Large maxillofacial defects from malignant tumor treatment are rarely rehabilitated by surgical reconstruction alone. Ameloblastic carcinoma, a rare aggressive odontogenic malignant tumor, requires wide surgical excision to gain a tumor-free margin. In the post-surgical defect, prosthetic rehabilitation is the treatment of choice to restore function and esthetics. Moreover, an intra-oral prosthesis such as an obturator restores speech, mastication and deglutition. Retention of the obturator is a major problem while rehabilitating large defects. The existing anatomical structures from the defect with the help of magnet attachments are suitable to enhance retention, stability and support of the prostheses. This case report presents a patient with an intraoral and extra-oral combination defect following surgical resection of ameloblastic carcinoma and describes the prosthetic techniques and design considerations for a magnet-retained obturator and mid-facial prosthesis. An implant-retained mid-facial prosthesis was fabricated. The retention of combined prostheses was obtained from the remaining right posterior teeth only. The patient had an unfavorable defect due to the large size and presence of scar contracture that vertically tends to dislodge the obturator. Magnet attachments were used to combine the facial and oral prosthesis, minimize the vertical dislodging forces and enhance retention. In addition, the retention was also gained from the scar band at lower border of mid-facial defect that avoided the need for more implants surgery. Magnet attachment with anatomical structure of the mid-facial defect provides an acceptable means of retention in large extraoral-intraoral combinations defects, improving the function, esthetic and the patients' quality of life.
Maxillofacial prostheses are used in rehabilitation of patients with facial defects. Typically, these prostheses are fabricated with medical grade silicone and are tinted corresponding to the patients’ natural skin color. However, exposure to environment and disinfectants can result in color changes. This study aimed to evaluate the effects of four different disinfection methods on the color stability of precolored and hand-colored maxillofacial silicones. Forty specimens each of precolored and hand-colored silicone were prepared. The specimens were randomly divided into eight groups (n = 10) and cleansed with four different disinfection methods. Disinfection was carried out six times/day for 60 days, simulating once-a-day disinfection for a year. Color evaluation was carried out at day 0 and day 60 using a UV-vis spectrophotometer. Color alterations were calculated by the CIE L ∗ a ∗ b ∗ system. Data were analyzed by two-way ANOVA with post hoc Tukey HSD and t-tests (α = 0.05). Disinfectants can affect the color stability of maxillofacial silicone. In our study, chlorhexidine solution and liquid soap resulted in the highest color change. Precolored silicone showed higher color stability than its hand-colored counterpart.
A BSTRACT Aims: This in-vitro study aimed to evaluate the efficacy of lemongrass ( Cymbopogon citratus ) essential oil in eradicating Candida albicans biofilm pre-established on the maxillofacial silicone specimens. Materials and Methods: Two maxillofacial silicones, namely, MDX4-4210 and Multisil Epithetik, were used for the fabrication of 6 mm diameter disks ( n = 21 for each brand of silicone). A 48-h mature C. albicans ATCC 10231 biofilm was pre-established on sterile silicone specimen. These disks were then exposed to various concentrations of lemongrass essential oil ranging from 0.31% to 5% (v/v), 20% (v/v) nystatin, and RPMI-1640 medium for 18–20 h. After exposure, the remaining viable fungal biofilm was examined by the XTT [2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide]-reduction assay. All data were analyzed by using a regression coefficient and a post hoc Tukey HSD multiple comparisons test ( α = 0.05). Results: Different brands of silicone used for fabrication did not significantly affect the formation of mature C. albicans biofilm ( P =0.302). A 5% (v/v) lemongrass essential oil significantly eliminated fungal biofilm by approximately 95% ( P =0.031). However, less than 50% of the fungal biofilm was eliminated by the tested oil at a concentration as low as 0.31% (v/v). Furthermore, the fungicidal efficacy against C. albicans biofilm of lemongrass essential oil at 2.5% (v/v) was as potent as that of 20% (v/v) nystatin suspension ( P = 0.99). Conclusion: Lemongrass essential oil expressed fungicidal effect on C. albicans biofilm pre-established on the disks fabricated from different brands of silicone. Additionally, the fungicidal effectiveness of the oil against the mature fungal biofilm was dose-dependent.
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