Dentaltown August 2021 - 46

This extrapolates to the actual prosthetic.
Dentures and facial prostheses start with a
physical or digital impression. The sculpting
and processing of both are also similar and so
are the adjustments at delivery. Who better
than a dentist to create these prostheses? Last
but not least, I am proud to tell patients and
other doctors that the originator of modern
facial prosthetics, Dr. Arthur Bulbulian, and
the originator of modern plastic surgery,
Dr. Varaztad Kazanjian, were not medical
doctors but dentists who began their careers
working on denture prosthetics.
Why not plastic surgery?
Most patients and many doctors assume
that the field of plastic surgery has evolved to
a point where a facial prosthesis is no longer
necessary. However, there are many limitations
on the plastic surgical reconstruction
of facial defects, and in some cases plastic
surgery is used as an adjuvant, not as a
primary treatment. In other cases, the defect
is restored entirely with a prosthesis. Plastic
surgery cannot replace the contents of the
eyeball, or an entire nose or ear when the
bone and cartilaginous support is missing,
and in general, the larger the defect is, the
more likely prosthetic intervention will
be required.
Another reason for the use of facial
prostheses is if the patient is considered a
poor risk for surgery, either because of a
systemic medical issue or local reasons such
as surgical scarring or radiation treatment
to the affected site. The likelihood of
tumor recurrence is also a factor, and
often the use of a prosthesis is considered
advantageous because it allows oncologic
surgeons to visually inspect the resection
site at recall visits.
Adequate communication with the
head and neck oncologic surgeon or plastic
surgeon before surgery is extremely
important, especially when plastic surgical
procedures are combined with a prosthesis.
Over- or underfilling a surgical defect with
grafted tissue can change the outcome of a
prosthetic reconstruction drastically, and
this becomes even more important when
implants are part of the treatment plan.
46 AUGUST 2021 // dentaltown.com
Having the maxillofacial prosthodontist in
the operating room to surgically place the
implants or to ligate a surgical prosthesis at
the time of ablative or reconstructive surgery
makes the delivery of treatment seamless
and improves the final result.
The advent of implants
Most facial prostheses used to be created
with anatomical or adhesive retention to
keep them in place. I have found this to
be the most discouraging part of wearing
a facial prosthetic for most patients. Any
kind of moisture-be it sweat, rain or a
dip in the pool-will loosen the adhesive
and cause the prosthesis to dislodge. The
use of spectacles or other mechanical
retention is uncomfortable and, of course,
the moment the spectacles dislodge, so does
the prosthesis.
The advent of craniofacial implants did
as much for the field of facial prosthetics as
it did for intraoral prosthodontics by giving
us a reliable method to affix prostheses to
tissue. The first craniofacial implants were
based on the Branemark intraoral implant
except that they had much shorter lengths
(3-4 mm) that allowed placement into the
mastoid, orbital or nasal bones. Current
versions like the Vistafix 3 implant by
Cochlear Limited possess a beveled flange
that can be recessed against the cortex
for support and allows for smooth tissue
coverage (Fig. 1).
A cylindrical tissue-penetrating abutment
similar to a multiunit abutment can be placed
at the time of initial surgery or at a second
stage through a punch incision. Impression
material such as vinyl polysiloxane is often
used to capture abutment copings (Fig. 2),
then encased in a layer of fast-setting stone,
acrylic or rigid impression material to prevent
the impression from flexing during pouring.
The result is similar to a splinted intraoral
implant impression where transfer copings
are embedded in a representation of the
surrounding soft tissues (Fig. 3). Abutment
analogs can then be attached (Fig. 4) and
once a stone model is created, a magnetic
or a bar-and-clip-style attachment system
can be fabricated by soldering prefabricated
Fig. 1
Fig. 2
Fig. 3
Fig. 4
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Dentaltown August 2021

Table of Contents for the Digital Edition of Dentaltown August 2021

Dentaltown August 2021 - Intro
Dentaltown August 2021 - Cover1
Dentaltown August 2021 - Cover2
Dentaltown August 2021 - 1
Dentaltown August 2021 - 2
Dentaltown August 2021 - 3
Dentaltown August 2021 - 4
Dentaltown August 2021 - 5
Dentaltown August 2021 - 6
Dentaltown August 2021 - 7
Dentaltown August 2021 - 8
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Dentaltown August 2021 - Cover3
Dentaltown August 2021 - Cover4
Dentaltown August 2021 - SI_1
Dentaltown August 2021 - SI_2
Dentaltown August 2021 - SI_3
Dentaltown August 2021 - SI_4
Dentaltown August 2021 - E_1
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