REVIEW
Retentive Aids in Maxillofacial Prosthodontics - A Review.
Rajesh Gurjar,1Sunil Kumar M.V.,2 Harikesh Rao,3 Alok Sharma,4 Sumit Bhansali5
ABSTRACT
Retention has always been a problem in prosthodontics.
Prosthodontists have always been struggling with retention in a
maxillofacial prosthesis . Increased retention improves comfort as
well as the confidence in the patient while wearing a facial
prosthesis at work and in social settings. Advances in techniques
used for retention of maxillofacial prosthesis and the materials
used have been remarkable in the past several years. The journey
from using metal bands to using adhesives to placing implants for
retaining a maxillofacial prosthesis has been fascinating and
satisfying to many, but, the aim of achieving the full potential still
remains incomplete.
Keywords: Retention, Maxillofacial prosthesis, Bio-adhesives,
Magnets, Implants.
Introduction
The Dentist in general and Prosthodontist in
particular has a major role in maxillofacial prosthetics
because of his knowledge of anatomy, physiology and
pathology as well as his skill and experience in using
materials that are compatible with the patients
remaining tissues. However, the Prosthodontist is
limited by inadequate materials available for facial
Keywords:
restorations, movable tissue beds, difficulty in retaining
large prosthesis, and the patient’s capability to accept
the final result.
There is a well-known quote given by a German
surgeon about the patient with facial disfigurement. He
quotes "at the sight of whom all men turn in disgust
and abhorrence and at whose presence children cry and
dogs bark".
This statement proves to be true in today's
modern world as well. The manner of looking at such
people has not changed much. Sometimes, even if the
disfigurement is slight, the psychological wound is so
great, that the disfigured person himself avoidsIJCD • JUNE, 2011 • 2(3)
social
contacts. It is very important to give © 2011 special
Int. Journal of Contemporary Dentistry
great, that the disfigured person himself avoids social
contacts. It is very important to give special
consideration to such patients.
Maxillofacial prosthetic therapy for acquired
defects has become more complex and sophisticated
with advances in surgical and radiation treatment
procedures. More people are now surviving disfiguring
injuries and diseases, which formerly claimed their
lives. A team effort is essential for the effective and
efficient treatment of patients with maxillofacial
problems.
Retention Methods
ANATOMIC RETENTION:
Intraoral retention includes the use of both
hard and soft tissues-teeth and mucosal and bony
tissues. Anatomic undercut areas are a welcome
feature in the postsurgical case. They may be found in
the palatal area, cheek, retromolar, labial, septal,
posterior nasal pharyngeal or anterior nasal spine areas.
Additional aids to anatomic retention include proper
occlusion, proper post dam, and surface adhesion.
Extraoral retention necessitates the use of both
hard and soft tissues of the head and neck area.
Examples would be any bony wall of a defect with
which part of the prosthetic device will come in contact
or a cartilaginous remnant of the ear. Soft tissues prove
to be more troublesome because of their flexibility,
mobility, lack of bony nasal support, lower resistance to
displacement when a force is applied, deficiencies as a
base for firmly securing the surgical adhesive during
cementation.
SM Parel4 discussed a method to use anatomic
under cuts in conjunction with flexible conformer in the
defective space as a mechanical retentive feature in an
orbital prosthesis (Fig 1).
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MECHANICAL RETENTION
Current mechanical means for retention of
facial prostheses include: -

 Eyeglass:
Parr GR 5 proposed a possible means of retaining a
nasal prosthesis by utilizing newly designed eyeglass
frames for the patients who has had the bridge of the
nose surgically removed. The eyeglass frame should be
opaque in color rather than translucent to prevent
retention marks from becoming visible.

Fig 1. Two piece orbital prosthesis showing anatomic retention  Magnets:

gained from the conformer.
ADHESIVES
The selection of a suitable adhesive involves
consideration of the prosthetic materials used in the
construction of the prosthesis. Several factors should
be considered when selecting an adhesive system for a
facial prosthesis:
 The strength of the adhesive bond to skin
and to the facial prosthetic material.
 Biocompatibility of the adhesive.
 Design and material of prosthesis.
 Composition of the adhesive.
 Type & Quality of patient’s skin.
 Convenience of handling and removing the
adhesive
Various types of skin tissue adhesives for facial
prostheses are acrylic resin, latex, silicone, pressure
sensitive tapes, spirit gum, water based adhesives.
Examples of Silicone adhesives include Hollister
Medical Adhesive (Hollister Inc., Libertyville.IL), Secure
Medical Adhesive (Factor II Inc., Lakeside, AZ), and Dow
Corning 355 Medical Adhesive (Factor II Inc. Lakeside
AZ). (Table 1)
Advantages Disadvantages
Ease of application and It may tear at the margins
manipulation
Readily available Routine removal
damage
pigmentation
No need to undergo any Patients with poor dexterity
surgical procedures or coordination may have
difficulty in applying
Behrman SJ 1 presented a technique for the
implantation of magnets in the jaw to enhance
retention of the prosthesis.
Robinson JE (1963) suggested a possible solution to
the problem of rehabilitating patients who have
undergone surgical removal of both maxillae by
constructing a two section intra oral prosthesis with the
use of attracting magnets as positive locking device.
Javid N (1971) used a coin shaped magnet as a means
for retaining a facial prosthesis combined with complete
dentures in a patient who had undergone the removal
of left maxilla, the palatine bone, a part of the
zygomatic bone and the complete left orbit.
Federick DR (1976) presented a technique for the
fabrication of a sectional interim maxillary obturator
with retention augmented by a magnet.
A simple technique for the use of magnets in over
dentures was described by Moghadam et al (1979)
which did not require any surgical procedure.
Tsutsui H et al 8 found Samarium – Cobalt magnet to
be remarkably superior in magnetic properties to other
kinds of magnets and stated cobalt-samarium is not
chemically harmful.
Highton R et al (1986) investigated six magnet –
keeper systems and found that the maximum retention
was obtained when the magnet and keeper were in
apposition with no air gap.
may
external Angelini E et al (1991) investigated the corrosion
resistance of the palladium – cobalt ferromagnetic alloy
(constituent of the keeper cemented on the abutment
teeth) coupled with the samarium – cobalt magnets
embedded in the removable part of the prosthesis,
strong corrosive attacks were not observed.

Less expensive as compared Some patients may develop Matsamura et al (2000) described fabrication
to implants allergic or irritative responses procedure of a removable sectional denture connected
to adhesives by a cobalt-samarium magnetic retention system for a
patient with severe maxillary defect (Fig 2).
Table 1: Advantages and Disadvantages of Bio-Adhesives

85 IJCD • JUNE, 2011 • 2(3)

© 2011 Int. Journal of Contemporary Dentistry

Fig 2. Completed section denture with 4 magnetic retainers
Grant GT et al (2001) described a procedure for the
fabrication of an extraoral prosthesis with an acrylic
resin substructure that retains a magnet sealed from
the environment by a polyurethane liner (Fig 3). Riley et
al (2001) stated that generally, the open-field systems
provide less retentive forces compared to closed-field
systems, however, even though the closed-field systems
provide higher retentive forces, the retention reduces
rapidly with increasing separation. Yoshida K et al
(2008) treated two female patients with orbital defects
after malignant tumor resection using custom-made
retentive components of an individual magnet for an
Epitec System orbital prosthesis. Voigt A et al9
determined which combination of differently designed
magnetic abutments provided the best retention for an
auricular prosthesis. The highest withdrawal force was
found in the combination of one telescopic magnet and
two large spherical magnets.
Fig 3. Intaglio surface of polyurethane-lined prosthesis with
magnet after 1 year.
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© 2011 Int. Journal of Contemporary Dentistry
REVIEW
 Cast clasps:
The most common method for retaining an
intraoral prosthesis uses a cast metal clasp which enters
an undercut. The properly designed and fabricated clasp
will provide stability, splinting, bilateral bracing, and
reciprocation, as well as retention.
 Acrylic buttons and retentive clips:
Acrylic buttons – retained facial prostheses usually have
an acrylic substructure that fits into the defect and one
or more mushroom – shaped acrylic projections
(buttons) attached to the substructure. The final
prosthesis is fabricated so that it will snap over the
mushroom buttons for retention. Retentive clips are
metallic or plastic clips that snap over the bar used as a
superstructure connected to the implants. Retentive
clips have more retentive ability in terms of breakaway
retentive force than magnets.
 Implants:
The successful clinical development of
intraoral implants to retain dentures and other
prosthetic replacements for missing teeth has led to use
of implants to retain extra oral structures. Jacobsson et
al (1988) reported nearly 83% success rate for implants
placed in irradiated bone sites Seals RR jr et al7
described fabrication and support for facial prostheses
by using osseointegrated implants. McCartnay J (1991)
described an auricular prosthesis in which
osseointegrated implants were placed in the temporal
bone and used a screw retained magnetic alloy casting
to retain an acrylic resin magnet keeper, to which
silicone ear prosthesis was attached. Arcuri MR et al
(1993) stated that tissue evaluation, structural designs
and retentive mechanism, combined with patient
compliance and the ability to perform hygiene around
retentive substructures produced an array of new
problems with the use of extra oral implants. Scherer UJ
et al (1995) described a new implant position site using
autogenous iliac bone graft and placed the implant in
axial direction in the middle of the orbit. Wolfaardt JF
et al10 mentioning the demerits of adhesives proposed
placement of two implants with the bar designed to
minimize torquing on the implants and to facilitate
hygiene. Roumanas ED et al6 found obturators to be
stable and retentive using implants in edentulous
maxillectomy patients (Fig 4). Bowden JR et al2
described two patients in whom zygomaticus implants
had been used to aid in salvaging prosthetic
reconstruction of the nose after rhinectomy (Fig 5).
Kreissl ME et al (2007) used a special retentive
anchoring abutment to integrate zygoma implant into a
telescopic crown-retained denture on the residual
dentition of a diabetic patient (Fig 6). Dib LL et al (2007)
satisfactorily placed a porous surfaced extraoral implant
into bone transplanted from the iliac crest for auricular
prosthesis. de Sousa AA et al3 found the retention
provided by the bar-clip attachments with 3 clips
remained stronger than provided by all other systems
indicated. Aydin C et al (2008) found implant success
rate to be 100% for silicone auricular prosthesis.
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Fig 4. Use of single implant helps retain posterior aspect of Fig 5. Radiograph showing the position of the zygomaticus
obturator. implants.

References
1] Behrman SJ. The implantation of magnets in the
jaw to aid denture retention. J Prosthet Dent
1960;10:807–41.

2] Bowden JR, Flood TR, DownieIP. Zygomaticus

implants for retention of nasal prostheses after
rhinectomy. British J Oral Maxillifac Surgery
2006:44:54-6.

3] de Sousa AA, Mattos BS. Magnetic retention

and bar-clip attachment for implant-retained
Fig 6. Inner telescopic crown copings after cementation. auricular prostheses: a comparative analysis. Int
J Prosthodont 2008:21:233-6.

4] Parel SM. Diminishing dependence on adhesive

for retention of facial prostheses. J Prosthet
Summary & Conclusions Dent 1980;43:552–60.
The retention provided by the implants makes it
5] Parr GR. Accessory retention for a facial
possible to fabricate large maxillofacial prostheses that
prosthesis. J Prosthet Dent 1979;41:546–7.
rest on movable tissue bed. Patient acceptance is
significantly enhanced because of the quality of the
retention. Methods for attaching and holding extraoral 6] Roumanas ED, Nishimura RD, Davis BK, Beumer
facial prostheses must be as invisible as possible to J 3rd. Clical evaluation of implants retaining
make them aesthetically pleasing. edentulous maxillary obturator prostheses. J
Prosther Dent 1997:77:184-90.
Using tissue undercuts or attaching the prosthesis to
the patient's eyeglasses or dentures can help 7] Seals RR Jr, Cortes AL, Parel SM. Fabrication of
mechanically retain the device. Medical-grade facial prostheses by applying the
adhesives or tapes are also used; however, they collect osseointegration concept for retention. J
dirt and are unhygienic. A prosthodontist, with his or Prosthet Dent 1989:61:712-16.
her skills and experience, has to decide the best mode
of retention possible for a maxillofacial prosthesis. 8] Tsutsui H, Kinouchi Y, Sasaki H, Shiota M, Ushita
Thorough evaluation of the situation and careful T. Studies on the Sm-Co magnet as a dental
judgment and treatment planning can give acceptable material. J Dent Res 1979;58:1597–606.
quality of maxillofacial prostheses, thus, improving the
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© 2011 Int. Journal of Contemporary Dentistry
 REVIEW
9] Voigt A, Christ S, Klein M. Experimental analysis
of retention forces of different magnetic About the Authors
devices for bone anchored auricular facial
prostheses. Int J Oral Maxillofac surg 1. Dr. Rajesh Gurjar
2008:37:664-8.
Department of Prosthodontics,
Jaipur Dental College, Jaipur,
10] Wolfaardt JF, Coss P, Levesque R. Craniofacial
osseointegration: technique for bar and acrylic Rajasthan, India.
resin substructure construction for auricular
prostheses. J Prosthet Dent 1996:76:603-7. 2. Dr. Sunil Kumar M.V.
Professor & Head,
Department Of Prosthodontics,
Jaipur Dental College, Jaipur,
Rajasthan, India.

3. Dr. Harikesh Rao

Professor,
Department Of Prosthodontics,
Jaipur Dental College, Jaipur,
Rajasthan, India.

4. Dr. Alok Sharma

Senior Lecturer
Department of Prosthodontics,
Jaipur Dental College, Jaipur,
Rajasthan, India.

4. Dr. Sumit Bhansali

Senior Lecturer
Department of Prosthodontics,
Jaipur Dental College, Jaipur,
Rajasthan, India.

Address for correspondence

Dr. Rajesh Gurjar,

Near Ghanta Ghar, Deeg,
Bharatpur, Rajasthan, India- 321203
Phone: +91-9829625111
Email:dr.rajeshkgurjar@gmail.com

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