‘’THE METTLE’’ -RECENT ADVANCEMENT IN MAXILLOFACIAL
PROSTHETICS
Dr. Amalorpavam.V1, Dr.Jithin2, Dr.T.Sreelal3, Dr.Giri Chandramohan4, Dr.Aparna.Mohan5
1,2
P.G Students, 3 Professor and Head of the department, 4Reader, 5Reader,
Dept of Prosthodontics, Sree Mookambika Institute of Dental Science, kulasekaram, Kanyakumari, Tamilnadu
 Abstract:
Maxillofacial disfigurement
can be congenital, developmental,
traumatic and also due to oral and facial
malignancies. Such defects
compromise appearance, function and
incapable of leading a relatively normal
life. With recent advancements in
prosthetic materials, coloring
techniques and retentive mechanisms, a
life like prosthesis can be given.
Incorporating these advances into
dental practice enables the practitioners
to offer a wide range of services and
additional treatment options.The
biggest impact of such prostheses is not
only on the appearance but majorly on
the psyche of the patient. The main
objective is not only rehabilitation of
the defect but also restoring confidence
and improving quality of life of the
patient . This paper gives an insight into
the recent advancement and
innovations in the field of maxillofacial
prosthodontics.
INTRODUCTION
Maxillofacial abnormalities or defects that
compromise appearance, function and
accommodation sufficient to render an
individual incapable of leading a relatively
normal life have usually prompted
responses that seek to bring the person to
state of acceptable normalcy. In response to
congenital or acquired defects man has
continually sought to cope with his
debilities by using his genius and the
material resources available for restoration.
Many dedicated and enthusiastic
prosthodontist coming forward take it has a
service to rehabilitate individuals with
maxillofacial defects. Rehabilitate with
maxillofacial prosthesis provides a
nonsurgical treatment for patients who are
not good candidate for plastic surgery
intervention because of advanced age , poor
health, large deformity or poor blood
supply due to radiation. 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 our aim is to explain
the salient features and the purpose of these
prostheses.
SCOPE OF MAXILLOFACIAL
PROSTHETICS :
In includes the following important
objectives
a) Restoration of esthetics or cosmetic
appearance of patient.
b) Restoration of function.
c) Protection of tissue.
d) Therapeutics or healing effect.
e) Psychologic therapy
Recent Advances in Maxillofacial
prosthetics.
In 2003, Wolfaardt et al.[15] suggested rapid
prototyping as an adjunctive tool in
digitally designing maxillofacial prosthesis
in head and neck construction
CAD-CAM generated maxillo-facial
prosthesis(eg;an ear cast made by means
of a laser scanner and rapid prototyping
machine)
This is a technique to create a cast by
laser scanning, a stone cast of the
existing ear. A 3D laser scanner
develops an integrated 3D digital image
of the unaffected ear, which is copied
and then mirrored. A rapid prototyping
machine collects the necessary data to
manufacture the definitive resin ear.
Randomly position a cast of the existing
ear on a platform with colored pins
,connected to a personal computer to
acquire the 3D spatial coordinates using
software(fig 1). Make the first
measurement after positioning the stone
cast in front of the laser scanner.
Figure 1
Use a laser scanner connected to a personal
computer to acquire the 3D spatial
coordinates using software. Make the first
measurement after positioning the stone
castin front of the laser scanner.
Figure 2: Eight random position of lase scanner
It develop an STL-integrated 3D digital file
with the software (fig 3)
Figure:3 Figure:4
Copy and mirror the existing surface using
the ‘‘Divide/Mirror’’ tool to permit
visualization of the defective ear as it
appeared before ablative surgery.CAD-
CAM technology and rapid prototyping
procedure Process the STL file using the
computer system to manufacture the
definitive acrylic ear cast in a single step
(fig4). Conversion of acrylic resin cast into
a wax ear,a mould is formed in poly vinyl
siloxane into the polyvinyl siloxane
modelling wax is poured and a wax model
is formed. It is tried in the patient. (Fig 5)
Figure: 5
Use a spectrophotometer to determine
the intrinsic color of the ear and
investing is done by conventional
method.Finishing and polishing of the
prosthesis done and final prosthesis is
inserted.
Figure: 6 Figure : 7
Robotic prosthetic eye for people
wearing artificial eye implants:
Robotic prosthetic eyes which can
move like a real eye. After two
generations of the prosthetic eye
model, here is the latest of the eye
implant as shown in the picture.
It detects the natural eye movement
of the good eye of the patient who
needs to wear a prosthetic eye, using
the patient's EOG (electro-ocular-
graph) signal taken through a pair of
 electrodes placed on both sides of
the head at the height of the eyes.
The built-in control system will then
control the movement of the robotic
prosthetic eye to follow the
movement of the good eye of the
patient with a tracking error smaller
enough so that people will not be
able to tell the difference of the
movements of the real and
prosthetic eyes.
Figure : 8 Figure: 9
Three‑dimensional printing
No matter how good we are, putting
silicone on soft tissue during impression
will deform the soft tissue, but with a digital
scan, we can record the tissues more
accurate 3D. In comparison with the
traditional hand‑sculpted, hand‑cast pieces,
use of 3D process along with digital
principles helps an anaplastologist to create
more life‑like facial prosthetics that gives
more accurate fit, because the prosthesis is
based on a scan of the patient, not a cast.
Mueller et al. used rapid prototyping to plan
the facial prosthetics which makes it easy in
the reconstruction of patient’s features in
specific shape when other techniques like
mirroring techniques cannot be applied.
The 3D color models[2] created by rapid
prototyping provides contours, color
shading to more “life‑like” when compared
to the conventional moulage impression
techniques.
Burn Mask: Treating facial burn patient is
a special challenge due to their close
proximity to the eyes, ears, nose and nasal
passages causing serious visual and
pulmonary complications, impaired
breathing or swallowing. Every effort
should be made to prevent scarring or
contracture of scar that may impact on
person’s self‑perception and well‑being.
The formation of these scars can be reduced
by fabricating burn mask. Historically, the
conventional method used to fabricate a
custom burn mask starts with impression of
the affected area with alginate or plaster
molding compound which is applied
directly to the affected area causing pain
and discomfort to the patient. Thanks to
Insignia,[6] which employs a 3D motion
tracking laser scanner and computer‑aided
design software to provide a custom burn
mask to the patient without contacting
patient’s skin [Figure 10 ,11].
Figure :10 Figure: 11
So what are custom burn mask/hanger burn
mask? A custom splint/burn splint or mask
is a clear plastic prosthesis used to apply
pressure to minimize the formation of
hypertrophic scars or to flatten those
already present. By applying direct pressure
over the wound site, it prevents the excess
formation of collagen fibers and realigns
them in a normal pattern, while protecting
the wound site from unwanted external
forces that may impair wound healing.
Calverian Reconstruction:
After oncologic resection, the form and
function of the face and body can be
restored by means of reconstructive
surgery. However, there are limitations to
reconstructive surgery due to lack of tissue
substitutes, which require the use of
prosthetics to achieve the desired esthetic
and functional outcome. plays an important
It plays role in reconstructive surgery in
improving patient confidence and quality of
life. Apart from autogenous bone, the
various alloplastic materials which are most
of disadvantages associated with metal
cranial implants like their high thermal
conductivity which may precipitate
headache and other neurological symptoms,
infection, less biocompatible,[5] and
difficult to interprete radiologically as they
produce scattering in computed
tomography and magnetic resonance
imaging evaluation.
Figure : 12
A newer implantable material, high‑density
porous polyethylene (HDPE)[5] which is
available in various shapes and forms is
found to be an excellent alternative to
existing methods of calvarial reconstruction
in being biocompatible and with good
flexibility to be molded into desired
contours. These HDPE hemispheres
[Figure 12] are used to recontour the natural
shape of the skull.
Figure :13
Conclusion: Prosthetic restoration
of maxillofacial defects is an
ancient art, in which success has
always been limited by the
unavailability of adequate
materials. In the perfect world
things do change. Advances in
electronic technology and materials
have influenced every aspect of our
society including dentistry.
Reference :
1.Andres, In Gettleman L, Khan Z. Eds et al. Survey of
materials used in extraoral maxillofacial prosthetics.
Proceedings of the conference on material research
in maxillofacial prosthetics. Transactions of the
Academy of Dental Materials. Vol. 5. 1992. p. 25-40
2.Beuer F, Schweiger J, Edelhoff D. Digital dentistry: An
overview of recent developments for CAD/CAM
generated restorations. Br Dent J 2008;204:505-11.
3.S. Padmaja An insight into the future beckons of
maxillofacial prosthodontics: Anaplastology
3.T. D. Taylor. Clinical Maxillofacial Prosthetics, 1st ed.
Quintessence Publishing Co. Inc, Illinois, 2000.
4.Gettleman L, Vargo JM, Gebert PH, Rawls HR.
Thermoplastic chlorinatedpolyethylene for maxillofacial
prostheses. In: Gebelein CG, editor. Polymer Science and
Technology Series. Advances in Biomedical Polymers.
Vol. 35. New York: Plenum; 1986. pp. 55-61
4. Dr. Aakarshan Dayal Gupta, Dr. Aviral Verma, Dr.
Tanay Dubey and Dr. Saloni Thakur. Maxillofacial
prosthetics part-1: a review , Int. J. Adv. Res. 5(10),
31-40
5.Prolo DJ, Oklund SA. The use of bone grafts and
alloplastic materials in cranioplasty. Clin Orthop Relat
Res 1991;268:270-8.
6.Spaeth JP. Laser imaging and computer-aided design
and computer-aided manufacture in prosthetics and
orthotics. Phys Med Rehabil Clin N Am 2006;17:245-63