Prosthodontic therapy for patients with acquired surgical defects of the maxilla can be arbitrarily divided into two phases of treatment with each phase having different objectives. The initial phase is called immediate surgical obturation and entails the placement of prosthesis at surgery immediately thereafter. This prosthesis must be modified at frequent intervals to accommodate for the rapid soft tissue changes that occur within the defect during organization and healing of the wound. The objective of immediate surgical obturation is to restore and maintain oral functions at reasonable levels during the postoperative period until healing is substantially completed. Three to four months after surgery the surgical site becomes stable dim6nsionany thus permitting construction of the definitive prosthesis, or the second phase of prosthodontic therapy.R> Immediate surgical obturationR> Immediate surgical obturation is particularly well suited for dentulous patients requiring a partial or total maxilleteomy because the remaining teeth can be used to help retain the prosthesis in position. The advantages of immediate surgical obturation are as follows:
l. The prosthesis provides a matrix on which the surgical packing can be placed; on closure of the wound, the obturator maintains the packing in the proper relationship thus ensuring close adaptation of the skin graft to the raw surface of the cheek flap.
2. The prosthesis reduces oral contamination of the wound during the immediate postsurgical period and may thus reduce the incidence of local infection.
3. The prosthesis enables the patient to speak more effectively postoperatively by reproducing normal palatal contours and by covering the defect.
4. The prosthesis permits deglutition: thus the nasogastric tube may be removed at an earlier date.
5. The prosthesis lessens the psychologic本论文由英语论文网/ impact of surgery by making the postoperative course easier to bear. The patient is reassured that rehabilitation has begun.
6. The prosthesis may reduce the period of hospitalization (Nakamoto. 1971 ). This benefit assumes even greater importance with the escalating costs of hospitalization.
There are several principles relative to the design of immediate surgical obturators that the prosthodontist should consider:
l. The obturator should terminate short of the skin graft-mucosal junction. As soon as the surgical packing is removed, extension into the defect may be accomplished with interim soft reline materials.
2. The prosthesis should be kept simple, lightweight, and inexpensive. Round 18-gauge wrought gold or stainless steel wire retainers are sufficient for dentulous patients.
3. The prosthesis for dentulous patients should be perforated at the interproximal extensions with a small dental bur to allow the prosthesis to be wired to the teeth at the time of surgery.
4. Normal palatal contours should be reproduced to facilitate postoperative speech and deglutition.
5. Posterior occlusion should not be established on the defect side until the surgical wound is well organ，英语毕业论文，英语论文范文 |
