Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 6

Details

Plan, design and manufacture a custom medical device for a patient requiring maxillary obturation using osseointegrated implants

Discuss the long-term treatment options for the case with a Consultant in restorative dentistry

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What are the advantages and disadvantages of implant-retained obturators?
• What intermediate and long-term treatment considerations need to be discussed with the consultant?
• What will you learn about the planning and surgical considerations for using osseointegrated implants in maxillary obturation?
• How will you integrate the implant placement into the obturator design?
• What are the key factors to discuss regarding long-term maintenance and potential complications?
• Have you reviewed the principles of maxillary obturation and the use of osseointegrated implants in prosthetics?
• Have you discussed implant-retained obturator design with experienced maxillofacial prosthetists and restorative dentists?
• Have you prepared questions for the consultant regarding long-term treatment options

In action

• During the planning, design, and manufacture of the implant-retained maxillary obturator, are you paying close attention to the interplay between the osseointegrated implants and the prosthetic component? What immediate design and manufacturing decisions are you making to ensure secure retention, adequate sealing, and patient comfort? Are you consciously integrating your knowledge of implant dentistry and obturator design as you proceed?
• Is your planning process effectively addressing the surgical placement of the implants and the subsequent obturator design? Are you facing any challenges in achieving a precise fit and stable retention of the obturator on the implants? What immediate insights are you gaining into the biomechanics and functional requirements of implant-retained obturators? How does this activity build upon your understanding of maxillary defects and osseointegration?
• If you encounter difficulties in achieving adequate obturator retention or sealing around the implants, what alternative design features or manufacturing techniques are you considering in real-time? Do you need to seek advice from implant surgeons or experienced prosthetists regarding the optimal design? Are you ensuring that your design and manufacturing adhere to relevant clinical standards and your level of training?

On action

• Describe the planning and design considerations for the maxillary obturator in conjunction with osseointegrated implants. Describe the manufacturing process of the custom medical device. What were the key aspects discussed with the Consultant in restorative dentistry regarding long-term treatment options? How did the planned device integrate with the osseointegrated implants?
• What specific skills or knowledge did you develop or improve in planning, designing, and manufacturing maxillary obturators using osseointegrated implants? What did you learn about long-term treatment options for maxillary defects and the role of osseointegrated implants? Were there any unexpected challenges or successes during the process or the discussion with the consultant? What did you learn from these? How did the discussion with the consultant influence your understanding of the case?
• What areas for continued development have you identified in the creation of implant-retained maxillary obturators and multidisciplinary treatment planning? How can you apply the knowledge and skills gained to future cases requiring similar treatment? What resources or support might you need to further develop in this area?

Beyond action

• Have you revisited experiences with implant-retained maxillary obturators? How has your understanding of the surgical-prosthetic interface and long-term management evolved?
• How have these experiences impacted upon your current practice in obturator design or the use of osseointegration? Have you become more aware of restorative dentistry perspectives?
• How might these experiences contribute towards your future practice in managing complex maxillary defects or collaborating with restorative specialists? What did you learn about obturator mechanics and implant integration?

Relevant learning outcomes

#	Outcome
# 1	Outcome Deliver quality patient centred care with the best interests of patients in all elements of practice.
# 2	Outcome Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance.
# 3	Outcome Communicate effectively with patients, relatives, healthcare professionals and other stakeholders.
# 4	Outcome Identify patients who need further specialist support and refer to the appropriate healthcare specialist.
# 5	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 7	Outcome Prepare surgical treatment plans for complex head and neck surgery.
# 8	Outcome Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	Outcome Practice in partnership with other clinical specialisms as part of a multidisciplinary team and understand their roles and their impact on patient care and pathway.
# 10	Outcome Apply the principals of a quality management system to their professional practice.
# 12	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.