This document provides an overview of orbital and ocular prosthetics. It discusses the definition and objectives of maxillofacial prosthetics as well as the history of ocular prosthetics from ancient times to modern acrylic prosthetics. Various impression techniques are described including direct, stock tray, custom tray, stock prosthesis modification, and wax scleral blank methods. The document also covers laboratory procedures, positioning, coloring, retention, and implant-supported prosthetics. In summary, it provides a comprehensive review of the fabrication and fitting of ocular prosthetics.

1. ORBITAL / OCCULAR PROSTHESIS
PRESENTED BY-ANJALI RATHORE
PG 1ST YEAR
DEPT OF PROSTHODONTICS

2. contents
• Introduction
• Definition
• Objective of prosthetic rehabilitation
• History of ocular prosthesis
• Glass eye prosthesis vs. acrylic eye prosthesis
• Different types of acrylic eye prosthesis
• Impression procedures for occular prosthesis
• Clinical & laboratory procedures for construction
• Post insertion care
• Removal & replacement of prosthesis.
• Orbital prosthesis
• Steps in fabrication procedure
• Positioning of prosthetic eye
•Coloring technique
• Retention of prosthesis
•Implant supported prosthesis
• Bionic eye
• Conclusion

3. INTRODUCTION
▪ Man's need for artificial replacements to supply missing or lost body
parts has probably existed as long as man himself.
▪ Body abnormalities or defects compromise appearance, function
render an individual incapable of leading a relatively normal life.
▪ The replacement of anatomical parts is a challenge to those properly
trained to construct acceptable substitutes.
Shah and Aeran: Prosthetic management of ocular prosthesis defect The Journal of Indian
Prosthodontic Society | June 2008 | Vol 8 | Issue 2

4. DEFINITION
MAXILLOFACIAL PROSTHESIS
‘’Maxillofacial prosthetics the branch of prosthodontics concerned
with the restoration and/or replacement of stomatognathic and
craniofacial structures with prostheses that may or may not be
removed on a regular or elective basis’’.-GPT 9

5. OCULAR PROSTHESIS: prosthesis
that artificially replaces an eye;
doesn't replace missing eyelids,
adjacent structures’
ORBITAL PROSTHESIS
A maxillofacial prosthesis that
artificially restores the eye, eyelids,
and adjacent hard and soft tissues.-
GPT 9

6. OBJECTIVES OF MAXILLOFACIAL
PROSTHETICS

7. 1. It requires little or no surgery.
2. The patient spends less time away from home
and job.
3. The reconstruction often has a more natural
appearance.
1. The necessity of fastening the appliance to
the skin daily.
2. Removing the appliance daily.
3. The occasional need of constructing a new
prosthesis.
ADVANTAGES
DISADVANTAGES

8. History of ocular prosthesis
▪ The Romans & Egyptian priests were the first to
make the ocular prosthesis as early as 500 B.C.
called as Ectblepharons.
▪ The artificial eyes were painted on clay &
attached to the cloth & worn outside the socket.
▪ In another method eye & lids were incorporated
as a single unit attached to flesh colored cloth.
▪ During the 16th C. in 1752 Glass Artificial eyes
were introduced.

9. • These early glass eyes were crude, uncomfortable
to wear, very fragile.
• But still glass became the material of choice for
ocular prosthesis for the next two hundred years.
• In mid 19th C. German glass blowers developed
the superior technique of making hollow Kryolite
glass prosthesis .

10. • In mid 19th C. the glass eye making introduced in united states
by immigrant German occularists.
• The stock glass eyes was another market that flourished among
5 to 7 German families of glass eye makers in North America.

11. Classification of ocular prosthesis
Availability
Stock eyesCustom made
eyes
Material
Glass
made
Acrylic
made

12. THE TRANSITION FROM GLASS TO PLASTIC
OCULAR PROSTHESIS
• During the world war II the export of Kryolite glass material
from Germany to United States was cut off.
• The department of Navy set up the crash course in applying
plastics to the field of ocularists this lead to the development of
acrylic ocular prosthesis.

13. DRAW BACKS OF GLASS EYES
▪ Inability to approximate the surface irregularities of the
anterior surface of the posterior orbit.
▪ Fragility of glass & its propensity to fracture.
▪ Cannot be polished or altered after completion.
▪ Need to be replaced every one or two years as tears &
secretions would roughen & discolor the front surface of
the glass.

14. ADVANTAGES OF ACRYLIC EYES
Patient comfort No fear of breakage
It would not roughen
with wear.
Easy to repair & polish.
Adapted to the
irregular
configurations of the
orbital tissues & atonal
weakness of eyelid.
Improved esthetic
appearance
Some degree of
movement of the
prosthesis from the
underlying tissue.

15. 3 types of acrylic resin
prosthesis used
• Stock eyes
• Stock eyes modified by various techniques
• Custom fitted eyes made from an impression of
the socket

16. Stock eyes (shell)
• Since mucosa can be displaced, some success can be obtained
with a stock prosthesis.
• But patient will definitely experience some discomfort because :
1. The mucosal surface doesn’t snugly fit the prosthesis .
2. Debris collected in the voids also causes the potential irritating
factor to the mucosa.

17. Custom ocular prosthesis
▪ Every socket differs in size and shape , hence
individually designed prosthesis constructed from an
impression of the socket provides :
• Full physiologic function to the accessory organs of the
eye.
• Provides maximum comfort.

18. What is the advantage of custom made eyes
over stock eyes
 Close adaptation to the tissues.
It minimizes the infection
Optimum cosmetic and functional result
Less chair side time.
Joseph R JPD 1982 VOL 48 No 6

19. Cause for loss of eye
congenital
defect
irreparable
trauma
tumor
a painful
blind eye
sympathetic
ophthalmia
excision for
histological
confirmation
of a
suspected
diagnosis

20. SURGICAL MANAGEMENT OF AN EYE
DEFECT
EVISCERATION
ENUCLEATION
EXENTERATION
• Surgical procedure
wherein the intraocular
contents of the globe
are removed
• Surgical removal of the
globe and a portion of
optic nerve from the
orbit
• En-bloc removal of the
entire orbit involving partial
or total removal of the
eyelids
• Performed primarily for
eradication of malignant
orbital tumor

21. Steps in Fabrication ocular prosthesis:
Patient evaluation
Ocular impression
Wax Try in
Characterization of
Prosthesis
Final polishing and finishing
of prosthesis
Taylor Maxillofacial Prosthesis

22. Patient Evaluation:
 The pt evaluation includes physical and psychological appraisal of the patient,
including the desires and expectation of the patient related to the proposed
prosthesis.
 Patient has to be counseled regarding expected results, with specific emphasis on
the role of both during the treatment phase and after completion of the prosthesis.
Patient examination ;
 Proper healing
 Presence of the any contracture
 Irritation due to any existing prosthesis
 Evaluation of the muscles control
Robert B Welden and John v Niranee JPD Vol 6 No 2 1956

23. Criteria for an acceptable impression:
Accuracy of recording the posterior wall
Position of the palpebral in relation to the posterior wall.
Greatest extent of the superior and inferior fornics.
Mark F.Mathew,Alan J Sutton J.Prosthodontics 2000,9,210-216

24. Material used
1) Materials used for fabrication of ocular prosthesis:
1) Glass eyes
2) Acrylic eyes
3) Vulcanite
4) Celluloid
2) Maxillofacial resins used in fabrication of eye prosthesis:
1) Acrylic resins
2) Vinyl plastisols (realistic mediplast)
3) Latex
4) Polyurethane
5) Siphenylenes
6) Acrylate skin and silicon elastomers

25. Impression techniques
 Direct impression/external impression,
 Impression with a stock ocular tray or modified stock
ocular tray,
 Impression with custom ocular tray,
 Impression using a stock ocular prosthesis, ocular
prosthesis modification, and
 The wax scleral blank technique
JAYAPRAKASH MB THE OCULAR IMPRESSION: A REVIEWTMU J. Dent Vol. 1; Issue 2 Apr –June 2014|

26. Bartlett and Moore.
 Mixing alginate material with excess
water until it is very free flowing
 fill the mix in a disposable syringe and
the eye lids are drawn apart and
impression material is introduced at the
inner side of the palpebral fissure.
Bartlett and Moore. Journal of prosthodontics Dentistry A Physiologic System 1973 29 450-459
Review of Literature of Various Impression Technique

27. Brown:
advocated an external impression tray
tech in which the ophthalmic
irreversible alginate is mixed and
injected into the ocular defects by
means of the syringe and later
he recommended an edentulous
perforated trays with additional
impression materials to combine with
the extruded material.
Kenneth E Brown JPD 1970 vol 24 no 2

28. The impression is boxed and poured in
the dental stone up to the height of
contour of the impression.
A separating agent is placed and the
reminder of the impression is poured
Two piece cast
Text book of Clinical maxillo facial prosthesis ; Thomas D.Taylor; Quitessence publication 2006

29. Molten base plate cast
poured
Sharp edges are removed

30. Scleral wax pattern in place

31. Taylor : Modified External tray impression
technique:
He advocated placing the perforated acrylic resin backing
tray for reinforcement.
Weldon and Nilranee: they selected esthetics stock tray.
Perforated acrylic backing
Stock tray
Weldon and Nilranee, JPD 0cular prosthesis 1956 vol 6 no 2

32. Stock tray impression technique
▪ Material required :
1. Disposable syringe
2. Stock ocular tray STEM
3. Non irritating impression material i.e.
opthalmic quality irreversible hydrcolloid

33. IMPRESSION PROCEDURE
Patient should be seated in an upright position with head
supported by head rest ( allows natural positioning of
palpebral and surrounding tissue relative to force of gravity.
stock tray is placed in the defect and check for over
extension and orientation .
Support the lids
Irreversible hydrocolloid impression material mixed
Loaded in syringe
Sufficient material ejected to fill the concavity of the tray

34. ▪ The tray reinsert and reorient in the defect
▪ Sufficient material is injected to elevate the lid contours
similar to that of normal side
▪ Assembly removed
▪ Impression tray is removed from syringe
▪ Proper lid contour and mobility of impression checked
▪ If the impression was properly oriented and extended,
Once it sets
Examine for defects
Replaced in defect
Patient asked to look right ,left, up, down .

35. ▪ Movement of tray follows pupil of natural eye
Proper extension and orientation
Lab procedure :
▪ Attach stem of the impression tray to an orange
wood stick with sticky wax
Assembly suspended over a small medicine cup
▪ Pour room temperature vulcanizing silicone mold material
into the cup to completely cover the impression

36. ▪ Mold is cut & spread apart to remove
impression tray
Mold is replaced in the cup
molten wax filled through the hole made by
stem of impression tray
▪ Cut the sprue and wax pattern
removed and smoothened.
Wax hard

37. Cain:
He suggested using the impression trays with
a hollow stem in the shape of the ocular
prosthesis. Once the impression set, he
recommended making a two piece dental stone
mold to make the wax conformer.
Cain JR jpd 1982,48, 690-4
Two piece dental stone

38. variation of Stock tray
impression technique
▪ Maloney placed three channels through the superior edge of
his own set of customized stock trays to prevent air
entrapment. Following his method, a raised ring around the
stem prevents the eyelid from blocking the channels.
Sajjad A (December 06, 2012) Ocular Prosthesis - A Simulation of Human Anatomy: A Literature
Review. Cureus 4(12): e74.

39. Englemeier:
Suggested casting a set of stock trays in
ticonium which is a nonprecious removable
partial denture alloy which can be sterilized in
an autoclave for reuse.
Englemeier jpd 1987 ,58 121-212
Stock metal tray
Sykes, et al. [20] advocated the use of
modeling plastic impression compound
as an ocular tray material, forming it
around one-half of a small rubber ball
and placing a hollow tube through it.

40. The impression technique using a stock ocula
prosthesis:
▪ Use of a stock ocular prosthesis of an appropriate size
and color, adapted by selective grinding or addition of
acrylic resin has been advocated by Laney and Gardener.
▪ A stock eye is selected with the correct iris size, color
and sclera shape. The periphery and posterior surface is
reduced 2-3 mm and retentive grooves are cut into it.

41. Alginate adhesive is painted over these surfaces and alginate
is injected into the defect and the modified stock eye is
placed into it. Impression is then invested, packed and cured
under 3500 psi pressure for at least one hour.
Limitations of this technique include the need to maintain a
fairly large supply of artificial eyes and the inability to match
all sizes and colors of the iris and pupil.

42. Variations of the stock ocular prosthesis
impression technique
▪ Modification of stock eye prosthesis can also be done using a tissue
conditioner as described by Ow and Amrith.
▪ This is comfortable and produces a healthy clinical soft tissue response.
Its biocompatibility allows the continued clinical use and evaluation of
the ocular prosthesis over an extended period of 24 to 48 hours.
▪ This method is particularly suitable in growing children where the
prosthesis needs to be regularly modified to suitably fit their growing
orbits. After 48hours, the elastic tissue conditioner must be converted
into heat-cured acrylic resin to complete the prosthesis.

43. Smith described a reline procedure for an existing prosthesis using a dental
impression wax, such as Korecta-Wax No. 4 (D-R Miner Dental, Orinda, CA).
For definitive refinement, the lined prosthesis is left in place for 30 minutes
while the patient intermittently moves his or her eyes in all directions.

44. Impression with Custom Ocular Tray
▪ In cases where anophthalmic socket was highly irregular or stock trays may
not be available, use of a custom ocular ray was suggested by Miller.

46. Mathews et al Ocular Impression Techniques December 2000, Volume 9, Number 4

47. Perforations are placed
in the tray

48. Tip of the syringe shortened
Syringe tip secured in the tray
Syringe is screwed into the tray

49. Suspend the impression in a small cup using a
clothes pin.
Pour a new mix of irreversible hydrocolloid into
the cup, surrounding the impression.
Resulting impression
Ophthalmic alginate impression material
was mixed & back loaded in syringe.
Tray was seated & alginate was injected.
After the material set, impression was
removed and checked for acceptability.

50. When set, alginate mold was removed
with impression from the cup. Mold
was partially sectioned, & impression
was retrieved.
The different mixes of alginate will not
adhere to each other.
The second alginate impression becomes
a mold to form the wax blank. Mold is
poured in the cup with ivory wax
through the sprue hole created by
syringe tip.

51. Ocular Prosthesis Modification
▪ Chalian has suggested trimming and polishing of a stock
prosthesis to gain acceptable fit. The stock prosthesis can also
be modified using alginate or soft wax, and then invested and
processed.

52. Wax Scleral Blank Technique
▪ The wax scleral blank has been advocated as the starting point in several
techniques. Benson created a wax pattern of half of the size of steel ball. The
resultant pattern is smoothed, tried in, and adjusted.
▪ The pattern is invested and Processed with iris button attached. Chalian et al
also followed the same.
▪ McKinstry suggested “compression impression” technique in which he
empirically formed a wax pattern based on examination of the site. Wax
pattern was tried in, modified as needed, and processed after addition of an
iris.

53. One particular advantage of the empirical wax blank
method is it accurately records and form an inferior
fornix if the patient’s lower lid is weak or the fornix is
shallow. LeGrand and Hughes20in their “empirical/
impression” technique attached a “dummy”
aluminum button to act as a handle.

54. Second appointment
• The socket , mould and the wax pattern is inspected
• Palpebrae is manipulated to ascertain how to contour the
scleral surface of the wax pattern ( roughly it should be egg
shaped and congruent with natural eye.)
• Height of convexity should be centered over the pupil,
slightly medial to the mid line between inner and outer
canthi.
• After the necessary modifications, a lubricant (petroleum jelly
or 25 % methyl cellulose based tear solution) applied before the
final try in.
• The wax pattern is converted to white acrylic resin(resin eye
blank)

55. Third appointment
• The polished resin eye blank is inserted into the socket and
examined carefully.
• Discrepancies should not exists between the right and left
palpebral opening or in the contours.
• After through comparison with the contralateral eye , a dot of
red ink placed in the location of the center of pupil.

56. •Measure the diameter of the natural iris , using a transparent
plastic strip punched with circular holes in gradation of 0.5mm..
•The patient is asked to fix his gaze on operators nose , then the
transparent strip is moved up , down , left & right until the hole in
front of the iris has the same circumference as that of the iris
•Since the limbus outline is not distinct , this measurement will be
accurate within about 0.25mm.

57. •The size of the iris is measured using a millimeter measurement
gauge or optical scale. The outline of the iris is then marked on
the scleral blank using Carmen red ink. The lower lid should just
touch the bottom of circle.
•If any discrepancy exists remove the blank repeat the procedure
until the symmetry is achieved.
Iris is marked on scleral blank Size and location of iris are verified
Characterization of prosthesis
1. Paper Iris Disk Technique
FOURTH APPOINTMENT
PAPER IRIS TECHNIQUE
BLACK IRIS TECHNIQUE

58. This ink will transfer to the investing stone, facilitating the appropriate
placement of the corneal prominence. The blank is tried in again to verify the
location and size of the iris. The location of the iris will transfer to the
investment and a scraper can then be used to create the corneal prominence of
the prosthesis in the investment.
A disk of ordinary artist's watercolor paper is punched out using a die. The size
selected should be 1 mm smaller than the measured size of the iris.
This will allow the iris to appear to be the appropriate size because the corneal
prominence will cause a slight magnification of the iris disk.
Processing of prosthesis done

59. A good selection of colors for this purpose includes ultramarine blue,
yellow ochre, burnt sienna, burnt umber, yellow oxide, titanium
white. Colors should be mixed and reapplied in a layering fashion
to mimic the colored striations in the patient's iris.
Pupil
Medial canthus
IRIS ANATOMY

60. Begin by painting the darkest color, the area toward the outer edge of
the iris ring (limbus). The color of the limbus varies from eye to eye, but
it usually is a combination of gray and iris body color. In the natural eye,
it can appear as a shadow from the overlapping sclera, covering the edge
of the cornea. Next the collarette is painted.
It is usually a lighter color than
the body of the iris. A black spot
should be painted in the center of
the disk to represent the pupil.
IRIS DISK PAINTING
Completed iris painting

61. The diameter should mimic the natural pupil
under indoor light conditions.
This will make size appear relatively
appropriate under most conditions. After the
paint has dried, a drop of water is applied to
create the magnification of the corneal
prominence and the color matched.
.
Verification of iris painting
Using a flat-end bur, a flat surface is prepared in the scleral
blank for the iris painting. A sprue wax is luted to the prepared
flat surface and tried in.
The orientation of the surface is adjusted until the sprue
points directly at the observer while the patient looks directly
into the observer's eye. This will ensure that the prosthesis and
the natural eye will have the same gaze
Use of an ocular blank

62. Using a large abrasive stone, the entire anterior surface of the scleral
blank is reduced at least 1 mm. The remainder of the prosthesis is then
painted to match the sclera of the natural eye.
Fine red embroidery threads are placed on the scleral painting to mimic
the blood vessels of the patient's natural eye. The entire scleral portion is
then coated with monomer polymer syrup to keep the blood-vessel fibers
in place and allowed to set.

63. Once the monomer-polymer syrup has set, the scleral blank is replaced into
the flask, and the iris painting is placed on the flat section. Clear ocular acrylic
resin is mixed and placed into the mold space and the flask trial packed.
Once trial packed, the flash is removed and the location of the painting verified to
ensure that it has not moved during trial packing.

64. ▪ Black iris disk technique :
▪ Windsor Newton oil pigment(factor II) are employed.
▪ Mixed with monomer-polymer syrup during the painting process.
▪ Sequence:
1. Iris disk painting
2. Attachment of lens button to disk
3. This is assembled to wax pattern
4. Checking the position in the patient
5. Final waxing around lens to correct contours, extensions
6. Flasking & packing with white scleral acrylic
7. After polymerization , scleral painting and reflasking
8. Packing with optical grade acrylic resin
9. Final finishing and polishing

65. Fifth appointment
1. Once the ocular prosthesis is inserted ,esthetic appearance, iris symmetry
with the contralateral eye , the palpebral openings, and patient’s comfort is
reassed.
2. The prosthesis will not have the same sheen or sparkle as the natural eye,
because the resin will not be completely wetted by lacrimal fluids.
3. But the appearance will improve during the first two days for the above
said reason and also the lids will get adjusted and contoured to the
prosthesis.
4. There should not be any discomfort to the patient while he is asked to look
in different directions.

66. Post insertion care
1. Adjusting to the prosthesis : the time required for an individual
patient to get used to the prosthesis is variable. some will
become accustomed to the prosthesis in a matter of hours,
others may require days, and few never get adjusted
comfortably.
2. Period of wear - artificial eye need not be removed for cleaning
each day ,the patient can wear the prosthesis as long as it
remains comfortable & nonirritating regardless whether it is a
day, week, a month, or more.

67. 3. Once removed from the socket the prosthesis should be
placed in water or contact lens soaking solution.
4. The prosthesis should never be allowed to dry otherwise it
causes various layers to separate.
5. The patient should be cautioned to maintain normal facial
animation and to avoid habits designed to hide the
prosthesis. These exaggerated habits often make the
prosthesis more obvious.

68. Removal & replacement
The prosthesis
sometimes may get
dislodged , so the
patient must be able to
replace in its position to
avoid any
embarrassment.
Hence it is essential
that each patient be
trained in the method of
removal and the
replacement of the
prosthesis before the
patient leaves the
dental office.

69. •Patient must clean and dry his hand.
•Looking in the mirror with chin down
•Top edge of the prosthesis engaged
under the upper eye lid, forefinger of the
other hand is used to elevate the upper
lid.
•The prosthesis should be gently pushed
upward and back ward.
•While the upper lid is released the
lower lid is pulled downward
• gentle pressure will cause prosthesis
rotate backward and inward behind the
lower lid to seat the prosthesis.

70. •Patient is asked to tilt the chin
downward looking at mirror.
•Forefinger used to pull the lower lid
and at the same time pushing
prosthesis gently backward and
toward the nose.
•This will disengage the lower edge of
the prosthesis and it is removed out.
•If it is not removed out with the
above said procedure, rubber suction
cup may be used .

71. Recall
• One year recall system should be instituted for all eye prosthesis patients.
• Normal fat and muscle atrophy will cause the socket to change shape leading
to poor fit, poor movement ,loss of retention of fluid collection behind the eye.
• Hence during recall period- fit, mobility and direction of gaze of the prosthesis
should be assed .
• The prosthesis soon made after surgery before edema subsides or the one made
for the growing child may have a sunken appearance,.
• The prosthesis should be removed and examined for scratches ,chips , bacterial
growth and accretions because all these would cause unaesthetic appearance,
socket irritation, increased drainage leading to socket infection.

72. • Socket secretions and discharge are normal & desirable since they
provide mild lubrication & antibacterial properties.
• But when the secretions amount increases or turn from normal yellow
white to yellow , yellow-green , yellow- brown, infection is suspected.
• In such instances refer to the opthalmologist for bacterial culture and
antibiotic treatment.
• If the prosthesis is not too old and not contaminated with bacterial growth or
deeply scratched it should be repolished and inserted.

73. • G.R.Parr (1983) has suggested that while polishing –gentle
pressure and at a slow speed polishing should be done otherwise
the heat generated may pit and roughen the prosthesis or even
give clouded appearance to the cornea.
• Polishing an artificial eye is much more delicate procedure than
polishing a denture.
• Polishing compounds used for dentures are too abrasive and only
polishing compounds specifically made for artificial eye should
be used.

74. Special conditions
• Following surgery ,some patients are left with inadequate volume of tears to
lubricate the artificial eyes & lids.
• These individuals will experience discomfort and irritation due to friction or to
adhesion of the conjunctiva to the prosthesis.
• Artificial tear replacements :
▪ 1. Mineral oil
▪ 2.Sunflower oil
▪ 3.Alchol based lubricants (contact lens soln.)
{problem : evaporates fast &leaving hard irritating methyl cellulose. }
▪ 4.Silicone based lubricant.
• Allergy due to acrylic resins are extremely rare, but associated to this are
common such as airborne allergens ( animal hair, plant pollen or poor socket
hygiene.)

75. conformers
Stock conformerProfile of tissue bed of conformer
•At the time of surgery or shortly after surgery the conformer(quasi-integrated ,
buried , muscle cone) should be placed.
•This rounded cones on the tissue bed side of the conformers, facilitate movement
of the prosthesis.
•Conformers can be a stock made or custom made but should be worn post
surgically for a better prosthetic result.
•Custom made : constructed from irreversible hydrocolloid impression.

76. ▪ Joseph R. Cain (1983) suggested custom ocular prosthesis with
dilating pupil. The author has described a technique in which
adjustable pupil has both constricted and dilated diameter ,which
can simulate according to the natural eyes reaction to high & low
intensity light.
▪ The patient can alter the pupil size without removal by using a
small magnet.
Dilating pupil
Review of literature

77. Irritation of ocular tissues by irreversible
hydrocolloids
▪ James R.Moergeli(1985) conducted study on irritation caused
by dental and ophthalmic irreversible hydrocolloids on rabbits
conjunctiva .In his histological study he concluded that the
dental irreversible hydrocolloid caused more acute type of
inflammatory response than the ophthalmic variety of
hydrocolloid impression material.

78. Digital imaging in the fabrication of ocular
prostheses
• Digital photograph of the patient's iris is recorded using a digital camera
• Photograph is evaluated and compare it to the patient's iris
• Using graphics software , slight differences in color, brightness, contrast, or
hue is adjusted and formatted. If necessary, further customization and color
modifications using professional quality color pencils .
*Ioli-Ioanna Artopoulou (2006) Digital photo

79. •The final image is printed on 20-lb white paper with brightness
87 using a laser printer.
• The paper iris is covered with 3 light coats of water-resistant
spray , used for artwork, and attach it to the ocular disk.
•Disk assembly is attached to the wax pattern , and evaluated
in the patient.
• Selected scleral acrylic resin is processed at the same
temperatures, using the procedure previously described for the
conventional technique.

80. Orbital prosthesis

81. Reversible
hydrocolloid
Irreversible
hydrocolloid
Room
temperature
vulcanizing
materials
Plaster of
paris
Impression
compound
IMPRESSION MATERIALS FOR OBTAINING FACIAL MOULAGE
Fabrication of orbital prosthesis

82. MODELLING MATERIALS
▪ Modelling Clay ( Sculptor’s Clay)
- A water based clay which, when
allowed to dry, becomes a hard,
stonelike substance
▪ Plaster
▪ Waxes

83. Extraoral impression
▪ Essential to a well-fitting and well-fabricated prosthesis.
▪ Patient preparation –
▪ Should either be reclined on a dental chair or preferably lying
on a table with head slightly elevated.
▪ Draped with sheet and hair boxed out with cloth towels.
▪ Face should be free of make up and eye glasses.
▪ Eyelashes, eyebrows and moustache should be coated with
vaseline.
▪ Deep undercuts blocked out with wet gauze or cotton.

86. STEPS IN THE FABRICATION OF ORBITAL
PROSTHESIS
▪ The Moulage impression and Working Cast fabrication
▪ Sculpture and Formation of the Prosthesis Pattern
▪ Fabrication of the Mold
▪ Processing of the Prosthesis Material with Intrinsic and
Extrinsic coloration
▪ Insertion of Eye lashes

87. When all drapes and protective materials have been applied, cotton
balls tied with the help of dental floss are used to plug the nostrils. These
cotton balls should be large enough, just to plug the nostrils without distorting
them.
Then patient is asked to practice breathing through the evacuator tube placed
in the mouth to ensure adequate ventilation. After the patient starts breathing
comfortably through the tubes, alginate is mixed using water/powder ratio of
1.25 to 1.50 times the normal amount of water.
1.The Moulage impression and Working Cast fabrication

88. After mixing, the alginate is applied to the skin surface with a round-end
mixing spatula, taking care to avoid air entrapment.
When the area has been covered, opened gauze squares or the bent paper
clips are applied over the entire surface using light pressure.
There will prosthesis means for mechanical retention for the rigid plaster
backing necessary for removal of the impression without distortion.

89. Then fast-set plaster is mixed to a cake-batter consistency and spread over the entire
impression surface to a thickness of about 0.25 inch.
A thicker ridge of reinforcement may be added at the midline. Surface of the plaster
is checked for tapping sound with a blunt instrument after 4-5 minutes to check
setting of the plaster.
For removal of the impression, the impression is grasped on both sides of the
patients’ head and gentle lifting force is applied.
During this procedure instruct the patient to wiggle or to produce wrinkles on the
face; this will assist in freeing the impression from the skin.
Also instruct the patient to release the breathing tube. Patient will usually appear
flushed due to the heat and moisture from the impression, but skin color and
temperature will rapidly turn to normal

90. Impression is inspected for any voids or distortion, especially in the area around the
defect where the margins of the prosthesis will be developed. Small defects or voids not
associated with the margin area may be filled in or chipped off the cast. Disinfect the
impression.
Points to be remembered:
•Packing an orbital defect before impression should be given special attention.
•Moist cotton or petrolatum gauze should be used to close the communication if any, with
the nasal or oral cavity.
•Full facial or midfacial impression is preferred.
•Patient should be cautioned to relax their faces to prevent marked changes in the orbital
opening.
•In cases of extensive defects, intraoral prosthesis should be in place so that soft tissue
contours around the mouth and cheek will remain stable.

91. ii. Sculpture and formation of the
prosthesis pattern
▪ Wax is preferred over modeling clay as residual oils from the clay
contaminate the mold surfaces.
▪ Wax formula – two sheets of beeswax,
▪ - one sheet of hard pink baseplate wax
▪ - two strips of clear rope boxing wax
▪ Dry earth pigments- to form skin color.
▪ A sheet of pink baseplate wax is adapted to the orbital defect which
forms the basis for positioning the ocular section of the prosthesis
within the defect in the same frontal, sagittal and horizontal planes as
the normal eye.

92. Positioning is best accomplished by
placing the ocular section on a stalk of
soft wax in the wax cup.
Assembly placed into orbital defect
and ocular section manipulated into
the position that matches the gaze
of the normal eye when the patient
is staring directly at a point at eye
level atleast 6 feet away.

93. Positioning the Prosthetic Eye
1. Anatomic references on the skin
2. Vernier caliper
3. Pupillometer An instrument to achieve pupil
alignment in eye prosthesis

94. 4. Ruler
Tongue blade
5. Profile gauge
6. Bright light

95. McArthur J. Prosthet. Dent. Aids for positiohg prosthetic eyes in orbital prosthesesarch, 1977
7. Ocular locator
Ocular locator and fixed caliper. Note the scribed midline and the two horizontal
lines. The fixed caliper duplicates the distance between the two horizontal lines.

96. Fabrication. A grid was drawn on graph paper
which contained an X and a Y axis and a mirror
image of the axes.
The X axis was labeled A through F. The distance
from A to B was 0.5 inch and was subdivided into
five equal parts. The pattern of division and
subdivision was repeated for all intervals on the X
axis. The Y axis was labeled 1 through 9 and was
divided and subdivided in a manner similar to that
for the X axis.
The grid was photographed with black-and-white
film. The negative was printed and enlarged on
photographic film to the actual size of the original
grid. The product was a black grid on a clear
background which was mounted between two
sheets of 1/8 inch Plexiglas with an opening in the
center for the nose.

97. A)The locator on the patient’s face, a
vertical midsagittal mark is made on the
forehead and chin
(B)fixed caliper is used to
determine the intersection of the
horizontal lines with the
midsagittal mark
(C) The locator is placed so that the scribed lines on the
locator are superimposed over the markings on the face. (D)
The anatomy of the eye is traced onto the surface of the
locator with a grease pencil or water-soluble felt-tipped pen.
(E)The locator is turned 180 degrees on the midsagittal
axis to produce its mirror image. The locator is placed on
the stone moulage to aid in the correct placement of the
eye.

99. 9. Relating pupil of the prosthetic eye to the existing
natural eye by facial measurements
8. Simplified ocular locator
10. Inverted anatomic tracing (Nusinov 1998)

100. ▪ Computer imaging may be used to assist establishment of the
correct ocular positioning and lid opening.
11. Computer imaging (Adobe Photoshop)

101. ▪ Once the correct positioning of the ocular section has been accomplished and the
eyelid aperture established, the soft sculpting wax mixture is added with a glass
eye dropper or spatula to roughly fill the remaining contour of the prosthesis out
to the area where margins are to be established.
Following the completion of the fine details in the pattern, the sculpture should be
placed onto the patient and verified for fit, direction of gaze, and eyelid aperture.
When satisfied, the pattern is ready for making the mold.

102. III. FABRICATION OF THE MOLD
▪ After the stone flasking material has set in the tissue-surface
half of the mold, Foil substitute is applied to the
exposed stone surrounding the pattern, because it
is least likely to contaminate the platinum catalyst
of the silicone prosthesis material.
▪ Indexing method applied to position the ocular
segment of the prosthesis, now incorporated in
the wax pattern, back into the mold in its same
orientation as in the pattern.
Prior to investing, an index in the form of
horizontal and vertical pyramids is placed on
the surface of ocular segment with sticky wax.

103.  Index reproduced in the cope segment of the mold
removed from drag to avoid damaging the indexing wax
ocular segment removed from the
wax pattern and duplicated using alginate impression.
duplicate segment including indexing wax poured in dental stone and
placed into the index indentations in the cope with cyanoacrylate
adhesive.
This segment forms a pocket in the final silicone prosthesis for
insertion of ocular segment.

104. IV. PROCESSING OF THE PROSTHESIS MATERIAL
WITH INTRINSIC AND EXTRINSIC COLORATION.
▪ Even when the contours of the prosthesis are not exact duplicates of the
contralateral structures and the skin texture not exactly reproduced
▪ Many methods are practised …
▪ Coloration technique ……
a)Micro air-spray techniques.
b)Brush-in technique (no
distinctive intrinsic color).

105. COLORATION TECHNIQUE
Mold cavity
prepared by
coating external
tissue surface with
catalysed
uncolored silicone
material
Hair drier
used to
partially
polymerize
first clear
layer
Characterizatio
n colours
chosen,mixed
with silicone
polymer,painte
d on the surfece
of clear layer
Colored rayon
fibres sprinkled
into the mold to
simulate the
microvasculatu
re
Base colour
mixture of
silicon
prepared to
fill mold
cavity

106. Silicone
catalyst
added and air
removed
from mixture
Colored, catalysed, air
less silicone placed
into mold cavity, allow
liquid to flow in all
areas
Mold then
clamped and
placed into dry
heat oven for
polymerization

107. V. INSERTION OF
EYE LASHES AND EYEBROWS
▪ Processed curved natural hair taken from
human arm used Broach holder and
‘Y’ needle required.
▪ When desirable number of lashes
have been thus placed, they are trimmed
to alternately long and short lengths to
lend a natural
appearance.

108. MAINTAINENCE OF THE
PROSTHESIS
▪ Prosthesis should be removed once a day to be cleaned
▪ The adhesive is removed with a rolling motion of the
ball of the finger or thumb.
▪ Foreign substances should be removed
▪ Prosthesis washed with mild soap and brush.
▪ Skin in contact with prosthesis should be cleaned.

109. Instructions to the patient.
▪ Since the artificial eye does not track with the natural eye of
the opposite side, the patient should learn to turn his head
when changing his line of vision
▪ How to orient and place it
▪ How to maintain the hygiene of both tissue and prosthesis (in
warm water with a mild soap)
▪ How to apply the surgical cement
▪ The prosthesis should not be worn while sleeping

110. ▪ Additionally, patients should be advised that the
color match depends on the color of their tissues,
which are susceptible to the seasons as well as
activity levels and environmental temperature
▪ Prosthesis is stored in a container away from
direct light or heat. Isopropyl alcohol may be
used to remove the oily residue.
▪ To prevent premature discoloration of the
prosthesis, it should not be exposed to cigarette
smoke.

112. Ocular Implant
Placed in tissue bed to facilitate
construction of ocular prosthesis.
Advantages:
•Prevents sunken appearance of orbit.
•Better movement of overlying
prosthesis muscles attached.
•In growing children additional
benefit restored muscle function creates
additional tension on orbital walls..ensures
normal pattern of orbital growth.

113. ..If there is insufficient tissue to cover the
implant following surgery.
Pemphigus, trachoma etc which predispose
to severe scarring implant placement not
possible.
Contraindications
..

114. Insertion of implant
Muscles attached to implant

115. tenon’s capsule &
conjunctiva
sutured back
conformer placed
(4-12wks)
(decrease edema,
maintain socket,
stabilizes implant)
•Materials used for Ocular Implants..
•First material glass.. Introduced by Mules(1884)
•Many materials have been tried:Bone, gold ivory, rubber, paraffin etc.
•In recent years inert resin polymers are used.
(Most of the implants are made of methyl methacrylate resin) .
•Hydroxyapatite

116. Classification of implants..
By Integration
▪ Integrated
▪ Semi-integrated
▪ Nonintegrated
By Location
▪ Buried
▪ Non Buried

117. Buried implants: totally buried in tissues(chance
of dehisence exposure of overlying implant)
Non buried: some part open. (High chance of
infection and migration)
Integrated implants..

118. Semi integrated..
(Allen implant, Iowa implant, Quad
motility implant)
•Protruding mounds on implant
prosthesis will have a counter contour
excellent motility and retention of the
prosthesis.
•Require excellent fit of the prosthesis
Most commonly used
(Mules’sphere) ( 10-22mm)
Smooth surface
Motility compromised
Non integrated Implants..

119. Hydroxyapatite Integrated Ocular Implant
Fibrovascular growth after 4-6 months (pores of 500micron)
..less likely to become infected since it is incorporated with host
blood vessels.

120. Implant supported prosthesis
▪ Not all patients with defects are candidates for implant
supported prosthesis.
▪ Contraindicated in
▪ - Patients with cartilaginous peripheral tissue
▪ - Thick layers of skin which cannot be reduced
further Implant sites
▪ - Superior lateral orbital rim
▪ - Superior maxilla

121. Retention of the prosthesis
A. Anatomic
Retention
Hard
tissues
Soft
tissues
B.Mechanical
Retention
Magnets
Snap Buttons
and Straps
Adhesives
Spectacle
Borne
Retention
Combination
of the Above

122. Attachments used in facial
prosthesis
▪ Magnets (Cobalt – samarium) More
recently neodymium, boron and iron
magnets.
▪ Clips ( Nobel Pharma DCA 078, O- Quist)
▪ Ball attachments (Nobel Pharma)
▪ Dalbo attachment ( Sjodings, Sweden)
BAR AND RETENTIVE CLIPS
INDIVIDUAL MAGNETS
BALL ATTACHMENTS

123. daily hygiene procedures should be performed by
the patient to maintain the health of the soft tissue.
stabilization of the soft tissue to ensure fit and
marginal adaptation of the prosthesis.
This allows time for adequate healing
Impression is made 8 – 12 weeks after connection
of the abutments.
Impression Techniques:

124. ▪ Before taking the impression the abutments and the
surrounding tissues are inspected for the cleanliness and
evidence of any infection. Once satisfied that the abutments
are of suitable size and clean of debris, small neo-mini
magnetic keeper are then screwed into the abutments, using a
placing tool.

125. ▪ The area is then prepared as for normal impression
techniques. Alginate is mixed and taking a 20 ml
syringe, load sufficient alginate and proceed to inject
this carefully all around the magnetic keepers and
abutments. Following complete coverage of the
abutment area, further alginate is added as normal so
as to achieve a full impression.
When set the impression is then removed. A separate
set of keeper are thin screwed into brass abutment
replicas.

126. ▪ The whole assembly is then placed carefully into the impression.
When all the keepers and abutment replicas are in place, the
impression is poured using a good quality stone plaster.
▪ If copings are placed before taking the impression, they
must be kept stable during the impression procedure, as any
movement can result in an inaccurate impression. There are two
ways of achieving this stability.
▪ (1)The first method involves winding dental floss between the
copings and then applying a self curing acrylic resin. When set
the floss and acrylic form a rigid frame work, so that the copings
are stabilized during the impression.

127. ▪ In a second method a firm rubber base impression material is
used. The two components are mixed and loaded into a 20 ml
syringe, and then injected around the copings ensuring that the
rubber base engages the undercuts on the copings. Undercuts
are then prepared at the margins of the rubber base so as to
provide retention for the alginate material.
▪ The alginate and plaster are then powered so as to completely
cover that rubber base and area of tissue required.
▪ Care should be taken so as not to cover the top of that coping
screw with plaster topping.
▪ When set, unscrew the copings and carefully lift away that
impression. If the rubber base separates from the alginate, the
two components should be carefully re-assembled. Brass
abutment analogues are then screwed onto the coping and the
whole impression is poured as normal. Once the working
model has been obtained we can begin to construct the
prosthesis.

128. Processing of prosthesis
▪ The mould cavity is prepared by coating the external tissue surface area with a
thin coat of catalyzed uncolored silicone material
▪ Characterization colors are chosen and mixed with the silicone polymer and
painted on the surface of the clear layer.
▪ Colored rayon fibers may be sprinkled into the mould to simulate
microvasculature.
▪ After the mould surface is characterized by localize application of color, a base
color mixture of the silicone material is prepared to fill the mould cavity.
▪ When a satisfactory base color has been mixed, the silicone catalyst is added,
and air may be removed from the mixture by placing the container in a bell jar
under vacuum

129. ▪ The colored catalyzed, air less silicone is then placed into the mould
cavity, taking care to allow the liquid to flow into all the thin areas.
▪ The mould is then clamped and placed into a dry heat oven at the
manufacturer prescribed polymerization time and temperature.
▪ Residual silicone may be left on the external surface of the mould to test
for complete polymerization.
▪ After polymerization cycle is complete, the mould should be allowed to
cool to room temperature before removing the completed prosthesis.

130. Complications in Fitting Anopthalmic Socket..
1. Ptosis.. Drooping eye
A) Pseudoptosis.. increase the volume of the prosthesis
B) True ptosis
Treatment..
1) Surgical Correction
2) Upper aspect of corneal prominence is
enlarged to raiselid..Superior aspect of
prosthesis is reduced to form shell or
depression on to which lid may rest & fold.

131. 3) Extended shelf..Holds
upper
eye lid at desired position
4) Crutch on spectacle..
Wire mounted on spectacle
frame.
Press eyelid tissue
upward and
backward

132. 2. Ectropion(everted eyelid)
Wax pattern modified by
extending a thin lower edge
that will press downward
upon the tarsus thus
creating lower fornix.
..Remove resin from mid inferior
margin...Add on medial and
lateral aspects.
Pressure directed in medial and
lateral areas of the lid. This directs
weight of the prosthesis.
Giving a larger prosthesis.
3. Sagging lower eyelid
4. Narrow palpebral fissure..

133. Micro-optical artificial
compound eyes.
For small invertebrates such as flies or moths, compound
eyes are the perfectly adapted solution to obtaining
sufficient visual information about their environment
without overloading their brains with the necessary image
processing.
it is shown that such optical systems can be
achieved using state-of-the-art micro-optics
Systems.
Duparré JW, Wippermann FC Bioinspir Biomim. 2006 Mar;1(1):R1-16. Epub 2006 Apr 6
A compound eye is a visual
organ found in arthropods such
as insects and crustaceans. It
may consist of thousands of
ommatidia (photoreceptor
units) that consist of a cornea,
lens, and photoreceptor cells
which distinguish brightness
and color.

134. Future Bionic Eye
▪ Prosthetic eye which connects to the brain function making it more
realistic and better functional capabilities .
1. Outside glasses – digital camera
2. Inside glasses – eye movement sensor will direct the camera
3. Side of glasses – digital processor and wireless transmitter
4. Brain implant – small implant under the skull will receive
wireless signals and directly stimulate the brain’s visual
cortex

136. Summary & Conclusion
▪ “Nothing is as constant as change”
▪ This very much holds good for science, although prosthetic science
evolved through ages there are still un explored thoughts which will exists
as truth in future for the sole reason of betterment of humanity .
▪ The goal of any prosthetic treatment is to return the patient to society
with a normal appearance and reasonable motility of the prosthetic eye.
The disfigurement resulting from loss of eye can cause significant
psychological, as well as social consequences. However with the
advancement in ophthalmic surgery and ocular prosthesis, patient can be
rehabilitated very effectively.

137. ▪ The maxillofacial Prosthodontist should provide prosthetic
treatment to the best of his ability and should also consider
psychological aspects and if necessary the help of other
specialist should be taken into consideration.
▪ A commitment of follow-up for the clinical evaluation of
implant tissues and the maintenance and periodic replacement
of the facial prosthesis are a team responsibility and in the best
interests of the patient.

138. References
• Text book of Clinical maxillo facial prosthesis ; Thomas
D.Taylor; Quitessence publication 2006
• Maxillofacial prosthetics handbook ; William Laney ;PSG
Publication 1979
• Ocular prosthesis : A Physiologic system Stephen
O.Barlett , Dorsey J. Moore ;
▪ J Prosthet Dent 1973;29;4;450Ocular prosthesis
▪ Robert B. Welden and John V.Niranen; J Prosthet Dent
1956;6;2;272

139. ▪ Modified ocular prosthesis impression technique .Robert L.Schneider ;
J prosthet Dent 1986 ;55 ;4 ;482
▪ Custom ocular prosthesis with dilating pupil.Joseph R.Cain ,Henry
LaFuente
▪ J prosthet Dent 1983 ; 49 ;6 ;79Irritation of ocular tissue by
irreversible hydrcolloids.
▪ James R.Moergeli ; J Prosthet Dent 1985 ; 54 ;2 ;286 Modified stock
eye ocular prosthesis
▪ Taicher S. , Steinberg H.M.J Prosthet Dent 1985 ; 54 ; 1 ;95
▪ Post insertion care of ocular prosthesis .G.R. Parr ; J Prosthet Dent
1983 ; 49 ;220
▪ Digital imaging in the fabrication of ocular prostheses Ioli-Ioanna
Artopoulou ; J Prosthet Dent 2006 ;95 ; 327

140. INTRODUCTION