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PubMed1977

Reconstruction of alveolar ridge and jaw defects resulting from gunshot wounds.

Reconstruction and rehabilitation of acquired defects of the oral cavity is an important dental service. Severe deformities of the jaws may result secondary to gunshot wounds of the oral-facial region. New advances in soft and hard tissue surgical reconstruction can be of great benefit to the patient when coupled with prosthetic rehabilitation. In recent years there has been a significant increase in the incidence of gunshot wounds in the civilian population in the United States, and those of the mouth and jaws are relatively common-place. Gunshot wounds to the face and jaws may cause gross destruction of tissues. Although immediate definitive treatment of wounds reduces the mutilating effect, a significant number of patients require extensive reconstructive procedures. In addition, prosthetic rehabilitation is almost always needed. The purpose of this paper is to briefly review some recent advances in reconstruction of the maxilla and mandible following gunshot injuries.

Alveolar Process↗
PubMed1980

Tear energy of elastomers for maxillofacial applications.

The energy necessary to generate a unit area of torn surfaces was measured for six elastomers with low moduli of elasticity. Four polyurethane materials and two commercial maxillofacial materials were included. The latter had tear energy values between 0.63 and 6.56 erg/cm2, while the polyurethanes ranged from 8.49 to 50.0 erg/cm2. Three of the materials demonstrated non-Hookian behaviour during testing, violating an assumption of the tear energy analysis. A method of compensating for this discrepancy is described.

Chemical Phenomena↗
PubMed1987

Stability of ceramic pigments for maxillofacial applications.

In this study samples made from pigmented porcelain and Silastic 44210 were evaluated for colour stability after accelerated ageing in order to determine the potential of coloured ceramic powders as maxillofacial pigments. These pigments demonstrated good clear colour stability compared with the same pigments which were not incorporated into a porcelain matrix.

Dental Porcelain↗
PubMed1987

Properties of a modified cross-linked silicone for maxillofacial prostheses.

A dimethyl siloxane-triacetoxy terminated silane, Type A adhesive, can be modified with the base component of a medium grade polydimethyl siloxane with vinyl groups, MDX 4-4210, to produce more pliable maxillofacial prostheses. The mechanical properties of samples with various Type A adhesive/MDX 4-4210 ratios were determined. Addition of the MDX 4-4210 base decreased the hardness, modulus, and ultimate tensile strength, while the percentage elongation increased. The initial tear strength was relatively constant for the various ratios except for the 50/50 mix, where a 50% decrease was observed. The ability to obtain different mechanical properties by using various ratios of Type A adhesive and MDX 4-4210 could result in the production of maxillofacial prostheses which will more closely stimulate the properties of facial tissues.

Adhesiveness↗
PubMed1992

Maxillofacial prosthetics--an international perspective of the British status quo.

Maxillofacial prosthetics is a recognized subspecialty of prosthodontics. In considering the international status of maxillofacial prosthetics it is found that this unique and superspecialized discipline has a varied implementation both in terms of educational structures employed and clinical services provided. There is a dirth of available literature on education in maxillofacial prosthetics. The available literature is reviewed and the conclusion drawn is that very little undergraduate or postgraduate curriculum time is devoted to maxillofacial prosthetics in prosthodontic curricula. This, it is felt, adds to the ignorance of this important aspect of dentistry. Educational guidelines are reviewed and from this it is evident that the North American model of prosthodontic education and training differs greatly from the British one. This dichotomy appears to have impacted on prosthodontic training in other countries. Maxillofacial prosthetics enjoys special status in the United States but does not seem to be an important aspect of training in the British model. Indeed there is little evidence that maxillofacial prosthetics is an important focus of the British Consultant in Restorative Dentistry. Given the availability of the superb skills of the British trained maxillofacial prosthetic technicians and the hospital based restorative services, it is remarkable that the Restorative Consultants have not exercised their natural opportunity to lead internationally in both clinical and research areas, in this important discipline of dentistry. This must undoubtably pose a challenge for the British dental profession as a whole in the future.

Humans↗
PubMed2005

A hollow-bulb interim obturator for maxillary resection. A case report.

The treatment of hemimaxillectomy patients include the construction of an interim obturator in the wound healing period. With the aim of simplifying this process, we describe construction of an obturator in a short single visit, in the dental chair with no need for impressions or for laboratory services. The obturator comprises: (i) the surgical obturator and (ii) a hollow light-cured resin bulb built onto the base, and providing a large surface for bonding of the soft reline material. The advantages of this approach are rapid construction and ease of ongoing adjustment during the healing process.

Adult↗
PubMed2006

Quality of life and masticatory function in denture wearers.

Successful prosthodontic treatments for a patient with removable partial dentures including maxillofacial prostheses hopefully brings about psychological wellbeing as well as improved health. The purpose of this study was to investigate the relationship between quality of life (QOL) and the various aspects of denture function. At first, a questionnaire with a visual analog scale with 16 question items concerning denture and/or eating problems, the present state of health, psychological and physical wellbeing, life satisfaction, and QOL was developed. To discuss the validity and reliability of the questionnaire, 48 outpatients who wore a denture were asked to fill it out. Next, to discuss the difference in QOL of the patient with various kinds of dentures and conditions, 103 outpatients were asked to complete the newly developed questionnaire. The questionnaire which contained four factor areas with eight questions for denture patients was developed by factor analysis with Varimax rotation. The reliability of the QOL scale was confirmed by reliability analysis (Cronbach's alpha = 0.784). The QOL score of edentulous patients with a complete denture having some trouble chewing was significantly lower than that of other denture patients. It was suggested that the wearing of a denture significantly affected the QOL of elderly persons.

Adult↗
PubMed1994

The use of a photoprotective agent to increase the color stability of a tinted extraoral prosthetic silicone.

PURPOSE: This study investigated the use of ultraviolet-absorbing or photoprotective agents as a method of decreasing the color changes caused by ultraviolet radiation on an intrinsically tinted facial prosthetic material. MATERIALS AND METHODS: Silastic MDX 4-4210 (Dow Corning Corp, Midland, MI) was the facial prosthetic material studied. It was intrinsically tinted with talc and nylon flock to approximate the color of skin. Three brands of commercially available sunscreens with sun protective factor (SPF) of 15 were placed on the surface of the cured silicone samples. The samples were rotated in an ultraviolet radiation chamber for 300 hours. A control group was placed in the dark for 300 hours. The second phase of the experiment had para-aminobenzoic acid (PABA) added to the tinted silicone. All samples were measured with a spectrophotometer at the beginning and at the end of 300 hours, and a delta E was obtained. RESULTS: None of the sunscreens provided any ultraviolet radiation protection to the silicone. The addition of PABA caused a significant color degradation of the silicone. CONCLUSIONS: No photoprotective agent tested provided any significant level of ultraviolet radiation protection for silastic MDX 4-4210.

Humans↗
PubMed1995

An in vivo evaluation of adhesives used in extraoral maxillofacial prostheses.

PURPOSE: This investigation introduces percent adherent area and 10-minute and 8-hour peel-strength values as an in vivo evaluation of three popular maxillofacial prosthetic adhesives when used with three extraoral prosthetic polymers. MATERIALS AND METHODS: Specimens of Silastic MDX 4-4210, Silastic Medical Adhesive A (Dow Corning Corporation, Midland, MI), and Silicone A-2186 (Factor II, Inc, Lakeside, AZ) were adhered to 25 subjects' arms using Secure Medical Adhesive (Factor II, Inc), Pros-Aide Adhesive (ADM Tronics Inc, Northvale, NJ), and Hollister Colostomy Adhesive (Hollister Inc, Libertyville, IL). After 10 minutes, the peel strength required to remove the specimens was measured. Additional specimens were then adhered to the subjects and worn for 8 hours. The nonadherent areas of the specimens were then marked, the peel strength was measured again, and then the percent adherent area was calculated. RESULTS: Hollister Colostomy Adhesive showed greater 10-minute peel-strength values when used with Silastic Medical Adhesive A. The peel-strength values of the Hollister Colostomy Adhesive when used with Silastic MDX 4-4210 increased with time. The greatest percent adherent area was obtained with Silastic MDX 4-4210 using Pros-Aide Adhesive, and the lowest was obtained with Pros-Aide Adhesive using Silicone A-2186 and Silastic Medical Adhesive A. CONCLUSIONS: There was no clearly superior adhesive/prosthetic material combination based on the tests used in this study; however, individual skin variations between patients affect the adhesive properties.

Adhesiveness↗
PubMed1995

Evaluation of a new silicone elastomer for maxillofacial prostheses.

PURPOSE: Although numerous advances in maxillofacial materials have been made in the past several years, the need for improvement continues. Currently, the most widely used materials are the silicones, especially the room temperature-vulcanizing type. This study compared the physical properties of a new silicone material Cosmesil K10 (Cosmedica Ltd, Cardiff, United Kingdom) with those of MDX4-4210 (Dow Corning Corporation, Midland, MI), a popular material for maxillofacial prostheses. MATERIALS AND METHODS: The properties that were investigated were tensile strength, modulus at 100% elongation, percentage of elongation, tear strength, and hardness. The properties tested were selected because of their clinical significance for fabricating maxillofacial prostheses. Tensile strength and elongation were measured with a Monsanto Tensometer (Monsanto Ltd, Swindon, England) and dumbell-shaped specimens according to the International Organization for Standardization (ISO) specification no. 37. The tear test was performed on the Monsanto machine with unnicked 90 degree angle-shaped specimen following the ISO specification no. 34. The type A Shore durometer was used to measure hardness on specimens 25 x 25 x 10 mm according to the American Society for Testing Materials specification no. D2240. RESULTS: The results showed that MDX4-4210 had a greater tensile strength and modulus (P = .0002; P = .0015). No significant difference (P = .1986) was found for the percentage of elongation between MDX4-4210 and Cosmesil K10. Cosmesil K10 had a greater tear strength and was slightly harder (P = .0022; P = .0421) than MDX4-4210. CONCLUSIONS: Cosmesil K10 showed physical properties similar to those of MDX4-4210. An improvement in the predictability of the mechanical behavior of Cosmesil K10 would further enhance the value of the material.

Elasticity↗
PubMed1995

Dental management of neonates requiring prolonged oral intubation.

An orotracheal route is frequently the preferred method of intubation for premature infants. Nasal intubation may contribute to airway obstruction and possible hypoxia, further contributing to labored breathing. Additional complications include occlusion of the nasal aperture during a crucial period of development, nasal infections, and hypertrophy of the nasal lining. Oral mucosa is less susceptible to damage than nasal mucosa; however, orotracheal tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Problems associated with rehabilitation of very-low-birth-weight neonates and other infants requiring long-term oral intubation include palatal grooving, acquired cleft palate, and damage to the primary dentition. Various intraoral aids have been used to reduce pressure application from intubation and feeding tubes on the palatal tissues. References to these procedures have yet to be reported in the prosthodontic literature. This article presents a rational for design and construction of an intraoral device which protects the palatal tissues and stabilizes the orotracheal tube.

Alveolar Process↗
PubMed1996

A comparison of microwave and dry-heat curing methods on the bond strength of silicone facial materials applied to acrylic resin.

PURPOSE: This study compared two curing methods (microwave irradiation and dry heat) on the tensile bond strength of silicone facial materials to cured acrylic resin. The facial materials studied were Mollomed, Silskin II, MDX4-4210, and A-2186. MATERIALS AND METHODS: The samples were processed with microwaves for 13 minutes at 90 W plus 2 minutes at 500 W and dry heat for 3 hours at 100 degrees C to cured acrylic resin. Facial materials 3-mm thick were processed between two half-dumbbells of acrylic resin. The bonding surfaces were treated with a primer. The samples were placed in tension until failure. RESULTS: The results showed that the bond strength was affected by the type of silicone material and not by the curing methods used. CONCLUSIONS: Mollomed had the highest bond strength of all materials tested. MDX4-4210 and A-2186 showed the lowest, and Silskin II had intermediate bond strength. Microwave irradiation has the potential of saving time, energy, and resources during the fabrication of facial prostheses, but further laboratory studies and clinical trials are indicated.

Acrylic Resins↗
PubMed1998

Using a colorimeter to develop an intrinsic silicone shade guide for facial prostheses.

PURPOSE: To determine if using CIE L*a*b* color measurements of white facial skin could be correlated to those of silicone shade samples that visually matched the skin. Secondly, to see if a correlation in color measurements could be achieved between the silicone shade samples and duplicated silicone samples made using a shade-guide color formula. MATERIALS AND METHODS: A color booth was designed according to ASTM specifications, and painted using a Munsell Value 8 gray. A Minolta colorimeter was used to make facial skin measurements on 15 white adults. The skin color was duplicated using custom-shaded silicone samples. A 7-step wedge silicone shade guide was then fabricated, representing the commonly encountered thicknesses when fabricating facial prostheses. The silicone samples were then measured with the Minolta colorimeter. The readings were compared with the previous L*a*b* readings from the corresponding patient's skin measurements, and the relative color difference was then calculated. Silicone samples were fabricated and analyzed for three of the patients to determine if duplication of the visually matched silicone specimen was possible using the silicone color formula, and if the duplicates were visually and colorimetrically equivalent to each other. The color difference Delta E and chromaticity was calculated, and the data were analyzed using a coefficient-of-variation formula expressed by percent. A Pearson Product Moment Correlation Coefficient was performed to determine if a correlation existed between the skin and the silicone samples at the p < or = .05 level. RESULTS: The highest correlation was found in the b* dimension for silicone thicknesses of 1 to 4 mm. For silicone thicknesses of 6 to 10 mm, the highest correlation was found in the L* dimension. All three dimensions had positive correlations (R2 > 0), but only the 1-mm and 4-mm b* readings were very strong. Patient and silicone L*a*b* measurement results showed very little change in the a* axis, while the L* and b* measurements showed more change in their numbers, with changes in depth for all patient silicone samples. Delta E numbers indicated the lowest Delta E at the 1-mm depth and the highest Delta E at the 10-mm depth. All duplicated samples matched their original silicone samples to a degree that visual evaluation could not distinguish any color differences. Using volumetric measurements, a shade guide was developed for all 15 patients. CONCLUSIONS: There was good correlation between the patient's colorimeter measurements and the silicone samples, with the b* color dimension the most reproducible, followed by the L* and the a*. Silicone samples at 6, 8, and 10 mm matched the patient the best, and this study showed that silicone samples can be duplicated successfully if a good patient-silicone match is obtained. Rayon flocking fibers and liquid makeup are effective at matching facial prostheses and can be used to develop a simple shade guide for patient application.

Color↗
PubMed2005

Color stability of dry earth pigmented maxillofacial silicone A-2186 subjected to microwave energy exposure.

PURPOSE: The purpose of this study was to measure spectrophotometrically the color stability of pigmented A-2186 silicone maxillofacial elastomer with 10% by volume of titanium white dry earth opacifier before and after exposure to microwave energy over a simulated 1.5-year period of microwave sterilization. MATERIALS AND METHODS: A-2186 silicone elastomer opacified with titanium white dry earth pigment, pigmented with 5 cosmetic dry earth pigment colors [no pigment (control) group (Pc), red (Pr), yellow ochre (Py), burnt sienna (Po), and a mixture of Pr + Py + Po color group (P3)], was used in this study. Each of the 5 experimental groups consisted of 5 specimens. All specimens were placed in a 250 ml glass beaker filled with 150 ml of water (replenished for each microwave exposure). An exposure of 6 minutes was used 18 times (simulating 1.5 years of microwave sterilization with one 6 minute exposure monthly). Reflectance values were measured by spectrophotometer. Three- and two-way analyses of variance with repeated measures were performed for the color difference (DeltaE*) with the factors of group/color/months, and group/months, respectively. Means were compared by Tukey Honest Significant Difference (HSD) multiple range test calculated at the 0.05 level of significance using SPSS. RESULTS: The trained human eye can detect color changes (DeltaE*) greater than 1.0. Most DeltaE* values of the red pigment group at all intervals and the mixed pigment group at 15- and 18- month intervals increased significantly greater than 1.0 (p < 0.001) compared with the control group. Yellow and burnt sienna groups remained the most color stable over time with DeltaE* values below 0.35. CONCLUSIONS: Lack of color stability of red dry earth pigmented A-2186 silicone maxillofacial elastomers was clinically significant after 12-month exposure to microwave energy as compared with yellow, burnt sienna, and opacified A-2186 dry earth pigments.

Analysis of Variance↗
PubMedDate not supplied

Facial moulage fabrication using a two-stage poly (vinyl siloxane) impression.

Traditional techniques for the fabrication of a facial moulage have relied on materials with various shortcomings. This article describes a two-stage Poly(vinyl siloxane) impression technique that avoids some of these shortcomings and provides a predictable and accurate facial moulage.

Dental Impression Materials↗
PubMed1999

First and second branchial arch syndrome: aspects on the embryogenesis, elucidations, and rehabilitation using the osseointegration concept.

BACKGROUND: The osseointegration concept has dramatically changed the possibility of rehabilitating patients with craniofacial defects due to branchial arch syndromes. PURPOSE: This article describes some problems related to the investigative routines and rehabilitation of individuals with malformations of the first and second branchial arches of the craniofacial region. Animal model systems have increased the knowledge of basic embryonic processes that can explain the extent of the malformations. Though most clinical first and second branchial arch syndromes are likely to be caused by sporadic mutations, inherited syndromes occur and also teratogenically induced syndromes are known. Prenatal diagnosis ruling out heredity and exogenous influence seems possible in the future. The possibility of preventing and alleviating fulminant syndromes prenatally also could be conceivable in the future. PATIENTS AND METHODS: The rehabilitation process starts early after birth and should involve a team of specialists including clinical geneticists, pediatricians, audiologists, plastic surgeons, maxillofacial surgeons, otosurgeons, anaplastologists, speech pathologists, pedodontists, and orthodontists. With the development of the osseointegration concept in which craniofacial prostheses and hearing aids can be adapted on implants anchored in the craniofacial skeleton, a new field in the rehabilitation of these malformations has opened. RESULTS: Important aspects in the use of the osseointegration concept include determination of the lowest age for implant surgery, accessibility of adequate bone for implants, the growth of the craniofacial skeleton during childhood, and the possibility for the patient and his or her parents to care for the skin penetration. Adverse tissue reactions, durability of craniofacial prostheses, and the possibility of unknown adverse reactions to metal implants in the body over a long time are other aspects of concern. CONCLUSIONS: Patients with branchial arch syndromes benefit from a well-planned multidisciplinary rehabilitation process in which osseointegrated bone-anchored hearing aids and bone-anchored ear prostheses can be useful tools.

Adolescent↗
PubMedDate not supplied

Bond strength of double-sided adhesive tapes used for facial prostheses.

This study evaluated the tensile bond strengths of five silicone facial elastomers to human skin by use of five different double-sided adhesive tapes. Discs of silicone elastomers were fixed in circular metal holders and glued to the inner aspect of a forearm with the various adhesive tapes. The specimens were pulled off 20 seconds after fixation by means of a universal testing machine at a cross-head speed of 1 mm/min. Eight specimens of each silicone/tape combination were tested. Significant differences were observed among the various silicone/tape combinations. MDX4-4210 and Cosmesil facial elastomers had the strongest bond to skin with the majority of adhesive tapes, whereas Silskin II, Cosmesil HC2, and RS 330T-RTV were the weakest. After the bond failure, tapes remained adhered to the skin and not to the silicone specimens.

Adhesiveness↗