Eye prosthesis/ cosmetic dentistry training

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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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Eye prosthesis/ cosmetic dentistry training

  1. 1. Eye prosthesisEye prosthesis 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. DevelopmentDevelopment  Lens placodeLens placode  Directed laterally face forwardsDirected laterally face forwards with narrowing of fronto nasalwith narrowing of fronto nasal processprocess  Eyelids from ectodermal foldsEyelids from ectodermal folds  Conjunctiva - ectodermalConjunctiva - ectodermal www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. AnatomyAnatomy  OrbitOrbit  Pyramidal bony cavitiesPyramidal bony cavities  Provide socket for rotatory movements ofProvide socket for rotatory movements of the eye ballthe eye ball  4 sided pyramid –4 sided pyramid – a) apexa) apex b) baseb) base c) 4 walls –c) 4 walls – roof ,floor, lateral & medialroof ,floor, lateral & medial www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7.  Long axis of orbit passes backward andLong axis of orbit passes backward and mediallymedially  Medial walls of two orbits are parallel andMedial walls of two orbits are parallel and lateral walls are set at right angleslateral walls are set at right angles  Roof:Roof:  Orbital plate of frontal boneOrbital plate of frontal bone  Lesser wing of sphenoidLesser wing of sphenoid www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8.  Lateral wall:Lateral wall:  Thickest, strongestThickest, strongest  Greater wing of sphenoidGreater wing of sphenoid  Frontal process of zygomatic boneFrontal process of zygomatic bone  Houses superior orbital fissureHouses superior orbital fissure  Floor:Floor:  Orbital surface of maxillaOrbital surface of maxilla  Orbital surface of zygomatic boneOrbital surface of zygomatic bone  Orbital process of palatine boneOrbital process of palatine bone  Houses inferior orbital fissureHouses inferior orbital fissure www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9.  Medial:Medial:  Very thinVery thin  Frontal process of maxillaFrontal process of maxilla  Lacrimal boneLacrimal bone  Orbital plate of ethmoidOrbital plate of ethmoid  Body of sphenoid boneBody of sphenoid bone www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. EyelidsEyelids  Also called palpebraeAlso called palpebrae  Movable curtains, protect eyesMovable curtains, protect eyes  Palpebral fissurePalpebral fissure  Medial and lateral canthiMedial and lateral canthi www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. Contents of orbitContents of orbit  EyeballEyeball  FasciaFascia  Muscles – extraocularMuscles – extraocular  VesselsVessels  NervesNerves  Lacrimal glandLacrimal gland  Orbital fatOrbital fat www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. Extraocular musclesExtraocular muscles  Voluntary :Voluntary :  four rectifour recti  superiorsuperior  InferiorInferior  MedialMedial  laterallateral  Two obliquiTwo obliqui  SuperiorSuperior  InferiorInferior  Levator palpebraeLevator palpebrae superiorissuperioris www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13.  InvoluntaryInvoluntary Superior tarsalSuperior tarsal Inferior tarsalInferior tarsal orbitalisorbitalis www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. MuscleMuscle OriginOrigin InsertionInsertion Four rectiFour recti CommonCommon annular ringannular ring ScleraSclera SuperiorSuperior obliqueoblique Body ofBody of sphenoidsphenoid ScleraSclera InferiorInferior obliqueoblique OrbitalOrbital surface ofsurface of maxillamaxilla ScleraSclera LevatorLevator palpebraepalpebrae superiorissuperioris Greater wingGreater wing of sphenoidof sphenoid SuperiorSuperior tarsustarsus www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16.  Nerve supplyNerve supply  Superior - trochlear (4 th cranial)Superior - trochlear (4 th cranial)  Lateral rectus - abducent (6 thLateral rectus - abducent (6 th cranial)cranial)  Rest ocular muscles - oculomotor (3Rest ocular muscles - oculomotor (3 rd)rd) www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17.  Action of extra ocular musclesAction of extra ocular muscles www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. Eye ballEye ball  Organ of sightOrgan of sight  3 coats:3 coats:  Outer fibrous coatOuter fibrous coat  Middle vascular coatMiddle vascular coat  Inner nervous coatInner nervous coat www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. ScleraSclera  Opaque, posterior 5/6Opaque, posterior 5/6  Firm, maintains shapeFirm, maintains shape  Outer surface – white, smooth,Outer surface – white, smooth, covered with tenson’s capsule,covered with tenson’s capsule, anteriorly covered by conjunctivaanteriorly covered by conjunctiva  Inner surface – brownInner surface – brown  Continuous anteriorly with corneaContinuous anteriorly with cornea www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20.  Provides insertion to muscles:Provides insertion to muscles:  Recti in front of equatorRecti in front of equator  Oblique behind the equatorOblique behind the equator sclera is almost avascularsclera is almost avascular www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21.  CorneaCornea  Transparent, anterior 1/6, avascularTransparent, anterior 1/6, avascular  ChoroidChoroid  Thin pigmented layer, separatesThin pigmented layer, separates sclera from retina in posterior partsclera from retina in posterior part www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22.  IrisIris  circular curtain with an opening incircular curtain with an opening in center called the pupilcenter called the pupil  colour determined by number ofcolour determined by number of pigment cells in connective tissue of irispigment cells in connective tissue of iris  RetinaRetina  thin delicate inner layer continuous withthin delicate inner layer continuous with optic nerveoptic nerve www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. Evolution of ocular prothesisEvolution of ocular prothesis  Egypt (before 3000 B.C.)-bronze and preciousEgypt (before 3000 B.C.)-bronze and precious stone eyesstone eyes  Romans – silver eyesRomans – silver eyes  Ambrose Pare (1510-1590) : first to describeAmbrose Pare (1510-1590) : first to describe use of artificial eye to fit an eye socket, useduse of artificial eye to fit an eye socket, used both glass and porcelain eyesboth glass and porcelain eyes www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25.  1820-1890’s – enamel prosthesis very1820-1890’s – enamel prosthesis very attractive but expensive and not very durableattractive but expensive and not very durable  By 1835 artificial eyes were being producedBy 1835 artificial eyes were being produced on a large scale in Germanyon a large scale in Germany  1943 – united states army and navy developed1943 – united states army and navy developed acrylic eyeacrylic eye www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26.  Advantages of plastic eye:Advantages of plastic eye:  Freedom from fragility and surface etchingFreedom from fragility and surface etching  Easy adjustments of size and formEasy adjustments of size and form  Esthetics requirements could be addedEsthetics requirements could be added  Actual 3 dimensional effectActual 3 dimensional effect  Pre fabricated iris buttons can be stockedPre fabricated iris buttons can be stocked  Less time consuming and each to teachLess time consuming and each to teach www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. Surgical consideration in prosthetic treatmentSurgical consideration in prosthetic treatment of ocular and orbital defectsof ocular and orbital defects  EviscerationEvisceration  involves removal ofinvolves removal of the contents of the globethe contents of the globe leaving in place theleaving in place the sclera and sometimessclera and sometimes corneacornea  spherical implant isspherical implant is generally placed – sizegenerally placed – size is importantis important  best prosthetic option isbest prosthetic option is cover shellcover shell www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28.  EnucleationEnucleation  Removal of entire globe afterRemoval of entire globe after the extra ocular muscles andthe extra ocular muscles and optic nerve have been transectedoptic nerve have been transected  Implants are placed in tenon’s capsule to fillImplants are placed in tenon’s capsule to fill orbital defect and support the muscles andorbital defect and support the muscles and eyelidseyelids www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29.  ExenterationExenteration Removal of the entire contents of orbit includingRemoval of the entire contents of orbit including the extra ocular musclesthe extra ocular muscles Periosteum may or may not be maintainedPeriosteum may or may not be maintained The eyelids may or may not be involvedThe eyelids may or may not be involved 1)1) leave the eye lids intactleave the eye lids intact 2)2) Preserve but split the lidsPreserve but split the lids 3)3) Remove lids totallyRemove lids totally www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30.  Presurgical conferences between the involvedPresurgical conferences between the involved specialists will help to resolve manyspecialists will help to resolve many rehabilitative problems leading to more idealrehabilitative problems leading to more ideal restorative treatmentrestorative treatment www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. Ocular prosthesisOcular prosthesis Fabrication:Fabrication: Examination –Examination – • ensure proper healingensure proper healing • absence if infectionabsence if infection • location of implantlocation of implant • movement of tissue bedmovement of tissue bed • Type of surgery doneType of surgery done • size and extent of the socketsize and extent of the socket • Amount of orbital adipose tissue presentAmount of orbital adipose tissue present • Extent of atrophy of musclesExtent of atrophy of muscles www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. ImpressionImpression A.A. Impression made from irreversibleImpression made from irreversible hydrcolloid:hydrcolloid:  Impression tray: hard baseplate waxImpression tray: hard baseplate wax  Wax handleWax handle  Tissue side is scored with hot spatulaTissue side is scored with hot spatula  Seated erect, asked to stare at a distant spot, holdSeated erect, asked to stare at a distant spot, hold his gaze in a straight forward position with eyeshis gaze in a straight forward position with eyes open while impression is madeopen while impression is made www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33.  Material mixed: smooth, runny mix which setsMaterial mixed: smooth, runny mix which sets quicklyquickly  Placed in large syringe, injected in socketPlaced in large syringe, injected in socket completely filling the socket without trappingcompletely filling the socket without trapping tiny air bubblestiny air bubbles  After set remove in one piece – care taken notAfter set remove in one piece – care taken not to tearto tear www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. Formulation of castFormulation of cast  Poured in two sectionPoured in two section  Impression is boxed with 3 inch masking tapeImpression is boxed with 3 inch masking tape  First half of the cast is poured with a mix ofFirst half of the cast is poured with a mix of dental stone and slurrydental stone and slurry  Pour up to and around the widest part ofPour up to and around the widest part of socket impressionsocket impression  At least two key ways are cutAt least two key ways are cut www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36.  Separating mediaSeparating media  Second half pouredSecond half poured  Mold can be separated after stone has setMold can be separated after stone has set www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. Fabrication of scleraFabrication of sclera  Enlarge mold openingEnlarge mold opening  Pour molten wax – coolPour molten wax – cool  Wax pattern is recoveredWax pattern is recovered  Anterior surface is contoured into smoothAnterior surface is contoured into smooth hemi spheroidhemi spheroid  Posterior surface reflects the tissue topographyPosterior surface reflects the tissue topography www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39.  Try wax pattern in eye-should be comfortableTry wax pattern in eye-should be comfortable  Invest using denture flask or crown and bridgeInvest using denture flask or crown and bridge flaskflask  After investing wax pattern is recoveredAfter investing wax pattern is recovered  Packed with scleral white acrylic resinPacked with scleral white acrylic resin ( or 1.5 gm zinc oxide with 100 gm of clear( or 1.5 gm zinc oxide with 100 gm of clear acrylic)acrylic) www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40.  Processed at 150 f for 9 hours and at 212 FProcessed at 150 f for 9 hours and at 212 F for 2 hoursfor 2 hours  Acrylic sclera is recovered and polishedAcrylic sclera is recovered and polished  Tried in eye and verifiedTried in eye and verified www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. Iris locationIris location  With sclera in placed and patient standing in aWith sclera in placed and patient standing in a relaxed positionrelaxed position  Center of pupil marked in comparison with theCenter of pupil marked in comparison with the natural eyenatural eye  Circle scribed of diameter of natural eyeCircle scribed of diameter of natural eye  Consider the iris in relation to opening of eye lidConsider the iris in relation to opening of eye lid  A piece of 28 guage casting wax is positioned overA piece of 28 guage casting wax is positioned over the iris circle-smoothened and merged leaving athe iris circle-smoothened and merged leaving a depression when reinvesteddepression when reinvested www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44.  ReinvestedReinvested  The depression formed by casting wax isThe depression formed by casting wax is deepened by 2mm- gives corneal prominencedeepened by 2mm- gives corneal prominence  Sclera is cut down for incorporation of iris- 3Sclera is cut down for incorporation of iris- 3 to 5 mmto 5 mm  Inserted again in socket for verificationInserted again in socket for verification www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46.  Anterior portion of sclera reduced by 1-1.5Anterior portion of sclera reduced by 1-1.5 mmmm  Sclera is tinted:Sclera is tinted: Children – blueChildren – blue light skinned – lighter blue or greenlight skinned – lighter blue or green Darker skinned – brown to orangeDarker skinned – brown to orange  Blood vessels – painted or rayon/cotton fiberBlood vessels – painted or rayon/cotton fiber www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47.  Replaced in flaskReplaced in flask  Packed with clear acrylicPacked with clear acrylic  Cured, finished and polishedCured, finished and polished www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. Iris illustrationsIris illustrations  Acrylic paints on water proof paper disksAcrylic paints on water proof paper disks  Oil paints on acetate disksOil paints on acetate disks  Mono-polyMono-poly  Oil paint and linseed oilOil paint and linseed oil  Iris button is inserted in cavity prepared byIris button is inserted in cavity prepared by removing wax in iris arearemoving wax in iris area www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49.  Scleral wax pattern with iris illustrationsScleral wax pattern with iris illustrations waxed in position are invested, processed,waxed in position are invested, processed, polishedpolished www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. Modification of stock eyeModification of stock eye  Select a stock eye of correct size, colour andSelect a stock eye of correct size, colour and shapeshape  Reduce periphery and posterior surfaces by 2-Reduce periphery and posterior surfaces by 2- 3 mm3 mm  Retentive groove in posterior surfaceRetentive groove in posterior surface  Small straight stick is secured with sticky waxSmall straight stick is secured with sticky wax over pupil – acts handle and guide for aligningover pupil – acts handle and guide for aligning www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51.  Irreversible hydrocolloid placed at back ofIrreversible hydrocolloid placed at back of prosthesis and impression recordedprosthesis and impression recorded  Prosthesis and impression are investedProsthesis and impression are invested  Two small projection of auto polymerizingTwo small projection of auto polymerizing resin attached to canthus area- hold prosthesisresin attached to canthus area- hold prosthesis in correction relationin correction relation  Pack, process and polishPack, process and polish www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. B.B. Using steel ball bearing:Using steel ball bearing:  Given by Dr. Victor DeitzGiven by Dr. Victor Deitz  Horizontal measurement of eye socket determinesHorizontal measurement of eye socket determines the size of ball bearingthe size of ball bearing  Hard base plate wax is softened and compressedHard base plate wax is softened and compressed over the ball bearingover the ball bearing  Wax cup is trimmed to triangular shape of posteriorWax cup is trimmed to triangular shape of posterior wall of socket – tried in socketwall of socket – tried in socket www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53.  Center of iris is marked on wax with a suitableCenter of iris is marked on wax with a suitable instrumentinstrument  Iris button with handle placed on hard wax cupIris button with handle placed on hard wax cup  Whole assembly tried in eye and necessaryWhole assembly tried in eye and necessary corrections madecorrections made  A special yellow high heat wax is used toA special yellow high heat wax is used to build up a smooth spherical prosthesisbuild up a smooth spherical prosthesis www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. FlaskingFlasking  Invested in HUE-LON flask with anteriorInvested in HUE-LON flask with anterior surface downsurface down  After separation and removal of wax, irisAfter separation and removal of wax, iris button is carefully lifted and again replacedbutton is carefully lifted and again replaced after applying separating media in exactafter applying separating media in exact positionposition Prepare scleral modifying and veining coloursPrepare scleral modifying and veining colours www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. PackingPacking  Select proper scleral shadeSelect proper scleral shade  Mix it with monomer in ratio of 1:3Mix it with monomer in ratio of 1:3  Pack, place in dry heat oven at 100 c for 3Pack, place in dry heat oven at 100 c for 3 hourshours  Recover, polishRecover, polish www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. Veining techniqueVeining technique  Red rayon threads applied with 5% solution ofRed rayon threads applied with 5% solution of monomer and polymermonomer and polymer  Follow natural patternFollow natural pattern  Use 00 sable brush with pointed tipUse 00 sable brush with pointed tip  Add dry pigments mixed in 5% momomer andAdd dry pigments mixed in 5% momomer and polymer solutionpolymer solution  Next apply 3 coats of 5% solution of clearNext apply 3 coats of 5% solution of clear monomer and polymermonomer and polymer www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57.  Each coat is dried for 4-5 minEach coat is dried for 4-5 min  Processed in oven at 72 C for 1 hourProcessed in oven at 72 C for 1 hour www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. ConjunctivaConjunctiva  Wood applicator attached at concave surfaceWood applicator attached at concave surface with sticky waxwith sticky wax  Dip in molten base plate waxDip in molten base plate wax  Flask, boil out wax and pack with clear acrylicFlask, boil out wax and pack with clear acrylic  Cure at 100 C for 3 hoursCure at 100 C for 3 hours  Finish and polish, attaining high lusterFinish and polish, attaining high luster www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. ComplicationsComplications  Ptosis :Ptosis : • Pseudo ptosisPseudo ptosis • True ptosis – Allen (1976)True ptosis – Allen (1976)  Lower lid droopLower lid droop  Entropion and ectropioEntropion and ectropio • Surgically – reen and beyer (1976)Surgically – reen and beyer (1976) • Prosthetically – Bulgarelli (1976)Prosthetically – Bulgarelli (1976)  BlepharosulcusBlepharosulcus www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60.  Cicatricial bands or adhesionsCicatricial bands or adhesions  Contracted socketContracted socket www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. Orbital DefectOrbital Defect  Facial moulageFacial moulage  Avoid displacement of tissueAvoid displacement of tissue  Patient must be seated in upright positionPatient must be seated in upright position  Use irreversible hydrocolloidUse irreversible hydrocolloid  Master castMaster cast  Fabricate trayFabricate tray www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62.  Record impression of the defectRecord impression of the defect  Use pins to support impressionUse pins to support impression  Fabricate cast in dental stoneFabricate cast in dental stone  Drill hole in posterior orbital wallDrill hole in posterior orbital wall  Select a stock ocular prosthesisSelect a stock ocular prosthesis  Use clay or wax for sculptingUse clay or wax for sculpting  Try in patientTry in patient www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63.  Mark the mid lineMark the mid line  Mediolateral, anteroposterior and inferiorMediolateral, anteroposterior and inferior superior positioning should mimic exactly thesuperior positioning should mimic exactly the position of natural eyeposition of natural eye  Next sculpting of peri-orbital tissue isNext sculpting of peri-orbital tissue is effectedeffected  Lines of juncture should be featheredLines of juncture should be feathered  Ended beneath eyeglasses or the shadow castEnded beneath eyeglasses or the shadow cast by themby them www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. Material selection and processingMaterial selection and processing  Fabricate the molds usual except thatFabricate the molds usual except that ocular prosthesis must be removedocular prosthesis must be removed  Acrylic resin –Acrylic resin – pour a layer of stone over thepour a layer of stone over the completed external surfacecompleted external surface  Remove ocular prosthesis carefully from theRemove ocular prosthesis carefully from the hole previously drilled in the posterior wallhole previously drilled in the posterior wall  Dental stone is then vibrated filling the areaDental stone is then vibrated filling the area occupied by ocular prosthesisoccupied by ocular prosthesis www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65.  Flexible materialFlexible material – ocular prosthesis should– ocular prosthesis should be duplicated, inserted in appropriate positionbe duplicated, inserted in appropriate position in the moldin the mold  According to Beumer: if prosthesis is limitedAccording to Beumer: if prosthesis is limited to orbital area methyl methacrylate is theto orbital area methyl methacrylate is the material of choicematerial of choice  Flexible material should be used when defectFlexible material should be used when defect extends beyond the orbital area and encountersextends beyond the orbital area and encounters movable tissuemovable tissue www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66.  Process in favoured materialProcess in favoured material  Tint either intrinsically or extrinsically or bothTint either intrinsically or extrinsically or both  Attach prosthetic eye lashesAttach prosthetic eye lashes  Secure resin eye with auto polymerizing resinSecure resin eye with auto polymerizing resin www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. RetentionRetention  Skin adhesivesSkin adhesives  Engagement of undercutsEngagement of undercuts  Attachment to eyeglass frameAttachment to eyeglass frame www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68.  According to Chalian and Drane:According to Chalian and Drane:  Facial moulage is made using reversibleFacial moulage is made using reversible hyrdo colloidhyrdo colloid  Prepare the cast in usual mannerPrepare the cast in usual manner  Select stock acrylic eyeSelect stock acrylic eye  Carve clay pattern, place stock eye and try inCarve clay pattern, place stock eye and try in place several timesplace several times www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. Constructing metallic moldConstructing metallic mold  Impression and cast of external moldImpression and cast of external mold  Seat properly in moldSeat properly in mold  Outline the cast with indelible pencil 1cmOutline the cast with indelible pencil 1cm away from clay patternaway from clay pattern  Box entire area beyond the pencil outlineBox entire area beyond the pencil outline  Pour impression materialPour impression material  After material sets, remove the impression,After material sets, remove the impression, box it and pour in gray investment materialbox it and pour in gray investment material www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70.  Impression and cast of tissue side moldImpression and cast of tissue side mold  Cut out clay in back of eye periphery, leavingCut out clay in back of eye periphery, leaving no undercutsno undercuts  Make key ways in clayMake key ways in clay  Floor of the orbital defect is also keyedFloor of the orbital defect is also keyed  Minimal amount of quick setting plaster isMinimal amount of quick setting plaster is placed within the eye periphery withplaced within the eye periphery with additional amount in eye orbitadditional amount in eye orbit www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71.  Clay pattern is quickly and accurately placedClay pattern is quickly and accurately placed on master caston master cast  After setting, clay is carefully removedAfter setting, clay is carefully removed  Prepare an undercut necessary for retention ofPrepare an undercut necessary for retention of eye in final prosthesiseye in final prosthesis  Once again box, record alginate impression toOnce again box, record alginate impression to get negative investment modelget negative investment model www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72.  The negative model is soaked in water andThe negative model is soaked in water and hydro colloid impression again recordedhydro colloid impression again recorded  Impression is again boxed and poured to getImpression is again boxed and poured to get positive modelpositive model  Both the models- one of external mold andBoth the models- one of external mold and another of tissue side- are waxed with 3mmanother of tissue side- are waxed with 3mm base plate waxbase plate wax www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73.  Add spruesAdd sprues  Invest the molds and let it setInvest the molds and let it set  Eliminate waxEliminate wax  Dry heat investment at 70 C for 10 hoursDry heat investment at 70 C for 10 hours  Cast the investment with molten metalCast the investment with molten metal  The metal molds should fit togetherThe metal molds should fit together www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. Painting and processing of vinyl resinPainting and processing of vinyl resin  Choose the colour of vinyl resinChoose the colour of vinyl resin  Mix it on glass baseMix it on glass base  Heat the mold for 3-5 minutesHeat the mold for 3-5 minutes  Painting on external moldPainting on external mold  Apply clear vinyl resinApply clear vinyl resin  Next apply tissue matched vinyl resinNext apply tissue matched vinyl resin  Each layer is processed in oven for 1 minEach layer is processed in oven for 1 min  Gain the required thickness, margins are kept freeGain the required thickness, margins are kept free www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75.  Painting on tissue side moldPainting on tissue side mold  Same procedure as beforeSame procedure as before  Colour matching not very critical except at theColour matching not very critical except at the marginsmargins  Final processingFinal processing  Place in oven for final vulcanizatiionPlace in oven for final vulcanizatiion  After heating, place in ice waterAfter heating, place in ice water www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76.  Two halves are separated and trimmedTwo halves are separated and trimmed  Oil soluble dye retuochingOil soluble dye retuoching  Required tinting for shade discrepancies doneRequired tinting for shade discrepancies done with xylene soluble oil dyeswith xylene soluble oil dyes  Insertion of eye lashesInsertion of eye lashes  Apply hair with y end needle on upper andApply hair with y end needle on upper and lower eyelidslower eyelids www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77.  Insert the acrylic eye into the vinyl portion ofInsert the acrylic eye into the vinyl portion of the prosthesis from the back sidethe prosthesis from the back side  The prosthesis is ready for placement in orbitalThe prosthesis is ready for placement in orbital defectdefect  Use a thin layer of surgical appliance cementUse a thin layer of surgical appliance cement on tissue surfaceon tissue surface  Press the margins firmly into placePress the margins firmly into place www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. Patient instructionsPatient instructions  Adjusting to the prosthesisAdjusting to the prosthesis  Artificial eye does not track with natural eye-Artificial eye does not track with natural eye- learn to turn his head when changing his linelearn to turn his head when changing his line of visionof vision  Period of wear: a rest period of 8 hours is notPeriod of wear: a rest period of 8 hours is not necessary as it is with a denturenecessary as it is with a denture  Wear eye glassesWear eye glasses www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79.  Removal and insertionRemoval and insertion  Clean the prosthesisClean the prosthesis  Application of surgical cementApplication of surgical cement  Recall – 1 year systemRecall – 1 year system www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. Ocular implantOcular implant  Placed in tissue bed to aid in prosthesisPlaced in tissue bed to aid in prosthesis fabricationfabrication  Implant moves as muscles move in normalImplant moves as muscles move in normal course – results in more realistic prosthesiscourse – results in more realistic prosthesis  Stallard (1973) – beneficial in growingStallard (1973) – beneficial in growing childrenchildren www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81. Implant insertionImplant insertion  Following enucleation tenon’s capsule isFollowing enucleation tenon’s capsule is preservedpreserved  Implant placed, dissected ocular musclesImplant placed, dissected ocular muscles attached to itattached to it  Superior and inferior recti are overlapped atSuperior and inferior recti are overlapped at center of implant at 12 o’clock and 6 o’clockcenter of implant at 12 o’clock and 6 o’clock positionspositions  Lateral and medial recti are overlapped andLateral and medial recti are overlapped and sutured at 3 o’clock and 9 o’clock positionssutured at 3 o’clock and 9 o’clock positions www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82.  Complete the closureComplete the closure  Conformer placed to reduce edema andConformer placed to reduce edema and maintain socket sizemaintain socket size  Stock prosthesis placedStock prosthesis placed  Custom fabricated prosthesis given at laterCustom fabricated prosthesis given at later datedate www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. Types of Ocular implantTypes of Ocular implant 1.1. BuriedBuried www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. 2. Buried, semi-integrated2. Buried, semi-integrated 3. Semi-buried, integrated3. Semi-buried, integrated www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86.  The first ocular implantThe first ocular implant made of hydroxyapatitemade of hydroxyapatite was implanted inwas implanted in 1985, after several years of1985, after several years of preliminary research.preliminary research.  The eye muscles can beThe eye muscles can be attached directly to this implant,attached directly to this implant, allowing it to move withinallowing it to move within the orbit-just like the natural eye.the orbit-just like the natural eye. www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87.  The result is a more natural-looking artificial eye thatThe result is a more natural-looking artificial eye that can be difficult to distinguish from the natural eye.can be difficult to distinguish from the natural eye.  Some of this movement is automatically transferredSome of this movement is automatically transferred to the artificial eye, which fits over the implant. Ifto the artificial eye, which fits over the implant. If greater movement is desired, then a titanium peg isgreater movement is desired, then a titanium peg is used to connect the artificial eye to the implant.used to connect the artificial eye to the implant. www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. ConclusionConclusion www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. ReferencesReferences 1.1. Maxillo facial prosthetics by Chalian, DraneMaxillo facial prosthetics by Chalian, Drane and Standishand Standish 2.2. Maxillofacial rehabilitation by Beumer,Maxillofacial rehabilitation by Beumer, Curtis and FirtellCurtis and Firtell 3.3. Human anatomy by ChaurasiaHuman anatomy by Chaurasia 4.4. Human embroyology by Inderbeer singhHuman embroyology by Inderbeer singh www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90.  Surgical considerations in prosthetic treatmentSurgical considerations in prosthetic treatment of ocular and orbital defects; JPD mar 1983of ocular and orbital defects; JPD mar 1983  Post insertion care of ocular prosthesis; jpd febPost insertion care of ocular prosthesis; jpd feb 19831983  JPD 2006 APRJPD 2006 APR www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com

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