Maxillary obturators are used to close defects after maxillectomy surgery. This document discusses techniques for relining obturators using thermoplastic wax. It also addresses issues like preventing fluid leakage, engaging the nasal side of the soft palate, and extensions into orbital or pharyngeal defects. Traumatic defects pose additional challenges due to poor tissue quality and bone displacement. Obturators must be carefully designed and fitted to restore function.

1. Maxillary obturators
Trouble shooting, relines and other issues
John Beumer III, DDS,MS
Division of Advanced
Prosthodontics
UCLA School of Dentistry
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2. Relines
Thermoplastic wax is recommended
Principal advantage:
The clinician is less likely to make
impressions that inadvertently
displace tissues resulting in fewer post
reline adjustments.

3. Relines
Prosthodontic Procedures
The acrylic resin is cut back 1-2 mm.
Strategic undercuts are removed
Contours in the undercut areas are redeveloped
with dental compound
The impression wax is heated and painted onto
the surface of the obturator with a PIP brush
The prosthesis is inserted and the patient asked
to make eccentric mandibular movements.

4. Relines (cont’d)
If needed the velopharyngeal musculature is activated
After a few minutes, the prosthesis is removed and
proper tissue adaptation verified. If areas of the acrylic
resin are exposed, these areas are reduced further and
additional wax is applied.
During border molding and refinement of the impression,
occlusal relationships and the vertical dimension of
occlusion must be maintained.
The wax lined prosthesis is reinserted for 60-90 minutes
for further molding.
The reline impression is removed, chilled and processed
in autopolymerizing acrylic resin

5. Relines – Complete
Dentures and Obturator
Note the amount of acrylic resin
removed from the surface of the
obturator. The undercuts have been
removed and a finish line has also
been created.
Completed reline impressions
Note the extension onto
the nasal side of the soft
palate (arrow).

6. Relines – Complete
Dentures and Obturator
l This complete denture and obturator retained with a
single implant was relined with thermoplastic wax.

7. Relines – RPD with Obturator
l The obturator portion is aggressively reduced
by approximately 2 mm.
The completed reline in thermoplastic wax.

8. Relines – RPD with Obturator
l The reline impression is removed, carefully
inspected, flasked and the reline is
accomplished with autopolymerizing acrylic
resin.
A small extension onto the nasal side of the soft palate
will reduce leakage of fluids into the nasal passage.

9. Additional issues of interest
a) Unusual defects
b) Prevention of leakage
c) Engagement of the nasal side of the soft palate
during soft palate elevation
d) Obturators that extend to the posterior
pharyngeal wall
e) Relationship to the torus tubaris
f) Extensions into an orbital exenteration defect
g) Uplifting the orbital contents to eliminate double
vision
h) Lid or no lid
i) Hollowing the obturator bulb

10. Small Partial Palatectomy Defects
Impressions for RPD frameworks
l Small defects should be packed with gauze to avoid
impacting impression material into the defect

11. Partial Palatectomy Defects
v Junction hard palate – soft palate defects
To maintain seal, an extension (arrow)
must be developed which engages the
nasal side of the soft palate when the
soft palate elevates.

12. Partial Palatectomy Defects
v Anterior Defects
In these defects a scar band is
usually present at the junction
of the oral and nasal mucosa.
It is difficult to develop normal
lip contours in such defects
because of wound contraction.
The use of a skin graft
results in less wound
contraction and allows for
the development of ideal lip
contours and should be
encouraged.

13. Partial Palatectomy Defects
v Anterior defects Mounted casts showing
Master cast extent of the defect
The prosthesis is in position. It was
extended as far superiorly without
interfering with nasal breathing. The
mustache hid the deficient lip contours
secondary to contracture of the upper
lip.

14. Partial Palatectomy Defects
v Anterior defects

15. Traumatic Defects
These defects are difficult to restore. Why?
a) Poor quality mucosa lines the defect
b) Defects are irregular in size and shape
c) Scarring of tissues adjacent to the defect
d) Residual maxillary segments may be displaced
e) Misalignment of the mandibular dentition
complicate the occlusal relationships

16. Traumatic Defects
v A traumatic defect secondary to a gunshot wound
Note the poor quality mucosa lining the
defect, its irregular shape and the scarring of
tissues adjacent to the defect. Only the
maxillary second molar remains.

17. Traumatic Defects
A traumatic defect secondary to self inflicted
gunshot wound
Note the poor quality mucosa lines the defect its, irregular
shape and the scarring of tissues adjacent to the defect.
The residual maxillary segments are displaced and the
mandibular fragments are misaligned.

18. Traumatic Defects
Impressions
Mucostatic impressions made with a thermoplastic wax are
preferred. With this method the stability, retention and support
derived from the defect can by maximized.
An occlusal index is required when this method
of impression making is employed.

19. Traumatic Defects
The altered cast of the defect is shown. Before completing
the prosthesis the removable partial denture framework
needs to be physiologically adjusted very carefully to allow
for movement of the prosthesis secondary to the forces of
occlusion.

20. Traumatic Defects
Fortunately there was a significant undercut posteriorly and
laterally on the left side of the defect (arrows).
The solitary molar retained the prosthesis in the right posterior
region and engagement of the undercuts referred to above
facilitated retention posteriorly and on the left side of the defect.

21. Traumatic Defects
The molar had a useful life of 11 years after delivery
of the prosthesis after which time it was replaced
with a solitary osseointegrated implant with an “O”
ring attachment.

22. Prevention of leakage
l Most leakage occurs posteriorly at the midline. Liquids
accumulate in the bulb and spill out when the patient tips
their head forward, or they travel along the surface of the
palate and exit the nose anteriorly.
This extension is too short on the obturator on the left
(arrows). Solution – Increase the vertical height of the
posterior medial portion of the obturator (oval).

23. Prevention of leakage
v This small addition with Rim
Seal (ovals) was sufficient to
eliminate leakage in this
patient

24. Extensions onto the
nasal side of the soft palate
v Such an extension is necessary if the defect
During speech and swallowing, as the soft palate
elevates, contact with the obturator is maintained,
minimizing leakage of air and liquids.

25. Maxillectomy defects that extend to the
posterior pharyngeal wall in edentulous patients
l Challenge:
l Retention
l Accurate positioning of the velopharyngeal segment
Ramus imprint Velopharyngeal
extension
These obturators are very large, are subject to a great deal of
movement, and these patients need osseointegrated implants
to retain the obturator effectively.

26. Maxillectomy defects that extend to the posterior
pharyngeal wall in edentulous patients
Velopharyngeal extension
The velopharyngeal extension must fit precisely into the zone of
contraction of the residual elements of the veli levator palatini,
present within the lateral pharyngeal wall, if speech is to be
restored to normal. Implants provides retention and maintains
accurate positioning of this extension.

27. Relationship with torus tubaris
v A large defect extending into the velopharyngeal
area. The obturator should not touch the torus
The impression wax has flowed into this
area but this extension was removed in
the processed obturator prosthesis.

28. Obturator extension into large orbital defects
A B
The obturator extension should terminate short of the height of
contour leading to the of facial portion of the defect. Otherwise,
as was the case in patient “A”, saliva will spill onto the skin and
down the cheek because of capillary attraction (arrows). Patient
“B” had no such difficulty.

29. Lifting the orbital contents
Can the orbital contents be
lifted with an obturator
prosthesis when the orbital
floor is resected?
v Generally not effective even
in dentulous patients. It is
best that the orbital floor be
reconstructed surgically.
v Patients generally
accommodate and the
vision returns to normal.

30. Lids for obturators
v Lids are provided when secretions accumulate in
the defect
v Most radical maxillectomy defects that are skin
lined do not require lids
v Most defects that are irradiated do not require lids
v Lids must be contoured so that secretions are
directed posteriorly (arrows)

31. Hollowing the obturator
This task is completed only after the first followup
appointment and after all the major adjustments
have been completed.

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