Ocular Prosthesis Bhavan
Ocular Prosthesis Bhavan
Ocular Prosthesis Bhavan
Bhavan Chand
CONTENTS
Introduction Definition Review of Literature Classification Fabrication Recent Advancement Conclusion and Summary
DEFINITION
The maxillofacial prosthodontics is the branch of prosthodontics concerned with restorations and replacement of stommatognathic and craniofacial structure with prosthesis that may be removed on a regular or elective basis.
(GPT 8)
INTRODUCTION
Physical defects that compromise appearance or function which prevents an individual from leading a normal life usually prompt the individual to seek treatment that will reinstate acceptable normalcy.
The loss of an eye impair the patient's visual function, yet also result in noticeable deformity. A prosthesis should be provided as soon as possible to raise the spirit and ease the mind of the afflicted.
Orbital prosthesis: A prosthesis that artificially restores the eye, eyelids, and adjacent hard and soft tissue lost as a result of trauma or surgery - GPT 2005
Ocular prosthesis: A prosthesis that artificially replaces an eye missing as a result of trauma, surgery, or congenital absence. - GPT 2005
Opthalmologist
Maxillofacial Prosthodontics
Ocular Prosthesis
Plastic Surgeon
HISTORY
2613-2494 B.C First ocular prosthesis in Egypt; excavation of tombs provided evidence of eye replacement by using precious stones, earthenware, enemelled bronze ,copper and gold.
(1510-1590)
Ambrose Par , a famous French surgeon, was the first to describe the use of artificial eyes to fit an eye socket. These pieces were made of gold and silver,
1820s-1890s);
Enamel prostheses were attractive color suitable for a prosthetic eye. German craftsmen are credited with this invention in 1835
19 century: Dental crop, Army of USA Fabrication of plastic eye :Various material like vulcanite and celluloid were introduced to improve this artificial eye prosthesis
20 th century second world war: A definitive technique was used by United States Naval Dental and Medical School use of acrylic eye.
Ocular Implant;
CLASSIFICATION OF OCULAR
PROSTHESIS
Material Availability
Stock eyes
Glass made
Acrylic made
It prevents socket dissolution. Fear of breakage is less. It can be reparable. It can be worn at night time The eye glasses are roughen and discolor caused by tears and secretion.
Normal eye
diagram
Gerodontology 2007 March 21 Sanjayagouda B.Patil, Roseline Meshramkar,B.H Naveen and N.P Patil
Evisceration; is a surgical procedure wherein the intraocular contents of the globes are removed, leaving a sclera, Tenons capsule, conjunctiva extra ocular muscle and optic nerves are undisturbed; cornea may be retained or exicised. Enucleation; is the surgical removal of the globe and a portion of the optic nerve from the orbit. Exenteration: Block dissection of eye.
EVISCERATION
ENUCLEATION
EXENTERATION
Wax Try in
Characterization of Prosthesis
Patient Evaluation:
The pt evaluation includes physical and psychological appraisal of the patient, including the desires and expectation of the patient related to the proposed prosthesis.
Patient has to be counseled regarding expected results, with specific emphasis on the role of both during the treatment phase and after completion of the prosthesis.
Patient examination ;
Proper healing Presence of the any contracture Irritation due to any existing prosthesis Evaluation of the muscles control
Robert B Welden and John v Niranee JPD Vol 6 No 2 1956
Impression Techniques:
Criteria for an acceptable impression:
Mixing alginate material with excess water until it is very free flowing
Bartlett and Moore. Journal of prosthodontics Dentistry A Physiologic System 1973 29 450-459
Brown:
advocated an external impression tray tech in which the ophthalmic irreversible alginate is mixed and injected into the ocular defects by means of the syringe and later he recommended an edentulous perforated trays with additional impression materials to combine with the extruded material.
diagram
He advocated placing the perforated acrylic resin backing tray for reinforcement.
Perforated acrylic backing
Allen and Webster; recommended a stock ocular tray which is perforated which helps in the retention of alginate for making ocular impression. Cain: He suggested using the impression trays with a hollow stem in the shape of the ocular prosthesis. Once the impression set, he recommended making a two piece dental stone mold to make the wax conformer.
Cain JR jpd 1982,48, 690-4
Englemeier:
Suggested casting a set of stock trays in ticonium which is a nonprecious removable partial denture alloy which can be sterilized in an autoclave for reuse. Stock metal tray
Resulting impression
CHARACTERIZATION OF PROSTHESIS
1.
Digital imaging:
The digital image provides acceptable esthetics results because it closely replicates the patients with minimum color adjustment and modification. Advantages: Techniques is simple
J Prosthet Dent. 2006 Apr;95(4):327-30 Mathews MF, Smith RM, Sutton AJ, Hudson R
PATIENT INSTRUCTIONS
Wear the prosthesis day and night It has to washed with soap solution once in every two weeks.
Once the prosthesis removed the soft tissues are irrigated with ophthalmic irrigation
Daily ocular hygiene can be maintained using ophthalmic irrigation solution as a eye drops to clean anterior portion of the prosthesis
OCCULAR IMPLANT
ADVANTAGES:
In growing children additional benefit restored muscle function creates additional tension on the orbital walls and ensures normal pattern of orbital growth.
Following enucleation not all patients are candidates for placement of an ocular implant:
possible.
Many materials have been tried: Bone, gold ivory, rubber, paraffin etc.
In recent years inert resin polymers are used. (Most of the implants are made of methyl methacrylate resin) .
Hydroxyapatite
CLASSIFICATION OF IMPLANTS
Advantages:
Inherent biocompactibility and proclivity to become fibrovascularity integrated with resiudual muscle and tissue. It also minimize the fear of the bacterial infection.
Dr Arthur Perry jpd 1995 vol73 67-69
Disadvantages:
Extended operative time required to locate and attach the extraocular muscle to the motility sphere. Cost effective.
Nov;121(11):1596-600
In this paper, it is shown that such optical systems can be achieved using state-of-the-art micro-optics Systems.
Duparr JW, Wippermann FC Bioinspir Biomim. 2006 Mar;1(1):R1-16. Epub 2006 Apr 6
CONCLUSION
The art of replacing missing eye with a prosthesis has been carried out many years and these can be stock or custom made. The use of an ocular prosthesis of appropriate size, contour and contour can prove to be of value functionally as well as aesthetically. It promotes physical and psychological healing for the patient and improve social acceptance.
Ocular prosthesis: JPD 1973:38:532 Fitting of ocular prosthesis:JPD: 1977:38:532 Custom ocular prosthesis: JPD 1982:48:690 HA motility implants: JPD 1995:73:267
Custom oc prosthesis:JPD 1997:78:218 Post insertion care: JPD 1983:49:220 Surgical considerations:JPD 1983:49:379 Pupil alignment: JPD 1969:22:487-489