Orbital Prosthesis

Sculpture of the orbit, Iris construction and flasking.

Presented By:

Nabaa Abd Al Sattar

Muhaj Hussaien
Mawada Mohammed

Supervised By :

Afeeaa Lateef
The fabrication of Orbital Prosthesis
-Taking measurements for the natural eye:
• The size of the iris and pupil is taken using the normal eye as a guide.
• The shade of sclera is taken using a shade guide.

A-First Method
• Molten sclera wax is poured into the alginate mold.
• Once cooling , the wax pattern is removed.

• the resultant wax pattern is smoothed using gauze and all sharp
edges are removed.
• The wax pattern is then ready for trial into the socket.

B-Second Method
• A silicone putty index was made of the impression.
• Once it set, it was cut open and a light yellow wax was flown through it.
• On hardening, the wax pattern was gently retrieved, cooled in cold water and
smoothened with the help of a carver and gauze.
 The tissue/fitting surface of the wax pattern was not manipulated at this stage. The wax pattern was then tried in the
patient's eye for fit, comfort, bulkiness of the pattern and drape and mobility of the eyelids.

Necessary adjustments were made. Corneal prominence was checked for by standing behind the patient, retracting
her eyelids and making her look downward. Mild blepharospasm was experienced and the patient was given a few
minutes to adjust to it.

Insertion
• The wax pattern is checked into the patient eye socket and compared with normal eye.
• The patient is asked to close and open the eye

• The wax pattern is modified if necessary to be similar to a normal eye.

The fabrication of Base Sclera Shell
○ The wax pattern is flasked in a two-part flask using dental plaster.

○ Once it has set, the wax pattern is removed and the flask is packed with Scleral Polymer, heat-
cured acrylic resin mixed with monomer.
○ A separating medium is used to facilitate easy removal.

Curing Protocol
A modified curing protocol, referred to as ‘reverse curing’ is followed to minimize
monomer content from the acrylic eye:
1-the flask is placed in water at 95°C for 20 minutes and thereafter in boiling water for an additional 20 minutes.

2-The flask is then held under running water to cool it.

3-The acrylic is retrieved and about 1mm of the acrylic surface is trimmed down and the black iris is reduced to make it almost
flat corresponding to the level of the iris plane of the natural eye.

4-The margins of the acrylic prosthesis are rounded off and the entire prosthesis is
smoothed out.
Coloring Of The Sclera Shell
The iris is colored using pigments or acrylic paints and clear light cure material.

It is done with the patient sitting in front of the clinician so that the color of the
contralateral eye can be matched accurately.
Coloring of the shell is generally done in natural daylight

○ The pupil was added as a small black dot in the center of the iris.
○ The base color was applied first and then other highlights were applied layer by layer with fine
strokes, resembling the spokes in a wheel.

○ Optiglaze is mixed as a medium with the paints and cured by a dental composite
resin curing LED

○ The colors are artistically painted and cured layer by layer preventing the mixing
of shades.

○ A fine line merging the iris into the sclera is indicated by painting the limbus.

○ The color of the sclera is matched to the adjacent eye and veins (red nylon fiber) are
added replicating blood vessels to give it a natural look. A thin layer of Optiglaze is
added as a final coating and light cured to seal the paint.
 Irs Construction
1. Iris Painting Technique
This technique is based on visual assessment of the contralateral eye for the color, 2. Digital Imaging
diameter, and the morphology of the patient under indirect sunlight, and depend on This technique uses color coordinates to

the individual's expertise. provide acceptable esthetic results with

Choice of the material which is used to paint iris depends on which surface the iris is minimal color modifications.

made.
advantages
Materials which are employed are gouache, automotive paints, and ○ it requires minimal artistic skills
acrylic oils. Furthermore, these materials should be carefully ○ is less tedious
selected depending on their reaction to polymerization and changes ○ and uncomplicated then the manual
painting technique.
during ultraviolet exposure.

oil paints have better color stability when exposed to the external environment.

Although it requires special equipment and software for image replication. paper
iris is attached with the help of monopoly syrup.
3. Prefabricated iris button
Stocks of prefabricated iris are sold in different shades of each color. However, a study conducted stated that
the prefabricated cap technique exhibited the highest change of color values before and after the
polymerization technique.

The iris is produced by :

• Paper iris disc technique
• Using a digital camera.
• Painting using oil paints
Iris Production

1. Paper iris disc technique

The iris is painted on a paper using acrylic paints to match the color of the normal
eye.
2.Painting using oil paints
The iris is painted on black iris disc using oil paints (e.g):
• Ivory Black • Zinc White • Titanium White.
3.Using a digital camera
• Make a digital photograph of the patient’s iris using a digital camera.

• Evaluate the photograph and compare it to the patient’s iris. Using a software
(Photoshop 7.0 ), adjust for slight differences in color, brightness, contrast, or hue,
and format the image.
• Print the final image on white paper using a printer
 Flasking Procedure

1- The upper and lower halves of the flask are separated using vaseline.

2- The wax pattern is invested where the fitting surface of the wax pattern is covered by dental
stone.
3- separating medium is then applied to the surface of the stone and left to dry.

4- The wax pattern is fully invested and left to set for one hour.

5- The mold is then placed into a boiling out machine for five minutes.

6- The mold is cleaned using detergent, and a separating medium is applied.

7- Methyl methacrylate polymer and monomer are mixed using a spatula.

8- When the mixture reaches the dough stage, it is packed into the mold and the upper and lower
halves of the flask are closed in a hydraulic press.
 Flasking Procedure
9- The mold is taken from the press and placed onto clamps and cured. The acrylic is taken out of the
mold and any excess is removed using an acrylic bur.
Grooves 1 mm deep are made on non- fitting surface to provide
space for clear acrylic resin

10- The sclera acrylic is then reduced until none of the grooves are visible.

11- The iris disc is seated on the sclera using cyanoacrylate.

12- The upper and lower parts of the mold are separated using unfoil.

13- A small amount of heat cure clear acrylic resin polymer and monomer
is packed into the mold and cured.

14- After curing , the ocular prosthesis (acrylic) is removed from the flask

15- The excess of acrylic is removed using burs and it’s smoothed and polished using acrylic burs,
stone burs and pumice & rauge then it's ready for insertion.
Trying eye prosthesis by Insertion and Removal
Insertion
1. Hands are washed thoroughly.

2. Make sure the eye socket is clean and free of any foreign matter. If necessary, gently remove any
foreign matter from the socket with a dry cotton swab.

3. The ocular prosthesis is held between thumb and middle finger, with the iris color facing
away from the socket and the black dot facing up.

4. The upper lid is pulled upwards so that the depth of the superior aspect of the eye
socket is exposed.

5. The superior edge of the prosthesis is inserted under the upper eyelid to the
maximum depth.

6. The eye is hold in position and the lower lid is deflected down over the
inferior of edge of the prosthesis.

7.The lower lid is gently massaged until the eye is positioned correctly.
Trying eye prosthesis by Insertion and Removal
Removal
1. Hands are washed thoroughly.

2. A towel is draped over a basin to catch the eye prosthesis to prevent it

dropping and damaging on hard surfaces .

3. A cupped hand is placed on the check to catch the prosthesis.

4. The index finger is placed on the lower lid gently and the soft tissue is pulled
away from the nose.

Suction cup can be used to remove the ocular prosthesis

• The suction cup is squeezed while pressing it firmly against the prosthesis. Then the suction cup is
released, thereby allowing it to fasten itself to the prosthesis.

• The lower lid is gently pulled down out and the prosthesis is completely removed.
Thank You
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