Maxillofacial Prosthetics and Geriatric Prosthodontics
Maxillofacial prosthetics and geriatric prosthodontics tests rehabilitation when anatomy, healing, or aging changes the rules. The board emphasizes obturator design, irradiated tissue, xerostomia, and realistic treatment planning.
Core rules
- A maxillary obturator restores the defect seal, support, and occlusion; extend into the defect but avoid pressure on healed flaps and use a hollow bulb to reduce weight.
- After radiation, tissue is poorly vascularized and friable; avoid traumatic impressions and minimize pressure.
- Xerostomia increases caries and Candida risk; prescribe fluoride, moisture replacement, and frequent recalls.
- In older adults, assess cognition, dexterity, polypharmacy, and nutrition before choosing a removable or fixed prosthesis.
- Denture stomatitis requires hygiene, antifungal care, and removal of nocturnal wear.
Worked example
A patient with a hemimaxillectomy needs an obturator. You record the defect with a resilient or sectional impression, design a hollow bulb, and use remaining teeth for support and clasping. Reasoning: the hollow bulb reduces weight and improves retention; tooth support protects the defect; the seal improves speech and swallowing.
Traps
Using a rigid impression in a trismus patient can injure tissue. Overextending the obturator into the defect causes pressure necrosis. A solid bulb is too heavy and displaces the prosthesis. Ignoring xerostomia leads to rampant caries. Treating a cognitively impaired patient with a complex removable design without caregiver support predicts failure.