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Bland-Altman analysis of maxillary obturator bulb accuracy in class III Brown classification maxillectomy defects
Shady M El Naggar1, Mohamed Adel Youssef Abdelsalam2, Youssef M Eissa3
1Assistant Professor of Removable Prosthodontics, Faculty of Dentistry, Benha National University, Obour City, Egypt.
Statement Of Problem:
Maxillofacial tumor resection leads to major functional and esthetic issues that adversely affect patients' quality of life. Obturators have been used to manage issues such as hypernasality and fluid leakage. However, their adaptation to maxillary defects and patient comfort requires further study. Understanding how material composition influences obturator retention, durability, and long-term satisfaction is essential for optimizing prosthetic design.
Purpose:
The purpose of this nonrandomized, self-controlled study was to compare the accuracy and patient satisfaction of polymethyl methacrylate (PMMA) bulbs on metal frameworks and flexible injection-molded resin bulbs.
Material And Methods:
Two obturator types were evaluated. Type PMMA-BMF used PMMA bulbs on metal frameworks, while Type FIMR used flexible injection-molded resin bulbs. Adaptation was assessed using 3-dimensional (3D) scanning and superimposition techniques, with root mean square (RMS) values and average positive and negative deviations as key metrics using the Bland-Altman analysis of agreement with bias ±standard deviation calculated and plotted (95% limits of agreement). Patient satisfaction was evaluated using the obturator functioning scale (OFS) domains.
Results:
Type PMMA-BMF obturators showed significantly higher RMS and average positive and negative deviations than Type FIMR (P<.001), indicating a less precise fit. The Bland-Atman analysis demonstrated strong agreement between the 2 material types. The limits of agreement were narrower for nondefect sites (0.93), suggesting stronger agreement in these areas than between defect sites (2.55) and obturator bulbs (4.84). Type FIMR showed better statistically significant OFS scores regarding all domains and overall than Type PMMA-BMF (P<.001).
Conclusions:
Type FIMR obturator offers better fit, stability, and patient satisfaction than Type PMMA-BMF. It also improves speech, mastication, and esthetics, highlighting its potential benefits. Further research should address issues such as improving patient outcomes.
