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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 10  |  Issue : 3  |  Page : 76-80

Custom-made silicone finger prosthesis: A case report


Department of Prosthodontics, Regional Dental College, Guwahati, Guwahati, Kamrup (M), Assam, India

Date of Submission11-Aug-2022
Date of Acceptance25-Aug-2022
Date of Web Publication29-Sep-2022

Correspondence Address:
Dr. Debjani Chakraborty
Department of Prosthodontics, Regional Dental College, P.O. Indrapur, Guwahati, Kamrup (M) 781032, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_16_22

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  Abstract 

Restoring the digit with a esthetic prosthesis with passive function will enhance patients’ acceptance and confidence. A 23-year-old female patient reported to the Department of Prosthodontics, Regional Dental College, Guwahti, Assam, India, with a chief complaint of a partially missing index finger on her left hand. She wanted to get it replaced because she was getting engaged. The prosthesis was inserted, and a wide silver ring over the margin of the finger prosthesis was placed at the mid part of middle phalanx to disguise the junction line. The patient expressed high satisfaction with the end result and the retention of the prosthesis.

Keywords: Prosthesis, prosthodontic rehabilitation, prosthodontics, silicone finger prosthesis


How to cite this article:
Barman J, Nath S, Chakraborty D. Custom-made silicone finger prosthesis: A case report. Int J Oral Care Res 2022;10:76-80

How to cite this URL:
Barman J, Nath S, Chakraborty D. Custom-made silicone finger prosthesis: A case report. Int J Oral Care Res [serial online] 2022 [cited 2022 Dec 10];10:76-80. Available from: https://www.ijocr.org/text.asp?2022/10/3/76/357313




  Introduction Top


The human hand represents a triumph of complex engineering, exquisitely evolved to perform a range of tasks. The basic function of hand is to grasp, hold, and manipulate items. Hand gesture is perhaps the most blatant example of nonverbal communication. Finger and partial finger amputations are most frequently encountered forms of partial hand loss. A loss of fingers can occur because of trauma, congenital disorders such as amniotic band syndrome, and excision for neoplastic disorders.[1] Amputation causes devastating physical, psychosocial, and economic damage to an individual. It is an experience linked with grief, depression, anxiety, loss of self-esteem, and social isolation. Many severely injured and traumatically amputated finger can be saved by microsurgical reimplantation. However, in some patients, surgical reconstruction is contraindicated, unsuccessful, unavailable, or unaffordable. Prosthetic rehabilitation as an alternative could be considered in these situations. Restoring the digit with an esthetic prosthesis with passive function will enhance patients’ acceptance and confidence. The most common methods of retaining a digital prosthesis are by vacuum effect on the stump,[2] the use of a ring at the junction of prosthesis and stump,[3] and the use of osseointegrated implants with customized attachments.[4],[5],[6]

The fabrication of finger prosthesis is as much an art as it is science. The success of the prosthesis depends on the precision in planning, making the impression, carving the model, and choosing the material that best suits the circumstance. This article describes the rehabilitation of a patient with ring-retained silicone finger prosthesis.


  Clinical Report Top


A 23-year-old female patient reported to the Department of Prosthodontics, Regional Dental College, Guwahati, Assam, India, with a chief complaint of a partially missing index finger on her left hand. She wanted to get it replaced because she was getting engaged. A history revealed that the patient lost a part of her index finger during childhood because of careless handling of a sharp dagger. The amputation was partial, involving the mid-part of the middle phalanx of the left index finger. The wound was completely healed, and the surrounding skin showed no signs of inflammation and infection. The patient had no history of a previous prosthesis. Informed consent was obtained before beginning the treatment procedure.

A thin layer of petroleum jelly was applied to the patient’s hand prior to making the impression with irreversible hydrocolloid impression material (Tropicalgin, Zhermack). Additional impression of the individual amputated finger was also made using the same material. Impressions were then poured with ADA type IV dental stone (Kal Rock, Kala Bhai Karson Pvt. Ltd.) to create positive replica of the amputated finger [Figure 1].
Figure 1: Pretreatment photograph

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An impression was made of the contralateral digit using light body and putty consistency of condensation silicon impression material (Speedex Light Body Surface Activated, Universal Activator, Putty Set Rubber Base Impression Material, Coltene Whaledent), and modeling wax (Samit modeling wax) was poured into the mold to create the wax pattern [Figure 2]. The wax pattern was modified and adapted on the stump cast. Surface characterization (skin folds and wrinkles) was incorporated using appropriate tools. This pattern was assessed and adjusted keeping in mind the size, shape, and contours of the contralateral finger.
Figure 2: Impression of amputated finger

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The wax pattern was then flasked using ADA type 2 plaster of Paris (Kal Dent, Kala Bhai Karson Pvt. Ltd.). Undercuts were avoided to facilitate easy opening of the flasks and subsequent removal of the set silicone prosthesis. The mold was created by the lost-wax technique. The silicone base material (M511 platinum silicone, Technovent Ltd., 5 York Park, Bridgend) was mixed with catalyst in a ratio of 10:1 by weight. The base color of the prosthesis was matched with the ventral and dorsal surface of the hand [Figure 3]. Colored silicone was then layered into the mold, and the flask was closed applying light pressure. Excess material was removed. The mold was then transferred to a clamp, and heat temperature vulcanizing silicone was then processed at 100°C for 1 h as recommended by the manufacturers. The silicone prosthesis was then retrieved from the mold, and excess silicone trimmed using sharp, curved scissors. Burs provided by the company were used to finish the prosthesis. The fit and shade of the finger prosthesis were evaluated on the patient. For better color/shade matching, extrinsic coloration (Xtrinsic silicone inks, Spectromatch) was applied on the dorsal and ventral areas of the finger prosthesis under daylight [Figure 4]. A commercially available fingernail was shaped to match the patient’s natural nails and was attached to the processed prosthesis with the help of clear self-curing acrylic (DPI- RR Cold Cure) [Figure 5]. The prosthesis was inserted, and a wide silver ring over the margin of the finger prosthesis was placed at the mid-part of the middle phalanx to disguise the junction line. The patient expressed high satisfaction with the end result and the retention of the prosthesis [Figure 6][Figure 7][Figure 8][Figure 9][Figure 10][Figure 11].
Figure 3: Impression of contralateral finger

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Figure 4: Model of hand with amputated finger

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Figure 5: Wax pattern

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Figure 6: Wax pattern try-in

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Figure 7: Invested mold

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Figure 8: Intrinsic coloration and manipulation

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Figure 9: Prosthesis try-in

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Figure 10: Extrinsic coloration

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Figure 11: Final prosthesis retained with ring

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Homecare instructions involving the use of a soft brush, soap, and warm water irrigation were given, and the patient was instructed to come back after 2 months for a recall check-up.

Recall examination revealed healthy skin at the amputation site and good retention of the prosthesis.


  Discussion Top


Partial hand loss is an easily noticeable deformity that can invite disturbing judgments of irrelevant people. In addition to an immediate loss of grasp strength and security, finger absence may also cause marked psychological trauma, which may not be related to the magnitude of amputation. The loss of even one finger produces significant deficiencies. The need to rehabilitate such defects may arise later in life, particularly at the marriageable age where the finger is particularly in focus for events like engagement. The concealment of amputation through prosthesis usage can shield an amputee from social stigma. Empowering the patient with a customized life-like prosthesis can give the patient a sense of ownership of their prosthetic hands or fingers.

Numerous methods of prosthesis retention are available such as medical grade adhesives, finger rings, or implants with attachments. In this case report, the prosthesis was retained utilizing ornamental silver finger ring; thus, bypassing the ill-effects of adhesives on skin and prosthesis and facilitating easy maintenance by the patient. In addition to ring retention, the silicone prosthesis itself stretched and grasped the residual digit with positive pressure. The residual digit can aid in retention by positive pressure only when it has firm, bony content, and is at least 1.5 cm in length.[7] Jacob et al. rehabilitated a similar amputation defect using multiple vacuum chambers by creating multiple grooves in the positive model that provided suction for retention.[2]

The use of osseointegrated dental implants to retain a finger prosthesis has been documented extensively in the literature.[8] The retention provided by implants is much superior to the retention obtained by medical grade adhesives and other retentive modes.[9] Although an implant could have been a viable option, it was not used as a retention modality in the present case as the patient required the prosthesis in a short time and within limited expense. Additionally, the patient did not want to undergo any surgical intervention.


  Conclusion Top


Prosthetic rehabilitation of the amputated finger is advantageous as it is relatively quick, reversible, and medically uncomplicated. The custom-made finger prosthesis is esthetically acceptable and comfortable for use, resulting in psychological improvement and personality.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McKinstrey RE Fundamentals of Facial Prosthetics. St. Petersburg, FL: ABI Professional Publications; 1995. p. 181-92.  Back to cited text no. 1
    
2.
Jacob PC, Shetty KH, Garg A, Pal B Silicone finger prosthesis: A clinical report. J Prosthodont 2012;21:631-3.  Back to cited text no. 2
    
3.
Palled V, Rao J, Singh SV, Chand P, Arya D, Aggarwal H, et al. Custom-soldered, double-ring retained silicone finger prosthesis. J Prosthet Orthot 2019;31:159-62.  Back to cited text no. 3
    
4.
Thongpulsawasdi N, Amornvit P, Rokaya D, Keawcharoen K Adhesive vs implant retained fingers prosthesis: A comparative study on esthetic and functional outcome. World Appl Sci J 2014;29:1015-19.  Back to cited text no. 4
    
5.
Houtman C, Sutherland NR, Bormett D, Donermeyer D Development of USPS laboratory and pilot-scale testing protocols. 2000 TAPPI Recycling Symposium, Washington, DC, USA. 2000;2:403-31.  Back to cited text no. 5
    
6.
Cervelli V, Bottini DJ, Arpino A, Grimaldi M, Rogliani M, Gentile P Bone-anchored implant in cosmetic finger reconstruction. Ann Chir Plast Esthet 2008;53:365-7.  Back to cited text no. 6
    
7.
Pereira BP, Kour AK, Leow EL, Pho RW Benefits and use of digital prostheses. J Hand Surg Am 1996;21:222-8.  Back to cited text no. 7
    
8.
Ozkan A, Senel B, Durmaz CE, Uyar HA, Evinc R Use of dental implants to retain finger prostheses: A case report. Oral Health Dent Manag 2012;11:11-5.  Back to cited text no. 8
    
9.
Pattanaik B, Pattanaik S Fabrication of a functional finger prosthesis with simple attachment. J Indian Prosthodont Soc 2013; 13:631-4.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]



 

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