Dr.Bhavan Chand
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