Dr. Phan, you have a wonderfully perceptive nature, and you are able to cut to the heart of matters in a way that I have not experienced before. I have had excellent care, but I would have benefitted from your concise explanations and realistic approach. I wish that NM were closer to Louisiana!

I am thankful that you discovered this site and offered your services. There are not many persons on this forum who use obturators, but with more specific support available, I'll bet that there will be more before long.

Thanks.

I go to my prosthodontist tomorrow.....2 hours out of town, but not as far away as NM....and I will go better armed to make my final decision about the attatchments.

For my information: Do you often recommend pterygoid or zygomatic implants for securing obturators?

And.....do you see much reconstructive surgery of palatal and maxillary surgical defects? or do most such patients find satisfactory results with the obturator and opt not to undergo the reconstruction?

I think that my prosthodontist intends to place a bar behind the lateral incisor and the central incisor on that side, for double support of the appliance, so that the lateral incisor doesn't take the entire force.

I am concerned that it will take perhaps more force with the clip behind it than it does now, with the small wire hugging the side of the tooth.

Also....I am beginning to think that the lateral incisor...the one closest to the surgical excision site.....is becoming slightly discolored, though the periodontist says that roots look healthy. I don't know what that might mean.

Hello Colleen,

Although I have worked on obturators with zygomatic implants, I have yet to recommend this type of treatment to one of my patients. Thankfully, most of the patients that I have treated only had partial maxillectomy where the remaining teeth on the other side provide satisfactory retention of the obturator. The implants retained prostheses are reserved for cases where the patient is edentulous (no teeth remaining), has recieved total maxillectomy or the remaining teeth are not suitable for clasps or attachments.

Regarding the surgical repair of the palatal defects, I cannot comment on it much because it is outside of my expertise. I have seen a case with excellent surgical repair where the defect is small however. On large maxillary defects that have multiple teeth missing, prosthetic repair makes more sense since you can use the appliance as a foundation to restore missing teeth. By the time the patients are referred to me for prosthetic reconstruction, the surgical approach is no longer a high end option.

I can tell you that it is very rare to have a surgical reconstruction of extra-oral defects such as the ear or nose that are satisfactory. All surgical recontructions I have seen in my short career so far leave lots to be desired. An implant retained prostheses I believe is the best treatment in this particular case.

Discoloration of the lateral incisor can be caused by many factors. If you have decreased saliva output, the "washing" action by the saliva is decreased thus plaque or food particles tend to accumulate and thus changing the color of the tooth. Very common in people who drink lots of coffee or tea with decreased saliva output. Medications also play a role. Peridex (oral rinse) is known to cause moderate stain on the teeth. Another cause is necrosis of the pulpal tissue inside the tooth (nerve tissues dying). Your dentist can check for the tooth vitality with some simple tests. There are more causes of tooth darkening but those mentioned are more common causes. Let me know how your visit with your dentist goes. DP

Dear Dr. Phan,

I hope that you do not regret offering to advise us online!! I do not mean to take advantage of you, but I am very, very glad to have your input. Thanks very much for your generosity!

My visit with the prosthodontist today went well enough...I have decide to delay any decision to have my teeth crowned. Your advice about avoiding too firm an attatchment coincided with that of a cousin who is a retired dentist, with whom I conferred this morning. My prosthodontist was ok with this decision.

We will continue to work with fine-tuning this appliance with re-lining material, and when we feel that we have it finalized, he will re-bake it for permanence. (This is my definitive obturator, made on a metal framework.)

I will undoubtedly have more questions for you, but for now, I am feeling more secure in my decision about the crowns, thanks to your advice. The crowns will always be an option down the line.

As for reconstruction, my current surgical recovery has been so perfect that I hesitate to interfere with that. Also, the surgery is quite drastic, in my opinion, with no guarantee of success, and I simply can not consider that experience at this time.

Hello Colleen,

I am glad you are doing well. I am here to offer my opinion and perhaps people may find it useful. It is my pleasure to be at your service. DP