Dr.Bhavan Chand

Introduction Definition Review of Literature Classification Fabrication Recent Advancement Conclusion and Summary

The maxillofacial prosthodontics is the branch of prosthodontics concerned with restorations and replacement of stommatognathic and craniofacial structure with prosthesis that may be removed on a regular or elective basis.

(GPT – 8)(GPT – 8)

Physical defects that compromise appearance or function which prevents an individual from leading a normal life usually prompt the individual to seek treatment that will reinstate acceptable normalcy.

The loss of an eye impair the patient's visual function, yet also result in noticeable deformity. A prosthesis should be provided as soon as possible to raise the spirit and ease the mind of the afflicted.

Orbital prosthesis:

“A prosthesis that artificially restores the eye, eyelids, and adjacent hard and soft tissue lost as a result of trauma or surgery”

- GPT 2005

Ocular prosthesis: “A prosthesis that artificially

replaces an eye missing as a result of trauma, surgery, or congenital absence”.

- GPT 2005

Maxillofacial ProsthodonticsMaxillofacial Prosthodontics

Plastic SurgeonPlastic Surgeon

OpthalmologistOpthalmologist

Ocular Ocular ProsthesisProsthesis

2613-2494 B.C - First ocular prosthesis in Egypt; excavation of tombs

provided evidence of eye replacement by using precious stones, earthenware, enemelled bronze ,copper and gold.

(1510-1590) Ambrose Paré , a famous French surgeon, was the first to

describe the use of artificial eyes to fit an eye socket. These pieces were made of gold and silver,

Adv Ophthalmic Plast Reconstr Surg. 1990;8:1-10. Danz W Sr.

(1820s-1890s);

Enamel prostheses were attractive color

suitable for a prosthetic eye. German

craftsmen are credited with this invention in

1835

19 century: Dental crop, Army of USA

Fabrication of plastic eye :Various material like

vulcanite and celluloid were introduced to

improve this artificial eye prosthesis

Adv Ophthalmic Plast Reconstr Surg. 1990;8:1-10. Danz W Sr.

20 th century second world war:A definitive technique was used by United States Naval Dental

and Medical School use of acrylic eye.

Ocular Implant;

Adv Ophthalmic Plast Reconstr Surg. 1990;8:1-10 Danz W Sr.

Availability

Stock eyesCustom made

eyes

Material

Glass made

Acrylic made

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

It prevents socket dissolution. Fear of breakage is less. It can be reparable. It can be worn at night time The eye glasses are roughen and discolor

caused by tears and secretion.

Chalian A Text book of Maxillofacial Prosthodontics

Normal eye

diagram

Etiology of eye loss;

Infection

Trauma

Malignancy

Gerodontology 2007 March 21 Sanjayagouda B.Patil, Roseline Meshramkar,B.H Naveen and N.P Patil

Surgical Management Three approaches(3E)

Evisceration; is a surgical procedure wherein the intraocular contents of the globes are removed, leaving a sclera, Tenon’s capsule, conjunctiva extra ocular muscle and optic nerves are undisturbed; cornea may be retained or exicised.

Enucleation; is the surgical removal of the globe and a portion of the optic nerve from the orbit.

Exenteration: Block dissection of eye.

EVISCERATION

ENUCLEATION

EXENTERATION

Steps in Fabrication ocular prosthesis:

Patient evaluation

Ocular impression

Wax Try in

Characterization of Prosthesis

Final polishing and finishing of prosthesis Taylor Maxillofacial

Prosthesis

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 controlRobert B Welden and John v Niranee JPD Vol 6 No 2 1956

Impression Techniques:

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 Mark F.Mathew,Alan J Sutton J.Prosthodontics 2000,9,210-2162000,9,210-216

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

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.

diagram

diagram

Kenneth E Brown JPD 1970 vol 24 no 2

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

Allen and Webster; recommended a stock ocular traywhich is perforated which helps in the retention of alginate for making ocular impression.

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

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

Benson : advocated Wax scleral Blank Tech;

Benson : journal of prosthodontics1997, 78 218-222

Tissue side of prosthesis poured in the stone

Perforations are placed in the tray

Tip of the syringe shortened

Syringe tip secured in the tray

Benson : journal of prosthodontics1997, 78 218-222

Resulting impression

Syringe is screwed into the tray

Fitting the Sclera Wax Pattern:

Two piece cast Molten base plate cast poured

Retrieving the wax pattern

Sharp edges are removed Scleral wax pattern in place

1. Paper Iris Disk Technique:

Iris is marked on scleral blank

Size and location of iris are verified

Completed iris painting

Processing of prosthesis done

Verification of iris painting

Use of an ocular blank

Digital imaging:The digital image provides acceptable esthetics

resultsbecause it closely replicates the patient’s with

minimum color adjustment and modification.Advantages: Techniques is simple

Less treatment time

Requires minimal artistic skill.

J Prosthet Dent. 2006 Apr;95(4):327-30 Mathews MF, Smith RM, Sutton AJ, Hudson R

Digital photograph of patient

Ocular button positioning on paper iris

Disk assembly attached to wax pattern

Complete ocular prosthesis matching pt iris

J Prosthet Dent. 2006 Apr;95(4):327-30 Mathews MF, Smith RM, Sutton AJ, Hudson R

Wear the prosthesis day and night

It has to washed with soap solution once in every two weeks.

Once the prosthesis removed the soft tissues are irrigated with ophthalmic irrigation

Daily ocular hygiene can be maintained using ophthalmic irrigation solution as a eye drops to clean anterior portion of the prosthesis

Reline of ocular prosthesis

Borders of prosthesis modified with the wax

Impression is made with korecta wax

Rick M. Smith., J. Prosthodontics, 1995:4; 160-163

Prosthesis after relining with clear acrylic

Placed in the tissue bed to facilitate

construction of ocular prosthesis.

Prevents sunken appearance of orbit.

•Better movement of overlying prosthesis muscles attached.

In growing children additional

benefit restored muscle function creates additional tension on the orbital walls and ensures normal pattern of orbital growth.

Following enucleation not all patients are

candidates for placement of an ocular implant:

Pemphigus, trachoma etc which predispose

to severe scarring implant placement not

possible.

If there is insufficient tissue to cover the

implant following surgery.

•First material glass. Introduced byMules(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

1. Integrated 2. Semi

integrated 3. Non integrated

1. Buried2. Non buried

Hydroxyapetite motility implant in ocular prosthesis: Volume deficiency syndrome

In 1995 Dr Arthur Perry introduced HA motility implant

Advantages:

Inherent biocompactibility and proclivity to become fibrovascularity integrated with resiudual muscle and tissue.

It also minimize the fear of the bacterial infection.Dr Arthur Perry jpd 1995 vol73 67-69

Disadvantages:

Extended operative time required to locate and attach the extraocular muscle to the motility sphere.

Cost effective.

Magnetically integrated microporous implant:This study establishes the safety of microporous

high-density polyethylene implants in the rabbit

model.

CLINICAL RELEVANCE: This technique may offer an alternative to patients with

previously implanted microporous high-density polyethylene implants seeking enhanced cosmesis and

prosthetic motility.

Escalona-Benz E, Benz MS, Murray TG, Hayden BC, Hernandez E, Garonzik SN, Cicciarelli NL. Arch Ophthalmol. 2007 Nov;121(11):1596-600

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.

In this paper, 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

The art of replacing missing eye with a prosthesis has

been carried out many years and these can be stock or

custom made. The use of an ocular prosthesis of appropriate size, contour and contour can prove

to be of value functionally as well as aesthetically. It promotes physical and psychological healing for

the patient and improve social acceptance.

Beumer J. Maxillofacial rahabilitation

Modified impression tech of artificial eyes: Am J

Opthalmol: 1969:67:189

Ocular prosthesis: JPD 1973:38:532

Fitting of ocular prosthesis:JPD: 1977:38:532

Custom ocular prosthesis: JPD 1982:48:690

HA motility implants: JPD 1995:73:267

Vein application: JPD 1975:34:193

Kumar D krishna:contact lens research integrated

implants:JPD 1974:32:439

Custom oc prosthesis:JPD 1997:78:218

Post insertion care: JPD 1983:49:220

Surgical considerations:JPD 1983:49:379

Pupil alignment: JPD 1969:22:487-489

History of eyes: Am J Opth:1969:67:167

Modified ocular prosthesis tech: jpd 1986:55:482

Snells clinical anatomy

Taylor: clinical maxillofacial prosthetics

Modified stock prosthesis: JPD 1985:54:95