Surgical procedures performed to improve the prosthetic prognosis in case of maxillary defects: a review of the literature

Aim The purpose of this review is to address the surgical procedures that need to be followed to obtain a maxillary defect that can be suitable to receive a prosthesis. Methods An extensive search of the literature was performed, on the databases of PubMed/Medline and Scopus, in addition to congress proceedings and books, written in English or Italian. Literature search was performed using combinations of the following keywords: (“obturator prognosis” OR “palatal obturator” OR “obturator prosthesis” OR “prosthetic prognosis”) AND (“maxillectomy” OR “maxillary defect”). Results 35 articles, 2 books and 3 congress proceedings were included. After the study of the records included in this review, it was found that surgeon must preserve the anterior maxilla as much as possible, because it is the most suitable site for the placement of implants. Furthermore, if the implant site is involved in post-operative radiotherapy, it is advisable to know the x-ray dose of such an exposition. The surgical cut should preserve mucosa and bone support around the tooth adjacent to the defect, and keratinized mucosa should cover the palatal margin of the defect Equally important is to prepare an adequate access to the defect, because the turbinates and the bands of oral mucosa may prevent the prosthesis from engaging key areas of the defect, impairing function. Conclusion A complete knowledge about the construction techniques and biological/mechanical principles of maxillofacial prosthesis is essential to perform surgical interventions that enhance the prosthetic prognosis.