Recommendations for post-rehabilitation care of maxillofacial prostheses

Aim: This study aimed to review the scientific literature to describe the main care and hygiene protocols for different types of maxillofacial prostheses (MFP). Methods: A bibliographic search on the PubMed / Medline database using the following keywords: ["maxillofacial prosthesis" OR "ocular prostheses" OR "palatal obturators"] AND ["Cleaning" OR "disinfection"] AND ["care"] AND ["color stability"] OR ["denture cleansers" OR "cleansing agents"]. Articles addressing materials, cleaning and disinfection protocols, and care related to MFP were included. The following exclusion criteria were applied: no adequate methodology, incompatibility with the area of interest, and unavailability for reading in full. Results: The papers were grouped into the following topics: facial prostheses, ocular prostheses, maxillofacial intraoral prostheses, and retention systems. Conclusion: Despite the MFP changes over time, its degradation decreases upon following the recommendations and post-adaptation care. The guidelines for cleaning and disinfection must be individualized to guarantee the longevity of the prosthesis and the patient health

Necesidad de implementar la consulta de prótesis bucomaxilofacial en la provincia Camagüey / Need to implement the consultation of oral-maxillofacial prosthesis in Camagüey

RESUMEN Fundamento: entre los diferentes campos que integran la prótesis estomatológica se encuentra la prótesis maxilofacial, somatoprótesis o prótesis bucomaxilofacial como de manera indistinta es denominada. Ésta permite la rehabilitación morfofuncional de las estructuras intra y parabucales por medios artificiales. Objetivo: valorar por la importancia social y docente la necesidad de implementar la consulta de prótesis bucomaxilofacial en la provincia Camagüey. Métodos: se realizó una búsqueda de la literatura en las bases de datos electrónicas PUBMED, MEDLINE, COCHRANE, HINARI y SciELO con los descriptores: necesidad de prótesis bucomaxilofacial, defectos bucomaxilofacial y rehabilitación bucomaxilofacial; para conducir un análisis crítico de la evidencia disponible sobre la necesidad de prótesis bucomaxilofacial en Cuba y en especial en la provincia Camagüey. Resultados: en estudios de necesidad de prótesis bucomaxilofacial de la población cubana se encontró una tasa de incidencia que osciló entre 3,1 y 8,1 por cada 10 000 habitantes. El sexo masculino predominó con promedio ente 60 y 75 % de la población estudiada y el grupo de edades fueron los mayores de 60 años con más del 30 %. El origen de estos defectos varió en dependencia del tipo de lesión para los pacientes que presentaron defectos oculares, su principal causa fue de origen traumática, el defecto maxilar tuvo como principales causas: congénita, traumática y adquirida por enfermedad de tipo oncológica. Los traumas, enfermedades de origen oncológico y congénito resultaron las principales causas de lesiones craneales y mandibulares. Conclusiones: se constató la necesidad de prótesis bucomaxilofacial a nivel nacional y provincial, las características clínicas y epidemiológicas de estos pacientes, las implicaciones económicas y docentes, por lo que es necesario y lógico entender la gran importancia que ofrece la creación del servicio de prótesis bucomaxilofacial en la provincia Camagüey.

ABSTRACT Background: among the different fields that make up the dentistry prosthesis is the maxillofacial prosthesis, somatoprothesis or oral-maxillofacial prosthesis, as it is indiscriminately denominated. This allows the morph-functional rehabilitation of intra and parabuccal structures by artificial means. Objective: to assess for the social and educational importance the need to implement the oral maxillofacial prosthesis consultation in the Camagüey province. Methods: this narrative review article aims to conduct a critical analysis of the available evidence on the need for oral and maxillofacial prosthesis in Cuba and mainly in the Camagüey province. An electronic literature search was carried out in search engines such as: electronic databases PUBMED, MEDLINE, COCHRANE, SciELO and HINARI with descriptors such as: need for an oral-maxillofacial prosthesis, oral-maxillofacial defects and oral-maxillofacial rehabilitation. Results: in studies of the need for oral and maxillofacial prosthesis in the Cuban population, an incidence rate that ranged from 3.1 to 8.1 per 10,000 inhabitants was found. The male sex predominated with an average of 60% and 75% of the population studied, and the age group were those over 60 years old with more than 30%. The origin of these defects varied depending on the type of lesion for patients who had ocular defects, its main cause was of traumatic origin, the main cause of the maxillary defect was: congenital, traumatic and acquired due to oncological disease. Traumas, pathologies of oncological and congenital origin were the main causes of cranial and mandible injuries. Conclusions: the need for oral and maxillofacial prostheses was confirmed at national and provincial level, as well as the clinical and epidemiological characteristics of these patients, and the economic and teaching implications. Therefore, it is necessary and logical to understand the great importance that the creation of the oral and maxillofacial prosthesis service offers in Camagüey province.

Maxillofacial reconstruction with Medpor porous polyethylene implant: a case series study

OBJECTIVES: The role of alloplastic materials in maxillofacial reconstruction is still controversial. Determining the utility of porous, high-density, polyethylene implants as a highly stable and flexible, porous alloplast, with properties such as rapid vascularization and tissue ingrowth, is crucial in cases of maxillofacial deformities and aesthetic surgery. MATERIALS AND METHODS: Thirty high-density porous polyethylene implants were implanted in 16 patients that had been referred to a private office over a three-year period. These implants were used for correcting congenital deformities, posttraumatic defects and improving the aesthetic in nasal, paranasal, malar, chin, mandibular angle, body and orbital areas. RESULTS: The outcomes of the cases in this study showed good aesthetic and functional results. The majority of patients had no signs of discomfort, rejection or exposure. Two implants suffered complications: a complicated malar implant was managed by antibiotic therapy, and an infected mandibular angle implant was removed despite antibiotic therapy. CONCLUSION: Based on the results, the Medpor implant seems to be an excellent biomaterial for correcting various facial deformities. Advantages include its versatility and relatively ideal pore size that allows for excellent soft tissue ingrowth and coverage. It is strong, flexible and easy to shape.

Prótese nasal implantorretida por magnetos ­ relato de caso com cinco anos de acompanhamento / Magnet-retained nasal prosthesis ­ case report with 5-year follow-up

O objetivo do presente estudo foi relatar, por meio de um caso clínico, a reabilitação de uma paciente com uma prótese nasal implantorretida. A mesma possuía 68 anos de idade e foi encaminhada para a reabilitação nasal pela equipe que realizou a cirurgia oncológica de um tumor de pele na região do seu nariz. A paciente reportou queixa com relação à estética da face e problemas no convívio social. Foi proposta reabilitação com prótese nasal, com implantes osseointegráveis associados ao sistema de retenção por magnetos. Após cinco anos e dez meses, três novas próteses foram fabricadas devido a queixas da paciente em relação à descoloração da peça. Na última consulta, a prótese foi removida e inspecionada, e se constatou problemas na higienização, motivo das pigmentações escurecidas na superfície interna da peça e do exsudato no tecido mole ao redor dos pilares protéticos. Foram realizadas a limpeza da barra e do tecido mole, e a confecção de novas próteses nasais implantorretidas à base de silicone elastomérico, além de instrução sobre a necessidade de higienização. Constatou-se que próteses nasais implantorretidas à base de silicone elastomérico são eficientes e seguras para a reabilitação de defeitos na região do nariz. Além disso, é extremamente necessário que o profissional transmita aos pacientes a necessidade de uma higienização satisfatória, solicitando retornos periódicos para obter o máximo do desempenho clínico de suas próteses e implantes.

The aim of present study was to report the rehabilitation of a patient with magnet-retained nasal prosthesis. A 68-year-old female patient was referred to nasal rehabilitation by the surgical team that performed the removal of a skin nose tumor. The patient complained about her facial aesthetics and also reported fearing social interactions. The rehabilitation with nasal prosthesis associated with osseointegrated implants, and retained by magnets was proposed to the patient. After 5 years and 10 months, 3 new prostheses have been fabricated because the patient complained about their discoloration. In the last check-up, the prosthesis was removed and visual inspection revealed lack of hygiene maintenance, which resulted in dark pigments in the intaglio surface as well as exudate in the peri-implant soft skin. The prosthetic components and soft tissue were cleaned, the fabrication of new magnet-retained nasal prosthesis was performed and instructions about the necessity of oral hygiene were also transmitted. The implant-retained nasal prosthesis is an effi cient and safe method for the rehabilitation of defects in the nasal area. Furthermore, it is extremely necessary that clinicians advise patients to perform satisfactory hygiene maintenance and periodic controls in order to obtain long-term success in such cases.

Biocompatibilidade de primers e adesivo utilizados na confecção de próteses maxilofaciais implantorretidas: análise in vitro / Biocompatibility of primers and adhesive utilized for implant-retained maxillofacial prostheses: in vitro analysis

A prótese bucomaxilofacial implantorretida pode ser suportada por pele ou por mucosa. Subprodutos dos materiais utilizados na confecção destas próteses podem atuar como irritantes ou causadores de reações alérgicas a tais tecidos. A proposta do presente estudo foi avaliar a citotoxicidade de primers e adesivo utilizados na confecção de próteses maxilofaciais retidas por implantes, por meio da análise da proliferação celular e da produção de citocinas pró-inflamatórias e de proteínas de matriz extracelular por queratinócitos humanos. Foram confeccionadas 28 amostras de resina e silicone, em forma de discos (10 x 1 mm), unidas ou não pela aplicação de primer e/ou adesivo. Estas amostras foram distribuídas em 7 grupos: Resina (R), Silicone (S), Resina + Silastic Medhical Adhesive Type A + Silicone (RAS), Resina + DC 1205 primer + Silicone (RDCpS), Resina + Sofreliner primer + Silicone (RSpS), Resina + DC 1205 primer + Silastic Medhical Adhesive Type A + Silicone (RDCpAS) e Resina + Sofreliner primer + Silastic Medhical Adhesive Type A + Silicone (RSpAS). Os extratos dos materiais testados foram preparados colocando-se quatro amostras de cada grupo experimental em tubos de ensaio contendo 9 mL de meio de cultura DMEM (Dulbecco’s Modified Eagle’s) e incubados a 37°C por 24 horas. Após o período de incubação, a citotoxicidade dos extratos foi avaliada pelo ensaio de MTT em cultura de queratinócitos humanos (HaCaT). Foi avaliada, também, a produção das citocinas IL-1, IL-6 e TNF-α e a quimiocina MIP-1α por meio do ensaio ELISA (Ensaio Imunoabsorbente de Ligação Enzimática). Também foi avaliada a expressão de RNAm para MMP-9, TGF-β e COL-IV por meio da técnica de RT-PCR em tempo real (Reação em Cadeia da Polimerase em Tempo Real). Os dados obtidos foram submetidos à Análise de Variância (ANOVA), seguido pelo teste Bonferroni, com nível de significância de 5%. Foi possível verificar maiores percentuais de proliferação celular para o grupo RAS, com diferença...

The implant-retained maxillofacial prosthesis can be supported by skin and mucosa. The sub-products produced by the materials used to fabricate these prostheses may act as an irritant factor and cause allergy in these tissues. The aim of this study was to evaluate the cytotoxic effect of primers and adhesive used to bond the acrylic resin and the facial silicone during implant-retained maxillofacial prosthesis fabrication, through the analysis of the cell proliferation, and the production of proinflammatory cytokines and extracellular matrix proteins by keratinocytes. A total of 28 round shape samples (10 x 1 mm) made of resin and silicone bonded or not with primer and adhesive was fabricated. Samples were divided into 7 groups: Resin (R), Silicone (S), Resin + Silastic Medical Adhesive Type A + Silicone (RAS), Resin + DC 1205 primer + Silicone (RDCpS), Resin + Sofreliner primer + Silicone (RSpS), Resin + DC 1205 primer + Silastic Medical Adhesive Type A + Silicone (RDCpAS), and Resin + Sofreliner primer + Silastic Medical Adhesive Type A + Silicone (RSpAS). Extracts of tested materials were prepared setting four samples of each experimental group in Falcon tube with 9mL of medium (Bulbecco’s Modified Eagle’s) and incubated at 37°C for 24 hours. After incubation period, the extract cytotoxicity was evaluated by an assay of cell survival/proliferation (MTT test) in cultures of human keratinocytes (HaCaT). The levels of IL-1, IL-6 and TNF-α and the chemokine MIP-1α were evaluated by ELISA (Enzyme-Linked Immunoabsorbent Assay). The mRNA expression for MMP-9, TGF-β and collagen type IV were analyzed by the RT-PCR (Real time polymerase chain reaction). Data were submitted to the analysis of variance with Bonferroni post-tests (p<0.05). The results showed increased cell proliferation for the RAS group. The RDCpS group showed the highest IL6 concentration values when compared to other groups. Regarding the relative quantification of mRNA for collagen type IV, MMP9...

Uso de implantes zigomáticos na fixação de próteses bucomaxilofaciais / Use of zygomatic implants in the fixacion of maxillofacial prothesis

A prótese bucomaxilofacial tem como objetivo a reabilitação de indivíduos com deformidades craniofaciais, decorrentes de traumatismos, más formações congênitas ou tumores. Muitas pesquisas foram realizadas para melhorar a estabilidade e retenção das próteses em pacientes mutilados. Com o advento da osseointegração, a prótese bucomaxilofacial sofreu um grande avanço tornando possível a realização de trabalhos protéticos com estabilidade, qualidade estética e resultados previsíveis. Esse trabalho faz uma revisão de literatura a respeito do uso de implantes zigomáticos na fixação de próteses bucomaxilofaciais...

The maxillofacial prosthetic rehabilitation aims of individuals with craniofacial deformities resulting from trauma, congenital malformations or tumors. Many researches have been done to improve the stability and retention of dentures in patients. With the advent of osseointegration, the maxillofacial prosthesis suffered a major advance making possible the realization of prosthetic works with stability, aesthetic quality and predictable results. This paper reviews the literature regarding the use of zygomatic implants in the fixation of maxillofacial prostheses...

Rehabilitación estética y psíquica de un paciente con deformidad facial

Se rehabilita un paciente masculino que acudió a nuestro servicio por presentar un defecto óseo de la región maxilomalar derecha y orejas prominentes que afectaban su estética y su psiquis. Se coloca implante de hidroxiapatita porosa en bloque en el defecto óseo y se le realiza otoplastia, con lo cual el paciente queda muy satisfecho en el posoperatorio.

Author accomplished rehabilitation of a patient came to our service presenting a bone defect of right maxillomalar area, and protruding ears affecting his aesthetics and psyche. Block porous hydroxyapatite implant was placed to cover bone defect and aotoplasty was performed. Patient is satisfied with postoperative results.