“Fabricating a Maxillary Gasket Obturator: A Case Report for a Patient with History of Radiation Therapy”

Dino J. Salvanera, DMD^a; Rafiullah Bashiri, DDS, MDS, AFAAMP^b,c

Resident^a, Clinical Assistant Professor^b, Maxillofacial Course Director^c

 

Introduction 

Patients with remaining dentition and history of radiation therapy can be challenging to rehabilitate. To restore a complex partially edentulous patient with history of multiple prior treatments for Squamous Cell Carcinoma, an analog workflow was utilized as the treatment of choice.

Case Report 

DM is a 70-year-old who presented to UNC Graduate Prosthodontics (Chapel Hill, NC) with a history of Squamous Cell Carcinoma and maxillary resection. The patient’s chief concern was their inability to  produce intelligible speech. The patient has never worn a removable prosthesis.

The obturator prosthesis was fabricated utilizing conventional processing techniques. Preliminary casts were made using alginate and a custom tray fabricated with light-cure tray material. Wax spacer in relief areas and around remaining tooth #6 was added for space for impression material. The custom tray was border-molded with greenstick compound and final impression made with elastomeric polyvinyl siloxane (PVS) impression material. A master cast was made from Type III microstone, maxillomandibular records captured with record base, and casts were articulated. 

A wax try-in was performed after setting Ivoclar Vivadent SR PHONARES II teeth. Phonetics and esthetics were determined. Adjustments to occlusal plane, incisal edge, midline, etc. were made. Final wax-up was sealed to master cast, festooned, and flasked.

At insertion appointment, areas of overextension and interferences were adjusted and occlusion was equilibrated. The window for tooth #6 was widened to allow for passive path of insertion for the obturator. The acrylic surface was treated with GC Reline II Primer and GC Reline II was added around the window of tooth #6 to engage the undercuts. Excess was trimmed. 

Discussion

The use of soft liners to fabricate gasket or Cu-Sil prostheses has positive benefits, such as delaying or eliminating the need for surgical extractions and increasing the retention of the prosthesis that would otherwise have decreased retention due to a palatal defect. With this patient and their history of radiation therapy, extractions were not advised due to risk of osteoradionecrosis.