Mechanical properties and bonding of maxillofacial silicone elastomers

Using a smartphone three dimensional scanning application (Polycam) to three dimensionally print an ear cast: A technique

This technique describes the use of a smartphone application for scanning an ear for 3-dimensional (3D) printing of an auricular prosthesis cast. The intact ear was scanned by using a smartphone and a 3D scan application (Polycam). The standard tessellation language (STL) file of the 3D data was used to produce a mirror image of the ear, which was sent to the 3D printing center where a resin cast was printed. This technique is harmless for the patient compared with radiological imaging methods, more comfortable, and cost-effective and is straightforward for the maxillofacial prosthodontist.

Development and Validation of Customized Silicone Shade Guide for Enhanced Aesthetic Integration in Maxillofacial Prostheses: A Cross-Sectional Study

INTRODUCTION

Maxillofacial prosthodontics focuses on restoring facial defects with prostheses, and achieving precise color matching is a significant challenge. Skin pigmentation varies significantly among the Indian population, ranging from light to dark tones, depending on melanin levels. Current shade guides lack the diversity to adequately address this variation. This study aimed to fabricate a silicone shade guide tailored for the Indian population and validate its reliability and clinical utility in color matching.

MATERIALS AND METHODS

This study included 370 Indian participants aged 20-45 years who were selected voluntarily from different regions of India. Skin color was measured using a SkinColorCatch colorimeter (Delfin Technologies, Kuopio, Finland). A 24-shade guide was developed and categorized into light (L1-L8), medium (M1-M8), and dark (D1-D8) tones, using Tech-Sil® S25 silicone (Technovent, South Wales, UK) and intrinsic pigments. Shade tabs with a thickness of 4 mm were used to mimic maxillofacial prostheses. The reliability and validity of the shade guide were tested in 110 participants. Four calibrated observers evaluated the color matching using a shade guide and scored the matches from 1 (poor match) to 4 (perfect match). The inter-observer reliability was analyzed using Cohen's kappa and Fleiss' kappa. Silicone swatches were fabricated for 79 participants with 100% observer agreement, and these swatches were assessed for color-matching satisfaction by the goodness-of-fit test.

RESULTS

The study demonstrated 100% observer agreement for 79 (71.9%) participants, 75% agreement for 27 (24.5%) participants, and 50% agreement for four (3.6%) participants. Cohen's kappa revealed excellent inter-observer reliability, with values ranging from 0.81 to 0.97 among the observer pairs. Fleiss' kappa for all observers indicated substantial agreement (0.85). Silicone swatches constructed for participants with perfect agreement were evaluated for color matching and achieved high satisfaction scores across all observers. Observers reported being "completely satisfied" with the shade guide in 52 (65.8%) to 55 (69.6%) participants, with minimal dissatisfaction. The shade guide demonstrated superior reliability and precision compared with prior studies, highlighting its clinical utility in Indian patients.

CONCLUSION

This research effectively established a silicone shade guide comprising 24 distinct shades specifically designed for the Indian demographic, organized into light, medium, and dark categories. Each of these categories included eight subshades. The guide exhibited excellent inter-observer reliability, accurate color matching, and substantial satisfaction levels among the observers, thereby providing notable clinical application in the field of maxillofacial prosthetics.

Effect of ultraviolet-protective 2-ethylhexyl salicylate incorporation on the mechanical properties of different maxillofacial silicone elastomers

STATEMENT OF PROBLEM

Whether the incorporation of ultraviolet-protective 2-ethylhexyl salicylate (UV-ES) affects the mechanical properties of different maxillofacial silicone elastomers, limiting the service life of facial prostheses, is unclear.

PURPOSE

The purpose of this in vitro study was to examine the mechanical properties of different maxillofacial silicone elastomers incorporating different ratios of UV-ES.

MATERIAL AND METHODS

Three different ratios of UV-ES were incorporated into 3 different types of maxillofacial silicones (M511, TechSil-25, and A-2000), and the mechanical properties of the silicones were investigated. Silicone pigments were added to each silicone type to mimic skin color. Dumbbell-shaped specimens were fabricated for tensile strength, percentage elongation, and hardness measurements, and trouser-shaped specimens for tear strength measurement. A total of 240 specimens were prepared. UV-ES in 3 different ratios (1%, 2%, and 5%) and a control group of each silicone type were generated (n=10). The effects of maxillofacial silicone type and ultraviolet protective ratios on hardness, tensile strength, percentage elongation, and tear strength were examined by factorial ANOVA (α=.05).

RESULTS

The Shore-A hardness in the control and UV-ES added groups was not significantly different in M511 material (P>.05), and a statistically significant decrease was observed in all ratios in TechSil S-25 and A-2000 silicones (P<.05). After adding 1%, 2%, and 5% UV protective into the silicones, the tensile strength and elongation of TechSil S-25 silicone material decreased significantly (P<.05), while these mechanical properties of M511 and A-2000 were not affected by UV-ES addition (P>.05). Tensile and tear strength values of the silicone elastomers were highest for TechSil S-25.

CONCLUSIONS

The mechanical properties of M511 and A-2000 silicone elastomers were not adversely affected by the addition of 1%, 2%, or 5% UV-ES.

The Effect of Chemical Disinfectants on Maxillofacial Silicone With the Addition of Silver Nanoparticles: An Original Research

Background and objective Silicone has emerged as the most widely accepted material for facial prosthesis fabrication. However, silicone materials have certain limitations. Several techniques have been investigated to lessen the degradation of the polymer, such as the use of nanoparticles and nano-oxides, etc. In this study, we aimed to evaluate the effect of various chemical disinfectants on color stability, hardness, and surface roughness of maxillofacial silicone, after the addition of silver nanoparticles. Materials and methods This was an in vitro study carried out in the Department of Prosthodontics, Sharad Pawar Dental College and Hospital; 80 samples of maxillofacial silicone incorporated with silver nanoparticles (in a concentration of 20 ppm) were fabricated in a mold of 3 x 10 mm dimension disc. The samples were then tested for surface roughness (using a digital roughness tester), Shore A hardness (using a durometer), and color stability (using a spectrophotometer). The samples were then classified into four groups according to various disinfectants used: sodium hypochlorite (1% w/w), chlorhexidine gluconate (0.2%), and neutral soap, and distal water was deemed the control group. After 48 hours, the samples underwent retesting to assess for changes in readings under the same parameters (i.e., surface roughness, Shore A hardness, and color stability) to obtain results, i.e., the samples were tested after fabrication, before immersion, and 48 hours after immersion in disinfectants. Results When taking into account the surface roughness, the maximum roughness value was observed in the sodium hypochlorite group and the least roughness value in distilled water (mean % change of 38.359 to negligible change in the distilled water group). As for the Shore A hardness, the maximum hardness value was seen in the sodium hypochlorite group and the least hardness value in distilled water (mean % change of 15.780 to 2.125 in distilled water). Regarding color stability, the maximum increase in color values was seen in the sodium hypochlorite group (mean: 2.4) followed by the neutral soap group (mean: 1.653); the chlorhexidine gluconate group (mean: -0.287) showed the maximum decrease in color value from the initial to the final phase. Conclusions Based on our findings, surface roughness altered the most when samples were immersed in 1% sodium hypochlorite disinfectant and the least when samples were immersed in neutral soap disinfectant. Shore A hardness altered the most when samples were immersed in 1% sodium hypochlorite disinfectant, but altered the least when samples were immersed in neutral soap disinfectant. Color stability altered the most when samples were immersed in neutral soap disinfectant, but altered the least when samples were immersed in 0.2% chlorhexidine gluconate. Disinfection with neutral soap seems to lead to fewer changes in physical properties (i.e., surface roughness and Shore A hardness) and hence is recommended as a disinfectant for silicone prosthesis. However, our study also showed that 0.2% chlorhexidine gluconate had the least effect on the parameter of color stability, and hence it could be the disinfectant of choice for prostheses with high esthetic requirements.

Microwave disinfection of facial silicone prostheses, part 2: Mechanical properties

STATEMENT OF PROBLEM

Part 1 of this 2-part study determined that microwave disinfection did not degrade the color stability of facial silicone prostheses. However, investigations on the effects of microwave disinfection on the mechanical properties of different silicone elastomers are lacking.

PURPOSE

The purpose of this in vitro study was to examine the mechanical properties of commonly used colored facial silicone elastomers before and after microwave disinfection over a simulated 1.5-year period.

MATERIAL AND METHODS

Six commonly used facial silicone elastomers: MDX4-4210, MDX4-4210/Type A, M511, A-2186, VST-50, and A-2000 were combined with functional intrinsic silicone pigments and opacifier (red, yellow, blue, and white). A total of 288 specimens were fabricated (n=12). Half of the specimens were tested for mechanical properties as the baseline, while the other specimens were tested after microwave disinfection. Microwave disinfection was performed with 660 W, 6 minutes of exposure time, and microwaved for 18 cycles to simulate 1.5 years of usage (one 6-minute exposure monthly). For mechanical property testing, all specimens were tested for tensile strength and percentage elongation (ASTM D412), tear strength (ASTM D624), and hardness (ASTM D2240). For each property, a 2-way ANOVA (silicone type and microwave disinfection factors) and Tukey multiple comparison test were performed using the R statistical software program (α=.05).

RESULTS

Following microwave disinfection, tensile strength and percentage elongation of A-2000 increased significantly (P<.05). MDX4-4210, MDX4-4210/Type A, and A-2000 showed significant increases in their hardness (P<.001). Tear strength also increased significantly for MDX4-4210 and VST-50 (P<.05). Among the materials tested (ranked from highest to lowest value,=not statistically significant different), for tensile strength, VST-50>A-2186=A-2000>MDX4-4210/Type A=M511=MDX4-4210 (P<.05). For percentage elongation, VST-50>MDX4-4210/Type A>A-2186>M511=A-2000=MDX4-4210=M511 (P<.05). For hardness, A-2000=A-2186>M511=VST-50>MDX4-4210>MDX4-4210/Type A (P<.05). For tear strength, VST-50>A-2186>A-2000>M511>MDX4-4210/Type A=MDX4-4210 (P<.05).

CONCLUSIONS

Overall, the mechanical properties of all the silicones tested were not adversely affected by microwave disinfection. VST-50 showed the best mechanical properties among the materials tested both before and after microwave disinfection. Microwave energy is a safe method of disinfecting the silicone elastomers tested in this study.

Effect of in vivo aging on the surface and electrochemical properties of magnetic attachments used in facial prostheses: A retrieval analysis study

STATEMENT OF PROBLEM

Reasons associated with the failure of facial prosthesis are of major concern and may be associated with deterioration of both elastomeric materials and magnetic attachments. However, the extent of deterioration of these components is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate selected retrieved facial prostheses and provide information regarding the electrochemical characterization of the recovered magnetic attachments.

MATERIAL AND METHODS

Five facial prostheses (RP1, RP2, RP3, RP4, RP5) fabricated at the University of Texas, M.D. Anderson Cancer Center were retrieved following clinical use. The intaglio and external surfaces of the prostheses along with the incorporated magnetic attachments were photographed. The areas with the detected failures on the retrieved prostheses, as well as the recovered magnetic attachments, were evaluated under a reflected light stereomicroscope at ×16 nominal magnification and photographed with a digital camera. Five magnetic attachments recovered from the prostheses (retrieved group RT) were evaluated for degradation of their corrosion resistance after electrochemical testing in artificial sweat solution and were compared with 5 unused magnetic attachments (control group, CT). To identify the elemental composition of the intact magnet surface, 1 specimen from the control group was investigated by X-ray energy dispersive spectroscopy (EDS). Means and standard deviations of the open circuit potential (EOCP), the zero-circuit potential (Ecorr), and Icorr were calculated and statistically analyzed by a t test (α=.05 for all tests).

RESULTS

The main reasons of failure were discoloration, degradation and rupture of the silicone elastomer, marginal misfit, and delamination of the polyurethane sheet. Additional findings were tarnish and discoloration of the magnetic attachments accompanied by considerable smear build-up. EDS results verified the Ni plating of tested magnets. Electrochemical testing revealed that retrieved magnets showed significantly lower OCP (P<.001) and Ecorr (P<.001) but similar Icorr (P=0.083) while the pseudopassivity region of unused magnets vanished in the retrieved group, denoting a degradation of electrochemical properties after clinical use.

CONCLUSIONS

In vivo aging exerts extended degradation on the elastomer part of facial prostheses as well as deterioration of their surface integrity and electrochemical properties.

Cohesive Zone Modeling of Pull-Out Test for Dental Fiber-Silicone Polymer

BACKGROUND

Several analytical methods for the fiber pull-out test have been developed to evaluate the bond strength of fiber-matrix systems. We aimed to investigate the debonding mechanism of a fiber-silicone pull-out specimen and validate the experimental data using 3D-FEM and a cohesive element approach.

METHODS

A 3D model of a fiber-silicone pull-out testing specimen was established by pre-processing CT images of the typical specimen. The materials on the scans were posted in three different cross-sectional views using ScanIP and imported to ScanFE in which 3D generation was implemented for all of the image slices. This file was exported in FEA format and was imported in the FEA software (PATRAN/ABAQUS, version r2) for generating solid mesh, boundary conditions, and material properties attribution, as well as load case creation and data processing.

RESULTS

The FEM cohesive zone pull-out force versus displacement curve showed an initial linear response. The Von Mises stress concentration was distributed along the fiber-silicone interface. The damage in the principal stresses' directions S11, S22, and S33, which represented the maximum possible magnitude of tensile and compressive stress at the fiber-silicone interface, showed that the stress is higher in the direction S33 (stress acting in the Z-direction) in which the lower damage criterion was higher as well when compared to S11 (stress acting in the XY plane) and S23 (stress acting in the YZ plane).

CONCLUSIONS

The comparison between the experimental values and the results from the finite element simulations show that the proposed cohesive zone model accurately reproduces the experimental results. These results are considered almost identical to the experimental observations about the interface. The cohesive element approach is a potential function that takes into account the shear effects with many advantages related to its ability to predict the initiation and progress of the fiber-silicone debonding during pull-out tests. A disadvantage of this approach is the computational effort required for the simulation and analysis process. A good understanding of the parameters related to the cohesive laws is responsible for a successful simulation.

Mechanical properties and bonding of maxillofacial silicone elastomer mixed with nano-sized anti-microbials

OBJECTIVES

The antibacterial efficacy of silicone is improved by impregnating it with antimicrobials such as chlorohexidine and zinc oxide. The purpose of this study was to examine mechanical properties and bonding of maxillofacial silicone elastomer mixed with Zinc Oxide nanoparticles (ZnO-NP), and Chlorohexidine Diacetate Salt (CHX) at three different concentrations (1 %, 3 %, and 5 %).

METHODS

Specimens of a silicone elastomer (M511) were prepared and divided into 7 groups. Group 1 was control of no additive. Groups 2-4 included silicone elastomer mixed with ZnO-NP (surface area = 67 m2/g) at 3 different concentrations (by weight %); 1 %, 3 % and 5 %. Groups 5-7 included silicone elastomer mixed with CHX at the same concentrations. Tear and tensile strengths, elongation percentage, modulus of elasticity, and shear bond strength to primed acrylic resin surfaces were evaluated. Data was analyzed with 1-way ANOVA, Bonferroni, and Dunnett's T3 post-hoc tests (P < 0.05).

RESULTS

There was significant effect of the additives on the tensile strength, elongation percentage, tear strength, and shear bond strength (P < 0.05). Shear bond strengths ranged from 0.55 to 0.96 MPa. Silicone elastomer mixed with CHX (5 %) resulted in the highest shear bond strength (P < 0.05). Non-linear regressions between tensile strength and ZnO and CHX additives were 0.95 and 0.96 respectively.

SIGNIFICANCE

All additives reduced the tensile strength of the silicone. However, CHX at 5 % optimized shear bond strength and thus is proposed in order to fabricate maxillofacial prostheses of sufficient mechanical properties, bonding and antimicrobial activity.

Colour Stability of Two Commercially Available Maxillofacial Prosthetic Elastomers after Outdoor Weathering in Al Jouf Province

Facial prostheses are created from special elastomers modified for their specific physical and mechanical properties; however, they also show two common major clinical problems: gradual discolouration of the prosthesis over time in service environment and deterioration of static, dynamic, and physical properties. As a result of external environmental factors, facial prostheses may become discoloured and discolour by changing colour from intrinsic and extrinsic colouring, and this is associated with the intrinsic colour stability of elastomers and colourants. Thus, in this in vitro study, a comparative evaluation of the effect of outdoor weathering on the colour stability of A-103 and A-2000 room-temperature vulcanised silicones used for maxillofacial prosthesis was conducted. To accomplish this study, a total of 80 samples were fabricated, 40 samples of each material were grouped as clear (20) and pigmented (20). These samples were mounted on wooden board and the assembly was placed on the roof of the dental school from October 2021 to March 2022. To maximise the amount of sunlight on the specimens, the exposure rack was set on five 68° angles from horizontal and also to prevent standing water. The specimens were left uncovered during exposure. The testing of samples was conducted with the help of a spectrophotometer. The colour values were recorded in the CIELAB colour system. It describes the three colour coordinates (colour values) x, y, and z in three new reference values of L, a, and b, aiding in numerically classifying colour differences. After 2, 4, and 6 months of weathering, testing was conducted using a spectrophotometer and the colour change (ΔE) was calculated. The A-103 RTV silicone group with pigmentation showed the maximum change in colour after six months of environmental conditioning. The data for colour difference within groups were analysed using a one-way ANOVA test. Tukey's post hoc test assessed the pairwise mean comparison's contribution to the overall significant difference. The nonpigmented A-2000 RTV silicone group showed the maximum change in colour after six months of environmental conditioning. After 2, 4, and 6 months of environmental conditioning, pigmented A-2000 RTV silicone showed better colour stability than A-103 RTV silicone. The patients requiring facial prosthesis do need to work on outdoor fields, and thus weathering will have deleterious effects on such prosthesis. Hence, the selection of appropriate silicone material with respect to the Al Jouf province region is crucial, which includes economic, durable, and colour stability.

Binder Jetting of Custom Silicone Powder for Direct Three-Dimensional Printing of Maxillofacial Prostheses

Recent advances in digital workflow have transformed clinician's ability to offer patient-specific devices for medical and dental applications. However, the digital workflow of patient-specific maxillofacial prostheses (MFP) remains incomplete, and several steps in the manufacturing process are still labor-intensive and are costly in both time and resources. Despite the high demand for direct digital MFP manufacturing, three-dimensional (3D) printing of colored silicone MFP is limited by the processing routes of medical-grade silicones and biocompatible elastomers. In this study, a binder jetting 3D printing process with polyvinyl butyral (PVB)-coated silicone powder was developed for direct 3D printing of MFP. Nanosilica-treated silicone powder was spray dried with PVB by controlling the Ohnesorge number and processing parameters. After printing, the interconnected pores were infused with silicone and hexamethyldisiloxane (HMDS) by pressure-vacuum sequential infiltration to produce the final parts. Particle size, coating composition, surface treatment, and infusion conditions influenced the mechanical properties of the 3D-printed preform, and of the final infiltrated structure. In addition to demonstrating the feasibility of using silicone powder-based 3D printing for MFP, these results can be used to inform the modifications required to accommodate the manufacturing of other biocompatible elastomeric materials.

Investigation of the effects of different nanoparticle additionals on the mechanical properties of silicone elastomer used in maxillofacial prosthesis

Objective: The aim of this study is to evaluate the change in the mechanical properties of silicone elastomer used in the production of maxillofacial prostheses with the addition of 3 different nanoparticles (TiO2-SiO2-ZnO). Material and Method: TiO2-SiO2-ZnO nanoparticles were added to the A part of the M511 Platinum (Technovent Ltd., England) silicone elastomer at a rate of 2% by weight. Test specimens were produced in sizes by ASTM D412 standards for tensile strength and percent elongation, ASTM D624 for tear strength, and ASTM D2240-68 for hardness testing. For each mechanical test, 4 groups were formed together with the control group and 3 other groups to which nanoparticles were added, and a total of 132 samples were produced, 11 samples for each group (n=11), (N=132). The data of tensile strength, elongation percentage, and tear strength tests were analyzed by Shapiro Wilk's and/or Kolmogorov Smirnov/Mann Whitney U, Kruskal Wallis-H tests; for the hardness test, the values ​​in each group showed a normal distribution within themselves, hardness test was analyzed with Oneway ANOVA/Tukey HSD tests. Results: The addition of TiO2 and SiO2 to the silicone elastomer significantly increased the tensile strength compared to the other groups (p

Effect of Superhydrophobic Coating and Nanofiller Loading on Facial Elastomer Physical Properties

Facial prosthetics are currently constructed of materials that are far from optimal; superior materials with a “skin-like” feel are required. In this study, the property changes brought about by the consecutive additions of hydrophobic- and uncoated nano-SiO2 to polydimethylsiloxane (PDMS) are assessed, and the alterations are compared with those observed for conventional submicron SiO2-filled materials. In sequence, 0%, 0.5%, 5%, 10%, and 15% by weight of each filler type were successively added to vinyl-terminated PDMS. Tensile, tear, Durometer hardness, translucency, and viscoelastic properties were assessed, and hardness and translucency were further measured after 3000 h of outdoor weathering. The results showed that 15% coated nano- SiO2-filled PDMS materials given the highest tensile strength, elastic modulus, storage modulus, loss modulus, tear strength, and durometer hardness (p < 0.05), whereas 15% submicron coated SiO2-filled materials displayed the highest failure strain and translucency parameter (p < 0.05). Only 10%- and 15%-filled submicron SiO2 PDMS materials were altered by outdoor weathering; nevertheless, the increases were assessed to be too small to be clinically perceptible. As increased filler levels provided protection against solar radiation, heat, and moisture, only unfilled and 0.5%-filled PDMS formulations discolored from weathering. 15%-filled superhydrophobic-coated nano- SiO2-filled PDMS was found to produce the strongest, most tear-resistant, and least translucent materials, but it also produced materials with limited stretchability and high hardness, which were regarded to be downsides for creating a “skin-like” feel.

Bonding strength of 3D printed silicone and titanium retention magnets for maxillofacial prosthetics application

PURPOSE

To assess the bonding between conventional and additively manufactured silicone elastomers and cylindrical retention titanium magnets for anchorage of facial prostheses.

METHODS

The customized titanium retention magnets were embedded in conventional and additively produced silicone blocks without primer application (n = 20) and with two commercially available primers G611 (n = 20) and A304 (n = 20) applied onto the magnet surface. The pull out test was performed in the universal testing machine using 45° and 90° angulation and the pull out strength was measured for each group. Additionally the SEM images of the pulled out magnets' surface were obtained and the amount of residual silicone onto the magnet surface was quantified.

RESULTS

Significantly higher pull out strength values (p < 0.05) were revealed for 90° specimens (0.11 - 0.17 ± 0.01 N/mm²) compared to the 45° group (0.03 ± 0.02 N/mm²). The pull out test with primer revealed no significant differences between the G 611 and A 304 primers in the additive group. However, significantly (p < 0,05) higher values were observed for conventional specimens in the A304 group (1.10 ± 0.21 N/mm²) compared to the G611 group (0.59 ± 0.27 N/mm²).

CONCLUSION

The application of both used primers may be an acceptable technical option for the anchorage of retention titanium magnets in silicone facial prostheses, produced additively in a fully digital workflow.

Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing

Millions of people worldwide experience disfigurement due to cancers, congenital defects, or trauma, leading to significant psychological, social, and economic disadvantage. Prosthetics aim to reduce their suffering by restoring aesthetics and function using synthetic materials that mimic the characteristics of native tissue. In the 1900s, natural materials used for thousands of years in prosthetics were replaced by synthetic polymers bringing about significant improvements in fabrication and greater realism and utility. These traditional methods have now been disrupted by the advanced manufacturing revolution, radically changing the materials, methods, and nature of prosthetics. In this report, traditional synthetic polymers and advanced prosthetic materials and manufacturing techniques are discussed, including a focus on prosthetic material degradation. New manufacturing approaches and future technological developments are also discussed in the context of specific tissues requiring aesthetic restoration, such as ear, nose, face, eye, breast, and hand. As advanced manufacturing moves from research into clinical practice, prosthetics can begin new age to significantly improve the quality of life for those suffering tissue loss or disfigurement.

Advancements in Soft-Tissue Prosthetics Part B: The Chemistry of Imitating Life

Each year, congenital defects, trauma or cancer often results in considerable physical disfigurement for many people worldwide. This adversely impacts their psychological, social and economic outlook, leading to poor life experiences and negative health outcomes. In many cases of soft tissue disfigurement, highly personalized prostheses are available to restore both aesthetics and function. As discussed in part A of this review, key to the success of any soft tissue prosthetic is the fundamental properties of the materials. This determines the maximum attainable level of aesthetics, attachment mechanisms, fabrication complexity, cost, and robustness. Since the early-mid 20th century, polymers have completely replaced natural materials in prosthetics, with advances in both material properties and fabrication techniques leading to significantly improved capabilities. In part A, we discussed the history of polymers in prosthetics, their ideal properties, and the application of polymers in prostheses for the ear, nose, eye, breast and finger. We also reviewed the latest developments in advanced manufacturing and 3D printing, including different fabrication technologies and new and upcoming materials. In this review, Part B, we detail the chemistry of the most commonly used synthetic polymers in soft tissue prosthetics; silicone, acrylic resin, vinyl polymer, and polyurethane elastomer. For each polymer, we briefly discuss their history before detailing their chemistry and fabrication processes. We also discuss degradation of the polymer in the context of their application in prosthetics, including time and weathering, the impact of skin secretions, microbial growth and cleaning and disinfecting. Although advanced manufacturing promises new fabrication capabilities using exotic synthetic polymers with programmable material properties, silicones and acrylics remain the most commonly used materials in prosthetics today. As research in this field progresses, development of new variations and fabrication techniques based on these synthetic polymers will lead to even better and more robust soft tissue prosthetics, with improved life-like aesthetics and lower cost manufacturing.

Evaluation of some mechanical properties of a new silicone elastomer for maxillofacial prostheses after addition of intrinsic pigments

OBJECTIVE

The approximate life span of a silicone maxillofacial prosthesis is as short as 1.5-2 years of clinical service, then a new prosthesis should be fabricated. The most common reason for re-making the prosthesis is silicone mechanical properties degradation. The aim of this study was to assess some mechanical properties of VST-30 silicone for maxillofacial prostheses after addition of intrinsic pigments.

METHODS

Two types of intrinsic pigments (rayon flocking and burnt sienna); each of them was incorporated into silicone. One hundred and twenty samples were prepared and split into 4 groups according to the conducted tests (tear strength, hardness, surface roughness, and tensile strength and elongation percentage) with 30 samples for each test. Each group was equally split into three subgroups. Group (A) was without pigment (control group), group (B) was with rayon flocking and group (C) was with burnt sienna.

RESULTS

Samples with rayon flocking showed a highly significant decrease in hardness and there was a significant increase in tear strength, while there were non-significant differences in surface roughness, tensile strength and elongation percentage. Samples with burnt sienna showed a highly significant increase in tear strength and a highly significant decrease in hardness, but surface roughness, tensile strength and elongation percentage showed non-significant differences. However, there were non-significant differences between experimental groups in all tests.

CONCLUSIONS

The addition of each of rayon flocking and burnt sienna changed the mechanical properties of the VST-30 silicone, while no superior pigment-silicone combination was revealed in all the conducted tests.

Effect of nano-titanium oxide addition on some mechanical properties of silicone elastomers for maxillofacial prostheses

OBJECTIVE

This study evaluated the effects of adding titanium oxide (TiO2) nanofillers on the tear strength, tensile strength, elongation percentage, and hardness of room-temperature-vulcanized (RTV) VST50F and high-temperature-vulcanized (HTV) Cosmesil M511 maxillofacial silicone elastomers.

METHODS

Two types of maxillofacial elastomers, VST50F RTV and Cosmesil M511 HTV, were used. Nano-TiO2 powder was applied as a nanofiller. A total of 120 specimens were fabricated, 60 each of VST50F and Cosmesil M511. The specimens of each type of elastomer were divided into three equal groups on which tests were conducted for tear strength, tensile strength, and hardness i.e., 20 specimens were used for each test. Each group of 20 specimens was further divided into two equal subgroups: (A) control i.e., silicone without nano-TiO2, and (B) experimental i.e., VST50F and Cosmesil M511 silicone incorporated with 0.25 wt% and 0.2 wt% nano-TiO2, respectively. Each subgroup thus had 10 specimens. The specimens were evaluated, and data were studied using descriptive statistical analysis and two-way analysis of variance (ANOVA).

RESULTS

The addition of 0.25 wt% and 0.2 wt% TiO2 nanofiller into VST50F and Cosmesil M511 elastomers, respectively, resulted in a statistically significant increase in the mean values (p < 0.01) of tear strength, tensile strength, elongation percentage, and hardness of the materials.

CONCLUSION

The mechanical properties of the VST50F and Cosmesil M511 maxillofacial silicone materials improved with the addition of select concentrations of nano-TiO2.

Prosthetic rehabilitation of a partially amputated finger using a customized ring-wire substructure

Defects of fingers or hands due to congenital reasons or trauma can be a catastrophic setback to an individual physically, emotionally, and psychologically. An artificial finger prosthesis is a lucrative option to camouflage such defects. The anatomy of the residual stump of the defect is of extreme importance and will dictate the mode of retention to be used, and the level of esthetics one can expect. Despite the availability of the advanced skills, best of materials, and laboratory support, sometimes, the anatomy of the defect may be a hindrance in furnishing a better prosthesis. This case report describes a cost-effective and simple approach of rehabilitation of a partially amputated finger with bulbous distal anatomy using a custom-made ring-wire substructure and maxillofacial silicone, thereby striking a balance between adequate retention and optimal esthetics.

Monomer conversion, dimensional stability, strength, modulus, surface apatite precipitation and wear of novel, reactive calcium phosphate and polylysine-containing dental composites

Purpose

The aim was to assess monomer conversion, dimensional stability, flexural strength / modulus, surface apatite precipitation and wear of mono / tri calcium phosphate (CaP) and polylysine (PLS)—containing dental composites. These were formulated using a new, high molecular weight, fluid monomer phase that requires no polymerisation activator.

Materials and methods

Urethane and Polypropylene Glycol Dimethacrylates were combined with low levels of an adhesion promoting monomer and a light activated initiator. This liquid was mixed with a hybrid glass containing either 10 wt% CaP and 1 wt% PLS (F1) or 20 wt% CaP and 2 wt% PLS (F2). Powder to liquid mass ratio was 5:1. Commercial controls included Gradia Direct Posterior (GD) and Filtek Z250 (FZ). Monomer conversion and polymerisation shrinkage were calculated using Fourier Transform Infrared (FTIR). Subsequent volume increases in water over 7 weeks were determined using gravimetric studies. Biaxial flexural strength (BFS) / modulus (BFM) reduction and surface apatite precipitation upon 1 and 4 weeks immersion in water versus simulated body fluid (SBF) were assessed using a mechanical testing frame and scanning electron microscope (SEM). Mass / volume loss and surface roughness (R_a) following 7 weeks water immersion and subsequent accelerated tooth-brush abrasion were examined using gravimetric studies and profilometer.

Results

F1 and F2 exhibited much higher monomer conversion (72%) than FZ (54%) and low calculated polymerization shrinkage (2.2 vol%). Final hygroscopic expansions decreased in the order; F2 (3.5 vol%) > F1 (1.8 vol%) ~ Z250 (1.6 vol%) > Gradia (1.0 vol%). BFS and BFM were unaffected by storage medium type. Average BFS / BFM upon 4 weeks immersion reduced from 144 MPa / 8 GPa to 107 MPa / 5 GPa for F1 and 105 MPa / 6 GPa to 82 MPa / 4 GPa for F2. Much of this change was observed in the first week of immersion when water sorption rate was high. Surface apatite layers were incomplete at 1 week, but around 2 and 15 micron thick for F1 and F2 respectively following 4 weeks in SBF. Mass and volume loss following wear were equal. Average results for F1 (0.5%), F2 (0.7%), and FZ (0.5%) were comparable but lower than that of GD (1%). R_a, however, decreased in the order; F1 (15 μm) > F2 (11 μm) > GD (9 μm) > FZ (5 μm).

Conclusions

High monomer conversion in combination with large monomer size and lack of amine activator should improve cytocompatibility of the new composites. High monomer molecular weight and powder content enables low polymerisation shrinkage despite high conversion. Increasing active filler provides enhanced swelling to balance shrinkage, which, in combination with greater surface apatite precipitation, may help seal gaps and reduce bacterial microleakage. High monomer conversion also ensures competitive mechanical / wear characteristics despite enhanced water sorption. Furthermore, increased active filler could help reduce surface roughness upon wear.

Maxillofacial prostheses challenges in resource constrained regions

BACKGROUND

This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations.

METHOD

A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries.

RESULTS

Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach.

CONCLUSIONS

In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities. Implications for Rehabilitation More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments. The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations. The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

Physical and Mechanical Evaluation of Silicone-Based Double-Layer Adhesive Patch Intended for Keloids and Scar Treatment Therapy

Growing interest in silicone elastomers for pharmaceutical purposes is due to both their beneficial material effect for scar treatment and their potential as drug carriers. Regarding their morphological structure, silicone polymers possess unique properties, which enable a wide range of applicability possibilities. The present study focused on developing a double-layer adhesive silicone film (DLASil) by evaluating its physical and mechanical properties, morphology, and stability. DLASil suitability for treatment of scars and keloids was evaluated by measurement of tensile strength, elasticity modulus, and elongation. The results indicated that mechanical and physical properties of the developed product were satisfying.

Biocompatibility of primers and an adhesive used for implant-retained maxillofacial prostheses: An in vitro analysis

STATEMENT OF PROBLEM

Implant-retained maxillofacial prostheses should be biocompatible, regardless of the primers and adhesives used to bond the acrylic resin and facial silicone. The authors are unaware of any study evaluating the influence of these primers and adhesives on the biocompatibility of maxillofacial prostheses.

PURPOSE

The purpose of this in vitro study was to evaluate the cytotoxic effect of primers and an adhesive used to bond acrylic resin and facial silicone during the fabrication of implant-retained maxillofacial prostheses.

MATERIAL AND METHODS

Twenty-eight circular specimens made of resin and silicone were fabricated, either bonded or nonbonded with primer and adhesive. The specimens were divided into 7 groups: resin; silicone; resin+silastic medical adhesive type A+silicone; resin+DC 1205 primer silicone; resin+Sofreliner primer+silicone; resin+DC 1205 primer+silastic medical adhesive type A+silicone; and resin+Sofreliner primer+silastic medical adhesive type A+silicone. Eluates of the materials tested were prepared by setting 4 specimens of each experimental group in Falcon tubes with medium and incubating at 37°C for 24 hours. The eluate cytotoxicity was evaluated by an assay of survival/proliferation ((3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide [MTT] test) in cultures of human keratinocytes. The levels of IL1, IL6, TNFα, and the chemokine MIP-1α were evaluated by enzyme-linked immunosorbent assay. The mRNA expressions for MMP-9, TGF-β, and collagen type IV were analyzed by the real time polymerase chain reaction. Data were submitted to analysis of variance with Bonferroni post hoc tests (α=.05).

RESULTS

An increased cell proliferation was observed for the RAS group, with statistically significant differences (P<.001) compared with the unstimulated group. The RDCpS group showed the highest IL6 concentration values (P<.001). No significant statistical difference was found in the relative quantification of mRNA for collagen type IV, MMP9, or TGFβ between the groups (P>.05).

CONCLUSIONS

The RAS group showed the highest cell proliferation percentage, while the RDCpS group exhibited the highest IL6 concentration values. No detectable levels of IL1β, TNF α, or CCL3/MIP1α were observed. The tested materials showed no toxic effects on the HaCaT cell line.

In Vitro Cytotoxicity of Maxillofacial Silicone Elastomers: Effect of Nano-particles

PURPOSE

Silicone elastomers are generally used for maxillofacial extraoral prostheses. The purpose of this in vitro study was to evaluate the cytotoxicity of different kinds of nanoparticles added to two types of maxillofacial elastomers.

MATERIALS AND METHODS

A-2000 and A-2006 silicone elastomers were used. The silicone specimens were divided into eight groups according to the presence of additional nanoparticles (n = 18). The following represents the groups in the study: Group A: A-2000 silicone (control group); Group B: A-2006 silicone (control group); Group C: A-2000 silicone and the addition of titanium dioxide (TiO₂ ); Group D: A-2006 silicone and the addition of TiO₂ ; Group E: A-2000 silicone and the addition of fumed silica; Group F: A-2006 silicone and the addition of fumed silica; Group G: A-2000 silicone and the addition of silaned silica; Group H: A-2006 silicone and the addition of silaned silica. A paired sample t-test was used to analyze the cytotoxicity of each group after 24, 48, and 72 hours.

RESULTS

Based on the results of the 24-hour analysis, the biocompatibility values of the (A-2006) fumed silica group were higher than those of the control groups. There was no statistically significant difference in A-2006 and A-2000 groups. The cytotoxicity values of the control groups and TiO₂ (A-2000 silicone) elastomer groups increased at all test times; however, the cytotoxicity values of the TiO₂ (A-2006), fumed silica (A-2006), silaned silica (A-2006), fumed silica (A-2000), and silaned silica (A-2000) groups increased significantly only from 24 to 48 hours.

CONCLUSION

Nanoparticles of TiO₂ , fumed silica, and silaned silica added to a commercial silicone-based elastomer used for fabrication of maxillofacial prostheses are nontoxic.

Influence of adding nanoparticles on the hardness, tear strength, and permanent deformation of facial silicone subjected to accelerated aging

STATEMENT OF PROBLEM

The efficiency of adding nanoparticles to silicone protection has proven to prevent color degradation. However, reports of other physical property changes in facial silicone are scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of adding nanoparticles on the hardness, tear strength, and permanent deformation of a facial silicone.

MATERIAL AND METHODS

Specimens were made for each test, with 140 for the hardness test, 140 for the permanent deformation test, but 280 for the rupture test. This higher number was due to the fact that the first 140 specimens were ruptured and unusable after the initial reading. ZnO, BaSO₄, and TiO₂ nanoparticles at concentrations of 1% and 2% of silicone were used, as well as specimens without nanoparticles that consisted of only oil paint and of only silicone. Outcomes were measured before and after 1008 hours of accelerated aging. Data were analyzed by nested analysis of variance (ANOVA) and Tukey honest significant differences test (α=.05).

RESULTS

Results showed that the presence of nanoparticles influenced the properties of the assessed groups. The nanoparticles decreased hardness values. The highest values of tear strength were observed for the groups with addition of BaSO₄. The 1% ZnO group without oil paint showed the lowest values of permanent deformation.

CONCLUSIONS

Based on the findings of this in vitro study, the use of ZnO nanoparticles is recommended, since they did not negatively affect the properties of the materials evaluated.

Peel strength and interfacial characterization of maxillofacial silicone elastomers bonded to titanium

OBJECTIVES

To investigate the effect of three adhesive primers on the morphology, chemistry and peel bond strength of two maxillofacial silicone elastomers with commercially pure titanium (cpTi).

METHODS

The effect of three primers (PR2:A-304 Primer/A-320 Bonding Enhancer, PR3:Super Bond, and PR4:Super Glue) on cpTi morphology and chemistry were studied by reflected light polarized microscopy (RPOLM) and reflection Fourier-transform infrared microspectroscopy (RFTIRM). For testing the bond strength between two elastomers (EL1:MDX4-4210, EL2:A-2006) and primed cpTi surfaces, a 90° T peel test was performed (PBS), using as reference EL1, EL2 specimens bonded to heat-cured poly(methyl methacrylate) resin (PMMA) primed with A-330G primer (PR1). Failure modes were analyzed under a stereomicroscope, and the percentage of remaining silicone (RS%) on cpTi and PMMA were calculated by image analysis. Scanning electron microscopy/energy dispersive X-ray spectrometry (SEM/EDX) was used to investigate representative failure patterns on cpTi. Data were analyzed with Weibull analysis, ANOVA plus post hoc tests, and Pearson correlation coefficient (a=0.05).

RESULTS

Thick-irregular (PR2), thin-smooth (PR3), and uniform-porous (PR4) films were identified on cpTi by RPOLM. RFTIRM revealed: a strong peak of Si-O-Si with a distribution following the outline of the image (PR2); COO-M groups developed, but unevenly distributed (PR3); and reduction in CC groups due to in situ polymerization (PR4). Following PBS, the ranking of the statistical significant differences in Weibull scale parameter (σ0) of the EL1 group was PMMA_PR1>cpTi_PR2,cpTi_PR3>cpTi_PR4, whereas for the EL2 group cpTi_PR2>PMMA_PR1>cpTi_PR4,cpTi_PR3. For RS%, the ranking in the EL1 group was: PMMA_PR1>cpTi_PR2>cpTi_PR3>cpTi_PR4, and in the EL2 cpTi_PR2>cpTi_PR3>cpTi_PR4,PMMA_PR1. There was no statistically significant correlation between PBS and RS%, with the exception of EL1_PMMA_PR1. In all groups mixed failure modes were found by SEM/EDX.

SIGNIFICANCE

Although there is evidence of bonding with cpTi, there are important differences among the primer/elastomer combination that may affect the clinical performance of these materials.

Improved Construction of Auricular Prosthesis by Digital Technologies

Implant-retained auricular prostheses are a successful prosthetic treatment option for patients who are missing their ear(s) due to trauma, oncology, or birth defects. The prosthetic ear is aesthetically pleasing, composed of natural looking anatomical contours, shape, and texture along with good color that blends with surrounding existing skin. These outcomes can be optimized by the integration of digital technologies in the construction process. This report describes a sequential process of reconstructing a missing left ear by digital technologies. Two implants were planned for placement in the left mastoid region utilizing specialist biomedical software (Materialise, Belgium). The implant positions were determined underneath the thickest portion (of anti-helix area) left ear that is virtually simulated by means of mirror imaging of the right ear. A surgical stent recording the implant positions was constructed and used in implant fixtures placement. Implants were left for eight weeks, after which they were loaded with abutments and an irreversible silicone impression was taken to record their positions. The right existing ear was virtually segmented using the patient CT scan and then mirror imaged to produce a left ear, which was then printed using 3D printer (Z Corp, USA). The left ear was then duplicated in wax which was fitted over the defect side. Then, it was conventionally flasked. Skin color was digitalized using spectromatch skin color system (London, UK). The resultant silicone color was mixed as prescribed and then packed into the mold. The silicone was cured conventionally. Ear was trimmed and fitted and there was no need for any extrinsic coloring. The prosthetic ear was an exact match to the existing right ear in shape, skin color, and orientation due to the great advantages of technologies employed. Additionally, these technologies saved time and provided a base for reproducible results regardless of operator.

Comparison of conventional and plant-extract disinfectant solutions on the hardness and color stability of a maxillofacial elastomer after artificial aging

STATEMENT OF PROBLEM

Silicone elastomers undergo physical and chemical degradation with disinfecting solutions. Phytotherapy may be a suitable solution for disinfection. However, its effect on the properties of the silicone material is unknown.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of disinfection with conventional and plant-extract solutions and of artificial aging on the hardness and color stability of a facial silicone associated with pigments and an opacifier.

MATERIAL AND METHODS

Four hundred specimens of silicone (MDX4-4210) were fabricated (5×6 mm). Two pigment shades and 1 dry opacifier were combined in the tested material, and 4 groups (n=10) were obtained: colorless (GI), colorless with opacifier (GII), medium pigment with opacifier (GIII), and black pigment with opacifier (GIV). Specimens were subjected to disinfection (30 days) using saline solution, water, and neutral soap (digital friction, 30 seconds), chlorhexidine 4%, Hydrastis canadensis, and Cymbopogon nardus extracts (immersion, 10 minutes). Shore A hardness (ASTM D2240) and color analyses were performed before and after disinfection. Specimens were then exposed to 1008 hours of artificial aging (ASTM 53) and subjected to final hardness and color readings. The results were analyzed with ANOVA and the Tukey significant difference test (α=.05).

RESULTS

The opacifier increased the hardness (GII). For GII, the H. canadensis solution and the friction with water and soap promoted significantly reduced hardness; the friction also promoted a reduction in this property for GIV. The GIII was not affected after disinfection. A significant difference was found between the ΔE values of the specimens disinfected with H. canadensis, C. nardus, and chlorhexidine, and specimens subjected to saline solution and neutral soap.

CONCLUSION

The hardness of MDX4-4210 after the experimental procedure was considered clinically acceptable for facial prostheses. All groups showed clinically unacceptable color alterations regardless of the disinfecting solution.

Effect of light aging on silicone-resin bond strength in maxillofacial prostheses

PURPOSE

The aim of this study was to investigate the effect of accelerated light aging on bond strength of a silicone elastomer to three types of denture resin.

MATERIALS AND METHODS

A total of 60 single lap joint specimens were fabricated with auto-, heat-, and photopolymerized (n = 20) resins. An addition-type silicone elastomer (Episil-E) was bonded to resins treated with the same primer (A330-G). Thirty specimens served as controls and were tested after 24 hours, and the remaining were aged under accelerated exposure to daylight for 546 hours (irradiance 765 W/m(2) ). Lap shear joint tests were performed to evaluate bond strength at 50 mm/min crosshead speed. Two-way ANOVA and Tukey's test were carried out to detect statistical significance (p < 0.05).

RESULTS

ANOVA showed that the main effect of light aging was the most important factor determining the shear bond strength. The mean bond strength values ranged from 0.096 to 0.136 MPa. The highest values were recorded for auto- (0.131 MPa) and photopolymerized (0.136 MPa) resins after aging.

CONCLUSIONS

Accelerated light aging for 546 hours affects the bond strength of an addition-type silicone elastomer to three different denture resins. The bond strength significantly increased after aging for photo- and autopolymerized resins. All the bonds failed adhesively.

Appropriateness of viscoelastic soft materials as in vitro simulators of the periodontal ligament

The periodontal ligament is a viscoelastic soft tissue that connects the tooth to the alveolar bone. This tissue should be simulated in numerical as well as in laboratory models. The mechanical properties of this tissue were previously determined ex vivo and in vivo. The aim of the study was to analyse the appropriateness of impression and reline materials used in dentistry to simulate viscoelastic behaviour of the periodontal ligament. Two reline [Durabase (Reliance Dental MFG, Co.) and Soft Liner (GC Corporation)] and two impression [President Plus (Coltene) and Prestige L (Vanini Dental Industry)] materials were examined in recovery and tensile relaxation tests. Recovery: This experiment simulated in vivo test. Roots of a pair of plastic maxillary premolar teeth were covered with each test material and embedded in acryl while maintaining the contact point. A 0·1-mm stainless steel strip, inserted at the contact point and maintained for 10 s, was used to tip the teeth. After removal, the tightness of dental contact point was measured over 30 min by determining the force needed to insert a 0·05-mm metal strip. Tensile relaxation: strips were elongated to 120%, 140% and 160% of their initial length and maintained at that length for 30 min. Two-phase decay function was applied. The results showed that elastic modulus and relaxation behaviour were significantly different between materials. Elastic modulus values were in the same range of those reported in the literature. However, the recovery values and behaviour showed that impression materials, especially President, are the materials of choice for this purpose because they simulated better the in vivo test.