Maxiilofacial Prosthodontic materials

Introduction
 OBJECTIVES OF MAXILLO-FACIAL
PROSTHESES
• Restoration of esthetics or cosmetic
appearance of the patient
• Restoration of function
• Psychologic therapy
• Therapeutic or healing effect
• Protection of tissues
  IDEAL BIOLOGICAL
1
PROPERTIES
• Compatible with supporting tissues
• Non allergenic and non toxic
• Cleansibility without loss of detail at surface or margins
• Cleansable with disinfectants
• Color stability
• Dimensionally stable
• Flexibility comparable to tissues
• Flexibility stable at extremes of temperatures
  IDEAL BIOLOGICAL
1
PROPERTIES
•

• Inert to solvents and skin adhesives

• Permeable to moisture release from underlying tissues
• Resistance to environmental discoloration
• Resistance to growth of micro-organisms
• Softness maintained during use
• Usable life of 2 or more years
  IDEAL PHYSICAL AND
1
MECHANICAL PROPERTIES
• Dynamic properties comparable to tissues
• High edge strength
• High elongation
• High resistance to abrasion
• High tear strength
• High tensile strength
• Low specific gravity
 IDEAL PHYSICAL AND
1
MECHANICAL PROPERTIES
• Low surface tension
• Low thermal conductivity
• Odorless
• Non-inflammable
• No water sorption
• Softness compatible to tissues
• Translucent
  IDEAL PROCESSING
1
CHARACTERISTICS
• Adjustability
• Chemically inert after processing
• Dimensionally stable during and after processing
• Ease of intrinsic and extrinsic coloring
• Ease of mould fabrication
• Ease of processing
• Ease of repair or re fabrication if needed
• Fidelity of detail reproduction
• Long shelf life
 IDEAL PROCESSING
1
CHARACTERISTICS
• Long working time
• Low enough viscosity for ease of processing
• Low processing temperature
• Non-inflammable
• No polymerization by products
• Non toxic components
• Non porous after processing
• No color change after processing
• Odorless before and after processing
• Reusable moulds
• Retain intrinsic and extrinsic coloration during use
• Short processing time
 Types of materials

FABRICATION
IMPRESSION MODELING PHASE
PHASE PHASE
• Prosthesis
1. Acrylic resins
2. Acrylic co-polymers
3. Vinyl Polymers
4. Poly urethane
5. Silicones-
• RTV silicones
• HTV silicones
• Pigments
• Dies
• Adhesives
 1,3,7,8
ACRYLIC RESINS

• The reaction between methacrylic acid and methanol results

in the ester methyl methacrylate (CH2=C[CH3]CO2CH3).
 1,3,7,8
ACRYLIC RESIN

• Methyl methacrylate polymerizes to form polymethyl

methacrylate
• Heat polymerized preferred
 3,7
ACRYLIC RESIN

Properties of methyl methacrylate :

• Clear, transparent liquid at room temperature
• Melting point : - 54.4 ° F
• Boiling point : 213.4 ° F
• Density : 0.945 gram per cubic centimeter
• Heat of polymerization : 12.0 kilocalories per molecule
•

• Polymerization can be initiated by uv light or heat.

 3,7
ACRYLIC RESINS

Properties of polymethyl methacrylate:

•

• Transparent resin of remarkable clarity

• Knoop hardness number : 18 – 20
• Tensile strength : 8500 pounds per sq. inch
• Specific gravity : 1.19
• Modulus of elasticity : 350000 pounds per sq. inch
• Soften at 260 ° F
• Thermoplastic material
• Soluble in organic solvents such as chloroform and acetone.
 1
ACRYLIC RESIN

• These materials are preferred for restoring defects that

require minimal movement like ocular prosthesis.
Advantage
• Readily available
• Strong
• Intrinsic and extrinsic coloration can be produced
• Better color stability
Disadvantage
• Rigid – discomfort
• Difficulty to make duplicates
• High thermal conductivity
 AUTOPOLYMERIZING
1,7
ACRYLIC
• This acrylic can be used to augment margins of a rigid
acrylic prosthesis when in position on the patient’s face.
 1
ACRYLIC COPOLYMERS
•

Eg. Palamed ( plasticised methyl methacrylate)

• Soft and elastic
• Not received wide acceptance due to a number of
objectionable properties
• Poor edge strength
• Poor durability
• Degrade when exposed to sunlight
• Processing and coloration difficult
 VINYL POLYMERS AND
1,3,7
COPOLYMERS
•

• Copolymers of vinyl chloride and vinyl acetate

• Vinyls are derivatives of ethylene ( CH2=CH2).
• flexible
• intrinsic and extrinsic coloration
• plasticizer migration and loss- resulting in
• discoloration and hardening of the prosthesis,
particularly at the margins
• Edges tear easily if thin and may require
reinforcement with nylon fabric
 POLYURETHANE
1,3,8
ELASTOMERS
Eg. Epithane 3
Superior cosmetic results
elasticity
edge strength and hence allows thin material at the margins.
Mobile tissue beds too can be restored with it.
Lifelike feel and appearance
POLYURETHANE ELASTOMERS

Disadvantages:
• Difficult to process consistently
• Little margin for error is possible when
measuring the constituents.
• moisture-sensitive and, when water
contamination occurs, gas bubbles cause
defects and poor curing
• Not color stable
 SILICONES

• Introduced in 1946
Formula of silicone:
• Silicone consists of chains of alternate silicon and oxygen
atoms
 SILICONES
First step in production of silicon:
•

• Reduction of silica (SiO2) to elemental silicon

• Silicon is combined with methyl chloride to form dimethyl
dichlorosiloxane
• When dimethyldichlorosiloxane reacts with water ,it forms
polymer
•

n Si(CH3)2Cl2 + n H2O → [Si(CH3)2O]n + 2n HCl

 SILICONES

• Polydimethyl siloxane, commonly referred to as silicone, is

made from these silicon fluid polymers
• The long-chained polymers, when tied together at
various points (cross-linked),create a network that
can be separated only with difficulty.
• The process of cross-linking the polymers is
referred to as vulcanization.
• Vulcanization occurs both with and without heat
and depends on the catalytic or cross-linking
agents utilized
 SILICONES

• Silicones + fillers additional strength

• Silicones + additives color
• Silicones + antioxidants and vulcanizing agents transforms
raw mass from plastic to rubbery resins during processing.
 SILICONES

• The process of cross-linking the polymers is referred to as

vulcanization
• Vulcanization occurs both with heat and without heat.
•

• Silicone elastomers are available in two forms:

1) Heat to effect vulcanization (HTV)

2) Vulcanize at room temperature (RTV)
 HEAT-VULCANIZING SILICONES
1
ELASTOMERS

• Heat-vulcanizing silicone is a semi­solid or putty-like

material that requires milling, packing under
pressure, and 30-minute curing at 1800 0 C.
• Requires heat for vulcanization
• Highly viscous, white, and opaque.
• Available as one or two component putty.
• Catalyst or vulcanizing agent is
1. dichlorobenzoic acid (for condensation
polymerization)
2. platinum salts (for addition polymerization).
• have superior strength and a more suitable
translucency than the RTV silicones
• Before vulcanization, they are a semisolid
material that must be forcibly packed into the
mold. To soften the uncured material and to
incorporate the pigments, the material must
be repeatedly passed through a roller mill
• Difficult to color- extrinsic
 HTV

• After milling, to blend the catalyst and cosmetic coloring

pigments, the prosthetic device is cured at elevated
temperature of 1800 0 C in a heat-transferring metal mold.
 HTV

TYPES

• Silastic 370, 372, 373, 4-4514, 4-4515

• Pdm silicones
• Q7-4635, q7-4650, q7-4735, se-4524u
 ROOM TEMPERATURE
VULCANIZING SILICONES
1,3,8
According to barley (RTV)
,
• Room temperature –vulcanizing silicone are composed of :
• Short chain silicone polymers which are partially end blocked
with hydroxyl groups
In addition,
• A cross linking agent such as tetraethoxysilane is present
•

• Gypsum molds used in the fabrication

 ROOM TEMPERATURE-
VULCANIZING SILICONES (RTV)
• These materials are either transparent or opaque white, and
before the catalyst is introduced, dry earth pigments are
added to match the color of the individual skin.
 RTV

• The prosthesis can be cured in an artificial stone mold. A more

durable mold can be made from epoxy resin or metal.
•

• The prosthesis can be simply fabricated in the general dental

laboratory with little equipment other than the material.
•

• However, room temperature-vulcanizing silicone is not as

strong as heat-vulcanizing silicone, and the intrinsic color is
monochrome.
 RTV

Some limiting aspects:

• With some grades, owing to the white source elastomer,

internal coloring is difficult.
• In mixing elastomer with the catalyst for the curing
(vulcanizing), air entrapment persists in the finished cured
prosthesis, which tends to initiate tear and accumulation of
skin exudates.
 RTV

• Tear resistance of Room temperature-vulcanizing grades is

generally inadequate to maintain edge resistance.
•

• Room temperature-vulcanizing silicones formulated with silica

fillers to enhance tensile strength and to mask yellowing or
discoloration sacrifice considerable translucency, making it
difficult to attain proper internal (intrinsic) coloration.
a and b: Ear prosthesis and nasal prosthesis from Room temperature- vul­canizing silicones.
 RTV
• To correct for these deficiencies, a transparent proprietary Room
temperature-vulcanizing grade silicone (Dow Corning MDX 4-
4210) is an improved alternative available but requires
considerably longer curing time of up to 16 hours at ambient
temperature.
•

• The curing time can be reduced by heating up to 1500 C for as

little as 5 minutes, which would require forming special
expensive metal molds.
•

• The improvement in tear resistance is significant, but nick tear

sensitivity under tension prevails, as does the propensity to
entrap air during blending and pigment mixing.
 RTV

TYPES:

• Silastic 382, 399

• Mdx4-4210
• SILASTIC 891 (silastic medical adhesive silicone type A)
• Cosmesil / silskin 2 systems
• A-2186 (factor ii)
 1,3
SILASTIC 382, 399
• Stannous octate catalyst & orthoalkyl silicate as cross linking agent
•

Advantages
•

• Color stable
• Clear solutions
• Easy to process
• Require stone molds
•

Disadvantages
•

• Poor strength
• Difficult to color
• Cosmetic results inferior
 1
Mdx4-4210

• Chloroplatinic acid
0
catalyst & hydro-methyl siloxane as cross-
linking agent. (80 C for 1hour)
• improved properties
•

Advantages:
•

• No reaction by-product
• Increased elongation
• Non-toxic, color stable
• Simple processing
• Compatible with adhesives
 SILASTIC 891 (silastic medical
1
adhesive silicone type A)
•

• Udagama & Drane

• Translucent, non flowing, polymerizes in air
• In 1987 Udagama used it along with polyurethane film to
improve its edge strength.
 SILASTIC 891 (silastic medical
adhesive silicone type A)
Advantages
•

• No need of molds
• No catalyst
• Compatible with wide range of colorants.
 1
Cosmesil / silskin 2 systems

• Woofaardt described it
• Two curing system:
•

Platinum cure:
• Utilizes vinyl terminated silicone & a platinum catalyst
• Addition reaction so no by-products. Hence no shrinkage
• Poisoned by latex
• Working time 1 hr & curing at 1000C for 1 hr
 Tin cure:
•

• Utilizes hydroxy terminated silicone fluids & a Tin catalyst

• Condensation reaction so by-product is formed
• Very robust & cures against most substrates/ conditions
• Working time 1hr & cures in 24 hr at room temperature
 COLORING FACIAL
1,3
PROSTHESES
• Duplicating skin with respect to texture, contour, and, above
all, color is very difficult.
• Skin color varies in different physiologic and pathologic
conditions, such as anemia, and in different emotional states,
which may lead to pallor or flushing.
• The color depends on capillary blood flow and oxygenation,
the thickness of the epidermis, and the presence of pigments
such as melanin and carotene. Prostheses may be colored by
either intrinsic or extrinsic procedures or a combination of the
two procedures.
 Cosmetic realism involves exacting replication of:
•

1) Sub dermal, commonly referred to as intrinsic coloration

and
2) External, or extrinsic, coloration.
• Additionally, the finished cosmetic matching needs to be
provided with a topical glaze or a subdued reflectance, and
the texture resembling that of the adjacent tissue.
 Coloration for cosmetic lifelike realism therefore involves:

• 1) Characterizing the spectral reflectance of individual

physiologic colorations or color centers of skin, and
•

• 2) Using dispersed pigments ,replicative of each of the

physiologic colorations blended to measured spectral
characteristics of natural living skin.
 1
INTRINSIC COLORATION

• This is the first step for incorporating in depth coloration

reflected internally by discrete pigment particles spectrally
equivalent or approximating that of the physiologic colorant
and color centers, namely arterial red, venous red-purple,
carotenoid yellow, melanoid brown, and opaque dispersed
cellular lipids.
•

• Replication of these physiologic colorants in relation to

commercially defined pure pigments was quantitatively
devised by Schweiger and Lontz.
• The range of intrinsic shades serves as the bulk coloration
onto which the extrinsic coloration is applied in proportions to
the individual’s coloration at the site of the prosthesis along
with incidental shadowed shades, age blemishes, and so on.
• According to Chalian intrinsic coloring in heat-vulcanized
silicone prostheses is accomplished with a milling machine.
Metallic oxides or pigmented silicone concentrates are
generally used, and red fibers may be incorporated, if desired,
to simulate blood vessels.
• Intrinsic coloring in room temperature-vulcanized silicone
(MDX4­4210), which is clear and has a honey-like consistency is
accomplished by mixing it with talc powder to make it
opaque.
• The correct amount of talc powder must be used, and it
should be mixed carefully until the desired translucency is
obtained.
• Red fibers and dry earth pigments are incorporated in the
base material.
• Dry pigments may become difficult to manage in very small
quantities. A sharp instrument is therefore used to remove
pigments from the bottle.
• For accurate measurement, these pigments are mixed with
room temperature-vulcanizing thinner in the ratio of three
grains of pigment to ten ml of Silastic room temperature-
vulcanizing thinner and then stored in a small bottle with a
dropper.
• The patient’s presence is required. It is advisable to mix
gradually until the desired color is achieved. This base color is
labeled and stored in a refrigerator for the next appointment.
 1,3
EXTRINSIC COLORATION

• The final realism by extrinsic coloration is an important, skilled

procedure to provide shade variations replicating that of the
natural skin coloration adjacent to the prosthesis and its
texture as recounted by Laney with reference to techniques
developed by others.
• Extrinsic coloring, according to Bartlett, Pineda, and Moore
(1971), is done with medical adhesive. After the silicone type
A medical adhesive (Dow corning) has been thinned with
xylene, a small amount of it is placed in a number of individual
medicine cups.
• Each cup is tinted with selected inorganic pigments, and the
adhesive is then applied to the surface with a cotton swab. A
Skin like texture can be achieved by dabbing a patch of lint-
free gauze over the area.
• Curing is completed in 30 to 45 minutes. Evaporation of xylene
during the curing leaves a dull skin like texture.
• Ouellette described spray coloring of silicone-elastomer max­
illofacial prostheses. Pigments selected to match the patient’s
skin are mixed in proportion with clear elastomer and solvent.
The mixture is sprayed on the prosthesis until the desired hue
is obtained. The catalyst spray is applied over the sprayed
pigment solution. The curing of catalyst sprayed dispersion is
done at 50°C for five minutes. Since fumes from spray coloring
may be toxic, a protecting device should be used to prevent
the inhalation of toxic fumes.
• According to Schaaf , the color easily peels off or rubs off
during manipulation of the prosthesis or during daily cleansing
of the patient.
• He also stated that the additional layer of material obliterates
the surface texture.
• Firtell and Bartlett and Roberts suggested that, in many cases,
the basic tone of the prosthesis should be made a lighter
color. Lighter basic tone can be obtained by intrinsic coloring
of the prosthesis, and this should be followed by minimal
surface characterization according to the needs of a given
patient.
 1
ADHESIVES

• An ideal adhesive should be one that provides firm functional

retention under flexure or extension during speech, facial
expression, eating, chance adjustment of eyeglasses,
inadvertent gestures, splash of water or rain, accumulation of
moisture and perspiration, and so on.