Search Results (18)

Background/Objectives: Maxillofacial silicone prostheses’ long-term color stability remains a challenge. This study aimed to evaluate and compare the color stability of conventional and digital maxillofacial silicone elastomers mixed with nano-sized antimicrobial additives (ZnO nanoparticles and chlorhexidine salt-CHX) at various concentrations over a 10-week period. Methods: A total of nine groups (n = 10) of maxillofacial silicone elastomers were prepared. These included a control group (no additives), conventionally pigmented silicone, digitally pigmented silicone (Spectromatch system), and silicone mixed with ZnO or CHX at 1%, 3%, and 5% by weight. Specimens were fabricated in steel molds and cured at 100 °C for 1 h. Color measurements were performed at baseline and after 1, 4, 6, and 10 weeks using a Minolta Chroma Meter (CIELAB system, ΔE₀₀ formula). Data were analyzed using two-way ANOVA and Tukey HSD post hoc tests (α = 0.05). Results: Color changes (ΔE₀₀) ranged from 0.74 to 2.83 across all groups. The conventional pigmented silicone group showed the highest color difference (ΔE₀₀ = 2.83), while the lowest was observed in the ZnO 1% group (ΔE₀₀ = 0.74). Digital silicone and all antimicrobial-modified groups exhibited acceptable color stability (ΔE₀₀ < 3.1). Time significantly affected color difference, with the largest change occurring during the first four weeks (p < 0.05), followed by stabilization. Regression analysis confirmed high color stability over time for all groups except the conventional pigmented group. Conclusions: This is one of the first studies to directly compare digital and conventional pigmentation methods combined with nano-antimicrobials in maxillofacial silicones. Maxillofacial silicone elastomers mixed with up to 5% ZnO or CHX maintained acceptable color stability over 10 weeks. Digital pigmentation is similar to conventional methods. The incorporation of nano-antimicrobials offers significant microbial resistance and improved color retention. Full article

The treatment of maxillofacial defects presents significant challenges due to the complexity of facial anatomy and the diversity of affected tissues. Traditional workflows are labor-intensive, costly, and limited in customization. Recent advancements in fully digital workflows and direct 3D printing technologies offer new possibilities for improving the fit, aesthetics, and efficiency of prosthetic manufacturing. This scoping review aims to evaluate the current state of direct 3D printing for maxillofacial soft prostheses, assess material properties and biocompatibility, and identify challenges and future directions in this field. Methods: A comprehensive search of PubMed and Scopus databases, along with a manual search of relevant journals, was conducted to identify studies published up to December 2024. Articles focusing on direct 3D printing of maxillofacial soft prostheses were included, while studies involving traditional or mold-based workflows, ocular prostheses, and literature reviews were excluded. Data on materials, manufacturing techniques, and clinical outcomes were extracted and analyzed. Results: Out of 898 articles screened, 11 were included, 5 of which were in vivo studies (case reports). The additive manufacturing methods used in these case reports were Drop-on-Demand (DoD) silicone printing and PolyJet technology. Conclusions: Fully digital workflows and direct 3D printing technologies show promise for advancing maxillofacial prosthesis manufacturing. However, the absence of dedicated software, biocompatible materials, and medium- to long-term clinical evaluations highlight significant research gaps. Future research should focus on material development, workflow optimization, and clinical validation to enable widespread clinical adoption. Full article

Emulating very soft tissues with synthetic materials is important for clinical prosthetists who want to improve compliance in maxillofacial and breast prosthesis. It is equally important for theatrical prosthetists wanting to model bariatric conditions and soft organs for surgical or palpation training. Polydimethylsiloxane (PDMS) gels, which are often used in medical model construction, are stiff and highly elastic compared to the friable soft tissues found in the body. Silicone oil is known to soften PDMS gels, but it is not known precisely how oil dispersal affects these gels and what proportion of oil is needed to simulate very soft tissue membranes like adipose tissue. In this work, internationally agreed test standards were used to mechanically characterize a range of PDMS gel membranes saturated with different amounts of silicone oil to determine whether materials with behavioral similarities to adipose tissue could be created. Mechanical properties like hardness, elasticity, strength, viscoelastic behavior and cure-time are presented in this study, which are all key factors required by the creators of such membranes. Results were compared to identical tests on porcine fat and data in the literature for porcine and human fat. The data revealed a strong correlation between increases in oil content and decreases in membrane hardness, strength and elastic modulus. It was also found that increases in oil content caused proportional increases in cure time, while membranes with equal amounts of oil and gel were best at mimicking characteristics of human and porcine fat, like hardness and elasticity. Full article

Although it is known (from the observations of medical professionals) that cigarette smoke negatively affects maxillofacial prostheses, especially through staining/discoloration, systematic research in this regard is limited. Herein, the color modifications of M511 maxillofacial silicone, unpigmented and pigmented with red or skin tone pigments, covered with mattifiers, or with makeup and mattifiers, and directly exposed to cigarette smoke, were investigated by spectrophotometric measurements in the CIELab and RGB color systems. The changes in color parameters are comparatively discussed, showing that the base silicone material without pigmentation and coating undergoes the most significant modifications. Visible and clinically unacceptable changes occurred after direct exposure to only 20 cigarettes. By coating and application of makeup, the material is more resistant to color changes, which suggests that surface treatments provide increased protection to adsorption of the smoke components. The dynamic water vapor sorption (DVS) measurements indicate a decrease of the sorption capacity in pigmented versus unpigmented elastomers, in line with the changes in color parameters. Full article

The biomedical applications of silicones are countless due to their outstanding properties. In dentistry, silicone for maxillofacial and plastic surgery has become indispensable, from both physiological and aesthetic points of view. In this mini-review, silicone materials for dentistry and facial prostheses are discussed, focusing on their properties and alterations when exposed for long periods to different environments. A significant number of studies reported in the literature have been conducted in vitro, mimicking some of the main degradative factors which have been identified as triggers for discoloration and deterioration of the mechanical properties. Among these, in artificial aging and accelerated natural aging studies, UV radiation is considered the most important. Other weathering factors, biological contamination, and disinfection agents may have dramatic effects as well. Several general properties of silicones are described at the beginning, with a focus on biocompatibility, cross-linking mechanisms, and applications in dentistry and maxillofacial prosthetics. We discuss the ongoing cross-linking and/or possible exudation after manufacturing, which also affects the stability of the prosthesis over time, and possibly the patient. Next, the main environmental factors that affect the prostheses in service are presented, including the role of cigarettes smoke, which has been discussed very little so far. A few aspects, such as biofilm formation, its negative effects, and proposed solutions to overcome this phenomenon regarding silicones, are also described. We conclude by proposing a set of topics for future research and development based on the gaps that have been identified in the literature. Although silicones are probably irreplaceable in maxillofacial prosthetics, improvements in terms of base materials, additives, surface treatments, and maintenance are possible and necessary for long-lasting and safer prostheses. Full article

Zeolites and zeolitic imidazolate frameworks (ZIFs) are crystalline aluminosilicates with porous structure, which are closely linked with nanomaterials. They are characterized by enhanced ion exchange capacity, physical–chemical stability, thermal stability and biocompatibility, making them a promising material for dental applications. This review aimed to provide an overview of the application of zeolites and ZIFs in dentistry. The common zeolite compounds for dental application include silver zeolite, zinc zeolite, calcium zeolite and strontium zeolite. The common ZIFs for dental application include ZIF-8 and ZIF-67. Zeolites and ZIFs have been employed in various areas of dentistry, such as restorative dentistry, endodontics, prosthodontics, implantology, periodontics, orthodontics and oral surgery. In restorative dentistry, zeolites and ZIFs are used as antimicrobial additives in dental adhesives and restorative materials. In endodontics, zeolites are used in root-end fillings, root canal irritants, root canal sealers and bone matrix scaffolds for peri-apical diseases. In prosthodontics, zeolites can be incorporated into denture bases, tissue conditioners, soft denture liners and dental prostheses. In implantology, zeolites and ZIFs are applied in dental implants, bone graft materials, bone adhesive hydrogels, drug delivery systems and electrospinning. In periodontics, zeolites can be applied as antibacterial agents for deep periodontal pockets, while ZIFs can be embedded in guided tissue regeneration membranes and guided bone regeneration membranes. In orthodontics, zeolites can be applied in orthodontic appliances. Additionally, for oral surgery, zeolites can be used in oral cancer diagnostic marker membranes, maxillofacial prosthesis silicone elastomer and tooth extraction medicines, while ZIFs can be incorporated to osteogenic glue or used as a carrier for antitumour drugs. In summary, zeolites have a broad application in dentistry and are receiving more attention from clinicians and researchers. Full article

The effects of incorporating a pioneer chitosan–TiO₂ nanocomposite on the mechanical and physical properties of room-temperature vulcanization (RTV) maxillofacial A-2186 silicone under accelerated aging protocols were rigorously examined. This investigation utilized 450 samples distributed across five distinct silicone classifications and assessed their attributes, such as tensile strength, elongation, tear strength, hardness, and surface roughness, before and after various accelerated aging processes. Statistical methodologies, including a one-way ANOVA, Tukey’s HSD, and Dunnett’s T3, were employed based on the homogeneity of variance, and several key results were obtained. Silicones infused with 1 wt.% chitosan–TiO₂ showed enhanced tensile strength across various aging procedures. Moreover, the 1 wt.% TiO₂/Chitosan noncombination (TC) and 2 wt.% TiO₂ compositions exhibited pronounced improvements in the elongation percentage. A consistent rise was evident across all silicone categories regarding tear strength, with the 1 wt.% chitosan–TiO₂ variant being prominent under certain conditions. Variations in hardness were observed, with the 1 wt.% TC and 3 wt.% chitosan samples showing distinctive responses to certain conditions. Although most samples displayed a decreased surface roughness upon aging, the 1 wt.% chitosan–TiO₂ variant frequently countered this trend. This investigation provides insights into the potential of the chitosan–TiO₂ nanocomposite to influence silicone properties under aging conditions. Full article

In this in vitro study, we assessed the color stability of an A-2186 room-temperature-vulcanizing (RTV) silicone elastomer by incorporating silver nanoparticles during accelerated artificial aging. Using five intrinsic silicone pigment types, including no pigment (colorless), red, blue, mocha, and a combination of the three, we created 160 disk-shaped specimens. These were evenly distributed across 20 experimental groups, each containing 8 samples (n = 8). The specimens underwent aging for 250 and 500 h in an artificial aging chamber. A colorimeter was used to measure the values of L*a*b* according to the Commission Internationale de L’Éclairage (CIE) standards. The 50:50% perceptibility threshold (∆E* = 1.1) and acceptability threshold (∆E* = 3.0) were used in the interpretation of the recorded color differences. At the 0.05 level of significance, the one-way analysis of variance (ANOVA) and Tukey post hoc test were used in the statistical analysis. Fourier-transform infrared spectroscopy with attenuated total reflectance (FTIR-ATR) showed that 0.2% AgNPs after 500 h of aging protected the silicone elastomer matrix and all characteristic bonds of the silicone elastomer. In contrast, silicone without AgNPs showed the distortion of all bonds after 500 h. Chromatic alterations (∆E* > 0) were observed in all specimen groups, surpassing the perceptible threshold (1.1 units), except for mocha, with 0.2% AgNPs after 250 h of aging, which remained below the perceptible threshold (∆E* = 0.97). All groups demonstrated ∆E* values below the acceptable threshold, except for the red color, which exhibited a highly significant color change (p = 0.000). This study determined that all specimens, including colorless silicone, underwent color changes (∆E* > 0), with red displaying a notably significant chromatic alteration. Additionally, AgNPs demonstrated substantial protection of the silicone and reduced the color change across all groups and colors, with enhanced efficacy corresponding to higher AgNP concentrations (0.2% AgNPs > 0.15% AgNPs > 0.1% AgNPs). Full article

(1) Background: Color changes, physical degradation, and fungal infections are challenges to the longevity of maxillofacial polydimethylsiloxane (PDMS) elastomers. This study aimed to evaluate color changes, physical properties, and antifungal properties of PDMS loaded with ZrO₂ and TiO₂ submicron- and nano-sized particles. (2) Methods: A 1% weight of 40 nm or 200 nm diameter ZrO₂ or TiO₂ nanoparticles was mixed into PDMS with 2% functional intrinsic yellow pigment and polymerized. Control materials contained 13% weight 200 nm silica. Samples were exposed to 3000 h of UVB radiation (200 µW/cm²) or darkness. Color parameters L*a*b* and ∆E_ab*, ultimate tensile strength, strain, elastic modulus, and Shore A hardness were measured. Candida albicans growth was measured using XTT and confocal microscopy, and data were analyzed with the Dunnett test (p < 0.01). (3) Results: TiO₂ 200 nm showed the least color change after 3000 h of UVB radiation, followed by TiO₂ 40 nm (p < 0.05). The silica-containing control group was superior in all physical property measurements due to higher additive content (p < 0.05). TiO₂-containing materials exhibited significantly lower C. albicans growth (p < 0.01) than those loaded with ZrO₂ or SiO₂. (4) Conclusions: TiO₂ nanoparticles of 40 nm and 200 nm, when added to pigmented PDMS at 1% weight, provided the best resistance to color change and significantly lowered C. albicans activity compared to silica- and zirconia-filled elastomers. Particle size differences rendered minor differences for most properties. The incorporation of low-level submicron- and nano-sized TiO₂ particles has the potential to improve color stability and antifungal activity in silicones designated for maxillofacial prostheses and may be extended to denture reline applications. Full article

Maxillofacial prostheses are essential for restoring natural appearance and function in individuals with defects in the head and neck regions. Thixotropic agents, as liquid additives, are known to increase the viscosity of silicone elastomers. However, color deterioration remains a challenge in facial prostheses, leading to the need for refabrication. Despite this, there is limited research on the effect of thixotropic agents on the color stability of silicone maxillofacial elastomers. This study aims to investigate the impact of different thixotropic agent amounts on the color degradation of various maxillofacial silicone elastomers. Three elastomers (A-2000, A-2006, and A-2186) were combined with five pigments (no pigment as control, red, yellow, blue, and a mixture of red, yellow, and blue), and mixed with six thixotropic agent quantities (0, 1, 2, 3, 4, and 5 drops). A total of 450 specimens were fabricated (n = 5) and aged in an artificial aging chamber. L*, a*, b* readings were obtained before and after aging using a digital spectrophotometer. Color difference (ΔE*) means and standard deviations for 150 kj/m², 300 kj/m², and 450 kj/m² were calculated. Statistical analyses, including four-way ANOVA and Fisher’s PLSD test, were conducted to determine any significant differences (p < 0.05) among the groups. A comprehensive analysis revealed significant four-way interactions among the groups. In the mixed-pigmentation group, adding 4 drops of thixotropic agent resulted in ΔE* above 3 only in A-2186 silicone at 300 and 450 kj/m² energy levels. However, the color stability of mixed-pigmented A-2000 and A-2006 remained within the acceptable thresholds of 3 ΔE* at all irradiance levels in this study. At each energy level, A-2006 exhibited the highest color stability with an increasing thixotropic agent quantity among all the silicones. Conversely, A-2186 was more affected by the increased number of thixotropic agent drops in each pigmentation group, including the control group at 450 kj/m². The quantity of thixotropic agent plays a crucial role in determining the color stability of different silicone elastomers pigmented with various intrinsic pigments. The thixotropic agent amount has a more significant impact on color stability than the type of pigment used in the silicone elastomers. A key overarching insight from this investigation is the identification of a safety threshold for the thixotropic agent quantity of 3 drops for each silicone type, pigmentation, and energy level. These findings highlight the importance of considering the proper combination of thixotropic agents, pigments, and silicone materials to achieve optimal color stability in maxillofacial prosthetic applications. Full article

This study explores the impact of the incorporation of a chitosan–TiO₂ nanocomposite on the color stability of pigmented room-temperature vulcanization maxillofacial silicone under various accelerated aging conditions. Five hundred disk-shaped specimens were formed with type A-2186 silicone elastomer, and they were distributed into groups based on pigment types and nanoparticle treatments. The color difference (ΔE) was assessed using a colorimeter in the CIELAB color system before and after exposure to aging conditions, including UV-accelerated aging and outdoor weathering. ANOVA, Dennett’s T3, and Tukey HSD tests revealed significant color alterations across all silicone types, with the most pronounced being in the red-colored 3% chitosan specimens and the least pronounced being in the 2% TiO₂ specimens that underwent UV-accelerated aging. Outdoor weathering consistently increased the ΔE values across all categories. This study suggests that while nanoparticles may offer some resistance against accelerated aging, they fall short in adequately defending against UV radiation during outdoor weathering. Full article

Silicone elastomers play a crucial role in the field of maxillofacial prosthodontics. To maintain optimal hygiene, various disinfectants have been reported to clean silicone prostheses. Nevertheless, when selecting a disinfectant, it is important to consider not only its antimicrobial efficacy, but also its compatibility with the materials, to minimize any potential impact on the physical properties of the material surfaces. The coloring effect of such disinfectants on different types of silicone is of interest. A total of 144 silicone specimens (72 pure silicones, 72 nano-TiO₂-incorporated silicones, from A-2000 and A-2006 silicones) were fabricated in this study. The spectrophotometric analysis was carried out, and the initial CIE L*a*b* color values were measured prior to disinfection. Specimens in each silicone group (with or without nano-TiO₂) were subjected to a 30-h disinfection period simulating 1 year of disinfection with the following disinfectants: Control (tap water), 0.2% chlorhexidine gluconate, 4% chlorhexidine gluconate, 1% NaOCl, neutral soap, and effervescent. After the second color values were recorded, the color change (∆E*) was calculated. Significant differences were observed among the disinfectants for both the A-2000 and A-2006 silicone groups. Nano-TiO₂ did not show a color protection effect in A-2000 silicone. In contrast, nano-TiO₂ incorporation provided color protection against CHG 0.2%, CHG 4%, and NaOCl in A-2006 silicone. Most of the disinfectants did not show acceptable color stability over time. In pure A-2000 silicone, except for 0.2% chlorhexidine, all disinfectant groups demonstrated a color change within the acceptability threshold of 50:50% (∆E* = 3.0). On the other hand, in nano-TiO₂-incorporated A-2006 silicone, only 0.2% and 4% chlorhexidine demonstrated an acceptable color change. Overall, chlorhexidine could be used as a suitable disinfectant in maxillofacial silicone prostheses. Full article

There are often bonding problems between acrylic resins and silicone. PEEK (polyetheretherketone), which is a high-performance polymer, has great potential for the implant, and fixed or removable prosthodontics. The aim of this study was to evaluate the effect of different surface treatments on PEEK to be bonded to maxillofacial silicone elastomers. A total of 48 specimens were fabricated from either PEEK or PMMA (Polymethylmethacrylate) (n = 8). PMMA specimens acted as a positive control group. PEEK specimens were divided into five study groups as surface treatments as control PEEK, silica-coating, plasma etching, grinding, or nano-second fiber laser. Surface topographies were evaluated by scanning electron microscopy (SEM). A platinum-primer was used on top of all specimens including control groups prior to silicone polymerization. The peel bond strength of the specimens to a platinum-type silicone elastomer was tested at a cross-head speed of 5 mm/min. The data were statistically analyzed (α = 0.05). The control PEEK group showed the highest bond strength (p < 0.05) among the groups. No statistical difference was found between control PEEK, grinding, or plasma etching groups (p > 0.05). The lowest bond strength was seen in the laser group, which was not statistically different from silica-coating (p > 0.05), and statistically different from control PEEK, grinding, or plasma groups (p < 0.05). Positive control PMMA specimens had statistically lower bond strength than either control PEEK or plasma etching groups (p < 0.05). All specimens exhibited adhesive failure after a peel test. The study results indicate that PEEK could serve as a potential alternative substructure for implant-retained silicone prostheses. Full article

Facial prostheses are created from special elastomers modified for their specific physical and mechanical properties; however, they also show two common major clinical problems: gradual discolouration of the prosthesis over time in service environment and deterioration of static, dynamic, and physical properties. As a result of external environmental factors, facial prostheses may become discoloured and discolour by changing colour from intrinsic and extrinsic colouring, and this is associated with the intrinsic colour stability of elastomers and colourants. Thus, in this in vitro study, a comparative evaluation of the effect of outdoor weathering on the colour stability of A-103 and A-2000 room-temperature vulcanised silicones used for maxillofacial prosthesis was conducted. To accomplish this study, a total of 80 samples were fabricated, 40 samples of each material were grouped as clear (20) and pigmented (20). These samples were mounted on wooden board and the assembly was placed on the roof of the dental school from October 2021 to March 2022. To maximise the amount of sunlight on the specimens, the exposure rack was set on five 68° angles from horizontal and also to prevent standing water. The specimens were left uncovered during exposure. The testing of samples was conducted with the help of a spectrophotometer. The colour values were recorded in the CIELAB colour system. It describes the three colour coordinates (colour values) x, y, and z in three new reference values of L, a, and b, aiding in numerically classifying colour differences. After 2, 4, and 6 months of weathering, testing was conducted using a spectrophotometer and the colour change (ΔE) was calculated. The A-103 RTV silicone group with pigmentation showed the maximum change in colour after six months of environmental conditioning. The data for colour difference within groups were analysed using a one-way ANOVA test. Tukey’s post hoc test assessed the pairwise mean comparison’s contribution to the overall significant difference. The nonpigmented A-2000 RTV silicone group showed the maximum change in colour after six months of environmental conditioning. After 2, 4, and 6 months of environmental conditioning, pigmented A-2000 RTV silicone showed better colour stability than A-103 RTV silicone. The patients requiring facial prosthesis do need to work on outdoor fields, and thus weathering will have deleterious effects on such prosthesis. Hence, the selection of appropriate silicone material with respect to the Al Jouf province region is crucial, which includes economic, durable, and colour stability. Full article

Although numerous studies have demonstrated the benefits of incorporating filler particles into maxillofacial silicone elastomer (MFPSE), a review of the types, concentrations and effectiveness of the particles themselves was lacking. The purpose of this systematic review and meta-analysis was to review the effect of different types of filler particles on the mechanical properties of MFPSE. The properties in question were (1) tensile strength, (2) tear strength, (3) hardness, and (4) elongation at break. The findings of this study can assist operators, technicians and clinicians in making relevant decisions regarding which type of fillers to incorporate based on their needs. The systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 original articles from 1970 to 2019 were selected from the databases, based on predefined eligibility criteria by two reviewers. The meta-analyses of nine papers were carried out by extracting data from the systematic review based on scoring criteria and processed using Cochrane Review Manager 5.3. Overall, there were significant differences favoring filler particles when incorporated into MFPSE. Nano fillers (69.23% of all studies) demonstrated superior comparative outcomes for tensile strength (P < 0.0001), tear strength (P < 0.00001), hardness (P < 0.00001) and elongation at break (P < 0.00001) when compared to micro fillers (30.76% of all studies). Micro fillers demonstrated inconsistent outcomes in mechanical properties, and meta-analysis of elongation at break argued against (P < 0.01) their use. Current findings suggest that 1.5% ZrSiO₄, 3% SiO₂, 1.5% Y₂O₃, 2–6% TiO₂, 2–2.5% ZnO, 2–2.5% CeO₂, 0.5% TiSiO₄ and 1% Ag-Zn Zeolite can be used to reinforce MFPSE, and help the materials better withstand mechanical degradation. Full article