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National Journal of Maxillofacial Surgery
 
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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 105-108  

Recreating first digit with silicone prosthesis


Department of Prosthodontics and Crown and Bridge, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Submission10-Jul-2018
Date of Acceptance03-Dec-2018
Date of Web Publication07-Jun-2019

Correspondence Address:
Dr. Amit Mahadeo Gaikwad
C-704, Vijeta Dosti Vihar, Near Vedant Complex, Vartak Nagar, Thane West, Thane - 400 606, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njms.NJMS_59_18

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   Abstract 


The hand is an integral part of our body. Any deviation in hand anatomy not only affects the day-to-day function but it even results in unesthetic appearance. Rehabilitation of these deformities is done either by microsurgery or with the help of silicone prosthesis. Nonsurgical treatment was carried out, where rehabilitation of the first digit was done with customized silicone prosthesis. Replacement of these deformities with silicone prosthesis is usually done by prosthetist. However, we being an oral and maxillofacial prosthodontist, replacement of these missing complete or partial fingers, thumb, ear, and nose is also done by prosthodontist. Rehabilitation of these deformities with silicone prosthesis can offer psychological, functional, and esthetic advantages. Recent advances in materials and skill of an individual made it possible to fabricate esthetically pleasing prosthesis. Mini implants are widely used for retaining silicone prosthesis; however, they are expensive and need surgical intervention. Vacuum-retained silicone-retained silicone prosthesis is a good and minimal invasive option for these patients. This clinical report describes a straightforward technique for fabricating silicone thumb prosthesis for a patient with amputated thumb.

Keywords: Amputated thumb, silicone prosthesis, thumb prosthesis


How to cite this article:
Gaikwad AM, Ram SM, Nadgere JB, Shah NP. Recreating first digit with silicone prosthesis. Natl J Maxillofac Surg 2019;10:105-8

How to cite this URL:
Gaikwad AM, Ram SM, Nadgere JB, Shah NP. Recreating first digit with silicone prosthesis. Natl J Maxillofac Surg [serial online] 2019 [cited 2019 Aug 21];10:105-8. Available from: http://www.njms.in/text.asp?2019/10/1/105/259838




   Introduction Top


Fingers, thumb, and their coordination play a critical role to carry out day-to-day function. Deformities of the hand may be congenital, accidental, or inflammatory. Accidental trauma is one of the most common causes for these deformities.[1] These deformities affect the socioeconomic life of an individual and also cause psychological disturbances. Microsurgeries can be used for reconstruction of these deformities. However, microsurgeries are expensive and require surgical intervention.[2] Sometimes, it contraindicated in medically compromised condition. In such a situation, prosthetic rehabilitation is the choice of treatment for managing such deformities. The main aim of such rehabilitation is to improve the esthetic which further improves the psychological status of an individual.[3] Various materials are available for prosthetic reconstruction of these deformities.[4] Various methods are available for retaining these prostheses, the choice of which depends on the operator and condition of an individual.[4],[5] This clinical report demonstrates a simple technique to reconstruct amputated thumb with silicone prosthesis.


   Case Report Top


A 54-year-old male patient was reported to the Department of Prosthodontics with a chief complaint of partial loss of the right thumb and wanted reconstruction for the same. History of the patient revealed that the patient had trauma to his right thumb 2 years back. On examination, partial amputated right thumb was seen at the middle phalanx. The skin of amputated thumb was completely healed with no pus discharge or with no any signs of inflammation [Figure 1]. Two treatment options were planned for the patient, first, implant-retained silicone prosthesis and second, vacuum-retained silicone prosthesis. The patient disagreed to implant-retained silicone prosthesis due to surgical intervention and cost factor. Hence, vacuum-retained silicone prosthesis was planned for the patient. Disposable glass with adequate space for making impression was selected. Irreversible hydrocolloid was used as the choice of material for making impression. Chilled water was used to manipulate irreversible hydrocolloid impression material to get enough working time. The patient was instructed to dip the amputated thumb into disposable glass and care was taken that the thumb did not touched the wall of glass. Similarly, impression of the left thumb was also made [Figure 2]. Impression of the amputated thumb was poured in dental stone and master model was obtained from it [Figure 3]. Impression of the left thumb was poured with modeling wax. Wax was poured only around the wall of the impression with sufficient thickness. Wax was allowed to cool and it was retrieved from the impression. Wax pattern was adapted on master cast, and final waxing and carving were done [Figure 4]. Wax pattern trail was done to determine the fit, length, width, and shape of wax pattern [Figure 5]. Necessary modifications were carried out to improve the fit and esthetic of wax pattern. Before flasking, ditching of 2 mm all round was done on master cast so that the prosthesis would have smaller diameter which would aid in vacuum retention of final prosthesis. Larger flask was used for flasking procedure and dewaxing was done [Figure 6]. Room temperature vulcanizing silicone was used as material of choice for final prosthesis. Packing of RVT silicone was done in front of the patient for shade matching. Color matching of the dorsal and ventral surface was done separately in natural light [Figure 7]. The silicone was manipulated and packed into the flask and pressed tightly. Curing was done for 24 h at room temperature. Once the final prosthesis was retrieved, the excess material was trimmed with scissors and final finishing was accomplished using silicone burs. Trial was done for final prosthesis to determine the fit, shape, and basic shade of final prosthesis [Figure 8]. Extrinsic staining was done using brush and extrinsic stain to match the final shade of prosthesis [Figure 9]. An acrylic nail was fabricated using putty index of the left thumb and cold-cure acrylic resin [Figure 10]. Shape and size of nail were determined and shade modification was done using extrinsic shade. Cyanoacrylate adhesive was used for bonding the acrylic nail to final prosthesis [Figure 11]. Final fit and appearance of the prosthesis were evaluated on the amputated thumb [Figure 12], and the patient was instructed about the maintenance of the prosthesis. Eight-month follow-up was done to determine the retention and esthetic of final prosthesis. The patient was happy and satisfied with the final treatment [Figure 13].
Figure 1: (a) Pre operative palmer surface of the right hand with amputed thumb, (b) Pre operative ventral surface of the right hand with amputed thumb

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Figure 2: (a) Impression of right thumb with irreversible hydrocolloid impression material, (b) Impression of left thumb with irreversible hydrocolloid impression material

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Figure 3: Master cast of the amputated thumb

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Figure 4: Wax pattern on master cast of the amputated thumb

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Figure 5: Trial of wax pattern on the amputated thumb

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Figure 6: Processing for silicone prosthesis

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Figure 7: Packing of silicone material into the flask

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Figure 8: Trial of final silicone prosthesis on the amputated thumb

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Figure 9: External staining of silicone prosthesis for shade matching

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Figure 10: (a) Putty index made form master cast of the left thumb, (b) Fabrication of acrylic nail from putty index

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Figure 11: (a) Final thumb prosthesis ventral surface, (b) Final thumb prosthesis dorsal surface

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Figure 12: Postoperative palmer and ventral surfaces of the right hand with silicone thumb prosthesis

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Figure 13: Extraoral postoperative smiling photograph

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   Discussion Top


Prosthetic rehabilitation of amputated thumb is a conservative and an economic choice of treatment for reconstruction of the amputated thumb. Various materials such as wood, clay leather, enameled porcelain, acrylic resin, and silicone elastomers are used in the fabrication of extraoral prosthesis.[6] Among these, acrylic resin and silicone are the most commonly used materials for rehabilitation.[4] Acrylic resin is hard and does not provide any mobility, thus giving a more artificial appearance.[7] Silicone is more flexible and compatible with intrinsic and extrinsic staining, thus giving a more life-like appearance.[8] Thus, silicone was used in this case. However, due to the environmental factors, silicones are more prone to discoloration and need frequent replacement.[8] Mechanical retention is another factor that should be considered while fabricating silicone prosthesis. Adhesives, ring, vacuum, and mini implants are the modes of mechanical retention for silicone prosthesis.[4],[9] Implants provide good retention and are more durable; however, they need surgical intervention and are expensive.[10] Vacuum-retained silicone prosthesis is a more economical and a more convenient mode for retaining prosthesis. Thus, vacuum-retained prosthesis was planned for this patient.


   Conclusion Top


Silicone prosthesis has served boon to the patient with hand deformity. Recent advances in materials and skill of an individual made it possible to fabricate esthetically pleasing prosthesis. Silicone thumb prosthesis for amputated thumb is a good alternative option for microsurgery which improves the normal functioning and gives life-like appearance to an individual.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shanmuganathan N, Maheswari MU, Anandkumar V, Padmanabhan TV, Swarup S, Jibran AH, et al. Aesthetic finger prosthesis. J Indian Prosthodont Soc 2011;11:232-7.  Back to cited text no. 1
    
2.
Asnani P, Shivalingappa CG, Mishra SK, Somkuwar K, Khan F. Rehabilitation of amputed thumb with a silicone prosthesis. J Nat Sci Biol Med 2015;6:275-7.  Back to cited text no. 2
    
3.
Pillet J. The aesthetic hand prosthesis. Orthop Clin North Am 1981;12:961-9.  Back to cited text no. 3
    
4.
Beumer J, Curtis TA, Firtell DN. Maxillofacial Rehabilitation. St. Louis: The C.V. Mosby Co.; 1979.  Back to cited text no. 4
    
5.
Beasley RW. Hand and finger prostheses. J Hand Surg Am 1987;12:144-7.  Back to cited text no. 5
    
6.
Aziz T, Waters M, Jagger R. Surface modification of an experimental silicone rubber maxillofacial material to improve wettability. J Dent 2003;31:213-6.  Back to cited text no. 6
    
7.
Reddy R, Bandela V, Bharathi M, Reddy G. Acrylic finger prosthesis: A case report. J Clin Diagn Res 2014;8:ZD07-8.  Back to cited text no. 7
    
8.
Gary JJ, Smith CT. Pigments and their application in maxillofacial elastomers: A literature review. J Prosthet Dent 1998;80:204-8.  Back to cited text no. 8
    
9.
Raghu KM, Gururaju CR, Sundaresh KJ, Mallikarjuna R. Aesthetic finger prosthesis with silicone biomaterial. BMJ Case Rep 2013;2013. pii: bcr2013010385.  Back to cited text no. 9
    
10.
Kini AY, Byakod PP, Angadi GS, Pai U, Bhandari AJ. Comprehensive prosthetic rehabilitation of a patient with partial finger amputations using silicone biomaterial: A technical note. Prosthet Orthot Int 2010;34:488-94.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]



 

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