Removable Palatal Augmentation Prosthesis

Removable Palatal Augmentation Prosthesis

Question. Define palatal lift prosthesis and write in detail about its fabrication and postinsertion instructions.
Answer:

Palatal lift prosthesis displaces the soft palate superiorly and posteriorly in order to assist the soft palate to affect closure with the peripheral pharyngeal tissues. The first prosthesis was made by Gibbons and Bloomer in 1958.

Palatal lift prosthesis  Uses

• Cleft palate, with palatal insufficiency and submucous cleft palate.
• Myasthenia gravis
• Bulbar poliomyelitis
• Cerebral palsy
• Injuries to soft palate (tonsillectomy, maxillary resections, etc.).

Read And Learn More: Complete Dentures Question and Answers

Palatal lift prosthesis Palatopharyngeal incompetence

Defined as having normal anatomy but ineffective or absent motor function is treated with a palatal lift.

• Palatopharyngeal insufficiency
• Is caused by abnormal anatomy and is treated with a pharyngeal bulb prosthesis or speech bulb.

Palatal lift prosthesis Advantages

• Gag response is minimized- due to superior positioning and sustained pressure of the lift portion of the prostheses against the soft palate.
• The physiology of the tongue is not compromised due to the superior position of palatal extension.
• Access to the nasopharynx for the obturator is facilitated.
• The lift portion can be developed sequentially to aid patient adaptation to the prostheses.

Palatal lift prosthesis Contraindications

• Inadequate retention for the basic prostheses
• The palate is not displaceable
• Uncooperative patient.

Palatal lift prosthesis Diagnostic tools

• Videofluoroscopy
• Nasal endoscopy and
• Air flow measurements.

Palatal lift prosthesis Requirements

Palatal lift prosthesis Positioning

• Position the weakened soft palate closer to the posterior pharyngeal wall
• Complete closure of residual muscle activity
• Maintain nasal airway
• Complete pharyngeal closure for speech and swallowing.

Palatal lift prosthesis Retention

• The primary requirement for a successful palatal lift is retention.
• The lift is a posterior extension cantilevered from a removable denture base, the ability to keep the base portion in the correct position is critical to success.

Palatal lift prosthesis Retentive aids

• Teeth mainly 1 and 2 molars
• Tissue undercuts
• Retentive undercuts on teeth created by adding composite or orthodontic brackets
• Complete denture.

Palatal lift prosthesis Fabrication

Palatal lift prosthesis Fabrication 1st Appointment

• Accurate hydrocolloid impression of both arches.
• An upper impression must extend at least 2 cm posterior to the fovea palatine.
• The cast is then surveyed and the ideal position of clasps is decided.

Palatal lift prosthesis Fabrication 2nd Appointment

• Lift generation
• A retentive loop should be made at the same plane as the hard palate with a relief at the posterior end of the lift portion extending approximately 2 cm.

Palatal lift prosthesis Fabrication Step 1

The oral portion with the loop is tried in the patient’s mouth to ensure complete seating, and
adjustments are made if necessary.

Palatal lift prosthesis Fabrication Step 2

• The modeling compound is applied to the loop, shaped, flamed to create a smooth surface, and then chilled before placing it into the mouth.
• The first edition of the compound should cover the loop evenly and extend several millimeters beyond.
• The patient is allowed to wear the prostheses for a few minutes at this stage, to familiarize with it.

Palatal lift prosthesis Fabrication Step 3

Small additions are made to the compound posteriorly until the soft palate is brought into light contact with the posterior pharyngeal wall.

Palatal lift prosthesis Fabrication Step 4

• Lateral pharyngeal closure. Reduction of hypernasality is achieved with the lateral extent of the lift.
• Addition of compound till there is a reduction in the size of lateral ports.
• With each addition, the patient is asked to breathe through the nose and attempt speech.
• Avoid the addition of compound on the oral side of the lift, which may induce a gag reflex if the posterior tongue comes into contact with the lift.

Palatal lift prosthesis Fabrication Step 5

• Assess improvement in speech. Ask them to say plosive sounds which increase intraoral pressure.
• Enlargement of the lift is stopped when the speech professional is satisfied with the result.
• Reduce the lateral aspect of the lift if the patient is unable to breathe, or if the downward force of the soft palate displaces the lift or the retentive limit of clasps has been reached.

Palatal lift prosthesis Fabrication Step 6

• The final step is to reduce 1-2 mm of the entire surface of the lift.
• Mouth temperature softening wax is applied in sufficient amounts to replace the lost compound.
• The lift is tempered and reinserted.
• The patient is asked to speak, swallow water, and move his head in all directions to form the wax.
• The lift is then removed after 5 minutes and examined for areas of excess pressure.

Palatal lift prosthesis Insertion and Patient Instructions

1. Confirm the effectiveness of the lift during the insertion appointment.
2. Check for excessive pressure with pressure-sensitive paste – reduce and polish areas of heavy pressure.
3. Check-up is done 2-3 days after delivery.
4. Check for mucosal irritation and relieve the areas.
5. If the lift completely occludes the nasal port, making the patient a mouth breather, the patient might prefer to wear it only during speech.
6. During eating – the usage of the lift is decided by the patient as many of them do not have a problem with food leakage.
7. Some do not tolerate the lift during eating as nasal airflow is necessary for the olfactory portion of taste.
8. The prostheses should be removed during the night.
   • To give rest to the tissues
   • To reduce the amount of time the abutment teeth are under orthodontic forces.