BLACK

SUMMARY 3. Academy of Denture Prosthetics. Principles, concepts, and practices in

prosthodontics-1989. J PROSTHETDENT 1989;61:88-109.
A technique for fabrication of a gated surgical prosthesis 4. Frame RT, King GE. A surgical interim prosthesis. J PROSTHETDENT
to allow for immediate obturation of the dentate patient is 1981;45:108-10.
5. Desjardins R. Early rehabilitative management of the maxillectomy
described. This proskhesis offers a wide range of stabilizing patient.J PROSTHETDENT1989;61:344-5.
options and provides a simpler, smoother transition be- 6. Huryn JM, Pire JD. The maxillary immediate surgical obturator pros-
tween wire-stabilized and removable obturation. thesis.J PROSTHETDENT1989;61:344-5.

Rep&t requests to:

REFERENCES DR. WILLIAM&BLACK
1. Cancer facts and figures, 1988. The American Cancer Society, New SCOTT&WHITE CLINIC
Z~OISOUTH~UTSTREET
York, 1988.
TEMPLE,TX 76508
2. Gainsford JC, ed. Symposium on cancer of the head and neck, ~012. St
Louis: CV Mosby, 1969:101-3.

A foam impression technique for maxillary defects

J. Schmaman, BDS, MDent,a and L. Carr, BDS, MDentb
University of Witwatersrand, Johannesburg, South Africa

This article presents a technique used to overcome the problems of withdrawal of

maxillectomy defect impressions with or without limited space as the result of
trismus.(J PROSTHET DENT 1992;68:342-4.)

aSpecialist/Lecturer,
bSenior Specialist/Senior
Department
Lecturer,
of Prosthetic
Department
Dentistry.
of Prosthetic
U se of the established impression techniques of re-
cording maxillary defects can result in various problems for
Dentistry.
B&W37619 the clinician. Many maxillary defects are characterized by
a cleft or opening that is smaller than the width of the na-
sal cavity (Fig. 1). A common problem in recording maxil-
lectomy defects is the presence of large undercuts, which
create difficulty in withdrawing the impression. Impression
material that is too rigid can traumatize the tissue on re-
moval, but more elastic materials, such as irreversible hy-
drocolloids, often tear. This is particularly true when a
composite prosthesis requires a section that projects into
the nasal cavity. An additional problem in certain patients
is trismus, which limits access to the defect.
A few impression techniques are mentioned in the liter-
ature. Luebkel describes a sectiona tray for use in patients
with trismus. Beumer et aL2 advocate a method in which
the impression is refined with modeling plastic, a soft
flowing wax, and an elastic impression material to record
the defect. Carl3 indicates the need for adhesives and un-
dercuts that add additional alginate to a set impression
when necessary.

TECHNIQUE
1. An intraoral primary impression of the maxilla and the
entry to the defect is taken in the conventional manner
with irreversible hydrocolloid.
2. A special tray is fabricated on the cast of the residual
maxillary structures. A mushroom-shaped acrylic resin
retention-relocating button is added to the special tray
Fig. 1. The defect. (Fig. 2 [blue]).

342 AUGUST 1992 VOLUME 68 NUMBER 2

FOAM IMPRESSIONS FOR MAXILLARY DEFECTS

Fig. 4. Withdrawing the impression.

Fig. 2. Special tray and siliconerubber impressionin po-

sition.

Fig. 5. Impression ready for casting.

sidual structures, including the perimeter of the defect,

Fig. 3. Injecting foam with modified syringe and nipple.
3. A 20ml disposableplastic syringe ismodified to received
a latex feeding nipple (Fig. 3). The tip of the nipple is
cut to widen the aperture to approximately 5 mm.
4. The nasopharynx and orifices within the defect are
blocked with petrolatum gauze.
5. Pressurepoints and extensionsof the custom tray are
adjusted with a pressure-indicatingmaterial.
6. After adhesiveis applied to the tray, siliconerubber im-
pressionmaterial is loaded onto the tray; the retention-
relocating button is excluded. An impressionof the re-
is taken in the normal manner (Fig. 2 [black]).
7. The impressionis withdrawn and is checked for detail
and extension. Any material that hascrept onto the re-
tention-relocating button is removed with a scalpel
blade. The tray with the rubber impressionis replaced
in the mouth and is held securely in position. The
patient is instructed to breathe through the mouth dur-
ing the next procedure.
8. The plunger is removed from the syringe and the nipple
is folded to prevent leakagewhile the syringe is being
loaded. The desiredvolume (3 ml) of Silastic Foam liq-
uid (Silastic Foam Dressing,Dow-Corning Medical S.A.,
Valbonne, France) is poured into the syringe. Catalyst
is added according to the manufacturers instructions,
and the material is rapidly and thoroughly mixed with
a thin spatula.
9. The plunger is replaced and the nipple is inserted into
the nostril that is continuous with the defect. The foam

THE JOURNAL OF PROSTHETIC DENTISTRY 343

 SCHMAMAN AND CARR

is rapidly injected through the nostril into the nasal
cavity, and the syringe is removed (Fig. 3).
10. The defect and nasal cavity are filled when the foam,
which expandsto four times its original volume, exudes
from the nostril. After setting is complete, this excess
foam is removed with scissors.
11. The tray with the rubber impressionis removed from
the mouth, and the retention-relocating button is
withdrawn from the extremely elastic foam.
12. The foam impressionis removed by inserting a finger
into the nostril and pushing the foam downward into
the oral cavity and by simultaneously,pulling the foam
from inside the oral cavity out through the mouth. The
foam disengagesfrom the undercuts (Fig. 4).
13. The foam impressionof the defect is relocated onto the
acrylic resin button and is luted with sticky wax (Fig.
5).
14. To fabricate a cast, the foam is initially painted with
a thin coat of stone to give it rigid support. When this
stone layer has set, the cast is poured in the conven-
tional manner.
conventional impressionmaterials do, it can be usedwith
success.The advantagesof this technique are that the im-
pressioncan be easily removed from severeundercuts and
that it is easierto remove when trismus is present.
A disadvantage of this technique is that the rapid reac-
tion of the foam liquid to the catalyst limits the time in
which the operator can perform the procedure.
This technique can be modified and used in other situ-
ations.
REFERENCES
1. Luebke RJ. Sectional impression tray for patients with constricted oral
opening. J PROSTHET DENT 1984;52(1):135-7.
2. Beumer III J, Curtis TA, Firtell DN. Maxillofacial rehabilitation. St.
Louis: The C.V. Mosby Company, 1979:221-6.
3. Carl W. Preoperative and immediate postoperative obturators. J PROS-
THET DENT 1976;36(3):298-305.
Reprint requests to:
DR. J. SCHMAMAN
DEPARTMENT OF PROSTHETIC DENTISTRY
UNIVERSITY OF WITSWATERSRAND, JOHANNESBURG
PO WITS 2050
SOUTH AFRICA

Although the foam doesnot yield the sameaccuracy as

344 AUGUST 1992 VOLUME 68 NUMBER 2