Combined intra and extra oral defects can be stated as those facial defects which have an intraoral communicating route. Midfacial defects are aptly classified into 2 major categories by Marunick et al. 1 as midline midfacial defects in which the nose and / or upper lip defects are included; and the second major group was lateral defects in which the cheek and orbital defects are categorized. However, defects which include combinations of the above-mentioned defects are in existence. Midfacial defects which are acquired, present themselves often with severe disfigurement of structures and hence show impaired function. It is a meticulous task to rehabilitate the defects which are caused as a result of cancerous lesion resection as they are huge. Such post resection lesions frequently are rehabilitated by a facial prosthesis to maintain function as well as the appearance in the normal form. In adjunction to the facial prosthesis, an intraoral prosthesis which constitutes of an obturator is also required to regain the natural speech and pattern of swallowing. Fabrication of such facial prosthesis not only requires the artistic capability but also excellent clinical decision making of the prosthodontist. Mode of retention of the combined prosthesis should also be kept in mind while fabricating as it is also a difficult task to retain them because of the size and weight of the same. Moreover the prosthesis should also be secured in its place with these aids which can also prove as a challenge. This case report states rehabilitating a large surgically resected midfacial defect with the assistance of a “3-piece prosthesis” which constitutes a sectional intraoral obturator along with maxillary and mandibular extraoral facial prosthesis.

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Statement of problem: Prosthodontics patients, dentist, and staff are at a high risk for cross-contamination and disease transmission from each other. Addressing the above problem, two identifiable concerns are: (1) How the dentist and his staff can be protected from disease acquisition and disease transmission to patients and (2) steps taken to help to minimize cross-contamination with prosthetic instrumentation. The recovery of microorganisms from the dental casts may be a medium of cross-contamination between patients and dental personnel. Aim: To determine whether saliva contamination contributes to bacterial growth on dental cast over a period of time and whether cleaning or disinfecting can minimize contamination and to evaluate the effectiveness of various chemicals disinfectants. Materials and methods: Five type III gypsum casts were contaminated with saliva. Blood agar plates were inoculated and incubated at 37°C for 72 hours. Standardized dental stone cylinders were contaminated with 25 μL of saliva and treated by rinsing in tap water, soaking in 2% glutaraldehyde, 0.525% sodium hypochlorite, 0.5% phenol, or as controls with and without saliva contamination. The treated dental stone cylinders were placed in individual test tubes containing 2.5 mL of sterile phosphate-buffered solution and a final dilution of 10-4 was achieved. Colony-forming units (CFU) were counted after 24 hours. Results: Rinsing the dental cast with tap water can diminish bacterial growth, but it cannot be considered as a reliable method of disinfection of the gypsum cast, as it may also sometimes even lead to further contamination. Immersion of the gypsum cast in 2% glutaraldehyde for 5 minutes completely eliminates bacterial colonization in almost all the instances. Conclusion: Bacterial contamination of dental casts can occur, and requires an effective method of disinfecting.

An area of soft tissue along the junction of the hard and soft palate on which pressure, within physiologic limits of the tissues, can be applied by a denture to aid in its retention can be defined as the posterior palatal seal (PPS). The functions of PPS are to provide retention, to prevent food from getting under the base of the denture, to diminish the gag reflex, to make the denture less conspicuous to the tongue, and to counteract denture warpage due to dimensional changes during the curing process by providing a thick border. The location and recording of the PPS, although being a very significant step, are still a frequently neglected procedure, because of lack of proper knowledge. Clinically, various different locations of the vibrating line resulted from different methods. This study was therefore designed to evaluate if the posterior and anterior vibrating lines could be distinguished as separate lines of flexion and to evaluate type of soft palate among Indian population, i.e., Wardha population. The following conclusions were made, from the above study: (a) Two separate lines of flexion could be located in Indian population, when the appropriate action was elicited for the posterior and anterior vibrating lines; (b) in flat group (group III), the vibrating line was farther posteriorly (i.e., closer to a line joining both hamular notches), resulting in the broadest PPS area, whereas the posterior extension of the PPS area in the deep vault was less than in groups II (medium) and III (deep). (c) In group III (flat), the width of the PPS area was greater than in groups I (deep) and II (medium). This width was the least in group I (deep).