Psychosocial distress and psychological adjustment in patients with ocular loss: a framework analysis.

BACKGROUND: Patients with ocular loss tend to have physical and psychosocial difficulties. Maxillofacial prosthetic specialists involved in the treatment should be trained with competence to manage psychological complications. However, due to the multifactorial origin of the psychosocial distress, designing such training activities can be challenging. This research aimed to construct a conceptual framework illustrating the effects of ocular loss on patients' physical and psychosocial well-being and their coping strategies, to propose the learning content of training sessions. METHODS: A semi-structured interview and a topic guide were employed to explore the perceptions from patients who were receiving their first custom ocular prosthesis, fabricated by maxillofacial prosthodontists. The participants were selected using a purposeful sampling up until data saturation. The data were analyzed using framework analysis. RESULTS: Twelve patients participated in this research. Four main themes emerged from the data analysis: (1) Impact of ocular loss, (2) Factors influencing psychosocial distress, (3) Psychological adjustment, and (4) Expected treatment outcomes. Each theme appeared to have influence on the other, rather than presenting itself independently. Although patients with ocular loss experienced both physical and psychosocial difficulties, psychological distress was greatly influenced by self-perceived disfigurement, etiology, and social status. Therefore, they needed to develop their coping strategies including rehabilitation with ocular prosthesis. CONCLUSION: Various forms of psychological adjustments were necessary in these patients with ocular loss to resume their daily lives. The specialist involved in the treatment should also partake in patients' psychological adjustment and should be competent in psychological management skills, such as supporting patients to meet their expectations.

Effects of Disinfection Methods on the Color Stability of Precolored and Hand-Colored Maxillofacial Silicone: An In Vitro Study.

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.

Fungicidal Effect of Lemongrass Essential Oil on Candida albicans Biofilm Pre-established on Maxillofacial Silicone Specimens.

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.

Combination prosthetic design providing a superior retention for mid-facial defect rehabilitation: A Case Report.

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. Key words:Mid-facial prosthesis, obturator, magnet attachment, maxillectomy.

Prevention of peri-implant skin inflammation using an acrylic resin housing with a tunnel design for an implant-retained auricular prosthesis.

Implant-retained auricular prostheses offer better retention than conventional adhesive retentive methods. Peri-implant skin inflammation, which results from improper substructure design, poor hygiene, skin thickness, and the hot and moist environment around abutments, however, is a common complication of craniofacial implants. This article describes a technique for fabricating an acrylic resin housing design with an extended arm to improve ventilation around implants and to reduce the risk of the silicone prosthesis tearing away from the acrylic resin housing.

A two-step functional impression technique for the fabrication of an implant-retained silicone auricular prosthesis.

Excessive movement of the underlying tissue bed can lead to poor retention of an implant-retained silicone auricular prosthesis. This article describes a 2-step impression technique with a secondary functional pickup impression of the wax pattern. A wide range of tissue movements can be recorded while maintaining a stable relationship between the abutment analog assembly and retentive elements. The definitive cast is modified accordingly to provide an accurate reproduction of the patient's tissues during function, thus, increasing the overall retention and stability of the definitive prosthesis.

Cell-Free DNA Profile in Peri-Implant Skin Exudate of Craniofacial Implants with Various Degrees of Inflammation: A Pilot Study.

PURPOSE: To profile human ß-globin gene fragment lengths from cell-free DNA in peri-implant skin exudate of craniofacial implants with various degrees of soft tissue inflammation. MATERIALS AND METHODS: Fifteen participants (30 implants) were recruited for this study. All participants were recalled for three consecutive visits at days 0, 14, and 28. During each visit, the soft tissue condition at the skin-abutment interface of each craniofacial implant was graded by Holgers score, and the implant stability quotient (ISQ) values of the implants were also measured. Peri-implant skin exudate specimens were collected and centrifuged to obtain cell-free DNA. Conventional polymerase chain reaction was used to assess DNA fragment lengths by amplifying five polymerase chain reaction amplicon sizes from 110-base pairs (bp) to 2-kilobase pairs (kbp) of human ß-globin gene. The longest polymerase chain reaction amplicon size found in each specimen was then recorded. RESULTS: No significant differences in the ISQ values of the implants (P > .05) were noted during the study period. In each recall visit, a correlation was observed between Holgers score and polymerase chain reaction amplicon sizes (P < .001). A gradual decrease in both parameters was also noted following the treatment protocol (P < .05). From the 90 exudate specimens obtained from all the observation visits, 1-kbp amplicon sizes were usually found in the group with Holgers score 1 (47 of 52 specimens); 2-kbp amplicon sizes were often found in the group with Holgers score 2 (22 of 32 specimens) and predominantly found in the group with Holgers score 3 (5 of 6 specimens). CONCLUSION: The 1-kbp amplicon sizes can serve as a marker for mild clinical inflammation of peri-implant skin. Similarly, 2-kbp amplicon sizes may be used as a prognostic marker for denoting greater cell destruction and inflammation, which indicate a greater risk of severe inflammation. However, further studies are required to support these findings.