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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 131-134

Prosthetic rehabilitation of acquired maxillary defect secondary to mucormycosis with magnet-retained two-part prosthesis


Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India

Date of Submission13-Feb-2022
Date of Decision20-May-2022
Date of Acceptance27-Apr-2022
Date of Web Publication31-Aug-2022

Correspondence Address:
Dr. Poonam Wakure
Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjoralsci.sjoralsci_6_22

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  Abstract 


Mucormycosis has recently become more common in India, with COVID-19 patients being the most affected. Pulmonary, gastrointestinal, disseminated, or rhinocerebral infections have various forms of mucormycosis. The most prevalent type is rhinocerebral, which affects the maxilla, nose, sinuses, and brain. A total or partial maxillectomy has an impact on a patient's cosmetic, functional, and psychological well-being. To replace not only missing teeth but also lost soft tissues and bone, such as the hard palate and alveolar ridges, a maxillofacial prosthodontist must overcome numerous obstacles. For the rehabilitation of such deformities, prosthetic rehabilitation has become the preferred option. Magnets are an efficient technique to provide retention, quality, and consistency in a system. This clinical report describes the prosthetic rehabilitation of an acquired maxillary defect secondary to mucormycosis with a magnet-retained two-part prosthesis.

Keywords: Magnets, mucormycosis, prosthesis, rehabilitation, two-part prosthesis


How to cite this article:
Rathee M, Wakure P, Malik S, Singh S, Chahal S, Divakar S. Prosthetic rehabilitation of acquired maxillary defect secondary to mucormycosis with magnet-retained two-part prosthesis. Saudi J Oral Sci 2022;9:131-4

How to cite this URL:
Rathee M, Wakure P, Malik S, Singh S, Chahal S, Divakar S. Prosthetic rehabilitation of acquired maxillary defect secondary to mucormycosis with magnet-retained two-part prosthesis. Saudi J Oral Sci [serial online] 2022 [cited 2022 Oct 4];9:131-4. Available from: https://www.saudijos.org/text.asp?2022/9/2/131/355223




  Introduction Top


Maxillectomy affects a number of functions such as mastication, speech, olfactory, and gustatory senses. These patients also have issues with nasal secretions seeping into the oral cavity, poor lip seal, xerostomia, exophthalmos, and diplopia. A multidisciplinary team approach combining both surgical and prosthetic personnel can achieve complete rehabilitation of a bilateral maxillectomy patient.[1] By constructing an anatomic barrier between the oral and nasal cavities, rehabilitation with a prosthesis allows for the restoration of esthetics and function, such as mastication, deglutition, and speech.[2]

These prostheses vary in size and shape according to the amount of the defect, and they should be lightweight and provide the patient with retention, stability, and comfort. Magnets are an efficient tool for ensuring appropriate retention and stability in such prostheses due to their small compact size and tremendous attraction forces.[3] The prosthetic rehabilitation of an acquired maxillary defect related to mucormycosis with a magnet-retained two-part prosthesis is described in this clinical report.


  Case Report Top


A 64-year-old male retired teacher was referred by an ENT specialist to the Department of Prosthodontics after surgery due to COVID-associated mucormycosis for prosthetic management. On extraoral examination, the patient had a collapsed midface, deviated midline. On intraoral examination, it was observed that total maxillectomy had been performed with oroantral and oronasal communication [Figure 1]. The partial dentulous mandibular arch with removable partial prosthesis is seen. A considerable portion of the nasal septum, part of the inferior nasal conchae, and the superior wall of the maxillary sinuses on either side could be presented. Computed tomographic scan showed significant soft tissue density lesion in the right and left maxillary sinus completely obstructing the antrum. Before making the impression, the procedures were explained to the patient and informed consent was taken.
Figure 1: Intraoral view

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After 1 month of surgery, an interim obturator was fabricated and inserted. Four months later, the fabrication of the definitive prosthesis was conducted in the form of a two-piece hollow bulb obturator retained with the help magnetic retention system.

Fabrication

Impression procedure

Various oronasal communications were blocked by a small gauge luted with petroleum jelly. A perforated dentulous stock tray was selected, and modification was done according to the size of the defect. A preliminary impression was made using irreversible hydrocolloid (Zelgan, Dentsply). Type III dental stone (Kalabhai, Ultrastone plaster) was used for pouring of impression, and primary cast was prepared followed by the fabrication of a special tray (2 mm shorter), using self-cure poly methyl methacrylate (PMMA) resin (DPI RR Cold cure). The final impression was made using elastomeric impression material (3M Espe Impregum Soft Polyether Medium body). The pouring of final impression and master cast was prepared with type III DENTAL STONE (Kalabhai, Ultrastone plaster) after beading and boxing of impression [Figure 2].
Figure 2: Final impression

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Antral part of obturator (hollow bulb)

Extreme undercuts in the master cast were blocked with clay. The hollow bulb antral component of the obturator was fabricated using a 2–4 mm thickness of modeling wax adapted onto the defect area of the master cast. The hollow bulb was made with a heat cure PMMA resin (DPI Heat cure) following compression molding technique. To make the bulb hollow, salt crystals were utilized. A small hole was drilled to allow water to be injected, allowing the salt to be drained from the interior. Self-cure PMMA was used to close the gap. The antral portion of the obturator was evaluated for fit inside the patient's mouth. Overextensions and sharp edges were corrected; relining was done with resilient liner. There were no complaints about the patient's breathing, and no hyponasal speech was detected. Because of the undercuts in the maxillary sinus areas and the perioral musculature, retention was satisfactory [Figure 3].
Figure 3: Intraoral view of antral part of obturator

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Anatomical edentulous ridge fabrication

Wax up is done on the inferior portion of the antral part of obturator and verified. Heat-cure PMMA resin (DPI Heat cure) was used for making the hollow edentulous ridge with conventional compression molding technique using salt crystal.

Oral part of obturator

An impression with irreversible hydrocolloid was made with the closed hollow bulb placed intraorally to obtain a diagnostic cast for the manufacture of the definitive obturator. The maxillomandibular relation between the arches was recorded using a denture base and occlusal rims. The try-in was done after teeth arrangement with semi-anatomic acrylic teeth (Acryrock crosslinked, Ruthenium). Heat-cure PMMA was used to create the definitive obturator. The oral part of the obturator was difficult to position when the plate was oriented over the antral part of the obturator. Four magnets (cobalt-samarium, Ambica Corporation, New Delhi, India) were put at a distance of 10 mm on the intaglio surface of the oral section of the obturator to ensure proper placement of these two parts. The counter alloy was applied to the cameo surface of the closed hollow bulb using self-cure resin [Figure 4]. Speech was understandable after insertion, and the esthetics were perfect. Postinsertion instructions were given. The patient was followed up at regular intervals after 1 week, 1 month, and 6 months, and a periodic recall was performed [Figure 5].
Figure 4: Oral and antral part of obturator

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Figure 5: Intraoral view of definitive prosthesis

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  Discussion Top


Maxillofacial rehabilitation necessitates a team effort. Communication with a surgeon about the extent of the disease, the surgical approach used, the extent of postoperative defects, and the healing time could aid in treatment planning. Separation of the oral and nasal cavities, which allows for appropriate speech and deglutition, and restoration of esthetics are among the goals of prosthetic treatment.[2]

The obturator bulb extends vertically to contact the surgical defect and horizontally to the lateral aspect of the orbital floor in big maxillary deformities. This increases the prosthesis's size and weight. As a result, the patient experiences pain and discomfort as the surviving structures are continually stressed. There are methods that fabricate a hollow bulb by using various materials and techniques.[4],[5]

Silicone liners, which are flexible or resilient, allow bone undercuts to be engaged, offering more comfort and stability without compromising retention.[6],[7],[8] Magnets are used for retention because of their small size and strong attractive forces, attributes that allow them to be placed within prostheses without being obtrusive in the mouth.[9] Advantages also include ease of cleaning, ease of placement for both dentist and patient, automatic reseating, and constant retention with a number of cycles.[10] A commercially available magnet (cobalt-samarium), which provided the essential retention, was used. In our case, we used the cobalt-samarium magnet available in our country. This was cost-effective for the patient.[11]


  Conclusion Top


In this clinical report, a novel method of obtaining retention for the obturator bulb and oral section of the obturator employing magnets in a complex defect is described for prosthetic rehabilitation of residual maxillary defects secondary to mucormycosis. The resulting prosthesis was cost-effective, biocompatible, attractive, comfortable to wear, simple to produce and clean, and provided the patient with optimal functional and esthetic rehabilitation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parents have given their consent for the patient's images and other clinical information to be reported in the journal. The patient's parents understand that the patient's name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chandra TS, Sholapurkar A, Joseph RM, Aparna IN, Pai KM. Prosthetic rehabilitation of a complete bilateral maxillectomy patient using a simple magnetically connected hollow obturator: A case report. J Contemp Dent Pract 2008;9:70-6.  Back to cited text no. 1
    
2.
Padmanabhan TV, Kumar VA, Mohamed KK, Unnikrishnan N. Prosthetic rehabilitation of a maxillectomy with a two-piece hollow bulb obturator. A clinical report. J Prosthodont 2011;20:397-401.  Back to cited text no. 2
    
3.
Chalian VA, Barnett MO. A new technique for constructing a one-piece hollow obturator after partial maxillectomy. J Prosthet Dent 1972;28:448-53.  Back to cited text no. 3
    
4.
Worley JL, Kniejski ME. A method for controlling the thickness of hollow obturator prostheses. J Prosthet Dent 1983;50:227-9.  Back to cited text no. 4
    
5.
Deogade SC, Mantri SS. Rehabilitation of a partial maxillary defect with magnet retained two-piece hollow bulb obturator. Eur J Prosthodont Restor Dent 2014;2:62-6.  Back to cited text no. 5
    
6.
Srinivasan M, Padmanabhan TV. Rehabilitation of an acquired maxillary defect. J Indian Prosthodont Soc 2005;5:155-7.  Back to cited text no. 6
  [Full text]  
7.
Minsley GE, Warren DW, Hinton V. Physiologic responses to maxillary resection and subsequent obturation. J Prosthet Dent 1987;57:338-44.  Back to cited text no. 7
    
8.
Antoniou DV, Toljanic JA, Graham L. Obturator prosthesis retention for edentulous patients with large palatal defects: A clinical report. J Prosthet Dent 1996;76:227-9.  Back to cited text no. 8
    
9.
Sjövall L, Lindqvist C, Hallikainen D. A new method of reconstruction in a patient undergoing bilateral total maxillectomy. Int J Oral Maxillofac Surg 1992;21:342-5.  Back to cited text no. 9
    
10.
Riley MA, Walmsley AD, Harris IR. Magnets in prosthetic dentistry. J Prosthet Dent 2001;86:137-42.  Back to cited text no. 10
    
11.
Khan Z, Farman AG. The prosthodontist role in head and neck cancer and introduction – Oncologic dentistry. J Indian Prosthodont Soc 2006;6:4-9.  Back to cited text no. 11
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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