The future of maxillofacial prosthodontics in North America: Part II - A survey

Innovations Driving the Future of Maxillofacial Prosthetics, Part I: The Technological Leap in Maxillofacial Rehabilitation

Maxillofacial prosthetics is a specialized field focused on replacing part or all of the facial and cranial structures. In recent years, digital technology has gained popularity over traditional methods for fabricating maxillofacial prostheses. This study aimed to provide a comprehensive review of recent innovations in maxillofacial prosthetic rehabilitation, with an emphasis on emerging technologies and their impact on patient outcomes, treatment efficiency, and overall quality of life.A comprehensive literature search was conducted across the Web of Science, PubMed, MEDLINE, and CENTRAL databases for studies published in English within the last decade. The keywords utilized included "Maxillofacial Prosthesis Implantation," "Maxillofacial Prosthesis," and "rehabilitation," as well as "Virtual Rehabilitation," "Artificial intelligence," and "digital technology." The initial search yielded 178 articles. After resolving 51 duplicates, 127 articles were screened based on titles and abstracts. Following full-text assessment, 81 articles met the inclusion criteria and were included in the review.The results indicated that advancements in digital technologies, digital imaging, data acquisition, and the integration of digital workflows have significantly transformed the rehabilitation of maxillofacial prosthetics. These innovations enabled customization and personalization, provided an improved fit, enhanced precision, reduced number of visits and chair time, and facilitated seamless rehabilitation of complex maxillofacial defects. Four-dimensional printing involves materials that can change shape or properties over time, enabled printed objects to adapt dynamically to external stimuli, enhancing both comfort and functionality of prosthetics. Further advancements, such as five-dimensional and six-dimensional printing, improved the sensory capabilities of prostheses. Virtual and augmented reality enhance real-world experiences by overlaying digital data, improving accuracy and fit, enabling virtual surgical planning, and developing patient-specific implants. Artificial intelligence (AI) assists automated decision-making and supports the design of AI-driven prostheses. AI algorithms have shown the potential to automate digital planning, replicate intricate anatomical features, and attain high diagnostic accuracy in maxillofacial prosthodontic scenarios.

Automated design prediction for definitive obturator prostheses: A case-based reasoning study

PURPOSE

This study aims to evaluate the effectiveness of a case-based reasoning (CBR) system in predicting the design of definitive obturator prostheses for maxillectomy patients.

MATERIALS AND METHODS

Data from 209 maxillectomy cases, including extraoral images of obturator prostheses and occlusal images of maxillectomy defects, were collected from Institute of Science Tokyo Hospital. These cases were organized into a structured database using Python's pandas library. The CBR system was designed to match new cases with similar historical cases based on specific attributes such as aramany class, abutment details, defect extension, and oronasal connection size. The system's performance was evaluated by clinicians who assessed the accuracy of prosthesis designs generated for 33 test cases.

RESULTS

A correlation analysis demonstrated a significant positive relationship (ρ = 0.84, p < 0.0001) between the CBR system's confidence scores and the number of correct prosthesis designs identified by clinicians. The median precision at five cases was 0.8, indicating that the system effectively retrieved relevant designs for new cases.

CONCLUSIONS

The study shows that the developed CBR system effectively predicts the design of obturator prostheses for maxillectomy patients. Clinically, the system is expected to reduce clinician workload, simplify the design process, and enhance patient engagement by providing prompt insights into their final prosthetic design.

The future of maxillofacial prosthodontics in North America: The role of advanced digital technology and artificial intelligence - A discussion document

STATEMENT OF PROBLEM

Maxillofacial prosthodontists were advanced digital technology (ADT) adopters early in the new Millennium. The past two decades saw a range of digital enablers emerge including digital imaging (internal and surface), digital surgical planning, digital functional assessment, subtractive and additive manufacturing, navigation, and robotics among others. Artificial Intelligence (AI) is the latest ADT arrival that will be a challenging disruptive technology. ADT has served as a profound change agent in maxillofacial prosthodontics. The intent was to explore the process and level of ADT engagement in maxillofacial prosthodontics.

PURPOSE

The purpose was twofold. Firstly, to explore maxillofacial prosthodontic engagement of ADT. Secondly, to develop a discussion document to assist the American Academy of Maxillofacial Prosthetics (AAMP) with establishing a collective awareness and considered opinion on the future of maxillofacial prosthodontics in the digital era.

MATERIAL AND METHODS

AAMP member interest in ADT was assessed through analysis of AAMP annual congress programs and publications in the Journal of Prosthetic Dentistry (JPD). The history of the maxillofacial prosthodontic journey to the digital era was undertaken with a selective literature review. The perceptions maxillofacial prosthodontists hold on ADT engagement was assessed through a survey of AAMP members. Developing an understanding of the influence AI was conducted with a review of pertinent literature.

RESULTS

From 2011-2020, an annual mean of 38% of papers published in the JPD involved clinical use of ADT. From 2017-2019, 44% of invited presentations at AAMP annual congresses included clinical use of ADT. The journey to the digital era distinguished three periods with formative and consolidation periods influencing the innovation digital era. The AAMP member survey had a 59% response rate and studied 10 domains through 31 questions. Of the respondents, 89% thought ADT important to the future of maxillofacial prosthodontics.

CONCLUSIONS

The discussion document will assist the AAMP in developing a collective consciousness and considered opinion on ADT in the future of maxillofacial prosthodontics. Members of the AAMP have a developed interest in clinical applications of ADT. A great challenge is that no formal education, training, or clinical competency requirements for ADT could be identified. Clinical competency requirements are important to prepare maxillofacial prosthodontics for the inevitability of a digital era future. The discussion document poses the fundamental question of whether maxillofacial prosthodontists will remain as passive end users of ADT and AI or will they become engaged knowledge workers that have determined clinical competency in ADT and AI in patient care. Without this knowledge worker role, maxillofacial prosthodontists may experience difficulty being part of the inevitable ADT-AI driven future.

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.

The future of maxillofacial prosthodontics in North America: Part I-Journey to the present

STATEMENT OF PROBLEM

Understanding how maxillofacial prosthodontists are perceiving changes in head and neck care and the impact of advanced digital technologies on maxillofacial prosthodontics is important. However, no studies could be identified that specifically addressed these subjects.

PURPOSE

The purpose of this review of selected literature was to identify issues that guided the development of maxillofacial prosthodontics and the concerns that persist. The review also considered contemporary influences that will affect the future of maxillofacial prosthodontics. The conclusions of the review were used to interpret the results of the exploratory survey reported in Part II.

MATERIAL AND METHODS

The review of selected literature was related to the development of maxillofacial prosthodontics in North America between 1950 and 2018. Literature that was considered relevant to the purpose of the review was included.

RESULTS

The review yielded 37 references of interest: 34 peer-reviewed publications, 1 guideline, 1 historical publication, and 1 website. Periods in the development of maxillofacial prosthodontics in North America were identified as formation, consolidation, and innovation.

CONCLUSIONS

It was concluded that concerns in subspecialty programs and clinical practice had origins in the formation and consolidation periods. These persisting concerns extended into the innovation period. Contemporary influences in head and neck surgery will continue to affect the future of maxillofacial prosthodontics. Advanced digital technologies appeared to be central to driving change. Understanding the evolution of maxillofacial prosthodontics was an important first step in providing context when interpreting the results of a survey of maxillofacial prosthodontists reported as Part II of this work.