Dear Dr. Phan, I will ask my questions on the open forum, in case anyone else can benefit from them.

I have decided to delay any decision about getting crowns for more firm attatchment of my obturator. My prosthodontist is ok with that. Now we must make the obt. work as well as possible. I have no teeth or maxilla remaining on the right side, beyond the lateral incisor.

My obt. is built on a metal framework, and the clasps surround three molars on the right side, and a small clasp hugs the lateral incisor at the surgery site.

There is considerable movement in the obturator. I find myself "playing" with it much of the time, moving it up and down off my palate. Is this looseness to be expected?

My speech is also much too nasal to be acceptable. It was much better with an older obturator. What is the cause of this. There is also leakage of liquids.

I will go back to my prosth. on Thursday for more refinements. I don't want to be unreasonable, but this is not satisfactory yet.

Thanks for any advice you have.

Hi Colleen,

If your interim obturator has given you acceptable functioning, then you should get the same or better results with the definitive obturator. The definitive obturator has the metal framework that allows the prosthesis to seat better on the teeth and reduce movements since it has design features to enhance retention and stability during function. Since I cannot see your prosthesis I can't determine why it is loose but I can offer you some possible causes. Please note that you may NOT have any of these problems on your appliance. You should ask your prosthodontist on why it is loose. If the wires on the framework do not engage in specific areas of the abutment teeth, then you will not get acceptable retention (prosthesis drops down too easily). Another possible cause is inadequate numbers of clasps or in the worse possible case, the framework does not fit well. You should also remember that the final prosthesis is heavier than the interim so weight do play a role too. Regarding nasality of the speech, it can be due to the height and the shape of the bulb. Too high will result in air blockage and your speech will sound like you have a cold. Too low will cause nasal air to escape along the periphery causing your speech to be hypernasal (like you are talking without the obturator). The key in getting the satisfactory definitive prosthesis is to duplicate what you have with the interim. What I do is to use soft reline material to work on the bulb and then have lab tech converts into hard acrylic ONLY after everything is satisfactory. Your leakage of fluids means that there is an air leak somewhere. You should also know that in some cases, you will have leakage of fluids that cannot be resolved with the definitive obturator that was not a problem before with the provisional! That is because of the hard plastic material used in the final appliance. Hard plastic does not lend itself to work into the "nook and cranies" well to seal them while soft material can "negogiate" into the defects and thus provides adequate seal. It is not uncommon to use the soft reline material on the final appliance and change it every three months since the material degrades overtime.

Working on the obturator requires patience from you as well as your prosthodontist. Replacing living moving tissues with artificial means is no simple task and that will require lots of trial and error. Each maxillofacial defect is different and even for seasoned prosthodontists, it make take a while but eventually both of you will get there.

I discover this thread by accident so if you or anyone put a topic that would like my input, please email me with the link so I know that they exist. If I can be of further help, please let me know. DP