Ocular prosthesis / fixed orthodontics long term courses


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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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  • A 41-year-old female was referred to Department of Prosthetic Dentistry for the Ophthalmology Department. On history it was found that the patient was suffering from malignant melanoma of the right eye and the eye had to be enucleated. So surgery was done and the eye was enucleated [Figure - 1]. On examination of the patient 15 days after the surgery, it was decided that a custom-made ocular prosthesis would be the best to meet the needs of the patient as the extra effort that is put into fabrication of a custom-made prostheses would enhance the esthetics and functional results rather than a stock ocular prosthesis.
  • Disinfect and lightly lubricate the patient’s existing prosthesis or conformer.
  • Fill a medicine cup with quick set stone and invest the tissue side of the prosthesis
    to the height of contour 3. When set, notch the edges of the stone cast. Mix a
    small amount of PVS putty and adapt it over the top of the prosthesis and into the notched indices
  • Remove the putty cope, and cut a large, beveled sprue hole into its center and a small vent to the side.
  • Remove the prosthesis from the mold, lubricate the stone surface (Liquid Tin Foil Substitute; Robert B. Scott, Inc, Tampa, FL), and replace the putty cope.
  • Mix chemical-cure polymethylmethacrylate (Great Lakes Co, Chicago, IL), and pour it into the mold
  • Remove the acrylic resin tray, trim and thin as needed. Perforate the approximate pupil location with a 3- to 4-mm diameter hole. Place multiple perforations over the remainder of the surface.Smooth and polish the custom tray
  • To fabricate the injection tube, unscrew the tip of a 5-mL plastic syringe (Becton Dickinson and Co, Franklin Lakes, NJ), and cut approximately 7 mm from the end (Fig 4). Roughen the sides of the tip and wedge it into the pupil perforation hole. Secure it with cyanoacrylate resin
  • Clean and disinfect the custom tray. Try in the tray and check for overextension and proper orientation. Attach the barrel of the 5-mL syringe to the injection tube. Orient the tube with the numbers facing upward .
    Mix 3 teaspoons water to 1 tablespoon ophthalmic alginate impression material (Robert B. Scott, Inc), and back load the syringe. Insert the plunger, seat the tray, and inject the alginate,the patient stares straight ahead until the material is set. After the alginate impression material has set, remove and check the mpression for acceptability.
  • .
  • .
  • A wax trial ocular prosthesis (blank) can be made chairside by using the “double alginate technique Suspend the impression in a small cup using a clothespin Pour a new mix of irreversible hydrocolloid into the cup, surrounding the impression.
    When set, remove the alginate mold with impression from the cup. Partially section the alginate mold, spread it, and retrieve the original impression. The different mixes of alginate will not adhere to each other
  • The second alginate impression becomes a mold to form the wax blank. Replace the alginate mold in the cup, and pour ivory wax
  • A prefabricated iris button, whose shade matched with the contra lateral eye, was selected. The position of iris was determined with help of landmarks making the patient look straight. Later the final try in was done keeping the iris in its defined position
  • Try in the wax trial prosthesis. Assess fit, contour, and comfort. Add the iris button to the pattern, then process.
  • Try in of the wax pattern was done. Petroleum jelly may be applied in the tissue surface of the wax pattern to avoid irritation to the tissues. The wax pattern was checked for the size support from tissue simulation of eye movement and eyelid coverage.
  • Flasking was done taking care that the iris is secured to one counter of the flask and remaining part in the other portion of flask. Packing was done with the selected heat cure tooth colored acrylic with small red colour silk thread, which may simulate the blood vessels. Slow curing cycle was carried out for acrylisation.
  • After you receive your new artificial eye (ocular prosthesis), there are a few things you should know about caring for and handling it properly:
  •    Enuclene is a mild decongestant and lubricant that can help patients with excessive secretions.   It may be obtained without a prescription at a pharmacy, from your ocularist, or ordered through this website.
       Sil-ophtho is pure lubricating silicone oil that may be applied directly to the prosthesis prior to insertion or while it is being worn.  Sil-ophtho will provide hours of comfort during those times when the humidity is excessively low. It is available in a light and heavy viscosity. Sil-ophtho is usually found only in an ocularist's office.
  • Ocular prosthesis / fixed orthodontics long term courses

    1. 1. OCULAROCULAR PROSTHESISPROSTHESIS An alternative techniqueAn alternative technique INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
    2. 2. INTRODUCTIONINTRODUCTION www.indiandentalacademy.comwww.indiandentalacademy.com
    3. 3. Ocular prosthesis is a modality of facial prosthesis that aims to repair total or partial ocular bulb losses or deformities. www.indiandentalacademy.comwww.indiandentalacademy.com
    4. 4. www.indiandentalacademy.comwww.indiandentalacademy.com
    5. 5. The main goals are to- Restore facial esthetics, Prevent eyelid collapse and deformity, Protect the socket against injuries caused by foreign bodies, dust and smoke, Re-establish the correct route of the lachrymal secretion to prevent accumulation in the cavity, and Preserve muscular tonus to avoid anti- symmetrical alterations. www.indiandentalacademy.comwww.indiandentalacademy.com
    6. 6. History www.indiandentalacademy.comwww.indiandentalacademy.com
    7. 7. The eye was a symbol of life to the ancient world, particularly in Egypt, where bronze and precious stone eyes were placed on the deceased.  The Romans decorated statues with artificial eyes made of silver. www.indiandentalacademy.comwww.indiandentalacademy.com
    8. 8.  Ambrose Paré (1510-1590), a famous French surgeon, was the first to describe the use of artificial eyes to fit an eye socket. These pieces were made of gold and silver. www.indiandentalacademy.comwww.indiandentalacademy.com
    9. 9.  Enamel prostheses (1820s-Enamel prostheses (1820s- 1890s) were attractive but were1890s) were attractive but were expensive and not very durable.expensive and not very durable.  The introduction of cryoliteThe introduction of cryolite glass, made of arsenic oxideglass, made of arsenic oxide and cryolite from sodium-and cryolite from sodium- aluminum fluoride (Na6A2F12),aluminum fluoride (Na6A2F12), produced a grayish-white colorproduced a grayish-white color suitable for a prosthetic eye.suitable for a prosthetic eye.  German craftsmen are creditedGerman craftsmen are credited with this invention in 1835.with this invention in 1835. www.indiandentalacademy.comwww.indiandentalacademy.com
    10. 10.  To make these glass eyes, a tube of glassTo make these glass eyes, a tube of glass was heated on one end until the form of awas heated on one end until the form of a ball was obtained. Various colors of glassball was obtained. Various colors of glass were used like paintbrushes to imitate thewere used like paintbrushes to imitate the natural color of the eyenatural color of the eye  The glass art form flourished in FranceThe glass art form flourished in France and Germany where fabricating secretsand Germany where fabricating secrets were handed down from one generationwere handed down from one generation to the next.to the next. www.indiandentalacademy.comwww.indiandentalacademy.com
    11. 11.  The town of Lausche, Germany, had aThe town of Lausche, Germany, had a particularly rich history in both decorativeparticularly rich history in both decorative (doll eyes, Christmas ornaments) and(doll eyes, Christmas ornaments) and prosthetic arts.prosthetic arts.  In the 19th century, German craftsmenIn the 19th century, German craftsmen ("ocularists") began to tour the United("ocularists") began to tour the United States and other parts of the world,States and other parts of the world, fabricated eyes and fit them to patients.fabricated eyes and fit them to patients. www.indiandentalacademy.comwww.indiandentalacademy.com
    12. 12.  Stock eyes (or pre-madeStock eyes (or pre-made eyes) were also utilized.eyes) were also utilized. An "eye doctor" mightAn "eye doctor" might keep hundreds of glasskeep hundreds of glass stock eyes in cabinets, andstock eyes in cabinets, and would fit patients with thewould fit patients with the best eye right out of thebest eye right out of the drawer.drawer. www.indiandentalacademy.comwww.indiandentalacademy.com
    13. 13.  In the United States, eyes continued to beIn the United States, eyes continued to be made of glass until the onset of World Warmade of glass until the onset of World War II, when German goods were limited andII, when German goods were limited and German glass blowers no longer toured theGerman glass blowers no longer toured the United States.United States.  The United States military, along with aThe United States military, along with a few private practitioners, developed afew private practitioners, developed a technique of fabricating prostheses usingtechnique of fabricating prostheses using oil pigments and plastics. Since World Waroil pigments and plastics. Since World War II, plastic has become the preferredII, plastic has become the preferred material for the artificial eye in the Unitedmaterial for the artificial eye in the United States.States. www.indiandentalacademy.comwww.indiandentalacademy.com
    14. 14.  By the mid-1940s, glassBy the mid-1940s, glass eyes were being replacedeyes were being replaced by plastic counterparts.by plastic counterparts.  In Virginia, this was ledIn Virginia, this was led by Joseph Galeskiby Joseph Galeski (of Richmond, Virginia),(of Richmond, Virginia),  Although American OpticalAlthough American Optical and several militaryand several military hospitals started tohospitals started to experiment and dispenseexperiment and dispense plastic artificial eyes.plastic artificial eyes. www.indiandentalacademy.comwww.indiandentalacademy.com
    15. 15.  An ocular implantAn ocular implant replaces the lost volumereplaces the lost volume of the natural eye. Theof the natural eye. The first account of placingfirst account of placing an implant in the socket,an implant in the socket, following enucleation,following enucleation, was in 1841.was in 1841.  Implants have beenImplants have been made of many differentmade of many different materials, shapes, andmaterials, shapes, and types throughout thetypes throughout the years. It also helps theyears. It also helps the artificial eye to haveartificial eye to have some degree ofsome degree of movementmovement www.indiandentalacademy.comwww.indiandentalacademy.com
    16. 16. A Case ReportA Case Report www.indiandentalacademy.comwww.indiandentalacademy.com
    17. 17. Examination Of The SocketExamination Of The Socket www.indiandentalacademy.comwww.indiandentalacademy.com
    18. 18. Examination of the stock eyeExamination of the stock eye www.indiandentalacademy.comwww.indiandentalacademy.com
    19. 19. Indexed cast with stock eyeIndexed cast with stock eye www.indiandentalacademy.comwww.indiandentalacademy.com
    20. 20. Putty copePutty cope www.indiandentalacademy.comwww.indiandentalacademy.com
    21. 21. www.indiandentalacademy.comwww.indiandentalacademy.com
    22. 22. www.indiandentalacademy.comwww.indiandentalacademy.com
    23. 23. www.indiandentalacademy.comwww.indiandentalacademy.com
    24. 24. Impression trayImpression tray www.indiandentalacademy.comwww.indiandentalacademy.com
    25. 25. www.indiandentalacademy.comwww.indiandentalacademy.com
    26. 26. www.indiandentalacademy.comwww.indiandentalacademy.com
    27. 27. Injecting the impression materialInjecting the impression material www.indiandentalacademy.comwww.indiandentalacademy.com
    28. 28. Final impressionFinal impression www.indiandentalacademy.comwww.indiandentalacademy.com
    29. 29. Final impressionFinal impression www.indiandentalacademy.comwww.indiandentalacademy.com
    30. 30. Double alginate techniqueDouble alginate technique www.indiandentalacademy.comwww.indiandentalacademy.com
    31. 31. Double alginate techniqueDouble alginate technique www.indiandentalacademy.comwww.indiandentalacademy.com
    32. 32. www.indiandentalacademy.comwww.indiandentalacademy.com
    33. 33. www.indiandentalacademy.comwww.indiandentalacademy.com
    34. 34. Stock eye shellsStock eye shells www.indiandentalacademy.comwww.indiandentalacademy.com
    35. 35. www.indiandentalacademy.comwww.indiandentalacademy.com
    36. 36. www.indiandentalacademy.comwww.indiandentalacademy.com
    37. 37. Wax try inWax try in www.indiandentalacademy.comwww.indiandentalacademy.com
    38. 38. FlaskingFlasking www.indiandentalacademy.comwww.indiandentalacademy.com
    39. 39. DewaxingDewaxing www.indiandentalacademy.comwww.indiandentalacademy.com
    40. 40. www.indiandentalacademy.comwww.indiandentalacademy.com
    41. 41. Customizing the shade guideCustomizing the shade guide www.indiandentalacademy.comwww.indiandentalacademy.com
    42. 42. PackingPacking www.indiandentalacademy.comwww.indiandentalacademy.com
    43. 43. www.indiandentalacademy.comwww.indiandentalacademy.com
    44. 44. Finished prosthesisFinished prosthesis-- External surfaceExternal surface www.indiandentalacademy.comwww.indiandentalacademy.com
    45. 45. Finished prosthesisFinished prosthesis–– Tissue surfaceTissue surface www.indiandentalacademy.comwww.indiandentalacademy.com
    46. 46. Pre-prosthetic Post-prostheticPre-prosthetic Post-prosthetic www.indiandentalacademy.comwww.indiandentalacademy.com
    47. 47. Stock eye Custom eyeStock eye Custom eye www.indiandentalacademy.comwww.indiandentalacademy.com
    48. 48. A custom ocular prosthesisA custom ocular prosthesis AdvantagesAdvantages – Improved adaptation to underlying tissues,Improved adaptation to underlying tissues, – Increased mobility of the prosthesis,Increased mobility of the prosthesis, – Improved facial contours, andImproved facial contours, and – Enhanced esthetics gained from controlEnhanced esthetics gained from control over the size of the iris, color of the irisover the size of the iris, color of the iris and sclera.and sclera. DisadsvantageDisadsvantage – It is more expensive than a stockIt is more expensive than a stock prosthesis, and several steps are requiredprosthesis, and several steps are required for its fabricationfor its fabricationwww.indiandentalacademy.comwww.indiandentalacademy.com
    49. 49. 1. Never clean or soak your artificial eye in1. Never clean or soak your artificial eye in rubbing alcohol because it will crack andrubbing alcohol because it will crack and destroy the ocular prosthesis.destroy the ocular prosthesis. 2. Remove the ocular prosthesis only as2. Remove the ocular prosthesis only as necessary. Too much handling can causenecessary. Too much handling can cause socket irritation and result in excessivesocket irritation and result in excessive secretions.secretions. 3. If you remove your ocular prosthesis, be3. If you remove your ocular prosthesis, be sure to store it in water or soft contactsure to store it in water or soft contact lens saline solution. This will keep depositslens saline solution. This will keep deposits from drying on the surface.from drying on the surface. www.indiandentalacademy.comwww.indiandentalacademy.com
    50. 50. 4.To clean your prosthesis, use an4.To clean your prosthesis, use an antibacterial soap. Wash the eye betweenantibacterial soap. Wash the eye between your fingertips.your fingertips. 5.If you wish to or need to rinse out the5.If you wish to or need to rinse out the socket, use sterile saline with bulbsocket, use sterile saline with bulb syringe.syringe. 6.Any eye drops can be used with the6.Any eye drops can be used with the artificial eye in place.artificial eye in place. 7.Visit at7.Visit at least once a yearleast once a year or more oftenor more often to have your ocular prosthesis checked,to have your ocular prosthesis checked, cleaned and polished.cleaned and polished. www.indiandentalacademy.comwww.indiandentalacademy.com
    51. 51. ConclusionConclusion The use of custom-made ocular prosthesis has been a boon to the patients. The esthetic and functional outcome of the prosthesis was far better then the stock ocular prosthesis. Although the patient cannot see with this prosthesis, it has definitely restored his self-esteem and allowed him to confidently face the world rather than hiding behind dark glasses.www.indiandentalacademy.comwww.indiandentalacademy.com
    52. 52. www.indiandentalacademy.comwww.indiandentalacademy.com