lec of prosthodontic

3. It is the God given right of every
human being to appear human

4. “the art and science of anatomic, functional,
or cosmetic reconstruction by means of
nonliving substitutes of those regions in the
maxilla, mandible, and face that are missing
or defective because of surgical
intervention, trauma, pathology, or
developmental or congenital
malformations”
Maxillofacial
prosthodontic

5. is an artificial device
used to replace missing
facial or oral structures.
Maxillofacial prosthesis

6. Reconstruct of missing parts in maxilla,
mandible and face with prosthesis.
To achieve:
1- Preservation of residual structures.
2- Reconstruction of function.
3- Improvement in esthetic.
The Aim of Maxillofacial Prosthetic:

7. Artificial facial parts found on Egyptian
mummies. Ancient Chinese known to
have made facial restorations.
ancient-artificial-eye

8. 1-Congental
2-Traumatic
3-Pathological with radical surgery
1- Intra Oral (Maxilla and Mandible).
2- Extra Oral (eye, nose, ear).
Causes of Facial and oral Tissues loss
These factors result to 2 types of defects either:

9. - Congenital
.Cleft lip.
.Cleft palate.
-Acquired
.Total maxillectomy
.Partial maxillectomy
Types of Maxillary Defects

10. Cleft lip occurs due to improper fusion
between the fronto-nasal and maxillary
process .
Cleft lip
&
palate

11. it is may be unilateral, bilateral and in
Mohr's syndrome ,midline cleft lip is
seen.

12. Cleft lip and the
combination of cleft
lip and cleft palate
occur twice as often
in males as in
females,
while cleft palate
alone occurs more
often in females.

13. Clefts occur most
often in children of
Asian, Latino or
Native American
These deformities
are known to occur less frequently in
African Americans.

14. As a result of the abnormalities in the upper
arch of the mouth, teeth may not erupt
properly or may be missing completely. In such
cases, artificial teeth and orthodontics (braces)
are usually required. Routine oral hygiene,
tooth brushing and flossing are still required to
maintain healthy teeth and gums and prevent
gum disease (periodontitis) and tooth decay.
Dental Problems

15. Treatments for Cleft Lip
and Cleft Palate

16. Children with cleft lip and/or cleft palate
are treated over the course of 18 or more
years. Treatment can involve a team of
professionals beginning shortly after
birth and continuing throughout
adolescence.

17. The treatment team includes
medical, dental and
other healthcare specialists
who work together to address
the many different and
complicated needs specific
to the individual.

18. Most acquired defect occur due to
surgical resection of tumors or
trauma .
Acquired Maxillary Defect

19. These are usually classified based on their extent .
1.Total maxillectomy : both the
maxillae are resected.
2.Partial Maxillectomy: resection of
one or a part of the maxilla or palate.
Types of
Acquired
Maxillary defect

20. Obturator
• Restores oro-nasal
partition
• At times can be
added to prior
dentures

21. The three types of
prostheses are constructed
for both edentulous and
dentulous patients

22. Surgical Obturator
Interim Obturator
Definitive Obturator

23. surgical obturator is constructed
before the surgery and is inserted in
the operating room

24. advantages
restoration of normal speech and eating
habits. Preventing the collapse of the soft
tissues.
Facial symmetry will be preserved, and
retention of the interim and definitive
prostheses will be facilitated.
Above all, the mental well-being of the patient
is improved considerably.

25. When the surgical dressing is removed
(7 to 10 days after the operation), the
immediate presurgical prosthesis can be
relined with a provisional denture liner.
Interim Obturator

26. Teeth may be added
to the interim
obturator prosthesis
if aesthetics are of
primary importance.

27. However, it is advantageous to omit
the placement of teeth to prevent
occlusal loading in the region of
resection during the early stage of
healing. This delay reduces the
chances of irritation that could affect
healing of the surgical site.

28. The interim prosthesis may be
inserted 1 to 3 weeks after maxillary
resection.

29. Most prostheses require relining or
refitting within the first 6 months to
1 year because of slow and
continuous tissue changes about the
surgical defect and normal alveolar
bone changes.

33. Extension obturates nasopharynx

34. • Small hole may
be plugged
• May close
enough with
time for flap
closure

35. Neoplastic resection is one of the most
common causes for an acquired
mandibular defect ( carcinoma of the
tongue , floor of the mouth ).
Acquired Defect Of The Mandible

36. Resection of the mandible may
often lead to speech and
swallowing dysfunction , which
are difficult to manage

37. A Large Maxillofacial Prosthesis
for Total Mandibular Defect

38. Frontal view showing the total
defect of the mandible
Lateral view showing the defect in
the inferior portion of the face
This defect resulting from surgical failure to
reconstruct the mandible.

39. After applying petrolatum around the defect and
maintaining an airway, a final impression of the defect
was made with hydrocolloid impression material,
using an individual acrylic
resin impression tray. A stone
cast was made from the
impression for the laboratory
phase of prosthesis
fabrication.
Impression with individual tray

40. The wax contours of the facial prosthesis were formed with
the aid of a presurgical photograph of the patient. The wax
prosthesis was evaluated on the patient for esthetics and
marginal adaptation. However, the soft tissue around the
defect lacked sufficient anatomic
undercuts to retain the prosthesis
and the remaining bony
structures were inadequate
for dental implants.
Wax prosthesis positioned
on the defect

41. Retention by clear resin rods hung
on the auricles

42. For support of the prosthesis interior, a basic
framework was made using a combination of
a U-shaped piece of acrylic resin and clear
resin rods .

43. However, this was not adequate for retaining the weight of
the prosthesis, so that the lower lip was separated from the
upper lip by a gap of 1 cm. To obtain more retention, a
lingual resin plate and two ball clasps for the upper front
teeth were developed and then attached to the interior of
the lower lip.
Attachment device placed on
the interior of the lower lip .
Lateral view of the facial prosthesis with an
attachment device and clear rods for hanging.

44. These devices enabled the patient to retain
the prosthesis adequately without the use of
adhesives or implants. Finally, the wax facial
prosthesis was invested and cast with silicone,
which was suitably colored with a base
pigment to match the patient's skin.

47. Extraoral Defects
These defects occur due to trauma ,
neoplasm or congenital
malformation .
Extraoral congenital malformations
that require maxillofacial prostheses
include:

48. 1-Microtia (small ear )
2-Anotia(complete absence of the
auricle )

49. 3-Ocular defect

50. 4-Nasal defect
5-Lip and cheek defect
like double lip .

51. Extraoral
Prostheses-
Nose

54. Maxillofacial Prosthetic Management of
a Patient with Hemifacial Microsomia
Bar and clip
assembly in place to
receive prosthetic
ear.

55. Patient satisfied with result. Her
shorter haircut reflects confidence
in her appearance due to the good
esthetics of her new prosthetic ear
Prosthetic ear in place. Notice anatomic
details, color and overall esthetics.

56. some examples of different types of
prostheses

57. A prosthetic ear may
be retained with
osseointegrated
implants.

58. A nasal prosthesis not only
replaces missing tissue but
supports glasses as well.

59. oculofacial prosthesis replaces the eye and surrounding tissues.

62. B
E
F
O
R
A
F
T
E
R
E
E

63. Custom Fitted Silicone
Prosthetic Devices

64. implants in radiated patients
experienced a very high success rate.
The benefits gained by the use of
implants are great.
This makes it highly recommended to
use dental implants in radiated
patients whenever it is possible.

65. Materials Used in Maxillofacial
Reconstruction

66. was once commonly used for maxillo- facial
prostheses, and is still used occasionally to
make artificial facial parts. When properly
pigmented, these prostheses can look quite
realistic.
POLY(METHYL METHACRYLATE)

67. these are plasticized methyl methacrylate
polymer , which show elastic property .These
are not commonly used because they get
tacky lead to collection of dust and stain ,
have poor edge strength and degrade under
sun light .
Acrylic copolymers

68. it is a hard , clear , tasteless and
odourless resin ,extensively used in
the beginning but its used decreased
due to shrinkage and long processing
time , discoloration and hardening of
the margin .
Polyvinyl Chloride And Copolymers

69. these materials have excellent properties like
elasticity without compromised edge strength
( this help to thin material at the margin ) .
They can be used to restore defect with
mobile tissue beds .
The disadvantages include the moisture
sensitivity during processing and poor color
stability .
Polyurethane Elastomers

70. it is the most commonly used
material for facial restoration but
poor tear strength and life- less
appearance have limited them from
universal acceptance .

71. The process of crosslinking the
silicone is known as vulcanizing.
Vaulcanizing can occur with or
without heat accordingly silicones
are available in two forms.

72. 1-HTV-Silicone : it requires heat for
vulcanization . It is highly viscous ,
white , opaque and has better
physical properties .

73. 2-RTV-Silicones : they are room
temperature polymerizing silicones .
It is esear to process and allow
intrinsic colouration .

74. Metal : metal implants are used to
obtain bone anchorage for
a prosthesis . Implant metals used
are Titanium alloys , base metal
alloys are used for denture base
fabrication

75. Realistic coloration of extraoral
prostheses is an
important feature
for patient
satisfaction and
acceptability.
Coloration

76. Cosmetic realism involves the correct
application of colorant formulations
within the base material before
polymerization (intrinsic) and after
polymerization (extrinsic).

77. Additionally, the finished
prosthesis requires subtle
characterization in order to
approximate the texture of the
adjacent tissue

78. The spectral values in natural skin
must be matched by corresponding
pigments to accommodate
environmental changes, seasonal
changes, and varying light
conditions.

79. The ultimate in realistic cosmetic
matching depends on the
combination of intrinsic and
extrinsic colorations.

80. is the first step in incorporating indepth
coloration reflected internally by
discrete pigment particles spectrally
equivalent or approximating those of the
physiologic colorant and color centers,
namely arterial red, venous red-purple,
carotenoid yellow, melanoid brown, and
opaque dispersed cellular lipids.
Intrinsic Coloration

81. Intrinsic coloration involves
incorporating precise proportions of
pigments by mixing (RTV) or milling
(HTV) into the base elastomer before
to packing in the mold and curing in
a dry heat oven.

82. In general, the extrinsic coloration
uses a medical-grade adhesive
combined with xylene and earth
pigments, which are applied to the
external surface of the prosthesis.
The prosthesis is then postcured in a
dry heat oven to evaporate the
xylene.
Extrinsic coloration

84. Fabrication Of
the Prostheses

85. The method for fabricating a prosthesis
is similar for most materials.
An impression is made of the affected
area with alginate. A master cast is
poured, duplicating the defect on the
patient.

86. The artificial part (such as a nose) is
then carved in wax or clay on the master
cast and tried on the patient to see if it
fulfills the esthetic requirements.
The pattern is then invested in a manner
similar to that used for complete dentures.
Denture flasks are often used for this
purpose.

87. When the prosthesis is quite complex (such as
an eye and orbit), three- or four-part molds
are made. With some materials, metal molds
are required because of high processing
temperatures.
After the pattern is invested, it is removed
from the mold by use of a boiling water bath.

88. The mold is now ready to make the
prosthesis. The patient should be
present so pigments may be added to
the elastomer to give a realistic
appearance and match the patient's
skin color.
Generally, dry mineral earth
pigments or artist's oil-based
pigments are used.

89. Color matching is done by
mixing small amounts of the
pigments into the elastomer.
Some clinicians use color tabs
and predetermined pigment
formulations to match skin
color.

90. When a color match is achieved, the
elastomer is compression molded and
processed according to the
manufacturer's instructions.
After processing, the prosthesis is
removed from the mold and the
excess flash is removed.

91. Step 1 - Seat patient comfortably, cover
hair and coat eyebrows with cold cream
to prevent entrapment of alignate .

92. Step 2 - Alignate mixed. Patient learns
hand signals protocol to communicate.
Pouring of alignate on forehead to allow
for flow down the face .

93. Step 3 - Alignate poured taking care not to
entrap air in anatomical undercut areas.
Incase the patient is traumatized (children
or burns victims with painful skins) by
process anaesthesia is needed .

94. Step 4- Guaze stockinet is removed from
patients hair.Impression is removed from
patients face (allowing time for patients
eyes to adjust to light in the room

95. Step 5 - Impression disinfected. Air passage
blocked in impression. Exposed plaster
coated with petroleum jelly to prevent
bonding with stone cast. Stone allowed to
gently flow over the surface of the alignate .

96. Step 6 - Stone cast may need trimming
on model trimmer.

101. Fabrication of a Maxillofacial
Prosthesis Using a Computer-Aided
Design and Manufacturing System

102. Seat patient comfortably, Adjust
receiver on patients head. Scanner
imaging, Polhemus FastScan digital
scanner

104. Maxillofacial prostheses are usually
fabricated on the basis of impressions
made with dental-impression
material.
The extent to which the prosthesis
reproduces normal facial
morphology depends on the clinical
judgment of the individual
fabricating the prosthesis.

105. This new technique describes a
computer-aided design and
manufacturing system (CAD/CAM)
for the fabrication of maxillofacial
prostheses. This system will provide
a more consistently accurate
reproduction of facial morphology.

106. Facial measurements were taken
using a non-contact three-
dimensional laser morphological
measurement system.

107. The measurements were sent to a
computer numerical controlled
(CNC) milling machine to generate
a cast of the patient's face for the
fabrication of prosthesis.

109. Facial contours were measured using a
laser. This method minimizes patient
discomfort and avoids soft tissue
distortion by impression material.
Moreover, the digital data obtained is
easy to store and transmit, and mirror-
images can be readily generated by
computer processing .
Results

110. This method offers an
objective, quantified
approach for fabricating
maxillofacial prostheses.
Conclusion

111. This picture shows the cavity in the mouth of the patient after
resection of a tumor.In order to protect the tissue weakened by
irradiation and to be able to breathe and eat normally, this hole
needs to be filled by an implant .
Obturator prosthesis for oncologic patients

112. CT-scan of the patient was made. The soft tissue
around the cavity, clearly visible on the scans, was
modeled. This model served as a direct mold for the
implant .

113. The implant, called obturator prosthesis,
was cast from the mold in a bio-compatible
silicone

114. Absolutely no surgery was needed to implant the
obturator prosthesis. As the silicone prosthesis is
plastic deformable, it can be implanted very easily .

115. CONCLUSION: The prosthesis fits
the cavity much better than ever could
have been achieved by using
impression techniques. These
traditional techniques produce a master
of the obturator prosthesis by making
an impression of the cavity in a plastic
deformable material.

116. The prostheses cast from such masters are
always less accurate because of the
presence of undercuts (the impression
technique is not sensitive to local internal
broadening of the cavity) and can severely
damage the sensitive and vulnerable
surrounding tissue.

117. The soft prosthesis is fixed by means
of magnets on a hard dental implant.
This makes it possible to take it out
for inspection and to replace it
afterwards.

118. fabrication of a meatus obturator prosthesis
made with visible light-cured (VLC) resin.
The fabrication technique is relatively easy
and saves time by eliminating some
laboratory procedures for both the patient
and the practitioner.
An alternative approach to fabricating
a meatus obturator prosthesis

119. Occlusal view of the defect Application of the visible-
light source in the patient's
mouth.

120. Definitive maxillary and
mandibular prostheses.
External application of the
visible-light source.

121. Making the impression with
tissue conditioner.
Finished prosthesis

122. Retention of
maxillofacial prostheses

123. Retention of facial prostheses has
been primarily by way of medical
adhesives. An ideal adhesive
should be one that provides firm
functional retention under flexure
or extension during speech, facial
expressions, and moisture or
perspiration contact.

124. Adhesives for extraoral maxillofacial
prostheses require a substantial
amount of supportive ingredients
properly formulated to provide
lasting viscoelasticity with a high
degree of retention. Numerous
brand names of adhesives have been
introduced over the years in
maxillofacial prosthetics.

125. Other methods of retention include
engagement of anatomic tissue
undercuts, thereby minimizing
dependence on adhesives. The
potential for tissue irritation exists
with this technique, and therefore it
must be used prudently. Areas that
have been irradiated contraindicate
the use of this technique.

126. Finally, with the increaed use of
osseointegrated
implants, dependence on
adhesive and anatomic methods of
retention has diminished.

127. Magnets can be used to minimize
force transfer to the implant and
supporting bone. The resultant
decrease in dependence on chemical
(adhesives) and anatomic (tissue
undercuts) sources of retention is
beneficial to both the patient and the
prosthetic rehabilitation.

128. Anterior view of the
anatomical defect
following maxillectomy Oblique view of the anatomical
defect showing communication
with nasal cavity .

129. Location of magnet placement between
the facial prosthesis extension and the
palatal obturator denture.

130. Positioning of the retention
magnets
A.Highligher paste on the
superior aspect of the
palatal obturator prosthesis .
B .Transfer of the paste to
the facial prosthesis
extension to demarcate the
location for the second
magnet .

131. Facial prosthesis in place after
one year of use.