Management of a Maxillary Defect Caused by Medication-Related Osteonecrosis of the Jaw with a Two-Piece Obturator: A Four-Year Case Report

Year 2025, Volume: 49 Issue: 3, 172 - 177, 12.12.2025

Aslı Bengisu Karayel , Bahadır Ersu

https://doi.org/10.65022/clindentres.1660664

Abstract

This case report describes the prosthetic rehabilitation of a maxillary defect resulting from medication-related osteonecrosis of the jaw (MRONJ) using a two-piece obturator-prosthesis system. A 75-year-old male patient with a history of prostate cancer and long-term antiresorptive therapy developed an oroantral communication following surgical resection of necrotic bone. Given the extent of the defect and the patient’s functional limitations, a two-piece obturator was designed, integrating a silicone-based soft liner for defect closure and a removable partial denture with a metal framework for retention. The prosthesis incorporated precision attachments on natural teeth and locator abutments on pre-existing implants to optimize stability and function. Follow-up assessments demonstrated significant improvements in phonetics, mastication, and overall patient satisfaction. A four-year follow-up confirmed the longterm success of this approach, emphasizing the advantages of a two-piece obturator over conventional single-unit designs. This case highlights the importance of individualized prosthetic planning for patients with MRONJ-related maxillary defects, offering a functional and durable solution to enhance quality of life.

Keywords

Osteonecrosis , Maxillofacial Prosthesis , Bisphosphonate-Associated Osteonecrosis of the Jaw

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