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This one is about: Opinions on Obturators by Dr. John Liu

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Opinions on Obturators
John Liu, DDS, comments on a parents questions
Dental Consultant, Wide Smiles

I've had a lot of experience with obturators before I left Loma Linda and moved to the Seattle area. Here is what we use to do at Loma Linda and what I thought of it: 

1. We placed an obturator on unilateral complete cleft lip and palate children.

2. Impression for the obturator was taken while the child was asleep in the operating room getting ready for their first lip repair/adhesion surgery.

3. (The child at this point is only 4-6 weeks old.)

4. The obturator or molding plate, is placed later that evening while the child is still in the hospital recovering from the surgery.

5. A new impression is taken when the child has the definitive lip repair, usually done when the child is 6-7 months old. A new molding plate or obturator is made if the old one is not fitting well or has been lost.

6. At age 14 months, the palate is closed and the molding plate or obturator, is no longer needed.

This method is was used by Loma Linda as well as the team at St. Louis' Children's Hospital. We called it a molding plate rather than an obturator. This is because the primary purpose of the appliance is to keep the two halves of the mouth from collapsing inward and to allow the front portion of the cleft, to come closer together.

As young as the child is, this appliance is not intended to improve speech. A side benefit is that most of the children with the molding plates, are able to feed easier.

Not every team uses this appliance. Techniques vary around the country and between doctors. There is no right or wrong way of doing things. Some have been shown to work better than others and some doctors can do miracles 
without much help. But as to the danger of taking impressions, it can be dangerous if the person taking it is inexperienced and attempting to do it with the child struggling. That is why I use to do it while the child was 
asleep in the operating room. Obviously, I wouldn't advocate putting a child to sleep just to take impressions. But, since the child is under a general anesthetic for a plastic surgery procedure, why not take advantage of it and take the impression then? Often, ENT will place PE tubes at the same time as well. This is why a team approach can be so beneficial.

I hope that this is helpful. There will be an article on appliances in a future issue of Wide Smiles I understand. I sent a copy of an article I co-wrote with Dr. Don Huebner of St. Louis to Joanne in preparation for such a article.

John R. Liu, DDS
Dental Consultant, Wide Smiles

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