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Resin bonding FOR
MAXILLOFACIAL
PROSTHESES
AMMAR G. SALEM
CONTENT
 Introduction
 Mouth preparation
 Bonded composite resin contours
 Metal bonded contours
 Precision and semiprecision attachments
 Problems associated with bonded contours
Introduction
 Resin bonding for maxillofacial prosthesis was
brought as an option since the discovery of
Rochette in 1973.
 At 1982 wong et al. bonded preformed
cingulum rests to mandibular canine, later
other clinicians began to create contours by
bonded resin alone.
 This contouring does not require full crown
preparation and reduce cost.
Mouth preparation
 Creating rests and guiding planes usually is a subtraction
procedure, but in the field of maxillofacial prosthesis the
additive process is frequently required.
 Drawbacks of subtraction method is the need of optimal
marginal integrity and the need for sound tooth reduction.
 The additive method can create:
 Rest seats.
 Guiding planes.
 Retentive contours.
 Bonded precision attachments.
Bonded composite resin contours
Subtractive
method
Good for simple
cingulum rest
on mandibular
canine
Not adequate
in multi-guide
planes
Additive
method
Good for multiple
guided planes
especially for
palatal surfaces
of maxillary teeth
Does not
guarantee ideal
milled guide
planes
Subtractive method
Polishing
enamel
surface
Isolate, acid
etching, wash
and dry
Apply resin
bond and
resin
composite in
excess
amount to
desired shape
Recontour to
desired shape
additive method
Taking
impression
and making
cast
waxing the
desired
contour on
the cast
Adjust the
paralleling
on the
surveyor
Duplicate
the cast
and use
vacuum
clear
template
(2-3mm)
disk
Use
template
to place
the resin
composite
Metal bonded contours
 They are more versatile, where the mill guide
planes surfaces are the same as the surveyed on
the teeth.
 More wear resistant.
 Important of providing optimal bond strength and
thin layered luting resin.
Metal bonded contours
• Primary impression & diagnostic cast
• Surveying and contouring
• Final impression
• Using phosphate bonded investment
• Contours are waxed –duplicate of diagnostic cast- on refractory cast
• Burnout and casting
• Finishing and polishing
• Ready for bonding
Precisional and semi-precisional
attachments
 Used where rehabilitation and obturation of large defect
> ideal esthetic outcome.
 In these instances an attachment > clasp.
 Cases like large defect next to the terminal abutment -
central or lateral incisor-.
 Life of an attachment increases when it is not used as a
rest or retentive component  thus milled rest seats are
developed on casting to transfer stress to long axis of
abutment tooth rather than the cantilevered attachment.
Problems associated with bonded contours
 Trismus and fibrosis  limited mouth opening (difficulty in
isolation and bonding).
 Possible loss of attachment  repair/modification, composite is
easily repaired.
 If metal component lost it’s easier to replace it with composite due to
difficulty of repositioning.
 If precision or semi-precision attachment is lost, it’s cleaned re-
etched and attached to prosthesis and carried to the mouth for re-
bonding.
 Area of prosthesis correspond to lost component should be smoothed,
polished to reduce chance of framework locking into tooth.
Thank you for attending

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Resin bonding FOR MAXILLOFACIAL PROSTHESES.pptx

  • 2. CONTENT  Introduction  Mouth preparation  Bonded composite resin contours  Metal bonded contours  Precision and semiprecision attachments  Problems associated with bonded contours
  • 3. Introduction  Resin bonding for maxillofacial prosthesis was brought as an option since the discovery of Rochette in 1973.  At 1982 wong et al. bonded preformed cingulum rests to mandibular canine, later other clinicians began to create contours by bonded resin alone.  This contouring does not require full crown preparation and reduce cost.
  • 4. Mouth preparation  Creating rests and guiding planes usually is a subtraction procedure, but in the field of maxillofacial prosthesis the additive process is frequently required.  Drawbacks of subtraction method is the need of optimal marginal integrity and the need for sound tooth reduction.  The additive method can create:  Rest seats.  Guiding planes.  Retentive contours.  Bonded precision attachments.
  • 5. Bonded composite resin contours Subtractive method Good for simple cingulum rest on mandibular canine Not adequate in multi-guide planes Additive method Good for multiple guided planes especially for palatal surfaces of maxillary teeth Does not guarantee ideal milled guide planes
  • 6. Subtractive method Polishing enamel surface Isolate, acid etching, wash and dry Apply resin bond and resin composite in excess amount to desired shape Recontour to desired shape
  • 7. additive method Taking impression and making cast waxing the desired contour on the cast Adjust the paralleling on the surveyor Duplicate the cast and use vacuum clear template (2-3mm) disk Use template to place the resin composite
  • 8.
  • 9.
  • 10.
  • 11. Metal bonded contours  They are more versatile, where the mill guide planes surfaces are the same as the surveyed on the teeth.  More wear resistant.  Important of providing optimal bond strength and thin layered luting resin.
  • 12. Metal bonded contours • Primary impression & diagnostic cast • Surveying and contouring • Final impression • Using phosphate bonded investment • Contours are waxed –duplicate of diagnostic cast- on refractory cast • Burnout and casting • Finishing and polishing • Ready for bonding
  • 13.
  • 14.
  • 15. Precisional and semi-precisional attachments  Used where rehabilitation and obturation of large defect > ideal esthetic outcome.  In these instances an attachment > clasp.  Cases like large defect next to the terminal abutment - central or lateral incisor-.  Life of an attachment increases when it is not used as a rest or retentive component  thus milled rest seats are developed on casting to transfer stress to long axis of abutment tooth rather than the cantilevered attachment.
  • 16.
  • 17. Problems associated with bonded contours  Trismus and fibrosis  limited mouth opening (difficulty in isolation and bonding).  Possible loss of attachment  repair/modification, composite is easily repaired.  If metal component lost it’s easier to replace it with composite due to difficulty of repositioning.  If precision or semi-precision attachment is lost, it’s cleaned re- etched and attached to prosthesis and carried to the mouth for re- bonding.  Area of prosthesis correspond to lost component should be smoothed, polished to reduce chance of framework locking into tooth.
  • 18.
  • 19. Thank you for attending

Editor's Notes

  1. Estimate the amount is not accurate and the seating of template can be fault. To correct mistake  make alginate impression and pour the cast  place on surveyor (check parallelism)  identify the area of subtraction
  2. Trim template to accurately position Estimate the amount of composite needed – using waxed-up diagnostic reference. Create few surfaces at a time Use composite of lighter or darker shade Material to be used for paralleling plane should be wear resistant, while for rests it is not of importance. Height of contour must be relative to path of insertion. Occlusogingival position must allow clasp to be at least 1mm from gingival margin. Transition of contour can be either gentle or abrupt (depending on desired retention). Use of composite gives the advantage of repair, when repairing avoid area that were blocked out on master cast as entrance of composite can lead to framework locking.
  3. fig.1: cingulum and lingual planes outlined. Fig.2: master cast in the dental surveyor. Fig.3: analyzing rod
  4. Fig.4: diagnostic wax-up Fig.5: labial heights of contour wax-up. Fig.6: vacuum formed template on duplicate of waxed cast. fig.7: composite guide planes and retentive contours.
  5. Fig.8: Completed hemi-mandibular reconstruction using composite guide planes, rests, and retentive contours.
  6. Bulk composite tend to show cohesive failure especially in mobile teeth –at function-. گگ
  7. Contouring in the form of slight ledges In case of increased rotational and lateral forces  make axial surfaces paralleled in lingual enamel + add microgrooves –parallel to path of insertion- in enamel to resist rotational forces. Using silicon impression material is compatible with investment material. For bonding it can be microblasted with abrasives, electronical etching, chemical etching or combination. For bonding using chemical or dual cure luting resin
  8. Fig.9: waxed-up for guide planes being made parallel. Fig.10: multiple wax-ups for cingulum rests with sprues and plastic bristles. Fig.11: spruing for multiple guide planes. Fig.12: etched casting attached to an amalgam plugger via sticky wax.
  9. Fig.13: lingual guide planes and cingulum. Fig.14: definitive obturator prosthesis.
  10. Fig.15: wax-up for multiple guide. Fig.16: CEKA attachment with guide planes. Fig.17: obturator casting seated on master cast, the lingual plate of casting rests on solid rest seats. Fig.18: completed attachment retained obturator.
  11. Fig.19: metal guide planes and cingulum rests in extremely difficult situation (teeth on one linear dimension + no palatal defect to augment retention). Fig.20: resin bonded guide plane has been lost and require replacement (to maximize distribution of load from prosthesis + to occlude the space left between the tooth and removable framework. Fig.21: polishing using rubber wheels to minimize the risk of framework locking after repair. Fig.22: surface sprayed with a silicone release agent/petroleum to reduce locking. Fig.23: composite resin guide repairing lost metal guide plane.