Maxillofacial Prosthodontics

Maxillofacial disfigurement can be congenital, developmental,
traumatic or because of ablative surgery. Such defects compromise
appearance, function and render an individual, incapable of leading a
relatively normal life and affect his\her psyche. As the patients quality
of life is altered; social integration becomes difficult and the
expectation to return to “normalcy” collapses. The prognosis for a
successful treatment outcome is dependent upon making a correct
diagnosis and anticipating issues beyond the realm of dentistry alone.
Microvascular surgical reconstruction by free flaps is usually the
treatment of choice. However, radiation therapy, anatomic complexity,
possibility of recurrence, and procedural complexity may exclude it as
an option.
Prosthetic rehabilitation over the years has proven its mettle when it
comes to such situations. It has considerable advantages; for example,
observation for recurrence of disease, esthetic superiority, technical
simplicity, and inexpensive care. Over decades several prostheses have
been developed for this purpose, through this review our aim is to
explain the salient features and the purpose of these prostheses.

Loss of eye has a bad effect on the psychology of the patient. Eye prosthesis is fabricated to
regain the patient’s confidence by meticulous replacement of the missing eye. Immediate
fitting of an anophthalmic socket with an artificial eye may not always be possible, and a
delayed prosthesis delivery may result in settling and sinking of the prosthesis into the
socket, therefore requiring orbital cavity conformation. It becomes a challenging task for a
maxillofacial prosthodontist to fabricate a prosthesis that replicates the healthy side of the
face. This article presents a short review of three functional ocular impression techniques
to achieve a better fit of the prosthesis to the defect area. These techniques aim to combine
cosmetic excellence with comfort for greater benefit to the patients.

Purpose: Silicone-based elastomeric materials are commonly used to fabricate max-illofacial prostheses. The aim of this study was to evaluate the effect of different types of silica and nanosized titanium dioxide addition on the mechanical properties of two RTV silicone elastomers. Materials and Methods: A-2000 and A-2006 silicone elastomers were used, and each was divided into four subgroups (n = 5). The first group was the control without additives. Other groups were titanium dioxide, fumed silica, and silaned silica. Each specimen was prepared in compliance with the manufacturer's instructions for the tensile strength, percent elongation, tear resistance, and the hardness tests according to ISO and ASTM standards. A factorial ANOVA with pairwise interaction indicated that the pattern for all four outcomes of the materials was different for A-2000 and A-2006 (p < 0.05). Therefore, the average outcome values for the materials within silicone elastomers were then analyzed by Tukey HSD. For the hardness test results, Kruskal-Wallis and Mann-Whitney U test methods were used. The level of statistical significance was p < 0.05. Results: There was a statistically significant interaction (p < 0.05) between materials and silicone type for all four tests (tensile strength, tear, hardness, percent elongation). The hydrophobic silica group had significantly higher tensile strength than TiO 2 for A-2000. The fumed hydrophilic silica group had significantly higher tensile strength than TiO 2 for A-2006. Most of silica specimens had higher tensile strength when compared with the control and TiO 2 groups for A-2000 and A-2006 silicones. The TiO 2 group had the highest hardness value for A-2000 while the lowest hardness value for A-2006 (p < 0.05). There was no significant difference of tear strength among the type of additives (p > 0.05) for A-2000. The fumed silica and TiO 2 groups had significantly higher tear strength than the control group for A-2006. The fumed silica and the hydrophobic silica groups had significantly higher percent elongation than the control group (p < 0.05) for A-2000. The TiO 2 group had the lowest percent elongation for A-2006. Conclusions: Results in this in vitro study may clarify future studies about the effect of different additives on the physical and mechanical properties of maxillofacial elastomers. There is a great interest in the effect of a new-generation hydrophobic silica incorporation into A-2000 silicone as well as the effect of fumed hydrophilic silica incorporation into A-2006 silicone. Future research should be supported with more in vitro trials in different percentages of such additives used in this study.

Copious alternates are available nowadays to address the challenge of immediately replacing a missing anterior tooth, these include a removable or fixed, temporary or permanent, acrylic prosthesis, or resin-bonded bridges. Ribbond single-visit bridges provide strength, durability, and immediate convenience. They are cost effective and reliable and are excellent for emergencies like implant temporization, congenitally missing teeth and patients who cannot afford conventional lab fabricated bridgework. In place of the pontic, a natural tooth, denture tooth can be used or composite build-up can be done. Creating an adhesive FRC bridge by using a composite resin pontic is a successful treatment option for the direct aesthetic replacement of missing anterior teeth.

Objectives: Silicone elastomers require replacement due to degradation of mechanical properties and deterioration in color over time. Recently, various nanoparticles have been incorporated into the silicones to reinforce their physical and mechanical properties. The purpose of this study was to evaluate the effect of nanosized particle addition on the color stability of a commercial RTV maxillofacial silicone elastomer submitted to an accelerated aging. Materials and Methods: The nanosized particles (titanium dioxide and silaned silica) were added, 10% by volume, into a maxillofacial elastomer. The samples (n=10) were polymerized in an oven according to the manufacturer's recommendations. Color measurements were performed using digital spectrophotometry according to the CIE L*a*b* color system. The samples were subsequently placed into an aging chamber for 168 h. The second color measurement of the samples was performed after the aging process. Data obtained from the measurement was recorded and assessed by (ANOVA) (α=0.05). Results: The highest color stability was obtained with the silica and the TiO 2 group samples; the lowest color stability was obtained with the control group samples in this study. However; no statistically significant difference in discoloration was observed in the ∆E values between the groups (p > 0.05). Conclusions: The results of this pilot study revealed that the addition of nanosized TiO 2 and silica particles used as reinforcing agents did not cause any color degradation of an A-2000 silicone during the first 2 months. Further studies should be done on the effect of such nanoparticles in long term aging procedures on the color stability of maxillofacial elastomers.

Objective: The objective was to investigate the effect of silver nanoparticles (AgNPs) incorporation on viscoelastic
properties of acrylic resin denture base material. Materials and Methods: A total of 20 specimens (60 × 10 × 2 mm)
of heat cured acrylic resin were constructed and divided into four groups (five for each), according to the concentration
of AgNPs (1%, 2%, and 5% vol.) which incorporated into the liquid of acrylic resin material and one group without
additives (control group). The dynamic viscoelastic test for the test specimens was performed using the computerized
material testing system. The resulting deflection curves were analyzed by material testing software NEXYGEN MT.
Results: The 5% nanoparticles of silver (NAg) had significantly highest mean storage modulus E’ and loss tangent
Tan δ values followed by 2% NAg (P < 0.05). For 1% nanosilver incorporation (group B), there were no statistically
significant differences in storage modulus E’, lost modulus E” or loss tangent Tan δ with other groups (P > 0.05).
Conclusion: The AgNPs incorporation within the acrylic denture base material can improve its viscoelastic properties.
Key words: Acrylic resin denture, nanoparticles, viscoelastic

Restoring a single central incisor should aim at preserving the affected tooth as well as re-establishing function and esthetic. This clinical report describes a patient with compromised smile due to the fracture of the tooth number 11which was immediately restored by resin waiting for the healing process after the trauma. A zirconia based ceramic restoration was performed. Basic guidelines were followed to guarantee a natural mimicry of the restoration. The maxillary central incisors have an effect on the visual aspect of a person either positively or negatively. In fact achieving a natural mimicry of the single maxillary central incisor restoration with the adjacent  dentition  is  a  real  challenge.  Thus  an  accurate  match  of  a  single  incisor  crown  with  the  supporting  tissues  leads  to  a  near  mirror image [1]. When the central incisor is decayed or fractured, the  situation  is  complicated  as  it  needs  a  prior  reconstruction.  Currently, fiber posts and cores solve the problem thanks to their elastic  behavior.  Their  modulus  of  elasticity  is  similar  to  that  of dentin, unlike metal or ceramic posts [2,3]. The restoration will  be  instantly  compared  with  the  natural  counterpart.  Hence  the  slightest  differences  of  shape  and  color  will  be  immediately  perceived. Knowing that the patient’s expectations in this case are normally very high, this integration of the restored central tooth is more challenging for both the clinician and the ceramist.

Maxillofacial defects are facial disfigurements resulting from congenital abnormalities, surgical resection of tumours, trauma, or a combination of these. The resulting deformity often leads to a difficult path of recovery with lifelong consequences, causing both physical disability and mental distress. The aim of maxillofacial prosthesis should be to restore the normal physiological function in these patients, various prosthesis used in the management of these defects. However, the knowledge amongst the various dental and medical practitioners about the same has been at sparse. This survey helps to evaluate the knowledge among different practitioners.

Oral submucous fibrosis (OSMF) is a chronic, debilitating disease characterized by tautness of the cheek musculature, eventually leading to a restricted mouth opening. It is a premalignant condition that offers a formidable challenge in terms of prosthodontic rehabilitation, as complete denture retention has traditionally been attained by anatomic and mechanical means. The primary aim of a dentist is to overcome the myriad complications seen in patients suffering from OSMF and to restore the natural form and function of the oral cavity. Here, a simplified approach was used to rehabilitate an edentulous patient with OSMF.

Maxillofacial disfigurement can be congenital, developmental, traumatic or because of ablative surgery. Such defects compromise appearance, function and render an individual, incapable of leading a relatively normal life and affect his\her psyche. As the patients quality of life is altered; social integration becomes difficult and the expectation to return to “normalcy” collapses. The prognosis for a successful treatment outcome is dependent upon making a correct diagnosis and anticipating issues beyond the realm of dentistry alone. Microvascular surgical reconstruction by free flaps is usually the treatment of choice. However, radiation therapy, anatomic complexity, possibility of recurrence, and procedural complexity may exclude it as an option. Prosthetic rehabilitation over the years has proven its mettle when it comes to such situations. It has considerable advantages; for example, observation for recurrence of disease, esthetic superiority, technical simplicity, and inexpensiv...

Literature has proved that implant-retained overdenture is one of the best prosthetic options in the rehabilitation of complete edentulism. Tissue-supported implant-retained overdentures have been an appropriate treatment modality for atrophic mandibular ridges. In this case report, the patient presented with Class I maxillomandibular relationship and Class II Prosthodontic Diagnostic Index. The patient was concerned about esthetics as well as the retention of the lower denture. Taking into consideration the above concerns, an implant-retained mandibular overdenture was the chosen treatment modality. There are numerous attachment systems that have been used to improve the retention, stability, and support of implant-retained overdenture. Every attachment system has its own set of advantages. The OT Equator is a new line of low-profile attachment which is a radically modified OT-CAP Normo. The rationale for using this attachment is that it is considered the smallest attachment system available with the least overall dimension. It is a resilient and self-aligning attachment system which can be used in limited inter-arch space situation. OT equator derives its name from the OT Dental Laboratory (Bologna, Italy) used as a brand name. Considering these advantages, this was the chosen attachment and proved beneficial in terms of both patient satisfaction and the overall success of the treatment.

The success of prosthetic rehabilitation has always been holistic rather than mere manual dexterity of the prosthodontist. The emphasis on restoration of facial esthetics is an integral part of any prosthetic rehabilitation. The unsupported and paralyzed facial musculatures of especially the cheeks and lips have a detrimental psychological effect on the patient’s professional and social life. Prosthetic rehabilitation of such patient not only confines to replacement of missing teeth but also restoring the lost cheek support. Cheek plumpers or cheek lifting appliances have been effectively used for the purpose of improving aesthetics and psychological profile in such patients. This article focuses on simple, effective and a noninvasive technique of restoring the slumped facial musculature by incorporating cheek plumper in the dentures.