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Standardization of a polyurethane elastomer for facial prostheses.

This study has shown that the polyester urethane elastomers are soft and flexible, characteristics which are desirable for simulating soft facial tissue. In addition, this material was found to have a larger resistance-to-tear when compared with othe materials. The physical and mechanical properties are very sensitive to the composition and the amount of catalyst added. Less influence on the elastomer properties was noticed for the range of temperatures at which it was polymerized. The range of curing time used in this study shows no significant statistical difference on the elastomer properties. Future studies will be directed toward the polymerization of the material at a wider range of times and temperatures to determine the effects at the low and high ends of the range.

Chemical Phenomena↗

Properties of silicone maxillofacial elastomer processed in stone and metal.

1. The effect of mold conditions on the UTS, n, and TS at 200% and 300% elongations, and Shore A hardness was measured for Silastic 44210. 2. There was no difference in n, Shore A hardness, and TS at 200% and 300% elongation between Silastic 44210 samples whether produced in metal or coated stone molds. 3. The highest UTS for Silastic 44210 was demonstrated for samples processed in aluminum molds. The UTS was slightly reduced when coated stone molds were used, and it was considerably reduced with untreated stone molds. It is felt that the slight decrease in UTS with coated stone molds would not compromise the use of stone molds clinically, particularly when ease of processing is considered. 4. Petroleum jelly, silicone spray, and tinfoil substitute were all equally effective in improving the physical properties of the elastomer when processed in a stone mold. These results demonstrate the necessity of using a mold sealant when processing Silastic 44210 in a stone mold.

Aluminum↗

Diminishing dependence on adhesives for retention of facial prostheses.

Attempts to augment or circumvent adhesives for retaining facial prostheses have been beneficial for many patients, particularly when a significant number of prostheses have failed because of insufficient retention. This approach is helpful in overcoming the problems created by the continued reluctance of surgeons to remove an entire facial organ in eradicating a relatively small disease process. There has been a positive response to suggestions that proposed surgery be planned to include the creation of sites which could be used for anatomic or mechanical retention.

Adhesives↗

Maxillofacial prosthetic principles in the surgical planning for facial defects.

In many localities, particularly in larger medical centers, presurgical communication and planning is increasing because the prosthodontist is becoming a more active member of the oncology, trauma, and cleft palate teams. Individuals involved both directly or indirectly in maxillofacial prosthetic therapy should be cognizant of the situations and solutions discussed in this article. In this way the prosthodontist and surgeon will be able to provide a better consultancy and rehabilitation service for their patients.

Ear, External↗

Maxillofacial prosthetics in the dental school curriculum.

A survey was sent to all dental schools in the United States to ascertain what type of training in maxillofacial prosthetics was included as a separate course or included within other courses. Eighty-six percent of the questionnaires were returned. The results indicated that, while only 31% of the respondents offered a specific course in maxillofacial prosthetics, much of this information was offered in several other dental school courses. Specific information should be included in the curriculum on subjects such as radiation therapy and chemotherapy. However, the emphasis should be aimed at familiarizing the dental student with the objective and scope of maxillofacial rehabilitation without providing details regarding the fabrication of the infinite variety of maxillofacial prostheses. This general information is essential so that dental students realize that appropriate treatment of carcinoma patients includes prosthetic rehabilitation and they can counsel and refer their patients appropriately.

Curriculum↗

Use of medical-grade methyl triacetoxy silane crosslinked silicone for facial prostheses.

The urethanes, PVC, acrylic resins, and silicones are still the most popular among a large number of materials being used to fabricate facial prostheses. Each material has advantages and disadvantages. The ideal material is not yet available. It was found that Silastic medical adhesive type A, a preparation of methyl triacetoxy silane crosslinked silicone, possesses a wide range of biologic, clinical, and technical advantages over other materials. However, the poor adheophilic properties of this material remain its most significant disadvantage. A processing technique for methyl triacetoxy silane crosslinked silicone is presented. Further investigations are being conducted to improve this material.

Color↗

Evaluating cosmetic results in maxillofacial prosthetics.

Fifty-two patients with maxillofacial prosthetic restorations answered questionnaires to measure their feelings of well being. Their overall scores averaged 38.6%. Subsequently, three independent observers reported their evaluation for each patient, yielding a combined improvement score of 35.1%. The apparently low figures reflect the strict criteria used. Men patients showed a greater response than women patients both in subjective questionnaire scores and objective evaluation rating. Greater improvement was reported in younger patients, yet the objective evaluators found better success in the older age group. The original etiology of the maxillofacial defect, i.e., traumatic injury, congenital malformation, or surgical tumor excision was the most important factor in the evaluation. Questionnaire scores were similar in all categories. However, the objective evaluation, especially that of the sculptor, who judged color slides alone, was significantly higher in the injury group than in cancer patients. Apparently, the inner desperation of many cancer patients is apparent in their facial appearance even after complete prosthetic rehabilitation. Such patients deserve greater psychologic attention during their treatment. Prosthodontists should realize their tendency to be hypercritical of their own treatment results. Their constant striving for improvement in their treatment results leads them to belittle their achievements and to underestimate their success. Public opinion, as represented by the artists, is significantly more enthusiastic about maxillofacial prosthetic achievements.

Adolescent↗

Controlling the porosity and density of silicone rubber prosthetic materials.

The chemical components of the four silicone rubber polymers were reviewed. Methods of controlling the porosity and density of both the one-component semisolid prepolymer and the two-component fluid prepolymer systems were evaluated. The variables examined were deairing of the fluid systems; trial packing, pressure sealing, and processing of the semisolid materials; injection versus hand packing of the mold; the effects of moist-heat versus dry-heat application during processing; and the need for investment of the mold within the confines of a closed flask. It can be concluded that porosity of medical-grade silicone rubber polymers may be totally prevented, or accurately controlled, by proper handling techniques.

Chemical Phenomena↗