Integrated Obturator–Guiding Flange Prosthesis for Rehabilitation of an Acquired Aramany Class II Maxillary Defect With Post-radiotherapy Trismus A Clinical Case Report

Abstract

This case report describes the prosthodontic rehabilitation of a 57-year-old woman with an acquired Aramany Class II maxillary defect, post-radiotherapy trismus, and marked mandibular deviation following oncologic surgery and flap reconstruction. A single-unit hollow maxillary obturator with an integrated palato-buccal guiding flange was fabricated using a modified impression technique adapted to the patient’s 1.5-cm mouth opening. The prosthesis provided obturation of the oro-nasopharyngeal communication while simultaneously guiding mandibular closure. A lost-salt technique was used to fabricate the hollow component, resulting in a final prosthesis weighing 13 g. The appliance provided direct retention through C-clasps on the remaining dentition. Following insertion, the patient reported cessation of nasal regurgitation and improved speech resonance, with improved mandibular guidance during closure. This case highlights the value of integrating obturation and mandibular guidance within a single lightweight prosthesis in complex post-oncologic rehabilitation.