The use of cone beam computed tomography and three dimensional printing technology in the restoration of a maxillectomy patient using a dental implant retained obturator

This case report presents an alternative method for fabricating an obturator for patients that develop xerostomia and mild trismus following radiation to the Head and Neck region. Multiple initial impression stages are avoided leading to less irritation to soft tissues and less discomfort to the patient. A 69-year-old male patient was referred to our dental practice by the Maxillofacial Surgery Department of the local General Hospital. The patient had undergone a right maxillectomy for removal of a Squamous Cell Carcinoma 2 weeks prior. Four endosseous dental implants were placed in the remaining upper jaw and 2 implants were inserted into the canine region of his edentulous mandible 3 weeks after ablative surgery. Five months following completion of radiotherapy and chemotherapy, a cone beam computed tomography of the maxilla was obtained, and a three dimensional model was constructed using an appropriate resin. Using the model as the detailed primary cast, a custom acrylic special tray was fabricated for the final impression of the remaining maxilla and the maxillary defect. An implant retained maxillary obturator and an implant retained mandibular overdenture were constructed to restore patient's speech, mastication and deglutition. The method presented here can limit the impression stages needed for construction of a maxillary obturator prosthesis to a single impression procedure advocating a partial digital workflow process. This can be very beneficial to the patient suffering from postradiation side-effects such as trismus, mucositis, and xerostomia

Rehabilitation of a maxillectomy patient using intraoral scanning impression technology and a computer-aided design/computer-aided manufacturing fabricated obturator prosthesis: A clinical report

Rehabilitation of a partially dentate postmaxillectomy patient using a novel approach is presented in this report. The patient was referred to our practice by the oral and maxillofacial surgery department of the local general hospital for the evaluation and prosthetic treatment planning. He had undergone biopsy for a lesion located in the right quadrant of his maxilla and was scheduled for a hemimaxillectomy for removal of a squamous cell carcinoma. A surgical obturator was prepared for placement at the time of ablative surgery. Following completion of adjuvant radiotherapy and chemotherapy, a digital intraoral impression of the remaining maxilla and mandible was obtained, and a computer-aided design/computer-aided manufacturing obturator removable partial denture utilizing a selective laser melting -produced metal framework was fabricated and delivered to the patient to restore function and esthetics. The need for conventional impression was eliminated leading to a reduction of necessary appointments and more comfort to the patient

Elevated left ventricular filling pressures can be estimated with accuracy by a new mathematical model

BACKGROUND: Although the clinical assessment of jugular venous pressure (JVP) provides accurate estimate of right atrial pressure (RAP), there is no reliable non-invasive method for assessing pulmonary capillary wedge pressure (PCWP). Our objective was to evaluate the sensitivity and specificity for detecting elevated left ventricular filling pressures using a model for PCWP estimation, based on the clinical assessment of RAP and association between RAP and PCWP, which is unique for each patient, identified in a recent right heart catheterization (RHC). METHODS: The study included 377 patients (age, 54.3 +/- 13 years) with heart failure with reduced ejection fraction (left ventricular ejection fraction of 30.5 +/- 10.8%) who underwent 2 RHCs within 1 year. In Group A (189 randomly selected patients), hemodynamic variables with significant correlation with the current wedge pressure (PCWP2) were identified and an equation estimating PCWP2 based on these variables was formed. The validity of the equation was evaluated in the remaining 188 patients (Group B). The equation was also evaluated, prospectively in 39 new patients where RAP was estimated clinically, by physicians blinded to the results of the RHC. RESULTS: PCWP2 in Group A correlated with RAP(1), systolic pulmonary artery pressure (SPAP(1) and PCWP1 of the first RHC and with RAP(2) and SPAP(2) of the second. The equation is PCWP2 = [3RAP(2) + (PCWP1 RAP(1)) + 4]/2. In Group B, the sensitivity and specificity of estimated PCWP2 for diagnosis of elevated LV filling pressures (invasive values > 18 mm Hg) was significant, reflected by an area under the curve (AUC) of 0.954 (p < 0.001). In the prospective sub-group, where JVP was entered in the formula as an estimate of RAP(2), correlation between estimated and measured PCWP2 was r = 0.803 (p < 0.001). CONCLUSIONS: The current PCWP of a patient with heart failure can be estimated accurately by a simple equation based on measurements of a previous RHC and the current value of clinically assessed JVP. J Heart Lung Transplant 2013;32:511-517 (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved