Dental (Maxillofacial Prosthodontics)
Founded in 1994, the MUSC Health Maxillofacial Prosthodontic Division of the Department of Otolaryngology/Head & Neck Surgery bridges medicine and dentistry together in the collaborative arenas of patient care, research and teaching. The Division’s mission is to be the leader in promoting the highest standards of excellence for patients afflicted with head and neck cancer, trauma, craniofacial defects, sleep disordered breathing disorders, and dental disorders by improving the quality of life and function of patients through patient care, teaching, and discovery of knowledge.
The Maxillofacial Prosthodontic Clinic provides the clinical component of the division with an emphasis on maxillofacial prosthetics, oral oncology, implant prosthetics, nasoalveolar molding appliances and sleep apnea appliances.
The teaching component of the division includes teaching students in MUSC’s College of Medicine, College of Dental Medicine, and College of Health Professions as well as at Clemson University’s Department of Bioengineering.
The research component of the clinic – The Center for Functional Outcomes and Reconstructive Biotechnology – is a multidisciplinary center dedicated to the evaluation of the functional recovery of patients treated for head and neck cancer, trauma, and craniofacial defects. The Center’s mission is to improve the quality of life and function of patients afflicted with head and neck cancer, trauma, or craniofacial defects through discovery, application, clinical efficacy, and outcomes research. The Center structure bridges basic scientists with clinical scientists to facilitate the development of innovative technologies in the focus areas of oral function assessment, 3D imaging, biomechanics, tissue surface interfaces, tissue engineering, and gene therapy.
Maxillofacial Prosthodontic Services We Provide
Extraoral prostheses include orbital, nasal, and auricular prostheses. An orbital prosthesis artificially restores the eye, eyelids, and adjacent hard and soft tissues lost as a result of trauma or surgery.
Dental implants are used extensively in the rehabilitation of craniofacial disorders such as amelogenesis imperfecta and ectodermal dysplasia.
A nasoalveolar molding (NAM) appliance is a treatment used for unilateral and bilateral cleft palate babies.
Resection of oral or mouth cancer can result in defects of the tongue, upper jawbone (maxilla), and lower jawbone (mandible). Defects of the tongue are best restored with a free tissue transfer of either the radial forearm, thigh, or scapula
Radiation therapy and/or chemotherapy may be used in the treatment of head and neck cancers.
Sleep-disordered breathing snoring and/or obstructive sleep apnea) is a serious medical condition with the potential to pose serious health risks since it disrupts normal sleep patterns and can reduce normal blood oxygen levels
Orbital prostheses (FIGURE 1)
Extraoral prostheses include orbital, nasal, and auricular prostheses. An orbital prosthesis (Figure 1) artificially restores the eye, eyelids, and adjacent hard and soft tissues lost as a result of trauma or surgery. It serves to restore normal appearance and allow the patient to socially interact with others on a day to day basis. It seals the defect from the external environment and maintains the normal humidity and moisture of the adjacent cavities, i.e. the maxillary sinus, oral and nasal cavities.
Nasal prostheses (FIGURE 2)
A nasal prosthesis (Figure 2) is fabricated to restore a defect created by the removal of all of the nasal area due to the cancer. It provides normal appearance and serves to maintain normal moisture present in the nasal cavity. It also assists in maintaining proper humidity and air flow within the nasal cavity and nasal sinuses. Additionally, it may provide support for eyeglasses, when worn and esthetic and psychological capabilities. An auricular prosthesis (Figures 3) is a removable prosthesis which artificially restores all of the natural ear. Its purpose is to restore normal appearance and acts to gather sound waves similar to the human ear, thus aiding in directional hearing. Also, it provides support for eyeglasses, when worn and esthetic and psychological rehabilitation.
Auricular prostheses (FIGURE 3)
All facial prostheses are made of medical grade silicone and are custom made for each individual patient.. For many years, the custom made prosthesis were fabricated by hand and were time intensive. In the past, an impression or mold is made of the defect which gives a model of the defect. Then the next several visits (usually six or seven) are for the sculpting of the prosthesis in wax. This procedure is done by hand and the patient has to be present. Currently, the use of technology is transforming the fabrication process in which the prosthesis is planned virtually (on the computer) resulting in the sculpted prosthesis by rapid prototyping. This results in a 50% reduction in time in the fabrication process. After the sculpting of the prosthesis is finalized, the wax pattern is flasked and then processed in silicone. Finally, the last several visits consist of painting the prosthesis by hand to match the patient’s skin tone. The average longevity of a prosthesis is one to two years. The skin portions are made of silicone, polyurethane or polymethylmethacrylate; the eye is made of acrylic resin or glass. The prosthesis usually is attached by special adhesives (glues) or clips connected to small titanium screws or implants that are implanted into the bone. Placement of osseointegrated titanium screws to retain the prosthesis aids greatly in the retention of the prosthesis. Home care instructions will be reviewed for insertion and removal of the prosthesis and daily care of the prosthesis.
Dental implants have revolutionized the practice of dentistry. Dental implants are titanium screws which are surgically placed in the bone for osseointegration (bonding to the bone). Implants can be used for single unit crowns (Figure 1), removable prosthesis such as a bar and overdenture (Figures 2 and 3), and for fixed (patient cannot remove prosthesis, but the dentist can) (Figure 4). Dental implants are used extensively in the rehabilitation of craniofacial disorders such as amelogenesis imperfecta and ectodermal dysplasia
Single unit crown (FIGURE 1)
Removable prosthesis bar (FIGURE 2)
Removable prosthesis overdenture (FIGURE 3)
Dental implants (FIGURE 4)
A nasoalveolar molding (NAM) appliance (Figure 1)is a treatment used for unilateral and bilateral cleft palate babies. Its purpose is to reduce the severity of the cleft in the upper gum pads or alveolar ridges and to reduce the deformity of the nose . Many times, babies with cleft lip or palate have no columella which is the middle part of the nose. The treatment has been shown to be beneficial in preparing the baby for surgical repair of cleft palate and lip. The procedures takes advantage of the malleability of the immature cartilage of the nose and the ability to use tissue expansion to construct the columella (middle part of the nose). Often times, the nasal portion of nasoalveolar molding corrects the nasal tip, the nasal base of the affected side, the philtrum, and columella. It involves making an impression of the upper arch within the first week of life in a hospital setting. The baby is seen weekly to make adjustments to the appliance. Total treatment time for unilateral cleft cases is approximately 2 to 3 months (Figure 2).
For bilateral cleft cases, it can be approximately 4 to 6 months, depending upon the severity of the cleft. Nasoalveolar molding is useful in shaping the philtrum which is the upper part of the lip. There are contraindications to treatment which the doctor will review with you. Dr. Betsy Davis is certified in nasoalveolar molding by the Institute of Reconstructive Plastic Surgery at New York University School of Medicine.
Palatal augmentation prosthesis (FIGURE 1)
Resection of oral or mouth cancer can result in defects of the tongue, upper jawbone (maxilla), and lower jawbone (mandible). Defects of the tongue are best restored with a free tissue transfer of either the radial forearm, thigh, or scapula. A reconstructive surgeon performs this procedure. In some situations for tongue cancer patients, a palatal augmentation prosthesis is needed. It is a removable prosthesis that alters the hard and/or soft palate’s topographical form adjacent to the tongue (Figure 1).
Defects of the upper jawbone include both hard and soft tissue deficits. If the defect is limited to the hard palate, either surgical reconstruction by the head and neck reconstructive surgeon or prosthetic obturation (Figure 2) is available.
Prosthetic obturation (FIGURE 2)
Your doctor will review your options with you at the time of your visit. If prosthetic obturation is used, the patient usually will have an surgical obturator placed at the time of surgical resection. The surgical obturator is a temporary prosthesis inserted during or immediately following surgical or traumatic loss of a portion of the upper jawbone including gums and teeth. During the healing process, the obturator will need to be relined periodically. After treatment for the cancer is completed, a definitive obturator can be fabricated which can include dental implants, if indicated (Figure 3).
Definitive obturator (FIGURE 3)
If the defect involves the soft palate, then a speech bulb prosthesis or soft palate obturator may be necessary (Figure 4).
Soft palate obturator (FIGURE 4)
The soft palate is dynamic or movable tissue which means that the prosthesis has to be molded to incorporate the movement of the back of the throat. This prosthesis improves speech by sealing off the soft palate defect to achieve velopharyngeal competency. Another prosthesis that may be used is a palatal lift prosthesis. This prosthesis is used when the soft palate is intact, but, it doesn’t move. This prosthesis elevates and assists in restoring soft palate function. In most situations, it is used as an interim measure to determine its usefulness in achieving palatopharyngeal competency or enhance swallowing reflexes.
For defects of the lower jaw, a resection appliance is needed. Most lower jawbone defects are reconstructed with a free tissue transfer consisting of bone and/or soft tissue depending upon the defect type (Figure 5).
Resection prosthesis (FIGURE 5)
The resection prosthesis can be made without any teeth similar to a denture, with teeth similar to a removable partial denture, and with dental implants.
Radiation therapy and/or chemotherapy may be used in the treatment of head and neck cancers. Radiation therapy given to the head and neck region results in permanent changes in your saliva. The side effects of radiation include a dry mouth (xerostomia), dental decay or cavities (radiation caries) (Figure 1), inflammation of the tissues of the mouth (mucositis) (Figure 2), loss of taste, muscle fibrosis (resulting in a decrease in mouth opening), and osteoradionecrosis (Figure 3). Due to an increase incidence in dental decay, fluoride carriers are recommended for daily use of fluoride (Figure 4). Radiation therapy has a direct effect on the portion of the jawbone which received the radiation resulting in a loss of blood supply. The effect on the jaw bone permanently reduces its ability to heal and resist infection. Therefore, it is strongly recommend to have an evaluation with a dental specialist with experience in head and neck radiation prior to any elective dental surgery.
Dental decay (FIGURE 1)
Mucositis (FIGURE 2)
Osteoradionecrosis (FIGURE 3)
Fluoride carriers (FIGURE 4)
Sleep-disordered breathing (snoring and/or obstructive sleep apnea) is a serious medical condition with the potential to pose serious health risks since it disrupts normal sleep patterns and can reduce normal blood oxygen levels. The reduction in normal blood oxygen levels may result in excessive daytime sleepiness, irregular heartbeats, high blood pressure, heart attack or stroke. An oral appliance therapy for snoring/obstructive sleep apnea attempts to assist breathing during sleep by keeping the tongue and jaw in a forward position during sleeping hours. Oral appliance therapy has effectively treated many patients. Its effectiveness is dependent upon multiple factors including but not limited to the upper and lower jawbone relationship, the status of the temporomandibular joint, and the bite. Oral sleep disordered breathing appliances can be fabricated only with a physician order. Therefore, a referral from a physician along with the sleep study documenting obstructive sleep apnea is necessary before seeing the dentist. After the appliance has been delivered, a post-adjustment sleep study is necessary to objectively assure effective treatment.
There are side effects and complications of oral appliance therapy. Short term side effects include excessive salivation, difficulty swallowing with the appliance in place, sore jaws, sore teeth, jaw joint pain, dry mouth, gum pain, loosening of teeth, short term bite changes, and dislodgement of crowns and bridges. Long term complications include permanent bite changes which can only be corrected with braces or new restorations. Before an appliance is fabricated, your dentist will review the advantages and complications of treatment. (Sleep Disordered Breathing Consent)
Treatment includes making impressions of the upper and lower teeth. There are various types of sleep disordered breathing appliances including but not limited to a Herbst® appliance, a tongue positioning appliance, a Klearway® appliance, SomnoMed® appliance a snoring appliance and a Thornton appliance.