Refabrication of an implant-retained auricular prosthesis using clip attachment pickup technique

Abstract

Increased patient acceptance and widespread use have led to a greater demand for refabrication of existing maxillofacial prostheses exhibiting wear and tear. Refabricating an osseointegrated implant-retained silicone auricular prosthesis on the existing Hader bar is a challenging task if it is performed without removing it. Therefore, an attachment level impression method is utilized for the refabrication of a new prosthesis on an existing Hader bar framework without removing it from the patient's defect. This case report discusses a modification of the Mahidol University technique. This modification provides a simple, speedy, and convenient method through which the relation between the metal framework and attachments could be obtained precisely. This precision allowed for easy fabrication of the acrylic housing, which in turn results in better adaptation of the auricular prosthesis to the patient's face. Therefore, this technique offers advantages to both the prosthetist in fabrication and the patient in facilitating him continue to wear his existing implant-retained prosthesis during refabrication process.

Keywords: Attachment level impression; craniofacial implants; implant retention; indirect acrylic housing; silicone auricular prosthesis.

Figure 1

Examination view of the right auricular defect with Hader Bar, auricular remnant, skin reaction around abutment, and proximity of implants seen

Figure 2

Examination of the right auricular prosthesis, ill-fitting, thick open margins, and improper shade match

Figure 3

Blockout under Hader bar metal framework with carding wax on the patient

Figure 4

Two Hader rider clips with clip housing in place

Figure 5

Both the clips assembly are attached with pattern resin for orientation

Figure 6

Attachment impression (mute-fit) technique using monophasic vinyl polysiloxane impression material, reinforced with pieces of tongue blades

Figure 7

Retrieved impression, picked up clip attachments, followed by placement of tooth preparation burs before cast pour

Figure 8

Working model cast with preparation burs in it

Figure 9

Clear autopolymerizing polymethyl methacrylate housing made indirectly on the cast with clips embedded

Figure 10

Three-piece auricular mold after the wax try-in

Figure 11

Finished prosthesis with acceptable esthetic and function

Figure 12

Compression between new and existing prostheses