Practical application of polyurethane and Velcro in maxillofacial prosthetics

Gerald T. Grant, DMD, MS,a Robert M. Taft, DDS,b and Steven T. Wheelerc Naval Dental School, National Naval Dental Center, Bethesda, Md.
A procedure is described for the fabrication of an extraoral prosthesis with an acrylic resin substructure that retains a magnet sealed from the environment by a polyurethane liner. Velcro is used to enhance the bond of the acrylic substructure to the silicone prosthesis. This procedure results in improved retention of the acrylic resin substructure and protection of the magnet with an encapsulating polyurethane liner. (J Prosthet Dent 2001;85:281-3.)

olyurethane, along with other materials such as acrylic resin and silicone, often is used as a liner for the tissue-bearing surface of an extraoral prosthesis; it provides a smooth, cleanable intaglio surface. Polyurethane also seals the more porous silicone materials and improves the tear strength and integrity of the margins. Magnets and clips frequently are used for retention of extraoral prostheses and, in that capacity, are attached to obturators or implant-retained retentive elements. However, the bonding of the acrylic resin substructures of the magnets and clips to silicone is limited, and exposed magnets can become corroded. Techniques have been developed for the lining of silicone facial prostheses with prefabricated polyurethane films.1,2 Polyurethane lining of a facial prosthesis provides increased tear strength to the edge of the prosthesis, limits fungal growth often associated with silicone restorative materials,3 and may help reduce the corrosion of magnets.4,5 Adhesion of the polyurethane to the silicone is enhanced by the use of a primer.6,7 The use of primers or bonding agents alone, however, has resulted in limited success for the adhesion of silicone to acrylic resin; this adhesion often is augmented by some form of mechanical retention.8-10 This article describes the use of a polyurethane liner and Velcro (Velcro USA, Inc, Manchester, N.Y.) to increase the retention of an acrylic resin substructure for clips and magnets11 on a silicone extraoral prosthesis.

Fig. 1. Acrylic-encased magnet in 2-part plaster mold.

PROCEDURE Velcro retention

1. Make a 2-part mold of the acrylic substructure (Fig. 1). 2. Remove 0.5 to 1 mm acrylic from the substrucPresented at the annual meeting of the American Academy of Maxillofacial Prosthetics, Victoria, British Columbia, Canada, November 1998. The views of the authors do not purport to reflect the views of the Department of the Navy or the Department of Defense. aFellow, Department of Maxillofacial Prosthetics. bHead, Department of Maxillofacial Prosthetics. cTechnical Leader, Maxillofacial Prosthetics.

Fig. 2. Acrylic-encased magnet with Velcro retention.

ture, taking care not to encroach on the retention of any attachments. 3. Cut a Velcro strip to fit the substructure contours. Velcro commonly is available in beige, black, and white but can be colored with acrylic or oil paint. Place the Velcro strip loops down and run a No. 6 round bur (H71-018 laboratory bur, Brasseler USA, Savannah, Ga.) at slow speed through the back of the strip, allowing some of the loops to become entrapped in the bur. Pull the bur

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Fig. 3. Diagram of polyurethane sheet adapted to cast with vacuum former.

Fig. 4. Magnet encased in silicone with polyurethane sealing magnet from environment and providing protection from corrosion.

through the backing until a double-sided Velcro strip is formed. 4. Place the acrylic substructure in the mold. Apply autopolymerizing acrylic resin to the substructure and to one side of the loops. Adapt the acrylic side of the loops to the acrylic substructure. Compress the substructure in the mold, secure it with rubber bands or a clamp, and submerge it in warm water in a pressure pot at 20 psi until it is completely polymerized. 5. Trim excess acrylic with a flame-shaped carbide bur (251GE-060 laboratory bur, Brasseler USA), and shorten the loops with scissors (Fig. 2).

Prosthesis fabrication
1. Fabricate a perforated cast by duplicating the master cast with alginate. Place fishing line or orthodontic ligature wire lubricated with petrolatum into the alginate before pouring the stone. Remove the wire or fishing line from the cast. 2. Clamp a polyurethane sheet in a vacuum former (Stalite-Stay-Vac, Buffalo Manufacturing, Buffalo,
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N.Y.). Wipe the bonding surface twice with a reagent-grade acetone (Acetone, Fischer Chemicals, Fair Lawn, N.J.) and allow it to dry. Apply 1 coat of 1205 silicone primer (Dow Corning, Midland, Mich.) and let dry for 15 minutes at room temperature. 3. Heat the polyurethane until it sags about 0.5 inches below the frame and vacuum adapt it to the fish line cast (Fig. 3). 4. With the vacuum on, position the acrylic substructure in the mold, and apply a layer of type A medical adhesive silicone (Silastic, Dow Corning) to the polyurethane sheet and loops of the acrylic substructure. Add intrinsic staining and characterization, and pack the mold with silicone (70% type A/30% MDX silicone by weight) under pressure. Remove the mold from the vacuum, secure it with clamps, and set it aside to complete polymerization (Fig. 4). 5. Remove the silicone prosthesis from the mold, and trim the borders of the polyurethane. If magnets are used in the prosthesis, do not remove the
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Fig. 5. Intaglio surface of polyurethane-lined prosthesis with magnet after 1 year.

polyurethane over them. If clips are used, they should be exposed by trimming the polyurethane away with a No. 25 blade (No. 25 carbon steel surgical blade, Bethpage, N.Y.).

DISCUSSION
This technique is not without disadvantages. Not all perforated casts fit the vacuum former; therefore, several casts must be made to allow overlap of the polyurethane on the processing cast before packing the prosthesis. Moreover, type A medical-grade adhesive must be used to bond to the polyurethane. The advantages, however, are more numerous. First, acrylic substructures can be mechanically secured to the prosthesis without the use of an acrylic resin primer or bonding agent to silicone. Second, polyurethane provides a smooth intaglio surface. Third, polyurethane can be trimmed to provide margins that are more tear resistant and esthetic. Fourth, polyurethane can be positioned to seal magnets from the environment and thereby reduce their corrosion potential. Fifth and finally, prostheses fabricated with this technique appear to be durable. Figure 5 shows one such prosthesis after 1 year in use.

2. Udagama A. Urethane-lined silicone facial prostheses. J Prosthet Dent 1987;58:351-4. 3. Udagama A, King GE. Mechanically retained facial prostheses: helpful or harmful? J Prosthet Dent 1983;49:85-6. 4. Drago CJ. Tarnish and corrosion with the use of intraoral magnets. J Prosthet Dent 1991;66:536-40. 5. Vrijhoef MM, Mezger PR, Van der Zel JM, Greener EH. Corrosion of ferromagnetic alloys used for magnetic retention of overdentures. J Dent Res 1987;66:1456-9. 6. Taft RM, Cameron SM, Knudson RC, Runyan DA. The effect of primers and surface characteristics on the adhesion-in-peel force of silicone elastomers bonded to resin materials. J Prosthet Dent 1996;76:515-8. 7. Wang R, Collard SM, Lemon J. Adhesion of silicone to polyurethane in maxillofacial prostheses. Int J Prosthodont 1994;7:43-9. 8. Lemon JC, Martin JW, Echeverri JC, King GE. An acrylic resin core for processing silicone facial prostheses. J Prosthet Dent 1992;67:374-6. 9. Marion LR, Rothenberger SL, Minsley GE. A method of fabrication of a facial prosthesis that improves retention and durability: a clinical report. J Prosthet Dent 1997;77:457-60. 10. Polyzois GL, Frangou MJ, Andreopoulos AG. The effect of bonding agents on the bond strengths of facial silicone elastomers to a visible lightactivated resin. Int J Prosthodont 1991;4:440-4. 11. Zolty J. A practical method of bonding silicone elastomer to acrylic resin. J Facial Somato Prosthet 1995;1:29-32. Reprint requests to: CDR GERALD T. GRANT DENTAL DEPARTMENT NMC CHARETTE HEALTH CENTER 27 EFFINGHAM ST PORTSMOUTH, VA 23708 FAX: (757)953-2754 E-MAIL: GTGrant@mar.med.navy.mil 10/1/114089

SUMMARY
The use of a polyurethane liner and Velcro to increase the retention of an acrylic resin substructure for clips and magnets has been described. This procedure results in improved retention of the substructure and protection of the magnets against corrosion.
REFERENCES
1. Lemon JC, Martin JW, King GE. Modified technique for preparing polyurethane lining for facial prostheses. J Prosthet Dent 1992;67:228-9.

doi:10.1067/mpr.2001.114089

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