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Journal of Prosthetic Dentistry

Getting to know today’s maxillofacial prosthodontist

  • Sarah K.Y. Lee
    Correspondence
    Corresponding author: Dr Sarah K.Y. Lee, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
    Affiliations
    Senior Associate Consultant, Division of Esthetic and Prosthetic Dentistry, Department of Dental Specialties, Mayo Clinic, Rochester, Minn
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      Abstract

      Maxillofacial prosthetics (MFP) is a subspecialty of prosthodontics that focuses on the management of complex craniofacial prosthetic rehabilitation. With advancements in treatment techniques and technology, the MFP specialist's roles have also evolved. This presentation describes who today's maxillofacial prosthodontists are, what they do, and how they care for the special population of patients with complex and unique needs.

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      March 29, 2022

      Getting to know today’s maxillofacial prosthodontist

      Sarah K.Y. Lee, DDS, MS

      Maxillofacial prosthetics (MFP) is a subfield within the prosthodontic specialty, and prosthetics are used to rehabilitate composite oral and maxillofacial defects derived from developmental and/or acquired etiologies.
      • Jacob R.F.
      On witnessing transitions in maxillofacial prosthodontics.
      • Wolfaardt J.F.
      • Brecht L.E.
      • Taft R.M.
      The future of maxillofacial prosthodontics in North America: Part I-Journey to the present.
      • Cristache C.M.
      • Tudor I.
      • Moraru L.
      • Cristache G.
      • Lanza A.
      • Burlibasa M.
      Digital workflow in maxillofacial prosthodontics—an update on defect data acquisition, editing and design using open-source and commercial available software.
      • Beumer J.
      • Esposito S.J.
      • Marunick M.T.
      Maxillofacial rehabilitation: Prosthodontic and surgical management of cancer-related, acquired, and congenital defects of the head and neck.
      Basic prosthodontic principles are applied within a wider and more complex landscape that covers extraoral, intraoral, oropharyngeal, and velopharyngeal applications.
      MFP is essential to survivorship, which broadly describes the experiences an individual with cancer has throughout its phases (diagnosis, treatment, and remission) and people, like friends and family, who support the individual in the process.
      • Hewitt M.
      • Ganz P.A.
      From cancer patient to cancer survivor - Lost in transition: An American Society of Clinical Oncology and Institute of Medicine symposium.
      Expansion of the definition of survivorship to include those born with significant maxillofacial defects, benign but maladaptive tumor processes, and acquired facial trauma is appropriate given the multifaceted and complex nature of care that these conditions and patients share (Fig. 1).
      Figure thumbnail gr1
      Figure 1Patient with facial trauma. A, Pretreatment full face smile. B, After prosthetic rehabilitation.
      In the evolution of the field, MFP-trained specialists provide a multitude of services, are key players in multidisciplinary teams, and are based in different clinical settings.
      • Jacob R.F.
      On witnessing transitions in maxillofacial prosthodontics.
      ,
      • Wolfaardt J.F.
      • Brecht L.E.
      • Taft R.M.
      The future of maxillofacial prosthodontics in North America: Part I-Journey to the present.
      ,
      • Sheets J.L.
      • Yuan J.C.
      • Sukotjo C.
      • Davis B.K.
      • Wee A.G.
      Maxillofacial prosthetics training and practice profiles in the United States.
      • Ariani N.
      • Reintsema H.
      • Ward K.
      • Sukotjo C.
      • Wee A.G.
      Maxillofacial prosthodontics practice profile: A survey of non-United States prosthodontists.
      • Plana N.M.
      • Malta Barbosa J.
      • Diaz-Siso J.R.
      • Brecht L.E.
      • Rodriguez E.D.
      Dental considerations and the role of prosthodontics and maxillofacial prosthetics in facial transplantation.
      • van den Heever J.H.
      • Sykes L.M.
      • Du Plessis F.
      The scope of maxillofacial prosthodontics.
      • Wolfaardt J.F.
      • Brecht L.E.
      • Taft R.M.
      The future of maxillofacial prosthodontics in North America: Part II - A survey.
      The demand for MFP specialists is likely to increase with the improvements of care efficacy and survivorship, but also the increasing incidence of head and neck oropharyngeal cancer.
      • Wolfaardt J.F.
      • Brecht L.E.
      • Taft R.M.
      The future of maxillofacial prosthodontics in North America: Part I-Journey to the present.
      ,
      • Sheets J.L.
      • Yuan J.C.
      • Sukotjo C.
      • Davis B.K.
      • Wee A.G.
      Maxillofacial prosthetics training and practice profiles in the United States.
      ,
      • Ariani N.
      • Reintsema H.
      • Ward K.
      • Sukotjo C.
      • Wee A.G.
      Maxillofacial prosthodontics practice profile: A survey of non-United States prosthodontists.
      Currently practicing MFP specialists fulfill roles within the spectrum of care modalities. For head and neck cancer, the MFP provider provides adjunctive dental oncologic oversight like providing oral positioning devices used in oral radiotherapy or prechemoradiation therapy dental clearance, in addition to actual prosthetic rehabilitation. This particularly exemplifies the extensive and adaptive knowledge and clinical skills required of the maxillofacial prosthodontist external to the prosthetic repertoire.
      Improvements in craniofacial and maxillofacial reconstruction have only broadened the possibilities for prosthetic rehabilitation. Just as technology has advanced capabilities of care within the health care industry, digital integration in MFP has enabled improved predictability and quality of treatment outcomes.
      • Cristache C.M.
      • Tudor I.
      • Moraru L.
      • Cristache G.
      • Lanza A.
      • Burlibasa M.
      Digital workflow in maxillofacial prosthodontics—an update on defect data acquisition, editing and design using open-source and commercial available software.
      Robotic surgery and virtual surgical planning have improved treatment techniques for resection and reconstruction while decreasing morbidity. With these advancements, not only did the need for MFP care increase, but also the incorporation of digital technology into MFP practice itself.
      • Wolfaardt J.F.
      • Brecht L.E.
      • Taft R.M.
      The future of maxillofacial prosthodontics in North America: Part I-Journey to the present.
      ,
      • Cristache C.M.
      • Tudor I.
      • Moraru L.
      • Cristache G.
      • Lanza A.
      • Burlibasa M.
      Digital workflow in maxillofacial prosthodontics—an update on defect data acquisition, editing and design using open-source and commercial available software.
      ,
      • Wolfaardt J.F.
      • Brecht L.E.
      • Taft R.M.
      The future of maxillofacial prosthodontics in North America: Part II - A survey.
      Commonly used digital techniques such as intraoral scanning, computer-aided design and computer-aided manufacturing (CAD-CAM), and 3D printing have been incorporated within the MFP clinical workflow.
      • Wolfaardt J.F.
      • Brecht L.E.
      • Taft R.M.
      The future of maxillofacial prosthodontics in North America: Part I-Journey to the present.
      ,
      • Cristache C.M.
      • Tudor I.
      • Moraru L.
      • Cristache G.
      • Lanza A.
      • Burlibasa M.
      Digital workflow in maxillofacial prosthodontics—an update on defect data acquisition, editing and design using open-source and commercial available software.
      ,
      • Wolfaardt J.F.
      • Brecht L.E.
      • Taft R.M.
      The future of maxillofacial prosthodontics in North America: Part II - A survey.
      These processes provide the opportunity to not only improve the efficiency and effectiveness of provider-driven procedures, but also enhance the experience of the patient undergoing treatment (Fig. 2).
      Figure thumbnail gr2
      Figure 2Patient with facial trauma demonstrating maxillary defect and malpositioning of remaining maxillary dentition. A, Pretreatment intraoral view. B, Postprosthetic rehabilitation consisting of implant-retained removable partial prosthesis with metal overlay on maxillary molars.
      The complex clinical attributes of the MFP specialty are often placed at the forefront; however, the maxillofacial prosthodontist’s most significant contribution is to be an advocate for the patient. Today’s maxillofacial prosthodontist supports not only physical and functional factors through prosthetic rehabilitation, but also the emotional, mental, and psychosocial aspects of a patient’s life throughout the care process.

      Acknowledgments

      The author thanks the consultants, trainees, dental allied health team, and colleagues in Otolaryngology, Oral and Maxillofacial Surgery, Radiation Oncology, Medical Oncology, and the Anatomic Modeling Laboratory for their support and collaboration on patient cases within this presentation.

      Supplementary Data

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