Frequently used extraoral maxillofacial prosthetic materials and their longevity - A comprehensive review

The longevity of an extraoral prosthesis depends on its physical and mechanical properties and user maintenance. Faced with multiple outcome measures, researchers find it difficult to determine the most appropriate extraoral prosthetic material. This comprehensive review evaluates the most used extraoral prosthesis materials and qualitatively assesses their longevity and function. The study aims to identify and interpret the results of current updates on the factors that affect longevity and functionality. This comprehensive review summarizes and evaluates differences in the properties of commonly used extraoral maxillofacial prosthetic materials. The review was planned to focus on all factors related to the longevity and function of the extraoral maxillofacial prosthetics. An electronic search covered English articles in PubMed, Scopus, Google Scholar, Web of Science, and grey literature. Manual searching was also performed. Six authors participated in the screening. Search engines extracted 1107 records, and 88 studies were included for qualitative and bias assessments. Silicones are the most frequently used extraoral maxillofacial prosthetic materials. Heat-cured silicones are more color-stable than those cured at room temperature. Additional ingredients and processing techniques affect prosthesis longevity.

The Effect of Cigarettes Smoke on the Color and Properties of a Silicone for Maxillofacial Prostheses

Although deterioration of silicone maxillofacial prostheses is severely accentuated in smoking patients, the phenomenon has not been systematically studied. To address a gap in the literature concerning the stability of maxillofacial prostheses during service, in this contribution, the effect of cigarette smoke on the aspect and physical properties of M511 silicone elastomer was evaluated. The aspect, surface, and overall properties of the silicone material, pigmented or not, were followed by AFM, color measurements, FTIR, water contact angle measurements, TGA-DTG and DSC, hardness and compression stress-strain measurements. The types of the contaminants adsorbed were assessed by XRF, ESI-MS, MALDI-MS, and NMR spectral analyses. Important modifications in color, contact angle, surface roughness, local mechanical properties, and thermal properties were found in the silicone material for maxillofacial prostheses after exposure to cigarettes smoke. The presence of lead, nicotine, and several other organic compounds adsorbed into the silicone material was emphasized. Slight decrease in hardness and increase in Young's modulus was found. The combined data show important impact of cigarette smoke on the silicone physical properties and could indicate chemical transformations by secondary cross-linking. To our knowledge, this is the first study making use of complementary physical methods to assess the effect of cigarette smoke on the aspect and integrity of silicone materials for maxillofacial prostheses.

Color Modifications of a Maxillofacial Silicone Elastomer under the Effect of Cigarette Smoke

Although it is known (from the observations of medical professionals) that cigarette smoke negatively affects maxillofacial prostheses, especially through staining/discoloration, systematic research in this regard is limited. Herein, the color modifications of M511 maxillofacial silicone, unpigmented and pigmented with red or skin tone pigments, covered with mattifiers, or with makeup and mattifiers, and directly exposed to cigarette smoke, were investigated by spectrophotometric measurements in the CIELab and RGB color systems. The changes in color parameters are comparatively discussed, showing that the base silicone material without pigmentation and coating undergoes the most significant modifications. Visible and clinically unacceptable changes occurred after direct exposure to only 20 cigarettes. By coating and application of makeup, the material is more resistant to color changes, which suggests that surface treatments provide increased protection to adsorption of the smoke components. The dynamic water vapor sorption (DVS) measurements indicate a decrease of the sorption capacity in pigmented versus unpigmented elastomers, in line with the changes in color parameters.

Silicones for Maxillofacial Prostheses and Their Modifications in Service

The biomedical applications of silicones are countless due to their outstanding properties. In dentistry, silicone for maxillofacial and plastic surgery has become indispensable, from both physiological and aesthetic points of view. In this mini-review, silicone materials for dentistry and facial prostheses are discussed, focusing on their properties and alterations when exposed for long periods to different environments. A significant number of studies reported in the literature have been conducted in vitro, mimicking some of the main degradative factors which have been identified as triggers for discoloration and deterioration of the mechanical properties. Among these, in artificial aging and accelerated natural aging studies, UV radiation is considered the most important. Other weathering factors, biological contamination, and disinfection agents may have dramatic effects as well. Several general properties of silicones are described at the beginning, with a focus on biocompatibility, cross-linking mechanisms, and applications in dentistry and maxillofacial prosthetics. We discuss the ongoing cross-linking and/or possible exudation after manufacturing, which also affects the stability of the prosthesis over time, and possibly the patient. Next, the main environmental factors that affect the prostheses in service are presented, including the role of cigarettes smoke, which has been discussed very little so far. A few aspects, such as biofilm formation, its negative effects, and proposed solutions to overcome this phenomenon regarding silicones, are also described. We conclude by proposing a set of topics for future research and development based on the gaps that have been identified in the literature. Although silicones are probably irreplaceable in maxillofacial prosthetics, improvements in terms of base materials, additives, surface treatments, and maintenance are possible and necessary for long-lasting and safer prostheses.

Polymers in 3D printing of external maxillofacial prostheses and in their retention systems

Maxillofacial defects, arising from trauma, oncological disease or congenital abnormalities, detrimentally affect daily life. Prosthetic repair offers the aesthetic and functional reconstruction with the help of materials mimicking natural tissues. 3D polymer printing enables the design of patient-specific prostheses with high structural complexity, as well as rapid and low-cost fabrication on-demand. However, 3D printing for prosthetics is still in the early stage of development and faces various challenges for widespread use. This is because the most suitable polymers for maxillofacial restoration are soft materials that do not have the required printability, mechanical strength of the printed parts, as well as functionality. This review focuses on the challenges and opportunities of 3D printing techniques for production of polymer maxillofacial prostheses using computer-aided design and modeling software. Review discusses the widely used polymers, as well as their blends and composites, which meet the most important assessment criteria, such as the physicochemical, biological, aesthetic properties and processability in 3D printing. In addition, strategies for improving the polymer properties, such as their printability, mechanical strength, and their ability to print multimaterial and architectural structures are highlighted. The current state of the prosthetic retention system is presented with a focus on actively used polymer adhesives and the recently implemented prosthesis-supporting osseointegrated implants, with an emphasis on their creation from 3D-printed polymers. The successful prosthetics is discussed in terms of the specificity of polymer materials at the restoration site. The approaches and technological prospects are also explored through the examples of the nasal, auricle and ocular prostheses, ranging from prototypes to end-use products.

Evaluation of the Mechanical and Physical Properties of Maxillofacial Silicone Type A-2186 Impregnated with a Hybrid Chitosan-TiO2 Nanocomposite Subjected to Different Accelerated Aging Conditions

The effects of incorporating a pioneer chitosan-TiO2 nanocomposite on the mechanical and physical properties of room-temperature vulcanization (RTV) maxillofacial A-2186 silicone under accelerated aging protocols were rigorously examined. This investigation utilized 450 samples distributed across five distinct silicone classifications and assessed their attributes, such as tensile strength, elongation, tear strength, hardness, and surface roughness, before and after various accelerated aging processes. Statistical methodologies, including a one-way ANOVA, Tukey's HSD, and Dunnett's T3, were employed based on the homogeneity of variance, and several key results were obtained. Silicones infused with 1 wt.% chitosan-TiO2 showed enhanced tensile strength across various aging procedures. Moreover, the 1 wt.% TiO2/Chitosan noncombination (TC) and 2 wt.% TiO2 compositions exhibited pronounced improvements in the elongation percentage. A consistent rise was evident across all silicone categories regarding tear strength, with the 1 wt.% chitosan-TiO2 variant being prominent under certain conditions. Variations in hardness were observed, with the 1 wt.% TC and 3 wt.% chitosan samples showing distinctive responses to certain conditions. Although most samples displayed a decreased surface roughness upon aging, the 1 wt.% chitosan-TiO2 variant frequently countered this trend. This investigation provides insights into the potential of the chitosan-TiO2 nanocomposite to influence silicone properties under aging conditions.

The impact of zirconium dioxide nanoparticles on the color stability of artificially aged heat-polymerized maxillofacial silicone elastomer

The limited service life of craniofacial prostheses due to degradation and color instability is a significant challenge. This in vitro study aimed to determine how zirconium dioxide (ZrO2) nanoparticles affect the color stability of M511 heat temperature vulcanizing (HTV) maxillofacial silicone elastomers after artificial aging. ZrO2 nanoparticles were added at concentrations of 1, 2, and 3 wt% to M511 HTV silicone elastomer. Two intrinsic silicone pigments were used (red and mocha). Silicone with pigment and without ZrO2 nanoparticles were used as the control. Eighty disk-shaped specimens were fabricated and divided into eight experimental groups, each containing ten specimens (n = 10). All specimens were subjected to artificial aging, and color changes were recorded at 252, 504, and 1008 h intervals. The L*a *b * values were measured using a colorimeter and the CIE-Lab system. To interpret the recorded color differences, a 50:50 percent perceptibility threshold (ΔE* = 1.1) and acceptability threshold (ΔE* = 3.0) were implemented. A one-way analysis of variance and Tukey's post hoc test at a significance level of 0.05 were used for the statistical analysis. We found that every evaluated specimen group exhibited a chromatic change (ΔE* > 0). The ΔE* values for the mocha pigments with and without ZrO2 nanoparticles were below the perceptible threshold (1.1 units). The ΔE* values of the red pigment with and without ZrO2 nanoparticles were significantly higher than the acceptable threshold (P < 0.000). According to the findings of this in vitro study, all the specimens underwent color changes (ΔE* > 0). The red pigment exhibited highly significant chromatic alterations. In contrast, mocha pigments with and without ZrO2 nanoparticles exhibited the least color change and were below the perceptible threshold. ZrO2 nanoparticles provided important protection and showed a reduction in color change.

Cohesive Zone Modeling of Pull-Out Test for Dental Fiber-Silicone Polymer

BACKGROUND

Several analytical methods for the fiber pull-out test have been developed to evaluate the bond strength of fiber-matrix systems. We aimed to investigate the debonding mechanism of a fiber-silicone pull-out specimen and validate the experimental data using 3D-FEM and a cohesive element approach.

METHODS

A 3D model of a fiber-silicone pull-out testing specimen was established by pre-processing CT images of the typical specimen. The materials on the scans were posted in three different cross-sectional views using ScanIP and imported to ScanFE in which 3D generation was implemented for all of the image slices. This file was exported in FEA format and was imported in the FEA software (PATRAN/ABAQUS, version r2) for generating solid mesh, boundary conditions, and material properties attribution, as well as load case creation and data processing.

RESULTS

The FEM cohesive zone pull-out force versus displacement curve showed an initial linear response. The Von Mises stress concentration was distributed along the fiber-silicone interface. The damage in the principal stresses' directions S11, S22, and S33, which represented the maximum possible magnitude of tensile and compressive stress at the fiber-silicone interface, showed that the stress is higher in the direction S33 (stress acting in the Z-direction) in which the lower damage criterion was higher as well when compared to S11 (stress acting in the XY plane) and S23 (stress acting in the YZ plane).

CONCLUSIONS

The comparison between the experimental values and the results from the finite element simulations show that the proposed cohesive zone model accurately reproduces the experimental results. These results are considered almost identical to the experimental observations about the interface. The cohesive element approach is a potential function that takes into account the shear effects with many advantages related to its ability to predict the initiation and progress of the fiber-silicone debonding during pull-out tests. A disadvantage of this approach is the computational effort required for the simulation and analysis process. A good understanding of the parameters related to the cohesive laws is responsible for a successful simulation.

Hybrid Chitosan-TiO2 Nanocomposite Impregnated in Type A-2186 Maxillofacial Silicone Subjected to Different Accelerated Aging Conditions: An Evaluation of Color Stability

This study explores the impact of the incorporation of a chitosan-TiO2 nanocomposite on the color stability of pigmented room-temperature vulcanization maxillofacial silicone under various accelerated aging conditions. Five hundred disk-shaped specimens were formed with type A-2186 silicone elastomer, and they were distributed into groups based on pigment types and nanoparticle treatments. The color difference (ΔE) was assessed using a colorimeter in the CIELAB color system before and after exposure to aging conditions, including UV-accelerated aging and outdoor weathering. ANOVA, Dennett's T3, and Tukey HSD tests revealed significant color alterations across all silicone types, with the most pronounced being in the red-colored 3% chitosan specimens and the least pronounced being in the 2% TiO2 specimens that underwent UV-accelerated aging. Outdoor weathering consistently increased the ΔE values across all categories. This study suggests that while nanoparticles may offer some resistance against accelerated aging, they fall short in adequately defending against UV radiation during outdoor weathering.

Mechanical properties and bonding of maxillofacial silicone elastomer mixed with nano-sized anti-microbials

OBJECTIVES

The antibacterial efficacy of silicone is improved by impregnating it with antimicrobials such as chlorohexidine and zinc oxide. The purpose of this study was to examine mechanical properties and bonding of maxillofacial silicone elastomer mixed with Zinc Oxide nanoparticles (ZnO-NP), and Chlorohexidine Diacetate Salt (CHX) at three different concentrations (1 %, 3 %, and 5 %).

METHODS

Specimens of a silicone elastomer (M511) were prepared and divided into 7 groups. Group 1 was control of no additive. Groups 2-4 included silicone elastomer mixed with ZnO-NP (surface area = 67 m2/g) at 3 different concentrations (by weight %); 1 %, 3 % and 5 %. Groups 5-7 included silicone elastomer mixed with CHX at the same concentrations. Tear and tensile strengths, elongation percentage, modulus of elasticity, and shear bond strength to primed acrylic resin surfaces were evaluated. Data was analyzed with 1-way ANOVA, Bonferroni, and Dunnett's T3 post-hoc tests (P < 0.05).

RESULTS

There was significant effect of the additives on the tensile strength, elongation percentage, tear strength, and shear bond strength (P < 0.05). Shear bond strengths ranged from 0.55 to 0.96 MPa. Silicone elastomer mixed with CHX (5 %) resulted in the highest shear bond strength (P < 0.05). Non-linear regressions between tensile strength and ZnO and CHX additives were 0.95 and 0.96 respectively.

SIGNIFICANCE

All additives reduced the tensile strength of the silicone. However, CHX at 5 % optimized shear bond strength and thus is proposed in order to fabricate maxillofacial prostheses of sufficient mechanical properties, bonding and antimicrobial activity.

Colour Stability of Two Commercially Available Maxillofacial Prosthetic Elastomers after Outdoor Weathering in Al Jouf Province

Facial prostheses are created from special elastomers modified for their specific physical and mechanical properties; however, they also show two common major clinical problems: gradual discolouration of the prosthesis over time in service environment and deterioration of static, dynamic, and physical properties. As a result of external environmental factors, facial prostheses may become discoloured and discolour by changing colour from intrinsic and extrinsic colouring, and this is associated with the intrinsic colour stability of elastomers and colourants. Thus, in this in vitro study, a comparative evaluation of the effect of outdoor weathering on the colour stability of A-103 and A-2000 room-temperature vulcanised silicones used for maxillofacial prosthesis was conducted. To accomplish this study, a total of 80 samples were fabricated, 40 samples of each material were grouped as clear (20) and pigmented (20). These samples were mounted on wooden board and the assembly was placed on the roof of the dental school from October 2021 to March 2022. To maximise the amount of sunlight on the specimens, the exposure rack was set on five 68° angles from horizontal and also to prevent standing water. The specimens were left uncovered during exposure. The testing of samples was conducted with the help of a spectrophotometer. The colour values were recorded in the CIELAB colour system. It describes the three colour coordinates (colour values) x, y, and z in three new reference values of L, a, and b, aiding in numerically classifying colour differences. After 2, 4, and 6 months of weathering, testing was conducted using a spectrophotometer and the colour change (ΔE) was calculated. The A-103 RTV silicone group with pigmentation showed the maximum change in colour after six months of environmental conditioning. The data for colour difference within groups were analysed using a one-way ANOVA test. Tukey's post hoc test assessed the pairwise mean comparison's contribution to the overall significant difference. The nonpigmented A-2000 RTV silicone group showed the maximum change in colour after six months of environmental conditioning. After 2, 4, and 6 months of environmental conditioning, pigmented A-2000 RTV silicone showed better colour stability than A-103 RTV silicone. The patients requiring facial prosthesis do need to work on outdoor fields, and thus weathering will have deleterious effects on such prosthesis. Hence, the selection of appropriate silicone material with respect to the Al Jouf province region is crucial, which includes economic, durable, and colour stability.

Titanium Dioxide/Polysiloxane Composites: Preparation, Characterization and Study of Their Color Stability Using Thermochromic Pigments

In order to improve thermomechanical, antibacterial and temperature-controlled color-response performance of polydimethylsiloxane (PDMS) in maxillofacial prostheses, the incorporation of titania (TiO2) nanoparticles and thermochromic pigments (TCP) into PDMS was examined. The thermal transitions of TiO2/PDMS nanocomposites, investigated by differential scanning calorimetry (DSC), remain almost unaffected, while an increase of the crystallinity of PDMS was recorded in specimens with higher titania concentrations. The incorporation of titania improves the thermal stability, as it was revealed by thermogravimetric analysis (TGA), as well as the tensile properties of the reinforced elastomer. Nanocomposites with 10 wt% titania presented antibacterial activity against Escherichia Coli, leading to 72% reduction of the bacterial colony after 3 h of exposure. Specimens colored with red TCP (0.2 and 0.6 wt%) showed significant color change at a lower temperature (−20 °C) in comparison with that at an ambient temperature, especially at lower TCP concentration (0.2 wt%). Accelerating aging experiments, consisting of repeated cycles of combined exposure to UV-radiation and damp heating, of PDMS colored with TCP showed poor color stability of the specimens, from the first hours of exposure. The addition of titania to polysiloxane specimens works as an opacifier providing a positive effect on the color stability of the examined thermochromic pigment.

Bonding strength of 3D printed silicone and titanium retention magnets for maxillofacial prosthetics application

PURPOSE

To assess the bonding between conventional and additively manufactured silicone elastomers and cylindrical retention titanium magnets for anchorage of facial prostheses.

METHODS

The customized titanium retention magnets were embedded in conventional and additively produced silicone blocks without primer application (n = 20) and with two commercially available primers G611 (n = 20) and A304 (n = 20) applied onto the magnet surface. The pull out test was performed in the universal testing machine using 45° and 90° angulation and the pull out strength was measured for each group. Additionally the SEM images of the pulled out magnets' surface were obtained and the amount of residual silicone onto the magnet surface was quantified.

RESULTS

Significantly higher pull out strength values (p < 0.05) were revealed for 90° specimens (0.11 - 0.17 ± 0.01 N/mm²) compared to the 45° group (0.03 ± 0.02 N/mm²). The pull out test with primer revealed no significant differences between the G 611 and A 304 primers in the additive group. However, significantly (p < 0,05) higher values were observed for conventional specimens in the A304 group (1.10 ± 0.21 N/mm²) compared to the G611 group (0.59 ± 0.27 N/mm²).

CONCLUSION

The application of both used primers may be an acceptable technical option for the anchorage of retention titanium magnets in silicone facial prostheses, produced additively in a fully digital workflow.

Effect of ultraviolet protective agents on maxillofacial silicone elastomer, part 2: Mechanical properties after artificial aging

STATEMENT OF PROBLEM

The addition of ultraviolet (UV) protectives may affect the materials' mechanical properties, which can limit the service life of facial prostheses.

PURPOSE

The purpose of this in vitro study was to investigate the effect of UV protectives on the mechanical properties of maxillofacial silicones after artificial aging.

MATERIAL AND METHODS

Six color groups (unpigmented, white, yellow, red, blue, and mixed) of addition-type maxillofacial silicone were prepared. Four UV protectives, benzophenone-3 (UV-BP), ethylhexyl methoxycinnamate (UV-EM), titanium dioxide (UV-TD), and ethylhexyl salicylate (UV-ES), at 0.5% and 1% concentrations by weight were incorporated into the silicone before polymerization. The specimens were subjected to accelerated aging in a weathering chamber for 300 and 600 hours and to thermocycling. The tensile strength and percentage elongation, tear strength, and hardness of maxillofacial silicones were evaluated. Data were analyzed by using 4-way ANOVA. The differences were compared by the Tukey honestly significant difference test (α=.05).

RESULTS

Tensile strength decreased after 300 and 600 hours of UV aging in 0.5% and 1% UV-BP protective-added groups and increased in thermocycled groups (P<.05). Aging conditions generally showed no effect on the tensile strength of UV-EM, UV-TD, and UV-ES added groups (P>.05). Aging generated a decrease in percentage elongation values compared with nonaged specimens of groups (P<.05). The addition of UV protectives generally did not significantly affect the tear strength of specimens compared with control in the aged groups (P>.05). The hardness of UV protective-added groups increased when compared with that of nonaged groups after 300 and 600 hours of UV aging (P<.05). Also, thermally aged groups showed increased hardness than nonaged groups (P<.05).

CONCLUSIONS

The protective UV-BP addition caused decreased tensile strength, percentage elongation, and tear strength in both concentrations. The UV-EM and UV-ES provided increases in tensile strength and percentage elongation of the silicone in the 0.5% concentration. The addition of UV-BP, UV-EM, and UV-ES did not make significant differences; however, UV-TD significantly decreased the hardness values of the silicone.

Effect of nano-oxides on the color stability of maxillofacial silicone elastomers

STATEMENT OF PROBLEM

A significant challenge of craniofacial prostheses is their limited service life because of degradation and color instability. In spite of improvements in the materials and techniques used for the fabrication of silicone maxillofacial prostheses, undesirable color change over time remains a challenge. Zn and Ti nano-oxides (nano-TiO₂) have been reported to impart an ultraviolet- (UV) shielding property to silicone elastomers. However, studies examining the effects of nanopigments on the color stability of craniofacial prostheses are sparse.

PURPOSE

The purpose of this in vitro study was to evaluate the color stability of a room-temperature vulcanizing (RTV) silicone elastomer with the addition of iron oxide and titanium dioxide nanopigments under accelerated artificial aging.

MATERIAL AND METHODS

Sixty disks (Ø15×2 mm) were fabricated from RTV silicone 4408 Q. The specimens were divided into 5 groups containing iron oxide nanopigment, iron oxide nanopigment and rutile nano-TiO₂ (as an opacifier), burnt sienna pigment, burnt sienna and nano-TiO₂, and silicone without pigment or opacifier. The specimens were subjected to accelerated aging in a Xenotest chamber for 1000 hours. CIELab color coordinates and the total color difference (ΔE∗) values were determined before and after aging. ΔE∗ values were compared between the groups by using 1-way ANOVA and Tamhane multiple comparisons (α=.05), and a standard deviation of 1.09 was considered.

RESULTS

ANOVA showed that the values of ΔE∗ differed among all groups (P<.05). The minimum amount of a color change perceived (ΔE∗ approximately =1.1) by the visual system as the threshold was observed in the specimens treated with burnt sienna and nano TiO₂. The greatest color change occurred in the specimens treated with iron oxide nanopigment. As per the acceptable clinical threshold, the color change was satisfactory in all groups.

CONCLUSIONS

Nano-TiO₂ with burnt sienna groups had a lower color change than the other groups. The color change in all groups was within a clinically acceptable range.

Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing

Millions of people worldwide experience disfigurement due to cancers, congenital defects, or trauma, leading to significant psychological, social, and economic disadvantage. Prosthetics aim to reduce their suffering by restoring aesthetics and function using synthetic materials that mimic the characteristics of native tissue. In the 1900s, natural materials used for thousands of years in prosthetics were replaced by synthetic polymers bringing about significant improvements in fabrication and greater realism and utility. These traditional methods have now been disrupted by the advanced manufacturing revolution, radically changing the materials, methods, and nature of prosthetics. In this report, traditional synthetic polymers and advanced prosthetic materials and manufacturing techniques are discussed, including a focus on prosthetic material degradation. New manufacturing approaches and future technological developments are also discussed in the context of specific tissues requiring aesthetic restoration, such as ear, nose, face, eye, breast, and hand. As advanced manufacturing moves from research into clinical practice, prosthetics can begin new age to significantly improve the quality of life for those suffering tissue loss or disfigurement.

Bespoke ocular prostheses

PURPOSE

To report the customized approach of patients with anophthalmia or microphthalmia with bespoke ocular prosthesis.

METHODS

Retrospective analysis of case series.

RESULTS

The study included cases with anophthalmia with upper eyelid deformity (one patient), microphthalmia and contralateral corectopia (one patient), microphthalmia with contralateral corneal graft (one patient), and congenital clinical anophthalmia with contralateral sclerocornea (one patient). Using techniques of embedded autologous hair and coating of adhesive pigment emulsion in the ocular prosthesis, the physical appearance of, respectively, an upper eyelid, corectopia, corneal graft, and sclerocornea was reproduced.

CONCLUSION

Tailoring the ocular prosthesis to the distinct condition of the anophthalmic socket and contralateral eye adds to the success of rehabilitative prosthetic treatment of the patient.

Direct 3D Printing of Flexible Nasal Prosthesis: Optimized Digital Workflow from Scan to Fit

A maxillofacial prosthesis is a successful treatment modality to restore missing facial parts. Digital technologies and 3D printing are employed in constructing facial prostheses such as ears; however, their application is still partial, and final prostheses are usually manufactured conventionally using stone molds. This report aims to introduce a complete digital workflow to construct a nasal prosthesis and compare it to the conventional workflow of a patient requiring a nasal prosthesis. A computer tomography scan showing the defect was exported to specialized software to create 3D reconstructions of the patient's face and underlying bone. The nose was digitally designed restoring facial esthetics, anatomy, shape, and skin color. Different skin tones were digitally matched to skin tissues adjacent to the defect area using the Spectromatch system. The design was 3D printed in flexible and colorful material at 16 μm resolution using a 3D printer. External color pigmentations were applied to the nose for optimum esthetics, and the prosthetic nose was sealed in silicone and left to heat polymerize for 15 minutes. The prosthetic nose was retained in place using biomedical adhesive, and the patient was pleased with it. This report proposes a complete digital workflow to directly design and fabricate a prosthetic nose of acceptable esthetics. Such a workflow can lead to enhanced prosthesis reproducibility and acceptability and may become an effective treatment option for treatment of patients with facial defects.

Maxillofacial prostheses challenges in resource constrained regions

BACKGROUND

This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations.

METHOD

A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries.

RESULTS

Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach.

CONCLUSIONS

In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities. Implications for Rehabilitation More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments. The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations. The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

Fabrication of an Orbital Prosthesis Combined With Eyebrow Transplantation

Fabrication of an orbital prosthesis is considered as a challenging procedure as compared to the other facial prosthesis due to the presence of inactive eye movements and the need of artificial hair in order to mimic eyelashes and eyebrows. Generally these structures are sewed or bonded in the silicone. However, deformation or hair loss is observed within time. This deformation is visible especially in the eyebrow. This clinical report represents a patient with an implant supported orbital prosthesis. Patient was not satisfied with the nature of her eyebrow that was sewed in the silicone. Therefore, an alternative approach of eyebrow transplantation was used for the patient. The patient expressed her better satisfaction of this definitive prosthesis supported with eyebrow transplantation.