Maxillofacial /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

CONTENTS :
INTRODUCTION
HISTORY OF MAXILLOFACIAL MATERIALS
IDEAL PROPERTIES
CRANIAL IMPLANT
FACIAL IMPLANT
MATERIALS USED:
• Acrylic polymers &co-polymers
• Polyvinyl polymers &co-polymers
• Chlorinated polymers
• Latex
• Silicone elastomer
• Organosilicone
• Polyphosphazines www.indiandentalacademy.com

Ambroise Paire - Nasal & Ear Prosthesis (1510-1590)
Tycho Brahe – Artificial nose (1546- 1601)
HISTORY:

“Gunner with the silver mask”

Metals - Gold & Silver
Wiiliam morton (1819) – Nasal
prosthesis – Enamel porcelain

Ottofy, Baker – Nasal prosthesis – Black vulcanized rubber (1905)
First Obturator - 1541 (Sponge) Ambrise Pare
Gelatin – Glycerine – Hennig – Ist
soft fleshlike material
Artificial eye – Venice (1579)
Tetamore (1894) – Cellulose nitrate – Nose prosthesis
Bourdet (1957) - silky ligatures – metal sheetwww.indiandentalacademy.com

Bulbian (1942) – prevulcanized latex – Facial restoration
MMA – World War II – translucency & colour matching
Dellabare (1820) – Ist
artificial velum
Snell (1823) – Gold obturator – speech

IDEAL PROPERTIES
Physical properties Processing properties Biological properties

Physical properties :
• High edge strength
• High tensile strength.
• High tear strength.
• High resistance to abrasion.
• High elongation
• Low coefficient to friction
• Low surface tension
• Low specific gravity
• Low thermal conductivity
• Odorless
• Translucent
• Pliable

Processing properties
• Adjustability
• Chemically inert
• Ease of processing
• Dimensionally stable
• Capable of being coloured
• Long shelf life
• Low processing temperature
• Colour stability
• Non porous
• Reusable moulds

Biological properties :
• Biological compatibility
• Non allergic & Non toxic
• Dimensionally stable
• Easy cleansibility
• Flexibility
• Resistance to environment discolouration

CRANIAL IMPLANTS :
1. Osteoplastic reconstruction.( Bone Grafts, Cartilage )
2. Restoration with alloplastic implants.
Alloplastic Material
Tantalum :
• 0.015” perforated sheets
• Small & Large defects
• Extension – 3mm

TITANIUM :
• 0.61mm
• Anodized – phosphoric acid (80%), Sulphuric acid (10%), water(10%)
STAINLESS STEEL :
• 316 Austentic steel
Advantages:
1. Malleability
2. Separating time
3. Readily available
Disadvantages:
1. Thermal conductivity
2. Radiographic interpretation
3. Deformation

AUTOPOLYMERIZING METHYL METHACRYLATE :
• Small & Large defects
Advantages :
1. Strong
2. Radiolucent
3. Availability
4. Thermal conduction
5. Complications
Disadvantages :
1. Infection
2. Free monomer
3. Contouring

HEAT POLYMERIZING METHYL METHACRYLATE :
ADVANTAGES :
1. Strong
2. Radiolucent
3. Good reproduction
4. Biocompatible
DISADVANTAGES :
1. Time consuming
2. Difficulty in processing
POLYETHYLENE :
• Aliphatic unsaturated chain
• Advantages
1. Inert
2. Tensile strength
3. Light www.indiandentalacademy.com

4. Flexible
5. Thermal & electrical conductivity
6. Resistance to fracture
7. Moldability
FACIAL MATERIALS ….

MATERIALS USED
Acrylic polymers :
• Intraoral & extraoral use
• Derivatives of ethylene
• Soluble in water – Polarity - carboxyl group
• Serviceable – 2yrs , but require repainting
• Colouration , Compatibility with adhesive
• Easy relining.
Methyl methacrylate
• M.P.= -48ºC , B.P.= 100.8ºC
• Density = 0.945gm/cm3
• Polymerization – Heat , Chemicals , u.v.light
• Volumetric shrinkage – 21% , linear shrinkage – 7%
• Rigid – little movement of tissues

• Characterization possible
• Compatibility – adhesives
Poly methyl methacrylate :
• Transparent liquid
• KHN – 18-20
• Tensile strength – 600 kg/in2
• Does not discolour in uv light
Acrylic co-polymers:
• Acrylic & methacrylic acid
• Soft resilient skin with a spongy central
mass
• L:P ratio = 1.5:1 / 1.8:1
• Skin shades
• Made soft by adding plasticizers

• Plasticizers added with foaming agent
• e.g.. Palamed , Polyderm
Advantages:
• Soft & elastic
• Light
• Esthetic
Disadvantages:
• Poor edge strength
• Poor durability
• Difficult Processing & coloration
• Predisposition to dust collection
• Stiffness with aging
• Subject to degradation

Vinyl plastisols:
• Clarke – 1833
• Ivan Ostromislensky (1929) – Plasticized polyvinyl chloride
• Vernon Ben Shoff (1943) – Is t
PVC for dental use
• Combination of vinyl polymers &vinyl chloride – vinyl acetate (15-20%)
&colour…

• Rigid ,odorless & clear substances
• Flexibility – Plasticizers
• Intrinsic & extrinsic colouring possible
• Koren et al (1983) studied the effect of processing temp. on
properties
• eg – Mediplast , Realistic

Advantages:
• Flexible
• Better appearance
• Intrinsic & extrinsic
colouration
Disadvantages:
• Loss of plasticizer
• Poor dimension stability
• Early staining
• Short life expectancy
• Lacks life like translucency
• Edges tear easily
• Absorbs secretions
Chlorinated Polyethylene :
• Chlorine ,calcium & soyabeen oil
• Processed by heat polymerization
• Colouration by oil – soluble dyes

Polyurethane :
• Dan Rosa
• Used in mx-facial prosthesis , Blood contacting devices , Cardiac
replacement
• Resin , Isocyanate , & catalyst
• Goldberg - Properties can be varied depending on reactants
• Ariyadosa udagoma (1987) - suggested polyurethane liners beneath
silicone elastomer – transparent, tear resistance, moldability , wettablility
• Samuel & Anne- Michelle (2004) - studied debonding of polyurethane from
silicone…

Advantages:
• Flexibility – moveable tissue beds
• Life like feel to touch
• Good edge strength
• Colouration possible
• Good masking effects with cosmetic
agents
Disadvantages
• Difficult to process.
• Isocyanates sensitive to moisture
• Poor colour stability
• Short life
• Improper adhesion
• Free isocyanates - toxic
• Goldberg - Polyurethane – aromatic amine
• 1978 – Aliphatic polyurethane – Isophorone polyurethane
prepolymer

• G.E Turner , TE Fischer , D.J.Castleberry (1984) studied the
properties of Isophorone & concluded :
1.Tensile , tear , strength & hardness
2.Aging in uv light
3.Colouring system

Latex:
• Discovered by Clarke
• Longer life than gelatin – glycerin predecessor
• Hollow
• Degenerates rapidly
• High flexibility
• Synthetic latex – Butylacrylate , MMA , methylmethacrylamide
Advantages:
• Inexpensive
• Easy manipulation
• Life like
Disadvantages:
• Time consuming
• Colour stability
• Poor edge strength
• Short life span

Silicone Elastomers :
• Polydimethyl silicone (1946)
• Barnhart (1960)
• Si – O – SI – O
• Formation of silicone
• Dimethyl siloxane polymer , Sliica , Platinum catalyst
• Curing agent – Dimethylsiloxane polymer
• Inhibitor , Cross linking agent

Advantages:
1. Inert
2. Superior esthetic qualities
3. Better strength
4. Durablity
5. Simple technique
Disadvantages:
1. Weak tear srength
2. Poor adeophilic properties
3. Non – Wettability
4. Non – Polishability
5. Fungal growth
6. Absorption of secretions

Classification of Silicone
According to Vulcanizing process:
1. Heat vulcanizing silicone
2. Room temperature silicone
According to Applications :
1. Implant grade
2. Medical grade
3. Industrial grade

HTV Silicones:
• Translucent, milky white, semisolid
• Vulcanizing agent – dichlorobenzoyl peroxide /
platinum
• Filler – hardness, strength, elongation
• Filler – silica (30 micron)
• Eg: Silastic S-6508, 382, 399, PDM Silioxane
Q7-4635, Q74650, Q 7435, SE-4524U (BELL)

Advantage:
• Excellent thermal stability
• Color stable
• Superior strength
• Inert
Disadvantages:
• Low edge strength
• Opaque
• Metal molds necessary
• Poor wettablility
• Low elasticity
RTV silicones:
Addition / condensation type
Addition – low temperature vulcanizing silicones
Eg – A-2186 , MDX 4-4210 , Medical Adhesive type A

Advantages:
• Easy handling
• Quick processing
• Good thermal and color
stability
• Inert
Disadvantages:
• Weak edge strength
• Zipper effect
• High specific gravity
• Stiff
• Poor wettablility
• Difficulty to apply
Silastic 382 , 399:
• Filler , Stannous octate , Ortho alkyl silicate
• Colour stable , Biologically inert ,
• Poor edge strength , difficult to colour

MDX – 4-4210 :
• Translucent
• Chloroplatinic acid – catalyst ,hydromethyl siloxane
• Tensile strength , inc. elongation , resistance to tear
• Low adhesion , Hydrophobic
• Milad M.Abdelnnabi et al (1984) :studied the tensile strength, tensile
modulus, tear resistance, surface hardness of MDX4-4210, PDM
and concluded ….
• J.W.FARAH et al (1987) : studied the effects of addition of dimethyl
siloxanetriacetoxy terminated silane to MDX 4-4210 …

Silastic 891 :
• Ist
reported by Udagama & Drane
• Translucent , non- flowing
• No catalyst
• Compatible with wide range of colours

Cosmesil (1982) :
• High flexibility with high tear strength
• Contains silicone elastomer
• Gregory L, Polyzois et al (2002) studied the bond strength of Cosmesil
& Ideal elastomer with denture resins (SR 3/60, SR 3/60 Quick , Triad)…
• ER Dootz et al (1994) compared the physical properties of MDX 4 -4210 ,
A- 2186 , Cosmesil as a function of accelerated aging …
Foaming silicone :
Sillastic 386 :
• Catalyst added (Stannous octoate) – release of gas
• Reduce wt., strength & tearing strength

Siphenylenes :
• Dr. Castle Burry
• Silicone & carbon polymer
• Biocompatible, resistance to degradation,
• Improved edge strength
• Robert A Sandhez et al(1992) :studied the properties of MDX 4-4210
and A-2186 comparing tensile , tear , & surface hardness…
• Gregory L Polyzois et al(2000):studied the effects of stimulated
skin secretions on silicone polymer…
• Polyphoasphazines:
Resilient denture reliner

J.H.Lai , LL Wang , C.C.Ko. (2002) studied the physical properties of new
Organosilicon (Methacryloxypropyl terminated polydimethylsiloxane
with A-2186 , MDX 4 -4210 , Medical adhesive type A….
John . F . Woolfaardt etal (1992) has described skin adhesives according to the
Presence of solvent , Method of activation , Purpose , & Duration of function.
Facial adhesives are classified according to dispension…
• They studied the adhesive strength of PSA1, Pros- Aide, Dow corning 355…
Steven P Haug, Carl J Andres et al (1992) studied the effect of aging, tensile
strength, percent elongation, tear strength, among A-2186, A-102, Silastic 4-
4515, Medical Adhesive type A, Silastic 4- 4210…

Steven P Haug, Carl J Andres, et al (1992): studied the effects of aging,
cleansers, cosmetics, adhesive agents on Silastic 4-4210, Silastic 4-4515,
Medical Adhesive type A & Polyurethane on optical properties A-102….
Eniko M Veres, John F Woolfardt (1990) : studied the effect of hardness
&wettablility of Cosmesil & Molloplast- B….
John F Woolfardt, H David Chandler (1985) : compared the properties of
Cosmesil & Silastic 382, 399 & MDX 4-4210…

Sudarat Kiat, Lawrence Gettleman, Goldsmith (2004) :compared the
multi-adhesive (Secure Medical adhesive, Epithane 3) to single adhesive
layering on retention of prosthesis ( Silastic MDX4 -4210,
Silastic Medical Adhesive)…

COLOURING
Colourwise a life like maxillofacial prosthesis is defined as the one that has
Distribution of pigments equivalent to that of human skin and whose overall
colour appears to change precisely as does that of human skin under all
types of illumination .
Primary, secondary, complimentary colours
Colouration techniques :
• Intrinsic colouration :
Applied within the mould
Longer life
Less vulnerable

• Spectrophotometery , computerized colour formulation
• Reduced time
• Metamerism
• Colour duplication
• Translucency
Ma et al (1988) has a described a technique for colour verification…
Mark W Beatty et al (1999) reported colour changes (Oil Pigment)….uv light
Colour used – Enamel porcelain, Ceramics, Artist’s paint, Water soluble dyes
Celluloid paints, Photographic stains, Acrylic resins stains, Oil colours, etc
Laminar glazes – Red bluish, Golden tan, Dark brown, Opaque yellow…

Extrinsic colouration :
• Applied after curing.
• More predictable
• Curing done – 900
C
• Stephen. O. Bertlett et al (1971) developed a technique for extrinsic
colouration by using Silicone medical adhesive
Extrinsic glazes – Glossy
• Cosmetic foam applicators
• Silicone fibres
• Kaolin powder
• James C . Lemon et al (1995) compared the effect of intrinsic broad
spectrum u-v light & artificial aging on colour stability….www.indiandentalacademy.com

List of References :
Beumer John Curtis, David Firtell; Prosthodontic & surgical
considerations
Chalian A, Drane P; Maxillofacial prosthetic
William R Laney, Gardner; Maxillofacial prosthetics
Lont Z, F John; DCNA 1990;34,307-25
Reisbick; Dental Materials In clinical Dentistry
JPD 1984,Apr 51(4), 523 - 6
JPD 1984,Apr 51(4), 519 - 22
JPD 1985,53(3),85-6
JPD 1983,50(2),230 - 5
JPD 1985,53(2),228 -
JPD 1998, 58(3),351 - 3
JPD 1990,63,193 - 7
JPD 1990,63,466 - 71

J Dent Res 1977,51(2),524
J Prosthodont 1995;4(1),38 - 41
Int J Prosthodont 2002;15,535 - 8
JPD 2000,83,572 - 7
DM 1999,115,450 - 5
JPD 1994,71(4),379 - 83
J Oral Rehab 1987,14,599 - 605
JPD 2001,85,438 - 41
JPD 1992;67(5),679 - 82

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