impt journal 2011

WINTER 2011 VOLUME 11 ISSUE 1 | ISSN 1366-4697 | www.impt.co.uk

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THE JOURNALOF MAXILLOFACIAL PROSTHETICS & TECHNOLOGY

Advancement & knowledgefor the benefits of patients.

Contents

Note from the editor

Articles of interest

Featured articles

5.

33.

6.

34.

46.

50.

8.

11.

23.

27.

20.

30.

15.

Editorial team & IMPT Council 2012

2012 Congress abstracts

Instructions for authors

Ian Kenneth MacLeod – an obituary

Fabrication of a hollow and a foam filled breast prostheses - a case study.

Survey about attitudes, opinions, and experience of maxillofacial prosthetists and technologists in the UK towards maxillofacial silicone prostheses.

Analysis of lecturing patterns at IMPT scientific congresses 1963 – 2011.

A review of current MPT practice in the provision of the prosthetic nipple areola complex.

Custom made nasal septum obturator.

Technical note. Profile dressings: the first restorative approach for head and neck external resections.

A modification to prevent vertical compression in intermediate silicone wafers for orthognathic surgery.

Sally Lane MIMPT

Muhanad M. Hatamleh AIMPT, PhD, MPhil, DPS, MScColin Haylock FIMPT, MBEJason Watson MIMPT, B Med ScDavid C. Watts BSc, PhD, DSc

Mr Adrian Kearns MIMPT, DPSCaroline Reed AIMPT, BSc (Hons), DPS

Dianne Bowers, Maxillofacial ProsthetistChris Maryan FIMPT, Principal LecturerPeter Gough, Senior Lecturer

Carmen Orbaneja Botija MIMPT

Carmen Orbaneja Botija MIMPT

Gavin J Carmichael MIMPT, FOTA, LBIDST, RDT

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IMPT WINTER 2011 3www.impt.co.uk

Note from the editor


As the new journal editor I sincerely hope you will be

in favour of the updated journal format, which I believe

is a step forward for the development of the journal and

makes the publication more accessible to members.

We are far from alone as a profession in adopting an

e-journal format, and it is easy to see why as there are

many benefits to be had from adapting to this change.

The cost implications to the membership regarding

production of the journal are greatly reduced.

There is the potential for authors to reach a far wider

audience using this format via search engines so your

work is more widely recognised. The website also allows

each member to download and print the journal if a

hard copy is desired. It is considerably easier for authors

to submit articles directly to the editor in an electronic

format and the e-journal is also more interactive for

the reader. The contents and abstracts of each journal

issued are available to non IMPT members in the Journal

area of the website. Whole articles or journals will be

available upon subscription request in PDF format. I trust

the authors agree their work is presented in a visually

appealing and professional manner.

Changes to the journal include the new “articles of

interest” section. This is designed for members input and

is open to the prodigious variety of publications available

to our profession. Please also take note of the new

authors instructions for all those wishing to be included

in the next issue, due out in Spring 2012. As editor I

would like to point out that papers do not always have

to be research projects or brilliant new ideas, welcome as

those always are. As highlighted at the conference journal

update, most other peer journals routinely have several

literature reviews in every edition, and yet I cannot

recall one literature review in the history of our journal.

This is definitely an area which requires expansion, so

if there is an area of particular interest, or a subject you

are considering researching, please consider writing a

literature review and submitting it to your journal.

Furthermore, most maxillofacial prosthetists will invariably

have a moment when they make a device which delivers

a successful outcome and think “that worked well”. If

so, that is what the journal is for, a sharing of ideas and

information. For first time writers, and indeed any article

submission, every effort will be made by the journal team

to ensure publication is achieved.

To conclude, I would urge the membership to consider

putting forward articles for submission to your journal.

While this is something which currently sits nicely

on someone’s personal CV, I envisage a time quite

soon where this becomes increasingly desirable and

eventually essential for those seeking new employment

or promotion. It is worth remembering the author is the

biggest benefactor of all.

Acknowledgements

The editor would like to thank the journal team for their

combined efforts in producing this latest edition of the

IMPT journal, however, particular acknowledgement must

go Jason Watson, Muhaned Hatamalah, Caroline Reed and

Naimesha Patel for their contribution, frequently outside

of work hours, to ensure production of this journal.

Barry Edwards MIMPT, MSc

Editor

Welcome all IMPT members to the new IPMT e-journal!

“I would urge the membership to consider putting forward articles for submission to your journal”

Mr Barry Edwards MIMPT, MScEditor

Barry has served on council before as minutes secretary and applied to rejoin after completing his MSc.

After being successfully voted onto council he has recently been elected as the new journal editor.

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Steven Dover FDSRCS (Eng), FRCS (Eng)

Adrian Farrow

Sarah Parkinson FIMPT, BSC (Hons)

Fraser Walker FIMPT, MSc, LCGI

Mrs Paramjit Kaur SandhuMIMPT, BSc (Hons), DPS, Pg Cert

Richard EggletonFIMPT

Liz Gill MIMPT, BSc (Hons)

Mark CutlerFIMPT, MBE

Barry EdwardsMIMPT, MSc

Jason WatsonMIMPT, BMed, Sci

David AllenFIMPT

Adrian KearnsMIMPT, DPS

Dr Mohamed BamberFIMPT, Phd

Carol WinterMIMPT

David ThompsonMIMPT

Karen Boyd-Glen MIMPT, GCGI

Stefan EdmonsonMIMPT, BSc (Hons), DPS

Barbara Anne Thompson MIMPT, BSC, DPS, PgCert

Naimesha PatelMIMPT, MSc

Steven Hutchinson MIMPT, MSc, DPS

Fraser MacnamaraMIMPT (Hons)

Council Members

6 WINTER 2011 IMPT THE JOURNAL OF MAXILLOFACIAL PROSTHETICS & TECHNOLOGY

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Editorial team & IMPT Council 2012


Hampson & Partners

All correspondence relating to membership of The IMPT should be sent via post or email to:

All correspondence to The IMPT should be sent via our website or email:

Mr. Barry Edwards MIMPT, MSc

Ginny KingsmillBDS, PhD, FDS, RCS (Rest Dent)

Dr Richard Bibb

Dr Harry Reintsema

Steve Worrolo

Chris Maryan

Peter Evans

Mark Cutler MBE

Colin Haylock MBE

Ken Sneddon

Fraser Walker

Steven Dover

Philip Federspiell

Andrew Brown

Mohit Kheur

Dr Trevor Coward

Joern Brom

K.F. Moos OBE

K. Thomas

J. Collyer

Naimesha Patel MIMPT, MSc

[email protected]

Pauline E PaulMIMPT, MSc

Muhanad Hatamleh AIMPT, BSc, Mphil, MSc, Dip (Max Fac), PhD

Peter Ward Booth FDS FRCS

Jason WatsonMIMPT, BmeD, Sci

Adrian KearnsHonorary Registrar IMPT Department of Maxillofacial Prosthetics

Barbara Anne ThomsonMIMPT Pg Cert, BSc,Dip (Eng)

Willwell Cottage,Wilford Road,Ruddington,NottinghamNG11 6NA

T. 01159 215 848www.handpdesign.co.uk

Royal Surrey County Hospital NHS Foundation Trust,Egerton Road, Guilford,Surrey GU2 7XX

[email protected]

Queen Victoria Hospital, Maxillofacial Department, Holtye Road, East Grinstead, West Sussex RH19 3DZ

[email protected]

Clinical Lecturer, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London E1 2AD

Leicester, UK

Groningen, NL

Birmingham, UK

Manchester, UK

Wales, UK

East Grinstead, UK

London, UK

East Grinstead, UK

Glasgow, UK

Birmingham, UK

Germany

East Grinstead, UK

India

London, UK

Germany

Scotland

Southend, UK

East Grinstead, UK

Caroline ReedAIMPT, BSc (Hons), DPS

Principal Maxillofacial Prosthetist,Maxillofacial Laboratory, Neurology Building, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF

School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester M15 6FH

Maxillofacial Surgeon, Howbourne Oast, Buxted TN22 4QD

Consultant MPT Healthcare Scientist, Maxillofacial Laboratory, Nottingham University Hospitals Trust, West Block B Floor, Derby Road, Nottingham

Maxillofacial Laboratory, Neurology Building, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF

ISSN 1366-4697 © The Institute of Maxillofacial Prosthetists and Technologists 2006. No part of this publication may be reproduced without the permission of the editor. Permission is not required to copy abstracts on condition that a full reference to the source is shown.

Membership of the IMPT is required to view the journal on the IMPT website. The contents page and abstracts will be accessible to non members and should access to the journal or individual articles be requested these can be supplied for a fee of £3.00 per article or £20.00 for the journal complete. Requests should be made directly to the editor at the address below.

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Contacting The IMPT

Analysis of lecturing patterns at IMPT scientific congresses 1963 – 2011

The first Maxillofacial Prosthetics scientific congress

was held in 1963 at the Queen Victoria Hospital, East

Grinstead. Over the years, there have been hundreds of

lectures given by Maxillofacial Prosthetists (MfPs) from all

over the world on a wide range of topics.

This paper outlines the variety of topics lectured upon

and how working and lecturing patterns have evolved

into the 21st century. The paper highlights individuals

who have significantly contributed to the IMPT scientific

congress lecture programmes over the years and

describes the influence they have had on others.

Programmes from each conference since 1963 to

2011 were obtained from IMPT members and the

lecturing timetables analysed to obtain data relating to

MfPs’ lectures. This included the number of lectures,

lecture topic, time of lectures, individual presenter and

their respective unit.

Only information printed in each conference programme

was used. Last minute alterations to lecture content

There have been 25 IMPT scientific congresses

since 1963. Twenty were held in England, three in

Scotland, one in Ireland and one in Sweden. In total,

477 lectures have been delivered by MfPs, totalling

over 145 hours.

The total number of lectures presented on each topic is

given Figure 1, and shows that prostheses total almost

one third of all lectures. Excluding miscellaneous, all

other topics range between 4% and 12%, showing a fairly

even spread. Computer technology is an emerging topic

and did not appear on the lecture programme in the first

fifteen congresses, which explains its low overall figure.

The first ten IMPT scientific congresses (Figure 2) totalled

99 lectures. Prostheses and oro-facial/intra-oral figure

quite highly, making up almost half (47%) of the total

lectures. The two main differences between Figure 1 and

Figure 2 are, oro-facial/intra-oral lectures, which have

a big contribution to the first ten lectures but show a

lower input to the overall lecture content, and computer

technology, which did not feature at all in the lecture

programme in the first ten conferences.

Figure 3 shows how the IMPT scientific congress has

changed in recent times. The last ten congresses

comprised 269 lectures – just over 56% of all lectures

and more than two and a half times the total for the first

ten congresses.

The 16th scientific conference in 1993 was the first to

include a lecture on computer technology, the second

being in 1999, and from then till 2011, the lecture rates

rose from 0% to 7%.

As Maxillofacial Prosthetists encounter more formalised

training, regulation and changes to the Health Service,

education and administration has doubled to 12% in the

last ten conferences. Overviews have more than doubled

from 7% to 15%, possibly reflecting the professions

growing involvement in research and development of

services and increased audit.

In the first ten conferences, prostheses and oro-facial/

intra-oral lectures accounted for 47% (26% and 21%

respectively) of the total lecture content. In the last ten

conferences, prostheses lectures have stayed at a similar

level (27%) while oro-facial/intra-oral lectures show

a drop of 28%, accounting for only 6% of the lecture

content over the last ten years. This explains the lower

percentage of total oro-facial/intra-oral lectures appearing

in Figure 1 (Total congress lectures) when compared to

Figure 2 (First ten congresses).

All other fields show limited fluctuation in comparison to

Figure 2.

and individuals lecturing that were not included in the

programme could not be taken into consideration for

this study. Lectures given at IMPT seminars were

not included.

Lecture categories

The lecture topics were divided into the following

ten categories:

Prostheses •

Materials •

Orthognathic•

Computer technology •

Overviews •

Oro-facial/intra-oral •

Trauma •

Implants •

Education and administration •

Miscellaneous•

Data analysis•

Since the first Maxillofacial Technicians conference

held at the Queen Victoria Hospital, East Grinstead,

in 1963, hundreds of lectures have been delivered

by Maxillofacial Prosthetists and other professionals

involved in rehabilitation of patients. This paper

reviews the lectures and the lecturers who have

contributed to the Institute of Maxillofacial

Prosthetists & Technologists (IMPT) scientific

congresses, and the changes in lecturing patterns

over the years.

Keywords

IMPT, scientific congress, history

8 AUTUMN 2011 IMPT THE JOURNAL OF MAXILLOFACIAL PROSTHETICS & TECHNOLOGY IMPT AUTUMN 2011 9www.impt.co.uk

Abstract

Introduction

Method

Results and discussion

Caroline Reed AIMPT, BSc (Hons) DPS, Maxillofacial ProsthetistMaxillofacial Laboratory, The Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex RH19 3DZ

Mr Adrian Kearns MIMPT DPS, Consultant Maxillofacial ProsthetistMaxillofacial Laboratory, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX

“There have been 25 IMPT scientific congresses since 1965, 477 lectures have been delivered, totalling over 145 hours”

Figure 1. Total congress lectures 1963 - 2011.

Prostheses 30%

Overview 12%

Materials 12%

Implants 11%

Oro-facial/intra-oral 10%

Education and Administration 8%

Orthognathic 6%

Trauma 5%

Computer Technology 4%

Miscellaneous 2%

830%

6%

2%

11%

12%

8%

12%

4%

10%

5%

39

51

24

49

5718

30

56

145

Figure 2. First ten congresses 1963 - 1981.

Prostheses 26%


Materials 14%

Implants 11%

Overview 7%


Miscellaneous 5%

Orthognathic 5%

Trauma 5%


526%

5%

5%

11%

6%

14%

7%

21%

5%

6

11

5

21

7

5

14

25

The total numbers of lectures given for each category,

throughout the entire history of IMPT conferences, were

ascertained to see which topics have been lectured on

more frequently.

Comparisons were made between lectures given in the

first ten conferences and the last ten to see how lecture

patterns have evolved over the years.

The individual lecturers, and their respective units, were

recorded to see which MfPs have significantly contributed

to the IMPT lecture programme and whether their input

has influenced others.


Many thanks go to everyone who supplied IMPT congress

programmes for this study, all of which have been

scanned and are available to view on the IMPT website -

www.impt.co.uk

The IMPT congress has grown from six lectures in 1963 to

a bi-annual international scientific event which regularly

consists of more than 20 lectures, as well as submitted or

invited lectures from other professionals. Lecture topics

show a shift in recent years away from

the subject of oro-facial/intra-oral to computer technology

and education and administration. The influence of

leading lecturers continues to supply the congress

with willing participants. These stimulating and

inspiring speeches affirm the professional and technical

progression of Maxillofacial Prosthetics.

Specific centres have significantly contributed to the

lecture programme over the years. Units such as

Roehampton (39 lectures), East Grinstead (36), Swansea

(24) and Birmingham (21) have contributed to just over a

quarter of all lectures since 1963.

MfPs from outside the UK have also had a significant

input, with 106 of the total lectures coming from

Australia (2), Austria (1), Canada (9), Germany (11),

Holland (20), India (7), New Zealand (2), Norway (4),

Saudi Arabia (1), South Africa (1), Spain (3), Sweden (23),

Switzerland (2), USA (18) and Yugoslavia (2). Hopefully

this is a trend that continues, with knowledge and

practices shared between MfPs all over the world.

Individual lectures

Table 1 shows the leading lecture contributors and the

total time of their combined presentations.

Roehampton

Professor Brian Conroy MBE presented 13 lectures while

head of the Maxillofacial Laboratory in Roehampton.

Professor Conroy was also one of the people involved in

the inception of the Maxillofacial Technicians Association

(later to become the Institute of Maxillofacial Prosthetists

& Technologists), and the IMPT scientific congress.

His enthusiasm and drive appeared infectious.

Numerous people who worked in Roehampton moved on

to other centres but continued contributing to congress

programmes. In some cases these units had little or no

previous lecturing history (Table 2).

Acknowledgements

Conclusion

Lecturing

Figure 3. Last ten congresses 1993 - 2011.

Prostheses 27%


Overview 17%

Materials 11%

Implants 9%



Orthognathic 6%

Trauma 6%

Miscellaneous 1%

227%

6%

1%

9%

12%

11%

7%

15%

6%

6%

31

23

15

42

15

18

17

31

75

Table 1. Most lectures at congress.

Number of lectures Name Total minutes

14

13

13

11

10

10

10

10

9

9

9

9

8

8

8

C.Haylock

B.Conroy

M.Pilley

P.Smith

M.Cutler

P.Evans

D.Allen

J.Watson

A.Roberts

G.Pratt

C.Maryan

K.Page

A.Bamber

A.Bocca

M.Townend

260

360

250

235

270

165

140

120

195

190

185

150

195

165

145

Table 2. Lectures and influences of ex-Roehampton MfPs.

Name Maxillofacial Laboratory

Lectures since arrival at unit

Lectures by MfPs before

arrival

Lectures by other MfPs since arrival

*Bristol employs one MfP

Kevin Page

Mark Townend

Mark Cutler

Colin Haylock

Bristol

Poole

East Grinstead

Charing Cross

7

7

8

5

3

0

6

0

0*

6

22

7

Fabrication of a hollow and a foam-filled breast prostheses - a case study

Many women choose to have reconstructive surgery

following a mastectomy to rebuild the contour of

the breast.1 Reconstruction can start as the mastectomy

is taking place, but it is also possible and sometimes

necessary to wait until months or even years after

the mastectomy.1 This can be because of a number

of reasons, one simply being a patient’s unwillingness

to undergo further surgery.1

The decision to delay breast reconstruction is not always

based on a woman’s preferences. Some women, for

example, may not be suitable surgical candidates because

they are having radiation therapy after a mastectomy.1

As well as additional surgery, reconstructing the breast

involves more recovery time, more scars, the possible risk

of disfigurement, infection and failure.1,2 It is for these

reasons that choosing to restore the breast through the

application of a prosthesis remains as valid as ever.4-6

A stock silicone gel-filled breast prosthesis may possess

various features that attempt to provide an acceptable

level of comfort, form, feel, weight distribution, fullness

and softness of the natural breast, and, for some

patients, they are an adequate alternative to a custom

made prosthesis. There are limitations, however, in the

standard sizes, shapes and colours available. They can

A patient presented with a mastectomy of the right breast.

Following surgery she had been wearing a stock silicone

gel-filled breast and was referred to the maxillofacial

laboratory for a custom made prosthesis.

The weight of the prosthesis was 675g (1lb 7oz) and this

was the patient’s main concern. It caused discomfort and

back pain, making her an ideal candidate for a hollow

custom made prosthesis.

During the consultation with the patient, assessments

were made to greatly improve the contour, shape and

size of the prosthesis.

Hollow box prosthesis

Stock breast prostheses are supplied in individual boxes

within moulded plastic trays. The tray provided an

appropriate size guide on which to base the

final prosthesis. Vaseline was applied and plaster poured

into the tray, producing a similar shape and size to that of

the prosthetic breast, therefore giving a suitable template

be heavy, ill-fitting and shapeless, having a tendency to

relax under their own weight within the bra, as well as

lacking both anatomical detail and realistic appearance.5,6

Many mastectomy patients struggle to cope with a stock

external prosthesis, resulting in the requirement of

custom made external breast prostheses.5,6

A custom made prosthesis is unique and designed to fit

the individual. The aesthetic, functional and psychological

needs of the patient are all considered in the construction

of such a prosthesis.2 - 6

This paper describes the method and construction

of both a hollow and a foam-filled custom made

breast prosthesis.

Its purpose is to emphasise the importance of

providing a lightweight, contoured and colour

matched alternative to a stock gel-filled

breast prosthesis.

Keywords

Lightweight, silicone foam, breast prosthesis

Abstract

Introduction

Case study

Methods and materials

Sally Lane MIMPT, Maxillofacial Laboratory, Russells Hall Hospital, Dudley Group of Hospitals NHS Trust, West Midlands DY1 2HQ

“The weight of the prosthesis was 675g and this was the patient’s main concern. It caused discomfort and back pain”


to work on. Sheets of softened wax were then added to

the plaster to create a more contoured and realistic

breast shape. This was then duplicated in wax, and

positioned inside the patient’s bra.

The underside of the pattern (the part in contact with

the skin) was modified by softening and removing wax to

achieve a more natural, slightly concave fit to rest against

the chest wall and also to help reflect changes that will

occur with bodily movements. The pattern was then

sculpted to simulate the contours of the natural breast.

The pattern was removed and the wax made smooth.

An impression of the patient’s existing nipple areola was

taken using a silicone-based material (Exafast injection

type, GC Ltd, Newport, Buckinghamshire, UK) and filled

with wax to produce a nipple areola. It was then softened

to gain a slight curvature for easy positioning onto the

wax pattern within the bra.

The existing prosthesis provided only a very basic outline

of a nipple areola with no visible protrusion. Once the

wax nipple was in position it highlighted the importance

of regaining some symmetrical projection. At the end of

the appointment, a skin shade match was recorded.

Before investing the pattern, a plaster model was cast to

the fitting surface of the wax pattern to provide a base,

and to record the fit surface for the foam-filled prosthesis

later on. This model was then put aside.

An Alginate (Heraus, Kulzer, GmbH, Gruner Weg 11,

63450, Germany) two-part mould of the wax pattern,

backed with impression composition (Kemdent, ADP Ltd,

Purton, Swindon, UK) was then made. This was separated

and placed in water to prevent shrinkage of the alginate

for later use (Figure 1).

The wax pattern was invested in a two-part mould, using

Crystacal R (British Gypsum) and sprayed with Aurofilm

(Bego, Bremen, Germany), to relieve surface tension.

Once set, the wax was removed with boiling water.

The mould was left to cool and a separator, Isolant

(Dentsply, Addlestone, Surrey UK), was applied to both

halves with a brush.

Fifty grams of maxillofacial silicone M511, shore hardness

25-30, were mixed with 10% M513 softening agent and

10% M514 anti-slump agent (Technovent Ltd, Principality

House, Western Valley Road, Rogerstone, Newport, UK)

and applied in a very thin layer to both halves of the

mould, taking care to eliminate any air bubbles.

The application was extended slightly beyond the edges

and also thickened to ensure a seal of the two halves.

A thicker layer was applied to the areola.

Two hundred and fifty grams of silicone M4408 (Abacus,

7 Oxford place, Bradford, U.K), with a shore hardness

of 8 was mixed with A-302 thixotropic agent (Factor 2,

Lakeside, USA), for ease of application. It was then added

to the mould directly on top of the M511 in a uniform

layer approximately 5-10mm thick, and to the nipple

area, filling it completely (Figure 2a). Strips of gauze were

placed within the silicone layers on the fitting surface

half of the mould to provide stability against the chest

wall (Figure 2b). The mould was placed in a clamp and

bench-cured for 48 hours, after which time the mould

was opened and the prosthesis trimmed and finished.

Foam-filled prosthesis

The composition-backed alginate mould (Figure 1) was

retrieved from the water and the two halves held together

with thick elastic bands. Using a scalpel, a large hole was

cut in the top between the two alginate halves. Molten

wax was poured into the mould and immediately poured

back out (Figure 3a). The mould was immersed into

very cold water and this process was repeated two more

times, each time the layer of wax thickening to produce

a shell of approximately 3mm thick. The wax shell will

determine the thickness of the silicone layer, which will

cover the foam for the finished prosthesis.

Figure 1. Alginate two-part mould.

Figure 2a. Application of silicone in a two-part mould.

Figure 2b. The addition of gauze for stability.

The wax within the mould was left to cool naturally,

removed, and the alginate disposed of, leaving the hollow

wax pattern. The hole in the top was sealed and the

pattern replaced onto the plaster model to check for any

distortion (Figure 3b).

The pattern was turned over with the nipple areola facing

downwards and, using a hot wax knife, the fitting surface

was cut away approximately half an inch from the edge.

At this point, the wax pattern was carefully held and

filled with water which was measured to determine the

approximate amount of silicone foam needed for

the prosthesis. It held 250ml of water which equates to

250g of silicone foam.7

The pattern was then dried off, returned to the model and

the nipple areola removed by carefully cutting around the

periphery with a scalpel. A funnel was then formed by

curving a sheet of wax into the shape of a cylinder to the

same diameter as the nipple areola. This was then sealed

into the hole to allow any excess foam to escape without

the risk of contacting the outside of the wax pattern.

A two-part platinum self-skinning foam M3240 (Abacus,

7 Oxford Place, Bradford, U.K) with the expansion rate

of five times the overall volume was stirred and poured

through the wax sheet funnel. As the foam expanded up

through the funnel (Figure 4a), it also filled the inside

of the wax pattern against the model creating the fitting

surface (Figure 4b). The pattern was held down onto

the plaster base for approximately three minutes until

expansion was complete. All of the wax surrounding

the foam, including the funnel, was taken away and the

excess foam removed with a scalpel.

A separator was applied to the original Crystacal mould

and 250g of M511 maxillofacial silicone was mixed with

10%M513 softening agent; 10% M14 anti-slump was

colour matched as before and applied to the concave half

of the mould (containing the nipple areola) in an even

layer. M4408 silicone was again used in the

nipple area. The foam was positioned onto the other

half of the mould and coated with silicone extending

the material down onto the plaster base. The flask was

pressed together and left in a clamp to bench

cure overnight. Once cured, the prosthesis was removed

from the mould, the flash trimmed away and cleaned with

an alcoholic wipe.

A one-part silicone dispersion sealant ME10 – 6607

(NuSil USA) was then applied using a brush to the

exposed foam on the underside of the prosthesis and left

to dry for approximately one hour.

Figure 3a. Pouring the hollow wax pattern.

Figure 4a. Expansion of the silicone foam within the wax pattern becoming visible as it travels up through the funnel.

Figure 3b. Wax template taken from the mould and replaced back on to the plaster model.

Figure 4b. The exposed foam on the underside of the pattern.

Both finished prostheses (Figures 5a and 5b)

were weighed.

The hollow prosthesis weighed 247g, a difference of

428g when compared to the manufactured prosthesis,

reducing the weight by almost two thirds. The foam-filled

prosthesis weighed 398g, a difference of 277g.

Although more than the hollow prosthesis, it was still

significantly less than the stock prosthesis, reducing the

weight by over one third.

Both the hollow and the foam-filled custom made

prostheses were fitted. The hollow prosthesis naturally

responds to pressure and once positioned inside the bra

became self-supporting. The softness of the prosthesis

helped it to mould against the skin on the chest wall,

distributing the weight evenly and deflecting it away from

Results and discussion

“The hollow prosthesis weighed 247g, a difference of 428g... reducing the weight by almost two thirds”


1. Ananthakrishman P, Lucas A. Options and considerations in the timing of breast reconstruction after mastectomy. Cleveland Clinical Journal of Medicine, Volume 75, Supplement 1, 2008, 75 (1): 30-33.

2. Roberts S, Livingston P, White V, Gibbs A. External breast prosthesis use: experiences and views of women with breast cancer, breast care nurses, and prosthesis fitters. Cancer Nursing, 2003, 26 (3):179-86.

3. Hart S, Meyerrowitz BE, Apolone G, Mosconi P, Liberati A. Quality of life among mastectomy patients using external breast prostheses. Journal of experimental and clinical oncology. 1997, 83 (2):581-6.

4. Reaby L L, Hort LK. Post mastectomy attitudes in women who wear external breast prostheses compared to those who have undergone reconstructions. Journal of behavioural medicine. 1995 18, (1): 55-67.

5. Healey I. External Breast Prostheses - Misinformation and False Beliefs. Can we do better to help women after mastectomy? Medscape General Medicine. Sept 2003:5 (3).

6. Healey I. Art Applied to Medicine: Reconfiguring the Body. 10th Annual Subtle Technologies Festival, Summary of article May 24th - 27th 2007. University of Toronto, Canada.

7. Collins Pocket Reference – Ready Reference. 2nd revised edition, 7th April 1994.

References

available and should be considered as a treatment

modality for patients in these circumstances.

The production of both hollow and foam-filled

custom made breast prostheses provide considerable

improvements when compared to the stock items

I would like to thank Mr. David Heath, Senior Chief

Maxillofacial Prosthetist, Russells Hall Hospital, for his

continued support.

the shoulder, improving the functional fit. The patient

experienced an almost immediate relief in her shoulder

due to this reduction in weight and also an improvement

in posture.

The foam-filled prosthesis, although heavier and firmer

than the hollow prosthesis, provided the patient with

a unique and possibly preferable alternative. Both

prostheses provided the patient with a combination of

comfort and customized shape, enhancing the overall fit.

The weight of a custom made breast prosthesis is one

of the most important areas to consider and will often

determine its success or failure. It needs to be designed to

accommodate an individual’s movement, correctly fitting

the torso, whilst maintaining the balance of the body and

reducing stress on the spine, making it comfortable

to wear.

Aesthetics are also a very important part of the finished

prosthesis. When fabricating a custom made prosthesis,

a number of colour swatches are used to create the

patient’s unique shade match. Additionally, thoughtful

silicone selection resulted in soft and flexible prostheses.

Whether the loss of a breast is partial or complete,

any change to a woman’s body image can be a

traumatic event.2,6 Many mastectomy patients who require

a prosthetic replacement do not want to be reminded that

they are wearing a breast prosthesis; they want to return

to the lifestyle they had prior to their diagnosis. Both of

the prostheses described above allow the patient to feel

more whole, as well as presenting a normal appearance

beneath clothing. This contributes greatly to a patient’s

body image, self worth and emotional well being.2-6

Conclusion

Acknowledgements

Figure 5a. The definitive hollow prosthesis.

Figure 5b. The definative foam-filled prosthesis.

Survey about attitudes, opinions, and experience of maxillofacial prosthetists and technologists in the UK towards maxillofacial silicone prostheses

While facial prostheses are in use, several factors

contribute to their deterioration. Degradation in

mechanical and physical properties and discoloration

are the most common problems reported. Several

studies have investigated these problems, employing

different types of silicones, and exposing them to severe

conditions, which affect silicone while in service.1-3

These studies have utilised different test standards,

and concluded recommendations based on the criteria

selected for their testing environments. Also, different

types of silicone elastomers have been compared. The

process of silicone discolouration was investigated and

’colour stable’ pigment silicone combinations were passed

fit to use in practice.4,5 Despite all of these theoretically

significant alternatives, MPTs still face problems with

serviceability of maxillofacial prostheses.6, 7

MPT techniques and experience have not been

investigated and evaluated regarding the process of

enhancing the serviceability of maxillofacial prostheses.

Furthermore, MPTs during their daily work have

developed their own techniques to create long-time

serviceable prostheses based on variations in health

market, patients’ attitudes, and environment among

different parts of country.

It is important to investigate MPTs’ professional practice,

and direct experimental studies to investigate clinically

related situations in order to make conclusions, as more

problem solving is connected to what is faced in

daily practice. The aim of this study was to investigate

MPTs’ opinions, attitudes, and experience regarding

The aim of this study was to investigate attitudes,

opinions, and experience of maxillofacial prosthetists

and technologists (MPTs) in the UK towards several

aspects related to maxillofacial silicone prostheses.

A ’closed and partial-closed ended questions’

questionnaire was carried out and distributed to

220 MPTs in the UK. The following areas were

investigated: airbubbles in silicone elastomers, effects

and how to eliminate them, silicone elastomers,

commercial types and colouring techniques, challenges

of fabricating maxillofacial prostheses, and non-

professional information.

The overall response rate was 43.6%. Cosmesil and

Technovent silicones were the most commonly used

silicones in the UK. MPTs affirmed that airbubbles

within silicone mixtures affected aesthetics, strength,

and hygiene of silicone prostheses. However, the

majority (71.4%) employed pressure packing to

minimize airbubbles.

Aspects of prosthesis maintenance (longevity 59.2%,

and colour change 57.1%) were the significant

challenges that MPTs face. During the last year, the

majority of MPTs who responded attended at least one

hands-on training course.

Keywords

Silicone elastomers, maxillofacial prostheses,

questionnaire, survey

Abstract

Introduction

Muhanad M. Hatamleh AIMPT, PhD, MPhil, DPS, MSc, Author for correspondenceSchool of Dentistry, University of Manchester, Higher Cambridge Street, Manchester, M15 6FH, UKColin Haylock FIMPT, MBE | Jason Watson MIMPT, BMedSc | David C. Watts BSc, PhD, DSc

“Ninety-six IMPT members responded to the questionnaire,indicating an overall response rate of 43.6%”


A self-administrated pilot questionnaire was first

carried out on eight experienced MPTs in a variety of

maxillofacial units in the UK to enhance the layout

and format of questions, and ensure that the questions

were easily understood. The National Research Ethics

Service (NRES) of the regional ethics committee was

supplied with a copy of the aims of the study and the

questionnaire asking for approval, but the information

sought from participants was not deemed to be sensitive

so approval was not required (Appendix A).

Closed and partial-closed ended questions were included

in following areas: silicone elastomers (commercial

types and colouring techniques), silicone elastomers

used, challenges of fabricating maxillofacial prostheses,

record keeping and hands-on training courses attended

(CPD). It was distributed via the Institute of Maxillofacial

Prosthetists & Technologists (IMPT) to all MPTs (220)

working in the UK.

The questionnaire was accompanied by a covering letter

explaining the aims and objectives of the study and

indicated that all information would remain confidential

and anonymous.

A prepaid envelope was included with the address of

the main investigator. The IMPT council did not approve

follow up reminders. After collecting the responses, data

was entered into SPSS windows software (release 16,

SPSS Inc., Chicago, IL, USA), and analysed.

Response rate details

Ninety-six IMPT members responded to the questionnaire,

indicating an overall response rate of 43.6%. Of the

original sample size (220), 32 proved to be non-usable

(10 returned cover letters only, 22 returned blank

questionnaires), and 15 returned mail. Accordingly, 47

were not considered when the data was analysed.8

Membership in maxillofacial-related associations: 89%

were members of the IMPT. Of them, 53.7% were MIMPT

(Member in the Institute of Maxillofacial Prosthetists &

Technologists), 36.6% were FIMPT (Fellow of the Institute

of Maxillofacial Prosthetists & Technologists), and 9.8%

were AIMPT (Associate in the Institute of Maxillofacial

Prosthetists & Technologists).

Air bubbles

A key question in the survey asked whether it is

important in your work to have prostheses free of

air bubbles. Respondents were asked two further

questions to specify possible effects of air bubbles, and

their techniques to minimise them. Multiple responses

were available in each question. The majority of

respondents (76.6%) indicated it was very important to

fabricate silicone prostheses free from air bubbles

(Table 1). Four possible effects of air bubbles in the

maxillofacial silicone prostheses were indicated in a

closed-end question (Table 2). The most frequently used

technique to eliminate air bubbles was packing silicone

mixtures under pressure (71.4%) (Table 3).

Silicone materials used

Participants were asked to mention the four common

silicone materials they use in fabricating maxillofacial

prostheses in descending order (most commonly to least

commonly used) (Table 4). Silicones made by Principality

Medical and Technovent were the most commonly used

materials in the UK.

Colouring

Respondents were asked about techniques used in

starting from the fabrication process, silicone materials

used, challenges they face, and continuous

professional development.

This paper is part two of a larger study.9

Materials and methods

Results

Table 1. Most of MPTs indicated it is very important to have maxillofacial prostheses free of air bubbles.

Table 2. Effects of air bubbles on maxillofacial silicone prostheses.

Table 3. Steps utilized in minimising porosity within silicone prostheses.

Importance

Possible effect

Step

*Number of respondents for this question was 49.



*Number (%)

*Number (%)

*Number (%)

Very important

Important

Not important

Aesthetics compromised

Bacterial colonisation of porous fitting surfaces

Effects on prosthesis colour

Difficulty in finishing margins

Packing silicone under pressure

Other (own technique)

Degassing silicone mixture in a vacuum chamber

Leaving silicone in fridge to let air escape

Mixing silicone mechanically under vacuum

Injecting silicone mixture into mould

Two steps including pressure packing

36 (76.6%)

9 (19.2%)

2 (4.2%)

41 (83.7%)

33 (67.3%)

28 (57.1%)

23 (46.9%)

35 (71.4%)

12 (24.5%)

11 (22.4%)

10 (20.4%)

5 (10.2%)

1 (2.0%)

24 (68.6%)

colouring silicone mixtures. Overall, 89.4.1 % of

respondents used both internal and external stains to

colour silicone prostheses, and 10.6 % used internal

stains only.

Challenges

Respondents were asked to indicate possible challenges

faced in fabricating maxillofacial prostheses. Factors

related to prosthesis maintenance (longevity) (59.2%)

and colour changes (57.1%) were considered as the most

significant challenges (Table 5).

Record keeping

Overall, 78.7% of respondents reported keeping records

of prostheses which required replacement. Of them,

94.6% thought it was useful to keep such a record,

whereas the remaining 5.4% of respondents were either

not sure (2.7%) or thought it is not useful (2.7%)

(Table 6).

Hands-on training courses

Overall, 93.5% of respondents had attended training

courses (Table 7). Moreover, the majority of respondents

(53.8%) attended at least one course and 30.8% of

respondents attended six to ten courses.

Moreover, all respondents (100%) agreed that such

courses were beneficial.

Discussion

Table 6. Record of prostheses requiring remake.

Whether it is helpful to keep such record?

Do you keep record of cases required remake?

Yes No

Yes

Not sure Total

Total

No

35 1 137

10

78.7%

21.3%

94.6% 2.7% 2.7% 100.0%

4 1 5

40.0% 10.0% 50.0% 100.0%

39 2 6 47

83.0% 4.3% 12.8% 100.0%

Table 4. Brands of silicone elastomers used by MPTs .

Manufacturer (brand series)

Total number of silicone/materials mentioned was 100.

* Please note the ‘only’ indicates the silicone manufacturer without specifying the brand name.

Percentage (%)

27%

21%

10%

8%

8%

5%

5%

3%

3%

2%

2%

2%

2%

1%

1%

Cosmesil (*only, M511, Z004 or Gel

Technovent (*only, Elastomer 42, TechSil only or 25)

Factor II (*only, FX 502, VST 50, A-2000, VST 30 or PSE 70)

Matrix (M3428 or M3040)

Nusil (*only, LSR2-5830 or 4920)

Realistic

Abacus (*only, shore 8, shore 24 or shore 40)

Molloplast B

Promax plastic (Gel or 10 R)

Microflex

Silorrm 20/20

Dow Corning (RTV or MDX)

Premium 2

TSE B455STA

Dragon Skin

Table 5. Challenges that MPTs face during fabricating maxillofacial prostheses.

Challenges

* Mutli answer question of 49 respondents per each answer.

*Number (%)

29 (59.2%)

28 (57.1%)

27 (55.1%)

14 (28.6%)

9 (18.4%)

6 (12.2%)

5 (10.2%)

2 (4.1%)

1 (2.0%)

Prosthesis maintenance (longevity)

Prosthesis maintenance (colour change)

Prosthesis construction (colouring)

Prosthesis design (sculpture)

Prosthesis construction (bonding)

Prosthesis design (material)

Communication

Patient dissatisfaction

Others

Table 7. Percentages of hands-on training courses that MPTs attended during the last year.

Number of courses attended


*Number (%)

1-5

6-10

11-15

16-20

Over 20

21 (53.9%)

12 (30.8%)

2 (5.1%)

2 (5.1%)

2 (5.1%)

It is important to analyse the opinions and attitudes of

MPTs toward enhancing serviceability of maxillofacial

prostheses. Earlier, we published part one of

this study.9 This is part two of the study. Most of MPTs

were members of the IMPT (89.8%), and 53.7% of them

were MIMPT, 36.6% were FIMPT, and 9.8% were AIMPT.

The IMPT levels of membership are: associate level

of membership (AIMPT), which accounts for all new

members with limited experience; the member level

(MIMPT), which includes experienced prosthetists with

a specialised qualification; and the fellow level (FIMPT),

which is the highest level of membership and is where

members are experienced prosthetists, often with a

postgraduate qualification, and the majority of them are

maxillofacial unit managers.

Although environmental and patient factors that diminish

silicone prostheses functionality have been investigated

thoroughly in the literature, the effect of operator related-

factors, including air bubble formation during mixing, are


Within the limitations of this study, and based on the

attitudes and opinions of MPTs sought, it was concluded

that:

1. Air bubbles within silicone prostheses adversely

affected prosthesis aesthetics and colour and enhanced

not known. Air bubbles within silicone mixtures adversely

affect the elasticity of silicone prostheses, elongation, tear

resistance, and appearance.10,11 Moreover, silicone porous

fitting surfaces enhance ’candida albicans’ bacterial

colonisation.12,13 Most of the MPTs (76.6%) stressed the

importance of air bubble-free prostheses. Moreover,

they indicated deterioration in prosthesis aesthetics

as the most detrimental effect of air bubbles (83.7%),

followed by increased chances of bacterial colonisation

(67.3%). An effect on prosthesis colour was third (57.1%),

whereas problems in finishing margins of prostheses were

the fourth effect (46.9%). Air bubbles are likely to be

trapped while silicone ingredients (rubber, hardener, and

pigments) are mixed.10 Packing silicone mixtures under

pressure (71.4%) was the most used technique by MPTs

to minimise air bubbles. However, 24.5% suggested other

methods such as careful and skilful manual spatulations;

stretching silicone out manually on slabs with a spatula;

leaving a silicone mixture to stand; packing silicone

slowly to allow air bubbles to surface; and keeping a

mould with the fitting surface uppermost during curing.

A large proportion of MPTs (68.6%) carried out additional

steps along-side pressure packing (i.e. degassing silicone

mixture in a vacuum chamber; leaving silicone in fridge

to let air escape; or mixing silicone mechanically

under vacuum).

Other factors that contribute to prosthesis functionality

are type of materials used. There is wide range of

commercial silicone materials available in the market, and

little is known about the most commonly used silicone

utilized in the UK. This study showed that silicone

elastomers produced by Principality Medical (Newport,

UK), including the Cosmesil series of silicones, were

the most commonly used (27%), followed by silicones

produced by Technovent (Leeds, UK), including TechSil

silicones (21%), and, finally, silicones produced by Factor

II (Lakeside, USA) (10%).

Cosmesil and TechSil silicones are manufactured in

the UK. Their properties include being readily available,

nationally promoted and easy to use, which made them

commonly used materials. Furthermore, the availability

of different hardeners to be used with Cosmesil made it

a suitable material to produce prostheses with varying

Shore A hardness which can be tailored to simulate the

elasticity of skin tissues where the defects site is

being restored.

Techniques for fabricating prostheses with a life-like

appearance included a hybrid technique for both external

and internal colouring, with 89.4.1% of MPTs using both

internal and external stains, and 10.6% using internal

stains only to colour silicone prostheses.

Extrinsic colouration included painting the outer surface

of the prosthesis, and intrinsic colouration involved

applying various colours in multiple layers into the

textured surface of the mould. However, intrinsic

colouration is mostly preferred as it does not affect the

translucency of the prosthesis.

Conclusions

“Prosthesis maintenance (longevity) (59.2%) and colour changes (57.1%) were considered the most significant challenges”

MPTs faced different challenges in fabricating

maxillofacial prostheses. Difficulty associated with

prosthesis maintenance (longevity and colour change)

was considered the most significant challenge (59.2%,

and 57.1% respectively). The second were issues

related to prosthesis construction, including colouring

of prosthesis and bonding of silicone to the retentive

plate (55.1%, and 18.4% respectively). Challenges related

to prosthesis design (i.e. sculpting the prosthesis and

finding a suitable fabrication material) were considered

of moderate importance (28.6%, and 12.2% respectively).

Team communication and patient dissatisfaction were

considered as the lesser challenges.

MPTs were asked whether they kept a record of history

of prostheses replacement and whether it was beneficial.

Such records might include information such as case type,

date of fabrication, causes of remake, retention method,

and other relevant information. A high proportion of

MPTs (78.7%) kept such records. Of them, 94.6% thought

it was useful, whereas the remaining 5.4% were either not

sure (2.7%) or thought it not useful (2.7%).

During the last year, the majority of MPTs had attended at

least one hands-on training course (53.8%) and 30.8% of

respondents attended between six and ten courses as part

of their continuous professional development (CPD).

bacterial colonisation. Packing silicone under pressure

was the most common technique to reduce inclusion of

air bubbles.

2. Cosmesil and TechSil series silicones were the most

commonly used silicone elastomers in the UK.

3. The longevity of facial prostheses and colour changes

were the most challenging factors that maxillofacial

prosthetists and technologists faced.

1. Hatamleh MM, Polyzois GL, Silikas N, Watts DC. Effect of extra oral aging conditions on mechanical properties of maxillofacial silicone elastomer. J Prosthodont 2011;20:439-446.

2. Eleni PN, KrokidaM K, FrangouM J, Polyzois GL, Maroulis ZB, Marinos-Kouris D. Structural damages of maxillofacial biopolymers under solar aging. J Mater Sci Mater Med 2007;18:1675-1681.

3. Mohite UH, Sandrik JL, Land MF, Byrne G. Environmental factors affecting mechanical properties of facial prosthetic elastomers. Int J Prosthodont 1994;7:479-486.

4. Hatamleh MM, Watts DC. Effect of extra oral aging conditionings on color stability of maxillofacial silicone elastomer. J Prosthodont 2010;19:536-543.

5. Kiat-Amnuay S, Mekayarajjananonth T, Powers JM, Chambers MS, Lemon JC. Interactions of pigments and opacifiers on color stability of MDX4-4210/type A maxillofacial elastomers subjected to artificial aging. J Prosthet Dent 2006;95:249-257.

6. Huber H, Studer SP. Materials and techniques in maxillofacial prosthodontic rehabilitation. Oral Maxillofac Surg Clin North Am 2002;14:73-93.

7. Lemon JC, Kiat-amnuay S, Gettleman L, Martin JW, Chambers MS. Facial prosthetic rehabilitation: preprosthetic surgical techniques and biomaterials. Curr Opin Otolaryngol Head Neck Surg 2005;13:255-262.

8. Locker D. Response and nonresponse bias in oral health surveys. J Public Health Dent 2000;60:72-81.

9. Hatamleh MM, Haylock C, Watson J, Watts DC. Maxillofacial prosthetic rehabilitation in the UK: a survey of maxillofacial prosthetists’ and technologists’ attitudes and opinions. Int J Oral Maxillofac Surg 2010;39:1186-1192.

10. Hatamleh MM, Watts DC. Porosities and bonding of maxillofacial silicone elastomer with embedded glass fibre-bundles. Int J Anaplast 2008;2:15-23.

11. Kent K, Zeigel RF, Kent K, Frost AL, Schaaf NG. Controlling the porosity and density of silicone rubber prosthetic materials. J Prosthet Dent 1983;50:230-236.

12. Nikawa H, Chen J, Hamada T, Nishimura M, Polyzois G. Candida albicans colonization on thermal cycled maxillofacial polymeric materials in vitro. J Oral Rehabil 2001;28:526-533.

13. Shi Y, Song W, Feng ZH, et al. Disinfection of maxillofacial silicone elastomer using a novel antimicrobial agent: recombinant human beta-defensin-3. Eur J Clin Microbiol Infect Dis 200928:415-420.

References

“DCW gratefully acknowledges the support of the

Alexander von Humboldt Foundation, Bonn, by a

Humboldt Research Award.”

Acknowledgement

The questionnaire distributed to MPTs.

Appendix A

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Custom-made nasal septum obturators

Septal perforation is an uncommon and very

uncomfortable condition and treatment is difficult

especially when confronted with large defects.1 The

condition is mainly caused by surgery, nasal steroids,

decongestive sprays, trauma, cautery, self induced injuries

(i.e. digital manipulation), and cocaine usage.1,2

Patients can experience pain, whistling when breathing,

crusting, bleeding, discharge, a distorted sense of smell

and neuralgia.1-3 These patients are usually referred to

ear, nose and throat (ENT) units where treatment can be

symptomatic (local application of ointments), prosthetic

or surgical to relieve symptoms.

Large and irregular perforations remain a challenge to

close surgically, and prefabricated obturators have limited

appeal due to imprecise fit.2

By using computed tomography (CT) and

stereolithographic modelling, an accurate close-fitting

septal obturator can be custom-made for any size or

A CT scan of the patient’s defect area is required to

obtain accurate data (Figure 1). This data is processed

using computer software into images which are examined

to determine the morphology and extent of the 3D model

required, before interfacing with the stereolithography

apparatus to build the replica model (Figure 2).4

A 3D medical model is then constructed in an epoxy-

based resin which is solid enough to withstand the

laboratory techniques required for the methodology

described in this paper (Figure 3). The high accuracy of

these reproductions makes them an ideal tool to avoid

discrepancies in the final prosthetic obturator.4

shape of defect that is encountered. This device may then

be fitted to the patient under local or general aneasthetic.

It may require replacement with a new obturator in the

future if the contour of the anatomy changes.

The models can also be sterilised for reference purposes

in theatre.5

Prior to duplicating the working area of the resin model,

the extension of the prospective obturator is marked in

pencil to ensure full coverage with impression material.

High definition flexible silicone impression material

(Epiform Flex, Claude Hill Dental and Plaster Supplies,

West Midlands) is spread slightly beyond the pencil

demarcation line with the nozzle of a mixing tip (Figure

4). The impression is cast in dental stone to enhance

its resistance to breakage, and creates a doughnut

shaped mould (Figure 5). The working area is slightly

sandpapered to eliminate layers made from the

stereolithography machine on the resin model, which

have been replicated in dental stone.

against tearing, obtain maximum clasping and a

smooth finish.

Nasal septum obturators tend to have an oval/circular

shape which makes it difficult to determine the exact

position on models/patients. For this reason, a small

indentation is created in the wax carving (in this case at

the right anterior superior aspect). A dot is also marked

on the model with indelible pen parallel to the

wax indentation. This will be a guide when fitting the

final device on either the model or the patient (Figure 7).2

A three-part mould is constructed, part one being the

doughnut shaped model (Figure 8). The wax is removed

from the mould with boiling water, and left to cool. The

author recommends using a metal flask to avoid breakage

of the dental stone during the packing process.

Separating fluid is applied to the three-part mould and

room temperature vulcanising silicone (Ufi Gel SC, Voco,

Zahn Laboratory, Gillingham, Kent) is injected through

the nozzle of a cartridge dispensing gun, ensuring the

mixture of the two silicone components within the

cartridge is bubble-free when entering the mould.

After mixing, Ufi Gel SC which has a working time of

one minute forty-five seconds will be fully vulcanised

and ready to be deflasked after 15 minutes at room

temperature. To extend the working time the cartridge

may be cooled in a fridge prior to use.

Any excess material can be removed with sharp scissors

or with silicone trimming disks.

The finished obturator can be fitted on the

stereolithographic model to confirm a precision fit has

been achieved (Figure 9).

The obturator is carved in modelling wax to reconstruct

the morphology of the septum. The width and length

of the flanges used to support and retain the obturator

are important because, although the obturator will be

flexible once fabricated in silicone, it should also be

robust to avoid tearing and elongated enough to prevent

dislodgment without compromising comfort, breathing,

and path of insertion.

Figure 6 (below) shows the standard contour from a

sagittal view. The edges are rounded to protect them

The construction of a highly accurate, comfortable,

long lasting and economical custom-made

silicone nasal septum obturator is described. This

is achieved by utilising computer tomography

imaging, stereolithographic modelling, and a

dimensionally stable soft silicone to construct

the device.

The technique was first utilised by the author at

Birmingham University Hospital and introduced to

Poole Hospital.

Keywords

Nasal septum obturator, septal button,

computer tomography, steriolithographic model


Abstract

Introduction


Carmen Orbaneja Botija, MIMPT, Maxillofacial ProsthetistPoole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB

Figure 6. Contour shown for nasal obturator, sagittal view.

Figure 3. Medical model of defect area.

Figure 1. CT image of the sinuses.

Figure 5. Doughnut shaped model.

Figure 8. Three-part mould.

Figure 4. Silicone impression of working area.

Figure 2. Image obtained from a scan of the defect area.

Figure 7. Location mark on obturator and model.

Figure 9. Final result on 3D resin model.

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1. LK Dosen, R Haye. Nasal septal perforation 1981-2005: Changes in aetiology, gender and size. BMC ENT Disorders 2007 7:1 http://www.biomedcentral.com/1472-6815/7/1

2. DL Price, DA Sharris, EB Kern. Computed tomography for constructing custom nasal septal buttons. Arch Otolaryngol Head Neck Sug Nov 2003 129 Full text http://archotol.ama-assn.org/cgi/reprint/129/11/1236.pdf

3. JP Barraclough, D Ellis, DW Proops. A new method of construction of obturators for nasal septal perforations and evidence of outcomes. Clinic Otolaryng 2007,32:1 51-4 http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2273.2007.01305.x/abstract © 1999-2009

4. J F Bouyssié, S Bouyssié, P Sharrock, D Duran. Stereolithographic models derived from X-ray computed tomography reproduction accuracy. Surg and Read Anat. May 1997: 19:3 193-9 http://www.springerlink.com/content/q8r61420x5l2n327 © Springer. Part of Springer Science+Business Media © Copyright Information

5. The National Centre for Product Design and Development Research (PDR), Cardiff. Customer Guidelines for Handling Medical Models.

6. Scientific Product Information Ufi Gel SC, pages 6,7,8,9.http://www.vocoamerica.com/praeparate/gb/html/prodinfo/wi/WP%20Ufi%20Gel%20en.pdf


References

Properties of Ufi Gel SC

This permanently soft material has a shore hardness of

26 and it is dimensionally stable. Due to its high elastic

recovery, it returns readily to its original shape.

Ufi Gel SC is thixotropic and it can be applied using

light pressure or directly with an injecting gun and a

mixing tip to be spread bubble-free over an entire

surface as required.6

A study carried out by VOCO® showed a water uptake

of this silicone of 0.1% after nine months’ storage at

37°C / 98.6°F. This type of silicone has a vastly reduced

toxicological and allergenic effects previously associated

with other silicones, which is one of the factors that

makes Ufi Gel SC an ideal implant material.6

Ufi Gel SC is also being tested in the medical field of

orthopaedics as a disc implant used in the lumber section

of the vertebrae with positive results recorded regarding

biocompatibility and biomechanics.6

Treatment options

Surgical intervention alone may not resolve nasal

septum perforation. Surgery is also costly and exposes

the patient to further risks and complications e.g. general

anaesthesia, infections.1,2

Custom-made nasal septum obturators constructed

following the technique described are an accurate

and inexpensive treatment option. Patients should not

experience major discomfort when positioning the

obturator and do not require hospitalisation or further

reviews in the short-term. In the long-term, they may feel

the obturator loosen if the defect area changes contour.

In this case, a new CT scan and 3D model would be

required to construct a new obturator.

The technique described to construct a custom-made

prosthetic obturator for nasal septal perforation is an

accurate, comfortable, rapid and inexpensive method

of treatment. Overall costs are reduced as interventions

can be performed in outpatient clinics with minimal

complications and follow up.

I would like to thank the following people:

Mr. Steve Worrollo, FIMPT, Consultant Maxillofacial

Prosthetist, University Hospital, Birmingham, for his

valuable support while training at his department.

Mr. David Ellis, MIMPT, Consultant Maxillofacial

Prosthetist, New Cross Hospital, Wolverhampton, for

instructing the author in the described technique.

Mr. Mark Townend, FIMPT Maxillofacial Prosthetist

Head of Service, and Mrs. Heidi Silk, MIMPT, Principal

Maxillofacial Prosthetist, Poole Hospital NHS Foundation

Trust for their help in this technical note.

Mrs. Becky Ward, Senior Medical Photographer, Poole

Hospital NHS Foundation Trust, for her effort in the

provision of the enclosed images.

Dr. Richard Bibb, Department of Design and Technology,

Loughborough University, for his assistance in the 3D

modelling of this case.

Dr. Dominic Eggbeer, The National Centre for Product

Design and Development Research (PDR), Cardiff, for his

assistance in the 3D modelling of this case.

Discussion

Conclusion

Acknowledgements

“Nasal obturators constructed following the technique described are an accurate and inexpensive treatment option”

Method of insertion

The surgeon may carry out insertion of the obturator

using local or general anaesthesia. Utilising the orientation

provided by the indentation created in the silicone, the

obturator is coated in antibiotic ointment or lubricating

jelly and inserted with bayonet forceps.2 After intranasal

insertion, an endoscopic view can verify its precise

positioning and fitting.

A review of current MPT practice in the provision of the prosthetic nipple areola complex

Statement of problem:

Due to the increased level of breast cancer incidence

and the decrease in mortality rate, it would be

expected that more women will require prosthetic

rehabilitation.

Purpose of study:

To identify the scope of practice of nipple areola

prostheses provided by members of the Institute of

Maxillofacial Prosthetists &Technologists (IMPT).

Materials and methods:

A web-based self-reporting questionnaire was utilised.

Results:

The results built a comprehensive picture of

current practice.

Conclusion:

The study identified significant variation in techniques

used, a lack of consistency in patient management,

particularly in continuing care and recall, and a lack

of audit to identify best practice. The low rate of

patients returning after two years, or for replacement

prostheses, suggests the need for formal recall systems

and regular audit of patient outcomes.

Clinical implications:

Members should be aware of applicable guidelines

to ensure that patients provided with nipple areola

complex prostheses should be offered regular recall

appointments and their use of the prostheses audited.

Early detection and improved treatment has meant

that survival of breast cancer patients has increased

significantly.1 Approximately 40% of women diagnosed

with breast cancer undergo a mastectomy. The options

for a woman to restore her appearance post mastectomy

are breast reconstruction or external breast prosthesis.2

The absence of a nipple areola or bilateral nipples can

be rectified by surgical nipple reconstruction or the use

of a nipple areola prosthesis. The uses of external nipple

areola prostheses following reconstruction of a breast

mound after mastectomy have been described by a

number of workers.3-13

The prosthesis may be used temporarily to assist in

determining the position of the reconstruction or as an

alternative to reconstruction.3-5 The prosthetic nipple

can be commercially available in different sizes and

skin colours, or may be custom made.6 Custom made

nipple prostheses offer a much more realistic and natural

looking alternative to the stock commercial prostheses

available and can provide a considerable psychological

boost to the patient.7, 8

The production of a custom made prosthetic nipple

areola complex was first published by Roberts et al

in 1988, who identified the importance of providing this

treatment for patients following breast reconstruction.9

Since then, variations of the original technique and their

use have been published to produce high quality realistic

nipple areola prostheses.10-13

The prosthetic treatment is non invasive and, as such,

requires no surgery, which is why this treatment might

appeal to many patients. The prosthetic nipple areola

complex may be bilateral, or unilateral, in which case the

prosthesis is made identical to the contralateral nipple.

Nipple prosthetics are offered by many maxillofacial

prosthetic units in UK hospitals. Parkinson7 and Janes8

identified that the majority of patients were satisfied

Abstract

Introduction

Dianne Bowers, Maxillofacial Prosthetist, Maxillofacial Laboratory, St Luke’s Hospital, Bradford UKChris Maryan FIMPT, Principal Lecturer, School of Biology Chemistry & Health Science, Manchester Metroploitan University, Manchester UKPeter Gough, Senior Lecturer, School of Biology Chemistry & Health Science, Manchester Metroploitan University, Manchester UK


A web-based self-reporting questionnaire was designed

to identify:

the provision of custom made nipple areola •

prostheses in the UK

the range of materials and techniques used, and to •

evaluate their popularity

the percentage of laboratory managers and •

prosthetists involved and their gender

variation in service provisions, patient usage, referral •

patterns, review policies and disciplines which may

benefit from further information on the service

provided by the MPT

whether the service was developing and over •

what period

The questionnaire, approved by the Council of the

Institute of Maxillofacial Prosthetists & Technologists, was

made available online to all members (approximately 200

members in approximately 100 units around the UK).

The membership was informed of the location of the

questionnaire by e-mail. The questionnaire was delivered

online using a form linked to a MySQL database table.

After completion, the form was written to the database

using PHP (Hypertext Pre-processor) scripts.

The questionnaire included open and closed questions,

as well as scaled responses. The responses to open

questions were completed in text boxes. Closed questions

or scaled responses were recorded using response

buttons or drop down menus. The records were exported

into Microsoft Excel® for analysis.

Alternate questionnaires were available for prosthetists

and laboratory managers. The questionnaire for managers

included questions about unit policy as well as questions

about their own practice. The questions were separated

as some managers may not have treated these patients.

or very satisfied. No multi-centred trials have been

undertaken; the materials and techniques available

suggest a possibility of national provision.

The aim of the study was to examine current practice.

Experimental design

Twenty two laboratory managers and twenty nine

prosthetists responded (approximately 25% in total

and by unit) which is disappointing for a professional

organisation of practitioners working in this area.

Service provision

The service for the prosthetic nipple areola complex has

been provided for an average of 8.8 years. The majority

of laboratory managers who responded (54%) felt it

should be a designated person who is responsible for

the service, and felt it was important that the prosthetist

develop a confidential relationship based on continuity

of care. However, a large minority (41%) feel that it is

not appropriate to allocate one prosthetist full-time to the

role and that all prosthetists should be capable of treating

these patients.

Ninety one percent of laboratory managers who construct

these prostheses also treat the patient themselves.

This means, with only 18% of all laboratory managers

questioned being female, 55% of prosthetists treating

patients requiring NAC are male.

Referrals

Fifty percent of the managers stated that they receive

fewer than 20 referrals per year and 5% are over 75, as

shown in figure 1.

Method

Results

“Alternate questionnaires were available for prosthetists and laboratory managers”

Figure 1. Number of referrals per year.

60%

50%50%

27%

18%

5%

40%

30%

20%

10%

0%0-20 20-50 50-75 75-100

Referrals mainly come from plastic surgeons, with the

lowest percentage of referral rates coming from general

practitioners, see figure 2.

Table 1. Method of construction of NAC prostheses.

What is the most common technique that you use for the construction of nipple prostheses?

Laboratory Manager (%)

Prosthetist (%)

Open Mould

Flask & Pack

Other

27.27

68.18

4.55

51.72

44.83

3.45

Table 2. Methods of retention.

What is the most common type of retention used? Laboratory Manager (%)

Prosthetist (%)

Adhesive

Suction

Sticky Gel

Petroleum Jelly

Other

31.82

27.27

18.18

4.55

18.18

48.28

17.24

13.79

10.34

10.34

Table 3. Pressure sensitive adhesives provided.

Laboratory Manager (%)

Prosthetist (%)

Total(%)

Cosmesil

Technovent Cream Adhesive G602

Technovent B460 thin

Klebi

Daro hydrobond

Secure

Prostick-Shermans

Hollister medical adhesive

Nil

8

1

0

0

1

4

0

1

6

9

2

1

1

1

1

1

0

0

46

8

3

3

5

14

3

3

16

Forty five percent of managers reported that there was

no formal recall system in place; some only reviewing

when the patient makes contact with the department for

replacement prostheses, and 64% reported a waiting list.

Materials and techniques

The most commonly used material for the impression was

silicone elastomer, which were used by 81% of managers

and 72% of prosthetists.

The construction technique most widely used by the

laboratory manager was flasking and packing. However,

the open mould technique was the preferred method by

the prosthetists, see table 1.

Contributing factors of life expectancy were frequency of

wear, patient motivation and maintenance. Other issues

include material fatigue, such as delamination of tacky

gel, and the use of adhesives which is thought to shorten

life expectancy of the prosthesis. The use of the adhesive

for retention of the prosthesis however, was inconsistent,

with the results of the questionnaire with the departments

using adhesive stating that the prosthesis life expectancy

ranged anywhere between six to twenty-four months.

Only 36% of laboratory managers and 38% of prosthetists

audit their patients’ satisfaction, one stating that they

have never had any negative feedback. However, 36%

of laboratory managers and 49% prosthetists claim that

fewer than 25% of the patients return for replacement

prostheses, and an even larger 45% of laboratory

managers and 52% prosthetists claim that less than 25%

require a nipple prosthesis after two years.

This questionnaire-based study examined current practice

in maxillofacial prosthetic services to identify variation in

patient management, service protocols and manufacturing

techniques. All members of the IMPT were contacted by

email and invited to complete an online questionnaire.

The online questionnaire was valuable in the process of

investigation; positive feedback was given on the ease of

completion. Unfortunately, some of the information could

not be used. This was due to the set amount of words

allocated to open questions and comments which resulted

in foreshortened answers. This was noted early in the

study and rectified; however, valuable information from

early respondents was lost.

The most common form of retention for the prosthesis

was adhesive (Table 2), with Cosmesil PSA1 the most

popular (Table 3).

Patient management

Most laboratory managers supplied the patient with two

prostheses whereas prosthetists supplied the patient with

four prostheses. Both, however, supplied the prosthesis

after two consultations.

The life expectancy of the prosthesis varied, with the

highest percentage of laboratory managers suggesting

six to twelve months, and the prosthetists claiming a life

expectancy of 12 months. Over 60% claimed a prosthesis

life expectancy of less than 18 months.

Figure 2. Referring disciplines.

60%

70%

50%

4.559.09

22.73

63.64

40%

30%

20%

10%

0%GP General Surgery Breast Care Nurse Plastic Surgery

Discussion


1. National Statistics Online. Breast Cancer Incidence rises while deaths continue to fall. 2007, London, National Statistics, (cited 2008 Feb 24).2. Carol Bird. Introduction to breast care. Whurr Publishers, London. 2003. P.86, 147.3. Altchek ED. Method for accurate determination of the site of nipple areola reconstruction (letter). Plastic and reconstructive surgery, 1982, 70 405. 4. Dinner MI, Dowden RV, Labandter HP. A useful aid in positioning the reconstructed nipple. Ann Plast Surg. 1983 Mar; 10(3):247. 5. Ward CM. The uses of external nipple-areola prostheses following reconstruction of a breast mound after mastectomy. Br J Plast Surg. 1985 Jan; 38(1):51-4. 6. Breast Cancer Care, A confident choice. Breast prostheses, bras and clothes after surgery, London, (cited: 25.08.11) available from http://www.breastcancercare.org.uk/upload/pdf/Confidenchoice_ERJ.pdf7. Parkinson S. Establishing a Custom-Made Nipple-Areola Prosthesis Service. The Journal of Maxillofacial Prosthetics & Technology 1999, 3;16-19.8. Janes S. Custom-made nipple prosthesis: A long-term satisfaction survey. J Can Res Ther [serial online] 2005 [cited 2008 Feb 24]; 1:111-3. Available from: http://www.cancerjournal.net/text.asp?2005/1/2/111/16712. 9. Roberts AC, Coleman D J, Sharpe D T. Custom-made nipple-areola prostheses in breast reconstruction. British Journal of Plastic Surgery, 1988, Vol 41, P.586-587. 10. Sainsbury R, Walker VA, Smith PM. An improved nipple prosthesis. Ann R Coll Surg Engl. 1991 Mar; 73(2):67-9.11. Ullmann Y, Peled IJ, Laufer D, Blumenfeld I. Nipple-areola reconstruction with a custom-made silicone ectoprosthesis. Ann Plast Surg. 1992 May; 28(5):485-7. 12. Thomas KF. Prosthetic rehabilitation, Quintessence books, London, 1994. P.9, 29, 30, 52, 139-145, 147-150.13. Insole S. A Method for Construction of a Custom-Made Nipple Prosthesis. The Journal of Maxillofacial Prosthetics & Technology 1999, 3;10-12.14. Breast Cancer Care, Standards of care for breast prosthesis fitting services, London, (cited 2011 Aug 25 ). Available from: http://www.breastcancercare.org.uk/upload/pdf/breastprosthesis_web_1.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/3967113?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

References

Although the response rate was low, it identified a

variety of treatment modalities. The materials, methods

of construction, and auditing of patients all vary. Staffing

issues for the service proved complex and dependent

upon numbers of referrals and current staffing. The need

for the evaluation of the benefits of dedicated female

prosthetists to provide the service was identified.

The study identified the need for service audits to be

undertaken to evaluate effectiveness, and the need for

further multi-centre studies.

The return was approximately 25% of the membership

of the IMPT; possible reasons for a low return

could have been that only members who provide the

service responded. An assumption that over 75% of

units do not provide the service cannot be drawn

from this data. The survey should have been designed

to ensure the recording of a nil response with the

information for respondents providing a rationale for

recording a nil response.

The questionnaire was anonymous with no indicators of

location of respondents so regional comparisons are not

possible either to establish possible service/workforce/

training needs, (although this was beyond the scope of

this research).

It would seem that there is considerable variation

between maxillofacial prosthetic departments and

between managers and prosthetists in the methods of

treatment, materials used, construction techniques, and

auditing of patients. One respondent stated that a female

MPT should be responsible for the treatment of post

mastectomy rehabilitation. Whether the female patients

would prefer a female MPT to treat them has not been

investigated in this study; however, breast cancer care

guidelines state that patient should have the choice of

a female prosthetist.14 Patient care is the most important

aspect of treatment and patient confidence may be

enhanced if one MPT is to undertake the treatment so

they may gain a sense of rapport.

The referral rate is highest from plastic surgeons, with

the lowest being from general practitioners. This could

indicate the need for further information on this service

from the MPT or it could indicate that the service has

been provided earlier in the treatment by referral from

the plastic surgeon or the breast care nurse who will be

largely involved with the patients’ care.

The majority of respondents have stated that the life

expectancy of the prosthesis is approximately six to

twelve months depending on various factors.

However, this does not correspond with the results of

the questionnaire, with some departments using adhesive

stating a life expectancy of anything between six and

twenty-four months.

The number of patients returning for replacement

prosthesis is low, as were patients returning after

two years. With the life expectancy of the prosthesis

being between six to twenty-four months, it would be

expected that more patients would return, especially as

it was stated that the audit has never returned negative

feedback. The fact that few patient are returning could be

due to many factors - surgical reconstruction, declining

personal need, recurrence of the disease, a poor recall

system, or the life expectancy of the prosthesis is

greater than expected.

It should be noted, however, that the life expectancy

of the prosthesis would increase with a decrease in

patient usage; a prosthesis which is worn every day by

the patient would expire more quickly than a prosthesis

which is only worn when the patient requires. The lack

of formal review mitigates against effective clinical audit

but the cost and resource implications could be significant

if an effective recall system is implemented.

Conclusion

“The majority of respondents stated that life expectancy of the prosthesis is approximately 6 to 12 months...”

A modification to prevent vertical compression in intermediate silicone wafers for orthognathic surgery

The use of silicone for the construction of occlusal

wafers for orthognathic surgery was first described

by Sunderland and Bainton in 1995.1 They used a

bite registration silicone with a Shore A hardness

of 76 and noted a number of advantages including

high translucency, flexibility allowing for minor tooth

movements, dimensional stability and a time/cost saving

over other materials.

They noted that the wafers lacked lateral stiffness and

that they could compress in thick sections, so care was

required with temporary intermaxillary fixation (IMF) in

bi-maxillary procedures. This technique did not allow

for the inclusion of attachments to fix the wafers to the

jaws during surgery, and the silicone material used lacked

lateral stiffness and did not give sufficient working time

for easy construction.

To overcome these problems, a development of this

technique was described by the author et al in this

journal in 2004, which allowed for a longer working time

prior to curing.2 The article described how a wire stiffener

could be incorporated that included loops for attachment

during surgery, and also how it gave the benefit of

considerable time savings over previously used methods.

East Lancashire Hospitals’ maxillofacial laboratory has

now constructed around 340 wafers using the technique

and the author is aware that this method is now in use in

a number of maxillofacial units in the UK.

Model surgery preparation and articulation is the same as

for conventional silicone wafers.

1. A softened strip of dental modelling wax, with

a width slightly greater than the vertical occlusal

opening, is adapted between the upper and lower

occlusal surfaces in a vertical orientation following

the incisal edges of the anterior teeth and the occlusal

fossae of the posterior teeth.

2. After cooling, the wax strip is removed from the

articulator and trimmed until the edges follow the

The only disadvantage is that thick intermediate wafers

can still compress with inappropriate loading during

the application of temporary IMF. Provided surgeons

are aware of this it does not usually present a major

problem, although some have experienced more difficulty

than others in controlling this. Recently however, a case

presented with an anterior open bite that required a

12mm posterior and 5mm anterior maxillary impaction

(Figures 1 and 2).

It was obvious that a silicone wafer of this depth would

need to be stiffened to prevent vertical and lateral

displacement. The author therefore developed the

technique described below to overcome this problem,

which can readily be used for any intermediate wafer

over 6mm thick.

This technical note describes both the construction

and method of inclusion in silicone occlusal wafers

of a supporting element to maintain the correct

vertical dimension when applying temporary

inter-maxillary fixation in maxillary orthognathic

surgery procedures. The reasons for development

and the advantages realised are outlined.

Abstract

Introduction

Method and materials

Gavin J Carmichael FOTA, MIMPT, LBIDST, RDT, Principal MPTEast Lancashire Hospitals NHS Trust, Maxillofacial and Orthodontic Laboratory, Burnley General Hospital, Casterton Avenue, Burnley, BB10 2PQ

Figure 1. Maxilla impacted. Figure 2. Checking planned autorotation.

! !


contours of the incisal and occlusal surfaces. It can

be retried in the articulator to confirm that it is a

good fit. It is then carefully opened out and flattened

to create a template (Figure 3).

3. The wax template is placed on a 125mm square x

2mm thick Erkodur thermoforming blank (E. M. Natt

Ltd, Marchpen House, 45-47 Friern Barnett Road,

London N11 3EG) and the outline of the strip is

drawn on the blank using a suitable marking pen.

The resulting outline is then roughly cut out from

the blank using a wheel-saw (H. S. Walsh and Sons,

243 Beckenham Road, Beckenham, Kent, BR3 4TS)

mounted on a standard dental mandrel and finished

to shape with a conventional acrylic trimming bur.

4. Following removal of the protective polythene layer,

the resulting shaped strip of Erkodur is heated with a

hot air torch (E. M. Natt Ltd) and formed into an arch

shape before finally adapting onto the articulated

models in the same location as the wax template.

Any final trimming can be done to allow it to seat

on the models without interfering with the vertical

dimension. The edges of the strip do not need to be

in hard contact with the occlusal surfaces and incisal

edges, as a slight clearance is needed for the silicone.

It should, however, remain locked between the

posterior teeth when the articulator is moved around.

5. The Erkodur strip is then randomly perforated all

over using 2mm rose-head bur or similar (Figure 4).

6. A 30 cm length of 0.7mm soft stainless steel wire (K.

C. Smith Monmouth Ltd, Hadley Works, Cranbourne

Road, Potters Bar, Herts, EN6 3JL) is then threaded in

and out of the upper row of perforations starting at

one distal end and forming a series of loops around

the buccal and labial aspects of the arch before

finishing by tying off at the other distal end.

(Figure 5).

The resulting loops should project just outside an

imaginary line between the upper and lower buccal

and labial aspects of the teeth (Figure 6).

7. The arch strip is then re-tried onto the articulator

to check for fit and position of the loops. It is then

removed and cleaned with isopropyl alcohol, and

air dried. A layer of silicone primer (P.U.M.A. soft

adhesive, DT&Wright) is applied to all surfaces of

the strip, care being taken not to touch the primed

surface once it has dried. At this point, any labels to

be included in the wafer for identification/orientation

can be applied to the labial aspect.

8. To construct the wafer, after applying an appropriate

separating medium or soaking the models,2 a layer of

silicone is applied to both upper and lower occlusal

surfaces,2 then the arch strip is carefully placed onto

the lower occlusal/incisal surfaces and the articulator

is closed.

9. A thin layer of silicone sufficient to encase the strip

is then carefully applied over the buccal, labial and

lingual surfaces of the strip and smoothed with

fingers dipped in soapy water.2

10. The silicone is then allowed to cure, either

under pressure, or by bench curing as per the

Figure 3. Wax strip flattened to form template.

Figure 6. Showing relationship of loops.

Figure 4. Lateral view of finished strip to illustrate perforations.

Figure 5. 0.7 mm soft wire woven into support.

!

!

! !

1. Sunderland T, Bainton R. A New Technique for the Construction of Interocclusal Wafers in Orthognathic Surgery. Br J Oral Maxillofac Surg 1995; 33: 321-322.

2. Carmichael GJ, Cousin GCS. Morton, ME. Thompson, E. Silicone Occlusal Wafers for Orthognathic Surgery - Fabrication and Clinical Application. J Maxfac and Prosthet Techno 2004; 7(1): 1-5.

References

Figure 8. Labial view showing label.

Figure 9. Upper occlusal view showing projection of loops.

!

!

A method of providing vertical support for thick silicone

occlusal wafers has been described. This eliminates the

remaining disadvantage associated with this technique

whilst retaining all the other advantages.

The method outlined gives a number of advantages

over that previously described for intermediate wafers.2

The Erkodur strip is self supporting, provides a useful

platform for the wire loops and label, and gives support

for the silicone build up, without the need for any wax

dams to be applied.

The construction time is approximately the same due to

the time saving gained by using soft wire to create the

loops instead of having to bend a hard wire stiffener

incorporating loops and subsequent waxing into position.

Conclusion

Discussion

“The method outlined gives a number of advantages over that previously described for intermediate wafers”

manufacturer’s instructions. The author routinely uses

pressure curing to eliminate any air trapped during

build up.

11. Following curing, the wafer is removed from the

articulator and any excess material trimmed with

scissors or a sharp scalpel blade. Detailed finishing

and shaping may be done using sharp soft-lining

burs. With careful build-up of the silicone, there

should not be any need for bulk removal of material.

After cleaning in warm soapy water and rinsing in

clean tap water, the wafer is air-dried and a layer of

Dreve® Odontosil Lacquer/Varnish (fume extraction

must be used with this material) or Molloplast Lustrol

Gloss Varnish (DT&Wright) is applied and left to dry.

After drying in a fume extraction unit, any residual

solvent fume can be driven off by placing in a dry

heat oven at 60° C for one hour (for Odontosil

lacquer only).

12. The finished wafer can now be re-fitted to the

models and checked before packaging for despatch

(Figures 7, 8 & 9).

Figure 7. Lingual view of completed wafer.

!

An average 2 - 3mm thick layer of silicone over the 2mm

thickness of Erkodur means that the wafer is as free of

bulk as possible but remains laterally and vertically stable.

The layer of silicone against the tooth surfaces retains the

resilient fit that give silicone wafers such an advantage

over hard acrylic types, where minor, unseen impression

imperfections and/or tooth movement occurring between

impression taking and operation, can cause fitting

problems.2 The slight loss of clarity apparent compared

with the previous technique is a minor price to pay for

the increased stability and does not affect the function of

the wafer.

Whilst the vertical dimension of the case illustrated is

highly unusual, there is no reason why this method

cannot be adopted for most thick intermediate wafers

over 6mm.

Technical noteProfile dressings: the first restorative approach for head and neck external resections

Different degrees of emotional instability have been

noticed in head and neck patients who have had anatomy

resected and where surgical reconstruction was not

an option.1 The radical change in facial profile these

operations can deliver may leave patients unwilling to be

exposed to the scrutiny of society. Even visits from family

members or neighbours could be unwelcome.2,3

Refusal from some patients to see and consequently start

accepting their new appearance can cause anxiety and

fear of such an event. The return to a normal routine post

operatively is known to aid patient rehabilitation.4

The cohort of patients who encounter nasal surgical

resection regularly includes spectacle wearers where

requirement of three points of support (ears and nose) is

essential. This support is not provided by conventional

dressings, as shown in Figure 1a below, and compared

with an anatomical dressing in Figures 1b and 1c.

Fabrication of a profile dressing requires an extended

impression of the area which is going to be or has been

resected. To avoid patient discomfort, this can be taken

during surgery when the patient is anaesthetised. Silicone

impression material (Epiform Flex Institut Schilling

Gmbh, Claude Hill Dental DY5 3UP and Coform M518

Impression Silicone Hard, Technovent Principality House,

Western Valley Road, Rogerstone, Newport NP10 9DS)

was found to be easier to spread and stabilise on the area

involved than alginate (Figure 2a).

The impression is cast in dental stone to create a

model. If the patient underwent resection in a previous

operation, the impression would follow the contour of

the defect area (Figure 2b). The missing anatomy can be

carved in wax directly onto the model. Pictures of the

patient before surgery or family members with a similar

anatomy can also be valuable to use as a guide in the

carving process (Figure 2c).

The profile dressings were then constructed with

crepe cotton stretch bandage and a 3mm thick soft

thermoforming blank (Erkodent Erich Kopp Gmbh, E.

M. Natt Ltd, 45-47 Friern Barnet Road, London N11 3EG)

which are bonded together with a pressure-forming

machine (Figure 3a).

Three methods of construction have been utilised:

1. Dressings with bandage underneath the

thermoforming blank.

A plaster model of the missing anatomy and its contour

was required (Figure 4).

The bandage was extended to cover the model, and

a soft thermoforming blank was pressed against the

bandage on the model once heated in the thermoforming

machine (Figure 5).

2. Dressings with bandage above the

thermoforming blank.

A negative model in the flask of the thermoforming

machine was created with a plaster model and can be

made with putty as shown in Figure 4. The bandage

is extended on the negative model and a soft

thermoforming blank is pressed as described previously.

3. A new design has been developed and tried recently.

The plaster model with the profile required is

constructed and a soft thermoforming blank pressed as

described previously. Once trimmed to the desired shape,

a tape apertured non-woven synthetic adhesive (Mefix

or similar) was self adhered onto the outer surface of the

profile dressing.5

Absorbent self-adhesive soft silicone dressing, which

incorporates a thin sheet of polyurethane foam (Mepilex

Border or similar, Mefix tape and Mepilex border:

Mölnlycke Healthcare, AB Box 13080, SE-402 52,

Göteborg, Sweden) was stuck to the edge of the profile

dressing to provide cushioning.6

With all three designs described above, the contour of the

fabricated dressings are trimmed with scissors and tried

on the patient to ensure comfort and good fitting.

The following article describes a technique

of using anatomical dressings which replicate

a resected area soon after surgery to re-establish

patients’ confidence, lifestyle and quality

of life. This methodology was introduced in

Poole Hospital having been developed and used

extensively for nasal profile dressings at University

Hospital Birmingham. Further development of

this procedure was performed at Poole Hospital

for the construction of orbital and auricular

profile dressings.

Keywords

Surgical dressing, external resection


Abstract

Introduction


Carmen Orbaneja Botija, MIMPTMaxillofacial Prosthetics Service, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB

Figure 3a. Stretch bandage and soft thermoforming blank.

Figure 4. Plaster positive model and putty negative model in Erkopress flask.

Figure 6. Second design, orbital and auricular dressing with bandage above.

Figure 1a. Standard dressing.

Figure 2a. Impression.

Figure 1b. Nasal profile dressing.

Figure 2b. Model.

Figure 1c. Glasses can be worn.

Figure 2c. Wax carving.

Figure 5. First design, nasal dressing with bandage underneath.

Figure 7. Third design of profile dressing: lateral aspect.

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1. Rieger J. et al. Surgical reconstruction versus prosthetic obturation of extensive soft palate defects: a comparison of speech outcomes. Interntl J of Prosthodontic 2009; 22,6:566-572

2. Thomas KF. Prosthetic Rehabilitation, Quintessence publishing 1994; 33

3. Changing Faces. Introduction to patients needs http://www.changingfaces.org.uk/show/feature/search/HEALTH-Introduction-to-patient-needs. Registered Charity No. 1011222

4. Dr Happ, Ms Roesch, Dr Kagan. Communication needs following head and neck surgery: Quality-of-life perceptions, disfigurement, and socialization. Cancer Nursing. 2004; 27(1) http://www.medscape.com/viewarticle/468719_2

5. SMTL dressings data card. Product name: Mefix. Revision author: Dr S Thomas. Revision number: 1.3. Revision date: 16/12/1997 http://www.dressings.org/Dressings/mefix.html

6. SMTL dressings data card. Product name: Mepilex Border. Revision author: Dr S Thomas. Revision number: 1.10. Revision date: 21/05/2009 http://www.dressings.org/Dressings/mepilex-border.html


References

Regardless of which design is adopted, anatomical

dressings can benefit patients as they regain their

previous facial profile and the defect area is not

noticeable by others. They also protect the tissues against

trauma and provide support for spectacles and hearing

aids which may aid a return to previous lifestyle.

I would like to thank the following colleagues:

Mr. Steve Worrollo, FIMPT, Consultant Maxillofacial

Prosthetist, University Hospital, Birmingham, for his

valuable support while training at his department.

Mr. David Ellis, MIMPT, Consultant Maxillofacial

Prosthetist, New Cross Hospital, Wolverhampton, for

instructing the author in the described technique.

Mr. Mark Townend, FIMPT Maxillofacial Prosthetist

Head of Service, and Mrs. Heidi Silk, MIMPT, Principal

Maxillofacial Prosthetist, Poole Hospital NHS Foundation

Trust for their help in this technical note

Mrs. Becky Ward, Senior Medical Photographer, Poole

Hospital NHS Foundation Trust, for these photographs.

The first and second designs provide a similar

aesthetic result. From the hygiene point of view, the

type which has gauze above the blank is easier to clean,

making it longer lasting. The third design described,

however, has two advantages. The outer layer of

adhesive tape and the rim of silicone dressing can be

easily replaced for new ones without the requirement of

another soft blank substructure, as this can be cleaned.

As tissue contracts when healing, the contour of the

defect area modifies. Sections of foam dressing may be

adhered to avoid any gapping, saving patients’ discomfort

and clinical time for the taking of future impressions.

Conclusion

Acknowledgements

Discussion

“The third design described has two advantages”

They can be held to the skin with medical tape, elastic,

silicone sheet or hypoallergenic surgical tape, the latter

two being kinder to sensitive skin. These dressings are

ready to use when it is safe to load the tissue

post surgery.

Articles of interest

This first paper describes the construction of an

obturator and nasal prosthesis for a patient with

microstomia, following resection of the maxilla,

upper lip and nose. It is an interesting case where

implants are contra-indicated, leading to the obturator

and nasal prostheses being connected by magnets.

The use of CAD/CAM in orthognathic surgery planning

has long been talked about. Here are two articles that

use computer technology in different ways to assist in

orthognathic planning and construction of surgical guides.

The first paper gives an easy to read overview of image

acquisition, planning and printing of surgical wafers. It

compares CAD/CAM and conventionally produced wafers

and highlights some advantages of 3D planning.

The second paper utilises 3D planning by printing

templates that are converted into cobalt-chromium

and screwed into the bone during surgery to position

the maxilla. This is a longer and more labour intensive

procedure than wafer printing, but rapid manufacture of

the templates is alluded to in the discussion.

Next is the presentation of a case study rehabilitating

a maxillectomy patient using zygomatic implants.

Surgical procedure, obturator construction and leverage

considerations are all discussed.

Finally, this is a good paper should you ever

need proof of the need for immediate obturation

following maxillectomy.

Bidra A.S., Montgomery P.C. and Jacob R.F.

Maxillofacial rehabilitation of a microstomic patient

after resection of nose, lip and maxilla. Journal of

Oral and Maxillofacial Surgery. 2010:68:2513-2519

Centenero S.A-H. and Hernández-Alfaro F.

3D planning in orthognathic surgery: CAD/CAM

surgical splints and prediction of the soft and hard

tissues results – our experience in 16 cases.

Journal of Cranio-Facial Surgery. 2011,

doi:10.1016/j.jcms.2011.03.014

Shizhu Bai, Bin Bo, Yunpeng Bi, Bo Wang, Jinlong

Zhao, Yanpu Liu, Zhihong Feng, Hongtao Shang,

Yimin Zhao.

CAD/CAM surface templates as an alternative to

the intermediate wafer in orthognathic surgery.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

2010:110:e1-e7

Shirota T., Shimodaira O., Matsui W., Hatori M. and

Shantani S.

Zygoma implant-supported prosthetic rehabilitation

of a patient with a maxillary defect.

Int J Oral Maxillofac Surg 2011:40:106-123

Süha T., Baykul T., Aydin A. and Mustafa Özarslan M.

Influence of immediate and permenant obturators

on facial contours: a case series.

Cases Journal 2009:2:6: doi:10.1186/1757-1626-2-6

Compiled by Caroline Reed AIMPT, BSc (Hons), DPSMaxillofacial Prosthetist, Queen Victoria Hospital, East Grinstead

Abstracts2011 IMPT Congress, Birmingham, UKLecture Program


10 years’ experience with Zygomatic Implants for extra oral prosthetics

Results with titanium mini plates for bone anchorage of craniofacial prostheses

The validation of an improved articulator system for orthognathic model surgery

The effectiveness of pressure splints on keloid scars

Evolution not Revolution: Integrating advanced digital technology into maxillofacial prosthetics

3D modelling and surgical planning in free tissue transfer; a short case series and review

Peter Ll. Evans MIMPT

Consultant in Maxillofacial Prosthetics

Maxillofacial Laboratory, Welsh Centre for Burns Plastics

and Maxillofacial Surgery, Morriston Hospital,

Swansea SA6 6NL, UK; [email protected]

Implants for the retention of nasal and mid third

facial prostheses have a relatively poor survival rate,

especially in those patients who undergo an oncological

radiotherapy regime. We report on an improved survival

rate using Zygomatic Implants placed across the maxillary

sinus in 24 patients from 1999 to 2011 with survival and

failure rates over this period. The presentation describes

the computer planning necessary to place the implants,

the guide-led surgical technique and also the retentive

mechanisms that are best suited to these fixtures.

Philippe Federspil

Consultant Ear Nose and Throat Surgeon; Heidelberg,

Germany; Vice President of the IASPE

University Hospital Heidelberg, Oto-Rhino-Laryngology,

Heidelberg, Germany

Purpose:

For the past 30 years, the Brånemark titanium fixtures

have represented the first and the most widely used

system for extra-oral percutaneous bone anchorage of

epitheses. However, in areas with lower bone availability

or quality such as the orbital and nasal region, the

implant placement is more critical. Hence, the idea to use

Pauline Paul MIMPT, MSc

Principal Maxillofacial Prosthetist

Maxillofacial Laboratory, Regional Maxillofacial Unit,

Neurology Building Ground Floor, Southern General

Hospital, Govan Road, Glasgow, G51 4TF, Scotland

A review of the literature showed that the outcome of

orthognathic surgery may differ from the pre-operative

planned prediction, that casts mounted on semi-adjustable

articulators show systematic errors of orientation and that

there may be a casual connection between them.

It was demonstrated that movements of casts mounted

on, and moved relative to, a standard articulator produced

movements of different magnitudes relative to the natural

head position. These movements produce significant

errors in relation to the prediction outcomes, which are

transferred to the patient via the perioperative wafer.

A mathematical model was developed to quantify the

difference and the predictions of the resulting equations

were confirmed in a photographic study using image

analysis.

The second stage of the study compared a standard

and the improved orthognathic articulator. The results

indicated that the improved articulator was significantly

more accurate than the standard articulator.Andrew Richmond MIMPT


Maxillofacial Laboratory,

Nottingham University Hospitals Trust, Derby Road,

Nottingham; [email protected]

3D modelling and rapid manufacturing is now an

everyday part of a full maxillofacial prosthetic service.

This paper describes the use of this technology in respect

of complex reconstruction and free tissue transfer.

In 19 cases utilising this method, the authors have found

that the technique is very useful for providing predictable

outcomes in surgery. It also reduces theatre time,

improves accuracy of the plating, reduces donor site

harvesting, and, importantly, ensures an improved and

informed patient consent to this complex and sometimes

problematic treatment option.

Graham Marshall MIMPT

Maxillofacial Laboratory, University Hospitals of Leicester

NHS Trust; [email protected]

A two-year retrospective audit to evaluate the

effectiveness of pressure therapy in keloid scars.

James Dimond MIMPT


Maxillofacial Prosthetics, 2nd Floor, Old Queen Elizabeth

Hospital, Edgbaston, Birmingham, B15 2TH;

[email protected]

The combination of Medical Imaging, Computer Aided

Design Software and Rapid Prototyping is a rapidly

expanding field with a large application potential in

maxillofacial prosthetics. Digital technology is used

routinely across the globe in a vast range of industries

and professions. It can be implemented into the daily

maxillofacial procedures associated with post-traumatic

reconstruction, orthognathic planning, cranioplasty

manufacture, pressure therapy and facial prosthetics.

Manipulation of data using specialised software in the

3D environment can improve efficiency by eliminating

traditional labour intensive techniques and produces

predictable results that can be utilised in a number

of ways.

This brief presentation gives an overview of acquisition

and manipulation of data, current and potential uses

a different form of implanted retention system as known

from osteosynthesis in craniofacial traumatology. Since

the year 2000, we were involved with the adaptation of

2.0 titanium miniplates for the needs of surgical epithetics,

called the Epiplating system, intended to overcome some

of the drawbacks of other systems.

Material and Methods

This study is a retrospective review of the patients

implanted with the Epiplating system at the University

Hospital Homburg 2000-2004 and University Hospital

Heidelberg, Germany, 2004-2010. Out of a total of 380

patients treated with titanium implants, 95 patients

received Epiplating implants solely or in combination

with other systems for bone anchored epitheses.

Results

185 Epiplating implants were used. Primary stability was

excellent in all cases. In all cases implant placement was

possible. Four plates (2.2%) lost osseointegration. In

five patients, parts of the plate were exposed; however,

without any signs of soft tissue or bone infection. We did

not note an elevated rate of adverse skin reactions at the

skin-penetrating site.

Conclusions

The Epiplating system is an excellent system for bone

anchorage of epitheses, especially in areas with low bone

quality or availability.

Lecture 1

Lecture 2

Lecture 4

Lecture 5

Lecture 6

Lecture 3


A new watusi collar used in the treatment of neck burn hypertrophic scarring

Prosthetic rehabilitation following Meningococcal Septicaemia

Extrinsic sealants - is it all in the timing?

A new patient consultation for a patient with a maxillary defect

Spectacles Adaption for Pressure Point Responsive Blepharospasm

Cranioplasty defects: a review of cases and the development of a classification for referral, identification and audit purposes

Evaluation of cranioplasty plate design and fabrication in the UK

Obturator versus surgical reconstruction of the maxillectomy patient

Yvonne Moore MIMPT

Maxillofacial Prosthetist

Glasgow Royal Infirmary, Prosthetics Laboratory, 2nd Floor

Walton Building, Castle Street, Glasgow, G31 2ER;

[email protected]

This lecture outlines a new design of watusi collar for

the treatment of post neck burn hypertrophic scarring/

contracture, first reported by Hurlin Foley et al. Changes

to the design are discussed. These have improved

hygiene, functional mobility, comfort, cost effectiveness

and negates the need to remake the collar as tissue

changes occur. Three early stage case studies are also

discussed.

Caroline Reed BSc (Hons) DPS


Queen Victoria Hospital, Holtye Road, East Grinstead,

West Sussex, RH19 3DZ; [email protected]

This case study describes the fabrication of bi-lateral

glove prostheses for a 12-year-old girl who had nine

toes amputated due to Meningococcal Septicaemia. The

lecture outlines the construction process; problems

encountered, and offer tips for Maxillofacial Prosthetists

undertaking similar cases.

Heidi Silk MIMPT, BSc (Hons)


Maxillofacial Prosthetics Service, Poole Hospital NHS

Foundation Trust, Longfleet Road, Poole, Dorset, BH15 2JB

Extrinsic sealants are needed to prevent the delamination

of colours added to enhance the aesthetics of silicone

prostheses. This project looks at three different types of

sealants used to create this seal and the times at which

they are applied. Results show that the time of sealant

application has an influence on the success of the bond.

Steve Bailey MSc MIMPT Dip CDT RCSEng


Maxillofacial Unit Pilgrim Hospital, Sibsey Rd, Boston,

Lincolnshire; [email protected]

To include: 1.Examining the patient intra oral examination

– tongue, lips, cheeks, floor of mouth, extra oral

examination facial symmetry, neck nodes, TMJ; 2.

Examining the patients existing prosthesis; 3. Medical and

social history; 4. Diagnosing the problem; 5. Discussing

the treatment options; 6. Formalising the treatment plan.

Dave Allen FIMPT

Queen Victoria Hospital, Holtye Road, East Grinstead,

West Sussex, RH19 3DZ; [email protected]

The paper will seek to give an introduction into the

condition of blepharospasm, along with the traditional

treatment and therapies used in its management.

The paper will then concentrate on pressure point

responsive blepharospasm where the adaption of

spectacles to provide pressure point therapy can improve

the condition.

Dr Muhanad Hatamleh

AIMPT, PhDd, MPhil, BSc (Hons), DPS

Manchester Dental School and Nottingham University

Hospitals Trust, UK; [email protected]

Nottingham University Hospitals Trust is a large regional

trauma unit that provides Neurosurgical services to the

whole East Midlands. Cranioplasty implants have been

provided since 2002 and in-house manipulation of the

data and subsequent rapid prototyping has proved a

useful adjunct to this service.

A review was undertaken utilising the in-house

processing of the DICOM data stored on the hospital

servers. The last 30 cases were chosen as an investigative

sample to look at average size and position of the defects.

This data was then used to classify the defects in terms

of position and size. This interim classification is being

used to identify the defect on initial referral, to provide an

estimate of build time and as part of an on-going

audit project.

Dr Richard Bibb PhD, BSC (Hons)

Loughborough Design School, Bridgeman Centre,

Loughborough University, Ashby Road, Loughborough,

Leicestershire, LE11 3TU; [email protected]

With many methods of cranioplasty production available

and the application of Computer-Aided Design (CAD)

technologies creating further options, there is a need to

measure the cost effectiveness of existing techniques in

order to compare new techniques accurately.

This research investigated the cost implications of

common methods of cranioplasty construction in the

UK. A questionnaire was sent to major UK maxillofacial/

neurological units. The same questions were asked

to each respondent but answers and discussions were

open ended. Records were kept of lab technician time,

material costs, equipment used and equipment lead-

time. A hemi-craniotomy case was chosen as an example

and the results were compared to theoretical Additive

Manufacture (AM) of a plate for this example.

The study found there is wide variation in production

costs but that more efficient CAD and AM methods are

required to ensure economic competitiveness against lab-

based techniques.

Barbara Anne Thomson MIMPT


A literature review on obturation versus surgical

reconstruction appears to be controversial. This

presentation will discuss and elaborate on the treatment

available and examine how they affect the quality of life

for patients.

Multiple published, evidence-based articles state different

advantages and disadvantages for maxillectomy patients,

although limited research has recommended more clarity

on techniques and options available. Published studies

on changes with prosthetic rehabilitation versus surgical

options are limited.

In reviewing the available literature, it is apparent that

there is insufficient evidence in relation to maxillectomy

patients; however, the bulk of the evidence all

acknowledge that more research in to obturation and

patients quality of life (QOL) need to undertaken.

Lecture 7

Lecture 8

Lecture 9

Lecture 10

Lecture 12

Lecture 14

Lecture 13

Lecture 11

of digital technology along with its limitations, and

the benefits that can be gained for the maxillofacial

prosthetist, surgical team, and, ultimately, the patient.


The Future of Retention: CAD-CAM custom made retentive components in facial prosthetic applications

The optimum site for implant placement in the orbital region: A Birmingham Review

Rehabilitation in Head and Neck Oncology: Advantages of implants and digital technology (or not?)

New trends utilising old methods

Three-part-mould technique

A Rapid Prototype (RP) jigsaw technique in the manufacture of a titanium orbital floor implant

A critical comparison of digital technologies in nasal prosthesis production

Jason Watson MIMPT, BSc (Hons)

Consultant Maxillofacial Prosthetist

Maxillofacial Laboratory, Nottingham University Hospitals

Trust, Derby Road, Nottingham; NG7 2UH

[email protected]

Rapid prototyping of 3D models is an everyday part of

a maxillofacial prosthetic service. Since 2008, we have

used in-house 3D models routinely in complex trauma,

craniofacial surgical planning, reconstruction, implant

planning, oncology resection, and deep buried

implant fabrication.

Understanding this technology has allowed us to look at

the use of Rapid Manufacture (RM) in other areas of our

work. We previously presented the use of this technology

in the field of cranioplasty manufacture to the IMPT

(2009). We are now applying this technology specifically

in terms of the retention of facial prostheses.

We have for too long relied on the basic retaining forms

of bars, clips and magnets. The next steps for custom

made bars and individual retention will be described and

its first case. Cost implications will also be addressed.

Hitesh Koria MIMPT, BSc (Hons)



Hospital, Edgbaston, Birmingham, B15 2TH

[email protected]

Since the start of the implant programme in 1988, there

have been significant changes in practice. The ‘ideal’

location for implant placement is of great importance

when considering facial prosthetic rehabilitation, whether

it is for an orbital prosthesis, nasal, auricular or midface.

The focus of this evaluation is to determine the optimum

location for implant placement within the orbital region

to achieve a lower rate of implant failure without

compromising the aesthetics. Many factors such as

lifestyle habits, tumour type/size and surgical skill all

contribute to implant failure.

The records of 20 retrospective patients are examined

to identify the number of implants inserted, the length

and type of implant used, and their placement within

the orbital cavity. The outcome will show which

location within the orbital rim will give best results for

osseointergration with a particular type of implant without

compromising the clinical result for patients.

Dr. Harry Reitsema AIMPT, DDS, PhD

Dept. for Maxillofacial Surgery and Maxillofacial Prosthetics

(Centre for Special Dental Care), University Medical Centre

Groningen, PO Box 30.001, NL-9700 RB

Rehabilitation in Head and Neck Oncology is very

challenging for patient and clinicians. Maxillofacial

Prosthetics plays an important role in the planning and

execution of this process as part of a team approach. New

techniques have become available over the last decades,

but have to be put in place appropriately.

Implantology has deserved its place to improve retention

of prostheses, especially in compromised cases, both

intra- and extra-oraly. However, risks have to be

taken into account as well. For planning, guiding and

construction of (implant retained) prostheses, digital

technology can be of great help, although ‘conventional’

thinking and craftsmanship will still be needed. Strategies

and results from the Groningen UMC Head and Neck

Oncology Team will be presented.

Matt Pilley MIMPT

Specialist in Clinical Prosthetics

University Hospitals of Leicester, Maxillofacial Laboratory/

Prosthesis Clinic; [email protected]

Robert Whitehead

Clinical Prosthetist, Artizan Medical

This paper describes the use of a non–contact structured

light scanning technique, computer aided design (CAD)

and Additive Manufacturing (AM) to produce selected

laser sintered (SLS) models for producing bespoke

prostheses. Non–contact structured light scanning was

used to capture accurate data from life casts. This data

was then post processed to produce SLS models of

the required anatomy for the production of bespoke

prostheses.

The results illustrate the benefits and effectiveness in

terms of accuracy of adopting an integrated surface

scanning, CAD and AM approach to produce lifelike,

anatomically accurate and labour saving prostheses.

Joern Brom AIMPT

Anaplastologist of the IASPE.

Brom Epithetik, Mittermaierstrasse 25, 69115 Heidelberg,

Germany; [email protected]

The lecture presents how to construct a three-piece

sectional mould in plaster and PMMA with locking

devices to enable the production of a large nasal

prosthesis, producing a large hollow silicone prosthesis

with reduced weight while maintaining the extensive

fitting surface. The technique developed can be modified

and utilised in the construction of many prosthetic

devices that require reduced weight because of the

simple construction and nature of application. The

technique produces excellent results and would be a

useful application for others to employ.

Gareth Robinson MIMPT, DPS


Worcestershire Royal Hospital, UK

[email protected]

The presentation explores the use of CAD to mirror

and sculpt an orbital floor onlay jigsaw piece to be

used in conjunction with an anatomical model built

using Additive Manufacture (AM). The improvements

in accuracy, production time and costs are discussed in

the context of downstream use in producing a wrought

titanium orbital floor implant.

Dr. Dominic Eggbeer PhD, BSc (Hons)

PDR, UWIC, Western Avenue, Cardiff, CF5 2YB;

[email protected]

This research helps to identify clinically viable methods

of using digital technologies in extra-oral prosthesis

production. A magnet retained nasal prosthesis case was

chosen as a single case study to illustrate three processes.

Three-dimensional surface capture, computer aided

design and additive manufacture methods were used

to produce a prostheses via a mould tool and directly.

These were compared to lab-based methods used

to create a prosthetic for the same patient. Pictures

of the final prostheses were taken and were subject

to rated qualitative analysis by a panel of observers.

Consideration was also given to the efficiency of the

workflow and clinical viability of the final prosthesis.

Critical comparisons of shape, colour, margins and

position were in favour of a digital version. The results

highlight the most effective method of utilising digital

technologies in facial prosthesis production as well as the

limitations. Future research directions are identified.

Lecture 15 Lecture 17

Lecture 19

Lecture 20

Lecture 21

Lecture 16 Lecture 18


The development of measuring tools for artificial eye research

An IMPT Survey: The design and manufacture of retention mechanisms for auricular prostheses

Evaluation of a new method of face-bow registration

Evaluation of colour stability in ocular prostheses

Using the Spectromatch Reality colouring system

Keith Pine BSc MIMPT, MBA

P.O. Box 31 306, Milford, Auckland 0620, New Zealand;

[email protected]

Hurst et al have created a photographic grading system

for contact lens deposits but in order to investigate

artificial eyes, an alternative method for displaying and

measuring deposits needs to be developed.

The nature and dynamics of deposition on artificial

eyes is very different from deposition on contact lenses.

Deposits revealed by the staining solution used in this

presentation form over all artificial eye surfaces except

perhaps for the inter-palpebral zone. Because the body

of an artificial eye is opaque, only very thick deposits are

visible unless they are stained. Contact lens deposits on

the other hand exist in the inter-palpebral zone and can

easily be seen because the material on which they form

is transparent.

This presentation describes a technique for displaying

and grading deposits on artificial eyes and for grading

conjunctival inflammation in anophthalmic sockets. The

development of the grading scales included consultation

with experienced ophthalmologists and optometrists

using perceptual and physical attributes.

Steffan Daniel BSC, MSc

PDR UWIC, Western Avenue, Cardiff, UK. CF5 2YB;

[email protected]

Research literature on user requirements and evaluation

of current extra-oral retention mechanisms is limited.

Computer Aided Design (CAD) in maxillofacial

prosthetics is becoming more common, but without user

requirements and performance specifications, proposed

new designs cannot be evaluated. This study captured

user requirements based on maxillofacial prosthetist and

technician opinions and evaluation of their work in order

to inform the development of new mechanism design.

A survey was distributed to IMPT members to discover

their preferences in designing and fabricating auricular

retention systems. Opinions on CAD were also captured.

The surveys showed that there are many factors that

determine the success of retention devices and the

success of current devices are largely based on subjective

measurements. There were also mixed opinions on

the application of CAD. Newly developed solutions for

retention devices must meet the user requirements and

match the performance of benchmark designs created by

maxillofacial prosthetists and technicians.

Elaine Baird DPS

Maxillofacial Laboratory, Southern General Hospital,

Regional Maxillofacial Unit, Neurology Building , Ground

Floor, 1345 Govan Road, G51 4TF

[email protected]

The poster demonstrates how a modified face bow

designed to be used in conjunction with a semi-adjustable

articulator has improved the accuracy of orthognathic

surgery. Therefore reducing unseen and unwanted

movements presently incorporated in commonly used

orthognathic model surgery techniques.

Holly Turner BSC

Trainee Maxillofacial Prosthetist


Hospital, Edgbaston, Birmingham, B15 2TH

[email protected]

Objectives

To evaluate the colour stability of light cure denture

pigments after being subjected to two curing cycles,

and conclude if this medically tested material would be

suitable for iris painting. The effect of background colour

on overall colour of the pigment was also assessed.

Materials and Methods

36 disks were prepared in four shades. Three disks from

each shade were painted with polar pigment, three with

umbre and three with white. Colour was then measured

using a colorimeter prior to curing, after one cure then

after a second and change in values calculated.

Lawrence Dovalski MIMPT, BSc

Maxillofacial Laboratory, Welsh Centre for Burns, Plastics

and Maxillofacial Surgery

[email protected]

The Spectromatch Reality colouring system is a new facial

and body prosthetic silicone colour system available in

the UK. The improvements in colour stability have been

researched and documented; we present our practical

analysis of the system, including working practice, costs

and time savings. The presentation will include direct

comparison to one of the more traditional

colouring systems.

Lecture 22

Poster 1 Poster 2

Poster 3

Lecture 23

Abstracts2011 IMPT Congress, Birmingham, UKPoster Program


The Nasal Hook

Production and use of a customized space-saving inhalation mask

Custom-made attachments for auricular prostheses

The socket’s response to artificial eye wear

The physical, chemical and biological nature of deposits on artificial eyes

Muciod discharge associated with artificial eye wear

Protocol for the management of keloid scars - a technical perspective

Joern Brom

Brom Epithetik / University Hospital Heidelberg,

Department for Head and Neck Surgery Heidelberg,

Germany

Purpose

The supply for facial defects is a great challenge for the

Anaplastologist. Epitheses supplies at existing rudiments

or after partial resections are particularly difficult

to provide.


A 59-year-old patient agreed to his nose ablation to keep

the front part of the nose. During the tumor surgery, a

medicon nasal-plate was inserted - the front part of the

nose (tip of the nose) didn’t become resection.

Results

After eight weeks, the defect could be provided with an

implant fixed epithesis. The problem was how to hold the

remaining nasal part in the natural position, because it

moved downward. The tip of the nose was brought back

into the natural position, fixed at the bone anchorage

with a ’hook’ made of acrylic.

Magnets became the epithesis established on this

construct via one.

Conclusion

By the combination of the bone anchorage and ’hook

technology’, a perfect restoration of the nose could

be carried out. The epithetic supply was despite a

questionable receipt of the tip of the nose, and gave the

patient a gigantic improvement to living quality.

Reitemeier Bernd, Brom Jörn, Böttcher Günther, Schöne

Christine, Kant Ludwig, Kleehaupt Karl, Meißner Heike,

Gronke Karin, Schmidt Frank

From: Fa. KET Liegau-Augustusbad, Technische Universität

Dresden,Fa. NRU Chemnitz, Fa. Kleehaupt Regensburg,

Schlafmedizinisches Zentrum Dresden

The production of a customized inhalation mask was

achieved with the use of digital data obtained from a

scanning process. The digital data set served as the basis

for a CAD-module for an inhalation mask manufacture.

The module consists of a commercially available standard

mask with customized features. This design combination

allows mask adaptations that minimize the dead space

in the mask. A cranial attachment was also developed

for the mask. The new mask design was tested on ten

patients. Patient comfort and selected anaesthesiology

parameters were also evaluated.

Caroline Reed BSc (Hons), DPS

Queen Victoria Hospital, Holtye Road, East Grinstead, West

Sussex, RH19 3DZ; [email protected]

The durability of silicone for auricular prostheses using

custom-made Omega attachments was investigated in

conjunction with their retentive strength. The durability

study simulated 16 months’ use. Tensile testing indicated

the retentive strength of prostheses before and after

durability testing.

Keith Pine MIMPT, BSc, MBA

P.O. Box 31 306 Milford Auckland 0620 New Zealand

[email protected]

A small number of researchers have investigated the

anophthalmic socket’s response to artificial eye wear but

aside from a link between giant papillary conjunctivitis

and prolonged artificial eye use, wearing behaviour and

artificial eye maintenance regimes have not been found to

have any effect on conjunctival cytological features or the

flora of the socket.

This presentation broadens the investigation into factors

that may affect the socket’s response to artificial eye

wear by examining daily removal and cleaning of the

prosthesis, no removal and cleaning for periods up

to four weeks, the standard of surface polish and the

removal of manufacturing blemishes from the surface of

artificial eyes.

Keith Pine MIMPT, BSc, MBA


[email protected]

The NHS National Artificial Eye Service website advises

patients to remove and clean their artificial eyes at least

once every 30 days but daily cleaning or several times

daily cleaning is also recommended if there is a lot of

Keith Pine MIMPT, BSc, MBA,


[email protected]

Mucoid discharge associated with artificial eyewear is

a common occurrence that impacts on anophthalmic

patients’ quality of life. Discharge is the second

most important concern for experienced artificial eye

wearers after health of their remaining eye and affects

93% of wearers - 60% of these on a daily basis. The

literature does not provide a complete understanding

of the nature and causes of discharge associated with

artificial eye wear. This is reflected in the inconsistent

and contradictory advice given to patients by ocular

prosthetists and the lack of a standardised treatment

protocol for this distressing condition.

This presentation will review what is known about

mucoid discharge and its management and will report

on the outcome of an investigation of the influence

on discharge of hand washing before handling the

prosthesis, removal and cleaning regimes, repolishing

frequency and effect, wearers’ age and wearers’ ethnicity.

Andrew Traynor MIMPT, BSc, DPS

University Hospital Birmingham, Queen Elizabeth Hospital,

Edgbaston, Birmingham B152TH

Tel: 0121 627 2314

Fax: 0121 6272302

[email protected]

Background

There are many types of treatments for keloid scaring,

many of which that can be used in conjunction, i.e.

surgical excision, splint therapy and drug treatments.

This study was to look at splint therapy alone and in

combination with other treatments and their effectiveness.

Objective

The aim of the study was to establish a framework with a

clearly defined timetable for management of keloid scars

and to assess the effectiveness of splint therapy.

Method

A wide range of patients were reviewed all with auricular

keloid scars. The patients were divided into the following

groups:

Treated by splint therapy alone•

Steroid injections and splint therapy•

Surgical excision followed by splint therapy•

Surgical excision followed by splint therapy and •

steroid injections

The scars were classified as new or a reoccurrence A

record was maintained of each patient and whether the

treatment was successful or not.

Results

The patient outcomes will be demonstrated along with

recommendations. This will be used to establish protocols

to be used in the management of this difficult condition.

Poster 4

Poster 5

Poster 7

Poster 9

Poster 10

Poster 8

Poster 6

Conclusions

The study revealed that background colour did have an

effect on the overall colour. It can be concluded that the

light cure denture pigments would not be suitable for use

in the painting of iris units as they do not remain stable

below the clinically acceptable level of 3.7 following two

curing cycles.

44 AUTUMN 2011 IMPT THE JOURNAL OF MAXILLOFACIAL PROSTHETICS & TECHNOLOGY

The IMPT Travel Award - A voluntary trip taken to Dhaka, Bangladesh, to provide a six-day hands-on course and treat patients Barbara Thompson MIMPT

A team of seven visited Dhaka Community Hospital and

Delta Medical Centre to provide ’free of charge treatment’

for patients.

A big ’Thank you’ to IMPT for making it possible for the

team to undertake this rewarding trip, and a big ’Thank

you’ to everybody who donated tools, material and

equipment, which means the delegates of the course

could continue to work once the team left.

Poster 11

discharge. Their recommended cleaning method is to

rub the prosthesis gently with the fingers using warm

water and mild, non-scented soap. The website suggests

that cleaning the artificial eye removes the main cause of

discharge, which is a build-up of dirt and dust from the

environment.

The presentation challenges this view and discusses

the physical, chemical, and biological nature of biofilm

deposits on artificial eyes and the role of tear film

behaviour on recently polished artificial eye surfaces.

Original articles and editorial correspondence should be

e-mailed directly to the current editor Barry Edwards at

[email protected]

Articles of interest should be e-mailed to Caroline Reed at

[email protected]

Authors are no longer required to send hard copies but

are instructed to e-mail the document directly to the

editor. Please ensure images, tables and graphs are placed

in the document in the order of the authors preference,

and please remember to compress documents and images

prior to sending.

Articles will be either full length papers or technical

notes. Full length papers should aim for a 2500 maximum

word count with a maximum of 30 references and

technical notes 1500 words with a maximum of 10

references. Letters to the editor are also welcome but

should not exceed 500 words.

The editor cannot accept responsibility for lost

documents. The editor will email the author to

acknowledge receipt of the article.

Articles are accepted on the understanding that they

have not been published or submitted simultaneously to

another journal in the English language.

Rejected articles will be returned to the author/s by

e-mail. Returned articles will be accompanied by

constructive comment for the author, every effort will be

made to help authors gain publication.

The editor reserves the right to make editorial and literary

corrections. Any opinions expressed or policies advocated

do not necessarily reflect the opinions or policies of

the editor.

Ethics

Papers that contain the results of human and/or animal

studies will only be considered for publication if it is

made clear that a high standard of ethics was applied

in carrying out the investigations. Appropriate ethical

approval should be gained from the relevant ethical

committees related to the institution in which the study

was carried out and that subjects gave informed consent

to take part.

Copyright

In order for the Institute of Maxillofacial Prosthetists and

Technologists (IMPT) to ensure maximum dissemination

and copyright protection of material published in the

journal copyright must be explicitly transferred from the

author to the IMPT.

The author/s may be assured that no limitation will

be put on your freedom to use material contained in

the paper without requesting permission, provided

acknowledgment is made to this journal as the original

source of publication.

Presentation of articles

Articles will only be accepted when presented in the

format described below. These guidelines standardise

the text and help the editorial board review articles more

efficiently. Failure to follow these simple guidelines will

result in the article being immediately returned

for formatting.

Articles should be typed in size 12 Times New Roman

font, be double line spaced and include page numbers in

the bottom right corner. The document should be set out

as follows: Title page, abstract, key words, introduction,

method and materials, results, discussion and conclusion.

Images should be set into the text in the appropriate

location. References are at the end of the article in the

order they appear in the text.

Title page

This page should include: a succinct title of the article

(in Bold and centered), name of the author/s with full

addresses, positions held, e-mail address and contact

phone number. The main author for any correspondence

should be listed first. Sources of support in the form of

grants should be included at the bottom of the title page.

Abstract

This should consist of between 100 to 150 (maximum)

words summarising the contents of the article. Up to five

key words should be included to accurately identify the

subject of the paper.

Headings

Should be appropriate to the nature of the paper. It

should be noted that headings enhance the readability

of a paper. Headings should be typed in bold using

lower case and start with a capital but not be capitals

throughout. Headings should be set in the left

hand margin.

Sub-headings

These should be set out in lower case to left hand side of

the page in bold and italic.

Introduction

This should be a short preface introducing the reader to

the subject matter, including background and aim of

the paper.

Method and materials

The name of suppliers of materials, instruments etc.

should be entered in brackets at an appropriate point

in the text, using lower case with an initial capital letter,

followed by the full address. Remember with research

and technical papers the purpose is often to allow the

reader to perform the experiment or construct the device

described in the article.

Results

These should be clearly set out. Tables are the most

useful means of presenting data but other forms of

presentation such as bar charts or pie charts are

also acceptable.

Discussion

This is the section where the author should evaluate the

results or methodology of the paper in a critical fashion

and make reference to why the subject matter is relevant

to the journal.

Conclusion

A brief summary of the paper and what it has achieved.

References

The accuracy of references is the responsibility of the

author. References should be entered in the Vancouver

style, superscripted after the appropriate text and in

numerical order.

For example: The method of using autogenous bone has

a logic which appeals to many neurosurgeons but is not

without complications.1,2

If there are more than two numbers cited in continuous

sequence, connect the first and last with a hyphen:

e.g.1-4, 5-9 otherwise use commas: e.g. 1,2.

The actual references are then placed at the end of the

article in numerical order as they appear in the text for

the reader’s convenience. References to journal articles

should include the author’s surname and initials. List all

authors when five or fewer. If six or more list the first

three then “et al”. Follow this with the full title of the

article, journal title abbreviated using index medicus

abbreviations only e.g. Journal of Dental Research

should be written as J Dent Res. Followed by the year of

publication, edition and /or volume number and first and

last page numbers.

For example: 1. Kingsmill VJ, Boyde A, Davis GR, Howell

PG, Rawlinson SC. Changes to bone mineral and matrix in

response to a soft diet. J Dent Res. 2010, 89 (5): 510-4

References to books should be set out as follows: 1.

Ward Booth P. Maxillofacial surgery. 2nd ed. Churchill

Livingstone. Dover M. Advanced oral implantology. Chap

80. 1550. 2007

Editor’s note on referencing: Vancouver style referencing

is the preferred system as it is less disruptive to the

flow of text. If a publication has multiple references

however, re-numbering and re-arrangements can be

time consuming. For this reason the editor strongly

recommends authors consider using a reference

management system, such as Reference Manager or

Endnote, if a paper has multiple references, i.e. more than

ten. All references must be referred to in the text.

Tables, graphs and images

Tables and graphs should have a short descriptive title

below each one and any footnotes suitably identified. The

axis should be clearly labeled and the information within

the table clear.

A guideline of up to 8 images per article is suggested but

the editor is open to further images if it aids the clarity

of the paper. The author should insert images into the

text in the preferred position, however this cannot be

guaranteed in the final draft. Captions should appear


Instructions for authors

IMPT AUTUMN 2011 47www.impt.co.uk

directly below each image with Figure number and text.

Avoid joining images together and if side by side then

label a and b accordingly, e.g., Figure 1a, Figure 1b.

Figures must be referred to in the text.

Patient confidentiality

Where images include recognisable individuals care must

be taken to ensure consent for publication has been

given. It is vital to ensure that not only is consent gained

but also that the patient is fully aware of the intended use

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not essential to the image then crop accordingly. Patient

consent is the author’s responsibility and a copy of the

consent gained should be included with the submission.

This can be on your own photographic consent form

signed by the patient or guardian.

Borrowed images

Permission to use borrowed images or tables/graphs must

be obtained and it is the author’s responsibility to do so.

This may be placed directly alongside the image or at the

end of the paper within acknowledgements. Borrowed

material must be acknowledged in the following style:

“Reproduced by the kind permission of (insert publisher)

from (reference author/s)”. A signed copy of consent

from the original author must be included.

Presentations

If the author has presented the paper previously please

include details of where and when the paper was

presented immediately following the abstract.

Abbreviations and units

Avoid abbreviations in the title and abstract. Abbreviations

should be used in brackets after their first introduction

in full: e.g. “The model is obtained from a computed

tomography (CT) scan.” The abbreviation can then be

used throughout the text from this point onwards without

brackets. Units should be expressed in metric although

imperial is acceptable for contributions from the USA.


Ian Kenneth MacLeod sadly passed away on 20th August

2011. Our friend and colleague, he was probably best

remembered for his enthusiasm and commitment to the

dental profession.

Ian started his career in the Royal Air Force Dental

Branch; he remembered those years fondly and those

that knew him well would enjoy stories of his antics over

dinner and drinks.

After a long period in the RAF, both as a dental and

maxillofacial technologist, Ian left to work at Walsall

Manor Hospital. Following a post in the Lake District,

where he was employed by a dental practice to design

and set up a lab, Ian joined University Dental Hospital

Manchester as Dental Laboratories Technical Manager.

Whilst there he encouraged the integration of real work

skill activities between the dental technology trainees

from the Manchester Metropolitan University and the

education of dentists at the University Dental Hospital

Manchester to further enhance team working in dentistry.

It was here that I was lucky enough to meet Ian in the

August of 1996 as a student.

On his training initiative and the subsequent

consolidatory year, Ian took me under his wing and

would always listen or offer advice. He was instrumental

in the direction I went at the very beginning of my career

when I took up a position in Poole.

As the years moved on, Ian was always there; a gentle,

caring and wise man that would give his time generously

and help whenever he was needed.

Throughout his career, Ian was actively involved with

many of the dental associations; he was a former

President of the Dental Technologists Association (DTA)

and was previously Chairman of the Dental Technicians

Education and Training Advisory Board Association

(DTETAB) – the forerunner to the DTA. He was also a

past Chairman of the Central Council for Health Authority

Dental Technology, posts that he held with remarkable

conviction and dedication.

Appointed Member of the Most Excellent Order of the

British Empire (MBE) in 2001, Ian also received many

other prestigious awards, such as The Dennison Award

from his peers in dentistry. In 2010, he was honoured by

the DTA with a Fellowship in recognition of his life time

of active commitment to dental technology. Earlier this

year, at the IMPT spring seminar, I presented Ian with the

honour of Fellowship from the IMPT. It was a moving

and emotional time for all those who were present.

Ian was always keen to help the underprivileged and

was active in gaining support for the charity Mission Cure

Bangladesh in their quest to set up a specialist centre for

head and neck cancer and maxillofacial trauma. He was

instrumental in encouraging a redirection of unwanted

UK dental equipment for this project and attending many

of the fundraising events in our region.

Ian is remembered by colleagues with the highest

regard. Mark Townend recalls a time when he and Ian

were taking their advanced maxillofacial qualification

together back in 1984 at Lambeth College, Tooley Street,

in London. He remembered that during an exam, Ian

miscast his silver cap splint but, rather than give up, in

true tenacious Ian style, he started again and managed

to successfully cast another within the allotted time. This

was an example of Ian’s true spirit that never left him.

An unfailingly honest, determined and compassionate

individual, my fondest memories of Ian were from

meetings or conferences where his knowledge for

procedure, ideas and contribution to the programme

were invaluable. For many years, Ian entertained

delegates with his amusing after dinner speeches, a role

he was seemingly comfortable with and thankfully for

us agreed to do. Ian’s absence at this year’s conference

in Birmingham was noticeable, as it will be at all

future IMPT meetings, seminars and social gatherings.

Enthusiastic and passionate to the last, Ian was a

remarkable man and it was a pleasure to know him.

God rest his soul.

Sarah Parkinson FIMPT

Ian is survived by his wife Julia, his mother Jean, his

daughter Gail and son Keith, and his much

loved grandchildren.

Thanks to Tony Griffin for his assistance in the details for

the compilation of this obituary.


Ian Kenneth MacLeod – an obituary

IMPT AUTUMN 2011 51www.impt.co.uk

Ian Kenneth MacLeod !

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