Single-visit hollow obturators for edentulous patients.

A method of fabricating a simple hollow obturator for edentulous patients was described. This procedure can be accomplished in a single office visit using readily available materials. The use of a relatively long-lasting soft reline material for obturators allows stable, comfortable, and effective obturation for many edentulous patients with recently created maxillary defects (Fig. 6). The hollow prosthesis is lightweight and sufficiently flexible to allow relatively simple placement in retentive undercut regions. Direct finger placement of the material insures complete duplication of all desired tissue undercuts. The soft reline material may also serve as a final impression of the defect when fabrication of the definitive prosthesis is undertaken.     

Fabricating auricular prostheses using three-dimensional soft tissue models.

This article describes a method for fabricating an auricular prosthesis. This procedure uses the contours of the soft tissue surface from computerized tomography scans to fabricate a computer-generated, side-inverted 3-dimensional soft tissue model from a solid block of polyurethane using an Endoplan milling machine. The resultant 3-dimensional soft tissue model can then be used as the basis for a wax sculpture. This procedure facilitates the planning of the prosthesis; symmetrical modeling, especially for large, hemifacial defects; and the impression, which can be made on the model itself.     

Digital Image Capture and Rapid Prototyping of the Maxillofacial Defect

In order to restore an extraoral maxillofacial defect, a moulage impression is commonly made with traditional impression materials. This technique has some disadvantages, including distortion of the site due to the weight of the impression material, changes in tissue location with modifications of the patient position, and the length of time and discomfort for the patient due to the impression procedure and materials used. The use of the commercially available 3dMDface? System creates 3D images of soft tissues to form an anatomically accurate 3D surface image. Rapid prototyping converts the virtual designs from the 3dMDface? System into a physical model by converting the data to a ZPrint (ZPR) CAD format file and a stereolithography (STL) file. The data, in conjunction with a Zprinter^® 450 or a Stereolithography Apparatus (SLA), can be used to fabricate a model for prosthesis fabrication, without the disadvantages of the standard moulage technique. This article reviews this technique and how it can be applied to maxillofacial prosthetics.     

Manufacturing implant supported auricular prostheses by rapid prototyping techniques

Maxillofacial prostheses are usually fabricated on the models obtained following the impression procedures. Disadvantages of conventional impression techniques used in production of facial prosthesis are deformation of soft tissues caused by impression material and disturbance of the patient due to. Additionally production of prosthesis by conventional methods takes longer time. Recently, rapid prototyping techniques have been developed for extraoral prosthesis in order to reduce these disadvantages of conventional methods. Rapid prototyping technique has the potential to simplify the procedure and decrease the laboratory work required. It eliminates the need for measurement impression procedures and preparation of wax model to be performed by prosthodontists themselves In the near future this technology will become a standard for fabricating maxillofacial prostheses.     

Fabrication of a meatus obturator on a titanium framework with a 1-step impression.

The fabrication of meatal obturator prosthesis with titanium framework using a 1-step final impression procedure is described in the case of a 44-year-old woman with congenital absence of the soft palate. The meatus obturator results in a more stable maxillary prosthesis and permits acceptable speech for a patient with total absence of the soft palate. The fabrication technique is relatively easy and saves time by eliminating some laboratory procedures.     

A modified technique and simplified laboratory procedure for ocular prosthesis fabrication

PurposeIn many cases dentist tries to satisfy the patient with stock prosthesis that comes in standard sizes, shapes and colors. However, most of the patients complain of discomfort even after appropriate adjustment because of insufficient adaptation to underlying soft tissues. The rehabilitation of a patient with loss of eye as a result of congenital defect, pathology or accidental trauma is a challenge in terms of re-establishment of the esthetics of the patient. The purpose of this technical procedure is to provide a well fitting prosthesis to the patient, reducing the number of laboratory steps and appointments for fabrication of ocular prosthesis.MethodA suitable stock eye shell was modified to fit the eye socket, followed by relining with low fusing compound and making a final impression with polyvinyl siloxane impression material. The impression was poured in die stone, flasking procedure was accomplished. After dewaxing, molten wax was flown in the lower half of the flask followed by repositioning of the upper half. The flask was reopened, the stock eye shell along with the hardened wax on tissue surface was tried in the patient's eye. Finally processing was done.ConclusionThis technique describes an impression procedure, followed by a wax pattern try-in in the same appointment and also the detailed laboratory procedure for fabrication of the ocular prosthesis, taking into consideration positioning of iris as a result enhancing the esthetic appearance of the patient.     

Impression procedure for creating a partial auricular prosthesis

Severe anatomic undercuts associated with tissue remnants or a defect site can often be an obstacle in achieving an accurate impression for a facial prosthesis. This article describes a procedure that overcomes the problems encountered in achieving an accurate impression. The distinct properties of 2 impression materials are applied to create a 3-piece impression that can be reassembled to develop an accurate stone master cast.     

Use of Implant‐Supported Custom Milled Impression Copings to Capture Soft‐Tissue Contours and Incisal Guidance

A technique is presented where a custom milled impression coping is used to replicate the clinically established anterior incisal guidance to the definitive prosthesis when multiple implants are restored in the esthetic zone. A conventional impression is initially made, then the stone cast is scanned, and a digitally designed custom screw‐retained, implant‐supported interim prosthesis is milled from a polymethylmethacrylate (PMMA) billet. This is aimed to digitally design the pontic areas, contour the gingival soft tissue, and establish an anterior incisal guidance. A custom milled impression coping (CMIC) is then fabricated. The CMIC has contours similar to the contours of the interim prosthesis and is fabricated from a PMMA billet. Titanium inserts are placed in the interim prosthesis and the CMIC. The CMIC is inserted intraorally and used for the final impression by using a custom tray and by following the open tray impression protocol. With the proposed technique, the exact contours of the digitally designed and clinically verified interim prosthesis are used to fabricate the definitive restoration.     

Duplication of interim speech aid for definitive impression tray fabrication.

A wax tray is stable and easily relieved if overextended. Unusual tray undercuts or angles needed for the partial resection patient need not be eliminated before the impression procedure. Relief of these undercuts is necessary with acrylic resin trays to ensure separation from the final stone cast. Because the wax tray is separated easily from the prosthesis during the boil-out, it is not necessary to "burn" or grind acrylic resin from the framework. The tray shape is duplicated from the existing interim prosthesis on the nasopharyngeal and oropharyngeal side. An arbitrarily shaped acrylic resin tray may be grossly overextended and require time-consuming clinical adjustments. An underextended tray on the nasopharyngeal side will not carry or support the impression material around or through the residual soft palate remnant. A tray that closely approximates the final prosthesis will allow use of a tissue conditioner final impression without need for border molding (Fig. 2). Duplicating the oropharyngeal side of the interim speech aid duplicates the previously established plane that is compatible with the tongue. The author has used this technique successfully for eight total and five partial soft palate resections. A cleft palate speech aid prosthesis has also been made with this technique.     

Precise Reproduction of Soft Tissue Structure around the Pontic Area Using Computer‐Aided Design and Manufacturing

Reproducing soft tissue contours around a pontic area is important for the fabrication of an esthetic prosthesis, especially in the anterior area. A gingival model that precisely replicates the soft tissue structure around the pontic area can be easily obtained by taking a pick‐up impression of an interim fixed dental prosthesis. After a working cast is fabricated using the customary technique, the pick‐up model is superimposed onto the working model for the pontic area using computer‐aided design and manufacturing (CAD/CAM). A definitive restoration using this technique would be well adapted to the pontic base, which is formed by the interim prosthesis.     

Nasopharyngoscopy in palatopharyngeal prosthetic rehabilitation: A preliminary report

PURPOSE: Prosthetic rehabilitation of speech disorders related to palatopharyngeal dysfunction is accomplished through separation of the oral and nasal cavities. The ability to achieve this separation is challenged when the disorder or defect involves the soft palate. Prosthetic rehabilitation of soft palate disorders and defects has traditionally relied on functional contouring of a prosthesis using functionally adapted impression materials. However, there are limitations to this process, particularly in its inability to visualize function as it relates to the prosthesis in a 3-dimensional space. The aim of this study was to address this limitation by describing outcomes related to the use of nasopharyngoscopy (NPS) for visualization of the velopharyngeal port during assessment and treatment of palatopharyngeal dysfunction. MATERIALS AND METHODS: A retrospective analysis of speech data was conducted for 5 patients who were assessed before treatment, after prosthetic intervention using conventional functional impression techniques, and after prosthetic intervention using NPS. Nasalance and velopharyngeal orifice area outcome measurements were collected for each patient at clinically predetermined intervals. Perceptual assessment of speech samples was performed as well. RESULTS: Improvements in speech function were observed for all patients after treatment with a prosthesis designed via a conventional functional impression technique; however, no patient showed normal values for nasalance or velopharyngeal orifice area. With the use of NPS to adjust the wax impression-derived prosthesis, both nasalance and velopharyngeal orifice area measurements for all patients were within normal limits. Similarly, perceptual judgment of speech found that normal resonance balance was obtained after use of NPS. CONCLUSION: The addition of NPS into prosthetic treatment for palatopharyngeal disorders shows promise for improved speech results.     

A technique for immediately restoring single dental implants with a CAD-CAM implant-supported crown milled from a poly(methyl methacrylate) block

This technique is used when a single dental implant is placed. A stent made of autopolymerized acrylic resin was used to transfer the implant position to the laboratory. Once the implant position was transferred, the stone cast was scanned, and a computer-aided design and computer-aided manufacturing (CAD-CAM) interim implant-supported crown was milled from a poly(methyl methacrylate) (PMMA) block. A titanium insert, in contact with the implant platform and not the PMMA material, was used to support the crown. The interim prosthesis was then placed intraorally. The soft tissues were sutured, and the interim prosthesis was left for a period of at least 3 months to confirm osseointegration and allow the soft tissue to heal. A CAD-CAM titanium impression coping was made and used for the definitive impression. The contours of the impression coping were identical to the contours of the interim restoration. The data of the digital design of the interim prosthesis were saved, and the definitive prosthesis was fabricated with contours identical to those of the interim prosthesis.     

Fabricating an Accurate Implant Master Cast: A Technique Report

The technique for fabricating an accurate implant master cast following the 12‐week healing period after Teeth in a Day® dental implant surgery is detailed. The clinical, functional, and esthetic details captured during the final master impression are vital to creating an accurate master cast. This technique uses the properties of the all‐acrylic resin interim prosthesis to capture these details. This impression captures the relationship between the remodeled soft tissue and the interim prosthesis. This provides the laboratory technician with an accurate orientation of the implant replicas in the master cast with which a passive fitting restoration can be fabricated.     

Simplified Technique for Orbital Prosthesis Fabrication: A Clinical Report

Loss of orbital content can cause functional impairment, disfigurement of the face, and psychological distress. Rehabilitation of an orbital defect is a complex task, and if reconstruction by plastic surgery is not possible or not desired by the patient, the defect can be rehabilitated by an orbital prosthesis. The prosthetic rehabilitation in such cases depends on the precisely retained, user‐friendly removable maxillofacial prosthesis. Many times, making an impression of the orbital area with an accurate record of surface details can be a difficult procedure. The critical areas are making a facial moulage, mold preparation, and attaching the retention device, particularly when eyeglass frames are used. This case focuses on these hindrance factors. A simple basket was used for the impression tray to obtain the facial moulage. A putty mold was used, and attachment of the prosthesis to a retention device was accomplished with positional distance. This method proves to be an economical and simple way of making an orbital prosthesis.     

Impression technique for a complete-arch prosthesis with multiple implants using additive manufacturing technologies

This article describes an impression technique for a complete-arch prosthesis supported by multiple implants where additive manufacturing technologies were used to fabricate a splinting framework and a custom tray. The technique presented uses a shim method to control the homogenous splinting acrylic resin and impression material during the procedure, thereby reducing laboratory and chairside time and the number of impression copings and laboratory analogs needed.     

Technique for superimposing a color slide onto a facial cast to sculpt a facial prosthesis

A precise and uncomplicated technique for superimposing a color slide onto a facial cast for sculpting a facial prosthesis of the periorbital region is described. This technique allows making a facial impression with the eye closed. The superimposed slide in full-face and profile views provide a natural appearance to the facial cast. Properly selected dental and photographic materials are essential to the success of this imaginative procedure.     

Prosthodontic considerations designed to optimize outcomes for single-tooth implants. A review of the literature

Background: The aim of this study was to review the literature on the restoration of single‐tooth implants, and to develop evidence‐based conclusions to optimize aesthetic, biologic and patient‐related outcomes. Methods: An electronic and hand search was conducted using the search terms ‘dental implants, single‐tooth; dental restoration, temporary; dental impression materials; dental impression technique; dental prosthesis, implant‐supported; dental prosthesis design; dental abutments; dental occlusion; maintenance; survival; and survival analysis’. Resultant titles were screened, and full text was obtained where relevant. The authors selected the most appropriate articles, giving preference to systematic reviews and long‐term, patient‐based outcome data. Results: Thirty‐nine articles were selected and critiqued by the authors. Conclusions: There was strong suggestion by several authors that peri‐implant soft tissue aesthetics can be sculpted through provisional restoration contour, but there are no clinical outcome studies to define or support this claim. Laboratory studies demonstrate that pick‐up type impression copings in conjunction with elastomeric impressions are the most accurate means for transferring implant position to a dental cast. Laboratory and finite‐element analysis studies suggest implants with an internal‐type connection show improved stress distribution, but supportive clinical data are lacking. The authors of this review favour a screw‐retained prosthesis for retrievability. Clinical and histological studies show that gold, titanium and zirconia ceramic abutment materials exhibit excellent biological responses, although there is insufficient data on the clinical service provided by zirconia as an implant‐substructure material. The literature does not associate any particular occlusal scheme with superior clinical outcomes. Implant‐borne single crowns offer comparable clinical service to tooth‐borne fixed dental prostheses. However, single‐tooth implant restorations are associated with an increased incidence of biological and technical complications.     

Relation of Gothic arch apex to dentist-assisted centric relation

This method of fabrication of an immediate nasal prosthesis has distinct advantages which recommend its use. These are (1) the use of an RTV silicone rubber impression as the refractory cast cuts fabrication time to minutes rather than hours, as compared with other methods of fabricating a nasal prosthesis; (2) the RTV silicone is permanent and stable and provides an exact reproduction of the part to be excised; (3) the initial RTV silicone impression may be used during fabrication of the definitive prosthesis as the mold for production of a wax sculpting model; (4) PVC prostheses offer a unique advantage of being soft enough for trimming with scissors at the time of surgery and are flexible and tissue-compatible; and (5) psychological trauma is minimized and the patient is better prepared for a definitive prosthetic restoration.     

Microstomia in a maxillectomy patient: A prosthetic challenge

The provision of a satisfactory denture in case of reduced stomal inlet has always been a trouble for the patient and a challenge to the prosthodontist. Fabrication of complete and removable partial denture prosthesis requires accurate diagnostic impression and diagnostic casts for the development of custom trays and final impression. The decreased mouth opening, technically called "Microstomia," poses problems in tray selection, impression making, jaw records and denture insertion. The causes for microstomia are numerous, one major cause being the after-effect of radiation therapy. Whatever the cause, the ability to make impressions and jaw records becomes taxing. A variety of impression techniques using modifications in the nature of the tray and impression materials are required. The present case report highlights an innovative and different aspect of impression making and fabrication of an obturator prosthesis for a microstomic patient who underwent maxillectomy.     

Two-step pick-up impression procedure for implant-retained overdentures

This article describes a procedure that permits careful border correction and impression fabrication of an edentulous arch, followed by pick-up of implant impression copings. The resultant master cast is accurate in terms of soft tissue detail, position of implant components, and relationship between soft tissue and implants.