. https://doi.org/10.1016/0022-3913(78)90065-3
  16. Parr GR, Tharp GE, Rahn AO. Prosthodontic principles in the framework design of maxillary obturator prosthesis. J Prosthet Dent 1989;62:205-12. https://doi.org/10.1016/0022-3913(89)90315-6
  17. Schwartzman B, Caputo AA, Beumer J. Occlussal force transfer by removable partial denture designs for a radical maxillectomy. J Prosthet Dent 1985;54:397-403. https://doi.org/10.1016/0022-3913(85)90560-8
  18. Martin JW, King GE. Framework retention for maxillary obturator prostheses. J Prosthet Dent 1984;51:669-72. https://doi.org/10.1016/0022-3913(84)90415-3
  19. King GE, Martin JW. Cast circumferential and wire clasps for obturator retention. J Prosthet Dent 1983;49:799-802. https://doi.org/10.1016/0022-3913(83)90352-9
  20. Ahmad I, Sherriff M, Waters NE. The effect of reducing the number of clasps on removable partial denture retention. J Prosthet Dent 1992;68:928-33. https://doi.org/10.1016/0022-3913(92)90553-M
  21. Stewart KL, Rudd KD, Kuebker WA, Clinical removable partial prosthodontics. 1st ed. St. Louis; CV Mosby; 1983. p. 101-2.
  22. Oral K, Aramany MA, McWilliams BJ. Speech intelligibility with the buccal flange obturator. J Prosthet Dent 1979;41:323-8. https://doi.org/10.1016/0022-3913(79)90017-9
  23. McAndrew KS, Rothenberger S, Minsley GE. An innovative investment method for the fabrication of a closed hollow obturator prosthesis. J Prosthet Dent 1998;80:129-32. https://doi.org/10.1016/S0022-3913(98)70098-8
  24. Yoon BK, Ko SO, Shin HK. A clinical study of palatal lift for treatment of velopharyngeal incompetency. J Korean Assoc Oral Maxillofac Surg 2001;27:92-6.
  25. Kummer AW. Cleft palate and craniofacial anomalies: the effects of speech and resonance. 1st ed. San Diego; Singular Thomson Learning Inc.; 2001. p. 145-76.
  26. Suh KS, Kim JY, Kim YK. Relationship between formants and constriction area of vocal tract in 9 Korean standard vowels. J Korean Soc Laryngol Phoniatr Logop 1994;5:44-58.
  27. Cho JH, Pyo WY, Choi HS, Choi BJ, Son HK, Sim HS. Physioantomy of nasopharyngeal space and hypernasality in cleft palate. J Korean Acad Pediatr Dent 2004;31:721-8.