the use of artificial substitutes to replace anatomic structures has long been an accepted method of treatment for patients with maxillary defects . treatment of patients with acquired maxillary defects differs from that of patients with congenital defects because of the abrupt alteration in the physiologic processes with which the maxillae are involved . construction of a transitional prosthesis will enable the patient to eat , speak and swallow normally . a moderately built 50-year - old male patient reported to the outpatient unit of the department of prosthodontics , sardar patel pg institute of dental and medical sciences , lucknow , complaining of difficulty in speech and nasal regurgitation . the medical records of the patient revealed that he had squamous cell carcinoma of the right alveolus of the maxilla . he had undergone maxillectomy on the right side with split skin grafting and palatal flap closure under general anesthesia one and a half months ago . on examination , the right side of his face was found to be depressed inward giving an unesthetic appearance . a conventional maxillary removable partial denture was fabricated following the accepted prosthodontic norms ; 21-gauge , round , wrought wire clasps were used for retention on the remaining natural teeth . highly cross - linked acrylic resin teeth were used and a processed acrylic resin denture base was made with the compression molding technique . although the anterior teeth were set as usual , the posterior teeth were reduced in number and also kept out of occlusion [ figure 3 ] . the border of the prosthesis in the region of surgery was then reduced about 2 mm . the tissue conditioner material ( autopolymerizing ; viscogel- dentsply - india ) [ figure 5 ] postoperative visits revealed acceptance of the prosthesis , decreased nasal twang and no nasal regurgitation . acquired defects are the most common maxillofacial defects managed by using removable prosthesis . during the immediate postoperative healing stage , the maxillary surgical defect undergoes dimensional changes that affect the fit and peripheral seal of the prosthesis . the main problem with using a hard acrylic resin material for the transitional prosthesis denture base is the difficulty in obtaining a satisfactory border seal at the surgical site . excessive pressure causes tissue injury , whereas insufficient contact will not create the necessary border seal . the material is used at the denture border at the surgical site to form a resilient border seal that will not irritate the tissues . this procedure is also used if the border seal is affected by shrinkage of tissue at the surgical site . the interim prosthesis is made of easily adjustable material to accommodate the rapidly changing tissue profile . tissue conditioners are helpful in this regard , by virtue of their viscoelastic nature , which permits continuous molding to the tissue and enhancing retention and peripheral seal . the patient must be instructed to take small sips of liquid and to keep the head horizontal when swallowing . stark , 1972 , reported the use of tissue conditioners to enhance peripheral seal at the border of the interim prosthesis . the lateral band of scar tissue was also used for the development of peripheral seal . the remaining dentition , on the contralateral side can be used for retention with wrought wire clasps , in the interim prosthesis . later , these teeth can serve as abutments to receive cast circumferential or bar clasp for direct retention , indirect retention and cross - arch stability . desjardins , 1977 , reported the problems faced by the patient immediately following maxillary resection . the objectives of presurgical prosthodontic planning are as follows : 
 psychologic support to the patientpreoperative dental managementpreoperative impressionssuggestions for the surgeon . the preservation of the remaining natural teeth and alveolar bone is important for the retention and stability of the prosthesis . the posterior soft palate is critical , since the prosthesis can obtain retention and support from it . functional contact of the soft palate with the posterior surface of the prosthesis can allow the closure necessary for speech and swallowing . javid and dadmanesh , 1976 , reported that with the conventional clasp design , because of the lack of a supporting residual alveolar ridge , the prosthesis tends to sink inside the tissue , thereby increasing the stress on the abutment teeth leading to the mechanical failure of the clasps . they reported the use of a swing lock design with multiple retention bar clasps on as many teeth as possible . the treatment of patients with acquired maxillary defects differs from that of congenital defects , because of the abrupt alteration in the physiologic processes involved in the maxillae . prosthodontic treatment should begin in the preoperative period , so as to provide the patient with the best rehabilitative case . this case report outlines the use of tissue conditioner in a maxillectomy patient who was given a split thickness skin graft and palatal flap closure in a transitional acrylic prosthesis with wrought wire retentive clasps .
hemimaxillectomy patients present with abrupt alterations in the physiologic processes of the maxillae , along with increased anxiety levels due to sudden impairment in esthetics , mastication , speech , deglutition and hypernasal speech . 
 such patients should be rehabilitated as early as possible , in the postoperative phase with the help of careful preoperative planning by the surgeon and the prosthodontist . 
 this case report illustrates the multidisciplinary approach to rehabilitate a patient , who had undergone maxillectomy on the right side , due to carcinoma alveolus . the transitional prosthesis given in this case used tissue conditioners , which , because of their viscoelastic nature , ensure continuous adaptation , helping peripheral seal and retention . 
 this greatly reduces discomfort and nasal reflux and improves speech .