Rehabilitation of a patient with multiple silicon finger ...

Case Report

Rehabilitation of a patient with multiple silicon finger prosthesis Dr. Sitansu Sekhar Das*, Dr. Abhilash Mohapatra**, Dr. Neeraj Sharma*** Dr. Abhijeeta Mohapatra****, Dr. Pradyumna Kumar Sahoo*****

ABOUT THE AUTHORS *Professor Department of Prosthodontics ,Institute Of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar **Senior Lecturer Institute of Dental Science, Siksha O Anusandhan University, Bhubaneswar ***Senior Lecturer Seema Dental College, Risikesh ****Reader Institute of Dental Science, Siksha O Anusandhan University, Bhubaneswar *****Senior Lecturer Institute of Dental Science, Siksha O Anusandhan University, Bhubaneswar

Address for Correspondence

Dr. Sitansu Sekhar Das Professor Department of Prosthodontics, Institute Of Dental Sciences, Siksha O Anusandhan University, K-8,Po-Ghatikia Bhubaneswar -751003 [email protected] Mobile- 9937301343

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Abstract Prosthesis should be similar in character to the existing fingers. Should mimic the real skin, be precise shape for each finger, the lines under each knuckle, and the way that fingerprints go all the way down. Fingernails should be natural to the individual. Planning the prosthesis, making the impression, sculpting the model and choosing the material - all contribute to a successful prosthesis. A case report has been presented where four custom made finger prosthesis; comfortable in use and esthetically acceptable to the patient was fabricated; using silicone material. Keywords : Mutiple finger, silicon prosthesis, medical adhesive

INTRODUCTION The fabrication of a digital prosthesis is as much as an art as it is a science. Here there are no limitations to your imagination and one cannot apply the inferences drawn from one patient to another. But we try to follow the doctrine “Every human has the divine right to look human”. Even if the disfigurement is slight, the psychological wound is so great that the disfigured person himself avoids social contacts. So the prosthodontics should not only make the person functional physically but also socially. The ideally constructed prosthesis must duplicate the missing feature so precisely that the casual observer notices nothing that would draw attention towards the prosthetic reconstruction1. To create such prosthesis, which has a realistic skin surface and seamless visual integration with the surrounding tissue one requires a technical qualification along with artistic ability2. Loss of finger total or partial is usually due to traumatic injury or congenital. Because any of the fingers may be affected in whole or in part, prosthetic restoration is often difficult. This is particularly true when multiple fingers are involved3. The material most commonly used for fabrication of finger prosthesis is polyvinyl chloride but the problem with this material is it takes stain permanently from ball point ink to food color4. For prosthesis to be universally accepted it has to satisfy four key rules as given by American academy of Orthotist and Prosthetist 1) character 2) color 3) durability 4) fit. The medical grade silicon prosthesis fulfills the entire requirement perfectly so its acceptance rate has been much higher when an individually sculpted custom restoration using silicone elastomer is provided5.The overall durability and stain resistance of silicone is far superior to any other material currently available for finger restorations. Almost all stains, including ballpoint ink, newsprint, clothing dyes and food colorings, can be removed easily with water and soap.

JODE, Kolhan University (Jharkhand), Vol - 2 No.-2 July 2015 87

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CASE REPORT A 36 year old person who has lost his four fingers in a grass cutting machine reported for reconstruction of the missing finger. As he was not ready to go through surgical procedure so a prosthodontics rehabilitation was planned. On examination all the defective fingers had a healed wound scar on the dorsal aspect. The surrounding area showed no signs of any infection and an informed consent was taken and treatment was started.

= Impression of the normal finger on the other hand was then taken in hydrocolloid impression material and wax pattern was fabricated from this. (Figure 2). Retention of the prosthesis was further enhanced by scraping grooves into the positive model, creating separate vacuum chambers6. = Then try in was done and the fit stability and seating of the wax pattern were evaluated along with the shape and size of the pattern. ( Figure 3) = Acrylic nail were fabricated from clear heat cure resin ( Dental products of India, Mumbai, India) and incorporated in the wax pattern

TECHNIQUE = The patient hand was lubricated with petroleum jelly (Vaseline, Hindustan Lever). Then a plastic container was used as a tray and hydrocolloid impression materials (Tropicalgin; Zermach Inc, California) were first placed on the palmer side first and then on the dorsal side (Figure 1)

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= The impression was then poured with dental stone (Kalstone; Kalabhai Pvt Ltd. Mumbai) and the positive replica was retrieved.

= The pattern was then flasked in a two part mould with dorsal and ventral aspect in two parts. (Figure 4) = The room temperature vulcanising silicon material (Cosmesil; medical grade, Technovent Co, UK) was colour matched in dorsal and ventral side separately


with intrinsic color and packed in the prepared mould, taking care there was no air entrapment. = During packing of silicon material, a straight hair pin was incorporated such that it remains in centre of prosthesis at distal interphalangeal joint. This provides rigidity to the prosthesis. = The prosthesis was processed according to manufacturer's instruction and it was then retrieved and the flashes were trimmed using a sharp blade and finished with silicon finishing burs. (Figure 5) = Final color matching was done with extrinsic pigmentation (Cosmesil; Silicon coloring kit, Technovent Co,UK) in presence of patient = To complete the prosthesis the artificial nail was removed and characterisation was done in nail bed similar to that of adjacent nail and readapted into place and to achieve an enhanced realistic appearance. = Medical adhesive (Edge adhesive, Cosmesil; Technovent Co, UK) was applied to the base of the prosthesis for retention and to reduce the gap between skin and prosthesis. = The final and most gratifying step was to place the prosthesis on the patient hand in lieu of the missing fingers. (Figure 6)

is esthetically acceptable and comfortable for use in patients with amputed fingers, resulting in psychological improvement and personality. But there are some disadvantages associated with early prosthetic rehabilitation like tissue bed contraction which leads to loss of retention of the prosthesis and this can also be overcome by use of silicon adhesives.

REFERENCES 1. Pillet J. Partial-hand amputation-aesthetic restoration. In: Bowker JH, Michael JW [eds]. Atlas of limb prosthetics: surgical, prosthetic and rehabilitation principles. St. Louis: CV Mosby, 1992: 227-35. 2. Pillet J. The aesthetic hand prosthesis. Orthop Clinics in North Amer 1981; 12;961-70. 3. Bunnell S. The management of the nonfunctional hand-reconstruction versus prosthesis. Artificial Limbs 1957;4: 1:76102. 4. Michael J. Partial-hand amputation: prosthetic and orthotic management. In: Bowker JH, Michael JW [eds]. Atlas of limb prosthetics: surgical, prosthetic and rehabilitation principles. St. Louis: CV Mosby, 1992: 217-26. 5. Buckner H. Cosmetic hand prostheses- a case report. Orthotics and Prosthetics 1980;34:3:41-5.

SUMMARY Prosthetic rehabilitation is advantageous in that it is relatively quick, reversible, and medically uncomplicated. The custom – made finger prosthesis

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6. Herring HW, Romerdale EH. Prosthetic finger retention: a new approach. Orthotics and Prosthetics 1983 ;37:2:28-30.
