Palatal Obturators
Scott Culpepper, DDS
Kings County Hospital
PALATAL OBTURATOR: A PROSTHESIS THAT OCCLUDES
AN OPENING SUCH AS AN ORONASAL FISTULA.
Surgical resection, as in SCCa
 Used in cleft lip and palate cases
 Traumatic injury to the palate


Function
o
o
o
o
Used in speech
Prevent nasal regurgitation that occurs during
feeding
Often used as a therapy for cleft lip and palate, or
for treatment of resected neoplasms.
Includes any missing teeth to provide occlusion and
esthetics
o
o
o
In some cases, a palatal obturator can be gradually
downsized, so that tissues can gradually strengthen over
time and compensate for the decreasing size of the
obturator.
They can be simple or complex, and reflect a whole area
of practice.
May involve
o
o
o
o
o
Dentists, Oral Surgeons
Plastic surgeons
Oral & Maxillofacial Prosthodontists
Speech therapists
Oncologists
TYPES
o
Palatal plate (most common)
LATHAM DEVICE
 Placed
by plastic surgeons, for babies with complete
clefts of lip and palate.
 Surgical placement, designed to bring two pieces of cleft
palate together and to make lip repair easier
NASAL ALVEOLAR TYPE
PLANNING
Ideally, obturator is planned prior to surgery, or
consistent with planned closure of cleft lip and
palate.
 Depends of extent of surgery, and subsequent
surgeries

 Eventual
closure of fistula?
 Additional resection of carcinoma?

Modification Obturator: very short term, used for
immediate blockage and seal of fistula. May be made
chairside.
Interim Obturator: used when no further surgical
procedures are planned. Great part of surgical
treatment planning.
 Preoperative
impressions, bite registrations and tooth
set-up.
 Placed and relined in the OR, for immediate use postoperatively.
 Requires constant revision as tissues heal.
TWO CASES
CASE #1: INTERIM
Male pt, complaining of existing obturator that
does not fit.
 Ca treatments, still ongoing, tissues are
continuously changing and Ca is probably out
of control at this point.
 Pt. did not receive radiation b/c proximity to
brain, surgical resections have also stopped at
this point.
 How do you get retention?

WHAT WOULD HELP
An oral and maxillofacial prosthodontist
 Presurgical treatment planning, there appeared
to have been some in this case
 Prosthesis would ultimately have 2 parts that
lock together: extraoral+intraoral
 Retentively engaging all involved tissues makes
a heavy prosthesis, and seems uncomfortable
for pt.
 Is there another way?

SECOND CASE: THIRD TYPE OF OBTURATOR
 Definitive
 Used
Obturator
when surgical rehabilitation is not possible.
 Long-term use after tissues have fully healed and
matured.
 May also be implant supported
CASE SELECTION

This was an appropriate case
 Isolated
defect
 No further surgery planned
 Mature and healthy tissues
 Not a far stretch from conventional dental
prosthesis
 Retention is mostly gained from the fistula or defect
itself, rather than by conventional means
PREPARE YOUR PATIENTS
Etiquette: If you’re conversing w/a patient, make
sure they have old obturator in, so they can
answer you….. Get all concerns, complaints,
questions up front.
 Sell implants: Conventional prosthesis may not
have enough retention. Understand that from the
start.
 Prepare the patient:

Estimated number of appts.
 Some discomfort, irritation while working to record the
tissues of the fistula. Gagging, sneezing.

PRELIMINARY IMPRESSIONS
Stock tray w/adhesive, lots of alginate
 Additional alginate to add to fistula
 Record opposing dentition if any
 Mark Midline, lab may not be able to tell
 Order custom tray

CUSTOM TRAY
Border molding
 Master impression, can also be multi-phase
 This is the hardest for the patient
 Order an occlusal rim on a record base where
fistula tissues have been blocked out
 You need to try in rims several times, no need
to engage fistula every time during this phase

OCCLUSAL RIMS
Make the record base so you can try it in
repeatedly w/o trauma.
 Establish VDO, check phonetics, occlusal plane,
etc.
 Tooth selection, wax try-in etc.

DELIVERY
Need time.
 Most adjustment is in area of fistula.
 Go easy with try-ins, often the patient is better
at placing it than we are.
 Final polish.
 Implant retention is always an option, even
after delivery.
