A 42-year-old male patient was referred to the Department of Prosthodontics and Crown and Bridge, Mahatma Gandhi Dental College and Hospital, Sitapura, Jaipur, India. The patient complained of missing right eye which was enucleated following an accidental traumatic injury []. Consequent to this, patient worded dark glasses specs for almost 1 year but at the same time, he was suffering from severe emotional trauma in terms of facial esthetics and social acceptance. Hence, the patient was seeking artificial eye replacement. On examination, defect with a shrunken orbit and intact tissue bed were observed. As the patient was economically very poor, the modified stock ocular prosthesis was advised. The treatment procedure and its limitations were explained to the patient to allay apprehension and elicit cooperation.\nA transparent, vesseled stock eye was selected with a close resemblance of the iris of the stock ocular prosthesis with that of the natural eye using both daylight and artificial light.\nAn ophthalmic socket was anesthetized with topical anesthetic followed by light lubrication of same side eyebrow and eyelashes to make the procedure more comfortable.\nA customized impression tray with injector was fabricated by joining hub of 10 ml syringe with perforated head of disposable plastic spoon using an adhesive. Later customizing and smoothening of corners of perforated head part according to the dimensions of anopthalmic socket of defect side was done [].\nThe primary impression of an ophthalmic socket was made using customized injector, by injecting the light viscosity addition elastomeric impression material (Virtual, Light body, Ivoclar Vivadent, India) slowly (to avoid any air bubbles), first into the depth below the upper eyelid and then into the lower. The patient was instructed to close his eye so that the excess material could flow out through perforations in the trays. While the material sets, instructions were given to the patient to do various eye movements in following order-moving eye laterally, followed by up and down motion and finally in a circular motion After the impression material had set, it was carefully removed from the anophthalmic socket The impression was checked to ensure that all the surfaces are recorded and there is no porosity present. This was followed by beading and boxing (Beading and Boxing wax, MP Sai Enterprises, India) of impression []. Investing with Type IV dental stone (Kalrock, Kalabhai, India) was done to obtain a primary cast Customization of the stock ocular prosthesis was done by selectively grinding and making it 2 mm short all around the margins of primary cast Border molding and secondary impression of the patient's anopthalmic socket was made by modified wax (sticky wax and utility wax in the ratio of 1:2). The objective was to obtain complete peripheral contact and proper curvature [] Centralization of the iris was checked by asking the patient to look straight ahead to a distant object, keeping in mind the symmetry with the iris of the adjacent unaffected left natural eye of the patient Now this wax modified stock ocular prosthesis was removed gently from the anophthalmic socket and was used to make sectional putty (Aquasil, Soft putty, Dentsply India Pvt. Ltd.) indexed mold (indexing of the first section was done so as to allow correct orientation of the second half of the mold) using putty viscosity addition elastomeric impression material []. This mold was used later for processing of definitive ocular prosthesis After the putty material had set, the two halves of putty mold were separated and the wax modified stock ocular prosthesis was retrieved so as to keep the mold space ready for processing of definitive ocular prosthesis []. Holes were made on second half of the mold to release excess resin to flow out The Modified wax was completely removed from the wax modified stock ocular prosthesis, which was followed by placing back of same ocular prosthesis into the first half of the sectional putty indexed mold in such a manner that inner surface faces upward []. Proportioning of clear and tooth colored auto-polymerizing methyl methacrylate resin (Dental Product of India (DPI), self-cure tooth molding powder and liquid, India) of appropriate shade was done in such a manner that resultant mixer matches with the color of the sclera of the unaffected eye of the patient. This resultant mixer was poured over the inner surface of wax modified stock ocular prosthesis []. Final packing was completed by tightening of second putty mold over the first mold. Excess material flows out through holes prepared and were removed. Acrylization was done by keeping sectional putty indexed mold into pressure pot at 30 psi for 20 min for complete polymerization, preventing any excess unreacted monomer, essential to prevent any untoward irritation or sensitivity and thereby a rejection of the prosthesis by the patient. This also enables the minimization of porosities and gives a good finish to the prosthesis as the eye socket is extremely sensitive and the residual conjunctiva and related structures react to any surface roughness and irregularities After complete acrylization, sectional putty indexed mold were opened and definitive ocular prosthesis retrieved []. The prosthesis was inspected for imperfections. Finishing and polishing were done to get a glass like finish to achieve maximum adaptation and overall success of the prosthesis []. The ocular prosthesis was washed with warm water and soap and inserted into the patient's anophthalamic socket and evaluated critically for lid drape, contour, and dimension\nThe final outcome of the prosthesis was ascertained from the satisfied look on the face of the patient and from the follow-up a week later. Instructions regarding ocular prosthesis were given as follow:\nCareful handling of the prosthesis with clean hands Removal of the prosthesis once a day, if necessary, and to wash it under warm water with a soft clean cloth and mild soap Cautioned to keep the eye moist by placing it in water if it's not in the anophthalmic socket, and never to allow it to come in contact with alcohol, or solvent of any kind Examination of anophthalmic socket once in a year or instantly when there is any irritation To improve the movement of the eyelids and the sparkle and sheen of the prosthesis, its beneficiary to use silicone base lubricant or mineral oil or safflower oil.[]
A 51-year-old female patient reported to the department of Prosthodontics, with a chief complaint of looseness of both upper and lower dentures and desired the replacement of the same. Her history revealed that, she had been edentulous for 15 years and had been wearing dentures for 14 years.\nThe intra-oral examination revealed a narrow and constricted U-shaped flat palatal vault and severely resorbed maxillary and mandibular ridges []. The treatment plan decided for the patient was the fabrication of a hollow maxillary complete denture combined with neutral zone concept to enhance the retention and stability of dentures. Because of severely resorbed ridges and increased inter-ridge distance, fabrication of hollow maxillary complete denture with utilization of neutral zone concept was planned for better stability and retention.\nMaxillary and mandibular impression was made followed by border molding with green-stick (DPI Pinnacle tracing sticks, The Bombay Burmah Trading Corporation Ltd.,) and final impression with zinc oxide eugenol impression paste (DPI Impression paste, The Bombay Burmah Trading Corporation Ltd.,). Compound occlusal rims were fabricated by using modeling compound (DPI Pinnacle Impression Compound, The Bombay Burmah Trading Corporation Ltd.) mixed with greenstick (DPI Pinnacle Tracing sticks, The Bombay Burmah Trading Corporation Ltd.) in ratio of 3:7 i.e. 3 parts impression compound +7 parts greenstick compound) as per McCord's technique for making a neutral zone record by having the patient perform various Orofacial movements. Then index of this record was then made with plaster of Paris and rims were duplicated in wax. The maxilla-mandibular relationship was recorded using wax occlusal rims and transferred to the articulator and the artificial teeth were arranged. Try in procedure was done and then, all the wax excluding the wax surrounding the teeth was removed and replaced with light body elastomeric impression material (Aquasil Ultra LV Dentsply Caulk, Milford, USA). Trial denture bases were reinserted into the patient's mouth and she was instructed to perform various Orofacial movements so as to record the polished surface of the denture in harmony with the Orofacial musculature. After the try in procedure, wax up was done and dentures were made ready for processing. The mandibular denture was processed using the conventional procedures.\nThe Special Steps Taken for the Fabrication of Hollow Maxillary Complete Denture were as Follows:\nThe maxillary trial denture was flasked [] and dewaxed in the conventional manner []. Half of the heat cure PMMA (Trevalon, Dentsply India Pvt. Ltd., Gurgaon, India) in dough stage was positioned accurately over the dewaxed mould and then salt crystals were placed over it []. Above that, the remaining heat cure resin was packed and cured at 74 degree C for 7-8 hours []. Cured denture was retrieved [] and 2 holes were made in the thickest palatal area []. All the residual salt crystals were removed by flushing water with the high pressure syringe through the holes. After making sure that all the salt crystals have been removed, the escape holes were closed with autopolymerizing resin (Trevalon, Dentsply India Pvt. Ltd., Gurgaon, India) []. The hollow cavity seal was verified by immersing the denture in water, if no air bubbles are evident, an adequate seal is confirmed. The dentures were inserted in the patient's mouth [] and instructions regarding care, hygiene and maintainance were given. On 3-month follow up, the patient reported that she was quite comfortable with the dentures and she had encountered no problems.