|Year : 2020 | Volume
| Issue : 1 | Page : 91-94
Custom-made ocular prosthesis manufactured with permanent soft denture lining material: An alternative method
Salah Khalaf, Najat Allah Taha Jazzaa, Mohammed R Abdul Jabbar
Prosthodontics Units, Faculty of Dentistry, University of Anbar Prosthodontics Unit, University of Anbar, Iraq
|Date of Submission||15-Mar-2019|
|Date of Decision||28-Nov-2019|
|Date of Acceptance||29-Nov-2019|
|Date of Web Publication||25-Feb-2020|
Dr. Salah Khalaf
Prosthodontics Units, Faculty of Dentistry, University of Anbar
Source of Support: None, Conflict of Interest: None
The eye plays a vital role as one of the six senses in humans. From vision to expression, it has its various functions. The aim of this study was to suggest a technique using soft denture lining material to improve the retention of an ocular prosthesis in a grossly resorbed orbital cavity to minimizes the trauma of thin, atrophic tissue. An ocular prosthesis restores lost anatomical structures and corrects the cosmetic defect. A custom-made ocular prosthesis is a good alternative as soft denture lining material used during the fabrication of scleral part of ocular prosthesis improves patient comfort by acting as a shock absorber and stress distributor, and yields longer duration of wear. A good alternative of a custom-made ocular acrylic prosthesis is presented here, which had acceptable fit, retention, and esthetics. Fabrication of new ocular prosthesis with permanent soft liner is a novel way to minimize trauma to underlying supporting tissues.
Keywords: Atrophic Tissue, Denture Soft Liner, Ocular Prosthesis, Shallow Orbital Cavity
|How to cite this article:|
Khalaf S, Jazzaa NA, Jabbar MR. Custom-made ocular prosthesis manufactured with permanent soft denture lining material: An alternative method. J Int Oral Health 2020;12:91-4
|How to cite this URL:|
Khalaf S, Jazzaa NA, Jabbar MR. Custom-made ocular prosthesis manufactured with permanent soft denture lining material: An alternative method. J Int Oral Health [serial online] 2020 [cited 2020 Apr 3];12:91-4. Available from: http://www.jioh.org/text.asp?2020/12/1/91/279224
| Introduction|| |
The trauma associated with the loss of an eye can cause significant physical, psychological, and social problems for patients. Reasons for an eye loss can be innumerable ranging from congenital defect, tumor, irreparable trauma, and sympathetic ophthalmia to the need for histological confirmation of a suspected diagnosis., Surgical procedures for the removal of an eye can be broadly classified as evisceration (where the contents of the globe are removed leaving the sclera intact), enucleation (most common, where the entire eyeball is removed after severing the muscles and the optic nerve), and exenteration (where the entire contents of the orbit including the eyelids and the surrounding tissues are removed).,,, The rehabilitation of a patient who has experienced eye loss requires a prosthesis that will provide optimal esthetic and functional results. In such cases, collaboration between a maxillofacial prosthodontist and an ophthalmologist is necessary. Today, the majority of patients are rehabilitated with an artificial eye made of acrylic, and conventional ocular prostheses fabricated by heat-cured acrylic resins are the most common type of eye prosthesis.,, Unfortunately, some patients are maladaptive in their ability to tolerate a conventional ocular prosthesis. In patients with anophthalmic sockets, blinking and tearing reflexes are either absent or do not function at optimal levels leading to problems such as dryness, discomfort, irritation, bacterial infections, and mucous deposition all of which makes prosthesis wear uncomfortable. A permanent soft liner normally is used to minimize direct pressure to soft tissues and/or to compensate for an ill-fitting prosthesis, and it is important to recognize that a soft liner should be used only to improve a clinically acceptable prosthesis. Permanent soft relining materials are processed in a dental laboratory in a manner similar to heat-cured acrylic denture base material. The reciprocal of the elastic modulus of the soft relining materials is called compliance, which is a measure of the compressibility or flexibility of the material. This study aimed to suggest an innovative technique to fabricate the scleral part of ocular prosthesis from permanent soft denture lining material to improve patient comfort and prosthesis softness for longer periods without hardening. Our null hypothesis is presented as follows: no difference is observed in the technique using soft denture lining material and conventional ocular prostheses fabricated by heat-cured acrylic resins.
| Case Report|| |
A 13‑year‑old female patient reported to the Department of Prosthodontics and of Maxillofacial Rehabilitation, Faculty of Dentistry, University of Anbar for prosthetic rehabilitation of her lost left eye. Case history revealed that the patient had sustained a traumatic shrapnel injury to her left eye. Clinical examination revealed a completely healed left eye socket with healthy conjunctival lining and absence of infection and healing. The treatment plan was to fabricate a custom-made ocular prosthesis, and the steps and procedures in prosthesis fabrication along with the risks and benefits of treatment were explained to the patient [Figure 1].
Method of fabrication of the ocular prosthesis
Impression tray selection
A stock acrylic ocular impression tray [Figure 2] was selected to fit into the confines of the socket. Modifications were made to achieve the correct shape and contour of the eye reducing any overextensions. The margins were smoothened with the help of a finishing bur to prevent any irritation to the tissues inside the socket [Figure 3].,
The patient was made to look straight ahead and keep all facial muscles relaxed. A very runny consistency of alginate (Lascod, Italy) was injected into the impression tray with a syringe. The tray was slowly placed into the defect to prevent overfilling. A little amount of align flowing out through the inner canthus indicates adequate material filling of the socket [Figure 4]. Upon setting, the impression was gently removed from the socket, washed, and disinfected.
Fabrication of the wax pattern
A polyvinylsiloxane silicone putty (Zhermack, Germany) index was made of the impression to obtain a positive mold of the eye socket. Once polymerized, it was cut open and a melting red wax was flown through it. On hardening, the wax pattern was gently retrieved, cooled in cold water, and smoothed with the help of a carver and gauze. The wax pattern was then tried in the patient’s eye for fit, comfort, size of the pattern and drape, and mobility of the eyelids.
Attaching the iris
The size of the iris of the natural eye was measured using a millimeter measurement gauge or an optical scale. Iris size should match the iris size of the adjacent eye and should replicate the normal gaze position [Figure 5]. The patient was made to look slightly medial and downward at this stage.
|Figure 5: Iris prosthesis adjustment and attachment made on the wax pattern|
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Fabrication of base sclera shell and finishing
Flasking and pressing: The wax pattern was then flasked in a two-part flask using type-IV dental stone (Lascod, Italy) [Figure 6]. Once the stone had set, the wax pattern was removed. After dewaxing, investing was performed via the compression molding technique with acrylic-based permanent soft lining material (Vertex company, Netherlands) with a small amount of titanium dioxide white pigment (GC, Grumbacher, USA) added to it for shade matching of the sclera of the adjacent eye in relation to the working eye. The flask was pressed for 10–15min at 100 kPa under a hydraulic press to permit the acrylic resin to gain adequate stiffness to avoid deformation by the permanent soft liner material during pressing.
Curing protocol: The flask was packed with white acrylic-based permanent soft lining material and placed in water at 95°C for 2h. Then, the flask was removed from its clamp and opened carefully. After curing: The final prosthesis was divested, and margins of the acrylic prosthesis were rounded off and the entire prosthesis smoothened out. The acrylic of the sclera was trimmed down approximately 1mm. The simulation of scleral vessels was achieved by spreading artificial veins (red nylon fiber) over the sclera surface to give it a natural look. A thin layer of Optiglaze (GC, USA) was added as a final coating and light cured to seal the paint. Later, a fine layer of clear heat-cured acrylic resin was applied upon the corneal prominence and sclera, thereby creating the illusion of depth and permitting exaggeration of the details of the iris and scleral vessels. Rough edges of the prosthesis were trimmed off, whereas mechanical polishing of permanent soft lining material prosthesis is not possible. To achieve high-gloss polishing, a layer of OPTIGLAZE was applied on the entire surface. At the borders along the junction of soft liner, the fine layer of clear heat-cured acrylic resin was polished, pumiced, and buffed to give the prosthesis a natural glossy finish before placement in the patient [Figure 7]. The patient was taught how to place and remove the prosthesis. Instructions regarding manipulation, care, and hygiene for the prosthesis were given to the patient.
| Discussion|| |
In the present clinical situation, before application of a soft liner, the eye cavity must be evaluated as clinically acceptable. Insertion of permanent soft liner within an ocular prosthesis improves retention in shallow ocular cavities with inadequate depth through enhanced intimate contact of the prosthesis with underlying tissues act as sandwiching a liner layer and also by reducing traumatic impact to residual tissue through better load distribution of forces applied by orbicularis oculi muscles. In this study, fabrication of new ocular prosthesis with permanent soft liner; the difference was observed in the technique using conventional ocular prostheses fabricated by heat-cured acrylic resins for another patient; in uniform distribution of stress at the lining interface, distributing residual stresses during function and reduced the effect of traumatic impact on underlying tissues by sandwiching a resilient liner layer. Thus, the initial null hypothesis was rejected because difference was observed between the technique using conventional ocular prostheses fabricated by heat-cured acrylic resins for another patient and the new technique in this study. This result is in agreement with that of a previous study, in which the soft denture lining materials lead to a more uniform distribution of stress at the lining interface and have excellent shock absorber properties, which are directly related to the thickness of the layer of the liner. A permanent soft liner acts as a stress distributor by absorbing some of the load and distributing residual stresses during function so that ocular cavity tissues receive less impact force.,
Parker further reduced the effect of traumatic impact on underlying tissues by sandwiching a resilient liner layer within in acrylic base. Permanent soft liner viscoelasticity and softness are maintained for longer periods due to lack of plasticizer, and being elastic in character, it may stretch during insertion and removal of a prosthesis without traumatizing the tissues and then “spring” back into close contact with undercut areas, thereby improving retention. The intimate contact of the permanent soft liner with tissues improves retention, particularly in patients with very shallow ocular cavities and patients with dry eyes, in whom lachrymal flow, critical for lubrication and retention, is decreased. Although permanent soft liners may be challenged to form a durable bond with the heat-cured acrylic resin applied on in the corneal prominence and scleral areas of an ocular prosthesis, this problem may be overcome by using a suitable solvent-based primer and a thin layer of OPTIGLAZE. The proposed fabrication of the ocular prosthesis with permanent soft liner method may improve the prognosis and minimize possible problems encountered when an ocular prosthesis fabricated with permanent soft liner is used. Hence, the results of this study provided information that could be used as a basis to simulate the clinical applications of these materials.
| Conclusion|| |
The fabrication of an ocular prosthesis with permanent soft liner is possible and suggested to improve the retention of the ocular prosthesis by maintaining intimate contact with the orbital cavity tissues.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]