Miscellaneous maxillofacial prosthesis/ dental education in india

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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

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*Introduction
*Requisites of Facial Prosthesis
*Restoration of Nasal Defect
*Restoration of Nasal Septum Defect
*Restoration of Auricular Defect
*Restoration of Large Midfacial Defect
*Cranial Implants

*Stents and Splints
*Auditory Inserts
*Trismus Appliance
*Recent Advances
*Conclusion
*References

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*Facial handicapped individual are with
inferiority complex.
*Facial prosthesis is a valuable resource which
reduces problems in such patients.

*
Charac
terizati
on
Retention
Form

*
*Nose due to its prominence, is difficult
structure to replace.
*Nose inspires not only Figurative( plastic art)
also Theatre, Poetry, Philosophy, Narration and
Music.

*
Accident
Neoplasm
Punishme
nt
Revenge
Fighting

Partial Nasal
Defect Total Nasal
Defect

Temporary
Nasal
Prosthesis
Definitive
Nasal
prosthesis

*
*Medical adhesives
*Strings or straps anchored behind head
*Intra oral or intra nasal extension
*Spectacle frame
*Osseointegrated implants

*
*Obstructions of the anterior portion of the nasal
passage, that is, the region of the naris, vestibule,
and external nasal valve, are typically of congenital,
traumatic, or iatrogenic etiology
*A key objective after surgical opening of any nasal
obstruction is preventing the newly established
airway from closing again due to granulation or
shrinkage processes

*Maintain the contours
*Minimize scar contracture
*Counteract previously formed scar
*Widen the nostril

*Young (1970), used modelling plastic
*Doran (1975), suggested use of expandable
nasal stent
*Vented stent fabricated if bilateral obstruction

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*Congenital malformation
*Trauma
*Removal of neoplasm
Partial
Resection
Total
Resection

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*Tissue bed not displaceable
*Patient in supine position
*Condylar movement examined
*Elastic impression material

*Make an impression that makes continuous skin
contact
*Construct master cast that provides adequate
space under prosthesis
*Construct master cast that doesn’t require
retentive bar to be returned to mold

*
*Presurgical cast if present ,
it is reproduced in cast
*Sculpted from beginning
*Donor technique
*Entire surface should be
stippled to match skin
texture

*
*Nusinov and Gay (1980)- parellel lines
transferred to cast.
*Shimodaira et al(1989)- color slide onto cast to
sculpt the prosthesis.
*James et al(1996)- transparency copy of
contralateral ear.

*Orientation lines for positioning of auricular prostheses
Vertical line from
above the helix,
through center of
EAM
Horizontal line
from helix
through centre
of EAM, beyond
tragus of natural
ear
Same vertical
and horizontal
lines drawn on
defective ear
side

*
*Medical adhesives
*Eye glasses
*Implant supported prosthesis.
*Tjellström et al(1985) first reported the use of
osseointegrated implants for the retention of
an auricular prosthesis.
* Positions of 1:30 and 3:30 for the left ear and,
conversely, 9:30 and 11:30 for the right ear, 20-
22 mm from the center of the EAC, and 15 mm
apart.

*
*Trauma
*Infection of bone flap
*Excision of tumours
*External decompression
*Craniectomy
*Hematogenous bone infection

*
Metal
Auto-
polymerising
resin
Heat
polymerising
resin
silicone
polyethylene
Combination of
metal and resin

*
*Light in weight
*Strong to resist trauma
*Malleable
*Inert

*DISADVANTAGES
*High thermal conductivity
*Electrical conduction precludes
interpretation of EEG
*Radio-opaque
*Deformation may occur

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*Strong
*Radio-lucent
*Heat of polymerisation
*Free monomer

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*Requires presurgical fabrication
*High strength
*No free monomer
*Tissue bed not exposed to heat of polymerization

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*Inert
*Compatible with tissue
*Light weight
*Flexible
*High resistance to fracture

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*Flexible
*Three forms
*Blocks
*Heat vulcanizing form
*Room temperature vulcanizing

*Locate the inner table
*Angle necessary to formulate the cast to form
margin that will fit

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*Congenital disorder
*Trauma
*Excision of tumors

orthodontist
Maxillofacial
surgeon
Plastic
surgeon

Free
standing
Linked to oral
structure

*
*Prosthodontic stents & splints may provide
significant benefit to the Radiation Therapist
by facilitating delivery of therapy to local
areas & thereby limiting post therapy
morbidity .
*Protect / displace vital structures ,
*Locate diseased tissues in repeatable
positions during treatment
*Position the beam
*Carry the radioactive material

*Positioning stents
*Peroral cone positioning devices
*Shielding
*Recontouring tissues to simplify dosimetry
*Positioning radioactive sources

*
*This type of stent is used primarily for tongue
lesions being treated with external Radiation
* Many radiation therapists use a cork to which
a tongue blade is taped to confine the tongue
within the lingual borders of the mandible

*Requires maxillary &
mandibular impressions ,
*With the use of an
interocclusal record , cast are
mounted on the articulator,
*Mandibular record base used
to form the portion of the
stent depress the tongue
*An occlusal index should be
incorporate into record bases
*If the existing denture is
adequate ---duplication of the
dentures should be carried out

*
*This type of stent is valuable when
treating lesions involving the
mandibular alveolus, buccal mucosa,
and posterolateral border of the
tongue.
*The stent separates the mandible
from the maxilla, thus sparing the
maxilla from the effects of
irradiation.
*One piece stent difficult to insert.

*
*The advantage of such an
approach is that structures
such as the mandible and
salivary glands are spared
from the effects of radiation.
*Such stents are usable in
both dentulous and
edentulous patients and
assure repeatable positioning
of the peroral cone during
therapy

*Small localized superficial lesion
of tongue, anterior floor of
mouth, soft palate

*
*Electron beam therapy
*Wallace 1971, a 1 cm thickness of Cerrobend*,
a low-fusing alloy, will prevent transmission of
95% of the electron beam from an 18 MeV
machine.

*
*LITHIUM FLUORIDE CAPSULES
-used as a dosimetric are an
accurate & efficient means
of determining dosage locally
.

*
*Lesion with upper and lower lip
*When the therapist adjusts the beam for the
midline, the dosage delivered will be less at
the corners of the mouth because of the
convex curvature of the lips and face in this
region.
*Stent fabricated to flatten lip and placing it on
same plane

*
*Radioactive source placed in stent and stent
secured in desired position

*
*Lesions of the retromolar trigone, buccal mucosa,
and tongue predispose to cheek and tongue biting.
*Mucositis and edema during radiation therapy may
accentuate this problem.
*A stent can easily be fashioned to displace the
tongue and/or buccal mucosa and help alleviate this
problem.

*
*It may be required as stent during surgical
reconstruction of external auditory meatus.
*Custom ear plugs after mastoid surgery or who
wear hearing aids
*Swimmers with ear infection

*
*A threaded tapered screw made
of acrylic resin
*Place between posterior teeth
and turn to wedge the teeth
apart
*Thread guides the teeth apart

*Dynamic opening device (Brown 1968, Rahn
and Boucher 1970, Chalian 1971)
*Apply firm and constant opening force between
maxilla and mandible with extra oral elastics

*
Collection
of 3 D data
Generation
of 3D model
Manufacture
of physical
prototype

*
*Enables direct fabrication of wax pattern
*Free form fabrication method
*Creates patterns using thermal fusing of powder
materials
*Models produced on a movable platform by
applying incremental layer of pattern material.
*Precision is reported with in 10μm

*
*Text book of Maxillofacial Prosthesis VAROUJAN
CHALIAN
*Text book of Maxillofacial Prosthetic WILLIAM R.
LANEY
*Maxillofacial Rehabilitation Beumer
* JPD 1998 ;79 :229 -231
*JPD 1980;43:552-560
*JPD 2001 ;86:386-389
*JPD 1984 ;52 :414 -417
*JPD,1996;75:45-49

*JPD, 1971;26:543-554
*JPD, 1966;16:339-343
*JPD, 1985; 53:686-688
*J Prosthodont,2006;15:195-197
*J Prosthodont ,2009;18:353-358
*J Prosthodont,2009;18:272-275

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