MAXILLOFACIAL PROSTHETIC MATERIALS (MFP MATERIALS) IN BRIEF

1. Maxillofacial Prosthesis
Materials
Dr. NAMITHA AP
KMCT DENTAL COLLEGE

2. MAXILLOFACIAL PROSTHETICS
defined as that branch of prosthodontics
concerned with restoration and/or
replacement of the stomatognathic and
craniofacial structures with prosthesis that
may or may not be removed on a regular
or elective basis.
MAXILLOFACIAL PROSTHESIS
defined as any prosthesis used to replace
part or all of any stomatognathic and/or
craniofacial structures.

3. I ) Patient wise, they are classified as:
1. Surgical - The defect to be restored was created by a
definitive surgical procedure. Ex: Cancer patients
2. Congenital - The defect is a result of congenital or
developmental anomaly. Ex: cleft lip /palate and
syndromes of head and neck.
3. Traumatic - The defect of the head and neck is a
result of a traumatic experience in automobile
accidents, industrial accidents or suicidal attempts.

4. II) By type of prosthesis, they can be
classified as:
1. Extra oral - Facial restorations. Ex: Nasal
prosthesis, orbital, ocular auricular
2. Intra oral - Ex: Obturator, speech aids,
modified complete or partial dentures
and infant feeding prosthesis.

5. • Facial defects can result from trauma, treatment
of neoplasm or congenital malformation.

6. General considerations in material selection
An ideal material for the fabrication of facial prosthesis must -
Have Excellent tissue receptivity i.e. non toxic and non allergic
Lend itself to accurate forming and fairing with retention of fine
detail and without introduction of obvious parting lines or
distortion
A degree of translucency is required
Essentially colorless when cast so that it maybe tinted to simulate
pastel skin tones

7. 5. Be durable and resistant to abrasion and outdoor
weathering.
6. Should be easy to clean , preferably with ordinary
cleaning agents.
7. Should have flexibility corresponding to surrounding
skin to which it adheres, Ideally over the range of
ambient temperatures from 40- 140 oF
8. Material must be able to adhere securely and
comfortably and to exhibit a fine line marginal contact.

8. • Physical properties- The material should be
flexible, dimensionally stable, light in weight,
with low thermal conductivity and good
strength.
• Biological and Chemical properties- remain
stable when exposed to environmental
assaults. Should be non-toxic, non-allergic
and biocompatible.
Properties of maxillofacial prosthetic materials

9. • Fabrication characteristics- Polymerization
should occur at a temperature low enough
to permit reusability of molds. Blending of
individual components should be easy. It
should have suitable working time and be
easy to color.
• Esthetic characteristics- The complete
prosthesis should be unnoticeable in public,
faithfully representing lost structure in the
finest detail. Its color, texture, form and
translucence must duplicate that of missing
structure and adjacent skin.

10. Historical background
BEFORE 1600 A.D.
• The origin of the prosthetic reconstruction of facial defects has not
been well documented by historians. Archaeologists have found
artificial eyes, noses and ears constructed from waxes, clay and
wood in ancient Chinese culture.
• Artificial eyes have also been found in Egyptian mummies; however, it
has now been found that those eyes were placed postmortem.

11. Ambroise Pare (1510-1590), a famous French
surgeon, appears to be the first medical writer on
this subject. He recommended a prosthetic nose,
which could be made of gold, silver, paper and
linen cloth glued together. He also described the
fabrication of an auricular prosthesis.
He was probably the first person to give an
excellent description of a simple but a very
practical obturator for closing a perforation of the
hard palate.
.

12. Pierre Fauchard (1678-1761), made a monumental
contribution to prosthetic facial reconstruction
by making a silver mask to replace the lost
portion of the mandible for a French soldier. The
silver prosthesis was painted with oil paints, and
the margins of the prosthesis were made in
conspicuous by covering them with facial hair.
He is the ‘Father of scientific dentistry’ who
contributed significantly to maxillofacial
prosthetics

13. 1800 to 1900
William Morton (1819-1868), fabricated a nasal prosthesis
using
enameled porcelain to match the patients complexion.
Kingsley (1880), made a combination nasal-palatal
prosthesis in
which the obturator portion was an integral part of the
nasal
prosthesis.
Claude Martin (1889), fabricated a nasal prosthesis using
ceramic
material.

14. 1900 to 1940
• Towards the end of the nineteenth century, vulcanite
rubber was widely used by the dental profession and
was adapted for use in facial prosthesis.
• Upham (1901) described the fabrication of nasal and
auricular prosthesis made from vulcanite rubber .
• In (1905) Ottofy Baird and Baker all reported
using black vulcanite rubber as a foundation for a
nasal
prosthesis.

15. They processed pink vulcanized rubber onto
the foundation, and painted with artist’s
paint.
The rigidity of the vulcanized rubber
presented a problem when adapted to facial
skin.
In 1913, gelatin-glycerin components were
introduced for use in facial prosthesis in
order to mimic the softness and flexibility of

16. Bercowitsch (1928) described the technique
of fabricating and coloring of gelatin-
glycerin facial prostheses using water-
soluble dyes. Unfortunately, the life span of
the gelatin-glycerin compound was too
short for practical clinical application. The
use of vulcanized rubber for facial
prosthesis continued despite of its
shortcomings

17. Various methods of coloring were used.
Kazanjian (1932) described the use of celluloid
paints for coloring vulcanized rubber facial
prostheses11.
In 1937 acrylic resin - introduced and replaced
vulcanite rubber.

18. 1940 to 1960
Transparent photographic paints were used
by Henry Bigelow (1943)
for coloring of acrylic resin facial prosthesis
Tylman, (1994) introduced use of resilient vinyl
copolymer for facial
prosthesis.
Adolph Brown, used colorants certified by the

19. 1960 to 1970
Various kinds of elastomers were
introduced.
Barnhart (1960), introduced silicone rubber for
constructing facial prosthesis.
• 1970 to 1990
Lontz, used modified polysiloxane
elastomers. Gonzalez, described- use of
polyurethane elastomers. Lewis and
Castleberry, described- use of siphenylenes
for facial prosthesis.

20. Turner, documented- use of isophorone
polyurethane. Udagama and Drane, introduced the
use of Silastic Medical Adhesive Silicone Type A for
fabrication of facial prosthesis.
• 1990 to present
A new generation of acrylic resins are being
investigated by Antonucci and Stansbury.
Gentleman, described the use of
polyphosphazenes. Silicone block copolymer is also
being evaluated.

21. Classification of Maxillofacial
Prosthesis materials
• According to Beumer:
1. Acrylic resins.
2. Acrylic copolymers.
3. Polyvinyl chloride & copolymers.
4. Chlorinated polyethylene.
5. Polyurethane elastomers.
6. Silicone elastomers – HTV, RTV, Foaming
silicones.
7. New materials- Silicone block copolymers,
Polyphosphazenes.

22. • According to ANUSAVICE:
1. Latex- a tripolymer of Butyl acrylate, Methyl
methacrylate & Methyl methacrylamide.
2. Vinyl Plastisols.
3. Silicone Rubbers.
4. Polyurethane Polymers.

23. ACRYLIC RESIN
• Acrylic resins – employed- specific types of
facial defects, particularly those in which little
movement occurs in the tissue bed during
function and for temporary facial prostheses.
• Acrylic resin - easily available, easy to stain
and color, has good strength to be fabricated
with feather margin and a good life of about
two years. Its rigidity and high thermal
conductivity is a drawback.

25. ADVANTAGES
⮚Both intrinsic and extrinsic
coloration can be
performed.
⮚Has good edge strength
⮚Alterations.
⮚Compatible with most
adhesive systems
⮚Color stability is good
⮚Can be easily relined
DISADVANTAGES
⮚RIgidity -compromised in
highly
movable tissue beds leading
discomfort and expose of
margins.
⮚ High thermal conductivity.
⮚ Duplication-estruction of
the mould during removal
from flasks.

26. ACRYLIC COPOLYMER
⮚Soft and elastic but have not received wide
acceptance because of a number of
objectionable properties. A well-documented
discussion of the properties and fabrication of
prostheses with Palamed® (a plasticized methyl
methacrylate) is provided by Cantor and
Hildestad
⮚It is a cross-linked copolymer of methacrylics
and acrylics, and its molecular structure
causes it to have an
inherent softness .

27. Disadvantages:
⮚ Poor edge strength.
⮚ Poor durability.
⮚ Subject to degradation when exposed to
sunlight.
⮚ Processing and coloration are difficult.
⮚ Completed restorations often become
tacky, predisposing to dust accumulation
and staining.

28. POLYVINYLCHLORIDE AND COPOLYMER
Realistic®, mediplast®, prototype III®
At one time vinyl polymers and co-polymers
were popularly and widely used for facial
restoration.
It consists of combination of polyvinyl
chloride (a hand clear resin that is tasteless
and odorless) + plasticizer which allows for
processing at reasonably low temperature

29. Disadvantages:
⮚ Plasticizer migration and loss resulting in
discoloration.
⮚ Edges tear easily.
⮚ These compound can be stained easily but
degrade when exposed to UV Light.
⮚ Absorbs sebaceous secretions, they
compromise the physical properties.
⮚ Require metal molds for curing at high
temperature.

30. POLYURETHANE ELASTOMERS
• Polyurethane elastomers contain a
urethane linkage. The reactants are a
polymer terminating with hydroxyl group
and others terminating with isocyanate in
the presence of a catalyst.
• They can be synthesized with a
wide range of physical properties
by varying the reactants and their
amounts.

31. • They have excellent properties like
elasticity and ease of coloration but have
certain deficiencies like isocyanates, are
moisture sensitive leading to gas bubbles
when water contaminated and can also
cause local irritation as described by
Gonzalez.
• Not color stable.
• Poor compatibility of this material with
adhesive systems.

32. SILICONE
ELASTOMERS
Barnhart (1960) was the first to use silicone elastomers
for extra-oral prostheses.
The most widely used materials for facial restoration .
They are a combination of organic and inorganic
compounds. Chemically, they are termed as
polydimethyl siloxane.

33. ⮚ The first step in their production is the
reductions of silica to elemental silicon.
⮚ Then, by various reactions, the silicone is
combined with methyl chloride to form
dimethyl dichlorosiloxzane which, when it
reacts with water, forms a polymer.
n Si(CH3)2Cl2 + n H2O → [Si(CH3)2O]n + 2n HCl

34. ⮚ These polymers are translucent, watery white
fluids whose viscosity is determined by length
of the polymer chain.
⮚ Most rubbery forms are compounded with
fillers that provide additional strength.
⮚ Antioxidants and Vulcanizing agents are
used to transform the raw mass from or
plastic to a rubbery -resin during processing.

35. ⮚The process of cross-linking the polymers is
referred to a vulcanization.
⮚Vulcanization occurs both with and
without heat and depends on the catalytic
or cross-linking agents utilized

36. Classification:
⮚Depending on the method of vulcanization,
two forms are
available:
1. Those that require heat - Heat
vulcanized (HTV)
2. Those that vulcanize at room
temperature- Room temperature
vulcanized (RTV)

37. ⮚ Silicones are classified into 4 groups,
according to their
applications:
1. Implant grade
2. Medical grade
3. Clean grade
4. Industrial grade

38. III. Based on chemistry:
a. Polydimethylsiloxanes - Silastic 382®, Dow
corning Corp., Midland, Michigan.
b.Methylvinyl/dimethylsiloxanes - MDX4-
4210®, Dow Corning
Corp.
c. Phenylmethylsiloxanes
d. Fluorodimethylsiloxanes

39. HEAT-TEMPERATUREVULCANIZING
SILICONE ELASTOMERS (HTV)
• HTV silicone is usually a white, opaque
material with a highly viscous, putty-like
consistency.
• The catalytic, or vulcanizing agent of the
HTV silicones is dichlorobenzoyl peroxide
or platinum salt.
• Filler is usually very pure, finely divided
silica with a particle size of about 30μm

40. Various types of HTV Silicones:
⮚ Silastic S-6508, 382 and 399 (Michigan).
⮚ Silastic S-6508 in raw stage is similar to sticky
modeling clay. It must be vulcanized at 2600F
and formed in pressure molds.
⮚ Silastic 382 is an opaque white fluid with a
viscosity like that of a thick honey.
⮚ Silastic 399 resembles white Vaseline in its raw
state.
⮚ Easily spatulated, but non-flowing.
⮚ Silastic 382 is tougher, non-flowing, but easier to

41. Advantages:-
⮚ Excellent thermal stability.
⮚ Color stable.
⮚ Biologically inert.
Disadvantages:-
⮚ Not adequately elastic in function.
⮚ Low edge strength.
⮚ Opaque, life less appearance.

42. ROOM TEMPERATURE VULCANIZING
SILICONE ELASTOMERS (RTV)
• Viscous silicone polymer
• Stannous octate - catalyst
• Orthoalkyl silicate cross linking agent
• Diatomaceous earth - Filler wstrength.

43. Silastic 382, 399®
● The viscous silicone polymer includes
filler, a stannous octoate catalyst, and
orthoalkyl silicate cross-linking agent.
● polymerization-condensation reaction.
● Fillers, epiderm diatomaceous earths,
are used to improve strength

44. MDX 4-
4210
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⮚ Medical-grade silicone elastomer
⮚ Most popular among clinicians.
⮚ Moore reported that it exhibits improved
qualities relative to coloration and edge
strength

45. Catalyst - Chloroplantinic acid
Cross-linking agent - Hydro-methylsiloxane.
Mixing: 1 part of curing agent 10 part of base
elastomer
Curing : temperature of 23ºc for 24 hrs, full
cure is achieved in 3 days at room
temperature.
Cure may be accelerated with temp

46. Cosmesil- Principality Medical Ltd
Products, UK)
⮚ RTV silicone
⮚ Can be processed to varying degrees of hardness
as described by Woofaardt .
⮚ Higher tear strength at failure than MDX 4-4210.
⮚ The material is a 2-part 10:1 and is supplied in wide
necked tubes for easy removal during use .

47. A-2186 ®, material (Factor II Inc.,
Lakeside Ariz.
Improved physical and mechanical
properties as compared to MDX 4-
4210.
After subjected to environmental
variables - did not retain its improved
properties when compared to same

48. FOAMING SILICONES
• Silastic 386 -The purpose of the foam
forming silicones is to reduce the weight of
the prosthesis. However, the foamed
material has reduced strength and is
susceptible to tearing, leading to weakening
of the material. This weakness can be
overcome partially by coating foam with
another silicone which adds strength but
increase stiffness.

49. • Siphenylenes - are siloxane copolymers
that contain methyl and phenyl groups.
These exhibit improved edge strength, low
modules of elasticity and color ability over
the more conventional polydimethyl
siloxane.

50. SILICONE BLOCK COPOLYMERS
• new materials under development to
improve on some of the weaknesses of
silicone elastomers, such as a low tear
strength, low elongation and the potential
to support bacterial and fungal growth.
They are more tear resistant than
conventional cross-linked silicone
polymers.

51. The type of block copolymer being
investigated is one that incorporates Poly
Methyl Methacrylate (PMMA) into siloxane
block. Various methods of synthesis are
under investigation. Data on physical and
mechanical properties of silicone block
elastomers have not been reported
MPDS – SILICONE BLOCK
COPOLYMERS

52. • Polyphosphazenes- Polyphosphazene
fluoroelastomers have been developed for
use as resilient denture liners (Novus,
Hygienic Corp.) and have the potential to
be used as maxillofacial prosthetic
materials.

53. ⮚ COLORATION
⮚ Color matching of maxillofacial prostheses to
human skin has long been a challenge to
maxillofacial prosthodontists.
⮚ Realistic coloration of external facial prosthesis is
an important feature for patient satisfaction and
acceptability.
⮚ From the standpoint of attaining ideality for any
extra-oral prosthesis, it ranks high and indeed is
the final, emotional arbiter in successful
rehabilitation.

54. Coloration technique can basically
be divided into 3 groups.
• Extrinsic
• Intrinsic
• Combination of extrinsic & intrinsic
• The combination technique is widely
used because it produces prostheses
with a more natural appearance.

55. Various types of colorants used are:
• Artist’s paint
• Water soluble dyes
• Celluloid paints
• Photographic
stains
• Acrylic resin stains
• Food coloring
• Oil colors
• Oil paints
• Dry earth pigments
• Nylon flockings
• Commercial
cosmetic

56. Retention of prosthesis
• Despite advances in plastic surgery,
there is still the need to rehabilitate
small and large portions of the face with
alloplastic materials.
• The success of facial prosthesis depends
partly on retention.
• A prosthesis can be retained either by
mechanical means, with the use of
available undercuts, skin adhesives, both
undercuts and adhesives or, more
recently, by the extra oral placement of
Osseo integrated implants.

57. Early facial prosthesis relied only on
mechanical retention, such as
• Wires
• Eyeglass frames
• Springs
• Straps

58. • Attaching the prosthesis to the skin with
a skin adhesive is an effective and most
commonly used method. Various types of
skin adhesives are available and include
.
• Interfacing pastes
• liquids
• emulsions
• spray-ons
• double sided tapes

59. Adhesive
tapes
PASTES
⮚ It can be applied using a brush, on the borders of
the prosthesis.
⮚ They are available in various shades and forms like
⮚ White, clear, black, red etc-based on the heat
resistant capacities.
⮚ They posses excellent bond strength
RTV red silicone
adhesive

60. LIQUIDS
Liqui-Tape Silicone Adhesive®
● Silicone based adhesive used for
extended wear.
● 3 to 5 week hold. (Use Soft Clean
Solvent for this adhesive.) 3.4oz brush
on applicator bottle.
NEW Perma Flex Adhesive®
● Used for extended wear ONLY
with Red Liner Tape.
● DO NOT PUT DIRECTLY ON
SYSTEM.
● Medicalgrade- no
crystallization, stays pliable. 4
to 6 week hold.

61. Latex Liquid®
M117.556.25
● Excellent adhesive for beards,
moustaches & prosthetics.
● Good for fake skin & wrinkles
● Colors: Clear, Soft Beige (light
flesh), or Sable (dark flesh).

62. SPRAY-ON
Factor II Secure Medical Adhesive®
● Pressure sensitive medical silicone
adhesive.
● Dispersed in ethyl acetate.
● Retains adhesive qualities in the
presence of moisture or
perspiration.
● Unaffected by normal temperature
variations.

63. COMPOSITION
1) Other siloxanes of low molecular weight (
most common being silastic medical
adhesives -used as vehicle base for
extrinsic coloring)
2) Polyisobutylene
3) Special acrylics in emulsion form.

64. APPLICATION