implant retained auricular prosthesis. a clinical report

7212019 Implant Retained Auricular Prosthesis a Clinical Report

httpslidepdfcomreaderfullimplant-retained-auricular-prosthesis-a-clinical-report 13

21 DENTAL STUDENTSrsquo RESEARCH

IMPLANT RETAINED AURICULAR PROSTHESIS A CLINICAL

REPORT

Dinesh Rokaya BDS1 Phonepaseut Sitthiphan DDS

1 Pokpong Amornvit DDS MSc

2 Arunee Tirasriwat DDS MSc

2 Sita

Thawaranunta DDS MS MSc3

Theerathavaj Srithavaj BS DDS MS3

1 Resident Maxillofacial Prosthetic Service Faculty of Dentistry Mahidol University Bangkok Thailand

2 Instructor Maxillofacial Prosthetic Service Faculty of Dentistry Mahidol University Bangkok Thailand

3 Assistant Professor Maxillofacial Prosthetic Service Faculty of Dentistry Mahidol University Bangkok Thailand

Authors declare no conict of interest

Abstract

Ears have an important role in function and aesthetics The loss of the ear can lead to psychological and hearing

problems Although several reconstructive techniques

exist for auricular defect the use of implants to anchor

auricular prosthesis presents a suitable alternative This

article presents a case of right auricular defect which was

result of trauma for which two bone-anchored implants

were placed Hader bar with ERA attachments were

used for retention of the silicone auricular prosthesis

Key Words Auricular defect ERA Extraoral implant

Hader bar Silicone prosthesis

Introduction

Auricular defects may be congenital or acquired which

may result from tumors or accidents (1-5) The auricular

defect cause esthetic functional and psychosocial problems

for the patient Rehabilitation of the defect can be achieved

by surgical reconstruction or prosthetic rehabilitation

Auricular prosthesis using extraoral implants have been

used to offer better retention compared to adhesives or

frameworks However the main limitation with extraoral

implants including implant retained auricular prosthesis is

the need for hygiene maintenance of the soft tissue around

the implants (5) Though the failure rate of the auricular

implants due to peri-implantitis is low it may lead to

complications such as bleeding pain and discomfort (6-8)

This article presents a case report of implant retained

medical grade RTV Silicone auricular prosthesis

Clinical Report

A 40-year-old male patient was referred to the MaxillofacialProsthetics Service Mahidol University for the prosthetic

rehabilitation of his right auricular defect which resulted

from trauma (Figure 1) On examination the partial antihelix

was remaining The treatment plan consisted of fabrication

of implant retained right auricular prosthesis using Hader bar

with ERA attachments in order to obtain a good retention

After evaluating of the computerized tomography (CT) scanthe first stage surgery was performed with the placement of

two (37 X 4 mm) craniofacial implants (Entific Gothenburg

Sweden) in the temporal bone After 7 months second

stage surgery was performed with a partial thickness

skin graft and placement of 55 mm abutments (Figure 2)

After 3 weeks an impression of the defect was made

with impression copings (Figure 3-5) using polyvinyl

siloxane impression material (3M ESPE Express 3M USA)

The impression was removed (Figure 6) and the cast

was poured in Type IV die stone (Lafarge Prestia Meriel

France) Then Hader bar was fabricated and 2 ERAs andlip were chosen for retention of the auricular prosthesis

(Figure 7) Subsequently heat resin (Vertex-Dental Zeist

Netherlands) substructure was fabricated where 1 clip

and ERA male parts were attached to it Wax pattern was

sculptured and tried on the patient (Figure 8-9) It was

checked for the fit and esthetic Then the mould was

made from die stone On next visit after 1 week the room

temperature vulcanizing (RTV) Silicon elastomer (MDX

4-4210 Dow Corning USA) was mixed chairside and

intrinsic coloration was done to simulate the patientrsquos

normal skin color Afterwards the mixed silicone was

packed at room temperature and allowed to set for 3 days

according to the manufacturerrsquos instructions After 3 days

the silicone prosthesis was secured the excess materials

were trimmed and the prosthesis was tried on the patient

Extrinsic coloration was done to match the patientrsquos left ear

The final auricular prosthesis was delivered (Figure 10-12)

to the patient and the home care instructions were given

On a recall visits after 1 month (Figure 13) a mild peri-

implantitis was noted around the both implants (Figure

14) The peri-implantitis was managed by cleaning the soft

tissues around implants implant abutments and the Hader

bar with hydrogen peroxide (11 diluted with normal saline)and betadine After 4 weeks peri-implantitis in both implants

was healed (Figure 15) The patient was strictly advised for

hygiene maintenance of the implants and the prosthesis



22DENTAL STUDENTSrsquo RESEARCH

Discussion

The use of craniofacial implants for retention of extraoral

prostheses not only offers excellent support and retention

but also improves the patientrsquos appearance and the quality

of life Implant retained auricular prosthesis provides

multiple advantages such as convenience security

consistent retention and positioning elimination of the

need for adhesives which may cause tissue irritation

and maintenance of marginal integrity and longevity (9)

For an auricular prosthesis two implants are sufficient to

retain the prosthesis Magnet and bar-clip retention are the

two other forms of retention used in the auricular region Use

of magnet was not recommended in this case because though

magnet may provide acceptable retention it is less stable

under the lateral force (10) The bar-clip system provides

good retention for the prostheses However bars may limit

access for performing hygiene procedures So in our case

implant retained auricular prosthesis was indicated (11)Numerous attachments are available for the retention of

implant-retained prosthesis Locator and O-Ring are also

used In addition to the prosthetic ear implant-retained

auricular prosthesis usually requires a bar-clip with other

retentive elements like ERA to offer better retention (9)

The factors that may cause peri-implantitis in extraoral

implants are thick skin graft movement of skin around the

abutment bar-clip design for retention of the prosthesis

improper hygiene humid environment and growth of

opportunistic microorganisms (12) In our case peri-

implantitis might be resulted from improper hygiene This

was managed with proper reinforcement of hygiene methods

The patient was satisfied with the prosthesis because of

acceptable esthetic and excellent support and retention

Conclusion

The implant retained silicone auricular prosthesis provides

an esthetically and functionally acceptable outcome in

patients with auricular defect Hygiene maintenance is

necessary for the success of the implant retained prosthesis

Pokpon983143 Amornvit DDS MSc

Instructor Maxillofacial Prosthetics Service Faculty of

Dentistry Mahidol University

Address 6 Yothe Rd Rajthevee Ban983143kok 10400 Thailand

Email pokpon983143amornvityahoocom

Figure 1 Frontal view

of the patient with right

auricular defect

Figure 2 Two

abutments in temporal

bone attached to fixtures

Figure 3 Impression

copings over the

abutments

Figure 4 Making

Impression of the defect

making with light body

polyvinyl siloxane

impression material

Figure 5 MakingImpression with medium

body polyvinyl siloxane

impression material

Figure 6 Impression afterremoval from the defect

side

Figure 7 Header bar withERA placed in attachment

Figure 8 Wax-up try-infrom front




Figure 9 Wax-up try-in

from back

Figure 10 Patient with

the final prosthesis

Figure 11 Prosthesis in

place while opening the

mouth

Figure 12 Final prosthesis

from right lateral view

Figure 14 Periimplantitis

around the implants on

recall visit

Figure 15Healed peri-

implantitis after 4 weeks of

maintaining hygiene

Figure 13 Patient at

follow-up visit

References

1 Nishimura RD Roumanas E Sugai T Moy PK Auricular prostheses and

osseointegrated implants UCLA experience J Prosthet Dent 1995 Jun73(6)553-8

2 Wang RR Andres CJ Hemifacial microstomia and treatment options for auricular

replacement A review of literature J Prosthet Dent 1999 Aug82(2)197-2 04

3 Visser A Raghoebar GM Van Oort RP Vissink A Fate of implant-retained

craniofacial prosthesis Lifespan and aftercare Int J Oral Maxillofac Implants 2008 Jan-

Feb23(1)89-98

4 Aydin C Karakoca S Yilmaz H Yilmaz C Implant-retained auricular prosthesis An

assessment of implant success and prosthetic complications Int J Prosthodont 2008

May-Jun21(3)241-4

5 Ozturk N Usumez A Tosun Z Implant-Retained Auricular Prosthesis A Case Report

Eur J Dent 2010 Jan4(1)71-4

6 Russell D Nishimura ER Toshiro Sugai Peter K Moy Auricular prostheses and

osseointegrated implantsUCLA experience J Prosthet Dent 1995 Jun73(6)553-8

7 Karakoca AC Yilmaz H Bal BT Survival rates and periimplant soft tissue evaluation

of extraoral implants over a mean follow-up period of three years J Prosthet Dent 2008

Dec100(6)458-64

8 Reyes TA Granstroumlm G Evaluation of implant losses and skin reactions around

extraoral bone-anchored implants A 0- to 8-year follow-up Otolaryngol Head Neck

Surg 2000 Feb122(2)272-6

9 Schaaf NG Kielich M Implant-retained facial prostheses InMcKinstry RL

Fundamentals of facial prosthetics Arlington ABI Professional Publications 1995

10 De Vale V Faulkner MG Wolfaardt JF Rangert B Tan HK Mechanical evaluation

of craniofacial osseointegration retention systems Int J Oral Maxillofac Implants 1995Jul-Aug10(4)491-8

11 Reisberg DJ Habakuk SW Hygiene procedures for implant-retained facial

prostheses J Prosthet Dent 1995 Nov74(5)499-502

12 Klein M Hohlfeld T Moormann P Menneking H Improvement of epidermal

adhesion by surface modification of craniofacial abutments Int J Oral Maxillofac

Implants 2000 Mar-Apr15(2)247-51



22DENTAL STUDENTSrsquo RESEARCH

Discussion

The use of craniofacial implants for retention of extraoral

prostheses not only offers excellent support and retention

but also improves the patientrsquos appearance and the quality

of life Implant retained auricular prosthesis provides

multiple advantages such as convenience security

consistent retention and positioning elimination of the

need for adhesives which may cause tissue irritation

and maintenance of marginal integrity and longevity (9)

For an auricular prosthesis two implants are sufficient to

retain the prosthesis Magnet and bar-clip retention are the

two other forms of retention used in the auricular region Use

of magnet was not recommended in this case because though

magnet may provide acceptable retention it is less stable

under the lateral force (10) The bar-clip system provides

good retention for the prostheses However bars may limit

access for performing hygiene procedures So in our case

implant retained auricular prosthesis was indicated (11)Numerous attachments are available for the retention of

implant-retained prosthesis Locator and O-Ring are also

used In addition to the prosthetic ear implant-retained

auricular prosthesis usually requires a bar-clip with other

retentive elements like ERA to offer better retention (9)

The factors that may cause peri-implantitis in extraoral

implants are thick skin graft movement of skin around the

abutment bar-clip design for retention of the prosthesis

improper hygiene humid environment and growth of

opportunistic microorganisms (12) In our case peri-

implantitis might be resulted from improper hygiene This

was managed with proper reinforcement of hygiene methods

The patient was satisfied with the prosthesis because of

acceptable esthetic and excellent support and retention

Conclusion

The implant retained silicone auricular prosthesis provides

an esthetically and functionally acceptable outcome in

patients with auricular defect Hygiene maintenance is

necessary for the success of the implant retained prosthesis

Pokpon983143 Amornvit DDS MSc

Instructor Maxillofacial Prosthetics Service Faculty of

Dentistry Mahidol University

Address 6 Yothe Rd Rajthevee Ban983143kok 10400 Thailand

Email pokpon983143amornvityahoocom

Figure 1 Frontal view

of the patient with right

auricular defect

Figure 2 Two

abutments in temporal

bone attached to fixtures

Figure 3 Impression

copings over the

abutments

Figure 4 Making

Impression of the defect

making with light body

polyvinyl siloxane

impression material

Figure 5 MakingImpression with medium

body polyvinyl siloxane

impression material

Figure 6 Impression afterremoval from the defect

side

Figure 7 Header bar withERA placed in attachment

Figure 8 Wax-up try-infrom front





from back





mouth





recall visit



maintaining hygiene


follow-up visit

References







Feb23(1)89-98



May-Jun21(3)241-4







Dec100(6)458-64



Surg 2000 Feb122(2)272-6














from back





mouth





recall visit



maintaining hygiene


follow-up visit

References







Feb23(1)89-98



May-Jun21(3)241-4







Dec100(6)458-64



Surg 2000 Feb122(2)272-6










implant retained auricular prosthesis. a clinical report

Documents