MAXILLOFACIAL

PROSTHESIS MATERIALS
Presented by:-
DR. AMAR ARBALE
MDS II
DEPARTMENT OF PROSTHODONTICS AND
CROWN & BRIDGE
Contents
• Introduction
• History
• Classifications
• Ideal properties
• Individual materials & their advantages &
disadvantages
• Recent advances
• Coloring
• Disinfection of prosthesis
• Conclusion
• References
 DEFINITION (GPT 9)

• Maxillofacial prosthesis : Any prosthesis used to replace part or all of any

stomatognathic and/or craniofacial structures.

• Maxillofacial prosthetics : The branch of prosthodontics concerned with the

restoration and/or replacement of stomatognathic and craniofacial
structures with prostheses that may or may not be removed on a regular or
elective basis.
Introduction
• Maxillofacial materials are used to correct facial defects or
deformities resulting from cancer surgery, accidents, or
congenital defects.

• Maxillofacial prostheses are difficult to fabricate and have a

relatively short life of 6 months to a few years in service.

• Due to economical considerations, acrylic resins which are not

the best of materials are still used more often in the fabrication
of maxillofacial prostheses.
 History
• Auricular, nasal and even ocular prostheses
fabricated of various materials like silver, gold,
bronze have been found on Egyptian mummies.

• Chinese are known to have fabricated nasal and

auricular prosthesis using natural waxes and
resin.

• Alphonse Louis fabricated silver mask and Louis

was known as the "Gunner with the silver mask”.
• According to Beder; the first obturator was described in
1541 by Ambroise [Link] consisted of a simple disc
attached to sponge.

• Tycho Brahe (1546-1601), used an

artificial nose made from gold to replace
his own nose.

• In 1880 - Kingsley described combination of nasal palatal

prosthesis in which obturator portion was integral part of
nasal prosthesis.
• In 1913 – Gelatin-glycerin compounds were introduced for use in facial
prosthesis in order to mimic the softness and flexibility.

• Barnhart was the first to use silicone rubber for construction and coloring
of facial prosthesis.

• In 1970 to 1990:- Gonzalez described the use of polyurethene elastomer.

CLASSIFICATIONS
According to Beumer:

1. Acrylic resins.

2. Acrylic copolymers.

3. Polyvinyl chloride & copolymers.

4. Chlorinated polyethylene.

5. Polyurethane elastomers.

6. Silicone elastomers – HTV, RTV, Foaming silicones.

7. New materials - Silicone block copolymers,

Polyphosphazenes.
According to Anusavice:

1. Latex- a tripolymer of Butyl acrylate, Methyl methacrylate &

Methyl methacrylamide.

2. Vinyl Plastisols.

3. Silicone Rubbers.

4. Polyurethane Polymers.
Extraoral Intraoral
materials materials

acrylic resin silicones

vinyl chloride poly (methyl

polymers methacrylate)

polyurethane

silicone
J of Biomedical material research 2004:8(4);349-363
 IDEAL PROPERTIES
Ideal Physical & Mechanical properties:

• High edge strength, elongation, tear strength.

• Softness compatible to tissue.

• Low coefficient of friction, glass transition temperature,

specific gravity, surface tension & thermal conductivity.

• Odorless, Non-inflammable, No water sorption.

Ideal Processing characteristics:

• Chemically inert after processing.

• Dimensionally stable during & after processing.

• Easy to repair & refabricate if needed.

• Long shelf life & working time.

• Retain intrinsic & extrinsic coloration during use.

• Short processing time.

• Low processing temperature.

Ideal Biological properties:

• Non-allergenic.

• Cleansable with disinfectants.

• Color stable.

• Inert to solvents and skin adhesives.

• Resistance to growth of microorganisms.

• Compatible with supporting tissues.

INDIVIDUAL MATERIALS
1. ACRYLIC RESINS:

• In cases where little movement of tissue bed during function. (Orbital

or Ocular etc).
• Acrylic powder: Polymethyl methacrylate
• Liquid : Methyl methacrylate

• The polymerization of MMA is initiated by UV light / heat as well as

chemical initiations.

• Heat polymerizing MMA is preferred over the autopolymerizing form because of the
presence of free toxic tertiary amines and color stability.

• However, since it is economical as compared to the silicones, it is still

quite commonly used.
 Advantages: Disadvantages:
• Durable • Rigidity
• Can be relined or • Duplicate prosthesis is
repaired not possible
• Good shelf life • high thermal
• Can be color matched conductivity
according to individual • Does not have the feel of
skin. skin.
• Both extrinsic & intrinsic • Poor margin esthetics.
coloring can be
performed.
• Compatible with most
adhesive system & can
be cleaned easily.
2. ACRYLIC COPOLYMERS: (Palamed, Polyderm)

• Acrylic & methacrylic acid.

• Made soft by adding plasticizers.

Advantages: Disadvantages:
• Soft • Poor edge strength
• Elastic. • Poor durability
• Degradation when exposed to
sun
• Processing coloration is difficult
• Completed restoration often
become sticky, predisposing to
dust collection and staining.
Toxicology of PMMA:

• Contact of the mucous membranes with polymer powders

may cause allergic and irritating reactions.

• Liquid monomer is a potent solvent that is highly volatile

and flammable. Due to the residual monomer release severe
skin reaction may occur.

• Monomer vapors may irritate the respiratory tract leading to

asthma.

• The vapors are also potentially harmful to the liver and may
cause reactions with soft contact lenses.
3. VINYL PLASTISOLS & COPOLYMERS: ( Realistic, Mediplast,
Prototype III)

• Introduced in 1940.

• The earliest form consisted of a combination of polyvinyl chloride (a hard,

clear resin that is tasteless and odorless) and plasticizers.

• Commonly used - vinyl chloride-vinyl acetate copolymer.

• The amount of vinyl acetate in the polymer varies from 5-

20%.

• Vinyl resins that are relatively rigid in their pure state made
Polyvinyl chloride :
• Is a clear, hard resin which is tasteless and odorless.

• Darkens when exposed to ultraviolet light and heat. Therefore

requires heat and light stabilization.

Polyvinyl acetate :
• It is stable to light and heat, but has low softening
temperature.

• Colouring pigments are incorporated to match the skin color.

 Advantages: Disadvantages:

• Flexible • Loss of plasticizer resulting

• Adaptable to both intrinsic in discoloration.
and extrinsic coloration. • Edges tear easily.
• Inexpensive & easy to • These compound can be
manipulate. stained easily but degrade
• Can be remade by when exposed to UV light.
resoftening & reheating. • Absorbs sebaceous
• Hydrophilic properties. secretions, they
compromise the physical
properties.
• Require metal molds for
curing at high temperature
which are expensive.
[Link] :

• It is the most recent addition to maxillofacial

prosthetics.

• Initiator used 1,4-butanediol

• It requires accurate temperature

control as a slight change in
temperature can alter the chemical
reaction.

• The reaction must be carried out in a

dry atmosphere or carbon dioxide will
be produced and a porous elastomer
 Advantages Disadvantages
• They can be made elastic • Difficult to process
without compromising consistently.
strength.
• Isocyanate is moisture
• They can be colored sensitive.
extrinsically and
intrinsically. • No color stability.

• Superior cosmetic results • Poor compatibility of this

can be obtained, over the material with adhesive
other materials currently systems.
available.
5. SILICONES:

• Introduced in 1946.

• Consists of alternate chains of silicone and oxygen which

can be modified by attaching various organic side groups to
the silicon atoms or by cross linking the molecular chains.

• They have a wide range of properties from rigid plastics

through elastomers to fluids.

• They exhibit good physical properties over a range of

temperature.
• Most rubbery forms of silicone are compounded with fillers that
provide additional strength.

• Anti-oxidants and vulcanizing agents are used to transform the raw

mass from a plastic to a rubbery resin during processing.

• The long chained polymers, when tied together at various points

(cross-linked), create a network that can be separated only with
difficulty.

• This network makes the silicones especially resistant to degradation

from ultra-violet exposure.

• The process of cross-linking the polymers is referred to as

‘Vulcanization’.
• Vulcanization occurs both with and without heat and depends on the
• The tear strength of a Polydimethylsiloxane (PDMS)
maxillofacial material is extremely important particularly at
the thin margins surrounding nasal and eye prostheses.

• This thin margin helps to mask the presence of a facial

prosthesis to the surrounding facial tissue.
HEAT VULCANIZED SILICONES (HTV) :
eg:- SILASTIC 370, 372, 373, 4-4514, 4-4515, PDM SILICONES :

• HTV silicone is a white, opaque material highly viscous, putty like

consistency.

• Catalyst / vulcanizing agent  Dichlorobenzyl peroxide/ platinum

salt.

• Filler  Silica (Size 30 m)

• Processing of heat cured silicones requires sophisticated

instrumentation and high temperature ( 220 0C).

• Display better strength and color stability than room-temperature

 Advantages Disadvantages
• Low edge strength
• Excellent thermal stability
• Opaque
• Color stability when
• Metal molds necessary for
exposed to UV light.
• Superior strength high temperature.
• Poor wettablility
• Biologically Inert
• Low elasticity
 ROOM TEMPERATURE VULCANIZED SILICONES
(RTV)
eg: (Silastic 382, 299, MDX 4-4210).

• Composed of comparatively short – chain silicone polymers which

are partially end-blocked with hydroxyl groups.

• Cross-linking agent - tetraethyoxysilane

• Filler – Silica, diatomaceous earth

• Catalyst – Chlorplatinic acid or stannous octate

• They are supplied as two-paste systems

• Prostheses can be polymerized in stone molds.

• Because of their good physical properties and favorable

processing characteristics RTV silicones are used more often
than any other maxillofacial prosthetic material.

• They are available as clear solution that enable the

fabrication of translucent prosthesis.

• RTV silicone is blended with suitable earth pigment; to

produce the patient basic skin color.
 Advantages: Disadvantages:

• Easy handling • Poor edge strength

• Quick processing • Stiff
• Good thermal and color • Poor wettablility
stability • Costly
• Biologically inert • Cosmetic appearance of the
• Retain physical and chemical material is inferior to that of
properties at wide range of polyurethenes, acrylic resins,
temperature polyvinyl chloride.
• Stone molds can be used.
NEWER MATERIALS
NEWER MATERIALS:
1. MDX4-4210 : (two component kit)

• This medical-grade silicone elastomer is basically a modified

(PDMS) poly dimethyl siloxane structure popular among
clinicians.

• It exhibits improved qualities relative to coloration and edge

strength.

• Vulcanizing mechanism involves addition of Si-H groups to

Silicone vinyl units.
2. SIPHENYLENES :

• Silicone & carbon polymer.

• Three component kit –

• Base elastomer
• Tetrapropoxysilane (cross linking agent)
• Organotin (catalyst)

• Many desirable properties including bio-compatibility and

resistance to degradation on exposure to ultra violet light and
heat.

• They exhibit improved edge strength and color stability over the
[Link] Block Copolymers:

• It is introduced to improve some of the weakness of silicone

elastomers, such as decreased tear strength, low percent
elongation and to support bacterial growth.

• It incorporates Polymethyl methacrylate into Siloxane

blocks.

[Link]:

• Fluro-elastomer has been developed for use as a resilient

denture liner, and has the potential to be used as a
maxillofacial prosthetic materials.
[Link] / SILSKIN 2 SYSTEMS :
• It is a RTV silicone showing high degree of tear resistance.
• Two curing system

a) Platinum cure:
- Utilizes vinyl terminated silicone & a platinum catalyst
- Addition reaction so no by-products. Hence no shrinkage
- Working time 1 hr & curing at 1000C for 1 hr

(b) Tin cure:

- Utilizes hydroxy terminated silicone fluids & a tin catalyst
- Condensation reaction so by-product is formed
- Working time 1hr & cures in 24 hr at room temperature.
[Link] SILICONES (SILASTIC 386):
• A form of RTV silicone.

• The gas forms bubbles within the vulcanizing silicone. After the silicon is
processed, the gas is eventually released; leaving spongy material.

Advantage Disadvantage
• Formation of bubbles within the • Foamed material has reduced
mass can cause the volume to strength and is susceptible to
increase by as much as 7 fold. tearing.

• Purpose of the foam silicon is to • Coating adds strength but shows

reduce the weight of the increased stiffness.
prosthesis.
[Link] SILICONE RUBBER (LSR) SYSTEMS :

• LSR Systems are two part 100% solids, pure dimethyl silicone elastomers,
engineered for optimum performance in liquid injection molding (LIM)
processes where high clarity, high strength molded parts.

• Liquid Silicone Rubber (LSR) is a pump able, colorless, translucent paste.

• When A and B components are mixed together in equal portions by

weight, the paste will cure to a tough, optically clear elastomer via
platinum catalyzed addition-cure chemistry.
RECENT ADVANCES
• Ti, Zn, or Ce nano‑oxides at concentrations of 2.0% and 2.5% improved
the overall mechanical properties of the silicone maxillofacial elastomer.

• TiO2 nanocoting effectively reduced the color degradation of the silicone

elastomer.

Effect of nanoparticles on color stability and mechanical and biological properties of maxillofacial silicone elastomer: A systematic review. The Journal of Indian Prosthodontic
Society. 2020 Jul 1;20(3):244.
Computer aided design and
manufacturing system

• Maxillofacial prostheses are usually fabricated

on the basis of impressions made with dental
impression material.

• The extent to which the prosthesis reproduces

normal facial morphology depends on the
clinical judgement of the individual fabricating
the prosthesis
Using the CAD-CAM

Facial contours are measured using a

laser.

• This method minimizes patient

discomfort and avoids soft tissue
distortion by impression material.

• Moreover, the digital data obtained is

easy to store and transmit, and
mirror images can be readily
generated by computer processing.
Before After
OTHER MATERIALS
Adhesives
• Adhesives are commonly used to
improve retention and stability of a
facial prosthesis to skin.

• They provide psychological benefit to

the patient.

Double sided adhesive tape

• Bi-phase adhesive tape is useful in
materials with poor flexibility and for
patients whose defects demonstrate
little or no movement.
• Most facial prostheses are retained with a
medical grade adhesive.

• Its selection depends on patient tolerance, ease

of application and removal, and compatibility Primers
with the material used for the facial prosthesis.

• Most cured silicones, because of their low

solubility and low surface energy, will not
adhere to conventional tissue adhesives.

• The one - component RTV silicones were Adhesives

developed to serve as adhesives for silicone
prostheses.
Types of Adhesives

• Silicone-based - These are the most commonly used

adhesives. Commonly silicone particles are dispersed in
ethyl acetate. e.g. MDX 4-4210, Silastic 891( Medical
Adhesive A), Dow Corning 355.

• Water-based - These are commonly used with

polyurethane liners e.g. Daro adhesive, Daro Hydrobond.

• Acrylic - These adhesives can be easily mixed with water

and applied. On drying, they leave a clear layer of the
material. E.g. Beta Bond.
COLORING
• Colour wise a life like maxillofacial prosthesis is
defined as the one that has distribution of
pigments equivalent to that of human skin and
Whose overall colour appears to change precisely
as does that of human skin under all types of
illumination .

• Accurate representation of skin color in a facial

prosthesis is essential in achieving a successful
esthetic result, yet it remains one of the greatest
challenges to the clinician.
• These include pigments (Art skin), rayon flock,
thread or yarn, and kaolin (opacifier).
• Achieving realistic skin color, texture, translucency, and
heterogeneity requires balance of these components.

• Effective coloration employs intrinsic and extrinsic coloring.

• Intrinsic coloration is longer lasting and is therefore preferred

but is more difficult to accomplish than extrinsic coloration.
 Materials for Pigmentation
Basic shades are mainly metal oxides like:

• Nickel oxide - Brown

• Manganese oxide - Lavender
• Titanium oxide - Yellowish brown
• Iron oxide - Brown
• Copper oxide - Green
 INTRINSIC COLORATION

• Intrinsic coloration is color applied within the mold during

processing procedure.

• A realistic 3-dimensional quality is accomplished by

incorporating subsurface details like blood vessels,
freckles etc.
• Colours used – Enamel porcelain, Ceramics, Artist’s paint,
Water soluble dyes, Celluloid paints, Photographic stains,
Acrylic resins stains, Oil colours, etc

• Advantages - Increased service life of the prosthesis and

 Laminar glazes
• Once the base color is identified, laminar glazes are applied to
simulate the skin complex appearance.
• Laminar glazes are layers of color painted into the mould before
packing the base color and this is combined with placement of
threads and flocks for blood vessel simulation.
• The application of laminar glazes is an attempt to mimic the
histologic structures of human skin.

Common colors for laminar glazes are :

1. Red blush glaze – simulates classic pink appearance of skin
2. Golden tan glaze – tan color observed due to presence of
melanin.
3. Dark brown – simulates freckles and moles.
4. Dark blue or purple – applied to shadow areas
Disinfection of the
Prosthesis :
• Facial prostheses exposed to the oral /
nasal secretions harbor micro-
organisms within the porous silicon
leading to discoloration and offensive
odors.

• Microwave energy has been used to

sterilize Medical devices made of
Plastic, Silicon and Rubber.

• Even Acrylic resin Dental prostheses

have been disinfected and sterilized
with Microwave energy.
EXTRINSIC COLORATION

• It is more predictable.
• It should be used sparingly.
• Apply the extrinsic pigments in small amounts and on the surface of the
prosthesis in a stippled fashion.
• Curing can be done by placing in an air-circulating oven at 90°centigrade.
• Additional glazes are applied and cured by using air drier.
Computerized Color formulation
• Spectrophotometry combined with computerized color
formulation provides an objective means of achieving a
skin match through a mix-correct procedure (Troppmann
et al, 1996).
• This is accomplished with color formulation software that
matches a measured skin color.
• Advantages – decreased clinical time, metamerism is
minimized, formula can be mixed repeatedly.
SUMMARY :
• When reviewing the advantages and disadvantages of each of
these materials, it is obvious that no single material is ideal for
every patient.

• Some of the problems inherent in all these materials are:

1. The continued effect of sunlight and vascular dilation and

contraction on the natural tissues, which cannot be
duplicated in the prosthesis.
2. The variations of skin tone when the patient is exposed to
different light sources (e.g., incandescent, fluorescent, and
natural light).
3. Emotional factors which cause color changes in the skin.
4. The inability of the prosthesis to duplicate the full facial
Conclusion:
• All materials in use exhibit undesirable properties.

• Selection of a material for a facial restoration more often is

dependent on the individual experiences and preferences of the
clinician.

• An attention to detail are paramount in the ability to detect and

duplicate skin tone.

• Ultimate challenge to a material is its clinical performance.

 References
:
1. Kenneth J Anusavice: Phillips science of dental materials, 11th edition,
755-756
2. John Beumer: Maxillofacial Rehabilitation, 323-328
3. Varoujan A. Chalian: Maxillofacial Prosthetics, 89-107
4. William R. Laney: Maxillofacial Prosthetics, 2, 6, 10,281-284, 288-291
5. D.H. Lewis &D.J. Castleberry: An Assessment Of Recent Advances In
External Maxillofacial Prosthetics. JPD, 43: 426-432,1980
6. Sudarat Kiat-Amnuay et al: Color Stability of Dry Earth Pigmented
Maxillofacial Silicone A-2186 Subjected to Microwave Energy
Exposure. Journal of Prosthodont Vol 14 No.2(June) 2005
7. Restorative dental material – Craig
8. Use of medical grade methyl triacetoxy silane cross linked silicone for
facial prosthesis. J. Prosthet Dent 1982.
THANK YOU…