6.Maxillofacial Prosthesis Materials
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Transcript of 6.Maxillofacial Prosthesis Materials
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Maxillofacial Prosthesismaterials
Presenter : Dr. Sumit Sethi
Guide : Dr. Dilip Kakade
03-04-06
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Contents
Introduction
History Classifications
Ideal properties
Individual material & their advantages &disadvantages
Comparison of physical properties
Technique of fabrication Limitations & degradation of the material
Conclusion
References
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Introduction
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History Before 1600 AD- ancient Chinese culture
Tycho Brahe (1546-1601)- nose from gold.
Ambroise Pare (1510-1601)- nose from gold, silver,paper.
Pierre Fauchard (1678-1761)- silver mask.
William Morton (1819-1868)- enameled porcelain.
Claude Martin (1889)- ceramic
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History
1900-1940
Uphamvulcaniterubber.
1905 Ottofy, Baird &
Baker- vulcaniterubber.
1913Gelatin-
glycerin compounds.
Bulbulian & Clarke -
Latex Vulcanite prosthesis given to Sigmond
Freud (Austrian psychiatrist) in 1923.
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History 1937- Acrylic resin.
Tylmanresilient Vinyl copolymer
1960 to 1970-
BarnhartSilicone & acrylic resin polymer stains.
1970 to 1990-
Lontz - modified Polysiloxane elastomers.
Lewis & CastleberrySiphenylenes.
Udagama & Drane- Silastic medical adhesive type A.
1990 to present-
Antonocci & Stansberrynew generation acrylic resin
Gettleman - Polyphosphazenes
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ClassificationClassification of materials used in Maxillofacial Prosthodontics
Impression
materials
Materials for
fabrication
Pigmentation
materials
Auxiliary
materials
Materials for
Retention
Composition
Macro-
cellular foam
Plaster of
Paris
Plaster
bandage
Alginate
Mould
making
Pattern
materials
Prostheticmaterials
Flasks
Separating
medium
Comfeel
Stellon
crown
Silastic
foam
Aerosil 130
Extrinsicsealant
Others
Implants
Magnets
Adhesives
Primers
Silicone
putty
Extrinsic
Intrinsic
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Classification of MaxillofacialProsthesis materials
According to Beumer:
1. Acrylic resins.
2. Acrylic copolymers.
3. Polyvinyl chloride & copolymers.
4. Chlorinated polyethylene.
5. Polyurethane elastomers.
6. Silicone elastomersHTV, RTV, Foamingsilicones.
7. New materials- Silicone block copolymers,
Polyphosphazenes.
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Classification of MaxillofacialProsthesis materials
According to ANUSAVICE:
1. Latex- a tripolymer of Butyl acrylate, Methyl
methacrylate & Methyl methacrylamide.
2. Vinyl Plastisols.
3. Silicone Rubbers.
4. Polyurethane Polymers.
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Ideal properties 1. Ideal Physical & Mechanical properties:
a. Dynamic properties comparable to tissues.b. High edge strength, high elongation, high resistance
to abrasion, high tear strength & high tensilestrength.
c. Low coefficient of friction, low glass transitiontemperature, low specific gravity, low surfacetension & low thermal conductivity.
d. Odorless, Non-inflammable, No water sorption.
e. Translucent.
f. Softness compatible to tissue & variable flexibility
without addition of leachable plasticizer.
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Ideal properties 2. Ideal Processing characteristics:
a. Adjustability.b. Chemically inert after processing.
c. Dimensionally stable during & after processing.
d. Ease of intrinsic & extrinsic coloring.e. Ease of mold fabrication & processing.
f. Ease of repair & refabrication if needed.
g. Fidelity of detail reproduction.h. High viscosity for maintaining even dispersion of
colorants.
i. Long shelf life & working time.
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Ideal properties
2. Ideal Processing characteristics: (contd)
j. Low viscosity for ease of processing.
k. Low processing temperature.
l. Low sensitivity to contamination during processing.m. Non-inflammable, non-toxic & non-porous.
n. No polymerization by-products.
o. Reusable molds.p. Retain intrinsic & extrinsic coloration during use.
q. Short processing time.
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Ideal properties 3. Ideal Biological properties:
a. Compatible with supporting tissues.b. Non allergic & non toxic.
c. Cleansable with disinfectants without losing detailsat surface or margins.
d. Color stability & dimensional stability.
e. Flexibility comparable to tissue & stable at hightemperatures.
f. Inert to solvents & skin adhesives.
g. Resistance to environmental discoloration & growthof microorganisms.
h. Inexpensive.
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Individual material1. ACRYLIC RESINS:
- used in areas with littlemovement. (Orbital or
Ocular etc)
Advantages: readily available, easy incoloring, good strength, compatiblewith adhesives, long service, colorstability, easily repaired or relined.
Disadvantages: rigidity, discomfort,high thermal conductivity, no
duplication possible.
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Individual material
2. ACRYLIC COPOLYMERS:
Advantages: soft & elastic.
Disadvantages:poor edge strength, degrade in
sunlight, processing & coloration is difficult, gets
stained easily .
- Antonucci & Stansbury reported new generation
development in this.
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Individual material
3. POLYVINYL CHLORIDE (PLASTISOLS) &
COPOLYMERS: ( Realistic, Mediplast,Prototype III)
- a rigid , clear, tasteless & odorless- glass transition temperature higher
- plasticizers are added
- cross linking agentsRecently a copolymer5%to 20% Vinyl acetate in it.
It is more stable, more flexible but less chemicallyresistant.
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Individual material
3. POLYVINYL CHLORIDE (PLASTISOLS) &
COPOLYMERS: ( contd)
Advantages: flexible, adaptable to coloration to yield
good appearance.
Disadvantages: leaching of plasticizers, tear easily,
easily stained, degrade easily, soil easily, metalmolds required, short service life, poor dimensional
stability.
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Individual material
4. CHLORINATED POLYETHYLENE:
- Lewis & Castleberry
- similar to Polyvinylchloride in both chemical
composition & physical properties.
- Gettleman also reported (CPE 726/19-15)
- clinical trials just initiated
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Individual material
5. POLYURETHANE ELASTOMERS:
- Diisocyanate + Polyol
- processing (1000C)
Advantages: elastic (without compromising edge
strength), flexible, easy coloration, superior
cosmetic results.
Disadvantages: difficult to process, moisture
sensitive, no color stability, service life less, poor
compatibility with adhesives, toxic.
initiator
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Individual material
6. SILICONES:
- Production
- dimethyl dichlorosiloxane + water
Classified into four groups:i) Implant grade
ii) Medical grade
iii) Clean grade
iv) Industrial grade
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Individual material
a. HEAT VULCANIZED SILICONES (HTV) :
- Polydimethyl vinyl siloxane copolymer with approx.
0.5% vinyl side chains, 2,4-dichlorobenzoyl
peroxide as an initiator & a silica filler obtainedfrom burning methyl silanes.
- processing temperature ( 2200C).
- difficult to pigment.
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Individual material
i. SILASTIC 370, 372, 373, 4-4514, 4-4515:
- white opaque material, highly viscous.
- dichlorobenzoyl peroxide or platinum salt as catalyst
- fillers added to harden (silica)
-Advantages: excellent thermal stability, color
stability, biologically inert.
-Disadvantages: less elastic, low edge strength,
opaque & lifeless, difficult to color extrinsically,
require metal molds.
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Individual material
ii. PDM SILICONES:
- Lontz and Schweiger& Lontz
- Abdelnnabi evaluated properties
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Individual material
iii. Q7-4635, Q7-4650, Q7-4735, SE-4524U:
- a new generation evaluated by Bell
- single component system
- unlimited shelf life
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Individual material
b. ROOM TEMPERATURE VULCANIZED
SILICONES (RTV) :
- used more often then any other
- good physical & mechanical properties
- vinyl & hydride containing siloxanes
- chloroplatinic acid as ctalyst
- tetraethoxysilane as cross-linking agent
di id l i l
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Individual material
i. SILASTIC 382, 399 :
- stannous octoate catalyst & orthoalkyl silicate ascross linking agent
- Advantages: color stable, clear solutions, easy to
process, require stone molds
- Disadvantages: poor strength, difficult to color,
cosmetic results inferior
di id l i l
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Individual material
ii. MDX4-4210 :
- chloroplatinic acid catalyst & hydro-methyl siloxaneas cross-linking agent. (800C for 1 hour)
-Moore reported improved properties
Advantages: no reaction by-product,
increased elongation,
surface texture & shore hardness,
non-toxic, color stable,
simple processing,
compatible with adhesives
I di id l i l
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Individual material
iii. SILASTIC 891 (Silastic Medical Adhesive
Silicone Type A) :- Udagama & Drane
- translucent, non flowing, polymerizes in air
- Advantages: no need of molds, no catalyst,
compatible with wide range of colorants.
- in 1987 Udagama used it along with polyurethane
film to improve its edge strength.
- Farah suggested a combination of:
40% MDX4-4210 + 60% MED.A 891
I di id l t i l
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Individual material
iv. COSMESIL / SILSKIN 2 SYSTEMS :
- Woofaardt described it
- two curing system:
a) Platinum cure:
- utilizes vinyl terminated Silicone & a platinum
catalyst
- addition reaction so no by-products. Hence no
shrinkage
- poisoned by latex
- working time 1 hr & curing at 1000C for 1 hr
I di id l t i l
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Individual material
iv. COSMESIL / SILSKIN 2 SYSTEMS (contd) :
(b) Tin cure:
- utilizes hydroxy terminated silicone fluids & a Tin
catalyst
- condensation reaction so by-product is formed
- is very robust & cures against most substrates/
conditions
- working time 1hr & cures in 24 hr at room
temperature.
I di id l t i l
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Individual material
v. A-2186 (FACTOR II) :
- a recently developedmaterial initially showed
improved properties.
- but Haug reported that itdoesn't retain them when
subjected to
environmental variables.- two types of curing system
similar to Cosmesil
I di id l t i l
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Individual material
7. NEW MATERIALS:
(i) Silicone block copolymers:
- incorporates Polymethyl methacrylateinto Siloxane
blocks.
- more tear resistant
(ii) Polyphosphazenes:
- developed as a resilient denture liner
Ph i l ti
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Physical properties
Tensile strength
Maximum Elongation
Pants Tear energy
Dynamic Modulus
Ph i l ti (CRAIG)
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Physical properties (CRAIG)
Material Tensile
strength(psi)
Max. %
elongation
Pants tear
test(dynes/cm
106
Dynamic
modulus(MPa)
Plasticized
polyvinylchloride 3.99 215 4.3 4.32
Polyurethane 0.83 422 6.7 3.46
HTV 5.87 441 Doesn't tearbut stretches as
in tensile
4.66
RTV 4.20 445 Elongation. 2.12
Ph i l ti (BEUMER)
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Physical properties (BEUMER)Elastomer A-2186 Silastic 382 MDX4-4210 MDX4-4515 MDX4-4516
Manufacturer Factor II Dowcorning
Dowcorning
Dowcorning
Dowcorning
Color Translu-
cent
Gray Translucent Translucent Translucent
Shore hardness 25 43 >25 52 72
Tensile strength
(psi)
900 350 >550 1350 1175
%Elongation 650 160 >350 450 370
Tear strength
(psi)
90 NA 50 NA NA
Specific gravity 1.12 1.13 1.12 1.15 1.21
Ph i l ti (CHALIAN)
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Physical properties (CHALIAN)
Silastic
S-6508
Silastic 382 Silastic 399
Durometer 26 45 50
Tensile (psi) 785 300 525
%Elongation 490 100 230
Tear (psi) 65 20 29
M ld ki t i l
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Mold making materials
Silicones.
Surgical plaster of Paris- for investing of allprosthesis & blanking out undesired areas ofimpression models.
Kaffir D dental stone- for all impression models.
Beta Dur 700 hard stone- vacuum mixed & used as atopping investment as it is hard & protects finerecorded details. Its color allows easy placement of
localized color.
Plaster / pumice- 30/70 ratio used for blanking areasthat need to be free of silicone in the mold
(Keith Thomas)
Flasks
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Flasks
Two part rectangular Aluminium alloy flasks, selfclamping.
Available in sizes :Small 6 4 3 Medium 6 6 3/8 6 1/12Large 9 6 7 Shallow 8 5 2
(Keith Thomas)
i di
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Separating media
Soap- useful for two part plaster moulds, also ifused in a 5% solution may be used as a releasing
agent for silicone prosthesis.
Cold mould seal- all plaster moulds, also as a
releasing agent for silicone.
Medi-Mould wax mould sealant & releasing
agent- sealing porous mould surfaces. Release agent
for silicone.
Pattern materials
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Pattern materials
Waxes: hard, soft , skin colored etc.
- Baseplate wax , Korecta wax ,
Utility Wax
Clay
Materials for retention
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Materials for retention
Double sided
adhesive tape
Primers & Adhesives
Mate ials fo etention
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Materials for retention
Implants
Materials for retention
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Materials for retention
Adhesive magnet plate
Neo- mini magnets
Materials for retention
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Materials for retention
SpectaclesSprung steel head band
Other materials
Materials for Pigmentation
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Materials for Pigmentation
Extrinsic & intrinsic pigments.
Basic shades are mainly metal oxides like:
Nickel oxide - Brown
Manganese oxide - Lavender
Titanium oxide - Yellowish brown
Iron oxide - Brown
Copper oxide - Green
Auxiliary materials
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Auxiliary materials
Extrinsic sealant
Aerosil 130- to reduce shine & alter viscosity
Silastic foam dressing
Macrocellular foam
Stellon crown & bridge- to facilitate construction of
custom made finger nails.
Adhesive removers or solvents
Auxiliary materials
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Auxiliary materials
Comfeel ( skin conditioner)
- it is Ethoxyethyl acid copolymer ethyl acetate- creates an elastic protective barrier
- applied to clean skin & after 1-2 min it forms
a film.
Fabrication of the Prosthesis
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Fabrication of the Prosthesis
Master cast
Color matching/ intrinsic pigmentation
Wax / clay pattern
Impression
Try-in
Processing
Compression molding
Two part or three or four part mould
Investment
Surface / extrinsic pigmentation
Finishing
Limitations & Degradation
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Limitations & Degradation
Discoloration due to
- external environmental factors.- due to loss of external coloration.
Degradation of properties
- tear at margins
- change in surface texture
- elongation at margins
- deterioration of static & mechanical properties
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Conclusion
Ultimate challenge to a material is its clinicalperformance.
Laboratory testing should be correlated to
clinical performance.
Sweeney in 1972 & Lewis & Castleberry in
1980 gave specifications for maxillofacial
elastomer.
Future research:
- improving the properties to service life.
- color stable & better color matching.
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References
Prosthetic Rehabilitation - Keith Thomas
Maxillofacial Rehabilitation - Beumer & Curtis
Maxillofacial Prosthetics - Chalian
Restorative dental material - Craig
Philips science of dental materials - Anusavice
Oral cancer - Silverman Cosmesil & Factor II catalogue
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