7/26/2019 History of Maxillofacial Prosthesis

1/34

History of maxillofacial

prosthesis

By

DR. MOATAZ BARAKAT

7/26/2019 History of Maxillofacial Prosthesis

2/34

Although the origin of the rst maxillofacialprosthesis is uncertain it is !i"ely accepte" thatattempts to replace missing structures "ate toancient times.

#t is a"mitte" that much of $no!le"ge of maxillofacialin%uries an" their treatment has &een "eri'e" fromthe treatment of &attleel" causalities. (Hippocrates)*+,-+ B./.0

#ntro"uction

7/26/2019 History of Maxillofacial Prosthesis

3/34

History of managementof fractures

7/26/2019 History of Maxillofacial Prosthesis

4/34

1+++ B./. in the city of Ba&ylon Hammurabi"re! up alegal co"e on clay !hich contains one of the rst !rittenreferences to the treatment of fractures2

3#f a physician set a &ro$en &one for a man

or cure his "isease" &o!els the patient shall

gi'e 'e she$els of sil'er to the physician.4

7/26/2019 History of Maxillofacial Prosthesis

5/34

5*++ B./. in 6gypt the !or$ of a military surgeon in a caseof a "islocate" man"i&le !as "ocumente" an" translate"

37ut your thum&s upon the en"s of the t!o rami of the man"i&le insi"e hismouth an" your t!o cla!s (groups of ngers0 un"er his chin an" thou shoul"st

cause them to fall &ac$ so that they rest in their places.4

8imple %a! fractures !ere treate" &y &an"ages fromem&almer an" soa$e" in honey an" !hite of egg.

7/26/2019 History of Maxillofacial Prosthesis

6/34

A&out the same perio" in ancient in"ia techni9ues !ere"e'elope" for use of pe"icle :aps from the forehea" orchee$ to repair "efects of the nose or lips.

#n )*+ B./. Hippocrates "escri&e" his treatment of"islocation of man"i&le similar to that a"'ocate" &y ancient6gyptians ho!e'er he !oul" appear to ha'e &een the rstto a"'ice !ith !iring in the case of man"i&le fracture

;#f the teeth at the !oun" &e "istorte" an" loosene" !hen the &one is a"%uste"

they shoul" &e connecte" together not only t!o &ut more of them !ith a

gol" threa" if possi&le &ut other!ise !ith a linen threa" until the &one &e

consoli"ate".;

7/26/2019 History of Maxillofacial Prosthesis

7/34

The rst 6uropean me"ical school !asesta&lishe" at 8alerno in #taly. Salicettiin 5

This seems to ha'e &een the rst clear in"icationof using the teeth in the sta&le upper %a! forimmo&ili?ation of the lo!er %a!.

7/26/2019 History of Maxillofacial Prosthesis

8/34

History of managementof ac9uire" an" congenital anomalies

7/26/2019 History of Maxillofacial Prosthesis

9/34

#n re'ie!ing the early history it is of interest to note thatthe o&turators !ere "e'ise" mainly in the el" of ac9uire""efects an" they !ere a"apte" later to ser'e in the area ofcongenital "efects.

7/26/2019 History of Maxillofacial Prosthesis

10/34

Demosthenes(-@),-

7/26/2019 History of Maxillofacial Prosthesis

11/34

During the late 5*thcentury oneof the most famous surgeonsAmbrose Pare !as cre"ite" to

&e the rst to refer to3O&turateurs4 "eri'e" from thelatin !or" 3O&turo4 !hich meansstop up.

7areC "escri&e" t!o appliancesto restore the palatal "efectcause" &y "isease or gunshot!oun"s

7/26/2019 History of Maxillofacial Prosthesis

12/34

The rst 3O&turateur4 as he "escri&e" is ma"e of a plate ofgol" or sil'er a little &igger than the ca'ity itself an" on theupper si"e a little sponge is place"

7/26/2019 History of Maxillofacial Prosthesis

13/34

The other "esign has a &utton !hich engages the un"ercutin the nasal ca'ity

7/26/2019 History of Maxillofacial Prosthesis

14/34

7areC also !as $no!n for the intro"uction of articial nosesan" eyes !hich !ere constructe" of &eaten sil'er an"suita&ly painte".

7/26/2019 History of Maxillofacial Prosthesis

15/34

Pierre Fauchards(5*=,5*50 authoritati'e !or$ 3 e/hirurgien Dentiste4 accre"ite" him !ith the title 3Eatherof "entistry4.

He "e'ote" four chapters of the secon" part of his &oo$ toa "etaile" "iscussion of 'e "ierent o&turators an" the

metho"s of their construction.

7/26/2019 History of Maxillofacial Prosthesis

16/34

The rst t!o "esigns !ere ma"e for "entate patients an"the thir" an" fth for e"entulous patients. The oralcomponent of the rst t!o "esigns !as metal !hile that ofthe thir" an" fth !as part metal an" part i'ory to !hichprosthetic teeth !ere attache" as re9uire".

7/26/2019 History of Maxillofacial Prosthesis

17/34

Eauchar" generally use" humanhippopotamus or ox teeth ortus$s from the !alrus or elephantas material from !hich prostheticteeth coul" &e ma"e.

The rst three an" the fth"esigns essentially "epen" onthe same retenti'e principle.#nstea" of relying on sponges to

retain his prostheses Eauchar"use" a "esign consisting of t!ometal !ings that !ere inserte"through the perforation in a'ertically upright position.

7/26/2019 History of Maxillofacial Prosthesis

18/34

The metal !ings !ere thena"%uste" into a hori?ontalposition &y means of a

threa"e" scre!. These thenengage" on the nasal si"e ofthe "efect pro'i"ing retentionfor the prosthesis.

7/26/2019 History of Maxillofacial Prosthesis

19/34

The fourth "esign !as ma"e for apatient !ho ha" lost her upper

incisor teeth an" ha" a "efect thatcommunicate" !ith the :oor of thenose.

This prosthesis !as ma"e of i'ory!hich !as shape" !ith >anele'ationC that exten"e" into the"efect an" to !hich !as attache" asponge.

7/26/2019 History of Maxillofacial Prosthesis

20/34

Although authors !ere greatly in:uence" &y Eauchar"Cs"esigns &ut they "iagree" the intro"uction of extensionsthrough the palatal "efect

Bourdet in 51 "escri&e" t!o o&turators ma"e of a thinsheet of metal !hich !ere attache" aroun" the teeth &ymeans of ligature.

7/26/2019 History of Maxillofacial Prosthesis

21/34

Delbarremo"ie" the "esign&y using metal extensionsaroun" teeth !hich in some!ay resem&le thecontemporary partial "enture"esign

Hence Del&arre !as the rstone to use metallic &an"s

(clasps0 aroun" teeth.

7/26/2019 History of Maxillofacial Prosthesis

22/34

#n 5* Verdialconstructe" an appliance !ith a u'ulama"e of sponge.

The appliance !as ma"e of spanish leather an" line" !ith a

thin layer of sponge the sponge u'ula !as attache" !ithelastic sil'er !ire.

Foucouin 5@+ attempte" to restore the "efect in the'elum &y highly elastic &an"s or metallic plates. The plateexten"e" from the palate &ac$!ar"s co'ering the "efecti'e

part of the soft palate.

7/26/2019 History of Maxillofacial Prosthesis

23/34

Del&arre in 5@

7/26/2019 History of Maxillofacial Prosthesis

24/34

One hun"re" years elapse" after Faucharduntil anotherre'olutionary impro'ement on the practice occurre"

#n 5@

7/26/2019 History of Maxillofacial Prosthesis

25/34

#t !asnCt until 5@* that Suersenintro"uce" the &asicprinciples &ehin" the "esign of speech ai" "e'ice as it ispresently $no!n.

He explaine" the anatomy an" physiology of thepharyngeal area an" he !as the rst to "ra! attention tothe action of the superior constrictor in 'elo,pharyngealclosure.

3The constrictor muscle contracts the ca'um pharyngo,palatinum the

pharynx !all &ulging out an" it is chie:y on the action of this musclethat # &ase the system of my articial plates4

7/26/2019 History of Maxillofacial Prosthesis

26/34

He use" har" caoutchouc toconstruct his one piece

o&turator !hich co'ere" thetissue in the har" palate an"exten"e" into the pharyngealspace to terminate in an3Apophysis4 &roa" enough toll the "efect.

7/26/2019 History of Maxillofacial Prosthesis

27/34

Fear the en" of the 5=th century 'ulcanite !as !i"elyaccepte" for use in maxillofacial prosthetics.

7olymethyl methacrylate (7MMA0 !as rst use" as a

"enture &ase material in 5=-*.

Lloyd suggeste" that methyl methacrylate has thea"'antages of light !eight an" a"apta&ility throughprocessing. Eor more than @+ years methyl methacrylatehas remaine" the "ominant material for fa&ricating most

remo'a&le "ental prostheses inclu"ing maxillofacialprosthesis

7/26/2019 History of Maxillofacial Prosthesis

28/34

Historically maxillofacial prostheses !ere ma"e of clothleather !rought or cast metal an" 'ulcanite.

illiam Morton (5@++,5==+0 !as cre"ite" !ith fa&rication ofa nasal prosthesis using enamele" porcelain to match thecomplexion of a patient.

#n 5=5- elatin,glycerin compoun"s !ere intro"uce" foruse in facial prosthesis in or"er to mimic the softness an":exi&ility.

Erom 5=-* to 5=*+ Acrylic resin !as intro"uce" in the"ental profession.

The intro"uction of 'arious $in"s of elastomers resulte" inma%or changes. Barnhart !as the rst to use silicone ru&&erfor construction an" coloring of facial prosthesis.

7/26/2019 History of Maxillofacial Prosthesis

29/34

Fe!er materials representing a 'ariety of polymer classesoering uni9ue characteristics ha'e recently &eenintro"uce" !hich are as follo!s2

, Acrylic resin copolymer, Iinyl polymers an" co,polymers

, 7olyurethane elastomers

, 8ilicone elastomers

7/26/2019 History of Maxillofacial Prosthesis

30/34

Materials of the rd Millennium

!emerdalestate" that the materials of the -r"milleniumare expecte" to &e translucent an" shoul" ha'epigmentation a&ility to match any s$in color.

7/26/2019 History of Maxillofacial Prosthesis

31/34

On the Hori?on

7/26/2019 History of Maxillofacial Prosthesis

32/34

Mo"ern technology may pro'i"e &etter solutions forreplicating extensi'e maxillary "efects "uring prosthesisfa&rication.

/omputeri?e" tomographyJmagnetic resonance (/TJMR#0imaging techni9ues hol" promise for pro'i"ing a metho" of

generating -,"imensional computer mo"els.

7/26/2019 History of Maxillofacial Prosthesis

33/34

/omputer,ai"e" "esign an" computer,ai"e" manufacturing(/ADJ/AM0 metho"s can then &e use" to fa&ricate the"eniti'e prosthesis.

The goal is to fa&ricate a more accurate prosthesis in lesstime. As an a""e" a"'antage since the information is

containe" in an 8T le the prosthesis can &e mo"ie" astissue changes occur !ithout necessarily rema$ing animpression.

7/26/2019 History of Maxillofacial Prosthesis

34/34