Acute invasive fungal sinusitis requires a high clinical suspicion and rapid diagnosis for initiation of surgical and medical treatment. Due to necessity of expedited surgical treatment, evaluation and impression making by a maxillofacial prosthodontist is rarely possible prior to debridement. Surgical debridement often results in maxillary defects, which can negatively impact speech, deglutition, and respiration. A surgical obturator occludes the palatal defect resulting in improved speech, swallowing and prevention of wound contamination with food particulate. This article focuses on utilizing medical imaging, usually acquired for diagnosis and surgical planning, to fabricate a well-fitting surgical obturator without conventional or digital intraoral dental impression making.

Background: Due predominantly to anatomic factors, most maxillary anterior extraction sockets exhibit greater resorption of facial rather than palatal alveolar walls. However, traumatic episodes can result in physical damage to interproximal and palatal alveolar walls, leading to complex deficiencies that can be difficult to manage. The purpose of this report is to describe the use of a two-piece, site-specific zirconia device to augment the facial, crestal, and palatal aspects of a deficient maxillary anterior alveolar ridge. Methods: A 25-year-old male with history of facial trauma presented to the Department of Periodontics, Army Postgraduate Dental School, Fort Eisenhower, Georgia, requesting replacement of teeth #8 through #10. A two-piece custom zirconia device was utilized to achieve multidimensional augmentation of a severely deficient alveolar ridge. Results: The procedure was well tolerated, resulting in favorable alveolar ridge volume for dental implant placement. Exposure of the device occurred at postoperative week 13. One of two planned implants were stabilized in the augmented alveolar ridge. At the #10 position a palatal dehiscence defect was noted during osteotomy preparation, and additional grafting was required. Conclusions: The custom zirconia device design shown in this report permitted convenient intraoperative packing of bone biomaterial and minimized loss of regenerative space during healing. The protocol relies upon technology that is increasingly accessible to periodontists and has the potential to substantially simplify a technique-sensitive procedure. Envisioned design improvements are presented.