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Maxillofacial prosthetics: theory and practice

Retention 11

Retention of Maxillofacial Prosthesis

I-Retention of Intraoral Prostheses

A-Anatomic Retention:

This includes the use of both hard and soft tissues (teeth, mucosal and bony tissues). Large alveolar ridge and high palatal vaults generally provide more retention than flatter ridges. Anatomic undercut areas play an important role in retention of prosthesis. The success of intraoral retention relates to the size and location of the defect and the type of the mouth, dentulous or edentulous e.g.

For edentulous patient with any palatal perforation, retention in the classical sense of complete denture is impossible. Even in dentulous patient with resected maxilla, clasping only will not give better results. The movement of the prosthesis will make stress on the abutment teeth and may result in loss of the abutment. So more than one method of retention should be used.

B-Mechanical Retention: (Temporary or Permanent)

Temporary Mechanical Retention:

1- A stainless steel wrought wire of 18-gauge size can be quickly adapted to a cast of the remaining teeth to retain the temporary prosthesis during the healing period. Preformed stainless steel wire clasps include Adams, Akers, or Hawley labial wires may be used

include Adams, Akers, or Hawley labial wires may be used Preformed stainless steel bands or crowns

Preformed stainless steel bands or crowns with prewelded brackets can be adapted to increase retentive form of a mutilated or conical tooth.

2- wiring the denture to infraorbital or zygomatic bones to obturate a maxillary defect is recommended for edentulous patient

Retention of prosthesis: Upper through circumzygomatic wiring and lower through circummandibular wiring.

prosthesis: Upper through circumzygomatic wiring and lower through circummandibular wiring. Dr.mostafa.fayad@gmail.com 1

Maxillofacial prosthetics: theory and practice

Retention 11

Permanent Mechanical Retention:

1-Cast clasps

The most common method for retaining a prosthesis is the use of cast metal clasps. There are many different types of cast metal clasps e.g. cast circumferential clasp, ring clasp and I- Bar clasp .

2-Prefabricated precision attachments:

and I- Bar clasp . 2-Prefabricated precision attachments : These attachments can be placed into cast

These attachments can be placed into cast crowns for the best esthetic and mechanical retention.

3-Semiprecision attachments, custom made

This attachments are formed in the wax pattern, using a specially shaped mandrel mounted on the parallelometer .

4-Snap-on attachment

A Baker bar or Anderson bar is the rod connecting two crowns of abutment, and the clip engages this rod.

5-Overdentures

of abutment, and the clip engages this rod. 5-Overdentures Improved retention may be obtained by one

Improved retention may be obtained by one of the several attachment devices or by lining the overdenture with one of the resilient denture liners to utilize available tooth undercuts.

6-Overlay (Telescoping) Crown and Thimble Crown

This type is used when an overlay denture is planned or an extremely malposed tooth is needed for stability.

or an extremely malposed tooth is needed for stability. It is also indicated when a major

It is also indicated when a major change in the vertical or centric dimension occur , as in cleft lip-cleft palate, and prognathic mandibles.

Maxillofacial prosthetics: theory and practice

Retention 11

7-Swing-lock attachments

Swing-lock partial denture design using long flexible arm to engage anterior and posterior abutment teeth. The swing-lock design should not be used at all unless splinting of the posterior teeth is first accomplished.

8- Retaining buccal flange

teeth is first accomplished. 8- Retaining buccal flange Retaining buccal flange engaging both tooth and tissue

Retaining buccal flange engaging both tooth and tissue undercuts

9-Using the undercuts in the defect

Soft silicone material is used to engage the undercuts in the defect more aggressively.

10-Engagement of the skin graft and scar band formed at the skin graft-mucosal junction .

and scar band formed at the skin graft-mucosal junction . Junction of oral mucosa and skin

Junction of oral mucosa and skin graft lining can give accessory retention and should be used whenever possible.

accessory retention and should be used whenever possible. (A) Junction of oral mucosa and skin graft,

(A) Junction of oral mucosa and skin graft, (B) Lateral defect space traced in compound showing construction of scar band and extension to lateral shelf created by tumor removal.

Maxillofacial prosthetics: theory and practice

Retention 11

11-Magnets

Small steel magnets are embedded beneath the molar and premolar teeth of upper and

lower dentures and arranged with similar poles opposite each other. At least two magnets

are required for the lower denture and four magnets for the upper denture.

This effective method of retention may be useful in cases of hemi-maxillectomy, or

extremely atrophied ridges. The use of magnets in two piece prosthesis is advocated.

12-Using of springs

The opposing arch can be used to assist in the retention of the maxillary prosthesis by

attaching a spiral spring to the prosthesis in the premolar region. These spiral springs are

made of coiled stainless steel or gold-plated base metal and have their ends attached to

swivels in the premolar areas on both sides of upper and lower dentures.

premolar areas on both sides of upper and lower dentures. ( A ) Spring - retained

(A) Spring - retained prosthesis, (B) Spring - retained denture with obturator.

Nylon springs of continental origin are available and have the advantage of being thin

and not collecting food .

Their life is limited to about six months, and the method of their attachment to the

denture, which is a nylon ball and socket joint, is not very efficient. If this were improved

they would be very satisfactory.

4
4

The disadvantages of nylon springs are:

1-The

absorption

constant

pressure

may

cause

excessive

alveolar

Dr.mostafa.fayad@gmail.com

Maxillofacial prosthetics: theory and practice

Retention 11

2-The mucous membrane may not tolerate the constant pressure.

3-The inner surfaces of the cheeks may become sore from frictional contact with the springs.

4-Lateral movements are extremely restricted.

5-Collecting foods and become unhygienic.

13-Implants in the intact side

Improved retention may be obtained by one of the several attachment which can be used

with the implants.

14-Adhesives (fixatives), Prosthetic Adhesives, 1970

These materials improve fit, comfort and retention of the prosthesis by producing a high

viscous layer between the denture and its supporting tissues.

This material is necessary to aid retention in the following cases:

a- Large surgical wound.

b- Flat palate.

c- Nonexistent maxillary tuberosities.

d- Missing of soft tissue undercuts in the area of surgery.

e- Diminished salivary flow due to pre-and postredication therapy.

f- loss immediate upper denture due to alveolar absorption .

The requirements of adhesives are

1. Highly adherent;

. The requirements of adhesives are 1. Highly adherent; 2. Nontoxic—that is, nonirritating to the tissues;

2. Nontoxic—that is, nonirritating to the tissues;

3. Elastic at the point of contact to the skin;

4. Non injurious to the prosthesis;

5. Highly durable;

6. Easily cleansed from the surface of the prosthesis as well as from the soft tissue involved.

Maxillofacial prosthetics: theory and practice

Retention 11

Disadvantages

1-It gives a temporary retention .

2-It has an unpleasant feel when pressed out from beneath the denture.

3-It is of little use for retaining lower dentures.

4-Its constant use may cause constipation.

The troubles with adhesive

Difficult to clean

They collect dirt and are unhygienic

Unreliable (swimming, sweating or greasy skin)

Awkward to position correctly

The

application

consuming.

of

the

adhesive

may

be

messy

and

time-

consuming. of the adhesive may be messy and time-  The edges of the prosthesis must

The edges of the prosthesis must often be thickened or reinforced with fabric to resist tearing that may occur as the adhesive is cleaned from the prosthesis on a daily basis.

The adhesive may cause skin irritation,

Retention by the skin adhesive may be unreliable, especially if the prosthesis is large, the weather humid, or if the patient has oily skin. Proper positioning of the prosthesis is difficult in the absence of key anatomical landmarks; especially if the patient has compromised manual dexterity or visual acuity.

Maxillofacial prosthetics: theory and practice

Retention 11

II-Retention of Extra-oral Prosthesis:

A-Anatomic retention

The dynamic extra-oral retention depends on many factors. These factors are related to the size and location of the defect, tissue mobility, undercuts and the wright of the prosthetic material.

Both hard and soft tissues should be used; The hard tissue act as a base and provide a better seal of the prosthesis with the use of adhesive. While the soft tissues are more troublesome because of their flexibility, mobility, lack of support, low resistance to displacement.

B-Mechanical retention

In cases of large defects involving half of the face additional retention is needed beside the use of adhesives.

The use of eye glasses with elastic strap as an indirect mechanical retention to retain the prosthesis.

The magnets may be imbedded in a nasal or orbital prosthesis to retain it to the maxillary obturator.

C-Adhesives

The adhesives aid retention, marginal seal, border adaptation, and recures the prosthesis against accidental dislodgment. Generally, each material provides its own adhesive according to its physical and chemical properties.

D- Combination of anatomic, mechanical and adhesive retention:

In case of large facial replacements all available means of retention should be used to obtain better stability and retention.