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15. MATERIALS IN MAXILLOFACIAL PROSTHODONTICS

PG FINAL YEAR

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1 MATERIALS IN MAXILLO-FACIAL PROSTHODONTICS
2 CONTENTS • Introduction • History • Properties • Materials • Colours in MFP • Retention types • Limitations in MFP • Conclusion 6/22/2022
3 INTRODUCTION MAXILLO FACIAL PROSTHESIS Any prosthesis used to replace part or all of any stomatognathic and/or craniofacial structures – GPT9 Glossary of Prosthodontic Terminology - 9 6/22/2022
4 Before 1600 Ambroise Pare – obturator – simple disc attached to sponge 1600 – 1800 Pierre Fauchard - silver mask painted with oil paints to replace the lost portion of mandible. 1800 – 1900 • William Morton - nasal prosthesis - enameled porcelain. • Claude Martin - nasal prosthesis - ceramic material. 1900 – 1940 Upham - nasal and auricular prosthesis - vulcanite rubber. 1940 – 1960 Tylman – resilient vinyl copolymer acrylic resin 1960 – 1970 Fine – colored nylon flockings – facial prosthesis 1970 – 1990 Gonzalez – polyurethane elastomers Lewis and Castelberry - siphenylene Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 6/22/2022
5 6/22/2022 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
6 PROPERTIES Biological and chemical properties: Non-allergenic Cleansable with disinfectants Color stability Inert to solvents and skin adhesives Resistance to growth of microorganisms Resistance to environmental discoloration Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 6/22/2022
7 PROPERTIES Mechanical properties: Flexible Dimensionally stable High edge strength High resistance to abrasion High tear strength High tensile strength Article - Materials of facial prosthesis: History and advance– Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages 6/22/2022
8 PROPERTIES Physical properties: Odorless Non-inflammable Light in weight Low thermal conductivity Low coefficient of friction No water sorption Translucent Softness compatible to tissue Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022
9 PROPERTIES Aesthetic properties: Color Texture Replace the missing structure with the finest details Article - Maxillofacial Prosthetic Materials – Khindria et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 6/22/2022
10 PROPERTIES Processing characteristics: Easily processed Ease of intrinsic and extrinsic coloring Long working time Chemically inert after processing No color change after processing Retain the coloration during use Easy to repair Article - Materials of facial prosthesis: History and advance– Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages 6/22/2022
11 MATERIALS 6/22/2022
12 ACCORDING TO BEUMER • Acrylic resin • Acrylic copolymers • Polyvinyl chloride and copolymers • Chlorinated polyethylene • Polyurethane elastomers • Silicone elastomers – HTV, RTV, forming silicones • New materials – silicone block copolymers, polyphosphazenes Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022
13 ACCORDING TO ANUSAVICE • Acrylic resin • Latex • Vinyl plastisols • Silicone rubbers • Polyurethane polymers • Chlorinated polyethylene Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022
14 PROSTHETIC RECONSTRUCTION Impression phase Modelling phase Fabrication phase • Agar agar • Alginate • Plaster of paris • Room temperature vulcanizing material • Modelling clay (Sculptor’s clay) • Plaster • Plastolene • Waxes • Intraoral materials • Extra oral materials 6/22/2022 Textbook of Oral and maxillofacial rehabilitation - beumer
15 IMPRESSION PHASE Reduces chair-time Eliminates discomfort to patient Patient education 6/22/2022 Textbook of Oral and maxillofacial rehabilitation - beumer
16 6/22/2022 Clinical Maxillofacial Prosthesis - Thomas D Taylor
17 MODELLING PHASE • Modelling materials should be ideally malleable with sufficient strength. • Should accept texture that will be imparted to the final prosthesis. • The closer the colour of material to skin, less is the visual distortion. 6/22/2022 Textbook of Oral and maxillofacial rehabilitation - beumer
18 MODELLING CLAY 6/22/2022 SCULPTOR’S CLAY Water based clay, when allowed to dry, becomes a hard stone-like substance. Readily available Consistency can be adjusted Inexpensive Grey in colour and colour differential causes visual distortion Must be kept moist at all times Textbook of Oral and maxillofacial rehabilitation - beumer
19 PLASTER 6/22/2022 Readily available Can be shaped or moulded in its plastic state Inexpensive Lacks elasticity Adding material to build contour is difficult Tendency to flake on the surface Cannot be used in undercuts Textbook of Oral and maxillofacial rehabilitation - beumer
20 PLASTOLENE Modelling clay with oil base. 6/22/2022 Takes texture well Always ready for use Easily malleable More expensive Colour does not match skin tone Colour seeps into the stone model and affects the finished product. Textbook of Oral and maxillofacial rehabilitation - beumer
21 WAXES 6/22/2022 Readily available Inexpensive Colour similar to skin tone Model must be carved rather than sculpted. Brittle when cooled Distorts easily Textbook of Oral and maxillofacial rehabilitation - beumer
22 FABRICATION PHASE 6/22/2022
23 ACRYLIC RESIN • Used in fabricating both intra- and extra-oral prostheses. • Types – heat activated, cold activated, light activated. 6/22/2022 Areas - Little movement occurs in the tissue bed during function Powder Liquid Polymethyl methacrylate Methyl methacrylate Colors (acrylic base paint/ chloroform solvent) Heat polymerized ˃ Auto-polymerized No residual monomer is more color stable and is free of tertiary amine activator. Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259
24 ACRYLIC RESIN Durable Color stable Can be relined/ repaired Both intrinsic and extrinsic coloring can be done Compatible with most adhesive system Rigid Duplication – not possible High thermal conductivity Less/ no movement of prosthesis Poor margin esthetics 6/22/2022 Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259
25 ACRYLIC COPOLYMERS 6/22/2022 Plasticized methyl methacrylate polymers, which show elastic properties. PALAMED – Tylman, 1943 Soft Elastic Light weight Poor edge strength Poor durability Degrade in sunlight Processing and coloration – difficult Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259
26 VINYL POLYMERS AND COPOLYMERS • Popular and widely used. • Copolymers of vinyl chloride and vinyl acetate. 6/22/2022 Flexible Accepts both intrinsic and extrinsic coloration Loss of plasticizers Tear of edges Easily stained Clinical expectancy – 6 months Require metal molds – curing at high temperature Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259
27 POLYURETHANE ELASTOMERS Urethane linkage Organotin Hydroxyl group Isocyanate group 6/22/2022 Elastomers with urethane linkages Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978
28 POLYURETHANE ELASTOMERS Flexible Ease of coloration High tear resistance Moisture sensitive Poor color stability Poor compatibility with adhesives Clinical expectancy – less than 6 months 6/22/2022 Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978
SILICONES The most widely used materials for facial restorations. External prosthesis by Barnhart in 1960 6/22/2022 29 Silica Silicon on reduction Reacts with methyl chloride to form Dimethyl-dichloro-siloxane Reacts with water to form a polymer Translucent, white, watery fluid
30 VULCANIZATION 6/22/2022 The process of cross linking polymer - vulcanization
31 CLASSIFICATION- SILICONES BASED ON MECHANISM • Room Temperature Vulcanized Silicones (RTV) • High temperature Vulcanized Silicones (HTV) 6/22/2022 BASED ON USE • Implant grade • Medical grade • Clean grade • Industrial grade BASED ON CHEMISTRY • Polydimethyl siloxanes • Methyl vinyl /dimethyl siloxanes • Phenyl methylsiloxanes • Fluoro dimethyl siloxanes
32 6/22/2022 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
33 ROOM TEMPERATURE VULCANIZING SILICONE 6/22/2022 Comparatively short chain silicone polymers which are partially end-blocked with hydroxyl groups Eg – Silastic 382, 399, MDX4-4210, Silastic 891, Cosmesil Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
34 6/22/2022 RTV (condensation) Viscous silicone polymer Stannous octate Orthoalkyl silicate Diatomace- ous earth • RTV-1 • RTV-2 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
35 • Only RTV-2 6/22/2022 RTV (addition) Viscous silicone polymer Chloroplatini c acid Hydro- methyl siloxane Diatomace- ous earth Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
36 RTV-1 • One component system. • Found in adhesives and sealants. • On exposure to atmospheric moisture, crosslinking immediately begins. • Available in sealed containers. 6/22/2022 Thin prosthesis Thick prosthesis Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
37 RTV-2 6/22/2022 RTV-2 condensation polymerization • Crosslinking when a curing agent and base combine. • Silastic 382 (Dow Corning Company) RTV-2 addition polymerization • Two component system. • RTV platinum catalysed silicones. • Less shrinkage – no by-product. • Disadvantages - difficulty with extrinsic staining, short working time, and impurities reducing curing efficiency Two component system. Available – both (condensation and addition) Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
38 EXAMPLES OF RTV1 AND RTV2 6/22/2022
39 Colour stable. Biologically inert. Easier to process. Prosthesis can be polymerized in stone molds. Retain physical and chemical properties at wide range of temperature. Poor edge strength. Costly. Cosmetic appearance of the material inferior to that of polyurethanes, acrylic resins, polyvinyl chloride. 6/22/2022 ROOM TEMPERATURE VULCANIZING SILICONE Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
40 • Crosslinking - addition or free radical polymerization • Temperature - 100 and 200°C for up to 30 min. 6/22/2022 HIGH TEMPERATURE VULCANIZING SILICONE Eg – Silastic 370, 372, PDM siloxane, Q7 -4635, 4650 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
41 6/22/2022 Addition polymerization HTV silicones • Transparent with no yellowing • Odorless • Demolded easily • Do not require any processing after curing • Relatively high tensile and tear strength. Free radical HTV silicones • Yellowing after curing • Strong odor both during and after processing • Tacky to touch - high surface friction • High-consistency • High tear resistance • Thermally stable. Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13
42 HTV VS RTV 6/22/2022 RTV silicones are not as strong as the HTV silicones Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13
43 METALS • Intra-oral maxilla facial prosthesis. • Titanium, Co-Cr., Ni-Cr. 6/22/2022 High strength Tarnish and corrosion resistant. Inexpensive. Not esthetically satisfying. Not flexible. Bond with acrylic and metal is by mechanical retention.
44 OTHER MATERIALS 6/22/2022
45 FOAMING SILICONES Silicone + catalyst Gas form bubbles within vulcanizing silicone After processing – gas releases Creates a SPONGY material 6/22/2022 Reduce the weight of the prosthesis. The volume to increase by as much as seven-fold. Article - Maxillofacial prosthetic materials - Khindria, et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1
46 Reduce the weight of the prosthesis. Reduced strength Susceptible to tearing. Increased stiffness. 6/22/2022 FOAMING SILICONES Eg. Silastic 386: A form of RTV silicone Article - Maxillofacial prosthetic materials - Khindria, et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1
47 SILPHENYLENES Base elastomer Tetrapropoxysilane - cross linking agent Organotin - catalyst 6/22/2022 Siloxane copolymers • Improved edge strength • Low modulus of elasticity • Superior coloration • Resistance to degradation on exposure to UV light and heat. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)
48 SILICONE BLOCK COPOLYMERS 6/22/2022 Blocks of polymers other than siloxane are positioned with the traditional siloxane polymers Silicones – hydrophobic in nature Foreign body reactions and the development of infections - interface between silicone and tissue. Blocks of polymers - Hydrophilic Improved wettability and tissue compatibility. Eg. Intertwining of poly methyl methacrylate into the chains of siloxane. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)
49 POLYPHOSPHAZENES • Fluoro-elastomers have been developed for use as resilient denture liners. • Potential to be used as maxillofacial prosthetic materials. 6/22/2022 Researchers in New Orleans, • Polyphosphazenes with little or no fillers and decreasing the ratio of acrylic to rubber yields a softer rubber, similar to human skin. • The rubber is compounded with pigments for appropriate matching with the patients’ skin. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)
50 MDX4-4210 • Translucent • Adequate tensile strength • Nontoxic • Color stable • Biologically compatible. 6/22/2022 • Room Temperature Vulcanizing Silicone Elastomers (RTV) • 2 component kit. • Moore et al, reported that it exhibits improved qualities relative to coloration and edge strength. Article - Maxillofacial Prosthetic Materials -An Update – Deepthi et al - Journal of International Medicine and Dentistry 2016; 3(1): 02-11
51 MPDS • Modification of silicone elastomer. • Incorporation of methacrylate groups in the silicone reduces the hydrophobicity of the silicone. • Enhances the adhesive bond strength to the non-silicone based adhesives. • Works thru thermal polymerization. 6/22/2022 Methacryloxypropyl terminated polydimethyl siloxane Article – New organosilicon maxillofacial prosthetic materials – J.H.Lai et al – Dental materials 18 (2002) 281-286
52 POLYETHER ETHER KETONE (PEEK) Used in fabrication of obturator. 6/22/2022 Organic thermoplastic polymer – PAEK family. Article - Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: A clinical report - Costa-Palau et al - The Journal of Prosthetic Dentistry - 2014
53 Biocompatibility Low specific gravity (1.31 g/cm3 ) Flexural bone-like modulus Resistance to cracking Ease of polishing and machinability White in colour Not preferred for extra-oral prosthesis. 6/22/2022 POLYETHER ETHER KETONE (PEEK) Article - PEEK in dentistry, properties and application areas – Akay et al - IDR — Volume 10, Number 2, 2020
54 3D PRINTING 6/22/2022 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
55 6/22/2022 Article - CAD/CAM ear model and virtual construction of the mold – Ciocca et al - The Journal of Prosthetic Dentistry - 2007;98:339-343
56 6/22/2022 Article - Effectiveness of digital data acquisition technologies in the fabrication of maxillofacial prostheses – A systematic review - N. Suresh et al - Journal of Oral Biology and Craniofacial Research 12 (2022) 208–215 Systematic review – characteristics of nasal prosthesis
57 Minimizes patient discomfort Mirror images are of great use. Expensive 6/22/2022 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
58 COLORATION • Accurate representation of skin color in a facial prosthesis is essential to achieving a successful esthetic result. • The ability to match skin tones effectively requires  Keen eye  Good understanding of color theory  Meticulous attention to details. 6/22/2022 Lewis et al - The ideal color properties required in a maxillofacial prosthetic material, • Must accept and retain the color • Appearance, mechanical strength and other properties – not to be changed by sunlight or other environmental factors. Clinical Maxillofacial Prosthesis - Thomas D Taylor
59 DIFFERENT PIGMENT COLOURING SYSTEMS Dry pigments Pigments suspended in silicone oil Pigments in pastes 6/22/2022 Intrinsic pigments Extrinsic pigments Combination • Intrinsic coloration is color applied within the mold during the casting procedure. • Extrinsic coloration is color applied to the surface of a prosthesis that has been cured and removed from the mold. Clinical Maxillofacial Prosthesis - Thomas D Taylor
60 FACTORS – COLOR INSTABILITY Accumulation of stains Dehydration Infiltration Surface roughness Chemical degradation 6/22/2022 Clinical Maxillofacial Prosthesis - Thomas D Taylor
61 STEPS Base color Laminar glazes Reassess the color match, pack mold Extrinsic coloration 6/22/2022 Clinical Maxillofacial Prosthesis - Thomas D Taylor
62 • The base shade - slightly lighter than the highest skin tones of the patient (because the prosthesis will darken as color is added). • Base shades are mainly metal oxides. 6/22/2022 Nickel oxide Brown Manganese oxide Lavender Titanium oxide Yellowish brown Iron oxide Brown Copper oxide Green Clinical Maxillofacial Prosthesis - Thomas D Taylor
63 • Once the base color is identified, laminar glazes are applied to simulate the skin complex appearance. 6/22/2022 Layers of color painted into the mold before packing the base color Red blush glaze Simulates classic pink appearance of skin Golden tan glaze Presence of melanin Dark brown glaze Simulates freckles and moles Dark blue/ purple Applied for shadow areas Clinical Maxillofacial Prosthesis - Thomas D Taylor
Base color is compared to patient skin with red bluish glaze , layered over a base color Red bluish glaze is painted into the first layer of mould. Tweezers and periodontal probe to place thread for blood vessel simulation Syringe used to inject silicone into the mould Instrinsically painted mold prior to packing the base color Clinical Maxillofacial Prosthesis - Thomas D Taylor
Application of extrinsic color Blending Application of kaolin (create opacity) to Cured surface of the prosthesis Compressed air used to eliminate excess kaolin Clinical Maxillofacial Prosthesis - Thomas D Taylor
66 RETENTION 6/22/2022 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
67 ADHESIVES • To retain the facial prosthesis in position. 6/22/2022 • Pastes • Liquids • Emulsions • Spray-ons • Double sided tapes Article - Materials of facial prosthesis: History and advance – Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015
68 FACTORS – SELECTION OF ADHESIVE • Biocompatibility • The strength of the adhesive bond to skin and the prosthetic material • Ease of applicability • Removal on daily basis • Nature of the material - prosthesis 6/22/2022 Article - Retentive aids in maxillofacial prosthesis: A review - Rohit Saini et al. - IP Annals of Prosthodontics and Restorative Dentistry, January-March, 2019;5(1):1-4
69 6/22/2022 Rubber based liquid adhesives Silicones Cyanoacrylates
70 PRESSURE SENSITIVE TAPE • These tapes consists of a backing strip composed of cloth, paper, film, foil or a laminate strip coated with a pressure – sensitive adhesive. • Applied by finger pressure. • Bond strength – tape < acrylic resin. 6/22/2022 Double coated polyethylene, surgical tape INDICATIONS: • Materials with poor flexibility • Defects demonstrate little or no movement 3M bifaceis Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020
71 ACRYLIC RESIN ADHESIVE • These can be easily mixed with water and applied. • On drying, they leave a clear layer – rubber like substance. LIMITATIONS: • Patients with poor manual dexterity or coordination may not be able to apply. • Require constant reattachment with facial movements. • Routine removal of adhesive - remove the external pigmentation . 6/22/2022 Beta bond Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020
72 BOND STRENGTH OF ACRYLIC RESIN ADHESIVES WITH SILICONE PROSTHESIS Bond strength between acrylic resin and maxillofacial silicone – Marcela et al (Journal of Applied Oral Science - 2012;20(6):649-54) 6/22/2022 Since the composition of these two materials is different, no strong bond between them was noted when no primer was applied.
73 SILICONE ADHESIVE • Are a form of RTV silicone dissolved in solvent. • Once the adhesive is applied, the solvent evaporates and a tacky adhesive results. 6/22/2022 Good resistance to moisture and weathering with low water sorption. Low adhesive strength Telesis silicone adhesive Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020
74 LIMITATIONS OF MFP MATERIAL 6/22/2022 No single maxillofacial material is ideal for every patient. 1. Continued effect of sunlight and vascular dilatation & contraction on the natural tissues cannot be duplicated in the prosthesis. 2. Variations of skin tone when the patient is exposed to different light sources (e.g., incandescent, fluorescent, & natural light) cannot be duplicated in the prosthesis. 3. The prosthesis cannot duplicate the full facial movement of the non defective side. 4. Varying physiologic conditions of the patient in everyday living (e.g., lack of sleep, infectious diseases, and edema resulting from interrupted lymph drainage caused by surgery) cannot be duplicated in the prosthesis. 5. Lack of predictability of the life of the prosthesis, because of variations among patients (i.e., secretions, smoking, and environment). Article - Maxillofacial Prosthetic Materials: A Literature Review - Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90
75 CONCLUSION • The success of the prosthetic rehabilitation of the facial defect limited by mechanical and physical properties of the material. • None of the materials meet our needs completely. • There are certain advantages and disadvantages of materials. • It is in clinicians hand, to choose the material wisely based on clinical scenario. 6/22/2022
76 REFERENCES • Glossary of Prosthodontic Terminology – 9 • Textbook of Oral and maxillofacial rehabilitation - beumer • Clinical Maxillofacial Prosthesis - Thomas D Taylor • Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 • Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122 • Article - Materials of facial prosthesis: History and advance– Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages • Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022
77 REFERENCES • Article - Maxillofacial Prosthetic Materials – Khindria et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 • Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259 • Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978 • Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122 • Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13 • Article - Maxillofacial prosthetic materials - Khindria, et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 6/22/2022
78 REFERENCES • Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1) • Article - Maxillofacial Prosthetic Materials -An Update – Deepthi et al - Journal of International Medicine and Dentistry 2016; 3(1): 02-11 • Article – New organosilicon maxillofacial prosthetic materials – J.H.Lai et al – Dental materials 18 (2002) 281-286 • Article - Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: A clinical report - Costa-Palau et al - The Journal of Prosthetic Dentistry - 2014 • Article - PEEK in dentistry, properties and application areas – Akay et al - IDR — Volume 10, Number 2, 2020 • Article - CAD/CAM ear model and virtual construction of the mold – Ciocca et al - The Journal of Prosthetic Dentistry - 2007;98:339-343 6/22/2022
79 • Article - Effectiveness of digital data acquisition technologies in the fabrication of maxillofacial prostheses – A systematic review - N. Suresh et al - Journal of Oral Biology and Craniofacial Research 12 (2022) 208–215 • Article - Retentive aids in maxillofacial prosthesis: A review - Rohit Saini et al. - IP Annals of Prosthodontics and Restorative Dentistry, January-March, 2019;5(1):1-4 • Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT - Volume 8, Issue 6 June 2020 6/22/2022 REFERENCES
80 THANK YOU!!! 6/22/2022

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15. MATERIALS IN MAXILLOFACIAL PROSTHODONTICS

  • 1.
  • 2.
    2 CONTENTS • Introduction • History •Properties • Materials • Colours in MFP • Retention types • Limitations in MFP • Conclusion 6/22/2022
  • 3.
    3 INTRODUCTION MAXILLO FACIAL PROSTHESIS Anyprosthesis used to replace part or all of any stomatognathic and/or craniofacial structures – GPT9 Glossary of Prosthodontic Terminology - 9 6/22/2022
  • 4.
    4 Before 1600 Ambroise Pare– obturator – simple disc attached to sponge 1600 – 1800 Pierre Fauchard - silver mask painted with oil paints to replace the lost portion of mandible. 1800 – 1900 • William Morton - nasal prosthesis - enameled porcelain. • Claude Martin - nasal prosthesis - ceramic material. 1900 – 1940 Upham - nasal and auricular prosthesis - vulcanite rubber. 1940 – 1960 Tylman – resilient vinyl copolymer acrylic resin 1960 – 1970 Fine – colored nylon flockings – facial prosthesis 1970 – 1990 Gonzalez – polyurethane elastomers Lewis and Castelberry - siphenylene Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 6/22/2022
  • 5.
    5 6/22/2022 Article - Past,Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 6.
    6 PROPERTIES Biological and chemicalproperties: Non-allergenic Cleansable with disinfectants Color stability Inert to solvents and skin adhesives Resistance to growth of microorganisms Resistance to environmental discoloration Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 6/22/2022
  • 7.
    7 PROPERTIES Mechanical properties: Flexible Dimensionallystable High edge strength High resistance to abrasion High tear strength High tensile strength Article - Materials of facial prosthesis: History and advance– Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages 6/22/2022
  • 8.
    8 PROPERTIES Physical properties: Odorless Non-inflammableLight in weight Low thermal conductivity Low coefficient of friction No water sorption Translucent Softness compatible to tissue Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022
  • 9.
    9 PROPERTIES Aesthetic properties: Color Texture Replacethe missing structure with the finest details Article - Maxillofacial Prosthetic Materials – Khindria et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 6/22/2022
  • 10.
    10 PROPERTIES Processing characteristics: Easily processed Easeof intrinsic and extrinsic coloring Long working time Chemically inert after processing No color change after processing Retain the coloration during use Easy to repair Article - Materials of facial prosthesis: History and advance– Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages 6/22/2022
  • 11.
  • 12.
    12 ACCORDING TO BEUMER •Acrylic resin • Acrylic copolymers • Polyvinyl chloride and copolymers • Chlorinated polyethylene • Polyurethane elastomers • Silicone elastomers – HTV, RTV, forming silicones • New materials – silicone block copolymers, polyphosphazenes Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022
  • 13.
    13 ACCORDING TO ANUSAVICE •Acrylic resin • Latex • Vinyl plastisols • Silicone rubbers • Polyurethane polymers • Chlorinated polyethylene Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022
  • 14.
    14 PROSTHETIC RECONSTRUCTION Impression phase Modelling phase Fabrication phase • Agaragar • Alginate • Plaster of paris • Room temperature vulcanizing material • Modelling clay (Sculptor’s clay) • Plaster • Plastolene • Waxes • Intraoral materials • Extra oral materials 6/22/2022 Textbook of Oral and maxillofacial rehabilitation - beumer
  • 15.
    15 IMPRESSION PHASE Reduces chair-time Eliminatesdiscomfort to patient Patient education 6/22/2022 Textbook of Oral and maxillofacial rehabilitation - beumer
  • 16.
  • 17.
    17 MODELLING PHASE • Modellingmaterials should be ideally malleable with sufficient strength. • Should accept texture that will be imparted to the final prosthesis. • The closer the colour of material to skin, less is the visual distortion. 6/22/2022 Textbook of Oral and maxillofacial rehabilitation - beumer
  • 18.
    18 MODELLING CLAY 6/22/2022 SCULPTOR’S CLAY Waterbased clay, when allowed to dry, becomes a hard stone-like substance. Readily available Consistency can be adjusted Inexpensive Grey in colour and colour differential causes visual distortion Must be kept moist at all times Textbook of Oral and maxillofacial rehabilitation - beumer
  • 19.
    19 PLASTER 6/22/2022 Readily available Can beshaped or moulded in its plastic state Inexpensive Lacks elasticity Adding material to build contour is difficult Tendency to flake on the surface Cannot be used in undercuts Textbook of Oral and maxillofacial rehabilitation - beumer
  • 20.
    20 PLASTOLENE Modelling clay withoil base. 6/22/2022 Takes texture well Always ready for use Easily malleable More expensive Colour does not match skin tone Colour seeps into the stone model and affects the finished product. Textbook of Oral and maxillofacial rehabilitation - beumer
  • 21.
    21 WAXES 6/22/2022 Readily available Inexpensive Colour similarto skin tone Model must be carved rather than sculpted. Brittle when cooled Distorts easily Textbook of Oral and maxillofacial rehabilitation - beumer
  • 22.
  • 23.
    23 ACRYLIC RESIN • Usedin fabricating both intra- and extra-oral prostheses. • Types – heat activated, cold activated, light activated. 6/22/2022 Areas - Little movement occurs in the tissue bed during function Powder Liquid Polymethyl methacrylate Methyl methacrylate Colors (acrylic base paint/ chloroform solvent) Heat polymerized ˃ Auto-polymerized No residual monomer is more color stable and is free of tertiary amine activator. Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259
  • 24.
    24 ACRYLIC RESIN Durable Color stable Canbe relined/ repaired Both intrinsic and extrinsic coloring can be done Compatible with most adhesive system Rigid Duplication – not possible High thermal conductivity Less/ no movement of prosthesis Poor margin esthetics 6/22/2022 Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259
  • 25.
    25 ACRYLIC COPOLYMERS 6/22/2022 Plasticized methylmethacrylate polymers, which show elastic properties. PALAMED – Tylman, 1943 Soft Elastic Light weight Poor edge strength Poor durability Degrade in sunlight Processing and coloration – difficult Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259
  • 26.
    26 VINYL POLYMERS ANDCOPOLYMERS • Popular and widely used. • Copolymers of vinyl chloride and vinyl acetate. 6/22/2022 Flexible Accepts both intrinsic and extrinsic coloration Loss of plasticizers Tear of edges Easily stained Clinical expectancy – 6 months Require metal molds – curing at high temperature Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259
  • 27.
    27 POLYURETHANE ELASTOMERS Urethane linkage Organotin Hydroxyl group Isocyanate group 6/22/2022 Elastomerswith urethane linkages Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978
  • 28.
    28 POLYURETHANE ELASTOMERS Flexible Ease ofcoloration High tear resistance Moisture sensitive Poor color stability Poor compatibility with adhesives Clinical expectancy – less than 6 months 6/22/2022 Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978
  • 29.
    SILICONES The most widelyused materials for facial restorations. External prosthesis by Barnhart in 1960 6/22/2022 29 Silica Silicon on reduction Reacts with methyl chloride to form Dimethyl-dichloro-siloxane Reacts with water to form a polymer Translucent, white, watery fluid
  • 30.
    30 VULCANIZATION 6/22/2022 The process ofcross linking polymer - vulcanization
  • 31.
    31 CLASSIFICATION- SILICONES BASED ONMECHANISM • Room Temperature Vulcanized Silicones (RTV) • High temperature Vulcanized Silicones (HTV) 6/22/2022 BASED ON USE • Implant grade • Medical grade • Clean grade • Industrial grade BASED ON CHEMISTRY • Polydimethyl siloxanes • Methyl vinyl /dimethyl siloxanes • Phenyl methylsiloxanes • Fluoro dimethyl siloxanes
  • 32.
    32 6/22/2022 Article - Past,Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 33.
    33 ROOM TEMPERATURE VULCANIZING SILICONE 6/22/2022 Comparativelyshort chain silicone polymers which are partially end-blocked with hydroxyl groups Eg – Silastic 382, 399, MDX4-4210, Silastic 891, Cosmesil Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 34.
    34 6/22/2022 RTV (condensation) Viscous silicone polymer Stannous octate Orthoalkyl silicate Diatomace- ous earth • RTV-1 •RTV-2 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 35.
    35 • Only RTV-2 6/22/2022 RTV (addition) Viscous silicone polymer Chloroplatini cacid Hydro- methyl siloxane Diatomace- ous earth Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 36.
    36 RTV-1 • One componentsystem. • Found in adhesives and sealants. • On exposure to atmospheric moisture, crosslinking immediately begins. • Available in sealed containers. 6/22/2022 Thin prosthesis Thick prosthesis Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 37.
    37 RTV-2 6/22/2022 RTV-2 condensation polymerization •Crosslinking when a curing agent and base combine. • Silastic 382 (Dow Corning Company) RTV-2 addition polymerization • Two component system. • RTV platinum catalysed silicones. • Less shrinkage – no by-product. • Disadvantages - difficulty with extrinsic staining, short working time, and impurities reducing curing efficiency Two component system. Available – both (condensation and addition) Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 38.
    38 EXAMPLES OF RTV1AND RTV2 6/22/2022
  • 39.
    39 Colour stable. Biologically inert. Easierto process. Prosthesis can be polymerized in stone molds. Retain physical and chemical properties at wide range of temperature. Poor edge strength. Costly. Cosmetic appearance of the material inferior to that of polyurethanes, acrylic resins, polyvinyl chloride. 6/22/2022 ROOM TEMPERATURE VULCANIZING SILICONE Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 40.
    40 • Crosslinking -addition or free radical polymerization • Temperature - 100 and 200°C for up to 30 min. 6/22/2022 HIGH TEMPERATURE VULCANIZING SILICONE Eg – Silastic 370, 372, PDM siloxane, Q7 -4635, 4650 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 41.
    41 6/22/2022 Addition polymerization HTVsilicones • Transparent with no yellowing • Odorless • Demolded easily • Do not require any processing after curing • Relatively high tensile and tear strength. Free radical HTV silicones • Yellowing after curing • Strong odor both during and after processing • Tacky to touch - high surface friction • High-consistency • High tear resistance • Thermally stable. Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13
  • 42.
    42 HTV VS RTV 6/22/2022 RTVsilicones are not as strong as the HTV silicones Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13
  • 43.
    43 METALS • Intra-oral maxillafacial prosthesis. • Titanium, Co-Cr., Ni-Cr. 6/22/2022 High strength Tarnish and corrosion resistant. Inexpensive. Not esthetically satisfying. Not flexible. Bond with acrylic and metal is by mechanical retention.
  • 44.
  • 45.
    45 FOAMING SILICONES Silicone +catalyst Gas form bubbles within vulcanizing silicone After processing – gas releases Creates a SPONGY material 6/22/2022 Reduce the weight of the prosthesis. The volume to increase by as much as seven-fold. Article - Maxillofacial prosthetic materials - Khindria, et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1
  • 46.
    46 Reduce the weight ofthe prosthesis. Reduced strength Susceptible to tearing. Increased stiffness. 6/22/2022 FOAMING SILICONES Eg. Silastic 386: A form of RTV silicone Article - Maxillofacial prosthetic materials - Khindria, et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1
  • 47.
    47 SILPHENYLENES Base elastomer Tetrapropoxysilane - crosslinking agent Organotin - catalyst 6/22/2022 Siloxane copolymers • Improved edge strength • Low modulus of elasticity • Superior coloration • Resistance to degradation on exposure to UV light and heat. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)
  • 48.
    48 SILICONE BLOCK COPOLYMERS 6/22/2022 Blocksof polymers other than siloxane are positioned with the traditional siloxane polymers Silicones – hydrophobic in nature Foreign body reactions and the development of infections - interface between silicone and tissue. Blocks of polymers - Hydrophilic Improved wettability and tissue compatibility. Eg. Intertwining of poly methyl methacrylate into the chains of siloxane. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)
  • 49.
    49 POLYPHOSPHAZENES • Fluoro-elastomers havebeen developed for use as resilient denture liners. • Potential to be used as maxillofacial prosthetic materials. 6/22/2022 Researchers in New Orleans, • Polyphosphazenes with little or no fillers and decreasing the ratio of acrylic to rubber yields a softer rubber, similar to human skin. • The rubber is compounded with pigments for appropriate matching with the patients’ skin. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)
  • 50.
    50 MDX4-4210 • Translucent • Adequatetensile strength • Nontoxic • Color stable • Biologically compatible. 6/22/2022 • Room Temperature Vulcanizing Silicone Elastomers (RTV) • 2 component kit. • Moore et al, reported that it exhibits improved qualities relative to coloration and edge strength. Article - Maxillofacial Prosthetic Materials -An Update – Deepthi et al - Journal of International Medicine and Dentistry 2016; 3(1): 02-11
  • 51.
    51 MPDS • Modification ofsilicone elastomer. • Incorporation of methacrylate groups in the silicone reduces the hydrophobicity of the silicone. • Enhances the adhesive bond strength to the non-silicone based adhesives. • Works thru thermal polymerization. 6/22/2022 Methacryloxypropyl terminated polydimethyl siloxane Article – New organosilicon maxillofacial prosthetic materials – J.H.Lai et al – Dental materials 18 (2002) 281-286
  • 52.
    52 POLYETHER ETHER KETONE(PEEK) Used in fabrication of obturator. 6/22/2022 Organic thermoplastic polymer – PAEK family. Article - Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: A clinical report - Costa-Palau et al - The Journal of Prosthetic Dentistry - 2014
  • 53.
    53 Biocompatibility Low specific gravity(1.31 g/cm3 ) Flexural bone-like modulus Resistance to cracking Ease of polishing and machinability White in colour Not preferred for extra-oral prosthesis. 6/22/2022 POLYETHER ETHER KETONE (PEEK) Article - PEEK in dentistry, properties and application areas – Akay et al - IDR — Volume 10, Number 2, 2020
  • 54.
    54 3D PRINTING 6/22/2022 Article -Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 55.
    55 6/22/2022 Article - CAD/CAMear model and virtual construction of the mold – Ciocca et al - The Journal of Prosthetic Dentistry - 2007;98:339-343
  • 56.
    56 6/22/2022 Article -Effectiveness of digital data acquisition technologies in the fabrication of maxillofacial prostheses – A systematic review - N. Suresh et al - Journal of Oral Biology and Craniofacial Research 12 (2022) 208–215 Systematic review – characteristics of nasal prosthesis
  • 57.
    57 Minimizes patient discomfort Mirror imagesare of great use. Expensive 6/22/2022 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 58.
    58 COLORATION • Accurate representationof skin color in a facial prosthesis is essential to achieving a successful esthetic result. • The ability to match skin tones effectively requires  Keen eye  Good understanding of color theory  Meticulous attention to details. 6/22/2022 Lewis et al - The ideal color properties required in a maxillofacial prosthetic material, • Must accept and retain the color • Appearance, mechanical strength and other properties – not to be changed by sunlight or other environmental factors. Clinical Maxillofacial Prosthesis - Thomas D Taylor
  • 59.
    59 DIFFERENT PIGMENT COLOURINGSYSTEMS Dry pigments Pigments suspended in silicone oil Pigments in pastes 6/22/2022 Intrinsic pigments Extrinsic pigments Combination • Intrinsic coloration is color applied within the mold during the casting procedure. • Extrinsic coloration is color applied to the surface of a prosthesis that has been cured and removed from the mold. Clinical Maxillofacial Prosthesis - Thomas D Taylor
  • 60.
    60 FACTORS – COLORINSTABILITY Accumulation of stains Dehydration Infiltration Surface roughness Chemical degradation 6/22/2022 Clinical Maxillofacial Prosthesis - Thomas D Taylor
  • 61.
    61 STEPS Base color Laminar glazes Reassessthe color match, pack mold Extrinsic coloration 6/22/2022 Clinical Maxillofacial Prosthesis - Thomas D Taylor
  • 62.
    62 • The baseshade - slightly lighter than the highest skin tones of the patient (because the prosthesis will darken as color is added). • Base shades are mainly metal oxides. 6/22/2022 Nickel oxide Brown Manganese oxide Lavender Titanium oxide Yellowish brown Iron oxide Brown Copper oxide Green Clinical Maxillofacial Prosthesis - Thomas D Taylor
  • 63.
    63 • Once thebase color is identified, laminar glazes are applied to simulate the skin complex appearance. 6/22/2022 Layers of color painted into the mold before packing the base color Red blush glaze Simulates classic pink appearance of skin Golden tan glaze Presence of melanin Dark brown glaze Simulates freckles and moles Dark blue/ purple Applied for shadow areas Clinical Maxillofacial Prosthesis - Thomas D Taylor
  • 64.
    Base color iscompared to patient skin with red bluish glaze , layered over a base color Red bluish glaze is painted into the first layer of mould. Tweezers and periodontal probe to place thread for blood vessel simulation Syringe used to inject silicone into the mould Instrinsically painted mold prior to packing the base color Clinical Maxillofacial Prosthesis - Thomas D Taylor
  • 65.
    Application of extrinsiccolor Blending Application of kaolin (create opacity) to Cured surface of the prosthesis Compressed air used to eliminate excess kaolin Clinical Maxillofacial Prosthesis - Thomas D Taylor
  • 66.
    66 RETENTION 6/22/2022 Article - Past,Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122
  • 67.
    67 ADHESIVES • To retainthe facial prosthesis in position. 6/22/2022 • Pastes • Liquids • Emulsions • Spray-ons • Double sided tapes Article - Materials of facial prosthesis: History and advance – Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015
  • 68.
    68 FACTORS – SELECTIONOF ADHESIVE • Biocompatibility • The strength of the adhesive bond to skin and the prosthetic material • Ease of applicability • Removal on daily basis • Nature of the material - prosthesis 6/22/2022 Article - Retentive aids in maxillofacial prosthesis: A review - Rohit Saini et al. - IP Annals of Prosthodontics and Restorative Dentistry, January-March, 2019;5(1):1-4
  • 69.
    69 6/22/2022 Rubber based liquidadhesives Silicones Cyanoacrylates
  • 70.
    70 PRESSURE SENSITIVE TAPE •These tapes consists of a backing strip composed of cloth, paper, film, foil or a laminate strip coated with a pressure – sensitive adhesive. • Applied by finger pressure. • Bond strength – tape < acrylic resin. 6/22/2022 Double coated polyethylene, surgical tape INDICATIONS: • Materials with poor flexibility • Defects demonstrate little or no movement 3M bifaceis Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020
  • 71.
    71 ACRYLIC RESIN ADHESIVE •These can be easily mixed with water and applied. • On drying, they leave a clear layer – rubber like substance. LIMITATIONS: • Patients with poor manual dexterity or coordination may not be able to apply. • Require constant reattachment with facial movements. • Routine removal of adhesive - remove the external pigmentation . 6/22/2022 Beta bond Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020
  • 72.
    72 BOND STRENGTH OFACRYLIC RESIN ADHESIVES WITH SILICONE PROSTHESIS Bond strength between acrylic resin and maxillofacial silicone – Marcela et al (Journal of Applied Oral Science - 2012;20(6):649-54) 6/22/2022 Since the composition of these two materials is different, no strong bond between them was noted when no primer was applied.
  • 73.
    73 SILICONE ADHESIVE • Area form of RTV silicone dissolved in solvent. • Once the adhesive is applied, the solvent evaporates and a tacky adhesive results. 6/22/2022 Good resistance to moisture and weathering with low water sorption. Low adhesive strength Telesis silicone adhesive Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020
  • 74.
    74 LIMITATIONS OF MFPMATERIAL 6/22/2022 No single maxillofacial material is ideal for every patient. 1. Continued effect of sunlight and vascular dilatation & contraction on the natural tissues cannot be duplicated in the prosthesis. 2. Variations of skin tone when the patient is exposed to different light sources (e.g., incandescent, fluorescent, & natural light) cannot be duplicated in the prosthesis. 3. The prosthesis cannot duplicate the full facial movement of the non defective side. 4. Varying physiologic conditions of the patient in everyday living (e.g., lack of sleep, infectious diseases, and edema resulting from interrupted lymph drainage caused by surgery) cannot be duplicated in the prosthesis. 5. Lack of predictability of the life of the prosthesis, because of variations among patients (i.e., secretions, smoking, and environment). Article - Maxillofacial Prosthetic Materials: A Literature Review - Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90
  • 75.
    75 CONCLUSION • The successof the prosthetic rehabilitation of the facial defect limited by mechanical and physical properties of the material. • None of the materials meet our needs completely. • There are certain advantages and disadvantages of materials. • It is in clinicians hand, to choose the material wisely based on clinical scenario. 6/22/2022
  • 76.
    76 REFERENCES • Glossary ofProsthodontic Terminology – 9 • Textbook of Oral and maxillofacial rehabilitation - beumer • Clinical Maxillofacial Prosthesis - Thomas D Taylor • Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 • Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122 • Article - Materials of facial prosthesis: History and advance– Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages • Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022
  • 77.
    77 REFERENCES • Article -Maxillofacial Prosthetic Materials – Khindria et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 • Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259 • Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978 • Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122 • Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13 • Article - Maxillofacial prosthetic materials - Khindria, et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 6/22/2022
  • 78.
    78 REFERENCES • Article –Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1) • Article - Maxillofacial Prosthetic Materials -An Update – Deepthi et al - Journal of International Medicine and Dentistry 2016; 3(1): 02-11 • Article – New organosilicon maxillofacial prosthetic materials – J.H.Lai et al – Dental materials 18 (2002) 281-286 • Article - Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: A clinical report - Costa-Palau et al - The Journal of Prosthetic Dentistry - 2014 • Article - PEEK in dentistry, properties and application areas – Akay et al - IDR — Volume 10, Number 2, 2020 • Article - CAD/CAM ear model and virtual construction of the mold – Ciocca et al - The Journal of Prosthetic Dentistry - 2007;98:339-343 6/22/2022
  • 79.
    79 • Article -Effectiveness of digital data acquisition technologies in the fabrication of maxillofacial prostheses – A systematic review - N. Suresh et al - Journal of Oral Biology and Craniofacial Research 12 (2022) 208–215 • Article - Retentive aids in maxillofacial prosthesis: A review - Rohit Saini et al. - IP Annals of Prosthodontics and Restorative Dentistry, January-March, 2019;5(1):1-4 • Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT - Volume 8, Issue 6 June 2020 6/22/2022 REFERENCES
  • 80.

Editor's Notes

  • #5 Computer numerical control - CNC
  • #23 Visible light cured resin is also being used, which has an organic filler made of acrylic resin beads of different sizes that become part of the polymer network structure upon curing. The matrix is a urethane dimethacrylate with microfine silica and contains a camphoroquinone amine as photoinitiator
  • #25 Powder - Plasticized methyl methacrylate polymers Liquid - MMA
  • #26 5-20% vinyl acetate – more flexible Loss of plasticizers – loss of color
  • #27 Organotin - catalyst
  • #28 Isocyanate – moisture sensitive – porous elastomers
  • #29 Viscosity – length of polymer chain Fillers – strength Additives - Colors
  • #30 140–160°C
  • #31 Implant grade: They are placed within the tissues (breast implants). Medical grade: They are approved for external use only. It is the most commonly used variety for fabricating maxillofacial prosthesis. Clean grade: Industrial use Industrial grade: Industrial use.
  • #33 According to curing – 2 types viscous silicone polymer Chloroplatinic acid, Stannous octate - catalyst Hydro-methyl siloxane, Orthoalkyl silicate – cross linking agent Diatomaceous earth – filler – strength The addition type give off very little or no byproducts during the curing process
  • #36 moisture cannot penetrate deep enough for polymerization.
  • #37 Impurities - (e.g., amines, sulfurous, or other catalyst poisons)
  • #39 Process with plaster, dental stone
  • #46 Process with plaster, dental stone
  • #51 Long working time
  • #52 POLYARYL ETHER KETONE
  • #53 Process with plaster, dental stone
  • #54 Mri, ct, laser, 3d photogrammetry
  • #57 Process with plaster, dental stone
  • #58 Hue – dominant color Value – lightness r darkness Chroma – saturation of color
  • #71 Latex adhesive