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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 97-100

Silicone finger prosthesis with customized ring wire loop substructure as a retentive aid


Department of Prosthodontics, Government Dental College, Thiruvananthapuram, Kerala, India

Date of Submission07-Jun-2020
Date of Acceptance15-Sep-2020
Date of Web Publication31-Aug-2021

Correspondence Address:
Dr. Senbagavalli Sagadevan
Department of Prosthodontics, Government Dental College, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jid.jid_48_20

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   Abstract 


Finger prosthesis is an artificial replacement of missing fingers. Defects of fingers or hands due to congenital reasons or trauma may affect the individual physically, emotionally, and psychologically. Major problem that we can anticipate during prosthetic replacement of missing or lost fingers is retention. The anatomy of the residual stump of the defect is the most important factor that will determine the mode of retention. Retention of the prosthesis can be enhanced by the numerous methods. This case report describes a cost-effective and simple approach of rehabilitation of a partially amputated finger using a custom-made ring-wire loop substructure which helped to enhance the fit and retention of the prosthesis along with fulfilling the functional demands of the patient.

Keywords: Amputation, customized ring, finger prosthesis, retention, silicone prosthesis


How to cite this article:
Sagadevan S, Ravichandran R, Kumar K H, Rajeev S. Silicone finger prosthesis with customized ring wire loop substructure as a retentive aid. J Interdiscip Dentistry 2021;11:97-100

How to cite this URL:
Sagadevan S, Ravichandran R, Kumar K H, Rajeev S. Silicone finger prosthesis with customized ring wire loop substructure as a retentive aid. J Interdiscip Dentistry [serial online] 2021 [cited 2021 Nov 28];11:97-100. Available from: https://www.jidonline.com/text.asp?2021/11/2/97/325110




   Clinical Relevance to Interdisciplinary Dentistry Top


Retention of partially amputated finger with inadequate stump height can be achieved using custom made ring soldered to orthodontic wire acting as a substructure for retaining silicone finger prosthesis. In endodontics silicone can be used as root canal sealers


   Introduction Top


Trauma leading to finger amputation causes functional disability, disfigurement, and psychological issues. Surgical reconstruction is the primary choice for saving traumatized fingers.[1],[2] However, insufficient residual tissues and vascular compromise often restrict such reconstructions.[1],[3] Rehabilitation of such defects with silicone prosthesis is a boon to the maxillofacial prosthodontists. In case of inadequate stump, adhesive pastes, elastic bands, and rings have been suggested to enhance the retention. This article describes a cost-effective and simple approach for rehabilitation of a partially amputated finger using a customized ring-wire loop substructure which enhanced the fit, retention, and fulfilling the functional demands of the patient.


   Case Report Top


A 23-year-old male patient reported to the department of prosthodontics with the chief complaint of missing the middle finger of the right hand. History revealed that a patient had lost his finger 1 year back due to a snake bite. On inspection, the defect was seen in the middle finger of the right hand, and the defect was at the mid-level of proximal phalanx of the middle finger [Figure 1]. The distal end of the defect was bulbous due to scaring, and no signs of discoloration, pulsating veins, and edema were seen. On palpation of the defect, the distal bulbous area was compressible in nature, no bony undercuts, or subcutaneous nodules were present. It was planned to rehabilitate the patient with ring-retained finger prosthesis.

Alginate impression material was used to make the impression of the middle finger [Figure 2], and the model was poured with type 3 gypsum product [Figure 3]. Suitable donor was selected, and an impression of the middle finger was made using polyvinyl siloxane putty impression material. Molten-modeling wax was poured in the impression, and the pattern was retrieved after cooling. The retrieved wax pattern thus obtained was hollow out from inside. Sculpting and modification of the wax pattern were done to mimic the middle finger of the patient's left hand.
Figure 1: (a) Dorsal aspect of the right hand with the defect. (b) Ventral aspect of the right hand with the defect

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Figure 2: Alginate impression

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Figure 3: Working model

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A suitable stainless steel ring was selected, and its fitness was checked. Then, 0.9-mm orthodontic stainless steel wire was used to fabricate a metal frame work which ran along the length of the finger from the ring to a point above the defect. Soldering was done on the both sides of the ring after the wire, and the ring were assembled on the finger model [Figure 4]. Then, the metal frame work-ring assembly try in was done [Figure 5]. After try in, metal frame work-ring assembly inserted into the previously made wax pattern and then try in was on patient hand to evaluate the esthetics, fit, comfort, and orientation on both the dorsal and ventral aspects of the patient's hand [Figure 6] and [Figure 7]. Scoring the finger model was done to improve the fitness of the prosthesis by compressing the tissues in the residual stump.
Figure 4: The customized ring wire substructure

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Figure 5: The try-in of the customized ring wire substructure

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Figure 6: Wax pattern-ring substructure assembly

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Figure 7: Try-in of the wax pattern - ring wire substructure assembly

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Flasking of the ring metal frame work-wax pattern assembly was done using two-pour technique. Dewaxing was done, and the mold was inspected for any impurities [Figure 8]. The separating medium was applied all through the surface of the mold. Factor II room temperature vulcanizing maxillofacial silicone was used for the fabrication of prosthesis. The silicone is available in Part A and Part B (Part A: Part B to be mixed in the ratio of 10:1). Intrinsic skin shade matching was done in the chair side, and it was done separately for the dorsal and ventral aspects of the finger. After satisfactory shade matching was obtained, Part B was mixed, and the silicone was introduced in the mold and left overnight for curing at the room temperature as per the manufacturer's recommendations [Figure 9].
Figure 8: Dewaxing

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Figure 9: Packing of silicone

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After polymerization, finger prosthesis was retrieved and that was inspected for any surface irregularities, nodules, fins, and dental stone remnants. After finishing the prosthesis, extrinsic staining was done in the presence of the patient, and minor detailing was done. The prosthesis was inserted and checked for the color matching, retention, fit, orientation of the prosthesis [Figure 10], and its camouflage with the remaining residual stump. The patient was made to practice and demonstrate various functions such as holding a tumbler and Shaking hands [Figure 11]. The prosthesis seemed to be functionally stable and acceptable by the patient. Postinsertion instructions were given regarding the maintenance of the prosthesis.
Figure 10: (a) The final insertion of the prosthesis (dorsal aspect) after extrinsic staining. (b) The final insertion of the prosthesis (ventral aspect) after extrinsic staining

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Figure 11: (a-c) Functional assessment of the prosthesis

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   Discussion Top


In the past years, wood, leather, polyurethane, and polyvinyl chloride have been used to fabricate maxillofacial prosthesis. Nowadays, silicone rubber has been most popular because of its life-like appearance.[4] Customized silicone prostheses have a broad range success, because their comfort, durability, and stain resistance, which are more superior than any other extraoral maxillofacial material.[5],[6]

Silicone finger restorations had shown their potency in terms of flexibility, excellent color matching, ease of fabrication, and more life-like appearance. Factor II brand medical grade silicone was used for the fabrication of the prosthesis. It has high tear strength, good electrical and thermal stability, easy to pour, and possesses remarkable color stability. It cures at the room temperature and does not require any special equipment for processing.[5] Protection and desensitizing the hypersensitive tissues at the amputation site were the additional functional benefits of silicone prosthesis by exerting constant gentle pressure over the affected area.

Michael and Buckner described a method of scoring the model to obtain a tight fitted prosthesis which took into consideration the compressibility of tissues on the residual stump.[7]

Surveys on using such artificial hands reveal that 30%–50% of upper extremity amputees do not use their prosthetic hand regularly.[8] The main factors for this are low functionality, poor cosmetic appearance, and low controllability.[8]

The use of osseointegrated dental implants are superior to retain a finger prosthesis than the retention obtained by medical grade adhesives and other retentive modes.[9] Although implant could have been a viable option, it is more expensive.

The custom-made ring-wire substructure proved to be beneficial in terms of being lightweight, providing adequate fit, offering resistance to corrosion, adequate mechanical interlocking of the silicone. The prosthesis can be cleaned with soap and water. The material used for the prosthesis was pleasant to wear, prevents pressure sores, and has good fixation. It ensures easy insertion and removal of the prosthesis, also there is enhanced counter support for existing fingers. A well-fabricated esthetic and functional prosthesis can help in providing the patients with psychological support.[10]


   Conclusion Top


Fabricating a maxillofacial prosthesis in situations encountering compromised anatomy has always been a challenge for maxillofacial prosthodontists. Advantages of this customized attachment are as follows: cost-effective, easily customizable, improves functional ability, and provides psychological advantages.[1] The finger prosthesis with custom-made ring wire substructure was functionally adequate and esthetically acceptable by the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mehta S, Agrawal R, Chitikeshi S, Nandeeshwar DB. Rehabilitation of missing digit using customized attachment supported prosthesis. J Indian Prosthodont Soc 2019;19:276-80.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Kamble VB, Desai RG, Arabbi KC, Mahajan K, Patil S. Finger prostheses for multiple finger amputations: Two case reports. National J Med Dent Res 2013;1:38.  Back to cited text no. 2
    
3.
Ozkan A, Senel B, Durmaz CE, Uyar HA, Evinc R. Use of dental implants to retain finger prostheses: A case report. Oral Health Dent Manag 2012;11:11-5.  Back to cited text no. 3
    
4.
Kumari N. A simplified silicone finger prosthesis: A boon to handicapped: Case report. Int J Oral Health Med Res 2015;2:45-7.  Back to cited text no. 4
    
5.
Saxena K, Sharma A, Hussain MA, Thombare RU, Bhasin SS. A hollow silicone finger prosthesis with modified metal-mesh conformer. J Indian Prosthodont Soc 2014;14:301-4.  Back to cited text no. 5
    
6.
Beumer JI, Curtis TA, Firtell DN. Maxillofacial Rehabilitation: Prosthodontic and Surgical Considerations. St. Louis, CV: Mosby; 1979.  Back to cited text no. 6
    
7.
Mehta S, Leela B, Karanjkar A, Halani AJ. Prosthetic rehabilitation of a partially amputated finger using a customized ring-wire substructure. J Indian Prosthodont Soc 2018;18:82-5.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Atkins DJ, Heard DC, Donovan WH. Epidemiologic overview of individuals with upper-limb loss and their reported research priorities. J Prosthet Orthot 1996;8:2-11.  Back to cited text no. 8
    
9.
Pattanaik B, Pattanaik S. Fabrication of a functional finger prosthesis with simple attachment. J Indian Prosthodont Soc 2013;13:631-4.  Back to cited text no. 9
    
10.
Shanmuganathan N, Maheswari MU, Anandkumar V, Padmanabhan TV, Swarup S, Jibran AH. Aesthetic finger prosthesis. J Indian Prosthodont Soc 2011;11:232-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]



 

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