Auricular Prosthesis Research Articles

Accuracy of the Conventional Facial Impression Method and Three-Dimensional Auricular Shape Data Obtained Using Extra- and Intraoral Optical Scanners

Background: Facial impression methods have been used to fabricate auricular prostheses; however, deformation due to the weight of the impression material remains. This study aimed to investigate the accuracy of auricular three-dimensional (3D) data obtained using a 3D optical extraoral scanner and an intraoral scanner compared with that of a conventional facial impression method. Methods: Six auricles were digitized using an extraoral scanner with and without a reference board around the auricle and an intraoral scanner. Auricle casts fabricated using auricle impressions were scanned using a laboratory scanner. All obtained data were superimposed, and the 3D deformations of the different methods were evaluated using measurement mapping and root mean square (RMS) values. The length, width, and height of the auricular casts and scanned data were measured and compared with the sizes of the original auricles measured using a caliper. Results: Large displacements of the back and margins of the ears were observed, and the RMS values ranged from 0.5–2.4 mm. Larger widths and smaller heights of the scanned and impression data were observed compared to the anthropometric ear data. Conclusions: The study concluded that the fabrication of auricular prostheses using optical scanning is clinically acceptable. All examined scanning techniques demonstrated discrepancies within acceptable limits when compared to the conventional facial impression method.

A scoping review on the potential of three-dimensional bioprinting in auricular cartilage regeneration

ABSTRACT Background: The human ear significantly influences facial appearance. Auricular abnormalities can arise from many causes, and the cartilage cannot self-regenerate. Three-dimensional (3D) printing and computer-aided design/computer-aided manufacturing technology are used to create auricular prostheses through various methods to mirror the healthy ear. Despite advancements, challenges such as natural skin tones and growth accommodation persist. Bioprinting, using “Bioink” for precise cell placement, offers promising improvements for cartilage replacement and personalized auricular tissue regeneration. Aim: This review discussed recent and groundbreaking research in regenerative medicine for the auricular cartilage. The clinical studies of 3D bioprinting are the main topic of this review. This review aimed to clarify the transition from 3D printing of auricular prostheses to 3D bioprinting of patient-specific auricular tissues. Methods: The literature underwent a scoping review, making use of the keywords “Bioink, maxillofacial prosthetics, patient need, maxillofacial, additive manufacturing, auricular prosthesis, 3D bioprinting AND auricle, 3D bioprinting, auricle, cartilage, and Clinical applications of 3D bioprinting of auricle in children’s patients. Researchers searched the Cochrane, Google Scholar, ScienceDirect, and PubMed databases. Studies using cell-laden, 3D bioprinted constructs, Bioink containing living cells, or interventions to regenerate cartilage or auricle tissue, as well as the use of tissue-engineered 3D bioprinting in the maxillofacial regions, primarily in children, were included. Full texts, abstracts, and titles were all previewed. Significant groundbreaking studies were included after reference searching. The search timeline was between 2018 and 2022. Results: A total of 242 papers were assessed for title and abstract, with 13 judged appropriate for inclusion. Ninety-nine articles were removed, primarily because they were off-topic (unrelated) or not in English. A total of 13 publications were considered for study. Conclusions: Recent research has shown the potential of 3D bioprinting for tissue regeneration in both in vitro and in animal models. Human studies that have implanted 3D bioprinted auricles are still in their initial stages; however, the results are promising.

Effective rehabilitation of auricular defects with two different prosthetic materials: case reports

A person’s face being a visible element, instant physical care and mental support is mandatory for patients affected with maxillofacial defects. Defects in noticeable locations like the ear create a lacuna which deteriorates the quality of life of the victims. Immediate restoration of the defect with artificial prosthesis becomes crucial. Two such cases of acquired auricular defects rehabilitated with maxillofacial prosthesis are described in this manuscript. This case report briefs about two patients with auricular defects reported for restoration. Case one had a congenital agenesis of his right ear whereas case two presented with a history of trauma. Immediate management with artificial ear prosthesis was decided to restore the patients to normalcy of life. Hence an effective restoration was carried out using maxillofacial auricular prosthesis made from medical grade silicone and acrylic. They were retained onto to the residual external structures.

Digital designing of a 3D printed stackable ear mold for auricular rehabilitation. A technical note.

The present study describes a technique for the virtual design of a three-piece stackable auricular mold for unilateral auricular defect rehabilitation using an open-source software program. An optical intraoral scanner is used to scan the patient's ears on both the affected and unaffected side. To maintain the relationship between the mold parts, a stackable attachment is designed and joined to the mold. The mold is 3D printed in resin. This technique provides the patient with a precise auricular prosthesis with perfect thickness, adaptation, and appearance. The workflow introduced in this technique could be considered as an alternative for the fabrication of auricular prostheses and decreased both the clinical and laboratory time compared to the conventional workflow.

Evaluation of the use of different intraoral scanners for auricular prosthetic reconstruction

The use of intraoral optical scanners has been introduced for direct digital data acquisition in maxillofacial prosthetics, but their clinical accuracy has not been evaluated sufficiently. The purpose of this observational study was to evaluate the use of different intraoral scanners for extraoral maxillofacial digitization of an ear and to assess visually the clinical outcome of the generated 3-dimensional ear casts. A selected intact ear was scanned by using 3 different intraoral optical scanners: CEREC Primescan (Dentsply Sirona), Medit i700 (Medit Corp) and Panda P2 (Pengtum Technologies). Three-dimensional printed auricular casts were fabricated from the obtained scans, and a questionnaire administered to assess visually the clinical outcome of the generated casts. Comparisons between scanners were done by using the Kruskal-Wallis test followed by the post hoc test with Bonferroni correction when results were significant. The Wilcoxon Sign Rank test was used to compare the responses of both the prosthodontists and the lay personnel. All tests were 2-tailed (α=.05). The 3-dimensional printed auricular casts fabricated from the data acquired by using Primescan and Medit i700 scanners showed a statistically significant difference in matching scores when compared with the Panda P2 scanner (P<.001). Digital ear scanning with the Primescan and Medit i700 intraoral scanners should produce auricular prostheses that more closely match the normal ear when compared with those scanned by the Panda P2 scanner.

Applications of CAD/CAM Technology for Craniofacial Implants Placement and Manufacturing of Auricular Prostheses-Systematic Review.

This systematic review was aimed at gathering the clinical and technical applications of CAD/CAM technology for craniofacial implant placement and processing of auricular prostheses based on clinical cases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic data search was performed. Human clinical studies utilizing digital planning, designing, and printing systems for craniofacial implant placement and processing of auricular prostheses for prosthetic rehabilitation of auricular defects were included. Following a data search, a total of 36 clinical human studies were included, which were digitally planned and executed through various virtual software to rehabilitate auricular defects. Preoperative data were collected mainly through computed tomography scans (CT scans) (55 cases); meanwhile, the most common laser scanners were the 3dMDface System (3dMD LLC, Atlanta, Georgia, USA) (6 cases) and the 3 Shape scanner (3 Shape, Copenhagen, Denmark) (6 cases). The most common digital design software are Mimics Software (Mimics Innovation Suite, Materialize, Leuven, Belgium) (18 cases), Freeform software (Freeform, NC, USA) (13 cases), and 3 Shape software (3 Shape, Copenhagen, Denmark) (12 cases). Surgical templates were designed and utilized in 35 cases to place 88 craniofacial implants in auricular defect areas. The most common craniofacial implants were Vistafix craniofacial implants (Entific Medical Systems, Goteborg, Sweden) in 22 cases. A surgical navigation system was used to place 20 craniofacial implants in the mastoid bone. Digital applications of CAD/CAM technology include, but are not limited to, study models, mirrored replicas of intact ears, molds, retentive attachments, customized implants, substructures, and silicone prostheses. The included studies demonstrated a predictable clinical outcome, reduced the patient's visits, and completed the prosthetic rehabilitation in reasonable time and at reasonable cost. However, equipment costs and trained technical staff were highlighted as possible limitations to the use of CAD/CAM systems.

Improved Fabrication of Implant Retained Auricular Prosthesis with Digital Technologies.

A 28-year-old male patient came to the prosthodontics department seeking replacement for his congenital defect left ear. With the use of digital technology, a silicone implant supported bar retained auricular prosthesis that is an exact match in size, shape, and orientation to the existing contralateral ear was made.

Using a smartphone three dimensional scanning application (Polycam) to three dimensionally print an ear cast: A technique

This technique describes the use of a smartphone application for scanning an ear for 3-dimensional (3D) printing of an auricular prosthesis cast. The intact ear was scanned by using a smartphone and a 3D scan application (Polycam). The standard tessellation language (STL) file of the 3D data was used to produce a mirror image of the ear, which was sent to the 3D printing center where a resin cast was printed. This technique is harmless for the patient compared with radiological imaging methods, more comfortable, and cost-effective and is straightforward for the maxillofacial prosthodontist.

Description of the Surgical and Prosthetic Workflow of a Patient Rehabilitated with Implant-Retained Auricular Prosthesis

Facial tissue loss is acquired as a result of congenital anomalies or acquisitional misshapen like tumoral lesions or accidents. These defects result in functional problems, esthetic concerns, and also psychosocial troubles and could be repaired by plastic surgery or reconstructed using facial prostheses. Conventional tissue-supported auricular prostheses meet lots of challenges due to dependence on tissue undercut or adhesive for retention. Implant-retained auricular prostheses lessen the complications related to adhesive-retained prostheses and alleviate the need for invasive plastic surgery. Implant-retained auricular prostheses provide patients with secure retention and avoid prosthesis disengagement caused by movable surrounding soft tissue. The impact of prostheses with secured retention and satisfactory esthetics on the self-confidence of patients with facial defects is promising. This paper aimed to describe the surgical and prosthetic workflow of a patient with acquired ear deformity due to basal cell carcinoma (BCC) which was rehabilitated with implant retained auricular prosthesis.

Surgery of Severe Cauliflower Ear Deformity

A cauliflower ear is an auricular deformity characterized by thickened soft tissue and cartilage. A subperichondrial hematoma or fluid collection causes this malformation. As a result of being cut off from the perichondrium blood supply, the ear cartilage becomes ischemic, developing scar tissue, fibrous tissue, new cartilage overgrowth, or necrosis beneath the skin, resulting in a permanent alteration in the shape of the external ear resembling that of a cauliflower. To properly fix defects, the surgeon must grasp ear anatomy and be familiar with a variety of reconstructive alternatives. It requires meticulous attention, due to the intricate design of the ear. Simple and complex techniques for treating cauliflower ears have been developed. However, in severe cases, simple techniques are often insufficient. As a result, complex techniques such as replacement with an auricular prosthesis or implant or autogenous costal cartilage framework were developed. We present a case of a 25-year-old man who experienced a severe cauliflower ear as a result of an infection during adolescence. The patient was concerned about the shape of his ear and was depressed. Ear reconstruction was accomplished using the costal cartilage framework engraved according to a three-dimensional cutting guide for surgical planning. Costal cartilage is chosen to provide a framework for reconstruction as it is strong and rigid, and its curved shape is similar to that of the external ear. There were no complications after surgery. The ear projection and shape have performed admirably. The patient was pleased with the outcome and felt more confident after surgery.

CUSTOMIZED THERMOPLAST RETENTIVE AID FOR PARTIAL AURICULAR PROSTHESIS-A CASE REPORT

Auricular prostheses were traditionally retained using chemical adhesives ,mechanical retentive aids or natural undercuts at retention sites.These methods have the limitation of frequent loss of retention, skin reactions to adhesives, or unnatural movements of the prosthesis. Osseo integrated implants which has superior advantages over others have disadvantages for patients with financial constraints and/or who are apprehensive of surgery.Also, extraoral implants require adequate thickness of bone, which may be deficient in certain cases. In this case report,we have described about a new technique of fabricating and incoporating a customized thermoplastic auricular retentive aid thus utilizing both anatomic and mechanical retention.

Silicone auricular prosthetics with adhesive retention: a case report

A-18-years-old male came to the Dental and Oral Hospital of Hasanuddin University with a complaint of losing his left ear due to a traffic accident several years ago and often feeling pain in his ear especially when blown by strong winds. The patient wants to make an auricular prosthesis so that his self-esteem returns to normal. The extraoral exa-mination showed convex profile, oval-shaped face, symmetrical eyes, nose and lips, submandibular lymph nodes ex-hibit without complaints. The right and left ears are not symmetrical. Manufacture of silicone auricular prosthesis with adhesive retention. Anatomical impressions of the patient's and his siblings' ears were performed as a guide for duplication of the patient's left ear using an irreversible hydrocolloid impression material. The wax pattern of the ear prosthesis that had been made on the die was paired with the patient to check the size accuracy and left and right symmetry. Then proceed with the process of acrylic packing and coloring. After the laboratory process was com-pleted, insertion is carried out. Signs of successful treatment: silicone ear prosthesis with adhesive retention has restored the patient appearance and self-esteem.

Accuracy of implant placement using CAD-CAM tooth-supported surgical guides for an auricular prosthesis in vitro.

To evaluate the accuracy of tooth-supported surgical guides used to place implants in auricular prostheses. The accuracy (trueness and precision) of the implant positions was evaluated, and the difference between the surgical guide with and without retention of the external auditory canal (EAC) was compared. This study simulated implant placement in vitro for the treatment of right auricle malformation. Surgical guides and other casts were fabricated using additive manufacturing technology. The casts were divided into 2 groups according to the surgical guide, with 10 bone blocks in each group (with or without the EAC plug (Guides 1 and 2)). Three implant positions (Implants 1-3) were prepared for each bone block using surgical guides. Implant positions were registered using light-body silicone impressions combined with optical surface scans to measure the coronal, apical, depth, and angular deviations. Four deviations of trueness and precision were reported as the mean±standard deviation, which was analyzed by Student's t-test. Each group of 10 bone blocks with 30 implant positions was successfully prepared and digitally reproduced as implants. The accuracies of implant position with surgical guides were acceptable when compared with the preoperatively planned implant positions. Compared with the Guide 2 group, there was a significant difference in the apical, depth, and angular deviations of Guide 1 group in terms of precision (p=0.001). There was a significant difference in the depth deviation of Implant 1 (p=0.028) and apical deviation of Implant 2 (p<0.001) compared two groups in terms of trueness. In terms of precision, there was a significant difference in the coronal (p=0.002), apical (p=0.001), and depth (p<0.001) deviation of Implant 1; apical (p=0.036) and angular (p<0.001) deviation of Implant 2 also existed significant difference; the coronal deviation of Implant 3 (p=0.018) also existed significant difference. Moreover, the group with the EAC plug showed lower deviation in precision and a smaller volume in the 95% confidence ellipsoid. Both types of tooth-supported surgical guides can provide acceptable accuracy. A surgical guide with an EAC plug was considered to be more precise.

Repositioning an Implant-retained Auricular Prosthesis using a Custom Acrylic Base: A Case Report

Prosthetic rehabilitation offers an alternative to surgical procedures for repositioning implant-retained auricular prosthesis. This report illustrates a prosthetic rehabilitation of a 15-year- old male with a unilateral microtia who presented with an unfavorable implant-retained left auricular prosthesis. The implants placed seven years ago were drifted posterosuperior away from the ideal ear canal position. The fabrication of a new prosthesis on the existing bar-clip attachment using a custom acrylic base was planned to correct the location. A skin-colour perforated custom acrylic base was fabricated and designed to extend anteriorly, therefore, shifting the prosthesis forwards into a more natural location. The custom base was able to relocate the prosthesis’ position without compromising its retention whilst engaging the existing implant attachment. This in turn enhanced prosthesis acceptability and improved the patient’s confidence. The custom acrylic base serves as a viable option to reposition the prosthesis influenced by age related growth and development.

A Case Report on the Rehabilitation of an Ear Deformity using an Implant Supported Auricular Prosthesis

Extraoral implant retained prostheses have been shown to be a reliable therapy choice for maxillofacial rehabilitation. The clinical and laboratory steps for creating an auricular prosthesis are described in this case report. A 27-year-old male patient met with a road traffic accident, lost his left ear, and developed an ear deformity. The patient then sought out rehabilitation. Extraoral implants and Hader bar-and-clip retention were used to ensure that the auricular prosthesis was properly connected to the implant. The patient was satisfied with the prosthesis remarkable support, retention, and aesthetic abilities. Treatment success depends on factors like patient acceptability, aesthetics, compatibility, durability, and prosthetic considerations like material availability, processing ease, and ease of duplication that make the prosthesis look natural and give the patient social confidence.

Half sphere and single clip-bar retained implant supported silicone auricular prosthesis.

Implant supported auricular prosthesis can be retained by several mechanical means, one of them being the Hader bar and clip system. Conventionally two or more rider clips are used. This technique describes a modified Hader bar design to maintain retention while eliminating the requirement of a second clip, significantly bringing down cost.

Use of 3-dimensional imaging and manufacturing for bilateral auricular prostheses: A case series of six patients with congenital auricular defects

The prosthetic reconstruction of unilateral ear deformity is a straightforward procedure which relies on copying the details, position, and symmetry of the existing contralateral ear. However, reconstructing bilaterally missing ears is challenging. The use of 3-dimensional (3D) technology in the prosthetic reconstruction of the bilaterally missing ears of 6 patients is described. The deformity site was created directly by segmenting the patient’s digital scan or indirectly via a desktop scanner. Adequate bone quantity and quality for implant retention and optimal implant locations were also identified virtually. The use of 3D technologies has made it more straightforward to accomplish ear symmetry, as well as to validate the orientation and location of the ears reliably with the minimum subjectivity. The printed ears were matched in shape, surface texture, and anatomy. The skin color was straightforward to record and store so that it could be reproduced at a future time. Overall, the digital manufacture of the ears was controlled, consistent, and reproducible.

Rehabilitation of a Patient with Anotia with Implant-retained Silicone Auricular Prosthesis Using Custom Fabricated Abutments and Bar: A Case Report

Rehabilitation of a Patient with Anotia with Implant-retained Silicone Auricular Prosthesis Using Custom Fabricated Abutments and Bar: A Case Report

Patient satisfaction with different types of craniofacial prostheses

Statement of problemA maxillofacial prosthesis represents an effective method of giving maxillofacial defects a positive esthetic appearance with minimal risk. However, studies of complications among prosthesis wearers are lacking. PurposeThe purpose of this cross-sectional study was to determine levels of patient satisfaction with various maxillofacial prostheses and retention types, as measured through a survey questionnaire package. Material and methodsPatients treated at the Sunnybrook Health Sciences Center Craniofacial Prosthetics Unit (CPU) since 2015 were included. They had been treated according to a standardized protocol and answered a survey questionnaire package with the following sections: demographics, frequency of prosthesis usage, and the Toronto Outcome Measure for Craniofacial Prosthetics (TOMCP-27) survey addressing patient satisfaction. To be eligible for this study, patients must have been more than 18 years of age, in possession of a maxillofacial prosthesis, and received treatment at the Sunnybrook Health Sciences Center CPU since 2015. ResultsA total of 157 patients were eligible and contacted, of whom 51 agreed to participate in the survey. The study population was overall extremely satisfied with their maxillofacial prostheses. In 77.8% of the TOMCP-27 questions, the largest group of patients chose the answer demonstrating the highest level of satisfaction. Of all prosthesis types surveyed, patients with auricular prostheses reported the greatest rates of satisfaction, with the entire group having selected answers corresponding to the highest levels of overall satisfaction. However, patients with orbital prostheses were more likely to experience varying degrees of dissatisfaction, with 72% of the highest reported levels of dissatisfaction being from this prosthesis group. In addition, patients with osseointegrated implant-retained prostheses reported higher satisfaction levels with other retention methods, with the bar clasp group outperforming the magnetic coupling retention group. ConclusionsPatients experienced an excellent overall rate of satisfaction with their maxillofacial prostheses. Future development should focus on the continued development of osseointegrated methods, improved magnetic coupling, and improved prosthesis technology, especially for orbital prostheses.

Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia.

The simultaneous implantation of the Bonebridge (MED-EL, Innsbruck, Austria), asemi-implantable active transcutaneous bone conduction hearing device and anchors for auricular prostheses can be challenging as both implants contain magnets and compete for the narrow space in the designated implantation area. Apreoperative planning tool (virtual surgery) was used with individual 3D computer models of the skull and implants for finding optimal implant positions for both the floating mass transducer (FMT) and the anchors for the auricular prosthesis. The interaction between the magnetic prosthesis anchors and the FMT was measured by means of static magnetic forces. A retrospective data analysis was conducted to evaluate the surgical and audiological outcome. Between 2014 and 2021, a3D planning of a simultaneous implantation of the Bonebridge with auricular prosthesis anchors was conducted on 6 ears of 5 patients (3males, 2females; age range 17-56years). The individual preoperative planning was considered very useful for the optimal placement of bone anchors in combination with the Bonebridge. Audiological data showed aclear benefit for hearing 3months and > 11months after implantation. No adverse interactions between the magnetic prosthesis anchors and the FMT were observed. In two patients, revision surgery was carried out due to skin inflammation or wound healing problems. No long-term complications were observed 3-5 years after surgery. Preoperative 3D planning represents a clear benefit for the simultaneous audiological and esthetic rehabilitation using the Bonebridge and anchors for auricular prostheses.