DENTAL TECHNIQUE
A surface roughening technique for maxillofacial prostheses Ebru D. Cifter, PhD,a Meltem Ozdemir-Karatas, PhD,b Erkan Sancakli, PhD,c and Ali Balik, PhDd Facial defects can be reconABSTRACT structed surgically or prosthetGiving a natural surface texture to the maxillofacial prostheses is one of the major goals for the ically. Small- to medium-size maxillofacial prosthodontists. This article describes a technique for application of an antiskid epoxy defects can be reconstructed resin to the surface of the definitive mold before pouring the maxillofacial silicone elastomer. This successfully if the cartilage matechnique produces evenly distributed and same-size pores that are more similar to the natural trix of the ear is not damaged; appearance of human skin. (J Prosthet Dent 2015;113:250-252) however the complete reconstruction of the missing ear remains a challenge for the 2. Place magnetic impression caps (EO magnetic surgeons.1,2 impression cap; Institut Strauman AG) on the center of the magnetic abutments (EO magnetic Unsatisfactory results of reconstructive surgery may abutment; Institut Strauman AG). adversely affect the psychological state of the patient, 3. Make a preliminary impression with an irreversible while implant-retained maxillofacial prostheses signifihydrocolloid impression material (Protesil; Vanini cantly increase the quality of life of the patients.3-5 Dental Industry). Pour the impression with Achieving a natural appearance with a maxillofacial prosthesis is a great challenge for maxillofacial prosthoType IV dental stone (Marmoplast N; Siladent Dr dontists. Color match, thinned edges, translucency, and Böhme & Schöps GmbH) to obtain a definitive cast. surface texture are the major determinants of a natural 4. Place the magnets (EO magnet; Institut Strauman look.6,7 Even if the color is matched accurately, the surAG) on the magnetic abutments in the cast and face characteristics of the patient’s skin should be place a base plate of wax (Imiwax; Imicryl) to create sculpted in the wax pattern, and must be precisely a space between the skin and the magnet holding transferred to the maxillofacial silicone elastomer. acrylic resin. Attach the magnets with autopolyBecause of the hydrophobic characteristics of the wax, surface details like the pores of the skin may not be merizing resin (Sila Press; Siladent Dr Böhme & precisely transferred to the cast. This causes an unnatural Schöps GmbH), and trim the excess resin after polymerization (Fig. 2). appearance of the facial prosthesis. The technique 5. Prepare the wax pattern of the missing ear by using described produces the porous structure of the skin to the conventional techniques and attach the magnet silicone elastomer in the polymerization stage. holding the acrylic resin to the wax pattern (Fig. 3). TECHNIQUE 6. Finish the surface with an alcohol-soaked silk stocking (Fig. 4). 1. Keep the patient in an upright, seated position, 7. Prepare the cast with Type IV dental stone (Marand coat the hairs around the impression area with moplast N; Siladent Dr Böhme & Schöps GmbH) petroleum jelly (Vaseline; Unilever Inc) (Fig. 1). and eliminate the wax, boiling the cast for 20
a
Research assistant, Department Research assistant, Department c Research assistant, Department d Research assistant, Department b
250
of Prosthodontics, Faculty of Dentistry, of Prosthodontics, Faculty of Dentistry, of Prosthodontics, Faculty of Dentistry, of Prosthodontics, Faculty of Dentistry,
Istanbul University, Istanbul University, Istanbul University, Istanbul University,
Istanbul, Turkey. Istanbul, Turkey. Istanbul, Turkey. Istanbul, Turkey.
THE JOURNAL OF PROSTHETIC DENTISTRY
March 2015
251
Figure 1. Magnetic abutments and impression area.
Figure 2. Magnet holding acrylic resin bar.
Figure 3. Magnet holding acrylic resin bar attached to wax pattern.
Figure 4. Surface of finished wax pattern before casting.
Figure 5. Epoxy coated cast surface, which will be in contact with external surface of maxillofacial prosthesis.
Figure 6. Surface roughness provided by epoxy resin.
minutes. Rinse the cast with hot water and let it dry for 1 hour. 8. Shake the can of epoxy resin (Amazing Goop Antiskid Epoxy With Grit; Eclectic Products Inc) for 2 to 3 minutes before application, and continue to shake it intermittently for 10 seconds. Cifter et al
9. Apply the epoxy resin from 12 to 15 inches away from the surface in a sweeping motion. Apply it only to the surface of the cast in contact with the external surface of the polymerized silicone (Fig. 5). 10. Let the epoxy dry for 20 minutes. Apply a second layer if deeper pores are needed (Fig. 6). THE JOURNAL OF PROSTHETIC DENTISTRY
252
Figure 7. Polymerized silicone before extrinsic coloration and porous structure of surface.
11. Cast the colored silicone elastomer (Cosmesil M 511; Principality Medical) and leave it to polymerize at 100 C for 1 hour. 12. Remove the prosthesis from the cast, rinse the surface with water, and wait until it dries before extrinsic coloration (Fig. 7). 13. Match the color with extrinsic color pigments (FEExtrinsic coloration; Factor II Inc) (Fig. 8). 14. Apply a layer of extrinsic sealant (Extrinsic sealant P799; Principality Medical) on the colored surfaces, and apply colored fibers (H-119 flocking; Factor II Inc) to the surface to avoid a shiny appearance. SUMMARY The technique described in this article helps give the maxillofacial silicone elastomer a more natural appearance. Antiskid epoxy resin creates a gritty layer on the surface of the cast, which is transferred to the silicone as pores.
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 113 Issue 3
Figure 8. Magnet-retained ear prosthesis after extrinsic coloration.
REFERENCES 1. González-Sixto B, Pérez-Bustillo A, Otero-Rivas MM, Rodríguez-Prieto MA. Subcutaneous pedicled V-Y advancement flap for surgical reconstruction of the auricle of the ear. Actas Dermosifiliogr 2014;105:23-6. 2. Kasrai L, Snyder-Warwick AK, Fisher DM. Single-stage autologous ear reconstruction for microtia. Plast Reconstr Surg 2014;133:652-62. 3. Atay A, Peker K, Günay Y, Ebrinç S, Karayazgan B, Uysal Ö. Assessment of health-related quality of life in Turkish patients with facial prostheses. Health Qual Life Outcomes 2013;11:1-9. 4. Nemli SK, Aydin C, Yilmaz H, Bal BT, Arici YK. Quality of life of patients with implant-retained maxillofacial prostheses: a prospective and retrospective study. J Prosthet Dent 2013;109:44-52. 5. Macgregor FC. Ear deformities: social and psychological implications. Clin Plast Surg 1978;5:347-50. 6. Wolfaardt JF, Coss P. An impression and cast construction technique for implant-retained auricular prostheses. J Prosthet Dent 1996;75:45-9. 7. Beumer J, Curtis TA, Marunick MT. Maxillofacial rehabilitation: prosthodontic and surgical considerations. St Louis: Ishiyaku EuroAmerica Inc; 1996. p. 388. Corresponding author: Dr Ebru D. Cifter Istanbul University 34093, Capa, Istanbul TURKEY Email: [email protected] Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Cifter et al
A surface roughening technique for maxillofacial prostheses Ebru D. Cifter, PhD,a Meltem Ozdemir-Karatas, PhD,b Erkan Sancakli, PhD,c and Ali Balik, PhDd Facial defects can be reconABSTRACT structed surgically or prosthetGiving a natural surface texture to the maxillofacial prostheses is one of the major goals for the ically. Small- to medium-size maxillofacial prosthodontists. This article describes a technique for application of an antiskid epoxy defects can be reconstructed resin to the surface of the definitive mold before pouring the maxillofacial silicone elastomer. This successfully if the cartilage matechnique produces evenly distributed and same-size pores that are more similar to the natural trix of the ear is not damaged; appearance of human skin. (J Prosthet Dent 2015;113:250-252) however the complete reconstruction of the missing ear remains a challenge for the 2. Place magnetic impression caps (EO magnetic surgeons.1,2 impression cap; Institut Strauman AG) on the center of the magnetic abutments (EO magnetic Unsatisfactory results of reconstructive surgery may abutment; Institut Strauman AG). adversely affect the psychological state of the patient, 3. Make a preliminary impression with an irreversible while implant-retained maxillofacial prostheses signifihydrocolloid impression material (Protesil; Vanini cantly increase the quality of life of the patients.3-5 Dental Industry). Pour the impression with Achieving a natural appearance with a maxillofacial prosthesis is a great challenge for maxillofacial prosthoType IV dental stone (Marmoplast N; Siladent Dr dontists. Color match, thinned edges, translucency, and Böhme & Schöps GmbH) to obtain a definitive cast. surface texture are the major determinants of a natural 4. Place the magnets (EO magnet; Institut Strauman look.6,7 Even if the color is matched accurately, the surAG) on the magnetic abutments in the cast and face characteristics of the patient’s skin should be place a base plate of wax (Imiwax; Imicryl) to create sculpted in the wax pattern, and must be precisely a space between the skin and the magnet holding transferred to the maxillofacial silicone elastomer. acrylic resin. Attach the magnets with autopolyBecause of the hydrophobic characteristics of the wax, surface details like the pores of the skin may not be merizing resin (Sila Press; Siladent Dr Böhme & precisely transferred to the cast. This causes an unnatural Schöps GmbH), and trim the excess resin after polymerization (Fig. 2). appearance of the facial prosthesis. The technique 5. Prepare the wax pattern of the missing ear by using described produces the porous structure of the skin to the conventional techniques and attach the magnet silicone elastomer in the polymerization stage. holding the acrylic resin to the wax pattern (Fig. 3). TECHNIQUE 6. Finish the surface with an alcohol-soaked silk stocking (Fig. 4). 1. Keep the patient in an upright, seated position, 7. Prepare the cast with Type IV dental stone (Marand coat the hairs around the impression area with moplast N; Siladent Dr Böhme & Schöps GmbH) petroleum jelly (Vaseline; Unilever Inc) (Fig. 1). and eliminate the wax, boiling the cast for 20
a
Research assistant, Department Research assistant, Department c Research assistant, Department d Research assistant, Department b
250
of Prosthodontics, Faculty of Dentistry, of Prosthodontics, Faculty of Dentistry, of Prosthodontics, Faculty of Dentistry, of Prosthodontics, Faculty of Dentistry,
Istanbul University, Istanbul University, Istanbul University, Istanbul University,
Istanbul, Turkey. Istanbul, Turkey. Istanbul, Turkey. Istanbul, Turkey.
THE JOURNAL OF PROSTHETIC DENTISTRY
March 2015
251
Figure 1. Magnetic abutments and impression area.
Figure 2. Magnet holding acrylic resin bar.
Figure 3. Magnet holding acrylic resin bar attached to wax pattern.
Figure 4. Surface of finished wax pattern before casting.
Figure 5. Epoxy coated cast surface, which will be in contact with external surface of maxillofacial prosthesis.
Figure 6. Surface roughness provided by epoxy resin.
minutes. Rinse the cast with hot water and let it dry for 1 hour. 8. Shake the can of epoxy resin (Amazing Goop Antiskid Epoxy With Grit; Eclectic Products Inc) for 2 to 3 minutes before application, and continue to shake it intermittently for 10 seconds. Cifter et al
9. Apply the epoxy resin from 12 to 15 inches away from the surface in a sweeping motion. Apply it only to the surface of the cast in contact with the external surface of the polymerized silicone (Fig. 5). 10. Let the epoxy dry for 20 minutes. Apply a second layer if deeper pores are needed (Fig. 6). THE JOURNAL OF PROSTHETIC DENTISTRY
252
Figure 7. Polymerized silicone before extrinsic coloration and porous structure of surface.
11. Cast the colored silicone elastomer (Cosmesil M 511; Principality Medical) and leave it to polymerize at 100 C for 1 hour. 12. Remove the prosthesis from the cast, rinse the surface with water, and wait until it dries before extrinsic coloration (Fig. 7). 13. Match the color with extrinsic color pigments (FEExtrinsic coloration; Factor II Inc) (Fig. 8). 14. Apply a layer of extrinsic sealant (Extrinsic sealant P799; Principality Medical) on the colored surfaces, and apply colored fibers (H-119 flocking; Factor II Inc) to the surface to avoid a shiny appearance. SUMMARY The technique described in this article helps give the maxillofacial silicone elastomer a more natural appearance. Antiskid epoxy resin creates a gritty layer on the surface of the cast, which is transferred to the silicone as pores.
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 113 Issue 3
Figure 8. Magnet-retained ear prosthesis after extrinsic coloration.
REFERENCES 1. González-Sixto B, Pérez-Bustillo A, Otero-Rivas MM, Rodríguez-Prieto MA. Subcutaneous pedicled V-Y advancement flap for surgical reconstruction of the auricle of the ear. Actas Dermosifiliogr 2014;105:23-6. 2. Kasrai L, Snyder-Warwick AK, Fisher DM. Single-stage autologous ear reconstruction for microtia. Plast Reconstr Surg 2014;133:652-62. 3. Atay A, Peker K, Günay Y, Ebrinç S, Karayazgan B, Uysal Ö. Assessment of health-related quality of life in Turkish patients with facial prostheses. Health Qual Life Outcomes 2013;11:1-9. 4. Nemli SK, Aydin C, Yilmaz H, Bal BT, Arici YK. Quality of life of patients with implant-retained maxillofacial prostheses: a prospective and retrospective study. J Prosthet Dent 2013;109:44-52. 5. Macgregor FC. Ear deformities: social and psychological implications. Clin Plast Surg 1978;5:347-50. 6. Wolfaardt JF, Coss P. An impression and cast construction technique for implant-retained auricular prostheses. J Prosthet Dent 1996;75:45-9. 7. Beumer J, Curtis TA, Marunick MT. Maxillofacial rehabilitation: prosthodontic and surgical considerations. St Louis: Ishiyaku EuroAmerica Inc; 1996. p. 388. Corresponding author: Dr Ebru D. Cifter Istanbul University 34093, Capa, Istanbul TURKEY Email: [email protected] Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Cifter et al
