Maxillofacial prosthetics--"the dental connection".
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Care of oral cancer patients requires the opinions and coordinated efforts of various consultants or therapists functioning as a multidisciplinary team to treat individual patients' physical, social, and economic problems. The modern medical concept of total treatment of the patient must include dentistry. Every dentist with interest and training in the basic principles of maxillofacial prosthetics can offer invaluable assistance in the treatment of maxillofacial patients.
A new (open-cast) technique for the fabrication of metal molds has been presented. Its simplicity relies on the use of gummed asbestos tape as a boxing agent for the investment models. This technique has the following advantages over the "lost wax" technique: (1) it requires approximately one-quarter the amount of investment material, (2) it eliminates the use of investing rings or wax patterns, (3) it eliminates the boil-out step for the wax pattern and reduces the total time required to make a metal mold, and (4) it affords a high degree of visibility. The only disadvantage is that the larger prostheses require large amounts of Lino-type metal which is very heavy. However, this has not restricted the use of this technique since these metals cast well and can be easily placed in large ovens. This technique, because of its advantages, offers more efficient use of laboratory time and personnel.
Removable prostheses were used to determine that esthetics and speech could be improved for patients with permanent unilateral facial paralysis. Esthetics had to be compromised somewhat to obtain the maximum benefit for intelligible speech. This procedure can be beneficial in helping patients who are high surgical risks or for whom surgery, for various reasons, is unacceptable.
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The methods for initial evaluation of a new prospective maxillofacial prosthetic material, MDX-4-4210, have been described and tensile and compressive test data have been obtained. Evaluation of the data indicates that this is a promising material with significant potential for use in maxillofacial prosthetics. Further studies of the material's biologic implant compatibility, its chemical and environmental stabilities, and its clinical performance are being done.
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Discussion between the surgeon and prosthodontist on surgical planning is important. It is necessary that they each be aware of the other's problems. Only in this way can continuity be established between surgical and prosthetic procedures. This will provide a maximum level of treatment for the maxillofacial patients, thereby returning them to society most expeditiously.
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1. No significant difference existed between the MMPI means of the test group and the MMPI means of the Mayo Clinic patient group. 2. The means of the test group and the Mayo Clinic patient group deviated from the MMPI normative data. 3. No apparent change in personality of the test group was suggested by the MMPI. 4. A much larger percentage of the patients than expected failed to complete the initial MMPI. One patient refused, and four patients had a raw score of "cannot say" responses greater than 120, thus invalidating the test. 5. The changes in the means of the ACL scales of total number checked, autonomy, change, and abasement were significant (p less than .05). 6. The patient became more outgoing and optimistic, as measured by the ACL, during the immediate postoperative period. 7. Speech and mastication were problems for some patients even after prosthodontic rehabilitation. 8. Most of the rehabilitated patients resumed their normal social habits. 9. The patients in the study seemed to respond to the new situation according to their already existing personality structure.