PMC10010593_01
(A) Close-up view of orbital socket following exenteration. (B) Segmental maxillectomy of the left side with dressing
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F1
Extraoral examination revealed exposed mucosal lining following the removal of the orbital contents with a thorough communication between the orbital and oral cavities [Figure 1A]. Intraoral examination revealed missing teeth [Figure 1B] in the left upper arch distal to the lateral incisors (Aramany Class II defect) opposing an edentulous mandibular arch with fair oral hygiene.
(A) Adaptation of interim obturator on the diagnostic cast. (B) Preparation of the impression site. (C) Retrieved impression for the facial moulage. (D) Facial moulage. (E) Adaptation of temporary conformer over the mould. (F) Adaptation of putty index over the conformer
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F2
An interim obturator [Figure 2A] was fabricated using the autopolymerising resin (DPI RR Cold Cure, India) following the diagnostic impression of the maxilla. The impression site was prepared [Figure 2B] and the impression for the facial moulage [Figure 2C] was made using irreversible hydrocolloid impression material (Algitex, DPI, India) following which it was poured using the dental stone (Ultrastone Kalabhai, India) and the moulage was retrieved [Figure 2D]. The temporary orbital conformer [Figure 2E] was fabricated using self-cure acrylic resin after blocking the unfavourable undercuts. A putty index (Avue, A-slicone impression material, India) was fabricated over the conformer [Figure 2F] over which a sheet of modelling wax (Maarc Dental, Modelling Wax, India) was adapted.
(A) Prepared rest seats on the right molars, premolars and canine. (B) Placement of conformer in the orbital cavity while making the impression for the cast partial framework. (C) Final impression for the framework. (D) Adaptation of dough stage of heat cure acrylic resin over the walls of the dewaxed mould along with placement of the putty index for trial closure. (E) Replacement of putty index with the salt solution, (F) Finished and polished final prosthesis
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F3
The rest seats [Figure 3A] for the cast partial framework were made on the right molars, premolars, canine, and left lateral incisor (#13, 14, 15, 16, 17, and 22) for the embrasure clasps between both premolars and molars, and I bar for the lateral incisor. The conformer was placed in the orbital cavity while making the impression for the cast partial denture so as to provide a superior stop for the intraoral obturator [Figure 3B]. The impression was retrieved [Figure 3C] following which the cast partial denture was fabricated in a conventional manner. The dough stage of heat cure acrylic resin (Clear DPI Heat Cure, India) was adapted over the walls of the mould and the putty index was placed following which trial closure was done [Figure 3D]. The putty index was retrieved and replaced with the salt solution [Figure 3E] following which the conventional curing was done. The hollow conformer was then finished and polished [Figure 3F].
(A) Arbitrary wax-up and positioning of prefabricated iris. (B) Iris positioning done with the help of millimetre grid attached to spectacles devoid of glasses. (C) Transfer of the distance between the glabella and centre of the iris of the unaffected eye through vernier calliper. (D) The facial mould was modified and acrylic stalk was placed over the iris. (E) Beading and boxing of the modified mould. (F) Adaptation of silicone over the mould
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F4
An arbitrary wax-up and positioning of the prefabricated iris was done on the hollow conformer [Figure 4A]. Accurate positioning of the iris was then done using vernier calliper and millimetre grid attached to spectacles devoid of glasses [Figure 4B]. The distance between the glabella and centre of the iris of the unaffected eye was measured which was then transferred to the defect site [Figure 4C]. An acrylic stalk was placed over the iris to prevent its displacement while dewaxing [Figure 4D]. Beading and boxing of the modified mould was carried out [Figure 4E] and second part was poured using die stone (Kalrock, Kalabhai, India). Dewaxing of the mould was carried out following which an appropriate shade of room temperature vulcanizing silicone was matched and adapted over the mould cavity of the second part [Figure 4F].
(A) Finished and polished orbital prosthesis. (B) Artificial eyebrows and eyelids were positioned on the prosthesis. (C) Adaptation of cast partial framework on the cast. (D) Final finished and polished intraoral prosthesis in situ. (E) Tripod pattern of magnets picked up using autopolymerising resin on the inferior surface of orbital prosthesis. (F) Magnets picked up using self-cure resin on the superior surface of the obturator
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F5
The retrieved prosthesis was finished and polished [Figure 5A]. Artificial eyebrows and eyelids were secured on the prosthesis using natural hair of the patient [Figure 5B]. The cast partial denture [Figure 5C] was checked for the fit intraorally following which jaw relation was recorded. The retrieved prosthesis was finished and polished and inserted intraorally [Figure 5D]. Magnets were picked up using autopolymerising resin and were arranged in a tripod pattern [Figure 5E]. Holes were made on the superior surface of the obturator following which the magnets were picked up using self-cure acrylic resin [Figure 5F].
(A) Magnetic assembly of orbital-obturator prosthesis. (B) Post-rehabilitative view. (C) Prosthesis reinforced with elastic strap attached to the spectacles
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F6
The prosthesis was further reinforced with the elastic strap attached to the spectacles [Figure 6].