Implant designs and materials/certified fixed orthodontic courses by Indian dental academy

EVALUATION OF
IMPLANT DESIGNS AND
MATERIALS
USED IN
THE MAXILLOFACIAL
PROSTHESIS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

CONTENTS
 IntroductionIntroduction
 Role of Osseointegration in maxillofacialRole of Osseointegration in maxillofacial
prosthesisprosthesis
 Implant retained prosthesis v/s adhesive retainedImplant retained prosthesis v/s adhesive retained
 Disadvantages of adhesives used in the retentionDisadvantages of adhesives used in the retention
of maxillofacial prosthesisof maxillofacial prosthesis

 Implant design consideration in the reconstructionImplant design consideration in the reconstruction
of various maxillofacial defectsof various maxillofacial defects
CONTENTS
• Orbital defects
• Nasal defects
• Auricular defects
- Bone anchored hearing aids (BAHA)Bone anchored hearing aids (BAHA)
• Mid-facial defects
• Maxillary defects
• Mandibular defects
 Historical development of maxillofacial materialsHistorical development of maxillofacial materials

 Characteristics of an ideal maxillofacial materialCharacteristics of an ideal maxillofacial material
 Vinyl polymers and copolymersVinyl polymers and copolymers
 Acrylic resinsAcrylic resins
 LatexesLatexes
 Silicones – RTV silicones and HTV siliconesSilicones – RTV silicones and HTV silicones
 PolyurethanePolyurethane
 Pigments and their application in maxillofacialPigments and their application in maxillofacial
 AdhesivesAdhesives
 Instructions to the patientsInstructions to the patients
 Summary and conclusionSummary and conclusion
 BibliographyBibliography
CONTENTS

INTRODUCTION
 Defects of the oral and maxollofacial regionDefects of the oral and maxollofacial region 
Congenital/acquiredCongenital/acquired  dysfunction anddysfunction and
disfigurementdisfigurement  significant morbiditiessignificant morbidities  uniqueunique
tissue management problemstissue management problems
 Esthetic and functional impairmentsEsthetic and functional impairments  normalnormal
life?life?
 RehabilitationRehabilitation  maxillofacial prosthesismaxillofacial prosthesis
 Retention, stability and supportRetention, stability and support  successfulsuccessful
prosthesisprosthesis www.indiandentalacademy.com

 Osseointegrated implants v/s conventionalOsseointegrated implants v/s conventional
maxillofacial prosthesismaxillofacial prosthesis
 Oral andOral and maxillofacial prosthodontist, materialmaxillofacial prosthodontist, material
scientist and polymer chemistscientist and polymer chemist
 Suitable, durable, stable, esthetic and economicSuitable, durable, stable, esthetic and economic
materialmaterial
 Retain the characteristics of living tissuesRetain the characteristics of living tissues 
colour, softness, flexibility and tear resistance.colour, softness, flexibility and tear resistance.
INTRODUCTION

MAXILLOFACIAL
PROSTHODONTICS
 ““A branch of Prosthodontics concerned withA branch of Prosthodontics concerned with
restoration, replacement of both stomatognathicrestoration, replacement of both stomatognathic
and associated facial structures by artificialand associated facial structures by artificial
substitutes that may of may not be removed. Itsubstitutes that may of may not be removed. It
encompasses prosthetic rehabilitation of patientencompasses prosthetic rehabilitation of patient
with oral, paraoral or facial defects, which may bewith oral, paraoral or facial defects, which may be
acquired (developmental/congenital) or resultingacquired (developmental/congenital) or resulting
from disease/trauma.”from disease/trauma.”

ROLE OF
OSSEOINTEGRATION IN
MAXILLOFACIAL
PROSTHESIS
 Branemark P.I. and his associates (1977) – pioneersBranemark P.I. and his associates (1977) – pioneers
 The prosthetic restoration of dentoalveolar andThe prosthetic restoration of dentoalveolar and
maxillofacial defects has significantly improvedmaxillofacial defects has significantly improved
with development of new materials and advances inwith development of new materials and advances in
clinical, surgical and lab techniquesclinical, surgical and lab techniques

 The advances, specifically the use of endosseousThe advances, specifically the use of endosseous
implants improved the retention, stability andimplants improved the retention, stability and
esthetics, resulting in more natural appearing andesthetics, resulting in more natural appearing and
functioning prosthesisfunctioning prosthesis
 Osseointegration establishes a direct structural andOsseointegration establishes a direct structural and
functional connection between ordered, livingfunctional connection between ordered, living
bone and the surface of a load carrying implant.bone and the surface of a load carrying implant.

 The concept of surface area, force and stressThe concept of surface area, force and stress
distribution are of significant concern in andistribution are of significant concern in an
implant retained prosthesis.implant retained prosthesis.
 The predominant limiting factor for maxillofacialThe predominant limiting factor for maxillofacial
implants is the decrease in the bone thickness inimplants is the decrease in the bone thickness in
the oral and maxillofacial region.the oral and maxillofacial region.

 The maxillofacial implants are made up of Cp TiThe maxillofacial implants are made up of Cp Ti
 They are short about 3-5 mm in length and possessThey are short about 3-5 mm in length and possess
peripheral flange measured about 5 mm in diameter.peripheral flange measured about 5 mm in diameter.
 The flange increases the implant surface area,The flange increases the implant surface area,
perforations provide mechanical stabilization.perforations provide mechanical stabilization.

IMPLANT RETAINED
V/S
ADHESIVE RETAINED
PROSTHESES

Improved retention and stability

Elimination of allergic skin reactions

Ease and enhanced accuracy of prosthesis
placement

Improved skin hygiene and patient comfortwww.indiandentalacademy.com


Decreased daily maintenance

Increased life span of the prosthesis

Enhanced lines of juncture between the prosthesis
and skin.

DISADVANTAGES
OF ADHESIVES

Daily removal may damage the extrinsic colours
and may eventually result in margin loss.

Adhesives tend to damage the prosthesis margin
gradually with daily use and may tend to lose
adhesive bond if perspiration present.

Leads to allergic skin reactions.

Require solvents for cleaning, which may cause
deterioration of the base metal.

IMPLANT DESIGNS –
ORBITAL DEFECTS
 Implants reduce need for adhesives and lead to
easy application and removal.
 Enhance support and retention of the prosthesis
 Blind duct characteristics of an orbital defects +
marginal seal using adhesives  chronic
inflammation of soft tissues.
 Discomfort and adversely affect the fit and
esthetic quality of the prosthesis

 For an orbital prosthesis, the implants are ideally
placed around the defect, because of bone anatomy,
placement is often limited to superior and lateral
aspect of the rim.
 In extensive orbital defects, implants can be placed
in zygoma/maxilla

VARIOUS RETENTIVE
OPTIONS
• Bar and clip attachments
• Bar and magnet attachments
• Individual magnets
• Ball attachments
• Combination of above

BAR AND CLIP
ATTACHMENTS
 It is a wire soldered to the gold cylinders &It is a wire soldered to the gold cylinders &
attached to the abutments by gold screws.attached to the abutments by gold screws.
 Retentive clips are placed on the inner aspects ofRetentive clips are placed on the inner aspects of
the prosthesis.the prosthesis.
 Good load distribution on the implants.Good load distribution on the implants.
 Good retention for large defects which haveGood retention for large defects which have
implants in the upper orbital rim to support theimplants in the upper orbital rim to support the
prosthesis.prosthesis.

INDIVIDUAL
MAGNETS
 It consists of a magnet cap that is threaded ontoIt consists of a magnet cap that is threaded onto
the abutment and a magnet is placed into the tissuethe abutment and a magnet is placed into the tissue
surface of the prosthesis.surface of the prosthesis.
 Used for orbital defects with the implants in theUsed for orbital defects with the implants in the
upper and lower rims.upper and lower rims.
 Recommended for shallow defects withRecommended for shallow defects with
insufficient space for a bar and clip construction.insufficient space for a bar and clip construction.
 Adv. – Hygiene & ease of use.Adv. – Hygiene & ease of use.www.indiandentalacademy.com

BALL ATTACHMENTS
 Preferred in cases of shallow defects as theyPreferred in cases of shallow defects as they
occupy little space behind the prosthesis.occupy little space behind the prosthesis.
 Three implants creating a tripod are required toThree implants creating a tripod are required to
provide satisfactory retention and stability.provide satisfactory retention and stability.

CONSOLE
ATTACHMENT
 Preferred in cases of small closed defects where 2Preferred in cases of small closed defects where 2
implants are inserted in the upper rim and 1 existsimplants are inserted in the upper rim and 1 exists
in the lower orbital rim and the direction of thein the lower orbital rim and the direction of the
implants are at difficult angles to each other.implants are at difficult angles to each other.
 It can alter the angle of tone implant relative eachIt can alter the angle of tone implant relative each
other.other.

CASE REPORTS

IMPLANTS DESIGNS &
NASAL DEFECTS
 Nasomaxillary & nasolabial defectsNasomaxillary & nasolabial defects  functional &functional &
esthetic problemsesthetic problems  require load bearing capabilityrequire load bearing capability
by the endosseous implant.by the endosseous implant.

 For nasal defects, implants can be placed in theFor nasal defects, implants can be placed in the
maxillary & frontal bones.maxillary & frontal bones.
 They should be in the confines of the outer contoursThey should be in the confines of the outer contours
of the prosthesis.of the prosthesis.
 Location of the frontal sinuses & superior margin ofLocation of the frontal sinuses & superior margin of
the prosthesis are the limiting factors in thethe prosthesis are the limiting factors in the
placement of the implant in the superior aspect ofplacement of the implant in the superior aspect of
the defect.the defect.
 If placed in the inferior aspect of the defect, careIf placed in the inferior aspect of the defect, care
has to be taken to provide accessibility for retentivehas to be taken to provide accessibility for retentive
aspects.aspects.

IMPLANT DESIGNS FOR
AURICULAR DEFECTS
 Implants placed in the post auricular area, whichImplants placed in the post auricular area, which
corresponds to the region of helix and anti-helix.corresponds to the region of helix and anti-helix.
 Tjellstrom et al – implants have to be 18-20 mmTjellstrom et al – implants have to be 18-20 mm
from the center of the external auditory meatus.from the center of the external auditory meatus.
 2-3 implants are sufficient for satisfactory2-3 implants are sufficient for satisfactory
retention .retention .
 Ideal position – 20 mm from center of externalIdeal position – 20 mm from center of external
auditory canal, which helps bar construction in theauditory canal, which helps bar construction in the
proper contour with enhanced esthetics.proper contour with enhanced esthetics.

ATTACHMENTS USED
 A gold alloy bar approximately 2 mm in diameterA gold alloy bar approximately 2 mm in diameter
which is soldered to the gold cylinders andwhich is soldered to the gold cylinders and
attached to abutments.attached to abutments.
 Retention by use of magnets – gold alloy bars mayRetention by use of magnets – gold alloy bars may
be fabricated to retain the magnets which arebe fabricated to retain the magnets which are
cemented to the abutments. Magnets are 6 mm incemented to the abutments. Magnets are 6 mm in
diameter and 2 mm in thickness.diameter and 2 mm in thickness.

BONE ANCHORED
HEARING AIDS (BAHA)
 Impaired hearingImpaired hearing  difficult to cope withdifficult to cope with
important aspects of life.important aspects of life.
 10 years of experience10 years of experience  importance of BAHA.importance of BAHA.
 Two groups suited for BAHATwo groups suited for BAHA  external auditoryexternal auditory
canal atresia and chronic otitis mediacanal atresia and chronic otitis media  not suitednot suited
for conventional air conduction hearing aidsfor conventional air conduction hearing aids

WHY BAHA IS
DIFFERENT?
 Sound reception – AIR condition via auditorySound reception – AIR condition via auditory
canal & bone conduction via jaws & skull bones.canal & bone conduction via jaws & skull bones.
 Air conduction hearing aids:Air conduction hearing aids:
most common hearing aidsmost common hearing aids
placed behind the ear/inside the auditory canalplaced behind the ear/inside the auditory canal
limited use as occlusion of auditory canallimited use as occlusion of auditory canal
worsens chronic inflammation/infection.worsens chronic inflammation/infection.
 BAHA uses the Principal of osseointegration to
overcome these problems

BAHA - INDICATIONS
1.1. Chronic otitis media with conductive & mixedChronic otitis media with conductive & mixed
hearing loss where the use of air conductionhearing loss where the use of air conduction
device is contraindicated.device is contraindicated.
2.2. Congenital malformation of external or middleCongenital malformation of external or middle
ear.ear.
3.3. Chronically draining ears.Chronically draining ears.
4.4. Chronic external otitis.Chronic external otitis.
5.5. Bone conduction pure-tone average of 45 dB orBone conduction pure-tone average of 45 dB or
less & speech discrimination of 60% of greater.less & speech discrimination of 60% of greater.

BAHA -
CONTRAINDICATIONS
1. Patients with drug & alcohol addictions.
2. Emotionally unstable and developmentally
retarded patients for the reason of handling &
hygiene

BAHA - PROCEDURE
 One stage surgical procedureOne stage surgical procedure ↓↓LA.LA.
 Placement of Ti implant & abutment in mastoidPlacement of Ti implant & abutment in mastoid
cortex.cortex.
 Maintenance of hair free area around the abutmentMaintenance of hair free area around the abutment
is required.is required.
 After osseointegration, abutment is loaded withAfter osseointegration, abutment is loaded with
the mechano-electric transducer system.the mechano-electric transducer system.

BAHA – VARIOUS
TYPES

BAHA –
COMPONENTS
 Implant & cover screws are made up of pure Ti.Implant & cover screws are made up of pure Ti.
 Flange implants - 3.75 x 3 mmFlange implants - 3.75 x 3 mm
- 3.75 x 4 mm- 3.75 x 4 mm

IMPLANT DESIGNS –
MIDFACE DEFECTS
 Midface defects often result from ablativeMidface defects often result from ablative
procedures used to control malignancies of nasalprocedures used to control malignancies of nasal
& maxillary structures.& maxillary structures.
 It may result in a small soft tissue defect/a massiveIt may result in a small soft tissue defect/a massive
defect involving intra & extra oral structures.defect involving intra & extra oral structures.
 As the size of defect increases, complexity ofAs the size of defect increases, complexity of
prosthetic rehabilitation increases.prosthetic rehabilitation increases.
 Palatal & extra oral defects – connecting bothPalatal & extra oral defects – connecting both
prosthesis together.prosthesis together.

 Intra & extra oral connection – use of adhesivesIntra & extra oral connection – use of adhesives
along with magnetic retention will enhancealong with magnetic retention will enhance
retention but affect stability.retention but affect stability.
 Movement of intraoral prosthesisMovement of intraoral prosthesis  movement ofmovement of
facial prosthesisfacial prosthesis  noticeable and unnaturalnoticeable and unnatural
appearance.appearance.
 Endosseous implants in the midface region willEndosseous implants in the midface region will
enhance retention, stability & esthetics of theenhance retention, stability & esthetics of the

 Jenson DT et al (1992):Jenson DT et al (1992):
 Described available sites for the implant placementDescribed available sites for the implant placement
in the midfacial regionin the midfacial region
 Suggested craniofacial site classification for theSuggested craniofacial site classification for the
osseointegrated implants – alpha, beta & delta sites.osseointegrated implants – alpha, beta & delta sites.

 Alpha sites: 6 mm or more in axial bone volumeAlpha sites: 6 mm or more in axial bone volume
available.available.
E.g. - anterior maxilla through the nasal fossa &E.g. - anterior maxilla through the nasal fossa &
the zygoma; zygomatic arch and lateral periorbitalthe zygoma; zygomatic arch and lateral periorbital
region.region.
 Beta sites: 4-5 mm of bone available.Beta sites: 4-5 mm of bone available.
E.g. - superior, lateral & inferolateral orbital rims,E.g. - superior, lateral & inferolateral orbital rims,
temporal bone & zygoma.temporal bone & zygoma.
 Delta sites: marginal sites with 3 mm or less ofDelta sites: marginal sites with 3 mm or less of
bone available.bone available.
E.g. - locations in temporal bone, piriform rim,E.g. - locations in temporal bone, piriform rim,
infraorbital rim, zygomatic buttress.infraorbital rim, zygomatic buttress.

CASE
REPORTS

IMPLANT DESIGNS –
MAXILLECTOMY
DEFECTS
 Tumors requiring maxillary surgical resectionTumors requiring maxillary surgical resection 
Para nasal sinus, palatal epithelium or from minorPara nasal sinus, palatal epithelium or from minor
salivary glands in submucosa.salivary glands in submucosa.
 Prosthetic rehabilitationProsthetic rehabilitation  close oral & nasalclose oral & nasal
cavities, substitute teeth and anterior soft tissues ofcavities, substitute teeth and anterior soft tissues of
the face.the face.
 Anchorage - skeletal components are removedAnchorage - skeletal components are removed
- zygoma & pterygoid region used.- zygoma & pterygoid region used.

 Tumors requiring mandibular surgical resectionTumors requiring mandibular surgical resection 
tongue, mandible & adjacent structures.tongue, mandible & adjacent structures.
 Common lesion – squamous cell carcinoma – lateralCommon lesion – squamous cell carcinoma – lateral
margins of the tongue & floor of mouth.margins of the tongue & floor of mouth.
IMPLANT DESIGNS –
MANDIBULAR
DEFECTS

MATERIALS FOR
MAXILLOFACIAL
PROSTHESIS –
HISTORICAL
DEVELOPMENT.
 Egyptian mummies – artificial eyes, ears & noses.Egyptian mummies – artificial eyes, ears & noses.
 Chinese – facial prosthesis made with waxes &Chinese – facial prosthesis made with waxes &
resins of various types.resins of various types.

 Ambroise Pare (1517-90): the famous French
surgeon was the first medical writer on
maxillofacial prosthetic materials. He
recommended a prosthetic nose which could be
made of silver and attached to the face by strings,
with the line of junction at lip being camouflaged
by an artificial moustache.

 Tycho Brahe – a Danish astronomer of the 16Tycho Brahe – a Danish astronomer of the 16thth
century lost his nose in a fight & replaced it withcentury lost his nose in a fight & replaced it with
an artificial nose made of silver and gold.an artificial nose made of silver and gold.
 Pierre Fauchard (1678-1761) – described that thePierre Fauchard (1678-1761) – described that the
wings that could be positioned by the patient fromwings that could be positioned by the patient from
the oral side of the obturator and made use of thethe oral side of the obturator and made use of the
nose for retention.nose for retention.
 The London Medical Gazette (1832) – described aThe London Medical Gazette (1832) – described a
case or the “Gunner with the silver mask”, acase or the “Gunner with the silver mask”, a
French soldier whose face was seriously injured inFrench soldier whose face was seriously injured in
a battle, who was rehabilitated with a prosthetica battle, who was rehabilitated with a prosthetic
restoration which looked like a mask.restoration which looked like a mask.www.indiandentalacademy.com

 William Morton (1868): constructed a noseWilliam Morton (1868): constructed a nose
prosthesis attached to spectacles using porcelainprosthesis attached to spectacles using porcelain
for a Boston lady, whose nose was lost due tofor a Boston lady, whose nose was lost due to
malignant disease.malignant disease.
 Tettmore (1894): described & illustrated 9 casesTettmore (1894): described & illustrated 9 cases
of nasal deformities which were treated by nasalof nasal deformities which were treated by nasal
prosthesis secured by bow spectacles, which wereprosthesis secured by bow spectacles, which were
made up of “very light plastic material” thatmade up of “very light plastic material” that
approximated the natural colour.approximated the natural colour.
 Towards the end of 19 century, Vulcanite havingTowards the end of 19 century, Vulcanite having
already proved its value in prosthodonticsalready proved its value in prosthodontics
replaced most of the earlier materials likereplaced most of the earlier materials like
cellulose, ceramics & metals.cellulose, ceramics & metals.www.indiandentalacademy.com

 In Germany (1913) the Gelatin-glycerinIn Germany (1913) the Gelatin-glycerin
compounds attracted much attention. Thecompounds attracted much attention. The
materials were simple to manipulate & possessedmaterials were simple to manipulate & possessed
pliability & translucency & adaptability ofpliability & translucency & adaptability of
intrinsic colouring to match the skin.intrinsic colouring to match the skin.
 The most contribution of prevulcanized latex eraThe most contribution of prevulcanized latex era
was that it provided the importance in the earlywas that it provided the importance in the early
1930s to further research towards the desirable1930s to further research towards the desirable
qualities of latex.qualities of latex.
 Bulbulin & Clarke (1965) introducedBulbulin & Clarke (1965) introduced
prevulcanized latex in the construction ofprevulcanized latex in the construction of

 Fonder & Winnetka (1955) presented an articleFonder & Winnetka (1955) presented an article
titled ‘Dental materials and skills in oral & facialtitled ‘Dental materials and skills in oral & facial
prosthesis.’ They used acrylic resin for fabricationprosthesis.’ They used acrylic resin for fabrication
of cleft palate, missing ears, noses and otherof cleft palate, missing ears, noses and other
missing parts of the face.missing parts of the face.
 Lontz JF (1990) described the use of most of theLontz JF (1990) described the use of most of the
general biomedical materials like acrylicgeneral biomedical materials like acrylic
polymers, polyurethanes, silicone elastomers inpolymers, polyurethanes, silicone elastomers in
the fabrication of various maxillofacial prosthesis.the fabrication of various maxillofacial prosthesis.

IDEAL
CHARACTERISTICS OF
MAXILLOFACIAL
MATERIAL1.1. Material should have physical & mechanicalMaterial should have physical & mechanical
properties similar to the human tissues beingproperties similar to the human tissues being
replaced.replaced.
- variable consistency- variable consistency
- dimensional stability- dimensional stability
- allow detail reproduction- allow detail reproduction
- high edge strength- high edge strength
- high elasticity- high elasticity
- light weight- light weightwww.indiandentalacademy.com

2. Material must be compatible with the human2. Material must be compatible with the human
tissue, non-toxic, non-allergic & easily cleaned.tissue, non-toxic, non-allergic & easily cleaned.
- non porous but permeable- non porous but permeable
- odourless- odourless
- resistant to microbial contamination- resistant to microbial contamination
- should not release toxic by-products- should not release toxic by-products
3. Material must be capable of adherence to human3. Material must be capable of adherence to human
tissue by adhesive or other mechanical means.tissue by adhesive or other mechanical means.
- permit easy removal of adhesive without- permit easy removal of adhesive without
damage to patient/prosthesisdamage to patient/prosthesis
- sufficiently strong to incorporate frame- sufficiently strong to incorporate frame
works for implant or other mechanicalworks for implant or other mechanical
retentionretention www.indiandentalacademy.com

4. Material must be compatible with intrinsic and4. Material must be compatible with intrinsic and
extrinsic means of colouring/staining.extrinsic means of colouring/staining.
- capable of layering for mould for depth &- capable of layering for mould for depth &
vitality in colouringvitality in colouring
- translucence, surface structure and surface- translucence, surface structure and surface
gloss consistent with tissuesgloss consistent with tissues
- permit extrinsic colouring without modifying- permit extrinsic colouring without modifying
surface characterization.surface characterization.

5. Should have relatively simple polymerization5. Should have relatively simple polymerization
process , not sensitive to minor processingprocess , not sensitive to minor processing
variables & require materials materials & moldingvariables & require materials materials & molding
procedures commonly used in dentistry.procedures commonly used in dentistry.
- capable of adjustments, repair & relining.- capable of adjustments, repair & relining.
- can be bonded or laminated to other- can be bonded or laminated to other
materials for better properties.materials for better properties.

6. Completed prosthesis must maintain the above6. Completed prosthesis must maintain the above
mentioned properties for acceptable period ofmentioned properties for acceptable period of
serviceservice
- prosthesis must have an acceptable service life- prosthesis must have an acceptable service life
of at least 1v year & preferably 5 years.of at least 1v year & preferably 5 years.
- must be capable of relining or readapting to- must be capable of relining or readapting to
the tissues surrounding the defect to prolong thethe tissues surrounding the defect to prolong the
service life.service life.

VINYL POLYMERS &
COPOLYMERS
 The most widely used materials for the fabricationThe most widely used materials for the fabrication
of maxillofacial prosthesis.of maxillofacial prosthesis.
 The amount of vinyl acetate in the polymer variesThe amount of vinyl acetate in the polymer varies
from 5 to 20%. In the elastomeric form, whenfrom 5 to 20%. In the elastomeric form, when
properly compounded, the vinyl exhibitsproperly compounded, the vinyl exhibits
properties which are superior to those of naturalproperties which are superior to those of natural
rubbers in the flexibility and resistance to sunlightrubbers in the flexibility and resistance to sunlight
and ageing.and ageing.

 The vinyl are the derivatives of ethyleneThe vinyl are the derivatives of ethylene
(CH(CH22=CH=CH22))
HH HH
ll
The vinyl acetate C -The vinyl acetate C -

 The vinyl chloride is polymerized in the presenceThe vinyl chloride is polymerized in the presence
of free radical catalyst to form polyvinyl chloride.of free radical catalyst to form polyvinyl chloride.

 Vinyl acetate forms polyvinyl acetate onVinyl acetate forms polyvinyl acetate on
polymerization.polymerization.

 Polyvinyl chloride is a clear, hard and odourlessPolyvinyl chloride is a clear, hard and odourless
resin. It darkens when exposed to UV light andresin. It darkens when exposed to UV light and
heat, and it requires heat and light stabilization toheat, and it requires heat and light stabilization to
prevent discoloration during fabrication and use.prevent discoloration during fabrication and use.
 Polyvinyl acetate is stable to light and heat but hasPolyvinyl acetate is stable to light and heat but has
an abnormal low softening point ( 35an abnormal low softening point ( 3500
-40-4000
))

Physical propertiesPhysical properties Flexible vinylFlexible vinyl Rigid vinylRigid vinyl
Specific gravitySpecific gravity 1.16-1.351.16-1.35 1.35-1.451.35-1.45
Tensile strengthTensile strength 1500-35001500-3500 5000-90005000-9000
Compressive strengthCompressive strength 900-1700900-1700 8000-130008000-13000
Impact strengthImpact strength
( ft.lbinch)( ft.lbinch)
Varies dependingVaries depending
on plasticizerson plasticizers
0.4-200.4-20
Thermal conductionThermal conduction
(10(10-4-4
calsec)calsec)
3-43-4 3-73-7
Water absorptionWater absorption
( 24hrs)( 24hrs)
0.15-0.750.15-0.75 0.07-0.40.07-0.4

 These materials were extensively used in theThese materials were extensively used in the
beginning but their use decreased due to :beginning but their use decreased due to :
excessive shrinkage,excessive shrinkage,
long processing time,long processing time,
discolouration and hardening of the marginsdiscolouration and hardening of the margins
due to plasticizers migration or loss.due to plasticizers migration or loss.
absorption of sebaceous secretions may leadabsorption of sebaceous secretions may lead
solidification due increased tackiness.solidification due increased tackiness.

REALASTIC
 It is a polyvinyl chloride compound whichIt is a polyvinyl chloride compound which
solidifies into a flexible material when heated.solidifies into a flexible material when heated.
 Materials of this chemical compositionMaterials of this chemical composition
deterioration by UV light, ozone, peroxide, anddeterioration by UV light, ozone, peroxide, and
tetra ethyl lead.tetra ethyl lead.
 These are esthetically satisfactory, but possess aThese are esthetically satisfactory, but possess a
short shelf life.short shelf life.

 It is extremely easy to handle.It is extremely easy to handle.
 Tinting can be accomplished both internally andTinting can be accomplished both internally and
externally using a variety of colouring agents.externally using a variety of colouring agents.
 Ferrous pigments incorporated into the mixtureFerrous pigments incorporated into the mixture
provide a longest shelf life and provide bestprovide a longest shelf life and provide best
esthetic results.esthetic results.
 Metal molds are suggested because of their shortMetal molds are suggested because of their short
shelf life.shelf life.

MEDIPLAS
 It is a heat curing plastisol of polyvinyl organicIt is a heat curing plastisol of polyvinyl organic
compound.compound.
 Available in a variety of premixed base colours,Available in a variety of premixed base colours,
which can be further tinted to match the patient’swhich can be further tinted to match the patient’s
skin tone.skin tone.
 The prosthesis becomes yellow when it is exposedThe prosthesis becomes yellow when it is exposed
to UV light, peroxide, ozone and tetra ethyl leadto UV light, peroxide, ozone and tetra ethyl lead
 Processing: initial set - 100Processing: initial set - 10000
cc
final set - 140final set - 14000
c at 10mtsc at 10mtswww.indiandentalacademy.com

ACRYLIC RESINS
 These are used in fabrication of both intraoral andThese are used in fabrication of both intraoral and
extra oral prosthesis.extra oral prosthesis.
 Derivatives of ethylene, and these contain phenylDerivatives of ethylene, and these contain phenyl
groups in their structural formula.groups in their structural formula.
 Obtained from acids (CH=CHCOOH), andObtained from acids (CH=CHCOOH), and
methacrylic acids [CHmethacrylic acids [CH22=C(CH=C(CH33)COOH].)COOH].

METHYLMETHACRYL
ATE
 It is a clear, transparent liquid at room temperatureIt is a clear, transparent liquid at room temperature
 Melting point of -48Melting point of -48oo
C &C &
 Boiling point of 100.8Boiling point of 100.8oo
C,C,
 Density of 0.945 gms/cubic cmDensity of 0.945 gms/cubic cm
 Heat of polymerization of 12 Kcal/molecule.Heat of polymerization of 12 Kcal/molecule.
 High vapour pressure & excellent org. solvent.High vapour pressure & excellent org. solvent.
 Polymerization can be initiated by UV light, heatPolymerization can be initiated by UV light, heat
or chemicalsor chemicals www.indiandentalacademy.com

ADVANTAGES
1.1. Can be satisfactorily coloured to match theCan be satisfactorily coloured to match the
individual skin tone. The colouring can be doneindividual skin tone. The colouring can be done
internally/externally.internally/externally.
2.2. Preferred for restoring defects which requirePreferred for restoring defects which require
minimal movements.minimal movements.
3.3. Useful in cases of rapidly changing defectsUseful in cases of rapidly changing defects
where relining is mandatory.where relining is mandatory.
4.4. Easily available, economical & familiarEasily available, economical & familiar

DISADVANTAGES
1.1. Rigid nature of the materialRigid nature of the material  tendency totendency to
dislodge the prosthesisdislodge the prosthesis  irritation ofirritation of
underlying tissues.underlying tissues.
2.2. RigidityRigidity  difficulty in duplicating prosthesisdifficulty in duplicating prosthesis

LATEXES
 Soft, inexpensive materials used to create life likeSoft, inexpensive materials used to create life like
 But, weak, degenerate rapidly and colourBut, weak, degenerate rapidly and colour
instabilityinstability  infrequently used.infrequently used.
 Synthetic latex = tripolymer of butyl acrylate,Synthetic latex = tripolymer of butyl acrylate,
methyl methacrylate & methyl methacrylamide.methyl methacrylate & methyl methacrylamide.
 Superior to natural latex – nearly transparent,Superior to natural latex – nearly transparent,
better colouring characteristics, improved blending.better colouring characteristics, improved blending.
 But, technical processes are lengthy and poorBut, technical processes are lengthy and poor
service life.service life.www.indiandentalacademy.com

SILICONES
 Introduced by around 1946, but extensive use onlyIntroduced by around 1946, but extensive use only
in the past few years.in the past few years.
 Most commonly used materials for maxillofacialMost commonly used materials for maxillofacial
 Combination of org. & inorg. Compounds.Combination of org. & inorg. Compounds.
 SilicaSilica  reduced to siliconreduced to silicon  reacted with metalreacted with metal
chloridechloride  demethyl-dichloro-siloxanedemethyl-dichloro-siloxane  reactsreacts
with waterwith water  polymer = translucent, white waterypolymer = translucent, white watery
fluid.fluid.
 Poly-demethyl-siloxane = siliconePoly-demethyl-siloxane = siliconewww.indiandentalacademy.com


Commercially available rubber form polymersCommercially available rubber form polymers
have filters foe additional strength, antioxidantshave filters foe additional strength, antioxidants
and vulcanizing agents are added to transformand vulcanizing agents are added to transform
raw mass into a rubbery resin during processing.raw mass into a rubbery resin during processing.

VulcanizationVulcanization  process of cross linkingprocess of cross linking
silicones.silicones.

Classification depending on the means used toClassification depending on the means used to
activate vulcanizing process:activate vulcanizing process:
1.1. Room temperature vulcanizing silicones (RTV)Room temperature vulcanizing silicones (RTV)
2.2. Heat vulcanizing silicones (HTV)Heat vulcanizing silicones (HTV)www.indiandentalacademy.com

RTV SILICONES
 Composed of comparatively short chains together with crossComposed of comparatively short chains together with cross
linking agent (ethyl ortho silicate) with addition of a catalystlinking agent (ethyl ortho silicate) with addition of a catalyst
(stannous octoate)(stannous octoate)

 They are transparent/opaque white.They are transparent/opaque white.
 Dry earth pigments added to colour match beforeDry earth pigments added to colour match before
the introduction of catalyst.the introduction of catalyst.
 Can be cured in stone mould.Can be cured in stone mould.
 Silica fillersSilica fillers ↑↑ strength & mask discolourationstrength & mask discolouration
 To enhance esthetics, a transparent RTV gradeTo enhance esthetics, a transparent RTV grade
silicone (Dow corning MDX 4-4210) issilicone (Dow corning MDX 4-4210) is
recommended.recommended.
 Supplied as single paste systems coloured bySupplied as single paste systems coloured by
addition of dyed rayon fibers, dry earth pigmentsaddition of dyed rayon fibers, dry earth pigments
and/or paints.and/or paints. www.indiandentalacademy.com

RTV SILICONES –
TECHNIQUES
 Dow corning manufactures different types of RTVDow corning manufactures different types of RTV
silicones.silicones.
 Differences are in curing time & strengthDifferences are in curing time & strength
 Clear, translucent MDX 4-4210Clear, translucent MDX 4-4210
 Semi-transparent, such as silastic 399Semi-transparent, such as silastic 399
 Opaque & white, such as silastic 382Opaque & white, such as silastic 382

 Supplied as semisolid/putty like materials.Supplied as semisolid/putty like materials.
 Require milling, packing under pressure, 30 minRequire milling, packing under pressure, 30 min
heat application cycle at 180heat application cycle at 180oo
C.C.
 Pigments are milled into themPigments are milled into them  better strength &better strength &
colour stability.colour stability.
HTV SILICONES


Chalian (1976) & Lontz et al (1974): HTVChalian (1976) & Lontz et al (1974): HTV
silicones superior to RTV silicones because:silicones superior to RTV silicones because:
- faster colouring procedure which is generally- faster colouring procedure which is generally
entirely intrinsic andentirely intrinsic and
- polychromatic- polychromatic

Disadv. – require a milling machine and metalDisadv. – require a milling machine and metal
mouldsmoulds

Due to high tensile strength,Due to high tensile strength, ↑↑ risks of damagingrisks of damaging
the mould.the mould. www.indiandentalacademy.com

 Translucent, milky white, semisolid materials.Translucent, milky white, semisolid materials.
 Dow Corning manufactures 3 consistencies:Dow Corning manufactures 3 consistencies:
- MDX 4-4514, MDX 4-4515 & MDX 4-4516.- MDX 4-4514, MDX 4-4515 & MDX 4-4516.
 MDX 4-4514 – extra oral prosthesis – Chalian etMDX 4-4514 – extra oral prosthesis – Chalian et
al (1972), Beder (1974) & Lontz et al (1974)al (1972), Beder (1974) & Lontz et al (1974)
 Cut & rolled in the milling machine beforeCut & rolled in the milling machine before
packing into moulds. Colours & fiberspacking into moulds. Colours & fibers
incorporated during rolling.incorporated during rolling.
HTV SILICONES –
TECHNIQUES

SILASTIC 399
 Resembles white VaselineResembles white Vaseline
 Supplied with 1 base paste & 2 catalystSupplied with 1 base paste & 2 catalyst
 When mixing with catalyst 1, cross linking agentWhen mixing with catalyst 1, cross linking agent
becomes milky, but working time will be longer.becomes milky, but working time will be longer.
 When mixing with catalyst 2, it sets up toWhen mixing with catalyst 2, it sets up to
translucent in 10-15 min.translucent in 10-15 min.

SILASTIC 382
 Medical grade siliconeMedical grade silicone
 Thick white liquid & comes with a separateThick white liquid & comes with a separate
container of organometallic catalyst, whichcontainer of organometallic catalyst, which
catalyses without the use of heat or pressure oncatalyses without the use of heat or pressure on
combining with silicone.combining with silicone.
 Working time varies from 2-6 min. depending onWorking time varies from 2-6 min. depending on
amount of catalyst.amount of catalyst.

SILASTIC 6508
 Resembles sticky modeling clay in the raw state.Resembles sticky modeling clay in the raw state.
 Must be vulcanized at 260Must be vulcanized at 260oo
F and formed inF and formed in
pressure mouldspressure moulds
 Requires much more sophisticated handlingRequires much more sophisticated handling
 Tensile strength = 785 psiTensile strength = 785 psi

SILPHENYLENE
 An analene silicone polymer synthesized &An analene silicone polymer synthesized &
formulated as a pourable, viscous RTV liquid.formulated as a pourable, viscous RTV liquid.
 Consists of 3 unit kit – base resin, tetrapropoxyConsists of 3 unit kit – base resin, tetrapropoxy
silicone (cross linking agent) & a catalyst.silicone (cross linking agent) & a catalyst.
 High tensile strength & low modulus of elasticity.High tensile strength & low modulus of elasticity.
 Feels like skinFeels like skin
 Incorporation of fillersIncorporation of fillers  ↑↑tear strengthtear strength

DERMASIL
 Self curing silicone, clear base material & catalystSelf curing silicone, clear base material & catalyst
are used to initiate the reaction.are used to initiate the reaction.
 Pigments added to base material to obtain properPigments added to base material to obtain proper
shade.shade.
 ↑↑pigmentspigments →→ dull appearance of materialdull appearance of material
 Fragile margins to be reinforced with nylonFragile margins to be reinforced with nylon
stocking materialstocking materialwww.indiandentalacademy.com

POLYURETHANE
ELASTOMERS
 Recent addition to materials used in maxillofacialRecent addition to materials used in maxillofacial
prosthetics.prosthetics.
 Linkage/presence of urethane.Linkage/presence of urethane.
 Synthetic proportions of long chain linearSynthetic proportions of long chain linear
polyesters/polyethers reacted with diisocyanatespolyesters/polyethers reacted with diisocyanates
 Can be thermoplastic/thermo settingCan be thermoplastic/thermo setting

 Hard segments – extended diisocyanatesHard segments – extended diisocyanates
 Soft segments – polyesters & ionocyanatesSoft segments – polyesters & ionocyanates
 Catalyst – stannous octoate or dibutylin diacirateCatalyst – stannous octoate or dibutylin diacirate
 Colouring agents – inorg. Colourants are preferredColouring agents – inorg. Colourants are preferred
 When properly processed, they are chemicallyWhen properly processed, they are chemically
inert, resistant to solvents, odourless, abrasioninert, resistant to solvents, odourless, abrasion
resistant, have high tear & tensile strength.resistant, have high tear & tensile strength.
 Do not harden with wear & are dimensionallyDo not harden with wear & are dimensionally
stable.stable.
 Can be coloured easily (externally/internally)Can be coloured easily (externally/internally)www.indiandentalacademy.com

COMMERCIALLY
AVAILABLE
NEWER MATERIALS
1. Acrylic resin copolymer – palamed-kulzer1. Acrylic resin copolymer – palamed-kulzer
2. Vinyl polymers & copolymers2. Vinyl polymers & copolymers
Realistic – prosthetic services, CaliforniaRealistic – prosthetic services, California
Mediplast – Std. Arts, ButlerMediplast – Std. Arts, Butler
3. Polyurethane elastomers – Epithane 33. Polyurethane elastomers – Epithane 3
Daroproducts, Butler.Daroproducts, Butler.www.indiandentalacademy.com

4. Silicone elastomer4. Silicone elastomer
 MDX 4-4210, Silastic 372, 373, Dow CorningMDX 4-4210, Silastic 372, 373, Dow Corning
Michigan.Michigan.
 Cosmosil, principality, UKCosmosil, principality, UK
 Elatosil M 3500, waker/chemicElatosil M 3500, waker/chemic
 Epsil – DentamidEpsil – Dentamid
 Silskin 2000 – Dupay Health CareSilskin 2000 – Dupay Health Care

DOW CORNING MDX
4-4210
 Very useful silicone, but viscosity problemsVery useful silicone, but viscosity problems
 Addition of Silskin (thickening agent) regulatesAddition of Silskin (thickening agent) regulates
viscosity.viscosity.
 Recommended where soft silicone is required.Recommended where soft silicone is required.
 The degree of softness can be varied with theThe degree of softness can be varied with the
addition of catalyst.addition of catalyst.
 Available in various colour systems.Available in various colour systems.

PALAMED
 Cross linked copolymer of methacrylic & acrylics.Cross linked copolymer of methacrylic & acrylics.
 Consists of powder & liquid, when mixed forms aConsists of powder & liquid, when mixed forms a
dough like material.dough like material.
 The processed prosthesis will have a sponge likeThe processed prosthesis will have a sponge like
center & a continuous skin like covering.center & a continuous skin like covering.
 Proper packing of the moulds is critical inProper packing of the moulds is critical in
obtaining satisfactory final prosthesis.obtaining satisfactory final prosthesis.
 It is necessary to use exact weight equivalent toIt is necessary to use exact weight equivalent to
Palamed to modeling materials.Palamed to modeling materials.

EPITHANE
 It is a polyurethane system.It is a polyurethane system.
 Consists of polyol components (mixture ofConsists of polyol components (mixture of
polyesters), diiscyonate components & organicpolyesters), diiscyonate components & organic
catalyst.catalyst.
 Soft & more flexibleSoft & more flexible
 Disadv. – deterioration & skin reactionDisadv. – deterioration & skin reaction

COSMESIL – SILSKIN 2
 Cosmesil is a HTV siliconeCosmesil is a HTV silicone
 Silskin is a RTV siliconeSilskin is a RTV silicone
 Available in elastomeric form & colour systemsAvailable in elastomeric form & colour systems
 Curing temp.Curing temp.
Cosmesil – 70Cosmesil – 70oo
C for 2 hrsC for 2 hrs
Silskin – bench press for 24 hrsSilskin – bench press for 24 hrs

ROLE OF PIGMENTS IN
MAXILLOFACIAL
PROSTHESIS
 Duplicating skin with respect to texture, contour &Duplicating skin with respect to texture, contour &
above all, colouring is very difficult.above all, colouring is very difficult.
 Colour occupies important position & everyColour occupies important position & every
attempt must be made to duplicate normal skin soattempt must be made to duplicate normal skin so
that the prosthesis ill look realistic.that the prosthesis ill look realistic.
 Colour varies in different physiological,Colour varies in different physiological,
pathological (anaemia) & emotional states whichpathological (anaemia) & emotional states which
may lead to pallor/ flushingmay lead to pallor/ flushing

 Colour depends onColour depends on
capillary blood flow,capillary blood flow,
oxygenation,oxygenation,
thickness of epidermis &thickness of epidermis &
presence of pigments (melanin & carotene).presence of pigments (melanin & carotene).
 Carl JA et al conducted a survey to analyze theCarl JA et al conducted a survey to analyze the
effect of environmental factors on maxillofacialeffect of environmental factors on maxillofacial
elastomers.They reported various intrinsic &elastomers.They reported various intrinsic &
extrinsic pigments foe colouring the prosthesis.extrinsic pigments foe colouring the prosthesis.

INTRINSICINTRINSIC
COLOURINGCOLOURING
EXTRINSICEXTRINSIC
COLOURINGCOLOURING
Dry earth pigmentsDry earth pigments Dry earth pigmentsDry earth pigments
Ryan fibersRyan fibers Artist’s oilsArtist’s oils
Artist’s oilsArtist’s oils Silicone pastesSilicone pastes
KaolinKaolin Ferro pastesFerro pastes
Silicone pastesSilicone pastes MDX 4-4210MDX 4-4210
Ferro pastesFerro pastes DyesDyes
Artist’s acrylic latexArtist’s acrylic latex TattoosTattoos
Cosmesil pigmentsCosmesil pigments Water coloursWater colours
Dermasil pigmentsDermasil pigments --www.indiandentalacademy.com

 Jong JG et al (1998) reviewed the pigments used inJong JG et al (1998) reviewed the pigments used in
silicone elastomers.silicone elastomers.

INTRINSIC
COLOURING
 According to ChalianAccording to Chalian
et al (1972, 1974),et al (1972, 1974),
intrinsic colouring inintrinsic colouring in
HTV silicones isHTV silicones is
accomplished with aaccomplished with a
milling machine.milling machine.

 Metallic oxides/pigmented silicone concentratesMetallic oxides/pigmented silicone concentrates
are generally used & red fibers may beare generally used & red fibers may be
incorporated to simulate blood vessels.incorporated to simulate blood vessels.
 Colouring in RTV silicones (MDX 4-4210) isColouring in RTV silicones (MDX 4-4210) is
accomplished by adding various dry earthaccomplished by adding various dry earth
pigments.pigments.
 For accurate measurements, these pigments areFor accurate measurements, these pigments are
mixed with RTV thinner in the ratio of 3 grains ofmixed with RTV thinner in the ratio of 3 grains of
pigments to 10 ml of thinner.pigments to 10 ml of thinner.www.indiandentalacademy.com

EXTRINSIC
COLOURING
 Bartlett et al (1971) recommended extrinsicBartlett et al (1971) recommended extrinsic
colouring of maxillofacial prosthesis usingcolouring of maxillofacial prosthesis using
medical adhesives.medical adhesives.
 Silicone type A adhesive has been thinned withSilicone type A adhesive has been thinned with
xylene & stored in containers.xylene & stored in containers.
 Each container is tinted with selected inorganicEach container is tinted with selected inorganic
pigments.pigments.
 This adhesive will then be applied with the help ofThis adhesive will then be applied with the help of
cotton swab on to the prosthesis, which willcotton swab on to the prosthesis, which will
provide a life like texture to the it.provide a life like texture to the it.www.indiandentalacademy.com

 Ouellete (1969) described spray colouring ofOuellete (1969) described spray colouring of
silicone elastomer maxillofacial prosthesis.silicone elastomer maxillofacial prosthesis.
 Pigments selected to match the patients’ skin arePigments selected to match the patients’ skin are
mixed in proper proportions with clear elastomersmixed in proper proportions with clear elastomers
& solvents & the mixture is sprayed on to the& solvents & the mixture is sprayed on to the
prosthesis until the desired colour is obtained.prosthesis until the desired colour is obtained.

 According to Schahf (1970), the colour easilyAccording to Schahf (1970), the colour easily
peals off or rubs off during manipulation of thepeals off or rubs off during manipulation of the
prosthesis or during daily cleansing.prosthesis or during daily cleansing.
 He introduced tattooing for surfaceHe introduced tattooing for surface
characterization using standard artist’s oil paintscharacterization using standard artist’s oil paints
which were applied on to the prosthesis surfacewhich were applied on to the prosthesis surface
using tattooing machine.using tattooing machine.

 According to Chalian et al (1972) & Beder (1974),According to Chalian et al (1972) & Beder (1974),
the intrinsic colouring is more effective thanthe intrinsic colouring is more effective than
extrinsic techniques due to longer service life.extrinsic techniques due to longer service life.
 Intrinsic colouring with minimal characterizationIntrinsic colouring with minimal characterization
is helpful in achieving skin like colouring of theis helpful in achieving skin like colouring of the

 Firtell & Bartlett (1969) & Roberts (1971)Firtell & Bartlett (1969) & Roberts (1971)
suggested that basic tone of the prosthesis shouldsuggested that basic tone of the prosthesis should
be made in lighter colour, which can be obtainedbe made in lighter colour, which can be obtained
by intrinsic coloring of the prosthesis with aby intrinsic coloring of the prosthesis with a
minimal surface characterization according to theminimal surface characterization according to the
needs of the patients.needs of the patients.

ADHESIVES
 Historically, facial prosthesis have been retainedHistorically, facial prosthesis have been retained
by various mechanical devices; recently, adhesivesby various mechanical devices; recently, adhesives
have been used.have been used.
 They are polymeric compounds which modifiedThey are polymeric compounds which modified
have been modified with solvents & tackifyinghave been modified with solvents & tackifying
fluids.fluids. www.indiandentalacademy.com

 Selection of adhesives is based on:Selection of adhesives is based on:
biocompatibility,biocompatibility,
retentive properties,retentive properties,
ease of applicability,ease of applicability,
removal on daily basis &removal on daily basis &
nature of the material fromnature of the material from
which prosthesis is fabricated.which prosthesis is fabricated.

 Udagama (1975) reported that biface adhesiveUdagama (1975) reported that biface adhesive
tape is suitable for polyvinyl chloride resin:tape is suitable for polyvinyl chloride resin:
 Davol may be used with polyvinyl chloride &Davol may be used with polyvinyl chloride &
polyurethane.polyurethane.
 Medico adhesives may be used with polyvinylMedico adhesives may be used with polyvinyl
chloridechloride
 Silicone and acrylic and epithane 3 adhesives haveSilicone and acrylic and epithane 3 adhesives have
been recommended for polyvinyl chloride andbeen recommended for polyvinyl chloride and
silicone elastomers.silicone elastomers.

SUMMARY &
CONCLUSION

REFERENCES
 Anders C.J., Haug S.P., Brown D.T. & Bernal G.Anders C.J., Haug S.P., Brown D.T. & Bernal G.::
Effects of environmental factors on maxillofacialEffects of environmental factors on maxillofacial
elastomers: Part II – A report survey.elastomers: Part II – A report survey. J. ProsthetJ. Prosthet
Dent. 1992; 68: 519-21.Dent. 1992; 68: 519-21.
 Anderson J.D.Anderson J.D. : Implants in the treatment of: Implants in the treatment of
maxillofacial patient.maxillofacial patient.
J. Prosthet Dent. 1990; 3(1): 20-9.J. Prosthet Dent. 1990; 3(1): 20-9.
 AnusaviceAnusavice: Science of Dental Materials:: Science of Dental Materials: SaundersSaunders
and CO. 11 edition, 2003.and CO. 11 edition, 2003.
 Archuri M.R., Rubenstein J.T.Archuri M.R., Rubenstein J.T.: Facial implants,: Facial implants,
DCNA 1998; 42: 161-75.DCNA 1998; 42: 161-75.

 Branemark P.-I.: Extraoral applications of
osseointegration, Quintessence Books, 1993.
 Branemark P.-I., Oliveira M.F.D.:Craniofacial
prosthesis, Quintessence Publications, 1997.
 Chalian V.A., Drane J.B., Standish S.M. :
Maxillofacial prosthetics.
W&W Company 1972, pgs 284-304.
 Bergstrom K: Prosthetic techniques for orbital
defects. Nobelpharma Intermational updates 2.93,
Pg. nos. 5-8.

 Fonseca R.J. & Davis W.H.Fonseca R.J. & Davis W.H.: Reconstructive: Reconstructive
Preprosthetic Oral & Maxillofacial Surgery.Preprosthetic Oral & Maxillofacial Surgery. W.B.W.B.
Saunders and Co. 2Saunders and Co. 2ndnd
edition, 1995.edition, 1995.
 Gupta A., Jain D.Gupta A., Jain D. : Materials used for: Materials used for
maxillofacial prosthesis reconstruction: Amaxillofacial prosthesis reconstruction: A
literature review.literature review.
J.I.P.S;2003:3(1): 11-15.J.I.P.S;2003:3(1): 11-15.
 Gary J.J., Smith C.T.Gary J.J., Smith C.T. : Pigments and their: Pigments and their
application on maxillofacial elastomers: aapplication on maxillofacial elastomers: a
literature review.literature review.
J Prosthet Dent. 1999: 80(2): 204-8.J Prosthet Dent. 1999: 80(2): 204-8.
 Gary J.J., Smith C.T.Gary J.J., Smith C.T. : Pigments and their: Pigments and their
application on maxillofacial elastomers: aapplication on maxillofacial elastomers: a
literature review.literature review. J Prosthet Dent. 1999: 80(2):J Prosthet Dent. 1999: 80(2):
204-8.204-8. www.indiandentalacademy.com

 Ismail J.Y.H., & Zaki H.M.Ismail J.Y.H., & Zaki H.M.: Osseointegration in: Osseointegration in
Maxillofacial prosthetics.Maxillofacial prosthetics. DCNA 1990; 34: 327-41.DCNA 1990; 34: 327-41.
 Izzo S.R., Berger J.R., Joseph A.C.,& Lazow S.K.Izzo S.R., Berger J.R., Joseph A.C.,& Lazow S.K.::
Reconstruction of after total maxillectomy using anReconstruction of after total maxillectomy using an
implant-retained prosthesis: A case report.implant-retained prosthesis: A case report.
Int J Oral Maxillofac Implants 1994; 9: 593-95.Int J Oral Maxillofac Implants 1994; 9: 593-95.
 Jensen D.T., Brownd C & Blacker JJensen D.T., Brownd C & Blacker J: Nasofacial: Nasofacial
prosthesis supported by osseointegrated implants.prosthesis supported by osseointegrated implants.
Int J Oral Maxillofac Implants 1992; 7: 203-11.Int J Oral Maxillofac Implants 1992; 7: 203-11.
 John Y. : Ossoeintegration in maxillofacial
prosthesis.
DCNA: 1990;34:2:327.

 Laney W.R., Chalian V.R. : Maxillofacial
Prosthetics
Post graduate dental handbook, PSG company
1979. Pgs-257.
 Lemon J.C., Chambers M.S., Wesley P.J., Reece
G.P., & Martin J.W.: rehabilitation of midface
defects with reconstructive surgery & facial
prosthesis: A case report.
Int J Oral Maxillofac Implants 1996; 11: 101-5
 Lontz J.F.Lontz J.F.: State-of-the-art materials used for: State-of-the-art materials used for
maxillofacial prosthetic reconstruction.maxillofacial prosthetic reconstruction.
DCNA 1990; 34: 307-25.DCNA 1990; 34: 307-25.
 Maniglia. Stucker & StepnickManiglia. Stucker & Stepnick: Surgical: Surgical
reconstruction of the face and anterior skullreconstruction of the face and anterior skull
base.base. W.B.Saunders & Co., 1999W.B.Saunders & Co., 1999

 Rahn A.O., Boucher L.J. : Maxillofacial
prosthetics: Principles and Concepts.
W.B Saunders Company 1970,pgs 113-69.
 Nobelpharma Product catalogue for BAHA 1994.
 Reisberg D.J., Zak J.F., & Goldberg JS: Implant
retained facial prostheses. Fonseca Vol 7
 Thomas K. F.: Prosthetic Rehabilitation.
Quintessence publications, 1994
 Valle V.D., Falukner G., wolfaardt J, Rangert Bo,
Tan H.K.: Mechanical evaluation of craniofacial
osseointergation retention systems.
Int J Oral Maxillofac Implants 1995; 10: 491-5

Implant designs and materials/certified fixed orthodontic courses by Indian dental academy

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