Maxillofacial Prosthodontist Research Articles

AI in Prosthodontics: A Narrative Review Bridging Established Knowledge and Innovation Gaps Across Regions and Emerging Frontiers

As the discipline of prosthodontics evolves, it encounters a dynamic landscape characterized by innovation and improvement. This comprehensive analysis underscores future developments and transformative solutions across its various subspecialties: fixed, removable, implant, and maxillofacial prosthodontics. The narrative review examines the latest advancements in prosthetic technology, focusing on several critical areas. The integration of artificial intelligence and machine learning into prosthetic design and fitting processes is revolutionizing the field, serving as a common thread that links these innovative technologies across all subspecialties. This includes advancements in automated diagnostics, predictive analysis, and treatment planning. Furthermore, the review offers a forward-looking perspective on how these innovations are influencing each prosthetic dentistry domain, patient outcomes, and current clinical practices. By thoroughly analyzing contemporary research and emerging technologies, the study illustrates how these advancements represent a growing focal point of interest in developing countries, such as Romania, with the potential to redefine the trajectory of prosthetic rehabilitation and enhance patient care not only within this country but also beyond.

Relationship Between Oral Hypofunction and Nutritional Status in Patients Treated With Maxillofacial Prostheses.

Introduction Patients who have jaw or tongue defects owing to head and neck cancer or congenital disease suffer from oral dysfunction such as speech, swallowing, and mastication. Although maxillofacial prostheses are applied to improve oral functions, their oral functions remain compromised compared to those of patients without jaw or tongue defects. On the other hand, it has been reported that oral hypofunction could lead to malnutrition in the general elderly. However, to date, no reports have evaluated the relationship between oral function and nutritional status in patients with maxillofacial prostheses. In this study, we comprehensively evaluated oral function according to the examination items for oral hypofunction. We assessed which functions were related to nutritional status in patients with jaw defects caused by tumors or congenital diseases who are candidates for maxillofacial prosthetic treatment. Methods Patients who underwent prosthetic treatment at the Department of Maxillofacial Prosthodontics, Aichi-Gakuin University Dental Hospital, between May 2021 and January 2024 and who were doing well were included in the study. Oral function was assessed with seven tests according to the criteria of the Japanese Society of Geriatric Dentistry, and nutritional status was evaluated using the Mini Nutritional Assessment Short-Form (MNA-SF). Patients were classified according to age and type of deficiency. Additionally, the presence or absence of oral hypofunction and malnutrition or risk of malnutrition were assessed. The impact of oral hypofunction tests and defect status on the risk of malnutrition was evaluated using a logistic regression model. Results Oral hypofunction and malnutrition or risk of malnutrition were more frequent in the elderly group by age. Regarding the type of defect, the rate of oral hypofunction and malnutrition or risk of malnutrition was highest in the tongue defect group. Results of the logistic regression analysis indicated that nutritional status was associated with tongue deficiency, tongue-lip motor function, tongue pressure, and swallowing function. Conclusion The nutritional status of maxillofacial prosthetic wearers was associated with oral hypofunction. Particularly, malnutrition and risk of malnutrition were increased with tongue defects and deficiencies in tongue-lip motor function, tongue pressure, and swallowing.

A review on modern prosthodontic practice using laser.

Lasers are a very appealing technology in many areas of dentistry because of their minimally invasive nature, quick tissue interaction & response, and ability to heal. Numerous investigations on the possible uses of lasers in dentistry have been carried out since Maiman developed the ruby laser in 1960. Numerous applications such as quick prototyping and computer-aided design, and the study of occlusion in complete denture using three-dimensional laser scanning has been used to develop dentures. Its uses are numerous from fixed prosthodontics to dentinal hypersensitivity treatment to surface treatment of base metal alloys. These days, it even encompasses maxillofacial prosthodontics and dental implantology. Hence, it is of interest to review the use of lasers in clinical prosthodontics.

Challenges during implant-assisted prosthetic rehabilitation in fibula reconstructed jaws and its management: a scoping review protocol

Introduction: Oral cancer is the sixth most prevalent cancer type worldwide. Patients are placed in a crippling predicament due to the functional and psychosocial difficulties brought on by the illness and its treatments. Both surgeons and maxillofacial prosthodontists may encounter challenges with reconstruction and therapy following cancer treatment. Over 20 years, the fibula has remained the mainstay of reconstructions for head and neck cancer. Maxillary and mandibular jaws with fibula reconstructions can use fixed or removable prosthetic rehabilitation solutions. The proposed scoping review aims to ascertain the volume and nature of evidence concerning the difficulties and corrective measures in the prosthetic rehabilitation of fibula-reconstructed head and neck cancer cases. The findings will aid in improving the prosthetic treatment care for the affected population. Materials and Methods: The Joanna Briggs Institute (JBI) scoping review protocol will be followed in developing and reporting the scoping review methodology. Methods to identify the relevant literature will involve the systematic search of databases like PubMed, Scopus, Google Scholar, Cochrane Library, and gray literature sources for pertinent articles on the subject. Only papers published in English literature will be considered for the review, and the data collection period is limited to the past 20 years. The screening process will utilize defined inclusion/exclusion criteria for Title/Abstract and Full-text screening by two independent reviewers in covidence, and a third reviewer will resolve any conflicts. The data extracted will include specific details about the participants, concept, population, study methods, challenges encountered during prosthetic rehabilitation, and their management. Inductive thematic analysis and descriptive statistics will be applied where appropriate. The narrative synthesis of the evidence will be accomplished through data extraction in a tabular format, and the results will be presented as a narrative summary.

Promising Prosthetic Rehabilitation Following Orbital Exenteration: A Case Report

This case report outlines the successful prosthetic rehabilitation after orbital exenteration. Postsurgical exenteration by an ophthalmologist and maxillofacial prosthetist led to a user-friendly customized ocular-orbital silicone prosthesis with spectacles providing an appropriate fit, restoring facial symmetry and aesthetics, and improving the patient's quality of life. This interdisciplinary approach highlights the significance of tailored prosthetic solutions in optimizing outcomes for such patients under the guidance of an ophthalmologist and maxillofacial prosthodontist.

A technique of speech aid adjustment with the assistance of nasalance values for non-nasal and nasal sounds

Evaluation of speech function is essential to maxillofacial prosthetic treatment. Measurement of nasalance with a nasometer is practical and typically done to detect hypernasality in maxillofacial defect patients. This case report describes a nasalance test used in the evaluation and rehabilitation of a patient who needed a speech aid. A 70-year-old man sought help at our clinic because his old speech aid had broken. Although a new speech aid was fabricated, he continued to have difficulty speaking and breathing. A nasalance test using nasal and non-nasal test words revealed hyponasality. The patient was satisfied with the speech aid after its adjustment in accordance with the nasalance test results. Nasalance testing that considers not only hypernasality but hyponasality helped the maxillofacial prosthodontist in the successful rehabilitation of this maxillofacial defect patient. (Int J Maxillofac Prosthetics 2020;3:23-27)

Image Guided Palatal Obturator Design and Fabrication for Maxillectomy Defect in the Case of Acute Invasive Fungal Sinusitis

Acute invasive fungal sinusitis requires a high clinical suspicion and rapid diagnosis for initiation of surgical and medical treatment. Due to necessity of expedited surgical treatment, evaluation and impression making by a maxillofacial prosthodontist is rarely possible prior to debridement. Surgical debridement often results in maxillary defects, which can negatively impact speech, deglutition, and respiration. A surgical obturator occludes the palatal defect resulting in improved speech, swallowing and prevention of wound contamination with food particulate. This article focuses on utilizing medical imaging, usually acquired for diagnosis and surgical planning, to fabricate a well-fitting surgical obturator without conventional or digital intraoral dental impression making.

Comparative Evaluation of Flexural Strength and Microhardness of Two Different Ceramic Reinforced 3-D Printed Resins with Cad-cam Milled and Conventional Tooth Coloured Heat Cured Polymethylmethacrylate Resins as Long-term Provisional Restorative Materials” – An in Vitro Study

Background: Long-term provisional restorations play a crucial role in complex clinical scenarios, Implant-supported prostheses, full-mouth rehabilitation cases & Maxillofacial Prosthodontics. Understanding the mechan-ical properties such as flexural strength and microhardness of newer commercially available provision-al restorative materials is necessary to select an optimum material for long-term provisional fixed den-tal prosthesis. This Research study was conducted to evaluate and compare the Flexural Strength and Microhardness of Two Different Ceramic-reinforced 3-D Printed Resins with CAD-CAM Milled and Conventional Tooth Coloured Heat Cured Polymethylmethacrylate Resins as Long-Term Provisional Restorative Materials. Methods: Twenty-one specimens of dimensions 25 mm × 2 mm × 2 mm (ADA-ANSI specification #27) were fabricated each using: Group A (Control group)-Conventional tooth colored heat cured polymethyl-methacrylate resin (DPI Heat cure tooth moulding powder), Group B-CAD-CAM milled resin, Group C- Ceramic reinforced polymer 3-D printed resin (Temporary CB resin) and Group D- Ceramic rein-forced polymer 3-D printed resin (Permanent CB resin). Flexural strength and microhardness were measured and the values obtained were evaluated. Results: The measured mean flexural strength values (Mega Pascals) were 39.41 (Group A), 153 (Group B), 124.91 (Group C), and 136.50 (Group D). The measured mean microhardness values (Knoop hardness number) were 37.9 (Group A), 40.5 (Group B), 34.67 (Group C), and 43.88 (Group D). The difference in flexural strength and microhardness values of the three groups was statistically significant according to the analysis of variance (ANOVA) as well as the intergroup comparison done using Tukey’s honest significant difference (HSD) Post Hoc test (P < 0.05). Conclusions: Flexural strength with higher values in Group B were noted and the Microhardness test showed higher values in Group D.

Epidemiological profile of patients attending the maxillofacial prosthodontics unit at Ibn Sina University Hospital in Rabat, Morocco: a cross-sectional study.

the present study aimed to establish an epidemiological profile of patients consulting the unit of maxillofacial prosthodontics in Rabat. Results deriving from this study will help enhance the quality of patient care in our center and can also serve as a comparison tool with other maxillofacial teams around the world. during 11 months all patients consulting the unit of maxillofacial prosthodontics in our center were included. We opted for a questionnaire with 3 variables: socio-demographics, clinical examination data, and the type of prosthetic treatment adopted. The study was conducted in the Department of Removable Prosthodontics in the Center of Consultation and Dental Treatment of Rabat Morocco (CCDTR) from September 2020 to July 2021. the study population consisted of 91 patients, with a majority of male patients at 53% (n=48). During our study period, the proportion of patients under one-year-old was predominant, accounting for 38.4% (n=35) of the total sample. Among the patients in the sample, 72.5% (n=66) had no profession, while 66% (n=60) had a low income. Regarding medical insurance, the majority of our patients, 85.5% (n=78), were covered by Public Health Insurance for the Low-income Population (PHILP). Among the total sample, 57.1% (n=52) consulted for a combination of pain function and aesthetics. Additionally, 61.5% (n=56) were referred by teaching hospitals. For the type of oro-facial defect, 52.7% (n=48) of the sample consisted of newborns with congenital facial cleft. Out of the 91 patients, 36 had maxillofacial tumors, with 47.6% (n=17) of them presenting squamous cell carcinoma. Furthermore, 63.7% (n=58) of the prosthetic treatments adopted involved presurgical orthopedic treatments for newborns with facial cleft. the study on the epidemiological profile of patients attending the maxillofacial prosthodontics unit at Ibn Sina University Hospital in Rabat, Morocco provides important insights. The findings highlight the predominance of male patients and the prevalence of oro-facial defects in newborns. Socioeconomic factors, such as low income and lack of profession, are significant considerations. The majority of patients are covered by the PHILP, indicating the importance of medical insurance. These findings contribute to improving healthcare planning and specialized care for this patient population.

Management of Edentulous Patients with Maxillary Substance Loss: A Case Report

Depending on the location and extent of the loss of substance following maxillary resection surgery, all functions of the masticatory apparatus may be adversely affected. Eating and communication are impaired, which has a negative impact on the patient's psychological state [1]. When reconstructive maxillofacial surgery is not possible, rehabilitation with a maxillofacial prosthesis is essential. It must restore functions (phonation, eating, breathing, etc.) and reintegrate the patient into his psychosocial environment by masking his disability [2]. To achieve these objectives, this prosthesis, like a conventional removable prosthesis, must meet the Housset triad (support - retention - stabilisation), but also the objective of tightness. We therefore speak of a "prosthetic tetrad in PMF" (Housset's triad completed by the objective of tightness) [3]. In the case of a completely edentulous arch with substance loss, the treatment becomes more complex due to the reduced support surface. The maxillofacial prosthodontist must therefore be extremely vigilant to ensure the success of this appliance. A wise choice of technique and impression material, as well as respect for the occlusal parameters (occlusal plane, vertical dimension, centric relation, etc.) will ensure prosthetic stability and integration [4]. In this article, we will focus on the peculiarities of the management and the different stages in the fabrication of a maxillofacial prosthesis for a patient with total edentulism and loss of maxillary substance.

Need for Innovations in Maxillofacial Prosthodontics in Pakistan.

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Comparative evaluation of accuracy of cranial prosthesis designed by four different workflow protocols analysed by software

Cranioplasty aims to reconstruct skull defects from tumours, congenital anomalies, decompressive craniectomies, and fractures in a cosmetically acceptable manner. Since the 1970s, polymethyl methacrylate (PMMA) prostheses have been manually prefabricated using a variety of techniques. However, more recent computer-aided design and computer-aided manufacturing (CAD/CAM) techniques appear to have eclipsed these older methods. These techniques essentially involve using imaging from the patient's cranial defect and prefabricating the PMMA prosthesis using a 3D printer. The traditional methods for producing prostheses require a number of intricate stages, can be extremely stressful for the patient, and their success depends on the expertise of the maxillofacial team. Although there have been advances in digital fabrication for prosthetics, there are still some constraints that prevent a full transition to digital fabrication for the final stages of prosthesis construction. Advance training and modification of current treatment procedures are required due to the introduction of new technologies and methods in the field of maxillofacial prosthodontics. The aim of this study is to compare and evaluate the accuracy of cranial prosthesis designed by conventional, digital and two hybrid workflows We will report on 10 consecutive patients who have undergone cranioplasty surgery or had trauma for an extensive skull defect. The final prosthesis will be analyzed using the software CloudCompare for its accuracy by using reverse engineering principle. The purpose of this research is to develop a hybrid protocol for fabricating a prosthesis that is both cost-effective and more dimensionally accurate than its conventional counterpart, thereby providing ease for both the patient and the maxillofacial team.

Aditive Manufacturing in Maxillofacial Prosthodontics

Additive manufacturing (AM) or additive layer manufacturing (ALM), defined by the International Organization for Standardization and American Society of Testing and Materials (ISO/ASTM 52900) as the “process of joining materials to make parts from 3D model data, usually layer upon layer, as opposed to subtractive manufacturing and formative manufacturing methodologies” [...]

Coloring Effects of Disinfectants on Pure or Nano-TiO2-Incorporated Maxillofacial Silicone Prostheses.

Silicone elastomers play a crucial role in the field of maxillofacial prosthodontics. To maintain optimal hygiene, various disinfectants have been reported to clean silicone prostheses. Nevertheless, when selecting a disinfectant, it is important to consider not only its antimicrobial efficacy, but also its compatibility with the materials, to minimize any potential impact on the physical properties of the material surfaces. The coloring effect of such disinfectants on different types of silicone is of interest. A total of 144 silicone specimens (72 pure silicones, 72 nano-TiO2-incorporated silicones, from A-2000 and A-2006 silicones) were fabricated in this study. The spectrophotometric analysis was carried out, and the initial CIE L*a*b* color values were measured prior to disinfection. Specimens in each silicone group (with or without nano-TiO2) were subjected to a 30-h disinfection period simulating 1 year of disinfection with the following disinfectants: Control (tap water), 0.2% chlorhexidine gluconate, 4% chlorhexidine gluconate, 1% NaOCl, neutral soap, and effervescent. After the second color values were recorded, the color change (∆E*) was calculated. Significant differences were observed among the disinfectants for both the A-2000 and A-2006 silicone groups. Nano-TiO2 did not show a color protection effect in A-2000 silicone. In contrast, nano-TiO2 incorporation provided color protection against CHG 0.2%, CHG 4%, and NaOCl in A-2006 silicone. Most of the disinfectants did not show acceptable color stability over time. In pure A-2000 silicone, except for 0.2% chlorhexidine, all disinfectant groups demonstrated a color change within the acceptability threshold of 50:50% (∆E* = 3.0). On the other hand, in nano-TiO2-incorporated A-2006 silicone, only 0.2% and 4% chlorhexidine demonstrated an acceptable color change. Overall, chlorhexidine could be used as a suitable disinfectant in maxillofacial silicone prostheses.

Digitalization in maxillofacial prosthodontics- A review

Maxillofacial deformities that result from trauma, developmental abnormalities, destructive cancer surgeries, surgically operated mucormycosis can be difficult for a person to deal with as it affects the esthetics and functions and further degrades their quality of life. Hence, maxillofacial prosthesis not only corrects the deformity but also boost the self-confidence so that the patient can live his/ her life to the fullest. The creation of prostheses is currently undergoing a revolution, crediting the new, cutting-edge technologies including 3D modelling, printing, and imaging. These innovative methods are replacing the manual, labour-intensive, and expensive traditional methods of producing prosthetics with faster, less expensive methods that enable the creation of patient-specific prostheses. Our research aim to provide an update on the digital workflow of fabricating a maxillofacial prosthesis, highlighting the data collecting techniques at hand for extraoral, intraoral, and complex maxillofacial abnormalities, as well as evaluating the software’s used for data processing and designing. Also as the demand for a digital approach to craniofacial rehabilitation increases, it may be seen that the work of software designers will be at demand to help create accessible and user-friendly modules similar to those used in dental laboratories. As the demand for a digital approach to craniofacial rehabilitation is increasing, it has been noticed that assistance from the software designer will be required in future to produce user-friendly and accessible modules comparable to those used in dentistry laboratories

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.

Fundamental Properties and Biocompatibility Classification of Extraoral Prosthesis: A Review

This review article discusses on fundamentals of extraoral prosthesis and concerns on the biocompatibility classifications of extraoral prosthesis as medical device. Maxillofacial prosthodontics is a field that seldom being explored. Due to the circumstances, the progression and evolution of research of this area for evidence-based practice are slower comparing to another dental field. Hence, the purpose of this paper is to contribute and provide additional scientific knowledge in related field. Electronic search was done on several databases with keywords ‘maxillofacial prostheses and ‘biocompatibility’. In general, maxillofacial prosthesis can be divided into extraoral prosthesis, intraoral prosthesis, or combination of both depending on the location and function. Ideal properties can be divided into ideal processing characteristics, ideal biologic properties, and ideal physical and mechanical properties of processed extraoral prosthesis materials. Extraoral prosthesis can be classify as Class I or Class II depending on the retentive system according to FDA, and USP Class I and Class III depending on the underlying tissue.

REHABILITATION OF A POST COVID MAXILLECTOMY DEFECT WITH DEFINITIVE OBTURATOR: A CASE REPORT

In the course of the second wave of COVID-19 in India,the nation witnessed a rapid surge of a deadly fungal infection leading to increased morbidity and mortality. The treatment of the mycosis necessitates timely and often invasive surgical debridement leading to the creation of acquired defects. With the maxillofacial region being a highly common area for the mycosis to occur the role of maxillofacial prosthodontists and surgeons becomes significant. This article elaborates on one such case of maxillary defect treated, restored and rehabilitated to almost life-like functionality (speech, mastication), appearance and efficiency by means of a definitive prosthesis. Through this article we highlight that the prosthodontic treatment does not end with the provision of a temporary solution but to continue with the maintenance to aid in substantial tissue healing and to meet demands of function and aesthetics.

Interdisciplinary management of a patient with medication-related osteonecrosis of the jaw: A clinical report

Medication-related osteonecrosis of the jaw (MRONJ) can be induced by Bisphosphonates (BRONJ), Denosumab, and other antiresorptive or antiangiogenic medications. The number of affected patients with MRONJ is increasing worldwide including in Japan. The treatment often includes surgical resection of necrotic bone and the resulting oral defect impairs oral functions which requires consultation with a maxillofacial prosthodontist before and after surgery for prosthetic rehabilitation. Therefore, there is an urgent need to improve collaboration among different institutions for better patient care. In this report, we emphasize the benefits of such collaboration during the treatment of a female patient with BRONJ in the right maxilla. This patient had breast cancer and received zoledronic acid therapy for the treatment of metastatic osseous lesions. The successful team-based collaboration allowed early restoration of oral functions after surgery using an immediate surgical obturator as well as after delivery of the definitive prosthesis. (Int J Maxillofac Prosthetics 2023;6:16-19)

Awareness and attitude of maxillofacial surgeons in India towards prosthetic rehabilitation after ablative jaw surgery

Purpose: The study investigated the awareness and attitude of maxillofacial surgeons towards prosthetic rehabilitation after ablative jaw surgery. Materials and Methods: A questionnaire-based survey using google forms was designed to assess the awareness and attitude of maxillofacial surgeons. The questionnaire comprising of 23 closed- ended and multiple-choice questions. A total of 150 forms were sent to maxillofacial surgeons through e-mail. Results: Upon analyzing 103 responses it was observed that in the case of maxillectomy defects, the size of the lesion was designated as the most common factor (87%) for deciding between surgical reconstruction or prosthetic rehabilitation. 89% of respondents agreed that presurgical consultation with a maxillofacial prosthodontist could improve the rehabilitation success rate. The most common modality used for the reconstruction of mandibulectomy defects is vascularized bone grafts (32 %), reconstruction plate (30 %), and locoregional flaps for reconstruction by 20% of surgeons. Speech (64.1%) and nasal regurgitation (62%) were the two most important functions that the patient demanded to be corrected after maxillectomy whereas after mandibulectomy masticatory difficulties faced by the patient were the primary reason for seeking the prosthesis as suggested by 84% of respondents. Conclusion: The findings of this study show lack of awareness among surgeons regarding prosthetic rehabilitation of the post jaw resection patients. Ablative tumors of jaws necessitate amultidisciplinary team approach due to their effects on the functional and esthetic aspects of the patients involved. The response also emphasizes the need for a maxillofacial prosthodontist in the complete rehabilitation of the patients. (Int J Maxillofac Prosthetics 2023;6:8-15)