jc ocular
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The Ocular Impression: A Review of the Literatureand Presentation of an Alternate Technique
Mark F. Mathews, Rick M. Smith, Alan J. Sutton
and Ron HudsonJournal of prosthodontics 2000;9:210-216
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Introduction
Anatomy
History
The ocular impression: review of literature
An alternative technique
Removal and replacement
Post insertion care
Discussion
References3
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Introduction
Introduction
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Maxillofacial prosthetics is the art and science ofanatomic, functional, or cosmetic
reconstruction by means of non-living substitutes of those regions in the maxilla,
mandible, and face that are missing or defective because of surgical intervention,
trauma, pathology or developmental or congenital malformation.
The branch of prosthodontics concerned with the restoration and/or replacement of
the stomatognathic and craniofacial structures with prostheses that may or may not
be removed on a regular or elective basis. -GPT8
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Ocular prosthesis have been used for centuries to provide a
cosmetic replacement for enucleated or eviscerated eyes.
Goal of prosthetic treatment - Return the patient to society
with a normal appearance.
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Anatomy
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Orbit
Contents of orbit
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1. Eyeball
2. Fascia: Orbital and bulbar.
3. Muscles: Extra ocular muscles
4. Vessels: Ophthalmic artery, superior
and inferior ophthalmic Veins and
lymphatic's.
5. Nerves: Optic, occulomotor, trochlear,
abducent, branches of ophthalmic
nerve and sympathetic nerves.6. Lacrimal gland
7. Orbital fat.
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EXTRAOCULAR MUSCLES
Voluntary muscles
1. Four recti: (a) Superior rectus
(b) Inferior rectus(c) Medial rectus
(d) Lateral rectus.
2. Two obliqui: (a) Superior oblique and(b) Inferior oblique
3. Levator palpebrae superioris
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Limbus
Medial canthus
Pupil
IRIS ANATOMY
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CAUSE FO LOSS OF EYE
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CAUSE FOR LOSS OF EYE
congenitaldefect
irreparabletrauma tumor
a painful blindeye
sympatheticophthalmia
excision forhistological
confirmationof a suspected
diagnosis
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SURGICAL MANAGEMENT
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SURGICAL MANAGEMENT
3 approaches :
evisceration- surgical procedure wherein the intraocularcontents of the globe are removed, leaving the sclera,
Tenon's capsule, conjunctiva, extraocular muscles, and optic
nerve undisturbed; the cornea may be retained or excised.
enucleation-is the surgical removal of the globeand a portion of the optic nerve from the orbit.
exenteration- is the en bloc removal of the entireorbit, usually involving partial or total removal of
the eyelids, and is performed primarily foreradication of malignant orbital tumor 16
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SURGICAL REHABILITATION IS LIMITED BY :
Availability of tissue
Tissue contractures
Physical condition of patient
Very large defect
Compromised vascular supply to radiated tissue
bed
Advanced age of patient
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History
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Dating from very early times in Egypt
(i.e., the predynastic Period, before 3000 B.C.),
simple inlaid eyes, consisting usually of white shellbeads, have been found, and human figures
bearing such eyes are to be seen in the Cairo
museum.
Ambroise Pare (1510-1590), a Frenchman, was the
first to use both glass and porcelain eyes.
By 1835 artificial glass eyes were being produced
on a large sale in Germany, which continued as the
center of production.
International Ophthalmology Clinics: Winter 1970 - Volume 10 - Issue 4 - ppg713-719
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During the two world wars, the supply of glass eyes from Germany to
the United States was halted, and in 1943 the United States Army and
Navy both undertook research to find a substitute.
Attention was concentrated on plastics, and the development of an
acrylic eye resulted.
By 1945, the Army thousands of artificial plastic eyes were beingproduced.
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The Ocular Impression: A Review ofthe Literature and Presentation of
an Alternate Technique
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Direct impression/external impression
Impression with a stock ocular tray or modified stock ocular tray
Impression with custom ocular tray
Impression using a stock ocular prosthesis
Ocular prosthesis modification,
The wax scleral blank technique.
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1.The Direct Impression/External Impression
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.
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2 I i Wi h S k O l T
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.
Most common impression technique
To help support the impression
material.
Also called as modified impression
method.
Perforations present in tray.
2. Impression With Stock Ocular Tray
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3 S k O l T M difi i
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.
Maloney - 3 channels were placed through the
superior edge of set of customized stock trays to
prevent air entrapment.
A raised ring around the stem prevents the eyelid
from blocking the channels.
Engelmeier -Casting a set of stock trays in
Ticonium to permit sterilization and reuse.
Sykes, Essop, and Veres - Use of modeling plastic
impression compound as an ocular tray
3.Stock Ocular Tray Modifications
Variations of the modified impression method
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4 I i With C t O l T
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.
Miller -A custom ocular tray is necessary in certain situations.
The anophthalmic socket could be highly irregular or stock trays may not be available.
Millers method involves attaching a solid suction rod to the patients existing
prosthesis, conformer, or wax shell and investing it in an alginate mold .
After the alginate sets, the prosthesis, conformer, or wax is removed and replaced with
clear acrylic resin.
Perforations are made in the resulting tray, and a tunnel is cut into the stem through
which impression material can be delivered.
An impression is made using injected alginate.
4.Impression With Custom Ocular Tray
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5 I i U i St k O l P th i
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.
Use of a stock ocular prosthesis as a tray to carry impression material.
Select an esthetic stock eye and reduce peripheral and posterior aspects.
Lined with a thin mix of ophthalmic alginate and inserted for the definitive impression.
The resulting impression is processed, providing a customized stock prosthesis.
5.Impression Using Stock Ocular Prosthesis
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6 O l P th i M difi ti
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.
Modification of an existing prosthesis to gain acceptable fit.
Trimming and polishing a stock prosthesis will sometimes achieve this goal.
Alternately, the stock prosthesis can be modified using alginate or soft wax, andthen invested and processed.
6.Ocular Prosthesis Modification
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Smith -Reline procedure for an existing prosthesis using a dental impression wax
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.
Smith Reline procedure for an existing prosthesis using a dental impression wax.
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Ow and Amrith- Use of a tissue conditioner as a reline material because of its
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.
Ow and Amrith Use of a tissue conditioner as a reline material because of its
biocompatibility and ease of manipulation.
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W S l l Bl k T h i
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Wax Scleral Blank Technique
Benson-Created a wax blank by adapting base plate wax around half of an
appropriately sized steel ball. The resultant pattern is smoothed, tried in, and
adjusted.
After the addition of an iris button, the pattern is invested and processed.
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Method of attaching the iris disk
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Method of attaching the iris disk
33Ref-Journal of Prosthodontics (2008) 223227
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Moore, Ostrowski, and King-an esthetic Iowa implant conformer for use during
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Moore, Ostrowski, and King an esthetic Iowa implant conformer for use during
healing.
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An alternative technique
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Disinfect and lightly lubricate the patients existing
prosthesis or conformer.
Fill a medicine cup with quick set stone
and invest the tissue side of the
prosthesis to the height of contour.
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When set, notch the edges of the stone cast. Mix a small amount of PVS
putty and adapt it over the top of the prosthesis and into the notched
indices.
Remove the putty cope, and cut a large, beveled sprue hole into its
center and a small vent to the side.
Remove the prosthesis from the mold , lubricate
the stone surface and replace the putty cope.
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Mix chemical-cure polymethylmethacrylate and pour it into the mold.
Place the assembly in a pressure pot for 20 minutes at 25 psi.
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Remove the acrylic resin tray, trim and thin as needed.
Perforate the approximate pupil location with a 3- 4mm diameter hole.
Place multiple perforations over the remainder of the surface.
Smooth and polish the custom tray .
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To fabricate the injection tube, unscrew
the tip of a 5-mL plastic syringe, and cut
approximately 7 mm from the end.
Roughen the sides of the tip and wedge
it into the pupil perforation hole.
Secure it with cyanoacrylate resin.
Repolish the tray, and check for rough
spots.
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Clean and disinfect the custom tray.
Try in the tray and check for overextension and proper orientation.
Attach the barrel of the 5-mL syringe to the injection tube.
Orient the tube with the numbers facing upward.
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Mix 3 teaspoons water to 1 tablespoon ophthalmic alginate
impression material , and back load the syringe.
Insert the plunger, seat the tray, and inject the alginate.
After the alginate impression material has set, remove and check
the impression for acceptability.
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A wax trial ocular prosthesis (blank) can be made chairside by using
the double alginate technique.
Suspend the impression in a small cup using a clothespin.
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Pour a new mix of irreversible hydrocolloid into the cup, surrounding
the impression.
When set, remove the alginate mold with impression from the cup.
Partially section the alginate mold, spread it, and retrieve the original
impression.
The different mixes of alginate will not adhere to each other.
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The second alginate impression becomes a mold to form the wax blank.
Replace the alginate mold in the cup, and pour ivory wax through the
sprue hole created by the syringe tip.
Upon cooling, remove the impression from the cup to retrieve the wax
blank.
Cut off the sprue, and shape and polish
the wax trial ocular prosthesis.
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Try in the wax trial prosthesis.
Assess fit, contour, and comfort.
Add the iris button to the pattern, then process.
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Post insertion care
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1. Adjusting to the prosthesis .
2. Period of wear .
3. Placed in water or contact lens soaking solution.
4. Never be allowed to dry otherwise it causes various layers to separate.
5. Maintain normal facial animation and to avoid habits designed to hide the
prosthesis.
6. Eye lubricants.
7. Polishing.
8. No contact with alcohol,spirits
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Removal & replacement
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The prosthesissometimes may get
dislodged , so thepatient must be able
to replace in itsposition to avoid any
embarrassment.
Hence it is essentialthat each patient be
trained in the method
of removal and thereplacement of the
prosthesis before the
patient leaves thedental office.
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Patient is asked to tilt the chin
downward looking at mirror.
Forefinger used to pull the lower lid
and at the same time pushing
prosthesis gently backward and
toward the nose.
This will disengage the lower edge of
the prosthesis and it is removed out.
If it is not removed out with the
above said procedure, rubber suction
cup may be used .
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P ti t t l d d hi h d
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Patient must clean and dry his hand.
Looking in the mirror with chin down
Top edge of the prosthesis engagedunder the upper eye lid, forefinger of
the other hand is used to elevate the
upper lid.
The prosthesis should be gently
pushed upward and back ward.
While the upper lid is released the
lower lid is pulled downward
Gentle pressure will cause prosthesis
rotate backward and inward behind the
lower lid to seat the prosthesis.53
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Discussion
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CUSTOM OCULAR PROSTHESIS
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Advantages
Disadvantages
CUSTOM OCULAR PROSTHESIS
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A good impression
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References
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References1. Bartlett SO, Moore DJ: Ocular prosthesis: A physiologic system. J Prosthet Dent 1973;29:450-
459
2. International Ophthalmology Clinics: Winter 1970 - Volume 10 - Issue 4 - ppg 713-719
3. Schneider RL: Modified ocular prosthesis impression technique.J Prosthet Dent 1986;55:482-
485
4. Taicher S, Steinberg HM, Tubiana I, et al: Modified stockeye ocular prosthesis. J Prosthet
Dent 1985;54:95-98
5. Brown KE: Fabrication of an ocular prosthesis. J Prosthet Dent 1970;24:225-235
6. Dorrey J. Moore,John S. Ostrowski, and Lawrence M. King;A quasi-integrated custom ocular
prosthesis jpd oct 1974
7. Sykes LM: Custom made ocular prostheses: A clinical report. J Prosthet Dent 1996;75:1-3
8. Ocular prosthetics: Use of a tissue conditioner material to modify a stock ocular prosthesis R.
K. Ow ,and S. Amrith-218 222
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Vision is the main aspect of the eyeProsthodontist cannot replace this aspect, but canRestore the most beautiful aspect next to god.
Thank you!