Diverse classification systems for maxillectomy defects: Simplifying or complicating the treatment plan?

Aggarwal, Himanshi; Eachempati, Prashanti; Kumar, Pradeep

doi:10.4103/0970-0358.155284

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…in 2015. [ 4 ] Each one has its own merit, like divided the defects according to their horizontal and vertical extensions, where the extension determined the treatment outcome. Bidra et al .…”

Section: Introductionmentioning

confidence: 99%

Obturators: A proposed classification and its associated techniques

Hazra¹,

Srivastava²,

Kumar³

2023

J Indian Prosthodont Soc

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Statement of Problem: Multiple classifications exist for maxillectomy defects. However, none of the existing classifications describes the defects as favorable or unfavorable from the prosthodontist’s standpoint. The most common problem with prosthetic treatment in such patients is in getting adequate retention, stability, and support. The size and location of the defect usually influence the amount of impairment and difficulty in prosthetic rehabilitation. Proposed Classification: A series of cases has been studied, and a newer type of maxillary defect is seen with a better presurgical involvement of the prosthodontist. This type of defects is not present in any of the existing classification; hence, a modification is proposed, and its requisite cast partial framework design is also given. Another treatment-based classification is also proposed for easy treatment planning in these cases. A case series of maxillectomy patients with varying types of defects rehabilitated with obturators with different designs, modes of retention, and fabrication procedure in accordance to the newer classification is described. Discussion: Surgical intervention creates communication among the oral cavity, nasal cavity, and maxillary sinus. The obturator prosthesis is commonly used as an effective means for rehabilitating such cases. There is a plethora of classifications available for maxillectomy defects though none of them takes existing dentition into consideration. While remaining dentition and various other favorable and unfavorable factors decide on the final prognosis of the prosthesis. Hence, a newer classification was planned with keeping in mind newer treatment modalities. Conclusions: Prosthodontic rehabilitation with obturator prosthesis design and manufactured by various principles and techniques restores the missing structures and acts as a barrier between the communication among the various cavities and definitely improving their quality of life. Considering the complexities of maxillary anatomy, the various permutations of the maxillectomy defect, the current trends in surgical management with presurgical prosthodontic planning, and various prosthodontic treatment options available, it is imperative that a more objective modification of the current classification described in this article is warranted for and could be more operator friendly in finalizing and communicating of the treatment plan.

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Section: Introductionmentioning

confidence: 99%

Obturators: A proposed classification and its associated techniques

Hazra¹,

Srivastava²,

Kumar³

2023

J Indian Prosthodont Soc

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“…1 Other classifications, such as Brown's and Okay's classifications, are also used. [2][3][4] Aramany's classification groups particular combinations of teeth and surgical defects relevant to the design of AUDIOABSTRACT maxillary obturator prostheses into six classes (I-VI). Among them, classes I, II, and IV are most common and interesting because they vary considerably in terms of shape and size.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and accuracy of using intraoral scanners to digitize maxillectomy defects for prosthetic rehabilitation: A systematic review

Elbashti¹,

Molinero‐Mourelle²,

Aggarwal³

et al. 2022

Int J Maxillofac Prosthetics

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Purpose: Few studies have focused on the feasibility and accuracy of intraoral digital impressions for maxillectomy defects, especially for extensive soft tissue defects. Using intraoral scanners alone might be feasible for producing maxillary obturator prostheses, albeit with some limitations. It seems logical to investigate this ambiguity. Therefore, this systematic review aimed to assessing the feasibility and accuracy of using intraoral scanners (IOSs) to digitize maxillectomy defects. Materials and Methods: PubMed, the Cochrane Oral Health Group Trials Register, and the Cochrane Central Register of Controlled Trials were electronically searched, and five prosthodontics journals were manually searched for English-language articles published as of December 2020 that assessed the feasibility and accuracy of using intraoral scanners to acquire digital impressions for maxillectomy defects. Results: Two in vitro studies, three clinical studies, six clinical reports, and three techniques were included (N=14). Aramany’s and Brown’s classifications were used to classify defects in twelve and one articles, respectively; the remaining article did not specify defect class. The 3M True definition IOS with Cone-beam computed tomography (CBCT), Computed tomography (CT), and/or optical scanners were used in both in vitro studies, mainly to evaluate accuracy. The Trios 3 scanner was used in nine studies as the main resource for data acquisition (75.0%), whereas the Trophy 3DI, Lava, and Cerec Omnicam scanners were used in three articles (25.0%). Four degrees of feasibility were identified: feasible (14.3%), feasible with limitations (28.6%), feasible with CBCT or CT (35.7%), and feasible with conventional impressions (21.4%). Accuracy was evaluated in four studies but was not mentioned in ten studies. Conclusion: The results revealed a low level of evidence for the feasibility and accuracy of using intraoral scanners to digitize maxillectomy defects. Additional multicenter clinical studies are needed to evaluate the feasibility and accuracy of digital workflow compared with the conventional approach.

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“…The extent of the obturator varies depending on the type of defect. Aramany’s classification of maxillary defects is commonly used as follows: Class I, a defect where the resection is performed in the anterior midline of the maxilla, with abutment teeth present on one side of the arch; Class II, a defect that is unilateral, retaining the anterior teeth on the contralateral side; Class III, a palatal defect that occurs in the central portion of the hard palate and may extend into the soft palate; Class IV, a defect that crosses the midline and involves both sides of the maxilla, with abutment teeth present on one side; Class V, a surgical defect that is bilateral and lies posterior to the abutment teeth (labial stabilization may be needed); and Class VI, an anterior maxillary defect with abutment teeth present bilaterally in the posterior segment [ 5 ]. This case report is classified as Aramany’s Class I defect.…”

Section: Introductionmentioning

confidence: 99%

Maxillary Defect Rehabilitation Using a Hollow Bulb Obturator

N¹,

KS²,

S³

et al. 2022

Cureus

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Rehabilitation of maxillofacial defects is an arduous task that involves restoring the form and function of the resected part of the defect. Obturators are the preferred choice of treatment for patients after resection involving the maxilla. Rehabilitation aims to separate the oral and nasal cavity and maintain anatomy while also assisting the patient with mastication, maintaining occlusion, supporting the mandible and facial tissues, and reestablishing speech and esthetics. Following surgery, a prosthetic evaluation is performed in which magnets are attached to the prosthesis to restore function and speech, as well as retention, stability, and quality of life. This case report describes how a hollow bulb obturator was used to treat a partial maxillectomy patient with magnets and clasps for patient rehabilitation.

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Diverse classification systems for maxillectomy defects: Simplifying or complicating the treatment plan?

Cited by 3 publications

References 5 publications

Obturators: A proposed classification and its associated techniques

Obturators: A proposed classification and its associated techniques

Feasibility and accuracy of using intraoral scanners to digitize maxillectomy defects for prosthetic rehabilitation: A systematic review

Maxillary Defect Rehabilitation Using a Hollow Bulb Obturator

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