Digital fabrication of obturators with immediate optimized facial support for extensive maxillectomy using the existing maxillary contour

PURPOSE: Extensive maxillectomy may result in rapid contour changes in the unsupported facial tissue, causing irreversible and severe aesthetic deformities. This technical report details a novel digital workflow for the fabrication of obturators with immediate facial support consistent with the existing maxillary contour. METHODS: Preoperative digital impressions were obtained using an intraoral scanner (IOS). A three-dimensional (3D) model of the presurgical maxillofacial hard tissue was constructed using cone-beam computed tomography (CBCT) and aligned with the IOS data. Surgical planning data were used to guide the separation and fusion of anatomical reference data for obturator design from the CBCT and IOS data. The obturator was designed using dental design software, and the existing maxillary morphology for facial support was transferred to the obturator. After the surgical resection, an immediate obturator with a surgical pack was placed at the defect site. CONCLUSIONS: The implementation of a fully digital workflow demonstrated the potential to streamline the complex procedure traditionally required to restore harmonious facial contour support through the transfer of maxillary morphology to the immediate obturator. This method offers a promising and viable alternative to conventional techniques, with the potential to minimize long-term aesthetic compromise, facilitate adaptation and functional restoration, and simplify postoperative prosthetic care.