15. MATERIALS IN MAXILLOFACIAL PROSTHODONTICS

PG FINAL YEAR

1. MATERIALS IN MAXILLO-FACIAL PROSTHODONTICS 1

2. CONTENTS Introduction History Properties Materials Colours in MFP Retention types Limitations in MFP Conclusion 6/22/2022 2

3. INTRODUCTION MAXILLO FACIAL PROSTHESIS Any prosthesis used to replace part or all of any stomatognathic and/or craniofacial structures – GPT9 Glossary of Prosthodontic Terminology - 9 6/22/2022 3

4. Before 1600 Ambroise Pare – obturator – simple disc attached to sponge 1600 – 1800 Pierre Fauchard - silver mask painted with oil paints to replace the lost portion of mandible. 1800 – 1900 William Morton - nasal prosthesis - enameled porcelain. Claude Martin - nasal prosthesis - ceramic material . 1900 – 1940 Upham - nasal and auricular prosthesis - vulcanite rubber . 1940 – 1960 Tylman – resilient vinyl copolymer acrylic resin 1960 – 1970 Fine – colored nylon flockings – facial prosthesis 1970 – 1990 Gonzalez – polyurethane elastomers Lewis and Castelberry - siphenylene Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 6/22/2022 4

5. 6/22/2022 5 Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

6. PROPERTIES Biological and chemical properties: Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 6/22/2022 6

7. PROPERTIES Mechanical properties: Article - Materials of facial prosthesis: History and advance – Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages 6/22/2022 7

8. PROPERTIES Physical properties: Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022 8

9. PROPERTIES Aesthetic properties: Article - Maxillofacial Prosthetic Materials – Khindria et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 6/22/2022 9

10. PROPERTIES Processing characteristics: Article - Materials of facial prosthesis: History and advance – Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages 6/22/2022 10

11. MATERIALS 6/22/2022 11

12. ACCORDING TO BEUMER Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022 12

13. ACCORDING TO ANUSAVICE Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022 13

14. PROSTHETIC RECONSTRUCTION Agar agar Alginate Plaster of paris R oom temperature vulcanizing material Modelling clay (Sculptor’s clay) Plaster Plastolene Waxes Intraoral materials Extra oral materials 6/22/2022 14 Textbook of Oral and maxillofacial rehabilitation - beumer

15. IMPRESSION PHASE 6/22/2022 15 Textbook of Oral and maxillofacial rehabilitation - beumer

16. 6/22/2022 16 Clinical Maxillofacial Prosthesis - Thomas D Taylor

17. MODELLING PHASE Modelling materials should be ideally malleable with sufficient strength . Should accept texture that will be imparted to the final prosthesis. The closer the colour of material to skin, less is the visual distortion. 6/22/2022 17 Textbook of Oral and maxillofacial rehabilitation - beumer

18. MODELLING CLAY 6/22/2022 18 SCULPTOR’S CLAY Water based clay, when allowed to dry, becomes a hard stone-like substance. Textbook of Oral and maxillofacial rehabilitation - beumer

19. PLASTER 6/22/2022 19 Textbook of Oral and maxillofacial rehabilitation - beumer

20. PLASTOLENE Modelling clay with oil base. 6/22/2022 20 Textbook of Oral and maxillofacial rehabilitation - beumer

21. WAXES 6/22/2022 21 Textbook of Oral and maxillofacial rehabilitation - beumer

22. FABRICATION PHASE 6/22/2022 22

23. ACRYLIC RESIN Used in fabricating both intra- and extra-oral prostheses. Types – heat activated, cold activated, light activated. 6/22/2022 23 Areas - Little movement occurs in the tissue bed during function Powder Liquid Polymethyl methacrylate Methyl methacrylate Colors (acrylic base paint/ chloroform solvent) Heat polymerized ˃ Auto-polymerized No residual monomer is more color stable and is free of tertiary amine activator. Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259

24. ACRYLIC RESIN 6/22/2022 24 Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259

25. ACRYLIC COPOLYMERS 6/22/2022 25 Plasticized methyl methacrylate polymers, which show elastic properties. PALAMED – Tylman , 1943 Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259

26. VINYL POLYMERS AND COPOLYMERS Popular and widely used. Copolymers of vinyl chloride and vinyl acetate. 6/22/2022 26 Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259

27. POLYURETHANE ELASTOMERS 6/22/2022 27 Elastomers with urethane linkages Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978

28. POLYURETHANE ELASTOMERS 6/22/2022 28 Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978

29. SILICONES The most widely used materials for facial restorations. External prosthesis by Barnhart in 1960 6/22/2022 29

30. VULCANIZATION 6/22/2022 30 The process of cross linking polymer - vulcanization

31. CLASSIFICATION - SILICONES BASED ON MECHANISM Room Temperature Vulcanized Silicones (RTV) High temperature Vulcanized Silicones (HTV) 6/22/2022 31 BASED ON USE Implant grade Medical grade Clean grade Industrial grade BASED ON CHEMISTRY Polydimethyl siloxanes Methyl vinyl /dimethyl siloxanes Phenyl methylsiloxanes Fluoro dimethyl siloxanes

32. 6/22/2022 32 Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

33. ROOM TEMPERATURE VULCANIZING SILICONE 6/22/2022 33 Comparatively short chain silicone polymers which are partially end-blocked with hydroxyl groups Eg – Silastic 382, 399, MDX4-4210, Silastic 891, Cosmesil Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

34. 6/22/2022 34 RTV-1 RTV-2 Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

35. Only RTV-2 6/22/2022 35 Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

36. RTV-1 One component system. Found in adhesives and sealants. On exposure to atmospheric moisture, crosslinking immediately begins. Available in sealed containers. 6/22/2022 36 Thin prosthesis Thick prosthesis Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

37. RTV-2 6/22/2022 37 RTV-2 condensation polymerization Crosslinking when a curing agent and base combine. Silastic 382 (Dow Corning Company) RTV-2 addition polymerization Two component system. RTV platinum catalysed silicones. Less shrinkage – no by-product. Disadvantages - difficulty with extrinsic staining, short working time, and impurities reducing curing efficiency Two component system. Available – both (condensation and addition) Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

38. EXAMPLES OF RTV1 AND RTV2 6/22/2022 38

39. 6/22/2022 39 ROOM TEMPERATURE VULCANIZING SILICONE Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

40. Crosslinking - addition or free radical polymerization Temperature - 100 and 200°C for up to 30 min. 6/22/2022 40 HIGH TEMPERATURE VULCANIZING SILICONE Eg – Silastic 370, 372, PDM siloxane, Q7 -4635, 4650 Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

41. 6/22/2022 41 Addition polymerization HTV silicones Transparent with no yellowing Odorless Demolded easily Do not require any processing after curing Relatively high tensile and tear strength. Free radical HTV silicones Yellowing after curing Strong odor both during and after processing Tacky to touch - high surface friction High-consistency High tear resistance Thermally stable. Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13

42. HTV VS RTV 6/22/2022 42 RTV silicones are not as strong as the HTV silicones Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13

43. METALS Intra-oral maxilla facial prosthesis. Titanium, Co-Cr., Ni-Cr. 6/22/2022 43

44. OTHER MATERIALS 6/22/2022 44

45. FOAMING SILICONES 6/22/2022 45 Reduce the weight of the prosthesis. The volume to increase by as much as seven-fold. Article - Maxillofacial prosthetic materials - Khindria , et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1

46. 6/22/2022 46 FOAMING SILICONES Eg . Silastic 386: A form of RTV silicone Article - Maxillofacial prosthetic materials - Khindria , et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1

47. SILPHENYLENES 6/22/2022 47 Siloxane copolymers Improved edge strength Low modulus of elasticity Superior coloration Resistance to degradation on exposure to UV light and heat. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)

48. SILICONE BLOCK COPOLYMERS 6/22/2022 48 Blocks of polymers other than siloxane are positioned with the traditional siloxane polymers Eg . Intertwining of poly methyl methacrylate into the chains of siloxane. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)

49. POLYPHOSPHAZENES Fluoro -elastomers have been developed for use as resilient denture liners. Potential to be used as maxillofacial prosthetic materials. 6/22/2022 49 Researchers in New Orleans, Polyphosphazenes with little or no fillers and decreasing the ratio of acrylic to rubber yields a softer rubber, similar to human skin. The rubber is compounded with pigments for appropriate matching with the patients’ skin. Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1)

50. MDX4-4210 Translucent Adequate tensile strength Nontoxic Color stable Biologically compatible. 6/22/2022 50 Room Temperature Vulcanizing Silicone Elastomers (RTV ) 2 component kit. Moore et al, reported that it exhibits improved qualities relative to coloration and edge strength. Article - Maxillofacial Prosthetic Materials -An Update – Deepthi et al - Journal of International Medicine and Dentistry 2016; 3(1): 02-11

51. MPDS Modification of silicone elastomer. Incorporation of methacrylate groups in the silicone reduces the hydrophobicity of the silicone. Enhances the adhesive bond strength to the non-silicone based adhesives. Works thru thermal polymerization. 6/22/2022 51 Methacryloxypropyl terminated polydimethyl siloxane Article – New organosilicon maxillofacial prosthetic materials – J.H.Lai et al – Dental materials 18 (2002) 281-286

52. POLYETHER ETHER KETONE (PEEK)  Used in fabrication of obturator. 6/22/2022 52 Organic thermoplastic polymer – PAEK family. Article - Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: A clinical report - Costa-Palau et al - The Journal of Prosthetic Dentistry - 2014

53. 6/22/2022 53 POLYETHER ETHER KETONE (PEEK) Article - PEEK in dentistry, properties and application areas – Akay et al - IDR — Volume 10, Number 2, 2020

54. 3D PRINTING 6/22/2022 54 Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

55. 6/22/2022 55 Article - CAD/CAM ear model and virtual construction of the mold – Ciocca et al - The Journal of Prosthetic Dentistry - 2007;98:339-343

56. 6/22/2022 56 Article - Effectiveness of digital data acquisition technologies in the fabrication of maxillofacial prostheses – A systematic review - N. Suresh et al - Journal of Oral Biology and Craniofacial Research 12 (2022) 208–215 Systematic review – characteristics of nasal prosthesis

57. 6/22/2022 57 Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

58. COLORATION Accurate representation of skin color in a facial prosthesis is essential to achieving a successful esthetic result. The ability to match skin tones effectively requires Keen eye Good understanding of color theory Meticulous attention to details. 6/22/2022 58 Lewis et al - The ideal color properties required in a maxillofacial prosthetic material, Must accept and retain the color Appearance, mechanical strength and other properties – not to be changed by sunlight or other environmental factors. Clinical Maxillofacial Prosthesis - Thomas D Taylor

59. DIFFERENT PIGMENT COLOURING SYSTEMS 6/22/2022 59 Intrinsic coloration is color applied within the mold during the casting procedure. Extrinsic coloration is color applied to the surface of a prosthesis that has been cured and removed from the mold. Clinical Maxillofacial Prosthesis - Thomas D Taylor

60. FACTORS – COLOR INSTABILITY 6/22/2022 60 Clinical Maxillofacial Prosthesis - Thomas D Taylor

61. STEPS 6/22/2022 61 Clinical Maxillofacial Prosthesis - Thomas D Taylor

62. The base shade - slightly lighter than the highest skin tones of the patient (because the prosthesis will darken as color is added). Base shades are mainly metal oxides. 6/22/2022 62 Nickel oxide Brown Manganese oxide Lavender Titanium oxide Yellowish brown Iron oxide Brown Copper oxide Green Clinical Maxillofacial Prosthesis - Thomas D Taylor

63. Once the base color is identified, laminar glazes are applied to simulate the skin complex appearance . 6/22/2022 63 Layers of color painted into the mold before packing the base color Red blush glaze Simulates classic pink appearance of skin Golden tan glaze Presence of melanin Dark brown glaze Simulates freckles and moles Dark blue/ purple Applied for shadow areas Clinical Maxillofacial Prosthesis - Thomas D Taylor

64. Base c olo r is c ompa r e d to patient skin w ith red b l u ish g l a ze , l a y ered o v e r a ba se c o l or R e d blui sh gla ze i s painte d in to t h e f ir s t la y e r of m ould . T w ee z er s an d period o ntal prob e to p l a ce thread for b l ood v e ss e l simu l at i on S y ringe u s e d to i n j e ct silic on e i nt o the mould I n strin s i c all y painted m ol d prio r to pa ck in g t he ba se c olor Clinical Maxillofacial Prosthesis - Thomas D Taylor

65. A p p lic a t ion of extrinsi c colo r Blend ing A p p lic a t ion of kaoli n (create opacity) to Cure d surfac e of t h e pros t hesis Co m pressed ai r used to eliminat e exces s k aolin Clinical Maxillofacial Prosthesis - Thomas D Taylor

66. RETENTION 6/22/2022 66 Article - Past , Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122

67. ADHESIVES To retain the facial prosthesis in position. 6/22/2022 67 Article - Materials of facial prosthesis: History and advance – Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015

68. FACTORS – SELECTION OF ADHESIVE Biocompatibility The strength of the adhesive bond to skin and the prosthetic material Ease of applicability Removal on daily basis Nature of the material - prosthesis 6/22/2022 68 Article - Retentive aids in maxillofacial prosthesis: A review - Rohit Saini et al. - IP Annals of Prosthodontics and Restorative Dentistry, January-March, 2019;5(1):1-4

69. 6/22/2022 69

70. PRESSURE SENSITIVE TAPE These tapes consists of a backing strip composed of cloth, paper, film, foil or a laminate strip coated with a pressure – sensitive adhesive. Applied by finger pressure. Bond strength – tape < acrylic resin. 6/22/2022 70 Double coated polyethylene, surgical tape INDICATIONS: Materials with poor flexibility Defects demonstrate little or no movement 3M bifaceis Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020

71. ACRYLIC RESIN ADHESIVE These can be easily mixed with water and applied. On drying, they leave a clear layer – rubber like substance. LIMITATIONS: Patients with poor manual dexterity or coordination may not be able to apply. Require constant reattachment with facial movements. Routine removal of adhesive - remove the external pigmentation . 6/22/2022 71 Beta bond Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020

72. BOND STRENGTH OF ACRYLIC RESIN ADHESIVES WITH SILICONE PROSTHESIS Bond strength between acrylic resin and maxillofacial silicone – Marcela et al (Journal of Applied Oral Science - 2012;20(6): 649-54) 6/22/2022 72 Since the composition of these two materials is different, no strong bond between them was noted when no primer was applied.

73. SILICONE ADHESIVE Are a form of RTV silicone dissolved in solvent. Once the adhesive is applied, the solvent evaporates and a tacky adhesive results. 6/22/2022 73 Telesis silicone adhesive Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020

74. LIMITATIONS OF MFP MATERIAL 6/22/2022 74 No single maxillofacial material is ideal for every patient. Continued effect of sunlight and vascular dilatation & contraction on the natural tissues cannot be duplicated in the prosthesis. Variations of skin tone when the patient is exposed to different light sources (e.g., incandescent, fluorescent, & natural light) cannot be duplicated in the prosthesis . The prosthesis cannot duplicate the full facial movement of the non defective side. Varying physiologic conditions of the patient in everyday living (e.g., lack of sleep, infectious diseases, and edema resulting from interrupted lymph drainage caused by surgery) cannot be duplicated in the prosthesis. Lack of predictability of the life of the prosthesis, because of variations among patients (i.e., secretions, smoking, and environment). Article - Maxillofacial Prosthetic Materials: A Literature Review - Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90

75. CONCLUSION The success of the prosthetic rehabilitation of the facial defect limited by mechanical and physical properties of the material. None of the materials meet our needs completely. There are certain advantages and disadvantages of materials. It is in clinicians hand, to choose the material wisely based on clinical scenario. 6/22/2022 75

76. REFERENCES Glossary of Prosthodontic Terminology – 9 Textbook of Oral and maxillofacial rehabilitation - beumer Clinical Maxillofacial Prosthesis - Thomas D Taylor Article - Maxillofacial Prosthetic Materials: A Literature Review – Harsh et al - Journal of Orofacial Research, April-June 2012;2(2):87-90 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122 Article - Materials of facial prosthesis: History and advance– Alqutaibi et al - International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 021015, 4 Pages Article - Materials used in Maxillofacial Prosthetic : A Review – Barhate et al – Pravara Med Rev 2015; 7 (1) 6/22/2022 76

77. REFERENCES Article - Maxillofacial Prosthetic Materials – Khindria et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 Article - Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review – Lanzara et al - International Journal of Applied Dental Sciences 2021; 7(2): 255-259 Article - Polyurethane Elastomers as Maxillofacial Prosthetic Materials – Jon et al - J Dent Res April 1978 Article - Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing – Sean et al - Adv. Mater. 2020, 2001122 Article - Maxillofacial Prosthetic Materials - An Inclination Towards Silicones - Aparajita Mitra et al - Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): ZE08-ZE13 Article - Maxillofacial prosthetic materials - Khindria , et al - The Journal of Indian Prosthodontic Society / January 2009 / Vol 9 / Issue 1 6/22/2022 77

78. REFERENCES Article – Materials used in maxillofacial prosthesis: A review – Barhate et al – Pravara Med Rev 2015; 7(1 ) Article - Maxillofacial Prosthetic Materials -An Update – Deepthi et al - Journal of International Medicine and Dentistry 2016; 3(1): 02-11 Article – New organosilicon maxillofacial prosthetic materials – J.H.Lai et al – Dental materials 18 (2002) 281-286 Article - Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: A clinical report - Costa-Palau et al - The Journal of Prosthetic Dentistry - 2014 Article - PEEK in dentistry, properties and application areas – Akay et al - IDR — Volume 10, Number 2, 2020 Article - CAD/CAM ear model and virtual construction of the mold – Ciocca et al - The Journal of Prosthetic Dentistry - 2007;98:339-343 6/22/2022 78

79. Article - Effectiveness of digital data acquisition technologies in the fabrication of maxillofacial prostheses – A systematic review - N. Suresh et al - Journal of Oral Biology and Craniofacial Research 12 (2022) 208–215 Article - Retentive aids in maxillofacial prosthesis: A review - Rohit Saini et al. - IP Annals of Prosthodontics and Restorative Dentistry, January-March, 2019;5(1):1-4 Article - Method of retentive for maxillofacial prosthesis : A REVIEW – Shivani et al - IJCRT -Volume 8, Issue 6 June 2020 6/22/2022 79 REFERENCES

80. THANK YOU!!! 6/22/2022 80