SRM Journal of Research in Dental Sciences

CASE REPORT
Year
: 2015  |  Volume : 6  |  Issue : 4  |  Page : 275--278

Glove silicone finger prosthesis


Laxman Singh Kaira1, Esha Dabral2,  
1 Department of Dentistry, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Srinagar, Pauri Garhwal, India
2 Private Practitioner, Ram Chanda Oro Dental Clinic, Srinagar Garhwal, Uttrakhand, India

Correspondence Address:
Laxman Singh Kaira
Type 2, House Nu 4, Block Nu 2, Faculty Residence, VCSGGMSRI Campus, Srinagar, Pauri Garhwal, Uttrakhand
India

Abstract

The loss of all or part of a finger following traumatic amputation may have a negative impact on physical and psychological well being. An esthetic prosthesis can offer psychological, functional, and rehabilitative advantages. The success of a prosthetic restoration primarily depends on its retention. This clinical report portrays a method to fabricate silicone rubber prosthesis for a patient who has a partial finger loss caused due to trauma.The methodology of treatment is also explained. Silicone material was used to provide function and esthetics.



How to cite this article:
Kaira LS, Dabral E. Glove silicone finger prosthesis.SRM J Res Dent Sci 2015;6:275-278


How to cite this URL:
Kaira LS, Dabral E. Glove silicone finger prosthesis. SRM J Res Dent Sci [serial online] 2015 [cited 2022 Aug 19 ];6:275-278
Available from: https://www.srmjrds.in/text.asp?2015/6/4/275/156225


Full Text

 INTRODUCTION



Along with functions like grasping and feeling, hands also have an esthetic impact and they can emphasize the beauty of a gesture or the grace of a movement. [1] Finger and partial finger loss are some of the most frequently encountered forms of partial hand loss. The most common causes are trauma, congenital absence and malformations. [2] Amputation of finger causes devastating physical, psychosocial and economic damage to an individual. Rehabilitation of amputed finger is of utmost importance as restoration of the natural appearance eliminates the trauma generated by the dysfunction and represents an efficient psychological therapy. The restoration of finger amputations depends on the amount of tissue involved, the involvement of bone, the angles and levels of amputation, and the involvement of other fingers. The microsurgical reimplantation helps to save many severely injured and traumatically amputed fingers. When surgical reconstruction is contraindicated, unsuccessful, unavailable or unaffordable, then a high quality esthetic prosthesis with passive function can be helpful. This paper presents case report of prosthetic rehabilitation of patients with middle finger partial amputation, with custom made silicone finger prosthesis.

 CASE REPORT



A male patient, aged 38 years, reported to the department, with a history of partial loss of left hand middle finger, about 3 years back, due to occupation-related trauma. The patient had suffered a long period of psychological depression immediately after the injury. Post-surgery, the patient had also observed difficulty in holding large-sized objects and any work that would be related to them for example using a hammer. Medical history was non-contributory except he was taking anti-depressants for many years. Clinical examination of the affected hand revealed that remaining part of middle finger was approximately 80 mm in length [Figure 1]. Examination of the fingers revealed the presence of undercuts in relation to lower one-third of the remaining tissue. The undercuts present were within the soft tissue and no evidence of hard tissue undercut was found. The surrounding area appeared to be normal with no signs of any infection over the digit. After having informed consent from the patient, to ensure his willingness and cooperation the treatment was executed.{Figure 1}

Technique

Impression making

The patient's hand with missing fingers was lubricated with a thin layer of petroleum jelly (Biolin, Biopharm laboratories, Bangalore, lot no-21012) and the area around the hand was boxed. A thin layer of irreversible hydrocolloid impression material (Imprint, Dental Products of India; batch no. 51114) was placed over the palmar side first and then the dorsal side. The patients were instructed to keep the hand in the normal resting position without stretching while impression making. [Figure 2]. {Figure 2}

Model preparation

When the material was set the impression was retrieved and sent to the laboratory for the fabrication of model. The impression was poured in stone plaster, type-III (Kalstone, Kalabhai, Mumbai: India); at the same appointment another impression was made of patient's right hand middle finger in a combination of light body and putty (Express, 3MESPE, India) [Figure 3]. The impression of the patient's right hand middle finger was poured with wax [Figure 4]. The pattern was removed from the elastomeric impression.{Figure 3}{Figure 4}

Wax pattern fabrication and try in

The wax pattern was then adjusted by sculpting and adapted on the working cast. Approximate length and angulations were determined on working cast and later confirmed during trial of wax pattern [Figure 5]. The wax pattern was tried on the patients affected left hand middle finger [Figure 6]. The necessary shades were selected for different areas of the finger especially the junctions of adjacent two surfaces. {Figure 5}{Figure 6}

Investment technique

The master cast was duplicated and the duplicate cast was used for investing. The pattern was sealed to the master cast at the junction, where the margins of the pattern overlapped the cast. The pattern and the cast were then invested in a large size Hanau flask [Figure 7]. The mold was first poured only up to half of the pattern. Tin foil substitute was applied and then the other half was poured, wax was eliminated in the conventional way. {Figure 7}

Colour matching

The mold cavity was prepared by first coating the external tissue surface with application of extrinsic color; a base color mixture of the silicone material (Multisil Epithetic, Bredent Gmbh and Co. kg, Seden, Germany) was prepared to fill the mold cavity. Kaolin powder was added to provide the radiopacity. Then silicone catalyst was added after satisfactory base color was developed. The two shades of silicone were used, one for the first layer which would represent the dorsal surface of the finger and the second which would represent the ventral surface of the artificial finger. Air dryer was used to partially polymerize the first layer. Air was removed from the mixture by placing the container in a bell jar under vacuum. The colored, catalyzed, airless silicone base was then placed into the mold cavity [Figure 8]. The two pieces were re-assembled and excess silicone was expressed using light pressure. The mold was then clamped and placed into a dry heat oven at the manufacturer's prescribed time and temperature.{Figure 8}

After polymerization, the mold was allowed to cool at room temperature, opened and flash removed with a sharp scalpel and finished with an abrasive stone.

Final prosthesis

The prosthesis was tried in the patient. The artificial prosthesis was quite retentive due to the vacuum created; for additional retention metal ring was also given. The prosthesis was finally delivered to the patient after giving instructions regarding its maintenance [Figure 9] and [Figure 10].{Figure 9}{Figure 10}

Patients follow up

For prostheses evaluation, the patients were asked to return on day 1 and 7 for follow-ups. There after a 6 month follow-up was done and it was noted that the patients had no complaints and were satisfied about esthetics and comfort of the finger prostheses.

 DISCUSSION



In this technique conventional impression method is used which has a certain advantage over the older technique. It is a less cumbersome quick, easy and economical technique using minimal material. For making of wax pattern the same person's unaffected hand can be used to eliminate the error in respect to size and shape. We can also use the analogous finger technique. [3]

Wax was preferred over clay to make the pattern because residual oils from clay contaminate the mold surface, which interferes with the platinum catalyst employed in silicone prosthesis materials. The resultant wax was pliable enough to form into small shapes with fingers when warm, yet stiff enough to carve with an instrument when chilled. [4] Placing it in chilled water for some time prevents distortion of the pattern. If any surface details were lost, then the wet gauze technique was used to recreate surface details. Silicone prostheses do not have color longevity. The ideal color properties required in a maxillofacial prosthetic material must accept and retain intrinsic and extrinsic coloration, and that the appearance and mechanical strength of the prosthesis must not be changed by sunlight or other environmental factors. [5] Color instability of the prosthesis may be attributed to ultraviolet (UV) light exposure, air pollution, cosmetics, and the use of strong solvents to clean the prosthesis. [6],[7]

The coloring of silicone is a technically sensitive procedure. The intensity of the non-polymerized silicone matched the one but after polymerization the same shade looked light, so external staining was also done. This definitely shows that there is a difference in intensity between non-polymerized and polymerized silicones. The retention of artificial prosthesis is of utmost important needing ring, adhesives and osseointegrated implants. [8],[9] That in turn enhances the function, comfort and improve quality of life of the patient. [10]

For most patients, the aesthetic appearance of an amputated finger plays a more important role than function. With the advancement in skill, technology and materials available today, the rehabilitation of an amputated finger is no more aesthetically challenging. When fabricated with immense care, they can be made life-like. A well fabricated aesthetic prosthesis can help in providing the patients with psychological support.

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