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SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 6  |  Page : 863-865
A modified technique for retention of orbital prosthesis


Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India

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Date of Submission28-Jan-2010
Date of Decision07-Feb-2011
Date of Acceptance04-Mar-2011
Date of Web Publication5-Apr-2012
 

   Abstract 

An orbital defect (congenital or acquired) causes severe facial asymmetry and disfigurement, which results in psychological and social disturbances to the patient. It becomes a challenging task for a maxillofacial prosthodontist to fabricate a prosthesis that replicates the healthy side of the face. Success of the prosthesis depends primarily on satisfactory retention of the same. This clinical report illustrates rehabilitation of a patient with an orbital defect by fabricating a hollow orbital prosthesis, utilizing anatomical undercuts for retention using an acrylic resin template relined by a resilient denture liner.

Keywords: Facial prosthesis, light weight orbital prosthesis, retinoblastoma of orbit

How to cite this article:
Shaikh SR, Patil PG, Puri S. A modified technique for retention of orbital prosthesis. Indian J Dent Res 2011;22:863-5

How to cite this URL:
Shaikh SR, Patil PG, Puri S. A modified technique for retention of orbital prosthesis. Indian J Dent Res [serial online] 2011 [cited 2019 Jul 18];22:863-5. Available from: http://www.ijdr.in/text.asp?2011/22/6/863/94688
Orbital exenteration is the en bloc removal of the entire orbit, usually involving partial or total removal of the eyelids, and is performed primarily for eradication of malignant orbital tumor. [1] It is indeed impossible to reconstruct an exenterated orbit with autogenous material in an anatomic situation in which there is a total loss of the upper and lower eyelids along with the eye. [2] The treatment of choice in such situations is a prosthesis to restore the lost orbital structures. Retention of the prosthesis is an important factor to be taken into consideration during fabrication. This article describes a method of retention of the silicone orbital prosthesis by fabricating an acrylic resin template relined with the resilient denture liner to engage anatomical undercuts. It also illustrates the procedure of making the prosthesis hollow and light weight.


   Case Report Top


A 23-year-old female reported to the Department of Prosthodontics with the chief complaint of facial deformity due to the loss of the left eye. History taking and clinical examination revealed exenteration of the left orbital contents 2 years back due to retinoblastoma. The socket was well healed and devoid of any secretions. Deep anatomical undercuts were present due to cauliflower-shaped soft tissue hyperkeratinisation [Figure 1]. The hyperkeratinised soft tissue showed no histopathologically significant findings.
Figure 1: Post-surgical facial view. Cauliflower-shaped soft tissue hyperkeratinisation seen in the defect

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   Procedure Top


Fabricating the acrylic template

The facial moulage was made with the irreversible hydrocolloid (Dentalgin; Prime Dental Products, Mumbai, India) from which a mould was obtained in Type III gypsum product (Kalstone; Kalabhai Karson, Mumbai, India) in a conventional manner. [3] The defect site on the mould was carefully examined and severe undercuts were blocked out using modelling wax (Maarc; Shiva Products, Mumbai, India). The defect site was then duplicated using putty-consistency polyvinyl siloxane impression material (Aquasil Putty; Dentsply Caulk, Milford, DE, USA) [Figure 2] and was poured in Type IV gypsum product (Ultra-Rock; Kalabhai Karson) to make a working cast. On the working cast, the heat-polymerised clear acrylic resin (DPI Heat Cure; Dental Products of India) template was prepared.
Figure 2: Duplication of defect using putty-consistency polyvinyl siloxane

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Relining of the template for retention purpose

Petroleum jelly was applied over the face on the defect site. Tinfoil substitute was applied over the mould. Long-term resilient denture liner (Permasoft; Dentsply Austenal, York, PA, USA) was mixed and applied over the tissue surface of the template and first placed over the mould [Figure 3]. Once dough consistency was reached, the template was removed from the mould and placed in the socket on the patient's face for 10 min. The patient was asked to perform functional movements of the eye. After the liner was set, sealer was applied as per the instructions given by the manufacturer.
Figure 3: Template placed on the mould for relining with the soft liner

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Fabricating a hollow, lightweight prosthesis

A stock eye was selected that closely resembled the color and size of the sclera and iris of the patient's contralateral eye. The stock eye was positioned correctly on the template using modelling wax, in accordance with the normal gaze of the contralateral eye [Figure 4], as described by Beumer et al. [4] The modelling wax from the lower aspect of the stock eye was removed without disturbing its position. The stock eye was then sealed on the lower aspect with the acrylic template using autopolymerising clear acrylic resin (DPI RR Cold cure clear; Dental Products of India). Once the position of the stock eye was secured, wax from the upper aspect was removed by pouring warm water. The open space [Figure 5] was carefully sealed using autopolymerising resin and, thus, making the prosthesis hollow to decrease its weight. Care was taken to avoid inadvertent contact of the acrylic resin with the stock eye.
Figure 4: Stock eye secured in correct position using modelling wax

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Figure 5: Lower aspect of the stock eye sealed to the template using autopolymerising acrylic resin. Space seen on the upper aspect of the stock eye after removal of wax

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Pattern sculpting and silicone prosthesis processing

Eye lid contours and periorbital tissues were sculpted in the modelling wax to mimic the contralateral normal side as closely as possible. The waxed-up prosthesis was tried on the patient's face. After try-in, the waxed-up prosthesis was flasked and dewaxed in a conventional manner. Medical-grade silicone (MDX4-4210, Factor II, Lakeside, AZ, USA) was mixed with intrinsic stains (KT-699, Silicone Colouring Kit, Factor II) to obtain the desired shade and packed in incremental layers. Curing was then carried out for 2 h at 90°C as per the manufacturer's instructions. After deflasking, the silicone flashes were trimmed and finishing and polishing of the prosthesis was carried out.

Prosthesis delivery

The final silicone prosthesis was inserted into the defect [Figure 6]. The spectacle frame was selected and the patient was instructed to use it to camouflage the prosthesis margins. Home care instructions were given. The patient was followed-up at regular intervals of 6 months to check the integrity of the soft liner and the silicone prosthesis and for examination of the defect area. After 6 months of the insertion of the prosthesis, no undesirable soft tissue changes were observed. The prosthesis was comfortable to wear and caused no tissue irritation. The integrity of the soft liner was found to be unaltered. Clinically insignificant alterations were found with the color and the consistency of the silicone used. The prosthesis was still serviceable and the patient was content with the prosthesis.
Figure 6: Post-surgical facial view with orbital prosthesis

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   Discussion Top


Retention of orbital prosthesis can be achieved in a number of ways. Pearl [5] emphasized the use of anatomic and anatomic-mechanical retentive mechanisms to reduce the use of visible unesthetic retentive aids or adhesives to retain facial prostheses. In the present case, retention of the orbital prosthesis was obtained by engaging anatomical undercuts using a long-term resilient denture liner applied to the acrylic resin template. Chances of degradation of the liner and microbial growth over the liner were minimal due to absence of secretions in the defect area. Application of the sealer over the liner was imperative to maintain integrity of the liner for more than 1 year.

Occasionally, extensive surgical procedures for advanced tumors of the facial region leave a large defect area, compromising the prosthetic retention caused by the weight of the final prosthesis. [6] Therefore, the prosthesis was made hollow to reduce its weight by sealing the stock eye to the acrylic template using autopolymerising acrylic resin.

Often, the gaze of the stock eye changes after processing of the prosthesis. This happens due to movement of the stock eye while dewaxing of the sculpted pattern. Sealing the stock eye to the acrylic template prevented any such movement and maintained the gaze of the stock eye that was positioned to match the contralateral eye.


   Conclusion Top


Utilisation of anatomical undercuts, with a resilient denture liner as described, is a novel and economic method to retain orbital prostheses. It is therefore certain that this technique has a definite potential as an excellent alternative retentive aid for orbital prostheses.

 
   References Top

1.Perman KI, Baylis HI. Evisceration, enucleation, and exenteration. Otolaryngol Clin North Am 1988;21:171-82.  Back to cited text no. 1
    
2.Stanley RB Jr, Beumer J 3 rd . Orbital rehabilitation: Surgical and prosthetic. Otolaryngol Clin North Am 1988;21:189-98.  Back to cited text no. 2
    
3.Taylor TD. Clinical maxillofacial prosthetics. London: Quintessence Publishing Co, Inc: 2000. p. 233-76.  Back to cited text no. 3
    
4.Beumer J, Curtis TA, Firtill DN. Maxillofacial rehabilitation: Prosthodontic and surgical considerations. St Louis: CV Mosby; 1979. p. 364-71.  Back to cited text no. 4
    
5.Parel SM. Diminshed dependence on adhesives for retention of facial prosthesis. J Prosthet Dent 1980;43:552-60.  Back to cited text no. 5
    
6.Kiat-amnuay S, Lemon JC, Wesley PJ . Technique for fabricating a lightweight, urethane-lined silicone orbital prosthesis. J Prosthet Dent 2001;85:210-3.  Back to cited text no. 6
    

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Correspondence Address:
Sameera R Shaikh
Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.94688

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

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