Prosthodontic management of palatal defects is fundamental to improve patient’s life undergoing to a maxillary surgical treatment.

Definition of palatal defects

The palatal defects represents the outcome of surgical intervention in maxilla or problems in palatal area. It might show as:

Palatal defects in orthodontics

Palatal defects may occur as a result of trauma, infection, or surgery. They may affect the palatal bone, the hard palate, the palatal mucosa, or the palatal muscles.

Palatal defects in Prosthodontics

The palatal defects include cleft lip and palate, congenitally missing teeth, and other causes like trauma, inflammations, and tumors.

The management of palatal defects is not a simple task. Prosthodontists play an important role in providing rehabilitation for these patients. The oral rehabilitation of these patients include prosthetic rehabilitation (removable or fixed), craniofacial surgery and orthodontic therapy.

The management of palatal defects includes custom made prosthesis, fixed prosthesis (fixed palatal obturator), prosthetic obturator (removable), and orthognathic surgery.

In custom made prosthesis, the obturator is fabricated using metals or acryl. These prosthetics are removable and light weighted.

Fixed prosthesis (fixed palatal obturator) is sometime indicated for patients with severe palatal defects. These prostheses are fabricated using metals, acrylic, or teflon, and they are fixed to the edentulous ridge using implants.

Prosthetic obturator obturator is fabricated using acrylic and is fitted over the ridge of the edentulous mouth. This obturator is removable and light weighted.

Orthognathic surgery is the other treatment modality for palatal defects. Orthognathic surgery is required for patients with severe palatal defects

Palatal defects in Maxillo-Facial Surgery

During maxillary surgical treatments, the palatal mucosal flap may be deficient. The palatal defect may be partial or total. The clinician must correct the palatal defect to restore the patient’s function and esthetics.

A partial palatal defect may occur from surgical trauma, or it may be a natural or developmental variation. A partial defect may be treated with a flap closure, or as a graft. A graft may be harvested from the patient’s palate, or from a donor site. A palatal graft is sutured to the recipient site, and is held in place with sutures.

A total palatal defect occurs when the entire palate is deficient. This occurs as a result of trauma, or from cancer resection. A total palatal defect may be treated with a soft tissue palatal reconstruction. A soft tissue procedure uses local soft tissue flaps to restore or reconstruct the palatal defect.

The palatal soft tissue reconstruction includes the palatal lining and the palatal musculature. The palatal lining is restored by transferring it from an intraoral donor site, or from an allograft. The palatal muscular layer is restored by transferring it from an intraoral donor site, or from an allograft.

The displaced palatal mucosa is sutured to the recipient site, with resorbable sutures. The transferred palatal lining is sutured to the recipient site, with resorbable sutures

Palatal defects in Speech

Palatal defects can be associated with phonetic and articulation problems. The phonetic disorders can be categorized in:

1. Palatal defects:

- Nasal air emission

- Lateralized velopharyngeal incompetency

Palatal defects in Dental Implantology

Palatal defects can occur during a maxillary surgery due to the removal of alveolar bone, the soft tissue or the palatal bone. When these palatal defects are due to the palatal bone, the palatal bone is reconstructed using an autologous graft or a bone block graft. When these defects are due to the soft tissue, the soft tissue is reconstructed using a palatal flap or a connective tissue graft.

In case of palatal bone defects, an autologous bone block graft is preferred for its osteogenic, osteoinductive, osteoconductive and osteoprogenitric properties. The autologous bone graft can be obtained either from the iliac crest or from the chin. The iliac bone block graft is preferred more because the chin graft only presents a bone block with cancellous bone, while the iliac crest presents a block with cortical and cancellous bone.

The iliac crest graft is practically carried out using 4 steps:

1. The incision of the iliac crest is done using a crestal approach.

2. Then, the soft tissues are dissected and the periosteal elevator is inserted under the periosteum.

3. The bone block graft is then harvested using a chisel.

4. Finally, the graft is inserted into the intraoral cavity.

Palatal

Palatal defects are surgically developed through surgical procedures, such as maxillary sinus elevation or maxillary tuberosity advancement.