Implant-retained digital prostheses with custom-designed attachments: a clinical report

Fabrication and assessment of partial finger prostheses made using 3D-printed molds: A case study

3D printing for custom prosthetic finger fabrication can have better fit and comfort than non-custom off-the-shelf ones while reducing fabrication labor time. The purpose of this case study was (1) to design and fabricate custom prosthetic fingers using 3D-printed molds for the treatment of partial finger amputation; (2) to evaluate patient satisfaction of the custom prosthetic fingers fabricated using 3D-printed molds and compare them to the custom prosthetic fingers fabricated through a conventional method of molding using plaster casts. The method to develop the custom prosthetic finger are as follows: (1) The shapes of the residual digits and contralateral fingers were acquired using a high-resolution 3D optical scanner. (2) Prosthetic fingers were designed by modifying the model of the residual digits and the contralateral fingers. (3) Molds of the prosthetic fingers were designed using computer-aided design software and fabricated by 3D printing. The study compared hand function tests and rehabilitation outcome surveys to evaluate the performance of the prosthetic fingers fabricated using 3D-printed molds and plaster casts. This case suggests that the prosthetic fingers fabricated using 3D-printed molds had comparable performance to the prosthetic fingers fabricated using plaster casts. The aesthetics and transparency of the prosthetic fingers contributed highly to the low satisfaction of the prosthetic fingers fabricated using 3D-printed molds.

Aesthetic rehabilitation of amputated phalanx by three part mould technique using silicone elastomer – case report

The unfortunate loss of all or part of a finger caused by traumatic amputation has a negative impact on physical and psychological well-being of a person. Thus an aesthetic prosthesis can offer psychological, functional and rehabilitative advantages. One of the major problems with the prosthetic replacement of a partially amputated finger is inadequate retention of the prosthesis and there are numerous means to enhance the retention. The most routinely used are adhesives, adhesive tape, magnets and implants. The present article describes a technique which utilizes room temperature vulcanizing silicone (RTV) as a prosthetic material retained by preformed artificial rings. Such treatment can be opted for in cases of financial constraints.

Simplified prosthetic rehabilitation of a patient with partial finger amputation after a firearm injury

OBJECTIVE

This study reports a clinical case of rehabilitation of a patient who had her left little finger amputated at the mesial phalanx because of a gunshot wound. The finger prosthesis was custom- made using a silicone.

CASE DESCRIPTION

This study presents a clinical case of a female patient who had her left little finger amputated at the mesial phalanx because of a gunshot wound in 2016. The patient was attended at a reference center in maxillofacial rehabilitation in the city of Brasilia, Distrito Federal, Brazil, for the manufacture of a finger prosthesis. After molding, a finger waxing was obtained using the right little finger as a template. The waxing was later adjusted on the plaster model of the affected stump. The prosthesis was manufactured with silicone and intrinsically stained with a makeup powder. A water-based adhesive and a ring were used to generate a slight compression so that the prosthesis was retained on the stump.

OUTCOMES

The rehabilitation showed satisfactory levels of stability, retention, and aesthetics, and it was usable and clinically acceptable, as observed in a follow-up appointment in February 2020.

CONCLUSIONS

The complete or partial reestablishment of functions performed by important structures, such as the fingers, is essential to increase the quality of life of individuals, improving their performance of daily activities. In addition, reporting on this public health problem allows scientific advancement in the area.

Osseointegrated Metallic Implants for Finger Amputees: A Review of the Literature

Digital trauma amputations and digital agenesis strongly affect the functionality and aesthetic appearance of the hand. Autologous reconstruction is the gold standard of treatment. Unfortunately, microsurgical options and transplantation procedures are not possible for patients who present contraindications or refuse to undergo transplantation from the toe (e.g. toe‐to‐thumb transplantation). To address these issues, osseointegrated finger prostheses are a promising alternative. The functional assessments registered during follow‐up confirmed the promising outcomes of osseointegrated prostheses in the treatment of hand finger amputees. This review outlines (a) a detailed analysis of osseointegrated finger metallic components of the implants, (b) the surgical procedures suggested in the literature, and (c) the functional assessments and promising outcomes that demonstrate the potential of these medical osseointegrated devices in the treatment of finger amputees.

Use of silicone finger prostheses in amputee patients: An integrative review

This study aimed to perform an integrative review of the literature on the use of silicone finger prostheses in amputee patients. Searches were performed in the PubMed, EMBASE, Web of Science, Scielo, and Cochrane Library databases until July 2021. Descriptors used in this article were: Silicone, finger, rehabilitation, and prosthesis. Clinical research and clinical reports on silicone finger prostheses, available in full and in English were included. Initially, 152 articles were identified. After establishing the inclusion/exclusion criteria, 23 studies were identified and constituted the final sample. Regarding the publication date of the included studies, 17.2% of them were published between 2012 and 2016. Most of the rehabilitations occurred in India (69.9%; n = 16), and the mean age of patients who used prostheses was 38.1 years. The level of scientific evidence of the included studies was IV and VI. Therefore, patients rehabilitated with silicone finger prostheses highlighted significant improvements in functional range of motion, restoration of self-esteem, advantages in psychological therapy, more pleasant social interaction, and changes in their quality of life.

Osseo integrated finger prosthesis with a custom abutment

One of the most regularly encountered forms of partial hand loss causing physical, psychosocial and financial burden to an individual is the finger amputation followed by trauma. The prosthetic rehabilitation of amputated finger is a good treatment option, when compared to all other means of complex and unaffordable options. Osseointegrated implant retained silicone finger prosthesis with innovative prosthetic designs can provide the patient a life changing experience.

Osseointegrated Finger Prostheses Using a Tripod Titanium Mini-Plate

Background

Digital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients.

Methods

A retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded.

Results

Seven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported.

Conclusions

When autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.

Interdisciplinary approach for somatoprosthetic rehabilitation of a patient with clino-syndactyly and unusual dermatoglyphics

BACKGROUND

Traumatic injuries are the most common cause of finger amputations. Therapeutic amputations are less common but may be essential in some patients with congenital malformations of digits.

CASE DESCRIPTION AND METHODS

A 21-year-old female patient reported for esthetic management of malformed middle and ring finger of right hand. Examination revealed clino-syndactyly with unusual dermatoglyphics. She was successfully rehabilitated by collaborative efforts of plastic surgeon and prosthodontist, by therapeutic amputation with surgical recontouring and fabrication of somatoprosthesis.

FINDINGS AND OUTCOMES

The patient was satisfied with esthetics of the prosthesis and somatoprosthesis improved function. At 6-month recall, no alterations or repair of prosthesis was required.

CONCLUSION

Individualized treatment planning with integration of modifications involving a multidisciplinary approach is required to meet needs of patients with congenital digital malformations. The duplication of unusual dermatoglyphics made the prosthesis more realistic.

CLINICAL RELEVANCE

An individualized treatment plan with modifications to conventional techniques is required to cater to rehabilitative needs of patients with congenital digital malformations.

Biocompatibility of primers and an adhesive used for implant-retained maxillofacial prostheses: An in vitro analysis

STATEMENT OF PROBLEM

Implant-retained maxillofacial prostheses should be biocompatible, regardless of the primers and adhesives used to bond the acrylic resin and facial silicone. The authors are unaware of any study evaluating the influence of these primers and adhesives on the biocompatibility of maxillofacial prostheses.

PURPOSE

The purpose of this in vitro study was to evaluate the cytotoxic effect of primers and an adhesive used to bond acrylic resin and facial silicone during the fabrication of implant-retained maxillofacial prostheses.

MATERIAL AND METHODS

Twenty-eight circular specimens made of resin and silicone were fabricated, either bonded or nonbonded with primer and adhesive. The specimens were divided into 7 groups: resin; silicone; resin+silastic medical adhesive type A+silicone; resin+DC 1205 primer silicone; resin+Sofreliner primer+silicone; resin+DC 1205 primer+silastic medical adhesive type A+silicone; and resin+Sofreliner primer+silastic medical adhesive type A+silicone. Eluates of the materials tested were prepared by setting 4 specimens of each experimental group in Falcon tubes with medium and incubating at 37°C for 24 hours. The eluate cytotoxicity was evaluated by an assay of survival/proliferation ((3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide [MTT] test) in cultures of human keratinocytes. The levels of IL1, IL6, TNFα, and the chemokine MIP-1α were evaluated by enzyme-linked immunosorbent assay. The mRNA expressions for MMP-9, TGF-β, and collagen type IV were analyzed by the real time polymerase chain reaction. Data were submitted to analysis of variance with Bonferroni post hoc tests (α=.05).

RESULTS

An increased cell proliferation was observed for the RAS group, with statistically significant differences (P<.001) compared with the unstimulated group. The RDCpS group showed the highest IL6 concentration values (P<.001). No significant statistical difference was found in the relative quantification of mRNA for collagen type IV, MMP9, or TGFβ between the groups (P>.05).

CONCLUSIONS

The RAS group showed the highest cell proliferation percentage, while the RDCpS group exhibited the highest IL6 concentration values. No detectable levels of IL1β, TNF α, or CCL3/MIP1α were observed. The tested materials showed no toxic effects on the HaCaT cell line.

Rapid fabrication of a digital prosthesis

Finger prosthesis often needs refabrication due to its discoloration following use. This article presents a novel, economical, and cost-effective technique to duplicate the patient׳s existing prosthesis to obtain a new wax replica, which is then clinically tried and processed to obtain new silicone finger prosthesis. This technique requires comparatively less clinical and laboratory steps as to fabricate an entirely new prosthesis. The newly fabricated silicone finger prosthesis has the fit and marginal adaptation of the patient׳s existing prosthesis but the esthetics is improved.

Rehabilitation of amputed thumb with a silicone prosthesis

Creating prosthesis, having realistic skin surface and seamless visual integration with the surrounding tissues, requires both artistic and technical skill. Anatomical design, thin margins, lifelike fingernails and realistic color/contours are essential for patient satisfaction. Prosthesis is especially useful in case of lost body parts, as reconstructive surgery cannot fully restore aesthetics. This case report describes a simple technique for fabricating silicon finger prosthesis for a patient.

Osseointegrated silicone finger prosthesis using dental implants: a renovated technique

AIM AND BACKGROUND

In clinical practice, we come across patients with traumatically amputated or congenitally missing partial or complete fingers that can be restored using microsurgical replantation or transplantation procedures. However, in some cases this might not be possible due to systemic or local factors and the lost or missing part has to be replaced prosthetically to offer psychological and functional wellbeing. These prostheses can be constructed with various materials like acrylics or silicone retained with the help of auxiliary aids. However, these prostheses cause some hindrance in performing functions like writing, typing, etc. The aim of the present trial was to ameliorate the existing design of implant supported finger prosthesis.

TECHNIQUE

Distal phalange of middle finger replaced with implant supported silicone finger prosthesis is modified by utilizing a metal framework to support silicone material to improve rigidity while working.

CONCLUSION AND CLINICAL SIGNIFICANCE

We could achieve a good function, esthetics and tactile sensibility with this modified design. Whenever, feasible this design can improve the performance and patients feel a deep sense of satisfaction and improved self-esteem with this modified prosthesis.

Acrylic finger prosthesis: a case report

Hands basic function is to grasp, hold and manipulate items. Hand gesture is perhaps the most blatant example of non-verbal communication. Finger and partial finger amputations are most frequently encountered forms of partial hand loss. Common causes are traumatic injuries, congenital absence or malformations present great clinical challenges. In addition to immediate loss of grasp strength, finger absence may cause marked psychological trauma. Individuals who desire finger replacement usually have high expectation for the appearance of prosthesis. This clinical report portrays simple method to retain acrylic finger prosthesis.

Fabrication of a functional finger prosthesis with simple attachment

Finger prosthesis is more acceptable by the patient when it allows some of the movement in the prosthesis along with the restoration of a natural appearance to the lost structures of the patient. This article describes a custom-fabricated, custom-colored prostheses made from silicone elastomers with a simple attachment to make the prosthesis functional to imitate some of the movement.

One- vs two stage surgery technique for implant placement in finger prosthesis

BACKGROUND

The loss of the finger can lead to psychological problems. Although several reconstructive techniques may exist, the use of osseous-integrated implants to anchor digital prosthesis presents a suitable alternative for the amputation of finger. The surgery for implant placement has initially been described as a two-stage technique. However, no study in the literature has attempted to compare this technique with one-stage technique and stated a clear superiority technique in the implant retained finger prosthesis.

METHODS

This article describes two cases of digital amputation as a result of accident; a 45-year-old female whose second finger of right hand was lost and a 25-year-old male patient with amputation of the first finger of right hand.

RESULT AND CONCLUSION

One-stage implant placement technique for implant retained finger prosthesis is a reliable, safe and efficient option that allows a good result in a significantly lower operating time and hospital visits compared to the two-stage technique. It could therefore, be considered as good option for implant retained finger prosthesis.

Aesthetic finger prosthesis with silicone biomaterial

The fabrication of finger prosthesis is as much an art as it is science. The ideally constructed prosthesis must duplicate the missing structures so precisely that patients can appear in public without fear of attracting unwanted attraction. A 65-years-old patient reported with loss of his right index finger up to the second phalanx and wanted to get it replaced. An impression of the amputated finger and donor were made. A wax pattern of the prosthesis was fabricated using the donor impression; a trial was performed and flasked. Medical grade silicone was intrinsically stained to match the skin tone, following which it was packed, processed and finished. This clinical report describes a method of attaining retention by selective scoring of the master cast of partially amputated finger to enhance the vacuum effect at par with the proportional distribution of the positive forces on the tissues exerted by the prosthesis.

Implant-retained finger prosthesis with modified retention system

BACKGROUND

Amputations affect both the physical and the psychological aspects of an individual, causing significant impact on self-esteem. The main causes of finger amputations are work-related accidents with dangerous machinery, road traffic accidents, and animal bites, as well as systemic diseases such as diabetes. This report aims to describe a simple technique for fabrication of implant-retained finger prosthesis with a modified base of the retention system.

CASE DESCRIPTION AND METHODS

The O-Ring retention system was used with a modified hexagon-shaped base and a metallic capsule adapted to the acrylic resin to attach the prosthesis to the implant.

FINDINGS AND OUTCOMES

The prosthesis was made with silicone, and after osseointegration, it was installed without complications, leading to a patient satisfied with the end result and encouraged to return to social life.

CLINICAL RELEVANCE

Restoring self-esteem in the patient and static and functional rehabilitation.

Design and fabrication of a finger prosthesis based on a new method of suspension

BACKGROUND AND AIM

Finger amputation is one of the most common types of amputation. Prosthesis with adequate suspension, user-friendly design, and an aesthetic appearance can be effective in the rehabilitation of these patients. The aim of this technical note was to propose a technique for fabrication of finger prosthesis with a new suspension approach for such patients.

TECHNIQUE

To design and accurately fabricate the socket of finger prosthesis, the socket was reduced by 2 mm less than the original value, and a central tunnel with 4 mm width and depth with length matching the distance between the end of the stump and the nail section was provided, so that the silicone material extended to the stump to provide appreciable suspension.

DISCUSSION

This study demonstrated the design and fabrication of a silicone finger prosthesis. It also showed silicone finger prosthesis with acceptable suspension, a user-friendly and light design, and a cosmetic appearance constructed for a patient with finger amputation.

CLINICAL RELEVANCE

Patients with finger amputation usually use prostheses with a simple suspension technique, but evidence suggests that the residuum of these patients experience atrophy and subsequently loss of appropriate suspension. Therefore, this study was required to provide an alternative suspension method in patients with finger amputations.

Prosthetic rehabilitation of amputated hallux after distraction osteogenesis: one-year follow-up

BACKGROUND

The great toe helps in maintaining body balance during standing, walking, running, dancing, and so on.

CASE DESCRIPTION AND METHODS

A 22 year-old female patient reported to the department, one month after losing her left hallux in a road accident. Anatomical reconstruction was performed with distraction osteogenesis. The prosthesis was constructed using a wax pattern of the normal hallux to create a silicone prosthesis. The residual limb mold was altered to increase prosthesis retention.

FINDINGS AND OUTCOMES

The procedure was economical, conserved materials, and produced lifelike anatomy without requiring artistic expertise.

CONCLUSION

Distraction osteogenesis helped in improving function and retention of the prosthesis. Satisfactory esthetic and functional results were observed at the one-year follow-up.

CLINICAL RELEVANCE

Distraction osteogenesis of the amputated hallux improved prosthetic prognosis by aiding retention. Modifications were made in the conventional prosthesis fabrication technique to increase retention, as the hallux is in constant movement and/or friction.

Bond strength between acrylic resin and maxillofacial silicone

The development of implant dentistry improved the possibilities of rehabilitation with maxillofacial prosthesis. However, clinically it is difficult to bond the silicone to the attachment system.

Esthetic, functional, and prosthetic outcomes with implant-retained finger prostheses

BACKGROUND

Traumatic amputation of fingers results in a serious impairment of hand function and affects the psychological status of the patients. The implant-retained finger prostheses are an alternative treatment. The aim of this case report is to represent the use of osseointegrated implants for retention of finger prostheses in a patient with amputated thumb and index finger.

CASE DESCRIPTION AND METHODS

Dental implants were placed in the residual bone of the fingers using two-stage surgery. Custom-made attachments were used to provide retention between implants and silicone prostheses. Prosthetic fingernails were made of composite resin material.

FINDINGS AND OUTCOMES

After 6 months, implants were clinically successful, and the patient was satisfied with the appearance and the function of the prostheses. The complications of broken prosthetic nail and mild discoloration were observed.

CONCLUSION

Reconstruction of amputated fingers with implant-retained prosthesis is a worthwhile treatment providing esthetic, functional, and psychological benefits, although some complications might be experienced. Clinical relevance Implant-retained finger prostheses are an acceptable treatment modality for patients with amputated fingers. Evaluating implant prognosis, functional results and prosthetic results of the patients are necessary to address the benefits and complications of the treatment.

Patient-specific prosthetic fingers by remote collaboration--a case study

The concealment of amputation through prosthesis usage can shield an amputee from social stigma and help improve the emotional healing process especially at the early stages of hand or finger loss. However, the traditional techniques in prosthesis fabrication defy this as the patients need numerous visits to the clinics for measurements, fitting and follow-ups. This paper presents a method for constructing a prosthetic finger through online collaboration with the designer. The main input from the amputee comes from the Computer Tomography (CT) data in the region of the affected and the non-affected fingers. These data are sent over the internet and the prosthesis is constructed using visualization, computer-aided design and manufacturing tools. The finished product is then shipped to the patient. A case study with a single patient having an amputated ring finger at the proximal interphalangeal joint shows that the proposed method has a potential to address the patient's psychosocial concerns and minimize the exposure of the finger loss to the public.

Comprehensive prosthetic rehabilitation of a patient with partial finger amputations using silicone biomaterial: A technical note

Finger and partial finger amputations are some of the most frequently encountered forms of partial hand loss. A high quality aesthetic prosthesis with passive function can be helpful to the patient since loss or congenital absence or malformation have both a social and psychological impact on the patient. Prosthetics is an art and science which provides a lifelike appearance to the lost structures of the patient. This case report presents the fabrication of a silicone finger prosthesis which had good suspension, adequate function, was comfortable to use and aesthetically acceptable to the patient.

Osseocutaneous integration of an intraosseous transcutaneous amputation prosthesis implant used for reconstruction of a transhumeral amputee: case report

Exoprosthetic replacement with an artificial limb is the main option for reconstruction after traumatic amputation of an upper limb. Direct skeletal attachment using an osseointegrated implant improves the ease of fixation of the exoprosthesis to the amputation stump. We now report the use of an intraosseous transcutaneous amputation prosthesis that is designed to achieve osseocutaneous integration. Osseocutaneous integration differs from osseointegration because the aim is to create a stable interface among the implant, the bone, and the soft tissues. This reduces the risk of soft tissue infection and troublesome discharge, which are problems encountered with current osseointegrated implants that focus largely on the bone-implant interface. We describe our experience with an intraosseous transcutaneous amputation prosthesis in a case of transhumeral amputation with 2 years of follow-up.

Implant-retained thumb prosthesis with anti-rotational attachment for a geriatric patient

This report presents the use of a dental implant with an anti-rotational attachment for the retention of a thumb prosthesis. A retention system was manufactured with an attachment (UCLA) screwed into the implant with a two-bar system that was cast in metallic silver palladium. A substructure made from heat-cured acrylic resin was joined to the retention system by clips to join the thumb to the finger (bar clip) in the cast with implant rejoinder. The silicone material, Silastic-MDX 44210, was used to achieve function and aesthetics. Following osseointegration, no skin problems were observed. Whilst the implant-retained digital prosthesis presented some motor limitations, it allowed the patient to return to entertainment and achieve social conviviality.

Survival rates and periimplant soft tissue evaluation of extraoral implants over a mean follow-up period of three years

STATEMENT OF PROBLEM

The use of implants with extraoral prostheses provides excellent support, stability, and retention, thereby offering the potential for improving a patient's appearance and quality of life. However, few studies have examined cumulative survival rates of extraoral implants, nor have these reports documented long-term aspects of treatment, such as soft tissue health around abutments.

PURPOSE

The purpose of this study was to evaluate the survival rates and the periimplant soft tissue responses of extraoral implants used to retain facial prostheses.

MATERIAL AND METHODS

Thirty-three patients with auricular, nasal, and orbital anatomical compromise were treated with 98 craniofacial and dental implants. Of the 33 patients, 14 had auricular, 9 had nasal, and 10 had orbital defects. After a 3-month osseointegration period, implant-retained prostheses were fabricated. Following completion of treatment, each patient was seen at 6-month intervals. These examinations were recorded for this patient cohort from 25 to 50 months. Data were analyzed using Kaplan-Meier survival analysis. A 5-point scale was used to record the health of periimplant soft tissues. The unit of measure as a visit/site unit was assigned for each instance and implant site. Periimplant soft tissue reactions were assessed for auricular, nasal, and orbital defects, for each implant site used for these patients' treatments.

RESULTS

The overall cumulative survival rates were 100% for auricular, 83.3% for nasal, and 77.4% for orbital implants, respectively. The survival rates of the implants were 72.7% for those placed in irradiated sites treated without adjunctive HBO therapy, and 93.4% for implants placed in nonirradiated sites. To evaluate the response of the periimplant soft tissues to the implants, a total of 524 visits/sites were recorded. Absence of inflammation (grade 0) of the periabutment soft tissues was observed in 73.3% of the visits/sites.

CONCLUSIONS

The anatomical site into which the implant is placed has an effect on success rate. The auricular site is the most predictable implant site. Survival rates of nasal and orbital implants were found to offer promising results in achieving reliable implant prognoses in these regions. Regardless of the implant site, a decreased survival rate was observed in the irradiated sites. Periimplant soft tissue reactions were most commonly associated with lapses in hygiene.