International Journal of Applied Dental Sciences 2021; 7(2): 255-259

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2021; 7(2): 255-259
Maxillofacial prosthetic materials: current status and
© 2021 IJADS recent advances: A comprehensive review
www.oraljournal.com
Received: 09-02-2021
Accepted: 25-03-2021
Dr. Rajat Lanzara, Dr. M Viswambaran and Dr. Dinesh Kumar
Dr. Rajat Lanzara
Graded Specialist, DOI: https://doi.org/10.22271/oral.2021.v7.i2d.1219
Prosthodontics, Military Dental
Centre, Bareilly, Uttar Pradesh, Abstract
India Body abnormalities or defects that compromise form, function and esthetics are sufficient to render an
individual incapable of leading a normal life. Maxillofacial disfigurement can be the result of a
Dr. M Viswambaran congenital anomaly, trauma or tumour surgery. Multiple times due to size, location of the defect or
Commandant, Air Force because of patient’s medical condition surgical reconstruction may not be possible so prosthetic
Institute of Dental Sciences,
rehabilitation is indicated in these cases. But the success of prosthetic rehabilitation is largely determined
Bangalore, Karnataka, India
by the physical and mechanical properties of the material used. Materials commonly used these days for
Dr. Dinesh Kumar fabrication of facial prostheses are acrylic resins, acrylic copolymers, vinyl polymers, polyurethane
HOD, Department of elastomers and silicone elastomers. There has always been a quest for a maxillofacial prosthetic material
Prosthodontics and Crown & that closely matches the defect tissues in appearance and properties. This article focuses on historical
Bridge, Army Dental Centre, background, changing trends and future aspects of various materials used in rehabilitation of
Research & Referral, Delhi, maxillofacial defects with their limitations and modifications.
India
Keywords: Maxillofacial defect, prosthetic materials, rehabilitation, silicone

1. Introduction
A healthy body, a beautiful face and a pleasing appearance forms an integral component for
personal and professional success. Occurrence of any defect in the body particularly in the
head and neck region adversely affects the appearance, function, social acceptance and
psychological confidence of the patient. Facial disfigurement can be the result of a congenital
anomaly, trauma or tumour surgery [1]. Among the defects, head and neck cancers contribute a
major factor as the etiology of the defect [2].
Most of the cases undergo surgery with or without radiotherapy and or/ chemotherapy.
Rehabilitation of these patients is the most essential and challenging phase of the treatment.
The aim of any rehabilitation procedure is to return the patient to the society in a near normal
status. Rehabilitation can be done either surgically or prosthetic [3]. A facial prosthesis restores
normal anatomy and appearance, protects the tissues of a defect, and provides great
psychological benefit to the patient.
Prosthodontic results are largely determined by the materials used in the construction. Success
of maxillofacial prostheses depends mainly on the physical and mechanical properties of the
material used. An ideal maxillofacial prosthetic material should have optimum physical and
mechanical properties. These include high tear strength, tensile strength, biocompatibility,
possibility of coloration and adequate hardness level similar to the tissues of defect site [4].
Materials commonly used for fabrication of maxillofacial prostheses are acrylic resins, acrylic
copolymers, vinyl polymers, polyurethane elastomers and silicone elastomers [5].

2. Historical Background
Early records indicate that artificial eyes, ears, nose were found on Egyptian mummies. They
Corresponding Author: were made from ivory, rock, silver, gold, bronze and were often overlaid with organically –
Dr. Rajat Lanzara pigmented porcelain [6]. Ambrose Pare in 1541 began keeping accurate records that benefited
Graded Specialist, deformed human subjects from facial prosthesis. He described the use of facial prosthesis as an
Prosthodontics, Military Dental alternative to surgical reconstruction and was first to use an obturator to close palatal
Centre, Bareilly, Uttar Pradesh,
India perforations [7].

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Tycho Brahe in 1576 lost his nose in a sword duel and oligomers, and macromers was reported by Antonucci and
replaced it with an artificial nose made of silver and gold. He Stansbury [8]. Their approach is to incorporate high-molecular
apparently made a wax pattern to fill the defect and cast it [7]. weight acrylic polymers with molecular block of other types
In 1728, Pierre Fauchard designed a prostheses supported of polymers, for example - Poly – ether urethane, Poly –
with wings that were positioned by patient from the oral side hydrocarbon, Poly – fluoro carbon, Poly – siloxane that can
of obturator and made use of floor of nose for retention. In eliminate the short coming of traditional acrylic co-polymers
1832 a young French soldier named Alphonse Louis was and meet the requirements of a maxillofacial elastomer.
injured and rehabilitated with prosthesis of silver which had
mandibular teeth, a hinged front replacing the facial 3.3 Polyvinyl Chloride & Copolymers
structures, and an internal collecting reservoir for the secreted Chalian VA, Phillips RW introduced use of this material for
saliva. Louis was known as “Gunner with the silver mask” [8]. fabrication of facial restorations [5]. The earliest form-
In 1880, Kingsley described fabrication of nasal prosthesis consisted of a combination of a polyvinylchloride (a hard,
and obturator. Upham in 1900 described the fabrication of clear resin that is tasteless & odorless) and plasticizer (which
nasal and auricular prostheses made from vulcanite rubber. allows for processing at low temperature) [16]. Later
1913, gelatine-glycerine compounds were introduced for copolymer of 5% to 20% vinyl acetate with vinyl chloride
fabrication of maxillofacial prosthesis. Acrylic resin was was introduced. The polymer was a thermoplastic material
introduced to the dental profession in 1940, and it replaced which was supplied as a solid suspension in a solvent. The
the older vulcanite rubber. Tylman introduced the use of a material was more flexible and adaptable to both intrinsic &
resilient vinyl copolymer acrylic resin for facial prostheses [7]. extrinsic coloration. The main drawback was that metal
In 1960, Barnhart was the first to use silicone rubber for mould had to be used for curing and material exhibited poor
constructing and coloring facial prostheses by combining a tear strength and color stability.
silicone rubber base material with acrylic resin polymer stains
[9]
. Gonzalez described the use of Polyurethane Elastomers [10]. 3.4 Polyurethane Elastomers
Lewis and Castleberry described the potential use of Juan B. Gonzalez, Edmund Y.S. Chao, Kai Nan-An described
Siphenylenes for facial prostheses [6]. Turner documented the the use of polyurethanes [17]. It is produced in presence of a
use of Isophorone Polyurethane [11]. Udagama and Drane catalyst, a polymer terminating with an isocyanate is
introduced the use of Silastic Medical Adhesive Silicone Type combined with one terminating with a hydroxyl group.
A for fabrication of facial prostheses [12]. Udagama reported Polyurethanes possess excellent properties like flexibility,
using prefabricated Polyurethane films as a lining for facial good edge strength, can be colored both intrinsically &
prostheses fabricated using Medical Adhesive Type A [13]. extrinsically and good cosmetic results [18]. An important
Advances in polymer chemistry have renewed interest in drawback is that curing requires precision as Isocyanate is
developing new materials for facial prostheses. moisture sensitive. When mold is contaminated with water –
gas bubbles cause defects & poor curing of material results.
3. Currently Available Materials Processing requires thorough dehydration before processing if
Selection of the material used for fabricating a maxillofacial stone molds are used.
prosthesis depends on the objectives of the rehabilitation
procedure. The following important objectives must be 3.5 Silicone Elastomers
fulfilled - Restoration of esthetics, function, protection of The silicones were introduced in 1946, but only past few
tissue, therapeutics or psychological effect. years they have been used in fabrication of maxillofacial
prosthesis [19]. Silicone is made up of alternate chains of
3.1 Acrylic Resin silicone and oxygen which can be modified by attaching
Acrylic resin has been successfully employed for specific various organic side groups to the silicon atoms or by cross
types of facial defects, particularly those in which little linking the molecular chains.
movement occurs in the tissue bed during function [14]. The Silicones have range of properties from rigid plastics through
major advantage of using acrylic resin is that material is elastomers to fluids. They exhibit good physical properties
readily available, chemical properties and processing over a range of temperature. Silicon is a combination of
techniques are familiar to dentists. Extrinsic and intrinsic organic and inorganic compounds. Mohammad SA in their
coloration can be utilized with acrylic resin. Goiato et al. study reported that silicon resist absorbing organic materials
reported that microhardness of the resin was not influenced by that lead to bacterial growth; so, with simple cleaning, these
the method of disinfection or the time of storage. Main materials are relatively safe and of adequate sanitary quality
drawback of the material is its rigidity so can’t be used in as compared to other materials [20]. Vulcanization makes the
highly movable tissue beds leading to local discomfort and silicone resistant to ultraviolet (UV) light [21]. Depending
exposure of margin [15]. whether the vulcanizing process uses heat or not, silicones are
available as heat vulcanized (HTV) or room temperature
3.2 Acrylic Co-Polymers (Palamed) vulcanized (RTV), and both exhibit advantages and
They are soft and elastic. The molds are underfilled (by 10%) disadvantages [22].
to permit expansion of the material and formation of the foam
like center. Cantor and Hildestad explained the complete A. High Temperature Vulcanized Silicone
procedure for fabrication of prosthesis [6]. Material however HTV silicone is usually a white, opaque, viscous material
didn’t receive wide acceptance because of objectionable having a putty like consistency. They are available as 1-
properties like - poor edge strength, poor durability, component or 2-component systems. The catalyst /
degradation when exposed to sunlight, processing and vulcanizing agent of HTV is Dichlorobenzyl peroxide/
coloration is difficult and the completed restoration becomes platinum salt [23]. Various amounts of fillers are added
tacky, predisposing to dust collection and staining. depending on degree of hardness, strength and elongation.
Development of a new generation of acrylic monomers, Polydimethyl siloxane may be added to reduce the stiffness or
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hardness of the prosthesis. Lontz reported use of modified 4.2 Polyphosphazenes

polysiloxane elastomers [24]. Gettleman was first to introduce use of polyphosphazenes for
The process of vulcanization requires greater milling of the fabrication of maxillofacial prostheses [31]. Polyphosphazenes
solid HTV stock elastomer for mixing the catalyst for fluoro elastomer has been developed for use as a resilient
cross-linking and pigmenting [24]. Vulcanization or denture liner and has the potential to be used as a
cross-linking occurs by free radical addition. The processing maxillofacial prosthetic material. Modifications of physical
temperature ranges from 180 to 220 °C for about 30 minutes and mechanical properties of this commercially available
under pressure using metal molds. Abdelnabbi et al. reported elastomer may be needed to satisfy the requirements for
favourable results for mechanical and physical properties [9]. fabrication of maxillofacial. Researchers in New Orleans dealt
They have excellent tear strength and highest tensile strength, with maxillofacial prosthesis, have found that compounding
high percent elongation, excellent thermal, color and chemical polyphosphazenes with little or no fillers and decreasing the
stability rendering it more biologically inert. ratio of acrylic to rubber yields a softer rubber, with a HDA of
25, similar to human skin [11].
B. Room Temperature Vulcanizing Silicones (RTVS)
Room temperature vulcanizing silicones (RTVS) are of two 4.3 Foaming Silicones
types – based on the type of reaction Firtell et al. introduced foaming silicone for fabrication of
1. Cross-linkage occurs by condensation reaction [25]: They light weight prosthesis [32]. When silicon is mixed with
have reactive groups, such as silariols (hydroxyl terminated stannous octoate catalyst, releases a gas in the vulcanization
polysiloxanes), cross-linking agent, e.g. tetraethyl silicate, and process as bubbles are released with the resulting silicone
a catalyst, such as triacetoxy silane is used as the mass being increased and density being decreased, which
cross-linking agent. Their use has been limited to that of an presents a much lighter material [33]. This process requires
extrinsic colorant carrier applied to the surface of the special flasks to deal with expansion problems while the gas
prosthesis eg Silastic 382 and 399. is forming during processing. The mold also requires venting
2. Cross-linking of polysiloxanes by addition reactions [26]: for gas release and reduction of expansion of the prosthesis.
These involve the addition of silyl hydride groups (-SiH) to The purpose of the foam forming silicones is to reduce the
vinyl groups (CH2==CH-) attached to the silicone in presence weight of the prosthesis.
of platinum as catalyst. These silicones are not truly room
vulcanized silicones as curing of these silicones require 4.4 Siphenylenes
heating the material at 150°C for an hour.Prostheses are Lewis and Castleberry described the potential use of
polymerized by bulk multiple packing. Recently, epoxy resins Siphenylenes for facial prostheses [34]. Siphenylenes are
and stainless steel molds are being used examples are silastic siloxane copolymers that contain methyl and phenyl groups.
382, 399, 891, MDX4-4210, Cosmesil, A-2186 and A-2186F. They are formulated as a pourable, viscous, room-temperature
RTV silicone is blended with suitable earth pigment to vulcanizing liquid. In tactile response, silphenylene
produce the patient basic skin color. elastomers feel more like skin. These polymers are
Doootz ER, Koran A, Craig RG in 1994 evaluated the effect transparent even when reinforced with silica fillers. These
of accelerated aging on the physical properties of three polymers possess many desirable properties of RTV silicones,
maxillo-facial materials i.e. MDX 4-4210, A-2186, Cosmesil. including biocompatibility and resistance to degradation on
They concluded that cosmesil substance showed maximum exposure to ultraviolet light and heat. In addition, they exhibit
effect, and MDX 4-4210 the least change in their properties, improved edge strength, low modulus of elasticity and
of aging [27]. Aziz T, Waters M, Jagger R in 2003 conducted a colourability. They also exhibit improved edge strength and
study to analyze properties of five commonly used low modulus of elasticity over the more conventional
maxillofacial silicone materials Factor II, Cosmesil HC, polydimethylsiloxane [34].
Cosmesil St, Nusil and Prestige. They concluded that none of
the commercially available silicone rubber materials 5. Future
possessed ideal properties for use as a maxillofacial prosthetic With the advancement in medical sciences and incorporation
material [28]. of engineering concepts have resulted in development of
prosthesis capable of perceiving sensory stimulus similar to
4. Recent Advances natural sense organs. These organs have been termed as
4.1 Silcone Block Co Polymers Bionic organs. The term ‘BIONIC’ means - having or
Silicone block copolymers are new materials under denoting an artificial, typically electromechanical, body part
development to improve some of the weaknesses of silicone or parts [35]. A Bionic organ is an engineered device or tissue
elastomers, such as low tear strength, low – percent that is implanted or integrated into a human interfacing with
elongation, and the potential to support bacterial or fungal living tissues to replace a natural organ, to duplicate or
growth [29]. It has been found that silicone block copolymers augment a specific function or functions so the patient may
are more tear-resistant than are conventional cross – linked return to a normal life as soon as possible [36]. Research in the
silicone polymers. This is achieved by a surface modification maxillofacial region have led to the development of Bionic
consisting of the incorporation of block copolymers eye, nose and ear which consist of microchips, transducers,
containing a PDMS block and a poly [2-(dimethylamino) polymers, semiconductors, electronic arrays and radio
ethyl methacrylate] (PDMAEMA) block in a PDMS matrix transmitters. Various models and systems are already
[30]
. The improvement of the bioadhesive properties of available and further research and development is under
elastomeric polydimethylsiloxane (PDMS) coatings is process.
reported. Observations highlight the significant role of Also the advancement in digital technology particularly Rapid
hydrophilic groups in the surface modification of silicone prototyping and CAD/CAM has opened new avenues for time
coatings. efficient, life like prosthesis. Multiple studies are focussed on

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production of 3D printed silicone for fabrication of prosthesis. Quintessence Publishing Company 2000, 352-356.
The CAD/CAM or 3D Printing can be joined with E-Skin 11. Turner GE, Fischer TE, Castlebcrry DJ, Lemmons JE.
spectromatch spectrometer uses a digital library of nearly Intrinsic color of isphorone polyurethane for
20,000 skin tones to match to patient skin for maxillofacial prosthetics, part I: Physical properties. J
prosthetic applications. All entries in the digital library have a Prosthet Dent 1984;51(4):519 -22.
matching colorant recipe. The E-Skin instrument measures 12. Udagama A, Drane JB. Use of rnedical grade methyl
skin color and instantly retrieves and displays on its screen a urethane silane cross linked silicone for facial prosthesis.
matching colorant recipe from its database. J Prosthet Dent 1982;48(3):86-88.
13. Udagama A. Urethane-linked silicone facial prosthetics. J
6. Conclusion prosthet Dent 1987;58:351-354.
The most common materials currently in use for the 14. Moore DJ, Glaser ZR, Tabacco MJ, Linebaugh MG.
fabrication of intraoral and extraoral prostheses are polymeric Evaluation of polymeric materials for maxillofacial
nature and they exhibit almost all desirable physical, biologic prosthetics. J Prosthet Dent 1977;38:319-26.
and clinical properties. The completed facial prostheses 15. Coelolho Goiato M, Alues Pesqueria A, Micheline Dos
should be unnoticeable in public, faithfully reproducing lost Santos D, Fiuza de Carvalho Dekon S. Influence of
structures in the finest detail. Its color, texture, form and investment, disinfection and storage on the
translucence must duplicate that of missing structures and microhardness of ocular resins. Journal of Prosthodontics
adjacent skin. To date, none of the commercially available 2008;2(18): 32-35
materials satisfy all the requirements of the ideal material. 16. Dorsey J, Zorach J, Glazer, Tabacco MJ, Linebaugh MG.
Each of the material has strengths and weakness. Future Evaluation of polymeric material for maxillofacial
research should concentrate on several major goals. prosthetics. J Prosthet Dent 1977;38(3):319-26.
1. Improvement of the physical and mechanical properties 17. Gonzalez JB, Edmund YS, Kai NA. Physical and
of existing materials available or development of new mechanical properties of polyurethane elastomer
alternative materials so that it will behave more like formulations used for facial prosthesis. J Prosthet Dent
human tissue and increase the service life of the 1978;39(3):307-318.
prosthesis 18. Gonzalez JB. Polyurethane elastomers for facial
2. Identification of Color-stable coloring agents that are prosthesis. J Prosthet Dent1978;39(1):212-218.
compatible with different types of elastomers. 19. Polyzois GL. Evaluation of a new silicone elastomer for
3. Development of scientific method of color matching to maxillofacial prostheses. J Prosthodont 1995;4(9):38-41.
human skin. 20. Mohammad SA, Wee AG, Rumsey DJ, Schricker SR.
4. Development of a scientific color formulation system that Maxillofacial materials reinforced with various
conforms to the color matching tool to allow objective concentrations of polyhedral silsesquioxanes. J Dent
replication of human skin shades. Biomech 2010;1(1):821-832
5. Development of 3D printed maxillofacial silicone 21. Deba K, Yunus N, Kumar V, Ahmad N. Oral and
prosthetic material. maxillofacial prosthesis-II materialistic approach. Heal
Talk 2012;4(6):18-20.
7. References 22. Mitra A, Choudhary S, Garg H, Jagadeesh HG.
1. Worthington P, Branemark PI. Advanced Osseo Maxillofacial prosthetic materials-an inclination towards
integration surgery: applications in the maxillofacial silicones. J Clin Diag Res 2014;8(12):8-13.
region. BJOM 1992;4(6):23-27. 23. Bellamy K, Limbert G, Waters MG, Middleton J. An
2. Mortaon RP, Izzard ME. Quality of life outcomes in head elastomeric material for facial prostheses: synthesis,
and neck cancer patients. World J Surg 2003;27(3):884- experimental and numerical testing aspects. J
889 Biomaterials 2003;24:506-16.
3. Bou C, Pomar P, Miquel JL, Poisson P. Maxillo-facial 24. Lontz JF. State-of-the-art materials used for maxillofacial
prostheses: an issue in public health. Odontostomatol prosthetic reconstruction. Dent Clin North Am
Trop 2006;29(113):34-40. 1990;34(2):307-325.
4. Eleni PN, Krokida M, Polyzois Gettleman L, Bisharat GI. 25. Anusavice, Kenneth J, Shen C, Rawls, Ralph H. Phillips’
Effect of outdoor weathering on facial prosthetic Science of Dental Materials. 11th ed. St. Louis: Elsevier;
elastomers. Odontology. 2011;99(1):68-76. 2012, 755-756.
5. Chalian VA, Philips RW. Materials in maxillofacial 26. Huber H, Studer SP. Materials and techniques in
prosthetics. Journal of Biomedical Materials Research maxillofacial prosthodontic rehabilitation. Oral
Symposium 1974;5(2):349-63. Maxillofacial Surg Clin N Am 2002;14(1):73-93.
6. Ring ME. The history of maxillofacial prosthetics. 27. Doootz ER, Koran A, Craig RG. Effect of accelerated
Journal of Plast Reconstr Surg 1991;87(1):174-184. aging on the physical properties of three maxillo-facial
7. Maller US, Karthik KS, Maller SV. Maxillofacial materials. J Prosthet Dent 1994;71(4):379-4.
prosthetic materials past and present trends. J Indian 28. Aziz T, Waters M, Jagger R. Analysis of the properties of
Acad Dent Spec 2010;1:25-30. silicone rubber maxillofacial prosthetic materials. J Dent,
8. Beumer J III, Curtis TA, Marunick M. Maxillofacial 2003;31(3):67-74.
Rehabilitation – Prosthodontic and surgical 29. Polyzois GL, Winter RW, Stafford GD. Boundary
considerations, Ishiyaku Euro America, Inc 1996;378- lubrication and maxillofacial prosthetic
453. polydimethylsiloxanes. Biomaterials 1991;12(1):79-82.
9. Khindria SK, Bansal S, Kansal M. Maxillofacial 30. Tsai FH. Synthesis of silicone blocks copolymers for use
prosthetic materials- Review Article. J Indian as maxillofacial materials. Proceedings of Conference on
Prosthodont Soc 2009;9(1):2-5. Materials Research in Maxillofacial Prosthetics.
10. Taylor TD. Clinical Maxillofacial Prosthetics. Berlin: Transactions of the Academy of Dental Materials
~ 258 ~
International Journal of Applied Dental Sciences http://www.oraljournal.com

1992;5:126-9.
31. Gettleman L, Ross BL, Gebert PH, Guerra LR. Novel
elastomers for denture and maxillofacial prostheses. In:
Biomedical Engineering IV: Recent Developments 141-
144
32. Firtell DN, Donnan ML, Anderson CR. Light weight
RTV silicone for maxillofacial prostheses. J Prosthet
Dent 1990;63:466-68.
33. Khindria SK, Bansal S, Kansal M. Maxillofacial
prosthetic materials. J Indian Prosthodont Soc 2009;9:2-.
34. Mahajan H, Gupta K. Maxillofacial prosthetic materials:
A literature review. J Orofac Res 2012;2(2):87-90.
35. Catapano G, Verkerke GJ. Handbook of Research on
Biomedical Engineering Education and Advanced
Bioengineering Learning: Interdisciplinary Concepts.
2012;(2):53-55.
36. Allin S, Eckel E, Markham H, Brewer BR. Recent trends
in the development and evaluation of assistive robotic
manipulation devices. Phys Med Rehabil Clin N
Am. 2010;21:59-77.

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