Volume 10, Issue 10, October – 2025 International Journal of Innovative Science and Research Technology

ISSN No: -2456-2165 https://doi.org/10.38124/ijisrt/25oct1575

Fabrication of an Interim Obturator for a Patient

with a Maxillary Defect and Restricted Mouth
Opening
Khaleel1; Sanjaygouda B. Patil2; Kiran Kumar H. S.3; A. H. Shoeab khan4;
Nivedha S.5; K. Aishwarya6; Chilakala Ravallika7; Prashant kumar8
1,2,3,4,5,6,7,8
Sri Hasanamba Dental College & Hospital

Publication Date: 2025/11/14

Abstract: Maxillectomy defects can lead to oroantral communication, causing difficulties with chewing, swallowing, speech, and
facial appearance. Prosthodontists play a crucial role in rehabilitating such defects using obturators1. The fabrication of an
interim obturator with acrylic framework for a patient who had an acquired maxillary defect. In this clinical report, the patient
with very limited mouth opening and an alternative impression making was done, retention was achieved by utilizing the
remaining teeth, employing one circumferential clasp on the right lateral and two ball end clasp on canine and first premolar.
A complete palate was designed to ensure optimal load distribution to the surrounding tissues.

Keywords: Palatal Defect, Obturator, Definitive Obturator, Partial Maxillectomy, Prosthodontics.

How to Cite: Khaleel; Sanjaygouda B. Patil; Kiran Kumar H. S.; A. H. Shoeab khan; Nivedha S.; K. Aishwarya; Chilakala Ravallika;
Prashant kumar (2025). Fabrication of an Interim Obturator for a Patient with a Maxillary Defect and Restricted Mouth Opening.
International Journal of Innovative Science and Research Technology,10 (10), 3192-3196.
https://doi.org/10.38124/ijisrt/25oct1575

I. INTRODUCTION A prosthesis used to close a palatal defect in a dentate or

edentulous mouth is referred to as an obturator. An obturator is
The maxilla is a vital component of the craniofacial a well-documented, time-tested, and cost-effective method for
skeleton, playing a key role in mastication, deglutition, speech, restoring such defects, especially when surgical reconstruction
esthetics, and facial harmony. Surgical resection of the maxilla, is contraindicated or delayed. Obturators are typically classified
commonly performed for the management of maxillary tumors, into surgical, interim, and definitive types, depending on the
trauma, or infections such as mucormycosis, often results in a stage of healing and the nature of the defect. The interim
communication between the oral and nasal cavities.1 This obturator is fabricated and delivered after initial wound healing
anatomical discontinuity leads to severe functional and and before definitive prosthesis fabrication, serving as a
psychological impairment including nasal regurgitation of food transitional prosthesis that restores function, supports tissue
and fluids, hypernasal speech, impaired mastication, and facial healing, and maintains the contours of the defect site.
disfigurement. The resulting defect not only compromises oral
functions but also impacts the patient’s self-esteem, social However, the fabrication of an obturator can be
interactions, and overall quality of life. 2 particularly challenging in patients presenting with restricted
mouth opening (trismus). Limited inter-arch space restricts
Maxillary defects are created by surgical treatment of proper access for impression making, tray insertion, and
benign or malignant neoplasms, congenital malformation and prosthesis placement, often resulting from postoperative
by trauma. Rehabilitation of such defects aims to restore the scarring, fibrosis, or radiation therapy. 5 Conventional
separation between the oral and nasal cavities, regain normal impression techniques using standard trays become impractical,
oronasal function, and re-establish facial esthetics.3 The size necessitating modifications in approach and material selection.
and location of the defects influence the degree of impairment In such situations, sectional impression techniques, flexible
and difficulty in prosthetic rehabilitation. Lack of support, trays, and sectional obturator designs have been advocated to
retention, and stability are common prosthodontic treatment overcome these limitations.6
problems for patients who have had a maxillectomy4.

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Volume 10, Issue 10, October – 2025 International Journal of Innovative Science and Research Technology
ISSN No: -2456-2165 https://doi.org/10.38124/ijisrt/25oct1575

The primary objectives in managing such cases are to  Acquired tooth loss, and
achieve an accurate impression of the defect and supporting  A suboptimal maxillary obturator causing oroantral
tissues, ensure proper fit and comfort of the prosthesis, and communication during eating.
restore essential oral functions while accommodating the
restricted access. The interim obturator not only restores The primary treatment goal was to close the
immediate function but also conditions the soft tissues and communication between the oral and nasal cavities using an
helps the patient adapt psychologically and functionally before interim obturator, thereby preventing the uncontrolled passage
the delivery of the definitive prosthesis.7 of food, liquids, and air between the two cavities. Following
this, a removable partial obturator for the maxilla was planned
This article presents a clinical case detailing the step-by- to restore function and esthetics.
step fabrication of an interim obturator in a patient with a
maxillary defect and restricted mouth opening. The report  Treatment Procedure
highlights the challenges encountered in impression making Considering the patient’s functional and esthetic needs, a
and prosthesis design, as well as the innovative modifications partial obturator for the maxillary arch was planned. The
adopted to achieve functional and esthetic rehabilitation. The restricted mouth opening made impression making difficult,
clinical outcome emphasizes the importance of individualized and the tissues on the operated side were taut and lacked normal
treatment planning and the adaptability of prosthodontic flexibility, which complicated the insertion of stock trays.
techniques in managing complex maxillofacial
rehabilitation cases. The maxillary impression was made in two steps. First,
baseplate wax was softened in warm water (41°C) and adapted
II. CASE REPORT to the maxillary arch to record the basic anatomy. After
applying tray adhesive to the wax, elastomeric impression
An 84-year-old female patient was referred to the material (medium and light body, SPEEDEX) was used to
Department of Prosthodontics, Sri Hasanamba Dental College capture the final details, including the depth and width of the
and Hospital, Hassan, Karnataka, with a chief complaint of defect area (Figure 4). The impression was poured using Type
leakage of fluids and food accumulation through the nose while IV dental stone to obtain a definitive cast.
eating and drinking.
The maxillary cast was duplicated for future reference.
The patient had a history of left partial maxillectomy and The study cast was surveyed to determine the design of the
segmental mandibulectomy with PMMC flap reconstruction, acrylic framework and clasp assembly. Undercuts were blocked
followed by radiation therapy two years ago, due to squamous out using modeling wax. After wax-up of the prosthesis and
cell carcinoma of the left maxillary sinus. clasp adaptation, dewaxing was performed (Figure 5). The mold
was packed with heat-cure acrylic resin, and the prosthesis was
Extraoral examination revealed gross facial asymmetry on processed and finished with a bulb extension for the obturator
the left side as a result of the partial maxillectomy (Figure 1) (Figures 6 and 8).
and segmental mandibulectomy. The patient also presented
with restricted mouth opening (1.4 cm) due to fibrosis of the The obturator was inserted into the defect and checked for
masticatory muscles (Figures 2 and 3). comfort and retention (Figure 9). The patient was instructed on
home care and prosthesis maintenance. She was advised to
Intraoral examination revealed a surgical defect on the left gently clean the wound area using a cotton swab soaked in 5%
side of the hard palate resulting from the left maxillectomy. Betadine solution and to clean the intaglio (tissue-contacting)
According to Aramany’s classification of maxillary defects, the surface of the prosthesis once daily.
defect was categorized as Class IV (Figure 4). The gingiva on
the intact side appeared swollen and erythematous with A post-insertion follow-up was scheduled three days after
generalized gingival recession. The remaining maxillary teeth insertion. At this appointment, the surgical area was evaluated
(12, 13, 14, and 15) exhibited plaque accumulation and blackish for tissue health, and necessary adjustments were made to
stains. relieve any pressure areas and to ensure proper fit. Emphasis
was placed on maintaining hygiene and following home care
The mandible was completely edentulous, and a left instructions. The patient was subsequently placed on a three-
segmental mandibulectomy was noted. month recall schedule for evaluation, maintenance, and
monitoring for any signs of recurrence.
 The Diagnosis Included:

 An acquired palatal defect resulting from surgical tumor

resection,
 Generalized plaque-induced gingivitis,

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Volume 10, Issue 10, October – 2025 International Journal of Innovative Science and Research Technology
ISSN No: -2456-2165 https://doi.org/10.38124/ijisrt/25oct1575

Fig 4 Intraoral view of Maxilla Showing the Site of Defect.

Fig 1 Preoperative View of Patient.

Fig 2 Neck View of Patient. Fig 5 Primary Impression of Maxilla.

Fig 3 Extra Oral View Showing Restricted Mouth Opening. Fig 6 Maxillary Master Cast

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Volume 10, Issue 10, October – 2025 International Journal of Innovative Science and Research Technology
ISSN No: -2456-2165 https://doi.org/10.38124/ijisrt/25oct1575

Fig 7 Polished Surface of Finished and Polished Prosthesis. Fig 8 Intaglio Surface of Finished and Polished Prosthesis.

Fig 9 Intra Oral View of Maxilla Before and After Placement of Obturator

III. CONCLUSION of such defect but obturators have been used commonly is most
of the patients. This clinical case report describes a method for
Rehabilitation of patients who have undergone surgical prosthetic rehabilitation of a patient with squamous cell
oncology procedures or trauma is a challenging task to carcinoma of the maxilla following partial maxillectomy with
rehabilitate as the treatment should address both functional and restricted mouth opening. Rehabilitation with obturator
aesthetics aspects of head and neck region. Maxillofacial prosthesis restored the separation between the oral and nasal
prosthodontist, as a member of interdisciplinary oncology team cavities, enabling the patient to swallow, masticate, supporting
plays a pivotal in the prosthetic rehabilitation of maxillofacial the soft facial tissues and reestablishing speech.
defect. Many devices have been fabricated for the rehabilitation

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Volume 10, Issue 10, October – 2025 International Journal of Innovative Science and Research Technology
ISSN No: -2456-2165 https://doi.org/10.38124/ijisrt/25oct1575

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