Facial prosthesis / dental implant courses by Indian dental academy

FABRICATION OFFABRICATION OF
FACIALPROSTHESISFACIALPROSTHESIS
– TECHNICALASPECTS– TECHNICALASPECTS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Educationwww.indiandentalacademy.com

CONTENTSCONTENTS
 IntroductionIntroduction
 DefinitionDefinition
 History of MFPHistory of MFP
 Objective of MFPObjective of MFP
 Maxillofacial prosthesis Vs Plastic SurgeryMaxillofacial prosthesis Vs Plastic Surgery
 Causes of Maxillofacial defectsCauses of Maxillofacial defects
 Post surgical anatomy of eye and contiguous structures.Post surgical anatomy of eye and contiguous structures.
 Impression techniques for obtaining facial moulageImpression techniques for obtaining facial moulage
 Review of techniques for facial impressions.Review of techniques for facial impressions.
 Modelling materialsModelling materials
 Orbital prosthesisOrbital prosthesis
 Aids for positioning the prosthetic eye in orbital and ocularAids for positioning the prosthetic eye in orbital and ocular
prosthesisprosthesis
www.indiandentalacademy.com

 Ocular prosthesisOcular prosthesis
 Brief insight into materials used for extraoral maxillofacial prosthesisBrief insight into materials used for extraoral maxillofacial prosthesis
 Coloring the prosthesisColoring the prosthesis
 Retention of the prosthesisRetention of the prosthesis
 Implant supported MFPImplant supported MFP
 Maintenance of the prosthesis and patient instructionsMaintenance of the prosthesis and patient instructions
 Review of literatureReview of literature
 Summary and conclusionSummary and conclusion
 ReferencesReferences

INTRODUCTIONINTRODUCTION
 Man's need for artificial replacements to supply missing or lostMan's need for artificial replacements to supply missing or lost
body parts has probably existed as long as man himself.body parts has probably existed as long as man himself.
 There has apparently always been a social awareness that theThere has apparently always been a social awareness that the
deformed body is not completely accepted.deformed body is not completely accepted.
 Body abnormalities or defects that compromise appearance,Body abnormalities or defects that compromise appearance,
function, sufficient to render an individual incapable offunction, sufficient to render an individual incapable of
leading a relatively normal life have usually promptedleading a relatively normal life have usually prompted
responses that seek to bring the person to a state of acceptableresponses that seek to bring the person to a state of acceptable
normalcy.normalcy.

 The replacement of anatomical parts is a singularThe replacement of anatomical parts is a singular
challenge to those properly trained to constructchallenge to those properly trained to construct
acceptable substitutes.acceptable substitutes.
 Several persons involved in helping them to adapt toSeveral persons involved in helping them to adapt to
their new appliance, present a clear composite of atheir new appliance, present a clear composite of a
highly trained, well-coordinated team.highly trained, well-coordinated team.

DEFINITIONDEFINITION
Maxillofacial prosthetics is the art and science ofMaxillofacial prosthetics is the art and science of
anatomic, functional, or cosmetic reconstructionanatomic, functional, or cosmetic reconstruction
by means of non-living substitutes of thoseby means of non-living substitutes of those
regions in the maxilla, mandible, and face that areregions in the maxilla, mandible, and face that are
missing or defective because of surgicalmissing or defective because of surgical
intervention, trauma, pathology or developmentalintervention, trauma, pathology or developmental
or congenital malformation.or congenital malformation.

HISTORY OF MAXILLOFACIALHISTORY OF MAXILLOFACIAL
PROSTHESISPROSTHESIS
 Artificial eyes, ears, and noses were found onArtificial eyes, ears, and noses were found on
Egyptian mummies.Egyptian mummies.
 Chinese reconstructed missing noses and ears byChinese reconstructed missing noses and ears by
using waxes and resinsusing waxes and resins
 Not until the 16th century that reliableNot until the 16th century that reliable
documentation became availabledocumentation became available

 Tycho Brahe, a Danish astronomer of the 16thTycho Brahe, a Danish astronomer of the 16th
century, lost his nose in an accident and replacedcentury, lost his nose in an accident and replaced
it with an artificial nose made of silver and gold.it with an artificial nose made of silver and gold.
 Ambroise Paré - first to use an obturator to closeAmbroise Paré - first to use an obturator to close
palatal perforations (pioneer in maxillofacialpalatal perforations (pioneer in maxillofacial
prosthetics )prosthetics )

 Pierre Fauchard, 1728, used perforations ofPierre Fauchard, 1728, used perforations of
palate to retain artificial denturespalate to retain artificial dentures
 All prostheses utilized grossly crude methods forAll prostheses utilized grossly crude methods for
retention, and the problems were probablyretention, and the problems were probably
compounded by the amount of metal andcompounded by the amount of metal and
ceramic material used in construction.ceramic material used in construction.

 TheThe LondonLondon MedicalMedical GazetteGazette of 1832 reportedof 1832 reported
"Gunner with the Silver Mask," a French soldier."Gunner with the Silver Mask," a French soldier.
 Kingsley in 1880 described artificial appliancesKingsley in 1880 described artificial appliances
for the restoration of congenital as well asfor the restoration of congenital as well as
acquired defects of the palate, nose, and orbit.acquired defects of the palate, nose, and orbit.

 Tetamore in 1894 described and illustrated nineTetamore in 1894 described and illustrated nine
cases of nasal deformities that received prostheticcases of nasal deformities that received prosthetic
restorations, made of a "very light plastic material"restorations, made of a "very light plastic material"
that approximated the natural color.that approximated the natural color.
 End of the 19th century, certain workers wereEnd of the 19th century, certain workers were
making facial restorations with vulcanite. Themaking facial restorations with vulcanite. The
surface of this material was painted in an effort tosurface of this material was painted in an effort to
match the skin coloring.match the skin coloring.

 Early part of the 20th century, prostheticEarly part of the 20th century, prosthetic
restorations were made through collaboration ofrestorations were made through collaboration of
dentists and plastic surgeonsdentists and plastic surgeons
 In 1953, a group of dentists founded theIn 1953, a group of dentists founded the
American Academy of Maxillofacial Prosthetics.American Academy of Maxillofacial Prosthetics.

 Today almost all patients with oral or facial defectsToday almost all patients with oral or facial defects
are referred to dentists for the construction ofare referred to dentists for the construction of
maxillofacial prosthesesmaxillofacial prostheses
 Profession of dentistry encompasses theProfession of dentistry encompasses the
knowledge, artistic skills, materials, and techniquesknowledge, artistic skills, materials, and techniques
for the prosthetic repair of these defects.for the prosthetic repair of these defects.

OBJECTIVE OF MAXILLOFACIALOBJECTIVE OF MAXILLOFACIAL
REHABILITATIONREHABILITATION
1. Restoration of esthetics or cosmetic appearance of1. Restoration of esthetics or cosmetic appearance of
the patient.the patient.
2. Restoration of function.2. Restoration of function.
3. Protection of tissues.3. Protection of tissues.
4. Therapeutic or healing effect.4. Therapeutic or healing effect.
5. Psychologic therapy.5. Psychologic therapy.

MAXILLOFACIAL PROSTHESISMAXILLOFACIAL PROSTHESIS
VERSUS PLASTIC SURGERYVERSUS PLASTIC SURGERY
 By no means should maxillofacial prostheticBy no means should maxillofacial prosthetic
repair be considered a substitute for plastic repair,repair be considered a substitute for plastic repair,
but in certain circumstances it may be anbut in certain circumstances it may be an
alternative.alternative.
 But it does form a very viable alternative inBut it does form a very viable alternative in
certain situations, including contraindications forcertain situations, including contraindications for
plastic surgery.plastic surgery.

Contraindications for plastic surgery include:Contraindications for plastic surgery include:
 Advanced age of the patient,Advanced age of the patient,
 Poor health,Poor health,
 Very large deformity,Very large deformity,
 And poor blood supply on post radiated tissue.And poor blood supply on post radiated tissue.

The maxillofacial prosthetic approach has three mainThe maxillofacial prosthetic approach has three main
advantages:advantages:
1.1. It requires little surgery or no surgery,It requires little surgery or no surgery,
2.2. The patient spends less time away from home and jobThe patient spends less time away from home and job
3.3. The reconstruction is often more natural-lookingThe reconstruction is often more natural-looking

The drawbacks include:The drawbacks include:
1.1. The necessity of fastening the appliance to theThe necessity of fastening the appliance to the
skin andskin and
2.2. Removing it every day andRemoving it every day and
3.3. The occasional need of constructing a newThe occasional need of constructing a new
prosthesis.prosthesis.

A very large defect which cannot be repaired with
plastic surgery, then maxillofacial prosthesis is the
treatment of choice www.indiandentalacademy.com

A defect of forehead and bridge of nose is not readily restored
by plastic surgery. Normal contour can be restore by a
prosthesis, camouflaged by spectacles and the hair style.www.indiandentalacademy.com

CAUSES OF MAXILLOFACIALCAUSES OF MAXILLOFACIAL
DEFECTSDEFECTS
 Acquired abnormal morphologic conditionsAcquired abnormal morphologic conditions
precipitated byprecipitated by
 TraumaTrauma
 Wounds produced by weapons or vehicular or otherWounds produced by weapons or vehicular or other
accidents.accidents.
 Surgical interventionSurgical intervention

 Congenital oral defectsCongenital oral defects
1.1. Holoprosencephaly (types of median faciocerebralHoloprosencephaly (types of median faciocerebral
defects)defects)
2.2. Median cleft face syndrome (Hypotelorism)Median cleft face syndrome (Hypotelorism)
3.3. Transverse and oblique facial clefts.Transverse and oblique facial clefts.
4.4. Hemifacial MicrosomiaHemifacial Microsomia
5.5. Facial Hemiatropy (Romberg’s Disease)Facial Hemiatropy (Romberg’s Disease)
6.6. Hemifacial HypertrophyHemifacial Hypertrophy

Surgical considerationsSurgical considerations
 The surgeon should consult a prosthodontist prior toThe surgeon should consult a prosthodontist prior to
performing the surgery.performing the surgery.
 The surgeon and the prosthodontist together can planThe surgeon and the prosthodontist together can plan
the most appropriate prosthesis.the most appropriate prosthesis.
 Often a surgeon who has not had prior consultationOften a surgeon who has not had prior consultation
with a prosthodontist will leave tissue which, from awith a prosthodontist will leave tissue which, from a
rehabilitative point of view, should have been removedrehabilitative point of view, should have been removed
especially around the nose & earespecially around the nose & ear

 The methods of retaining are many and varied andThe methods of retaining are many and varied and
are dependent upon existing conditions and theare dependent upon existing conditions and the
ingenuity of the prosthodontist and surgeon.ingenuity of the prosthodontist and surgeon.
 Whenever possible, one should try to utilizeWhenever possible, one should try to utilize
cohesion, adhesion, pressure of the atmosphere andcohesion, adhesion, pressure of the atmosphere and
gravity.gravity.
 When the cohesion is absent or diminished one canWhen the cohesion is absent or diminished one can
utilize undercuts around the defect which are inutilize undercuts around the defect which are in
discretion of the surgeon.discretion of the surgeon.
 Thus the desirable and undesirable undercuts can beThus the desirable and undesirable undercuts can be
controlled if the surgeon is previously informed.controlled if the surgeon is previously informed.

Post surgical anatomyPost surgical anatomy
 Pharyngeal cavity (2).Pharyngeal cavity (2).
 The nasal septum (3) is composedThe nasal septum (3) is composed
of the vomer bone, theof the vomer bone, the
perpendicular plate of the ethmoidperpendicular plate of the ethmoid
bone, and a triangular-shaped piecebone, and a triangular-shaped piece
of cartilage between the two.of cartilage between the two.
 The mucosa (4) is denuded overThe mucosa (4) is denuded over
the area of the lacrimal recess.the area of the lacrimal recess.
 The right frontal sinus (5)The right frontal sinus (5)

IMPRESSION MATERIALS FORIMPRESSION MATERIALS FOR
OBTAINING FACIAL MOULAGEOBTAINING FACIAL MOULAGE
Ideal requirementsIdeal requirements
 impression materials should be able toimpression materials should be able to
reproduce fine detailreproduce fine detail
 be inherently strongbe inherently strong
 easy to manipulate,easy to manipulate,
 easy to obtaineasy to obtain
 and comparatively inexpensive.and comparatively inexpensive.www.indiandentalacademy.com

Reversible HydrocolloidReversible Hydrocolloid
A. AdvantagesA. Advantages
1. Reproduces fine detail1. Reproduces fine detail
a. Records undercutsa. Records undercuts
2. Easy to manipulate2. Easy to manipulate
a. Can be painted on, assuring coverage with noa. Can be painted on, assuring coverage with no
bubblesbubbles
b. Has short setting periodb. Has short setting period
3. Easy to obtain3. Easy to obtain
4. Comparatively inexpensive4. Comparatively inexpensive
a. Unused portion can be reusea. Unused portion can be reuse

B. DisadvantagesB. Disadvantages
1. Requires rigid backing for sufficient strength1. Requires rigid backing for sufficient strength
2. Fragility in fine undercut areas2. Fragility in fine undercut areas
3. Requires two hours of preparation3. Requires two hours of preparation
prior to making the impressionprior to making the impression
4. Needs intermediary to bond the backing material4. Needs intermediary to bond the backing material

II. Irreversible HydrocolloidII. Irreversible Hydrocolloid
1. Reproduces fine detail1. Reproduces fine detail
a. Records undercutsa. Records undercuts
a. Readily availablea. Readily available
b. Short setting timeb. Short setting time
4. Comparatively inexpensive4. Comparatively inexpensive

1. Requires backing for strength1. Requires backing for strength
2. Fragility in fine undercut areas2. Fragility in fine undercut areas
3. Sets slowly at the required consistency3. Sets slowly at the required consistency
4. Requires retaining wall to hold the impression4. Requires retaining wall to hold the impression
material in the desired areamaterial in the desired area
5. Possibility of bubbles, necessitating remakes5. Possibility of bubbles, necessitating remakes
6. Lumpiness at the required consistency making6. Lumpiness at the required consistency making
painting difficultpainting difficult
7. All mixed must be used7. All mixed must be used

III. Room Temperature Vulcanizing MaterialsIII. Room Temperature Vulcanizing Materials
AdvantagesAdvantages
1. Fine details obtainable1. Fine details obtainable
a. Reproduces undercutsa. Reproduces undercuts
2. Inherent strength2. Inherent strength
a. Will not tear in fine undercutsa. Will not tear in fine undercuts

1. Needs backing1. Needs backing
2. Difficulty in adjusting setting time2. Difficulty in adjusting setting time
3. Retaining walls needed for3. Retaining walls needed for
confinement of materialconfinement of material
4. High cost4. High cost

IV. Plaster of ParisIV. Plaster of Paris
1. Fine detail obtainable1. Fine detail obtainable
2. Inherent strength2. Inherent strength
5. Low cost5. Low cost

1. Cannot reproduce undercuts without fracture1. Cannot reproduce undercuts without fracture
a. Easily chipped, with the possibility of patienta. Easily chipped, with the possibility of patient
aspirating small fragmentaspirating small fragment
2. Exothermic setting reaction of the material2. Exothermic setting reaction of the material
causes discomfort to the exposed mucouscauses discomfort to the exposed mucous
membranemembrane
3. Requires separating medium to prevent3. Requires separating medium to prevent
impression from adhering to the model (eg.impression from adhering to the model (eg.
Glycerine)Glycerine)
4. Cannot be used in defects which are large,4. Cannot be used in defects which are large,
fresh, and bleeding.fresh, and bleeding.

V. Impression CompoundV. Impression Compound
1. Quick impression can be made with patient in1. Quick impression can be made with patient in
upright positionupright position
1. Creates a rough impression which can be poured1. Creates a rough impression which can be poured
only onceonly once

REVIEW OF TECHNIQUES FORREVIEW OF TECHNIQUES FOR
FACIAL IMPRESSIONFACIAL IMPRESSION

F.A. Pflughoeft & H.H. Shearer (1977)F.A. Pflughoeft & H.H. Shearer (1977)
Plastic facial moulagePlastic facial moulage
Teaching aids, models, records.Teaching aids, models, records.
Face mask frameFace mask frame Plastic moulagePlastic moulage

M. Levy et al (1980)M. Levy et al (1980)
Flexible moulage for orbitalFlexible moulage for orbital
prosthesisprosthesis

Three piece moulageThree piece moulage

 Permits continued transfer of wax pattern from moulage to patientPermits continued transfer of wax pattern from moulage to patient
 Utilizes tissue undercuts for retention and stability of prosthesisUtilizes tissue undercuts for retention and stability of prosthesis
 Proper alignment of eyeProper alignment of eye
 Simplifies carvingSimplifies carving
 Well- adapted thin marginsWell- adapted thin margins

A.J. Coleman et alA.J. Coleman et al
Two- stage impression techniqueTwo- stage impression technique

Completed impression and masterCompleted impression and master
castcast

 Custom impression tray fabricated at initial visitCustom impression tray fabricated at initial visit
 Additions to tray can be done quicklyAdditions to tray can be done quickly
 Airway can be maintained without the use ofAirway can be maintained without the use of
tubestubes
 Patient in upright position, thus gravity effectsPatient in upright position, thus gravity effects
on facial tissues reducedon facial tissues reduced
 Reduced dimensional changes compared to useReduced dimensional changes compared to use
of alginate and changes in facial muscle tone dueof alginate and changes in facial muscle tone due
to position by use of silicone impressionto position by use of silicone impression
materialmaterial

T.R. Saunders, N.A. Hansen (1995)T.R. Saunders, N.A. Hansen (1995)
Synthetic casting tape as tray materialSynthetic casting tape as tray material

Synthetic casting tape – fiber glass fabricSynthetic casting tape – fiber glass fabric
impregnated with polyurethane resinimpregnated with polyurethane resin
Available in 3,4, and 5 inch width rolls sets onAvailable in 3,4, and 5 inch width rolls sets on
exposure to moistureexposure to moisture

 Uniform thickness for impression materialUniform thickness for impression material
 Tray is light weight thus reduces tissue distortionTray is light weight thus reduces tissue distortion
 Size and shape modification of tray possible bySize and shape modification of tray possible by
trimming the casting tape.trimming the casting tape.
 Tray can be disinfectedTray can be disinfected
 EconomicalEconomical

L.H. Chen et alL.H. Chen et al
(1997)(1997)
CAD/ CAM technique for fabricating facial prosthesisCAD/ CAM technique for fabricating facial prosthesis
Resin model usingResin model using
laser lithographylaser lithography

E.H Pow and A.S McMillan (2000)E.H Pow and A.S McMillan (2000)
Functional impression techniqueFunctional impression technique

MODELING MATERIALSMODELING MATERIALS
 Materials used in the modeling process should have certain intrinsicMaterials used in the modeling process should have certain intrinsic
properties that lend them not only to the modeling procedures butproperties that lend them not only to the modeling procedures but
also to thealso to the handling necessary in making the molds.handling necessary in making the molds.
 They should be malleable to facilitate making gross adjustments toThey should be malleable to facilitate making gross adjustments to
the contours.the contours.
 The material should haveThe material should have sufficient body and strength to permitsufficient body and strength to permit
sculpting a feather edge and yet besculpting a feather edge and yet be able to withstand slight abuse.able to withstand slight abuse.
 It should be possible to sculpt texture into thisIt should be possible to sculpt texture into this material which willmaterial which will
be imparted to the finished mold.be imparted to the finished mold.
 The closer the color ofThe closer the color of the material is to skin tone, the less visualthe material is to skin tone, the less visual
distortion there will be.distortion there will be.
 NeedlessNeedless to say, cost and availability are important factors.to say, cost and availability are important factors.

TheThe American Academy ofAmerican Academy of
Maxillofacial ProstheticsMaxillofacial Prosthetics
I. Modeling Clay (Sculptor's Clay)I. Modeling Clay (Sculptor's Clay) (A water-base clay(A water-base clay
which, when allowed to dry, becomes a hard, stonelikewhich, when allowed to dry, becomes a hard, stonelike
substance)substance)
1. Consistency can be adjusted by adding water1. Consistency can be adjusted by adding water
2. Lends itself to gross sculpting of sweeping2. Lends itself to gross sculpting of sweeping
planesplanes
3. Takes texture well3. Takes texture well
4. Can be feathered on the edge4. Can be feathered on the edge
5. Inexpensive5. Inexpensive
6. Readily available6. Readily availablewww.indiandentalacademy.com

1. Must be kept moist at all times. If allowed1. Must be kept moist at all times. If allowed
to dry it tends to crack and flake.to dry it tends to crack and flake.
2. If the modeling must be set aside for any length of2. If the modeling must be set aside for any length of
time the cloth utilized to keep it moist tends totime the cloth utilized to keep it moist tends to
wipe out the finer texture which has beenwipe out the finer texture which has been
incorporated into the model.incorporated into the model.
3. It is gray in color, and the color differentiation3. It is gray in color, and the color differentiation
causes visual distortion.causes visual distortion.

II. PlasterII. Plaster
1. Readily available1. Readily available
2. Inexpensive2. Inexpensive
3. Easily and quickly prepared for use3. Easily and quickly prepared for use
4. Can be shaped or molded in its plastic4. Can be shaped or molded in its plastic
statestate
1. Lacks elasticity1. Lacks elasticity

III. WaxesIII. Waxes
1. Its color may be similar to skin tone.1. Its color may be similar to skin tone.
2. Readily available in the dental operatory2. Readily available in the dental operatory
3. It can keep a feather edge3. It can keep a feather edge
4. Takes texture well4. Takes texture well
1. They must be carved rather than1. They must be carved rather than
sculpturedsculptured
2. Wax becomes brittle when cool.2. Wax becomes brittle when cool.

Ocular prosthesisOcular prosthesis
 An ocular prosthesis is an artificial replacement for theAn ocular prosthesis is an artificial replacement for the
bulb of the eyebulb of the eye (bulbous oculi, eyeball). The eyeball, or(bulbous oculi, eyeball). The eyeball, or
organ of sight, is contained in thisorgan of sight, is contained in this cavity of the orbit,cavity of the orbit,
where it is protected from injury and is moved by thewhere it is protected from injury and is moved by the
ocular muscles.ocular muscles.
 When the entire contents of the orbit (includingWhen the entire contents of the orbit (including
musclesmuscles fascia, eyelids, conjunctiva, and the lacrimalfascia, eyelids, conjunctiva, and the lacrimal
apparatus) are removed, theapparatus) are removed, the artificial replacement isartificial replacement is
referred to as an orbital prosthesis.referred to as an orbital prosthesis.

Plastic Acrylic EyePlastic Acrylic Eye
 Surface itching does not resultSurface itching does not result
 Not so fragileNot so fragile
 Adjustability to size and formAdjustability to size and form
 Other features can be adaptedOther features can be adapted
 Actual three-dimensionalActual three-dimensional effect in iriseffect in iris
constructionconstruction
 Prefabricated iris buttons can bePrefabricated iris buttons can be stockedstocked
 Permits elimination of time-consuming stepsPermits elimination of time-consuming steps
 Method is easy to teachMethod is easy to teachwww.indiandentalacademy.com

TechniqueTechnique
Steps in fabricating eye prosthesis:Steps in fabricating eye prosthesis:
 Painting Of The Iris DiscPainting Of The Iris Disc
 The Iris ButtonThe Iris Button
 The Wax FormThe Wax Form
 MoldingMolding
 The ScleraThe Sclera
 Veining TechniqueVeining Technique
 The ConjunctivaThe Conjunctiva
 Polishing and Fitting.Polishing and Fitting.www.indiandentalacademy.com

Iris discIris disc
 Precut ethyl cellulose transparent discs are prepared inPrecut ethyl cellulose transparent discs are prepared in
diameters of 11, 11.5, 12, and 12.5 mm.diameters of 11, 11.5, 12, and 12.5 mm.
 Center of the disc is punched out to form the papillaryCenter of the disc is punched out to form the papillary
aperture approximately 3.5 mm in diameter .aperture approximately 3.5 mm in diameter .
 Colors used for the painting of the iris disc are artist's oilColors used for the painting of the iris disc are artist's oil
pigments of high quality.pigments of high quality.
 The following shades are selected for color permanence:The following shades are selected for color permanence:
titanium white, terre verte, ivory black, yellow ochre,titanium white, terre verte, ivory black, yellow ochre,
cerulean blue, burnt umber, crimson red, and cadmiumcerulean blue, burnt umber, crimson red, and cadmium
red.red.

Painting the iris discPainting the iris disc
Ethyl cellulose discEthyl cellulose disc Painted discPainted disc
Zones of IrisZones of Iris
 LimbusLimbus
 CollaretteCollarette
 StromaStroma
 The fourth zoneThe fourth zone
 Dried for 3 hours in an electric drying ovenDried for 3 hours in an electric drying oven at 70°C.at 70°C.

Iris Button or Corneal Lens
 Processed in a set of stainless steel dieProcessed in a set of stainless steel die platesplates
 Consist of a template, a die, one pierced baffle, andConsist of a template, a die, one pierced baffle, and twotwo
baffles.baffles.
 Painted iris disc is then placed in thePainted iris disc is then placed in the correct sizecorrect size
aperture of the template,aperture of the template,

 A small round discA small round disc of vinyl acetate is placed overof vinyl acetate is placed over
the papillarythe papillary aperture of the painted disc to formaperture of the painted disc to form
thethe illusion of the pupil.illusion of the pupil.
 Making the corneal lens, 3 parts clearMaking the corneal lens, 3 parts clear methylmethyl
methacrylate is mixed with I partmethacrylate is mixed with I part monomer.monomer.
 The requiredThe required amount of methyl methacrylate mixamount of methyl methacrylate mix
isis placed in the openingsplaced in the openings
 The die plates are then reassembledThe die plates are then reassembled upon eachupon each
other with sheets of cellophaneother with sheets of cellophane between thebetween the
template, die, and baffle totemplate, die, and baffle to act as separators.act as separators.

 Placed in a bench press, and pressure isPlaced in a bench press, and pressure is appliedapplied
slowlyslowly
 Die plates are compressed sufficiently, thenDie plates are compressed sufficiently, then
removedremoved
 TheThe template is then placed in its proper position,template is then placed in its proper position,
and all parts of the dies are reassembled andand all parts of the dies are reassembled and
placed in a spring compress andplaced in a spring compress and the clamp isthe clamp is
tightened.tightened.
 PlacedPlaced in a dry heat oven at 70°C for 3 hours.in a dry heat oven at 70°C for 3 hours.
 The die is cooled and the buttons are removed.The die is cooled and the buttons are removed.

Buttons curedButtons cured

Conformer can be placed in the socket afterConformer can be placed in the socket after
enucleationenucleation..
Support the lids andSupport the lids and keep them from collapsing untilkeep them from collapsing until
artificial prosthesis is made.artificial prosthesis is made.

ImpressionImpression
There are two methods for fitting theThere are two methods for fitting the prosthesis to theprosthesis to the
socket.socket.
Dr. Victor Dietz isDr. Victor Dietz is responsible for the most commonlyresponsible for the most commonly
used scleral patternused scleral pattern from a stainless steel ball bearingfrom a stainless steel ball bearing

 Hard baseplate wax is softenedHard baseplate wax is softened Bunsen flame andBunsen flame and
compressed over thecompressed over the ball bearing.ball bearing.
 The wax cup is trimmed onThe wax cup is trimmed on its periphery to the triangularits periphery to the triangular
outline ofoutline of the posterior wall of the socket.the posterior wall of the socket.
 wax pattern trimmed to shape and size as determined bywax pattern trimmed to shape and size as determined by
observation is then tried in the socket.observation is then tried in the socket.
 AA small cone of soft green wax is placed on the back ofsmall cone of soft green wax is placed on the back of
the iris button and secured on the hard wax cup.the iris button and secured on the hard wax cup.
 This is then tried in the socket to check forThis is then tried in the socket to check for optimal lidoptimal lid
form, mobility, and iris line-up .form, mobility, and iris line-up .

FlaskingFlasking
 The stem of the iris button is covered with tin foil, andThe stem of the iris button is covered with tin foil, and
the wax form is invested in a HUE-LON flaskthe wax form is invested in a HUE-LON flask
 After separation and the removal of theAfter separation and the removal of the wax, the iriswax, the iris
button is carefully lifted out.button is carefully lifted out.
 The entire mold is covered with tin foil,The entire mold is covered with tin foil, and the irisand the iris
button is replaced in the exactbutton is replaced in the exact spot in the mold.spot in the mold.
 Prepare the scleralPrepare the scleral modifying and veining colors.modifying and veining colors.
 The Windsor and Newton dryThe Windsor and Newton dry powder colors are usedpowder colors are used

PackingPacking
 After the proper scleralAfter the proper scleral
shade the monomer isshade the monomer is
mixed with the selectedmixed with the selected
scleral shade in the ratioscleral shade in the ratio
of 1 : 3.of 1 : 3.
 Mix is packed in theMix is packed in the
lower half of the flasklower half of the flask
and bench pressed.and bench pressed.
 Placed in a dry heat ovenPlaced in a dry heat oven
at 100°C for 3 hours.at 100°C for 3 hours.

Veining TechniqueVeining Technique
 Red rayon threads are used for thisRed rayon threads are used for this
purposepurpose
 The separated monofils are tackedThe separated monofils are tacked
in place with 5% solution ofin place with 5% solution of
monomer and polymermonomer and polymer
 00 sable brush and pushing the00 sable brush and pushing the
fibers into the various designsfibers into the various designs
such as straight, tortuous, andsuch as straight, tortuous, and
sinuous or any combination .sinuous or any combination .
 Placed in the oven at 72°C for IPlaced in the oven at 72°C for I
hour.hour.

ConjunctivaConjunctiva
 A wood applicator is attached to the back orA wood applicator is attached to the back or
concave surface with sticky wax,concave surface with sticky wax, and the anteriorand the anterior
or front surface is dippedor front surface is dipped into melted baseplateinto melted baseplate
wax to the peripherywax to the periphery
 Flasked with stone.Flasked with stone.
 Cured at 100°C for 3 hours.Cured at 100°C for 3 hours.

PolishingPolishing andand FittingFitting
 All rough areas are removed with fine acrylic stonesAll rough areas are removed with fine acrylic stones
and polished.and polished.
 A drop of mineral oil is placed on the forefingerA drop of mineral oil is placed on the forefinger
and distributed over both sides of the acrylic eye.and distributed over both sides of the acrylic eye.
 Patient is then shown how to insert and remove thePatient is then shown how to insert and remove the
eye.eye.
 Instructions are given on the care of the socket andInstructions are given on the care of the socket and
the eye.the eye.

Orbital locator (D.R.Mc Arthur 1977)Orbital locator (D.R.Mc Arthur 1977)

ORBITAL PROSTHESISORBITAL PROSTHESIS
Steps in FabricationSteps in Fabrication
I Impression of Orbital DefectI Impression of Orbital Defect
II Making the stone castII Making the stone cast ((laboratory)laboratory)
III Selection of eyeIII Selection of eye
IV Carving of clay patternIV Carving of clay pattern
V. Construction of metallic moldsV. Construction of metallic molds
VI. Painting and processing the vinyl resinVI. Painting and processing the vinyl resin
VII. Insertion of eye lashesVII. Insertion of eye lashes
VIII. Insertion of acrylic resin eye.VIII. Insertion of acrylic resin eye.
IX. Fitting the artificial (vinyl resin) eye prosthesis.IX. Fitting the artificial (vinyl resin) eye prosthesis.

Custom stock eyesCustom stock eyes

Fabrication of metal moldFabrication of metal mold

Impression of the second half ofImpression of the second half of
metal moldmetal mold

Instructions to the patient.Instructions to the patient.
 Since the artificial eye does not track withSince the artificial eye does not track with thethe
natural eye of the opposite side, the patient shouldnatural eye of the opposite side, the patient should
learn tolearn to turn his head when changing his line ofturn his head when changing his line of
vision.vision.
 Wearing of eye glasses also enhances theWearing of eye glasses also enhances the naturalnatural
appearanceappearance
 Taught how to clean the prosthesis (inTaught how to clean the prosthesis (in warm waterwarm water
with a mild soap)with a mild soap)
 How to apply the surgical cementHow to apply the surgical cement
 The prosthesis should not be worn while sleepingThe prosthesis should not be worn while sleeping

MATERIALS USED FORMATERIALS USED FOR
EXTRAORAL MAXILLOFACIALEXTRAORAL MAXILLOFACIAL
 Silastic 382 RTVSilastic 382 RTV
 Silastic 399 ( Formerly MDX 4-4043)Silastic 399 ( Formerly MDX 4-4043)
 Realastic (PVC)Realastic (PVC)
 Methyl MethacrylateMethyl Methacrylate
 Mediplas ( Heat cure Plastisol)Mediplas ( Heat cure Plastisol)
 Dermasil ( Self- curing silicone)Dermasil ( Self- curing silicone)
 Palamed ( cross- linked copolymer)Palamed ( cross- linked copolymer)
 PolyetherurethanesPolyetherurethanes

Patient acceptancePatient acceptance ProstheticConsiderationsProstheticConsiderations
FlexibilityFlexibility
TranslucencyTranslucency
NonconductionNonconduction
CompatibilityCompatibility
Lightness Of WeightLightness Of Weight
AvailabilityAvailability
Ease of ProcessingEase of Processing
Ease of DuplicationEase of Duplication
DurabilityDurability
HygienicHygienic
Common Considerationswww.indiandentalacademy.com

Commercially available materialsCommercially available materials
SiliconesSilicones
 Comesil T001, Principality Medical- addition curing HTVComesil T001, Principality Medical- addition curing HTV
(70ºC for 2hr)(70ºC for 2hr)
 Elasto Synsil, Dr Hinz Dental – addition curing HTVElasto Synsil, Dr Hinz Dental – addition curing HTV
(140ºC for 2hr)(140ºC for 2hr)
 Elastosil M3500, Wacker/Chemie- condensation curingElastosil M3500, Wacker/Chemie- condensation curing
RTV (23ºC ± 2ºC)RTV (23ºC ± 2ºC)
 Episil, Dreve/Dentamid- addition curing RTVEpisil, Dreve/Dentamid- addition curing RTV
 Ideal, Orthomox- addition curing RTVIdeal, Orthomox- addition curing RTV
 Premium, Prestige Dental- addition curing RTVPremium, Prestige Dental- addition curing RTV
 Silskin 2000, DuPuy Healthcare- addition curing RTVSilskin 2000, DuPuy Healthcare- addition curing RTV

 Palamed – Kulzer- acrylic resin copolymerPalamed – Kulzer- acrylic resin copolymer
 Realistic- Prosthetic services, Calif. Mediplast StdRealistic- Prosthetic services, Calif. Mediplast Std
arts, Butler.- vinyl acrylic resin copolymerarts, Butler.- vinyl acrylic resin copolymer
 Epithane – 3 Daro products – polyurethaneEpithane – 3 Daro products – polyurethane
elastomerselastomers
 MDX 4- 4210 Dow Corning Mich.- siliconeMDX 4- 4210 Dow Corning Mich.- silicone
elastomers.elastomers.

COLORING FACIAL PROSTHESESCOLORING FACIAL PROSTHESES
 Duplicating skin with respect to texture, contour,Duplicating skin with respect to texture, contour,
and, above all, color is very difficult.and, above all, color is very difficult.
 Skin color varies in different physiologic andSkin color varies in different physiologic and
pathologic conditions, such as anemia, and inpathologic conditions, such as anemia, and in
different emotional states, which may lead to pallordifferent emotional states, which may lead to pallor
or flushing.or flushing.
 The color depends on capillary blood flow andThe color depends on capillary blood flow and
oxygenation, the thickness of the epidermis, andoxygenation, the thickness of the epidermis, and
the presence of pigments such as melanin andthe presence of pigments such as melanin and
carotene .carotene . www.indiandentalacademy.com

 Realistic coloration of external facial prosthesis isRealistic coloration of external facial prosthesis is
an important feature for patient satisfaction andan important feature for patient satisfaction and
acceptability.acceptability.
 Cosmetic realism involves exacting replication of :Cosmetic realism involves exacting replication of :
(1) Subdermal, commonly referred to as(1) Subdermal, commonly referred to as
Intrinsic coloration andIntrinsic coloration and
(2) External, or Extrinsic coloration.(2) External, or Extrinsic coloration.
 Spectral measurements of the extremely diverseSpectral measurements of the extremely diverse
coloration of human skin are well known andcoloration of human skin are well known and
published extensively in the classic work of Beardpublished extensively in the classic work of Beard
and Brunsting."and Brunsting."

IntrinsicIntrinsic ColorationColoration
 This is the first step for incorporating in-depthThis is the first step for incorporating in-depth
coloration reflected internally by discrete pigmentcoloration reflected internally by discrete pigment
particles spectrally equivalent or approximating that ofparticles spectrally equivalent or approximating that of
the physiologic colorant and color centers, namelythe physiologic colorant and color centers, namely
arterial red, venous red-purple, carotenoid yellow,arterial red, venous red-purple, carotenoid yellow,
melanoid brown, and opaque dispersed cellular lipids.melanoid brown, and opaque dispersed cellular lipids.
 The range of intrinsic shades serves as the bulkThe range of intrinsic shades serves as the bulk
coloration onto which the extrinsic coloration is appliedcoloration onto which the extrinsic coloration is applied
in proportions to the individual's coloration at the site ofin proportions to the individual's coloration at the site of
the prosthesis along with incidental shadowed shades,the prosthesis along with incidental shadowed shades,
age blemishes, and so on.age blemishes, and so on.

 According to Chalian et al. (1972, 1974) intrinsic coloring inAccording to Chalian et al. (1972, 1974) intrinsic coloring in
heat- vulcanized silicone prostheses is accomplished with aheat- vulcanized silicone prostheses is accomplished with a
milling machine.milling machine.
 Metallic oxides or pigmented silicone concentrates areMetallic oxides or pigmented silicone concentrates are
generally used, and red fibers may be incorporated, if desired,generally used, and red fibers may be incorporated, if desired,
to simulate blood vessels.to simulate blood vessels.
 Intrinsic coloring in room temperature-vulcanized siliconeIntrinsic coloring in room temperature-vulcanized silicone
(MDX4-4306) which is supplied as a transparent viscous(MDX4-4306) which is supplied as a transparent viscous
material is accomplished by adding talc, to make the materialmaterial is accomplished by adding talc, to make the material
opaque, and various dry earth pigments.opaque, and various dry earth pigments.

Extrinsic ColorationExtrinsic Coloration
 The final realism by extrinsic coloration is anThe final realism by extrinsic coloration is an
important, skilled procedure to provide shadeimportant, skilled procedure to provide shade
variations replicating that of the natural skinvariations replicating that of the natural skin
coloration adjacent to the prosthesis and its texturecoloration adjacent to the prosthesis and its texture
as recounted by Laney.as recounted by Laney.
 Extrinsic coloring uses an adhesive, the mostExtrinsic coloring uses an adhesive, the most
common being a proprietary medical gradecommon being a proprietary medical grade
adhesive silicone (Dow Corning) thinned withadhesive silicone (Dow Corning) thinned with
xylene, to which pigments are paletted and thenxylene, to which pigments are paletted and then
applied topically to the intrinsically colored, moldedapplied topically to the intrinsically colored, molded
prosthetic device.prosthetic device.www.indiandentalacademy.com

 The silicone adhesive auto- catalyzes to a cured,The silicone adhesive auto- catalyzes to a cured,
polymerized state by evaporation of the thinner withpolymerized state by evaporation of the thinner with
applied heat.applied heat.
 With siloxane-molded prostheses, the siliconeWith siloxane-molded prostheses, the silicone
adhesive of similar silicone configuration provides aadhesive of similar silicone configuration provides a
covalent bonding that becomes an integral part withcovalent bonding that becomes an integral part with
the prosthesis.the prosthesis.
 This concept of integral extrinsic covalent bonding isThis concept of integral extrinsic covalent bonding is
usually modified by appropriate surface texturing,usually modified by appropriate surface texturing,
such as stippling, to replicate the indentations, pocksuch as stippling, to replicate the indentations, pock
marks, and so on of the adjacent skin.marks, and so on of the adjacent skin.

 Ouellette (1969) described spray coloring ofOuellette (1969) described spray coloring of
silicone-elastomer maxillofacial prostheses.silicone-elastomer maxillofacial prostheses.
 Pigments selected to match the patient's skin arePigments selected to match the patient's skin are
mixed in proportion with clear elastomer andmixed in proportion with clear elastomer and
solvent.solvent.
 The mixture is sprayed on the prosthesis until theThe mixture is sprayed on the prosthesis until the
desired hue is obtained.desired hue is obtained.
 The catalyst spray is applied over the sprayedThe catalyst spray is applied over the sprayed
pigment solution.pigment solution.
 The curing of catalyst-sprayed dispersion is done atThe curing of catalyst-sprayed dispersion is done at
50° C for five minutes.50° C for five minutes.

 According to Schaaf (1970), the color easily peels off or rubs offAccording to Schaaf (1970), the color easily peels off or rubs off
during manipulation of the prosthesis or during daily cleansing byduring manipulation of the prosthesis or during daily cleansing by
the patient.the patient.
 He also stated that the additional layer of material obliterates theHe also stated that the additional layer of material obliterates the
surface texture.surface texture.
 He introduced tattooing for surface characterization of facialHe introduced tattooing for surface characterization of facial
prostheses.prostheses.
 Standard artist's paints were used in this technique.Standard artist's paints were used in this technique.
 With a tattooing machine the colors are tattooed into the surfaceWith a tattooing machine the colors are tattooed into the surface
of silicone rubber according to the pattern desired.of silicone rubber according to the pattern desired.
 Dry gauze is used to wipe the remaining paints from the surface ofDry gauze is used to wipe the remaining paints from the surface of
the prosthesis.the prosthesis.
 The prosthesis is further cleansed with mild detergent to removeThe prosthesis is further cleansed with mild detergent to remove
all excess pigments from the surface.all excess pigments from the surface.
 This process can be repeated until the desired shade is obtained.This process can be repeated until the desired shade is obtained.

 According to Chalian et al. (1972) and Beder (1974),According to Chalian et al. (1972) and Beder (1974),
the intrinsic coloring of extraoral prostheses is morethe intrinsic coloring of extraoral prostheses is more
effective than the extrinsic techniques because iteffective than the extrinsic techniques because it
produces a longer-lasting result.produces a longer-lasting result.
 Intrinsic coloration, sometimes followed by minimalIntrinsic coloration, sometimes followed by minimal
surface characterization, is helpful for achievingsurface characterization, is helpful for achieving
skin-like color.skin-like color.

 Firtell and Bartlett (1969) and Roberts (1971)Firtell and Bartlett (1969) and Roberts (1971)
suggested that, in many cases, the basic tone of thesuggested that, in many cases, the basic tone of the
prosthesis should be made a lighter color.prosthesis should be made a lighter color.
 Lighter basic tone can be obtained by intrinsicLighter basic tone can be obtained by intrinsic
coloring of the prosthesis, and this should becoloring of the prosthesis, and this should be
followed by minimal surface characterizationfollowed by minimal surface characterization
according to the needs of a given patient.according to the needs of a given patient.
 Selection of a particular technique for surfaceSelection of a particular technique for surface
characterization is best left to the individualcharacterization is best left to the individual
practioner to determine.practioner to determine.

List of pigments used in MFPList of pigments used in MFP

RETENTION OF THE PROSTHESISRETENTION OF THE PROSTHESIS
 A. Anatomic RetentionA. Anatomic Retention
a. Harda. Hard tissuestissues
b. Soft tissuesb. Soft tissues
 B. Mechanical RetentionB. Mechanical Retention
a. Magnetsa. Magnets
b. Snap Buttons and Strapb. Snap Buttons and Strap
 C. AdhesivesC. Adhesives
 D. Combination of aboveD. Combination of above

AdhesivesAdhesives
 An ideal adhesive should be one that provides firmAn ideal adhesive should be one that provides firm
functionalfunctional retention under flexure or extension duringretention under flexure or extension during
speech, facial expression,speech, facial expression, eating, adjustment of eye-glasses,eating, adjustment of eye-glasses,
inadvertent gestures, splashinadvertent gestures, splash of water or rain, accumulationof water or rain, accumulation
of moisture and perspiration, and soof moisture and perspiration, and so on.on.
 Because these adventures induce local dislodgment byBecause these adventures induce local dislodgment by
pushingpushing or pulling away of the prosthesis from attachmentor pulling away of the prosthesis from attachment
to the contactingto the contacting tissue or skin, the basic adhesive chemicaltissue or skin, the basic adhesive chemical
component is variouslycomponent is variously modified with emollients, hygienicmodified with emollients, hygienic
agents, pleasant scent, and soagents, pleasant scent, and so on.on.

 Retention can be enhanced and may rely entirelyRetention can be enhanced and may rely entirely
on the use of a surgical grade extraoral adhesive.on the use of a surgical grade extraoral adhesive.
 In general, each material provides its ownIn general, each material provides its own
adhesive because of its inherent physical andadhesive because of its inherent physical and
chemical properties.chemical properties.
 The adhesives aid retention, marginal seal, andThe adhesives aid retention, marginal seal, and
border adaptation.border adaptation.
 This secures the prosthesis against accidentalThis secures the prosthesis against accidental
dislodgment.dislodgment.

Precedently, over the years of nondescript formulations, thePrecedently, over the years of nondescript formulations, the
prominent chemical configurations withstanding theseprominent chemical configurations withstanding these
adhesiveadhesive experiences comprise basically:experiences comprise basically:
 Other siloxanes of low molecularOther siloxanes of low molecular intermediate to that ofintermediate to that of
siloxane fluids and solid elastomers,siloxane fluids and solid elastomers, thethe most prominentmost prominent
being Silastic Medical Adhesive, which alsobeing Silastic Medical Adhesive, which also actsacts as theas the
vehicle base for extrinsic coloring.vehicle base for extrinsic coloring.
 Polyisobutylene, a configuration noted for its tackiness andPolyisobutylene, a configuration noted for its tackiness and
self-sealing attribute and as active component in oralself-sealing attribute and as active component in oral
adhesive bandages.adhesive bandages.
 Special acrylics in emulsion form.Special acrylics in emulsion form.

 Alkyl cyanoacrylates, well-known for cohesiveAlkyl cyanoacrylates, well-known for cohesive
bonding to skin but inordinately toxic; its use inbonding to skin but inordinately toxic; its use in
orofacial prosthetic retention is highlyorofacial prosthetic retention is highly
prohibitive.prohibitive.
Commercially available materialsCommercially available materials
 Silicone Silastic (registered trademark for DowSilicone Silastic (registered trademark for Dow
Corning Medical Adhesive Silicone, Type A,Corning Medical Adhesive Silicone, Type A,
Dow Corning Corp., Midland, MI)Dow Corning Corp., Midland, MI)
 An acrylic formulation Pros-Aide (product ofAn acrylic formulation Pros-Aide (product of
ADM Tronics, Inc., Northvale, NJ).ADM Tronics, Inc., Northvale, NJ).

Implant supported prosthesisImplant supported prosthesis
 Not all patients with facial defects are candidatesNot all patients with facial defects are candidates
for Implant supported prosthesis.for Implant supported prosthesis.
 Pioneers works of Branemark(1977) andPioneers works of Branemark(1977) and
Tjellstom(1983)Tjellstom(1983)
ContraindicationsContraindications
 Patients with cartilaginous peripheral tissue.Patients with cartilaginous peripheral tissue.
 Thick layers of skin which cannot be reducedThick layers of skin which cannot be reduced
further.further.

Implant sitesImplant sites
 Bone in postauriculotemporal regionBone in postauriculotemporal region
 Superior lateral orbital rimSuperior lateral orbital rim
 Malar processMalar process
 Superior maxillaSuperior maxilla

Attachments used in facial prosthesisAttachments used in facial prosthesis
 Magnets (Cobalt – samarium) More recentlyMagnets (Cobalt – samarium) More recently
neodymium, boron and iron magnets.neodymium, boron and iron magnets.
 Clips ( Nobel Pharma DCA 078, O- Quist)Clips ( Nobel Pharma DCA 078, O- Quist)
 Ball attachments (Nobel Pharma)Ball attachments (Nobel Pharma)
 Dalbo attachment ( Sjodings, Sweden)Dalbo attachment ( Sjodings, Sweden)

MAINTAINANCE OF THEMAINTAINANCE OF THE
1. The prosthesis should be removed at least once a day to1. The prosthesis should be removed at least once a day to
bebe cleaned in the following manner:cleaned in the following manner:
a.a. The adhesive should be removed with a rolling motionThe adhesive should be removed with a rolling motion
of the ball of the finger or thumb. In the directionof the ball of the finger or thumb. In the direction of theof the
borders of the appliance.borders of the appliance.
b.b. Free the surfaces of the prosthesis from all foreignFree the surfaces of the prosthesis from all foreign
substances, such as facial creams, cosmetics, etc.substances, such as facial creams, cosmetics, etc.
c.c. Wash it with a mild soap and a brush. (If the prosthesisWash it with a mild soap and a brush. (If the prosthesis
includes an artificial eye, both the prosthesis and theincludes an artificial eye, both the prosthesis and the eyeeye
should be cleaned separately, the eye being handledshould be cleaned separately, the eye being handled andand
replaced with care.replaced with care.

2.2. The skin in contact with the prosthesis should beThe skin in contact with the prosthesis should be
thoroughly andthoroughly and gently cleaned.gently cleaned.
 The patient is carefully directed to removeThe patient is carefully directed to remove and to stopand to stop
wearing the prosthesis should any irritation occurwearing the prosthesis should any irritation occur
wherever the prosthesis contacts the tissues, and to seewherever the prosthesis contacts the tissues, and to see
thethe doctor as soon as possible for treatment.doctor as soon as possible for treatment.

 keep the supporting area clean, dry, and make it free of oil.keep the supporting area clean, dry, and make it free of oil.
 replace the prosthesis as directed. (If adhesive is used,replace the prosthesis as directed. (If adhesive is used, use ituse it
as sparingly as possible, and not too frequently).as sparingly as possible, and not too frequently). Adhesive mustAdhesive must
be "tacky" before prosthesis is placed.be "tacky" before prosthesis is placed.
 take care to look in one or more mirrors when placing thetake care to look in one or more mirrors when placing the
prosthesis. This will help the patient to place it in itsprosthesis. This will help the patient to place it in its correctcorrect
relationship with surrounding anatomical areas.relationship with surrounding anatomical areas.

 hold the appliance in place with finger pressure for fivehold the appliance in place with finger pressure for five
minutes.minutes.
 check all edges by the use of the mirror for completecheck all edges by the use of the mirror for complete
adaptation to all surfaces. The surfaces of the prosthesisadaptation to all surfaces. The surfaces of the prosthesis
were made to fit the supporting areas, so they shouldwere made to fit the supporting areas, so they should
matchmatch accurately.accurately.
 avoid too much exposure of the appliance to directavoid too much exposure of the appliance to direct
sunlight.sunlight.

Stereolithography in MaxillofacialStereolithography in Maxillofacial
SurgerySurgery
 Stereolithography is an industrial process which usesStereolithography is an industrial process which uses
data generated from computer-assisted design (CAD)data generated from computer-assisted design (CAD)
to generate three-dimensional models. The data drives ato generate three-dimensional models. The data drives a
laser over a bath of photosensitive resin whichlaser over a bath of photosensitive resin which
produces a series of stacked slices, which produce aproduces a series of stacked slices, which produce a
accurate three-dimensional industrial prototype oraccurate three-dimensional industrial prototype or
model. This technique can be used by the maxillofacialmodel. This technique can be used by the maxillofacial
surgeon to produce three-dimensional representationssurgeon to produce three-dimensional representations
of facial bony structures using data from CT or MRIof facial bony structures using data from CT or MRI
scans.scans.

REVIEW OF LITERATUREREVIEW OF LITERATURE

 Kent T. Ochiai: Patients with a
tracheostomy stoma experience
compromised speech due to the associated
changes in airflow patterns. Prosthetic
obturation of the stoma restores the normal
airflow patterns required for proper speech.
(J Prosthet Dent 2000;83:578-81.)

Impression of stomal defect made
with tissue treatment material
on acrylic resin carrier.
Standard commercial tube stent did
not adequately match dimensions of
defect

Extension wings were carved 3 to 4 mm
into cast using No. 10 round bur.
Polysulfide rubber material reinforced with
quick-set plaster was used to make impression
of peristomal tissues and to “pickup” stomal
impression. Two-piece cast of improved dental
stone was fabricated by pouring in 2 layers
with indexing notches. First layer is shown.

Plastic centering rod was used to position
Speaking value
Silicone impression putty was used to
maintain valve in proper position over
plastic centering rod.

Custom stomal prosthesis positioned
in defect providedimproved comfort, fit,
and function for patient
Contours and shape of valve housing were
completed in baseplate wax. Speaking
valve was then removed from
plastic centering rod.

 Ansgar C. Cheng: The fabrication of a
craniofacial implant-retained maxillofacial
prosthesis usually involves the fabrication of
metallic retentive elements on the implants, the
incorporation of appropriate corresponding
retentive elements in an acrylic resin housing,
and the processing of silicone elastomer onto
the acrylic resin housing.
 (J Prosthet Dent 2002;88:224-8.)

Flasked working cast with metallic implant
substructure and acrylic resin retentive element
housing.
Working cast of defect made of dental
stone with implant analogs.

Prostheses fabricated without incorporation of
acrylic resin housing, then colored under
different light conditions and clinical settings.
Note variation in resulting appearance.
Intaglio surface of silicone elastomer elementwww.indiandentalacademy.com

A, Acrylic resin housing with perforations, ready for final bonding of silicone prosthesis.
B, Mixed silicone elastomer injected into prepared acrylic resin housing.

A, Intaglio surface of completed prosthesis. B, Completed prosthesis in situ (right sidewww.indiandentalacademy.com

 Arum .C:Arum .C: Stereolithography in MaxillofacialStereolithography in Maxillofacial
Surgery: Stereolithography is an industrialSurgery: Stereolithography is an industrial
process which uses data generated fromprocess which uses data generated from
computer-assisted design (CAD) to generatecomputer-assisted design (CAD) to generate
three-dimensional modelsthree-dimensional models
 British Association of Oral and MaxillofacialBritish Association of Oral and Maxillofacial
Surgeons 2007Surgeons 2007

 MadhanMadhan RR Nayar: Prosthetic management of a patient withNayar: Prosthetic management of a patient with
Treacher Collins syndromeTreacher Collins syndrome Treacher Collins syndromeTreacher Collins syndrome
encompasses a group of closely related defects of theencompasses a group of closely related defects of the
head and neck. It is a rare syndrome characterized byhead and neck. It is a rare syndrome characterized by
bilaterally symmetrical abnormalities derived from thebilaterally symmetrical abnormalities derived from the
first and second brachial arches and the nasal placode.first and second brachial arches and the nasal placode.
The facial appearance of these patients can beThe facial appearance of these patients can be
improved by either surgical or prosthetic rehabilitation.improved by either surgical or prosthetic rehabilitation.
 Indian J Dent Res 2006;17:78-81Indian J Dent Res 2006;17:78-81

Preoperative frontal view of patient Postoperative frontal view of patient

CONCLUSIONCONCLUSION

 It is crucial that such patients receiveIt is crucial that such patients receive
maxillofacial rehabilitation in the best possiblemaxillofacial rehabilitation in the best possible
manner. This can most effectively be donemanner. This can most effectively be done
trough team efforts of the prosthodontist,trough team efforts of the prosthodontist,
surgeon, radiotherapist, nurse, family, and allsurgeon, radiotherapist, nurse, family, and all
those responsible for the patient’s physical andthose responsible for the patient’s physical and
mental well-being.mental well-being.

REFERENCESREFERENCES

 John Beumer; Maxillofacial rehabilitationJohn Beumer; Maxillofacial rehabilitation
prosthodontic and surgical considerationsprosthodontic and surgical considerations
 Varoujan A. Chalian; Maxillofacial prosthesisVaroujan A. Chalian; Maxillofacial prosthesis
multidiciplinary practicemultidiciplinary practice
 Thomas D. Taylor; Clinical maxillofacialThomas D. Taylor; Clinical maxillofacial
ProstheticsProsthetics
 B. D. Chaurasia’s; Human anatomy.vol 3. 4B. D. Chaurasia’s; Human anatomy.vol 3. 4thth
ed.ed.
 Shafer William G; A textbook of oral pathology. 4Shafer William G; A textbook of oral pathology. 4thth
eded

 H. Siadat, A. MirfazaelianH. Siadat, A. Mirfazaelian: Use of casting tape for support of: Use of casting tape for support of
an extraoral impression.an extraoral impression.
J. Prosthet Dent 2003; 90(6): 598-9.J. Prosthet Dent 2003; 90(6): 598-9.
 B. Karayazgan, Y. Gunay, G. EvliogluB. Karayazgan, Y. Gunay, G. Evlioglu: Improved edge strength: Improved edge strength
in a facial prosthesis by incorporation of tulle: a clinical report.in a facial prosthesis by incorporation of tulle: a clinical report.
J. Prosthet Dent. 2003; 90(6):526-9J. Prosthet Dent. 2003; 90(6):526-9
 H. Murata et al:H. Murata et al: Dynamic mechanical properties of siliconeDynamic mechanical properties of silicone
maxillofacial prosthetic materials and influence of frequencymaxillofacial prosthetic materials and influence of frequency
and temperature on their properties.and temperature on their properties.
Int. J Prosthodont 2003; 90(3): 369-74.Int. J Prosthodont 2003; 90(3): 369-74.
 D.R. McArthur:D.R. McArthur: Aids for positioning prosthetic eyes in orbitalAids for positioning prosthetic eyes in orbital
prosthesis.prosthesis.
J. Prosthet Dent. 1977;37(3): 192-3.J. Prosthet Dent. 1977;37(3): 192-3.

 D.M. Hecker:D.M. Hecker: Maxillofacial rehabilitation of a large defectMaxillofacial rehabilitation of a large defect
resulting from an arteriovenous malformation utilizing a two –resulting from an arteriovenous malformation utilizing a two –
piece prosthesis.piece prosthesis.
J. Prosthet Dent. 2002; 8992): 109-13.J. Prosthet Dent. 2002; 8992): 109-13.
 E.H. Pow, A.S. McMillan:E.H. Pow, A.S. McMillan: Functional impression technique inFunctional impression technique in
management of an unusual facial defect: a clinical report.management of an unusual facial defect: a clinical report.
J. Prosthet Dent. 2000; 84(4):458-61.J. Prosthet Dent. 2000; 84(4):458-61.
 J.J. Gary, C.T. Smith:J.J. Gary, C.T. Smith: Pigments and their application onPigments and their application on
maxillofacial elastomers: a literature review.maxillofacial elastomers: a literature review.
J Prosthet Dent. 1999: 80(2): 204-8.J Prosthet Dent. 1999: 80(2): 204-8.
 T.J. Salinas et al:T.J. Salinas et al: A multiple tray technique for implant –A multiple tray technique for implant –
retained orbital prosthesis.retained orbital prosthesis.
J. Prosthet Dent. 1995; 73(4): 43-9.J. Prosthet Dent. 1995; 73(4): 43-9.
 A.J. Coleman et al:A.J. Coleman et al: A two- stage impression technique forA two- stage impression technique for
custom facial prosthesis.custom facial prosthesis.
J. Prosthet Dent. 1995; 73(3): 262-6.J. Prosthet Dent. 1995; 73(3): 262-6.

 A. Gupta, D. Jain:A. Gupta, D. Jain: Materials used for maxillofacial prosthesisMaterials used for maxillofacial prosthesis
reconstruction: A literature review.reconstruction: A literature review.
J.I.P.S;2003:3(1): 11-15.J.I.P.S;2003:3(1): 11-15.
 J. Jethwani:J. Jethwani: Extraorbital prosthesis.Extraorbital prosthesis.
J.I.P.S; 2003:3(1): 36-38.J.I.P.S; 2003:3(1): 36-38.
 Y. John:Y. John: Ossoeintegration in maxillofacial prosthesis.Ossoeintegration in maxillofacial prosthesis.
DCNA: 1990;34:2:327.DCNA: 1990;34:2:327.
 V.A Chalian, J.B. Drane, S.M. Standish:V.A Chalian, J.B. Drane, S.M. Standish: MaxillofacialMaxillofacial
prosthetics.prosthetics.

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