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Prosthesis are artificial materials that serve as replacements for a missing
organ or group of organs in an organism . Prosthesis which are applied to a
congenital or acquired tissue deficiency in the maxillofacial area are called
“maxillofacial prosthesis.” Prosthesis which can be removed and replaced by
the patient are called “removable prosthesis,” while prosthesis which the
patient cannot remove or replace are called “fixed prosthesis” . Prosthesis
can be supported by different types of structures in the areas in which they
are applied. By this means , prosthesis can be classified as :-
1. Teeth-supported prosthesis: prosthesis that are supported only by teeth in
the intra-oral area .
2. Tissue-supported prosthesis: prostheses that are supported only by the
tissue in the edentulous area .
3. Teeth-and-tissue-supported prosthesis: prosthesis that are supported by
both teeth and tissue in the area in which prosthesis are applied .
4. Implant-supported prosthesis: prosthesis supported by implants in the
bone .
Maxillofacial Prosthodontics :-
The art and science of anatomic, functional, or cosmetic reconstruction by
means of nonliving substitutes of those regions in the maxilla, mandible, and
face that are missing or defective because of surgical intervention, trauma,
pathology, or developmental or congenital malformations.
Maxillofacial Prosthesis :-
Is an artificial device used to replace missing facial or oral structures.

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These prosthesis may be in :-
1- Intra-oral ( Maxilla&Mandible )
2- Extra-oral ( Ears,Eyes,nose,cranial bones )
Indication of maxillofacial prosthesis :-
1- After surgical intervention.
2- After trauma.
3- Congenital defects.
4- Acquired defects.
The Aim of Maxillofacial Prosthetic :-
- Reconstruct of missing parts in maxilla, mandible and face with prosthesis to
achieve:
1- Preservation of residual structures.
2- Reconstruction of function.
3- Improvement in esthetic.
4- Therapeutic or healing effect.
5- Psychological therapy
The applied prostheses should adhere to the following guidelines :-
1. Should be easily placed and removed
2. Should fix the lost function
3. The appearance should be close to normal
4. Should be easily cleaned
5. Should be long lasting and resistant
6. Should be light and easy to make

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1- Acquired Defects : include those defects that are the
result of trauma, or disease and its treatment. These may
include a soft and/or hard palate defect resulting from
removal of a squamous cell carcinoma of the region .
2- Congenital defects : are typically craniofacial defects
that are present from birth. The most common of these
include cleft defects of the palate that may include the
premaxillary alveolus .
3- Developmental defects : are those defects that occur
because of some genetic predisposition that is expressed
during growth and development .
A functional jaw position developed because of a combination of tooth loss and
growth discrepancy. This developmental defect is illustrated by a protruded and
overclosed mandibular position .

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Maxillofacial Prosthesis Classified to be :
1- Intraoral (involving the oral cavity )
2- Extraoral (cranial or facial replacement )
A. Maxillary Prosthesis:
1. Obturator prosthesis.
2. Feeding aid prosthesis.
3. Speech aid Prosthesis.
4. Palatal treatment prosthesis.
5. Saliva stimulating prosthesis.
6. Palatal lift prosthesis.
7. Palatagmentation prosthesis.
B. Mandibular Prosthesis:
1. Mandibulectomy prosthesis.
2.Marginal mandibulectomy
prosthesis.
3. Mandibular guide flange
prosthesis.
4.Interarch fixation prosthesis.
5. Stent prosthesis.
C. Tongue Prosthesis

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That component of a prosthesis that fits into and closes a defect within the oral
cavity or other body defect . An obturator fulfills many functions :
1. It helps in feeding.
2. Helps in keeping surgical site clean.
3. Enhances healing of traumatized tissues.
4. Helps to reshape and reconstruct palatal contour.
5. Improves speech or makes speech possible.
6. Used to improve deglutition and mastication.
7. Reduces flow of nasal exudates into mouth.
Obturators prosthesis is classified as :-
1- Surgical obturator :- It is a prosthesis inserted immediately after operation ,
lasts 10-14 days after surgery , the Material used mostly acrylic and the advantage
of the surgical obturator is maintain function (feeding , speech) , Promote healing ,
Restore esthetic , Act as stint (keep surgical pack and medication close to the
wound) , Improve psychology of the patient and Prevent contamination of the
wound .
2- Interim obturator :- Constructed few days after operation to help in restoring
oro-nasal function , Carries teeth and stays 3- 6 months , the function of the
interim obturator is help in restoring Speech , Feeding , Esthetics and Prevent
wound contamination.
3- Definitive Obturator :- After the interim obturator has been worn for 3-6
months the definitive obturator is fabricated. For the dentulous patient it usually
has a metal framework and cast clasps with hollow bulb orbturator. For the
edentulous patient the obturator is fabricated along with the denture and it serves
in retention, however, care should also be taken to record the limiting structures
accurately during impression procedures . The obturator itself can either be
fabricated in acrylic or silicone.
Obturators

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A removable maxillofacial prosthesis used to restore an required or congenital
defect of the soft palate with a portion extending into the pharynx to separate the
oropharynx &nasopharynx during phonation &deglutition, thereby completing
pharyngeal sphincter , this prosthesis consist of
1- palatal component which contacts the teeth to provide stability and anchorage
for retention; a palatal extension, which crosses the residual soft palate .
2- a pharyngeal component which fills the palatopharyngeal port during muscular
function, serving to restore the speech valve of the palatopharyngeal region .
A prosthesis which maintains the right &left maxillary segments of an infant cleft
palate patient in their proper orientation until surgery is performed to repair the
cleft. It closes the oral- nasal cavity defect, thus enhancing sucking &swallowing.
Used on an interim basis, achieves separation of the oral &nasal cavities in infants
born with wide clefts necessitating delayed closure. It is eliminated if surgical
closure can be affected or alternatively, with eruption of the deciduous dentition, a
pediatric speech aid may be made to facilitate closure of the defect .
Speech aid Prosthesis
Feeding aid prosthesis

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The palatal lift prosthesis (PLP) is used to improve soft palate dysfunction. The PLP
places the soft palate in contact with the lateral and posterior pharyngeal walls to
prevent nasal air escape during speech and prevent regurgitation of food and liquid
during swallowing .
The meatus obturator was first described by Schalit in 1946.It only provides static
obturation and is not dependent on surrounding muscle activity to provide
physiologic separation between the oral and nasal structures. It is not located in a
region of muscle activity; therefore is not effective in refinement of speech, as seen
with the pharyngeal obturators. For this reason the meatus obturator has not
proved to be as effective as the horizontal obturator in cleft palate patients .
Palatal lift Prosthesis
Meatus Obturator

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A maxillofacial prosthesis used to maintain a functional position for the jaws
(maxilla and mandible), improve speech and deglutition following trauma and/or
surgery to the mandible and/or adjacent structures. The main objective of using
guidance prosthesis is to re-educate the mandibular muscles to re-establish an
acceptable occlusal relationship (physiotherapeutic function) for residual hemi-
mandible
IS characterized by a very low palate that allows the tongue (which has limited
mobility) to come in contact during swallowing and speaking, thus allowing easy
articulation of speech and trouble free swallowing .
Mandibular Resection Prosthesis
Palatal augmentation prosthesis

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An ocular prosthesis, artificial eye or glass eye is a type of craniofacial prosthesis
that replaces an absent natural eye following an enucleation, evisceration, or
orbital exenteration. The prosthesis fits over an orbital implant and under the
eyelids.in this type of prosthesis can use many method for fixation like adhesive
method or implant depending upon the size of defect area .
1-Ocular prosthesis-eye.
2. Nasal prosthesis -nose.
3. Auricular prosthesis- ear.
4. Part of the face.
5. Nasal stent-prevent nasal septum
collapse.
6. Cranial prosthesis - cranial bone.
7. Radiation stent- direct the radiation
beam .
Ocular prosthesis (eyes)

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Facial defects resulting from neoplasm, congenital malformation or trauma can be
restored with facial prosthesis using different materials and retention methods to
achieve life-like look and function. A nasal prosthesis can re-establish esthetic form
and anatomic contours for mid-facial defects, often more effectively than by
surgical reconstruction as the nose is relatively immobile structure. For successful
results, lot of factors such as harmony, texture, color matching and blending of
tissue interface with the prosthesis are important . fabrication of a nasal prosthesis
require creation of an original mold .
Placement of enosseous implants in the temporal bone may overcome the
apparent disadvantages of skin adhesives and skinpockets for the fixation of
auricular prostheses. it is obvious that osseointegrated implants have great
advantages compared with skin adhesives and skinpockets to rehabilitate patients
suffering from auricular defects especially in patients with hair in this area and
absent of anatomic irregularities . The major achievement of implant-supported
auricular prostheses is the patients″ increased comfort and confidence wearing
these types of prostheses .
Nasal prosthesis (nose)
Auricular prosthesis (ear)

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An external cranial protective device which provides a
protective and aesthetically pleasing function in protecting
the brain of an individual where a section of the bone has
been removed from the skull or face .
Like any other specialty in dentistry the success in the field of maxillofacial
prosthodontics also depend a lot on the appropriate knowledge about dental
material sciences related to it. A skillful dentist would exploit this knowledge to
fabricate prosthesis with best possible esthetics, functions and durability. Materials
used in the construction of facial and body prosthesis are varied. Materials for
maxillofacial prosthetic reconstruction span the full range of chemical structures,
with physical properties ranging from hard, stiff alloys, ceramics and polymers to
soft, flexible polymers and their formulation as latex and plastisols. The scope of
this article is in providing some background about the evolution and current trends
in using these materials.
DESIRED PROPERTIES :-
1- Esthetic Properties : Color, texture, form and translucence must duplicate that
of missing structure and adjacent skin.
2- Physical Properties :
● Material should have sufficient flexibility that it is comfortable in movable tissue.
● Dimensionally stable.
● Light in weight.
● Good edge strength.
● Low thermal conductivity.
Cranial prosthesis
Maxillofacial Prosthesis Materials

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3- Biologic and Chemical Properties :
● should be stable when exposed to ultraviolet rays, oxygen , and adhering.
● Nontoxic, Nonallergic, Noncarcinogenic.
● Biocompatible.
● Resistance to stains.
● It should be durable for at least 6 months without compromising esthetic and
physical properties.
4- Fabrication Properties :
● Material should be easily processed.
● Polymerization should occur at low temperature to permit reusability of molds.
● Working time should be sufficient.
● Materials should be adaptable to intrinsic as well as extrinsic coloration.
-ilable :Materials ava
1- Silicones : The silicones are probably the most widely used materials for facial
restorations but they exhibit objectionable properties that prevent them from
being accepted by all clinicians. Silicones are a combination of organic and
inorganic compounds. They are of two basic types :
1. Room temperature vulcanizing (RTV) : RTV (room-temperature vulcanized)
silicones became popular not only because of their good physical properties but also
because they are easily processed. The physical properties of RTV silicones are good,
processing and colorization are easy, and they provide opportunities to use gypsum
muffles.
2. Heat vulcanizing (HTV) : Designed for higher tear resistance in engineering
applications, this type of polymer requires more intense mechanical milling of the
solid HTV stock elastomers compared with the soft putty RTV silicone, especially for
incorporating the required catalyst for cross link .

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2- Acrylic resin : Polymethyl methacrylate was once commonly used for
maxillofacial prostheses and is still used occasionally to make artificial facial parts.
Its can be successfully employed for specific types of facial defects, particularly
those in which little movement occurs in the tissue bed during function (e.g.
fabrication of orbital prostheses). Acrylic resin is easily available, easy to stain and
color, has good strength to be fabricated with feather margin and a good life of
about 2 years.
3- Acrylic copolymer : Acrylic copolymers are soft and elastic but have poor
edge strength, poor durability and being subject to degradation when exposed to
sunlight. In addition complete restoration is often tacky predisposing to direct
collection and staining.
4- Polyvinyl chloride and copolymer : Polyvinylchloride has been used
widely for maxillofacial application, but it has been replaced by never material with
superior properties. It was the most widely used plastics for maxillofacial
prostheses. Polyvinyl chloride is a rigid plastic that is clear, tasteless, and odorless,
with a glass transition temperature higher than room temperature. For
maxillofacial application plasticizers are added to produce an elastomer at room
temperature.
5- Materials of the 3rd Millennium : Remerdale EH stated that the
materials of the 3rd millennium are expected to be translucent and should have
pigmentation ability to match any skin color, they should have :
• Increased elongation and tear strength.
• Should be easily moldable.
• They should readily accept extrinsic coloration.
• High temperature – metal molds should not be necessary.

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Comparison of Silicone- and Acrylic-Based Soft Lining Materials
There are significant differences between silicone and acrylic based soft
lining materials, as listed below:
1. Silicone-based soft lining materials can maintain their softness longer than
acrylic-based materials. This difference comes from their main structure‟s
softness. But for the acrylic materials, plasticizers are added into them in
order to make them soft. Hardening is seen as these materials leak by time.
2. Silicone-based soft lining materials are more resistant to color change
compared to acrylic-based ones.
3. Acrylic-based soft lining materials bind better to the acrylic base plate
because of their structure. 4. Acrylic-based soft lining materials absorb more
water than silicon materials.
5. Silicone-type materials are more elastic than the acrylic ones. Thereby,
they can be used more successfully in cases with undercut.
6. Silicone-based soft lining materials allow fungal microorganisms to
reproduce at a higher rate, as acrylic materials have a bacteriostatic effect.

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Primary impression:
A gauze pack may be placed in the defect undercut area &the preliminary impression
was made in a stock tray using irreversible hydrocolloid impression material as the
tissues were in the healing phase, be careful because in certain cases alginate may be
tear in the defect area during removal. Silicon impression material can be used. In
some cases 2 compatible impression materials can be used in modified technique. The
impression must extend as possible in the defected areas. The primary cast obtained
was used to fabricate a custom tray for the definitive impression. Any undercuts may
interfere with tray construction must be blocked. Relief areas must be determined also.
Proper border molding is done on the non-defect side of the denture, by following the
conventional methods of denture fabrication.
:Final impression
of the defect area is made in rubber base impression materials. Sectional trays or
double trays technique can be used but this might complicate the procedure .A master
cast is procured out of it and the borders are outlined for the record bases. The
undercuts on the sides of the defect are blocked with wax and also, the internal part of
the cavity is painted with a thin layer of wax before making the acrylic record bases.
Digital impression:
laser surface scanning was applied to acquired three-dimensional imaging data of the
patient’s facial defect. Transferred to a CAD/CAM interactive program in computer
system for image processing produced a model for fabrication of the facial prosthesis
Jaw relation:
record is made by a conventional method, an attempt must made to compensate for the
loss of facial support on the defect side to improve the esthetics. Minimal block out
should be made because excessive block out result in unstable record base.estimation
of the occlusal plane &wax level is difficult in most of the cases due to the tissue scar
&block out procedure. The record jaw relation was transferred to a semi-adjustable
articulator. Teeth are selected &arranged according to principles.
Treatment Plan

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Verification of jaw relation &esthetic try in:
Waxed up dentures are tried and checked for retention, stability and comfort in the
mouth. It must ensure that there is simultaneous contact of posterior teeth at centric
relation position. Adjust the occlusal plane &teeth alignment, scars &asymmetry of
the face due to surgery may require some modifications &extra-care. The patient
approval regarding esthetics must also obtain.
Flasking:
The wax up denture is flasked &dewaxed, finally during the procedure, a layer of
acrylic in dough stage should be packed to the walls of the defect. The center space is
filled with salt &an acrylic lid is placed over which acrylic is packed as for a
conventional denture. The obturator is cured &retrieved. A small perforation is made
in cured bulb of the obturator &salt is flushed out using water in a syringe &the
perforation is seated with autopolymerizing resin.
Insertion:
all the border must be adjust, use of pressure indicating paste to check for the
pressure areas that must be removed. Jaw relation &occlusion must be checked;
remounting of the prosthesis for occlusal adjustment, premature occlusal contact
must be eliminated to have smooth occlusion. The patient must be instructed
that mastication might be difficult in early time &it is better to use a non-
surgical side; soon the patient will adapt &tolerate the limitations. Adhesives
may be given but concentrate about its used. Give instruction to the patient to
maintain good oral hygiene.

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These prostheses are retained with adhesives, tissue undercuts, or in some cases
extra-oral osseointegrated implant. Facial &intraoral prostheses can be connected
with magnets. The aesthetic result depends on the amount of tissue removed, type
of reconstruction, morbidity adjunctive treatment, and the physical characteristics
of the tissue base available to support &retain the prosthesis.
So prosthesis fixation may be :
1. Anatomic (teeth, alveolar ridge, residual hard palate, undercut)
2. Mechanical.
3. Magnets.
4. Implants.
5. Screw.
Primary factors that affect prosthetic success:
All prostheses must resist a variety of forces that may displace it &generate stress
to the residual structure of the orofacial complex. Prostheses success is often
dependent upon methods of compensation for diminished anatomic capacity for
support, retention &stability of a prosthesis.
Support : Is the ability to resist displacement of the prosthesis towards the
supporting structure. Remaining teeth, remaining edentulous areas &the
postsurgical defect are the supporting tissues for prosthesis & prosthesis loads are
generated through these tissues to the underlying supporting bone.
A.Since the tissue has limited capacity for displacement, the greater the surface
area of tissue contact, the less the displacement of the prosthesis towards the
tissue.
B.Maximum peripheral extension combined with an accurate adaptation to the
remaining teeth, the residual ridges & the postsurgical site will provide the most
favorable support for prosthesis.
Prosthesis fixation:

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Stability : Is the ability to resist displacement of the prosthesis by functional
forces. Adhesives enhance retention through optimizing interfacial force. The
alteration in the normal structures results in diminished potential for support
&retention. Since the majority of forces are not directed towards or away from the
tissue, but generated at an angle to the tissue, it is stability that is tested most
frequently in function.
An alternative method of prosthetic retention has been developed. Endosseous
implants may be used to address the concerns of diminished support, retention
&stability.
Osseointegration in the maxillofacial :
For a facial prosthesis to be successful, it must meet criteria of aesthetic
acceptability, functional performance, biocompatibility, and longevity. As a result
of the problems encountered with adhesive systems, advocacy of the use of
mechanical retention has been made. In the past, mechanical retention has
involved the engagement of divergent undercuts within the defect or the use of
external retention by headbands, elasticized retention, spectacle frames, or other
methods. With the introduction of osseointegrated implants to facial prosthetics,
there is an opportunity to provide secure retention of prostheses without
jeopardizing the integrity of the skin and underlying tissues or the prosthesis.
Advantage of Maxillofacial implants over conventional adhesives :
1-Improved retention and stability of prosthesis.
2-Elimination of occasional skin reactions to adhesives.
3-Ease and enhanced accuracy of prosthesis placement.
4-Improved skin hygiene and patient comfort.
5-Increased longevity of prosthesis.
6-Enhanced esthetics at the lines of junction between the prosthesis and skin.

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Criteria of success of Maxillofacial implants :
1- The implants should be immobile, as verified by clinical examination.
2- No prolonged symptoms, such as pain, infection, tactile disorders, or nerve
damage, should be present in connection with the implants.
3- Penetrated soft tissueshould be free from irritation in skin-penetrating at least
85% of the regular outpatient postoperative check ups.
4- At least 95% of the temporal bone implants and at least 75% of other extra oral
implants should be functional after 5 years.
Case 1:
• In May 1950 a 58 year old man entered the hospital for prosthetic
reconstruction after radical surgery of the right eye and zygomatic area,
necessitated by carcinoma. The surrounding tissues were well healed with no
evidence of recurrence of the carcinoma.The perforation was packed with
cotton, and a facial impression was made with alginate. Stone plaster was
used to make a working model. The prosthesis was sculptured in dental
baseplate wax. A plastic eye was selected and inserted in the wax model. The
prosthesis was finished with soft acrylic resin. Eyelashes and coloring were
then added. Retention was obtained from the nasal surface of the deformity
and from the bridge of the glasses.

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Case 2:
In January 1949 a 23 year old white man was referred to the hospital for
further treatment of a repaired bilateral cleft lip and cleft palate. Because of
a previous postoperative infection, surgery of the palate had been
unsuccessful. Examination revealed a maxilla resembling an infant’s. There
were three teeth were made. Retention for the maxillary denture was
obtained by means of cast gold clasps.
1- https://www.hindawi.com/journals/ijd/2019/8657619/
2- https://slideplayer.com/slide/13171575/
3- Text book:Maxillofacial Prosthetic Materials: A Literature Review Harsh
Mahajan, Kshitij Gupta
4- Text book:Maxillofacial prosthetic materials : SK Khindria, Sanjay Bansal, Megha
Kansal Department of Prosthodontics, MM College of Dental Sciences and
Research, Mullana, Ambala, India
5-Text book:OVERVIEW OF MAXILLOFACIAL PROSTHETICS.ARZU ATAY, M.D.
SURGERY - PROCEDURES, COMPLICATIONS, AND RESULTS
6- Text book :Maxillofacial prosthesis. William H. Olin, D.D.S., M.S., I o w a City
References

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