21080 Impression and custom preparation; definitive obturator prosthesis

Name of the Procedure:

Impression and Custom Preparation; Definitive Obturator Prosthesis

Summary

An impression and custom preparation, definitive obturator prosthesis is a dental procedure designed to create a custom-fit prosthesis used to replace missing tissue and support the functions of the palate. This is particularly useful for patients who have undergone maxillectomy or have significant deficits in the maxillary region.

Purpose

This procedure addresses the need for restoring speech, mastication (chewing), and improving the aesthetics and quality of life for patients with defects or missing tissue in the maxillary region. The primary goal is to create a functional and comfortable prosthesis that fits the patient's unique anatomy.

Indications

• Patients who have had a maxillectomy due to cancer or trauma.
• Congenital defects such as cleft palate.
• Significant maxillary bone loss due to trauma or disease.
• Issues with speaking, chewing, or aesthetics due to missing maxillary tissue.

Preparation

• Pre-procedure dental examination and impressions.
• Any necessary imaging, such as CT scans, to assess the extent of bone and tissue loss.
• Discussion with the patient regarding options and what to expect.
• Patients may need to stop taking certain medications before the procedure.

Procedure Description

1. Initial Assessment and Primary Impression:
   • A primary impression of the maxillary arch is taken to create a preliminary model.
2. Custom Tray Fabrication:
   • Using the preliminary model, a custom tray is designed to take a more accurate impression of the mouth.
3. Definitive Impression:
   • The definitive impression is taken using the custom tray and special dental materials to ensure a precise fit.
4. Prosthesis Design and Fabrication:
   • A detailed model of the patient's mouth is created from the definitive impression, and the custom obturator prosthesis is fabricated in a dental laboratory.
5. Final Fitting:
   • The definitive obturator prosthesis is fitted to the patient, and adjustments are made for comfort and functionality.

Tools used include impression materials, custom trays, and laboratory equipment for prosthesis fabrication. Local anesthesia may be used to ensure patient comfort during the impression phase.

Duration

The entire process, including initial impressions, custom tray fabrication, definitive impression, and fitting of the prosthesis, typically spans several weeks to a few months, with multiple appointments lasting about 1-2 hours each.

Setting

This procedure is usually performed in a dental clinic or a specialized maxillofacial prosthetics center.

Personnel

• Prosthodontists or maxillofacial prosthetists.
• Dental assistants or technicians.
• Occasionally, anesthesiologists if sedation is required.

Risks and Complications

• Discomfort during the impression process.
• Risk of an improper fit leading to discomfort or ineffective function.
• Possible irritation or sores from the prosthesis.
• Rare allergic reactions to impression materials.

Benefits

• Restoration of normal speech and chewing functions.
• Improved aesthetics and facial symmetry.
• Enhanced quality of life and self-esteem.
• Benefits are typically realized soon after the final fitting, although minor adjustments might be needed.

Recovery

• Immediate post-procedure care instructions from the dental professional.
• Patients may experience mild discomfort initially, which can be managed with over-the-counter pain medications.
• Maintenance of oral hygiene and follow-up appointments for adjustments.

Alternatives

• Surgical reconstruction of the maxilla.
• Temporary obturator prostheses.
• Each alternative comes with its set of pros and cons, including variations in recovery time, cost, and invasiveness.

Patient Experience

• Some patients might feel slight discomfort during the impression process.
• Post-procedure, patients may need time to adapt to the new prosthesis.
• Pain is typically minimal and can be managed with standard pain relief methods.
• Dental professionals will provide comfort measures and support throughout the process.