FABRICATION OF

AURICULAR & ORBITAL

PROSTHESIS
 CONTENTS
• Introduction
• Definition
• Objective of maxillofacial rehabilitation
• Advantages and disadvantages
• Fabrication of auricular prosthesis
Impression and working cast fabrication
Sculpture and formation of pattern
Mold fabrication
Processing of prosthesis
• Coloring techniques
Intrinsic coloration
Extrinsic coloration
• Retention of prosthesis
• Fabrication of orbital prosthesis
• Fabrication of ocular prosthesis
• Retention of prosthesis
• Recent advances in prosthetic fabrication
• Summary and conclusion
• References
 INTRODUCTION
• Man's need for artificial replacements to supply missing or lost body

parts has probably existed as long as man himself.

• Body abnormalities or defects compromise appearance, function

render an individual incapable of leading a relatively normal life.

• The replacement of anatomical parts is a challenge to those properly

trained to construct acceptable substitutes.

DEFINITION

Maxillofacial prosthetics is the art and science of

anatomic, functional, or cosmetic reconstruction by

means of non-living substitutes of those regions in the

maxilla, mandible, and face that are missing or defective

because of surgical intervention, trauma, pathology or

developmental or congenital malformation.

OBJECTIVE OF MAXILLOFACIAL
REHABILITATION

1. Restoration of esthetics or cosmetic appearance of the

patient.

2. Restoration of function.

3. Protection of tissues.

4. Therapeutic or healing effect.

5. Psychologic therapy.
Advantages:

1. It requires little surgery or no surgery,

2. The patient spends less time away from home and job

3. The reconstruction is often more natural-looking

Disadvantages

1. The necessity of fastening the appliance to the skin

2. Removing it every day

3. The occasional need of constructing a new prosthesis.

Fabrication of auricular
prosthesis

• Impression and working cast fabrication

• Sculpture and formation of pattern
• Mold fabrication
• Processing of prosthesis
 Impression

Reversible hydrocolloid

• Advantages :

• Applied to skin in thin layers and impress large areas,

• Can reproduce fine details.

• Disadvantages

• Preparation time for liquefying the gel,

• hot temperature at the time of application,

• material tear easily,

• distorts during the removal from undercut areas.

• Elastomeric impression materials-

• Advantages
• excellent detail reproductions,

• high tear strength,

• good flow properties

• Disadvantages-
• Short working time,

• Difficult in mixing large quantities,

• High cost

• Elastomeric materials are excellent for small defects

and relatively flat surfaces, such as an auricular defect.

Irreversible hydrocolloid-

• Advantages are;
• inexpensive,

• long shelf life,

• good detail reproduction,

• satisfactory physical properties.

• Disadvantages;

• Possible entrapment of air during application,

• Possibility of distortion,

• Tearing during removal from large under cut areas.

Working cast fabrication

• The patient must be prepared for the impression

procedure both physically and mentally.

• Patient should be questioned about a history of

claustrophobia (fear of confined spaces),

achluphobia (fear of darkness)

• Marks should be made with an indelible pencil in the defect

area, so as to allow correct alignment of the prosthesis with

the natural ear.

A) The junction of the helix with the side of the head.
B) The junction of the lobe with the side of the head
The patient is prepared; should be positioned on their side to allow
full access to the area.
• Various materials can be used to define and contain the impression;

among these are plasticine stripes, red boxing wax.

• The cheapest and the easiest are the plastic tubs. A portion is cut out

of the middle of the tub to allow access to the defect area.

• The external auditory canal should be blocked off with cotton wool or

Vaseline gauze
• Alginate mixed to fluid consistency is then poured. No need to provide

a plaster backing, good thickness of alginate is enough.

• To enable good carving an impression of the existing ear is taken

• When pouring the alginate pour the back part of the helix first, so as to

provide support for the helix when full amount of alginate is added.

Poured in stone.
 Sculpting technique

• Once the impression is cast, the

resulting marks on the model will

provide the necessary landmarks

around which the carving can begin.

• Better results are obtained if the

ear is carved from a mirror image

of the patients natural ear

• The plaster model is soaked in water to allow easy removal of the wax
pattern.

• A wax sheet is then adapted to form the base plate. The general shape
of the ear is moulded using the marks present on the model to
ascertain the correct size.

• Using a rolled length of wax helix is then added

• The projection of the ear is measured to achieve the correct distance.

• The carving detail of the ear is then commenced, during which the size

is constantly checked with a verneir gauge.

Try In

• The fit of the prosthesis on the tissue

• The correct horizontal alignment with the natural ear.

• The projection of the ear in relation to the side of the head

• The integrity of the margins during simple jaw movements.

Dr Sarkis Isikbay –technique
of ear sculpting
 Investment and fabrication of
mould
• The wax prosthesis is now sealed to the model and the

leading edge is thinned as much as possible so as to allow

the silicone edges to feather into the natural skin.

• A three part mould is necessary to achieve easy placement

of silicone
• Embed the mould in plaster upto the leading edge.

• Locations are cut in the helix area of the mould to allow the second

piece of the mould around the helix to locate accurately.

• The plaster is soaked in soap solution which acts as a separator.

• Additions of wax spacer which will help remove

the helix section when the ear has secured.

• Apply wax pattern with aurofilm to breakdown the

surface tension, the ear is fully invested.

• when set the wax is boiled out of the flask leaving

the three piece mould.

 Processing of the prosthesis

• The mould cavity is prepared by coating the

external tissue surface area with a thin coat of
catalyzed uncolored silicone material.
• characterization colors are chosen and mixed with
silicone polymer and painted on the surface of the
clear layer
• Colored rayon fibers may be sprinkled into the
mould to simulate microvasculature.
• After the mould surface is characterized by
localized application of color, a base color mixture
of silicone material is prepared to fill the mould
cavity.
• When a satisfactory base color has been mixed, the silicone catalyst is

added, and air may be removed from the mixture by placing a container in

a bell jar under vacuum.

• The colored, catalyzed, air less silicone is then placed into the mould cavity,

taking care to allow the liquid to flow into all thin areas.
• The mould is then clamped and placed into dry heat oven at

the manufacturers prescribed polymerization time and

temperature

• Residual silicone may be left on the external surface of the

mould to test for complete polymerization.

• After the polymerization cycle is complete, the mould should

be allowed to cool to room temperature before removing the

completed prosthesis.
• Colouring techniques

Intrinsic coloration

Extrinsic coloration
• Creating a facial prosthesis that appears to have a realistic skin

surface while achieving seamless visual integration with the

surrounding tissue requires both artistic and technical

expertise.

• The ability to match skin tones effectively requires a keen eye,

a good understanding of color theory and application,

meticulous attention to detail, practice and perseverance.

• Intrinsic coloration is color applied within the mould during the

casting procedure.

• Extrinsic coloration is color applied to the surface of a

prosthesis that has been cured and removed from the mould.
Lighting considerations

• If colored corrected lighting is not available, incandescent

with ample natural light may be used. A color match is best

evaluated under various light sources such as day light,

fluorescent and incandescent to reduce metamerism

Materials and equipment
 Identifying and mixing the base color
• The base color makes up the bulk of the
prosthesis; therefore, mix ample material
to fill the mould. Considering that the skin
is laminar, the objective is to mix the color
of the underlying skin tone.

• Common places to identify the base color

are on the under side of the fore arm,
along the hairline, anterior to the tragus,
and at base of the helix.
 Traditional trial and error method of
mixing a base color
• One of the most common approaches to mixing color for facial prosthesis is
a trial and error process of adding pigments in small quantities to silicone
and frequently comparing the mixture to patient’s skin in adequately lit
environment.
• Measure 40gm of silicone into a 100ml clear plastic cup using a clean metal
spatula. On a glass palette, arrange small amounts of red, blue, yellow,
white, and green pigments. Pigments should be added to the silicone in
conservative amounts and blended thooughly.White pigment and kaolin
are important in achieving the right opacity and value for the base color.
• to achieve a color closer to that of skin , add small amounts of red and
yellow pigments.
• Human skin has a chroma (saturation) between 2 to 4

which is greyer than most pigments(5 to 14)

• For repeatability, pigments amount added should be

measured and recorded by weight or dropper.

• When the color of the silicon approaches the desired base

color, place a small amount of colored silicone in the center

of a folded transparent sheet. Compare the mixed silicone

color with the target base color of the patient’s skin and

modify as necessary.
 Computerized color
formulation
• Spectrophotometry combined with computerized color formulation provides
an objective means of achieving a skin color match.
• This is accomplished by computing a pigment formula with color formulation
software that matches a measured skin color.
• The computerized formulation process involves selecting a color to measure,
measuring the color with spectrophotometer, transferring the measurement
data to the computer, calculating and mixing a formula, and preparing a
batch of colored silicone for packing.
 Laminar glazes
• Laminar glazes are layers of color painted individually into
the mould before packing the base color.

• Red blush glaze- simulates the classic pink appearance of

the skin as evidence of surface vasculature.

• Golden tan glaze- the tan color observed in skin due to the
presence of melanin.

• Dark brown glaze - simulates freckles and moles.

• Opaque, yellow white color- simulates cartilage.

• Dark blue or purple - applied for shadow areas.

• Opaque, pink to red helix color - often a portion of base.

Mixing laminar glazes
 Surface characterization

• Incorporation of surface characterization is important in creating

lifelike results. Freckles, moles, broken capillaries, prominent

blood vessels and other skin marking on the contra lateral ear

that can be used to characterize the prosthesis. The base color is

the last color packed in the mould.

 Extrinsic coloration
• A prosthesis that is too light in value can be corrected with extrinsic coloration;
however, a prosthesis that appears too dark in value is difficult to remedy and
most often needs to be reprocessed.

• Extrinsic coloring is necessary to disguise the appearance of a seam along the

helix and to blend the anterior margin to the surrounding tissues.
• Reducing shine – the application of the extrinsic glazes

often results in a glossy appearance that many appear

unnatural and draw unwanted attention to the

prosthesis.
 Retention of prosthesis
• Two main methods of retention are employed,

• The osseointegrated implants and direct adhesive fixation.

• Traditional methods -

• Spring steel bands

• Double sided adhesive tape

• Adhesives
• Magnet or bar and clip retention are the two primary forms of
retention used in the auricular region.

• Magnet retention should be used where low dislodging forces

are anticipated.
Fabrication of orbital prosthesis

• Impression and working cast fabrication

• Sculpture and formation of pattern
• Mold fabrication
• Processing of prosthesis
Steps in fabrication of the ocular
prosthesis
Impression
Sculpture and formation of
pattern
• Residual oils from the clay contaminate the mould surfaces,
which can interfere with the platinum catalyst employed in
modern silicon prosthesis materials
• Positioning is best accomplished by placing the ocular section on a

stalk of wax in the wax cup.

• Ocular section manipulated into the position that matches the

gaze of the normal eye when the patient is staring directly at a

point at eye level atleast six feet away.

Orbital locator (D.R.Mc Arthur
1977)
• Computer imaging may be used to assist establishment of the

correct ocular positioning and lid opening.

• Once the correct positioning of the ocular section has been

accomplished and the eyelid aperture established, the soft

sculpting wax mixture is added with a glass eye dropper or

spatula roughly fill the remaining contour of the prosthesis out

to the area were margins are to be established.

• Following the completion of the fine details in the pattern, the

sculpture should be placed onto the patient and verified for fit,

direction of gaze, and eyelid aperture. When satisfied with the

results, the pattern is ready for making the mould.

 Mold fabrication
• For orbital prosthesis, an indexing method must be applied to position
the ocular segment of the prosthesis, now incorporated in the wax
pattern, back into the mould in its same orientation as in the pattern.

• Prior to investing the orbital prosthesis pattern, an index in the form of

horizontal and vertical pyramids is placed on the surface of the ocular
segment with sticky wax.
• This index is reproduced in the cope segment of the mould.

• The cope is carefully removed from the drag to avoid damaging

the indexing wax.

• Then the ocular segment is removed from the wax pattern and
duplicated using an alginate impression

• The duplicate ocular segment including the indexing wax is

poured in dental stone and placed into the index indentations in
the cope with cyanoacrylate adhesive.

• This segment will form a pocket in the final silicone prosthesis for
insertion of ocular segment of the prosthesis
 Processing of prosthesis
• The mould cavity is prepared by coating the external tissue surface area with a
thin coat of catalyzed uncolored silicone material

• Characterization colors are chosen and mixed with the silicone polymer and
painted on the surface of the clear layer.

• Colored rayon fibers may be sprinkled into the mould to simulate

microvasculature.

• After the mould surface is characterized by localize application of color, a base

color mixture of the silicone material is prepared to fill the mould cavity.

• When a satisfactory base color has been mixed, the silicone catalyst is added, and
air may be removed from the mixture by placing the container in a bell jar under
vacuum
• The colored catalyzed, air less silicone is then placed into the mould cavity,
taking care to allow the liquid to flow into all the thin areas.

• The mould is then clamped and placed into a dry heat oven at the
manufacturer prescribed polymerization time and temperature.

• Residual silicone may be left on the external surface of the mould to test for
complete polymerization.

• After polymerization cycle is complete, the mould should be allowed to cool

to room temperature before removing the completed prosthesis.
Addition of eyelashes and
eyebrows
 Retention of orbital prosthesis
• Spectacle borne fixation
 USING OSSEOINTEGRATED
IMPLANTS

• Orbital implants are placed into the lateral, infraorbital

supraorbital rim.

• Freestanding abutments with magnet retention or

alternatively, bar and clip retention are routinely employed

in the orbit. In the orbit, given the problems of path of

insertion, the most common approach is to use freestanding

cantilevered abutments with magnet retention.

 Recent Advances
• CAD CAM TECHNIQUE FOR FABRICATING PROSTHESIS
Digital imaging in the fabrication of ocular
prosthesis
Instructions to the patient.

• Since the artificial eye does not track with the natural eye of the

opposite side, the patient should learn to turn his head when

changing his line of vision.

• Wearing of eye glasses also enhances the natural appearance

• Taught how to clean the prosthesis (in warm water with a mild

soap)

• How to apply the surgical cement

• The prosthesis should not be worn while sleeping