Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

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I wish all success to your journal and look forward to sending you any suitable similar article in future"



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Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

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It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2010 | Month : February | Volume : 4 | Issue : 1 | Page : 2125 - 2128

Rehabilitation of a Hemimaxillectomy Patient with Innovative Interim Obturator Prosthesis – A Clinical Report

PRAKASH V*, GUPTA R**

*BDS, MDS, Reader Department of Prosthodontics I.T.S. Centre for Dental Studies & Research,Delhi-Meerut Road, Muradnagar, Ghaziabad, Uttar Pradesh, (India)**BDS, MDS ,Reader Department of Conservative Dentistry I.T.S. Centre for Dental Studies & Research,Delhi-Meerut Road, Muradnagar, Ghaziabad, Uttar Pradesh,(India)

Correspondence Address :
Dr. Vijay Prakash (MDS)Department of Prosthodontics,I.T.S. Centre for Dental Studies & Research Delhi-Meerut Road, Muradnagar, Ghaziabad, UttarPradesh (India)e-mail:drvjprakash22@yahoo.co.in,drruchigupta@rediffmail.com,Fax: 0091 -0123225380, 0123225381,Tel: 009899932210, 009810167164

Abstract

Rehabilitation of hemimaxillectomy patients can be challenging. The most common prosthetic treatment problem with such patients is, getting adequate retention, stability and support. The size and location of the defect usually influences the amount of impairment and difficulty in prosthetic rehabilitation. Obturator prosthesis is commonly used as an effective means for rehabilitating hemimaxillectomy cases. In cases of large maxillary defect, movement of the obturator prosthesis is inevitable and requires a form of indirect retention to limit the rotation of the prosthesis. This clinical report describes a modified labial flange as a means of indirect retention, to minimize the rotation of the obturator prosthesis. This approach adequately increases the retention and stability of the prosthesis.

Keywords

obturator, hemi-maxillectomy, modified labial flange

How to cite this article :

PRAKASH V , GUPTA R. REHABILITATION OF A HEMIMAXILLECTOMY PATIENT WITH INNOVATIVE INTERIM OBTURATOR PROSTHESIS – A CLINICAL REPORT. Journal of Clinical and Diagnostic Research [serial online] 2010 February [cited: 2019 Aug 25 ]; 4:2125-2128. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2010&month=February&volume=4&issue=1&page=2125-2128&id=628

Introduction
The intraoral defects in the maxilla are due to trauma, disease, pathological changes, radiation burns or surgical intervention. The defect may be small or it may include any portion of the hard and soft palate, the alveolar ridges and the floor of the nasal cavity. Post surgical defects in the maxilla result in hypernasal speech, fluid leakage into the nasal cavity and impaired masticatory function. The primary objectives in rehabilitating the maxillectomy patient are to restore the function of mastication, deglutition and speech and to achieve normal oro-facial appearance (1). The most common prosthodontic treatment problems with maxillectomy patients are lack of retention, stability and support. The size of the defect, the number of remaining teeth, the amount of the remaining bony structure and patient ability to adapt to the prosthesis are few factors which affect the prognosis of the treatment (2),(3). The complex anatomy of the midface and its endless potential for surgical or traumatic defect size, shape and location also presents with numerous possible configurations of treatment considerations.

Prosthetic rehabilitation is planned (4) depending upon the type of surgical defect and the relationship of the defect area to the remaining abutment teeth (5). Obturator prosthesis is commonly used as an effective means of rehabilitating partial or total maxillectomy patients. This type of prosthesis helps in separating the oral and nasal cavities to allow for adequate deglutition, speech, possible support of the soft tissue to restore the midfacial contours and acceptable aesthetic results (6),(7).

The movement of the obturator prosthesis is common and the degree of movement depends on the number and position of the teeth available for retention, size and configuration of the defect, the size, contour, and lining mucosa of the defect, height of the residual alveolar ridge and the availability of the undercuts. This movement of the prosthesis should be minimized in order to provide adequate retention, stability and support (7),(8). Retainers are one of the most important components contributing to the success of the obturator prosthesis. Selection of the type of retainer is based on the size, location of the defect and the number, position and periodontal status of the remaining teeth. Indirect retention components should be strategically positioned in order to minimize the movement of the prosthesis (9),(10).

In this clinical report, a hollow bulb interim obturator with a modified labial flange was used to restore speech, deglutition and normal orofacial contour for a patient with partial maxillectomy. There is no case in literature where this type of labial shield has been used as a means of achieving retention.

Case Report

Clinical Report
A moderately built 35 years old male patient reported to the Department of Prosthodontics, complaining of difficulty in speech and leakage of food and liquid from the oral cavity into the nasophaynx. The medical records of the patient revealed that he had cemento-ossifying fibroma of the right maxilla involving the maxillary antrum. He underwent right side extended maxillectomy one month ago. On examination, the right side of his face was found to be depressed inwards and gave an unaesthetic appearance. The patient had a large defect extending from right incisor region to the soft palate. He had Class 1 defect according to the Armany classification (Table/Fig 1). An obvious nasal twang was observed in the speech of the patient. The lower arch was completely dentulous. Considering the large palatal defect on the right side, a closed type hollow bulb interim obturator was planned. To enhance the retention, a labial flange on the left side was modified and was joined with the prosthesis by means of clasps.

The preliminary impression was made with irreversible hydrocolloid (Zelgan 2002, Dentsply India, Gurgaon, India) and a stone cast was poured from the impression. An acrylic resin base was fabricated and green stick compound (DPI Tracing sticks, Dental products of India, Mumbai, India) was used to properly record the tissue on the defect side, so as to achieve a proper peripheral seal. The final impression was made of silicone putty impression material (Aquasil, Dentsply/ Caulk, Milford, DE). The impression was boxed and the master cast was poured in type IV dental stone ( Ultrarock, Kalabhai Karson Ltd, Mumbai, India). The denture base was fabricated with self cure resin and occusal rims were made to record the jaw relation. After selecting the teeth (Cosmo HXL, Dentsply Ltd, Surrey, U.K.), denture try-in was performed in the conventional manner, as in the complete denture construction. On the unresected side, a ‘W’ shaped clasp was placed in the canine – premolar region. After verification of the jaw relation, the trial denture was sent to the lab for interim prosthesis fabrication. A closed type hollow bulb obturator was fabricated as a two step procedure. First, the open bulb was fabricated with the heat cure resin (Trevalon Hi, Dentsply India, Gurgaon, India), with a conventional method. Later, in the second step, the lid is sealed to the body of the bulb with an autopolymerising resin. A modified labial flange was fabricated in the canine premolar region (Table/Fig 2). The final prosthesis was inserted into the patient’s mouth and it was checked for proper palatal contour and peripheral seal (Table/Fig 3) . The patient was educated about the maintenance of the prosthesis and was recalled for regular post-insertion visits. Adequate retention, stability and support were observed on subsequent recalls. The patient’s normal swallowing ability was restored by the prosthesis and he was pleased with the dramatic improvement of speech and retention of the prosthesis.

Discussion

Acquired defects in the maxillae due to surgical resection result in a communication between the oral and nasal cavities, that causes difficulty in deglutition, speech and an unaesthetic appearance. Apart from this, it also results in psychological trauma to the patient. Small defects are usually closed by surgical means, but larger defects are often prosthodontically rehabilitated by obturators (11). Class 1 defect is a unilateral defect which is most commonly seen in maxillofacial rehabilitative practice. It represents the classic maxillary defect where the hard palate, alveolar ridge, and the dentition are removed to the midline (5).

This clinical report illustrates a class 1 defect which was rehabilitated by a closed hollow bulb obturator. The main objective was to decrease the weight and minimize the rotation of the prosthesis. Hollow bulb obturators help to reduce the weight of the obturator, to decrease pressure to the surrounding tissues and to aid in deglutition and to encourage regeneration of the tissues. The lightness of the obturator also does not cause excessive atrophy and physiological changes in muscle balance (1),(8).

The patterns of forces affecting the obturator prosthesis are complex because of their concurrent occurrence and mostly destabilize the prosthesis. These destabilizing forces need to be controlled by effectively and strategically positioning the indirect retainers. In the class 1 situation, the functional fulcrum line lies along the bony contours, next to the resected area and to provide maximum retention, the indirect retainer should lie in the premolar region. In this case, a modified labial flange was placed over the canine and premolars and was connected to the obturator by means of wire clasps. This provision in the prosthesis helped in minimizing the rotation of the prosthesis around the functional fulcrum line and also, it is easy to fabricate and greatly enhances the retention of the obturator.

Conclusion

The most challenging part in rehabilitating the patient with hemimaxillectomy, is to obtain adequate retention and stability. The modified labial flange on the unresected side not only improves retention, but also provides adequate stability to the prosthesis. This type of retention aid provides an easy option to achieve the primary objective of restoring the functions of mastication, speech and aesthetics.

Key Message

In cases of large maxillary defects, the rotation of the interim obturator around the functional fulcrum line can be minimized by providing modified labial flange in the canine- premolar region.

References

1.
Beumer J, Curtis TA, Firtell DN. Maxillofacial Rehabilitation. Prosthodontic and surgical considerations. C.V. Mosby Co., St Louis, Toronto. 1979 pp.183-243.
2.
Parr GR, Tharp GE, Rahn AO. Prosthodontic principles in the framework design of maxillary obturator prosthesis. J Prosthet Dent 1989; 62: 205-12.
3.
Desjardins R. Early rehabilitative management of the maxillectomy patients. J Prosthet Dent 1977; 38: 311-18.
4.
Taylor TD. Clinical maxillofacial prosthetics. Chicago: Quintessence Publishing; 2000.pp103-54.
5.
Aramany MA. Basic principles of obturator design for partially edentulous patients. Part 1: classification. J Prosthet Dent 1978; 40: 554-57.
6.
Desjardins RP. Obturator prosthesis design for acquired maxillary defects. J Prosthet Dent 1978; 39: 424-35.
7.
Wang RR. Sectional prosthesis for total maxillectomy patients: a clinical report. J Prosthet Dent 1997; 78: 241-44.
8.
Keyf F. Obturator prosthesis for maxillectomy patients. J Oral Rehab 2001; 28: 821-29.
9.
Aramany MA. Basic principles of obturator design for partially edentulous patients. Part II: design principles. J Prosthet Dent 1978; 40: 656-62.
10.
Dumbrigue HB, Fyler A. Minimizing prosthesis movement in a midfacial defect: a clinical report. J Prosthet Dent 1997; 78: 341-45.
11.
Zarb GA. The maxillary resection and its prosthetic replacement. J Prosthet Dent 1967; 18: 268-81.

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