Finger Prostheses - Overcoming A Social Stigma

GOOD MORNING
Use of Dental Implants to Retain Finger Prostheses: A Case Report
Ozkan A et-al. Journal of Oral Health and Dental Management. 2012; Vol. 11(1 ) ,11-15.
INTRODUCTION
An injury such as the loss of a finger is considered as a significant functional, life-long deficiency. The prosthesis helps in restoring such defect aesthetically and functionally, playing an immense role in making the patient socially acceptable and therefore brings back the confidence of walking into the society.
METHODS OF RETENTION FOR FINGER PROSTHESIS

Rings Glove type Implant retained
CASE REPORT
A 30-year-old male whose fourth and fifth finger of his right hand were lost at the level of the distal interphalangeal joint as a result of an accident during carpentry Physical examination of the hand showed that the patients index finger was also amputated at the distal phalanx in the same accident but the joint was preserved and functional.
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The first stage of the surgical procedure was to raise an ellipsoid flap on the stumps under local anaesthesia (digital block) and an ischemic tourniquet. Drill holes were prepared longitudinally, in appropriate dimensions for the implants, in the medullar canals of the middle phalanxes of both digits.
Two dental implants (Laser-Lok collar with RBT body, internal hex; BioHorizons, Birmingham, AL, USA) with the dimensions of 4.6 mm x 12 mm and 3.8 mm x 10 mm were placed in the prepared holes in the middle phalanxes of the fourth and fifth fingers, respectively. Clinical and radiographic reviews were performed after three months.
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At the second surgical operation, the skin was reopened with an ellipsoid flap, cover screws on the implants were removed, and healing caps were attached to the implant fixtures
The flaps were then sutured back into place. At the end of a 15-day healing period, impressions were taken using silicone impression material (Zetaplus; Zhermack SpA, Badia Polesine, Italy) after attaching impression caps (close tray) in place
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Once the impression material had set, the impressions were carefully removed and implant analogues were attached to the impression caps that were removed from the fingers.
Working casts were produced using Type- V dental stone (Die-Keen; Heraeus Kulzer, Armonk, NY, USA).
The models were trimmed with a bur to have undersized sleeves so that the sleeves had a vacuum effect on the stumps
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Impressions of the same fingers of the other hand were made with an irreversible hydrocolloid impression material (Hydrogum Soft; Zhermack SpA) and wax was poured into the negative moulds to duplicate the lost fingers. The wax patterns were adapted on the stump cast with analogues and definitive ball attachments.
The female parts of the ball attachments were embedded into the wax patterns. The patterns were then tried on the stumps and checked for the size and shape at all aspects of both fingers.
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After the necessary adjustments had been made, the nails were attached to the beds with a silicone sealant. The prostheses were inserted and evaluated for fit and aesthetics. Instructions for home care were given to the patient, including the debridement of the skin and cleaning of the removable prostheses with a soft toothbrush and soap under flowing warm water.
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After three months, further clinical and radiographic reviews were performed and no complications were found. The skin was healthy and the retention of the attachments was unchanged.
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THUMB AMPUTATIONS
The first stage of the procedure included insertion of the fixture into the medullary cavity of the first metacarpal bone Period of three months was allowed for the unloaded fixture to become firmly osseointegrated into the bone. The second stage of the procedure involved attachment of a skin-penetrating abutment on top of the fixture and modification of the skin graft to minimize relative mobility. A removable thumb prosthesis can then be attached to the fixture
Branemark .R.Osseointegration in skeletal reconstruction and rehabilitation;A review; 13 Journal of Rehabilitation Research and Development 2001 Vol. 38 No. 2 ;175-181.
CLINICAL CASE
A detailed history revealed that the patient lost his fingers 5-year-ago in a road accident. The amputated stumps were well-healed with completely missing little finger and partially missing ring finger
Finger Prostheses - Overcoming a Social Stigma: Clinical Case Reports. Indian Journal of Multidisciplinary Dentistry, 2011. Vol. 2, Issue 1, 407-410.
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A ring of suitable size and width was selected to mask the margin of the prosthesis
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CLINICAL CASE
A nine year old boy reported with a lost finger one year ago while firing cracker Examination of the stumps revealed adequate healing with two-thirds of the finger remaining. Only the terminal one-third of the finger was lost
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Use of a ring looks unnatural in the terminal third of the finger Using the ring near the lower third would make the prosthesis longer, bulky and unesthetic.
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FABRICATION OF THE PROSTHESIS
The basic steps in fabrication of the prostheses for both the patients were the same and hence described together
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Making the impressions and casts the impression

A plastic container of sufficient length and diameter The containers were tried on the patients hands to provide adequate clearance of at least 5 mm around for the impression material Hands were dipped vertically into the container without touching the sides or the bottom of the container
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Impressions of both the affected and normal hands were made. The impressions were poured in stone and casts were made.
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Selection of a donor and making wax patterns

Donor hand for making the wax patterns was essential to avoid the laborious task of sculpting. Using the cast of the normal hand a reference, a donor hand was selected Impressions of the fingers of the donors were made using condensation silicone in putty consistency.
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Wax was molten and poured into the putty impressions.

After the wax cooled down, it was retrieved from the impression and tried on the casts.
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Color matching and incorporation of nail

Maximum efforts were made to match the color of the prostheses. The nails were made from cold cure clear acrylic resin. They were properly shaped and trimmed to the required size. Around 1 mm of nail bed was carved in the wax patterns and the nails were incorporated in that space.
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Stump preparation in order to fabricate a glove type prosthesis

A reduction of 1-1.5 mm was done on the stone casts. This would produce prosthesis with a smaller diameter which can be stretched over the amputated stumps to provide retention.
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Procesing and finishing the patterns were flasked and a two part mould was obtained after dewaxing Prostheses were finished using alpine stones and silicone burs.
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METHODS OF RETENTION
Clinical case 1- ring
Clinical case 2- glove type
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CONCLUSION
Successful prosthetic rehabilitation of these patients is a challenging task, but it is our duty to make the best use of the available materials and techniques to enable these patients to reenter the society as confidently as possible. ITS THE RIGHT OF EVERY HUMAN TO LOOK HUMAN
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REFERENCES
Branemark .R.Osseointegration in skeletal reconstruction and rehabilitation;A review; Journal of Rehabilitation Research and Development 2001 Vol. 38 No. 2 ;175-181.
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THANK YOU..
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Finger Prostheses - Overcoming A Social Stigma

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GOOD MORNING

Use of Dental Implants to Retain Finger Prostheses: A Case Report

METHODS OF RETENTION FOR FINGER PROSTHESIS

FABRICATION OF THE PROSTHESIS

Making the impressions and casts the impression

Selection of a donor and making wax patterns

Wax was molten and poured into the putty impressions.

Color matching and incorporation of nail

Stump preparation in order to fabricate a glove type prosthesis

Clinical case 2- glove type

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