My obturator does not fit. What can I do?

Dear Sigmund Freud,

I understand that you are experiencing difficulties with the fit of your obturator. An ill-fitting obturator can cause discomfort, pain, and problems with speech and eating. I will outline a step-by-step treatment plan to address this issue.

Initial Consultation and Examination:
The first step is to schedule an appointment for a comprehensive examination. During this visit, I will assess the current state of your oral cavity, the condition of the existing obturator, and any changes in the anatomy that may have occurred since the last fitting.

Impressions and Molds:
If the examination reveals that the obturator no longer fits properly, we will take new impressions of your oral cavity. This will help us create an accurate model of your mouth, which is essential for crafting a well-fitting prosthesis.

Design and Fabrication:
Based on the new molds, we will design a new obturator. The design will take into account any specific needs you have, such as the precise location of the defect and the retention requirements. We will use modern materials that offer improved comfort and durability.

Fitting and Adjustments:
Once the new obturator is fabricated, we will schedule a fitting appointment. During this session, we will ensure that the obturator fits snugly and comfortably. We will make any necessary adjustments to achieve the best possible fit.

Follow-Up and Maintenance:
After the fitting, we will schedule follow-up appointments to monitor the obturator’s performance and make any minor adjustments if needed. Regular maintenance is crucial to ensure the longevity of the prosthesis and to prevent any discomfort.

Education on Care and Usage:
I will also provide you with instructions on how to care for your new obturator, including cleaning and handling practices. Proper care will help maintain its function and comfort.

Please be assured that my team and I are committed to providing you with the highest standard of care. We will work closely with you throughout this process to ensure that your new obturator improves your quality of life.

To proceed with the treatment, please contact my office to schedule your initial consultation. I look forward to assisting you with this matter.

Sincerely,

Prof. R. E.
University Vienna
(AI generated)

2024-02-06 20:09 Telekonsultation

Hans Pichler (1877 – 1949)
Head of the Maxillofacial Surgery Department
First Surgical University Clinic
(AI generated)

Dear Sigmund,

I understand that you are experiencing discomfort and difficulties with your obturator prosthesis. Let us address this issue with a systematic approach to ensure we provide the best possible treatment advice.

Step 1: Broad Differential of Treatment Advices

1. Adjustment of the existing obturator: This involves modifying the current prosthesis to improve fit and comfort.
2. Fabrication of a new obturator: Creating a new prosthesis that accounts for the changes in the maxillectomy cavity and the oral mucosa.
3. Surgical intervention: In cases where prosthetic solutions are insufficient, additional surgery may be considered to revise the contours of the surgical defect to better support a prosthesis.

Step 2: Reference to Patient Information

Given your history of multiple surgeries and the constant changes in the maxillectomy cavity, it is likely that the obturator has become ill-fitting due to tissue changes and healing. The evidence of repair palatal to the anterior teeth suggests that the prosthesis has undergone adjustments previously, indicating that the shape of the cavity has been changing.

Step 3: Narrowing the Differential

Considering the information provided, the following treatment advices are narrowed down:

1. Adjustment of the existing obturator: This is often the first line of management, as it is less invasive and can be done relatively quickly.
2. Fabrication of a new obturator: If adjustments are no longer sufficient due to significant changes in the cavity, a new prosthesis may be necessary.
3. Surgical intervention: This is less likely to be the first choice due to the invasiveness and your history of extensive surgeries.

Step 4: Further Reference to Patient Information

The fact that insertion of the obturator could only be achieved with great difficulty and that you continue to experience pain and inefficient obturation suggests that an adjustment or new fabrication may be necessary rather than surgical intervention.

Step 5: Treatment Advice

1. Fabrication of a new obturator: Given the ongoing changes in your oral cavity and the difficulties you’ve been experiencing, I recommend that we proceed with creating a new obturator prosthesis. This will be tailored to the current anatomy of your maxillectomy cavity and should provide better comfort and function.
2. Adjustment of the existing obturator: If a new prosthesis is not immediately feasible, we can attempt further adjustments to the existing obturator to improve fit and alleviate discomfort in the short term.

Please schedule an appointment at your earliest convenience so that we can take the necessary impressions and begin the process of fabricating a new obturator or adjusting the current one as needed.

Sincerely,

Hans Pichler
Head of the Maxillofacial Surgery Department
First Surgical University Clinic

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

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