Popular reality television shows have in recent years introduced many of us to the role that specialists play in making smiles look beautiful and function the way they should. Prosthodontists are experts in the restoration and replacement of teeth, but few of us are aware of the important role of maxillofacial prosthodontists in reconstructing the faces of patients who have suffered traumatic injuries or disfigurement due to accidents, diseases or birth defects.

Patients who have suffered traumatic injuries to the facial area as a result of for example gunshot wounds, motor vehicle accidents or fires, often require prostheses to replace missing areas of bone or tissue. In the case of head and neck cancers, patients may require major surgery to remove tumours that would otherwise be life-threatening. Unfortunately this surgery can sometimes be so extreme that facial tissue or bone is lost in the process. Furthermore, owing to the nature of these tumours, chemotherapy and radiation can cause further damage to facial tissue, which may have an effect on the patient’s ability to function normally. Maxillofacial prosthodontic surgery offers hope to these patients by restoring oral functions such as swallowing, speech and chewing, or by providing aesthetic restoration in cases where facial features such as ears or noses have been damaged. Patients who suffer these kinds of physical trauma often also experience an extremely negative impact on their psyche and self-confidence. It is generally believed that psychological damage can be minimised by starting treatment as soon as possible.

The Department of Prosthodontics in the School of Dentistry at the University of Pretoria (UP) is one of only a few centres in the country where specialised maxillofacial prosthodontics services are offered to state patients. The Maxillofacial Prosthodontics Project, which is run by staff in the Department, is multidisciplinary in nature and includes the services of a team of specialists consisting of maxillofacial surgeons, plastic surgeons, ear, nose and throat (ENT) specialists, and in cases involving patients suffering from cancer, oncologists and radiotherapists. As part of an extended rehabilitation programme after surgery, the services of a speech or language therapist may also be enlisted.

The majority of patients seen by staff at the Department are adults suffering from oral or head and neck defects due to trauma, cancer or congenital anomalies, who have been referred from the Steve Biko Academic Hospital, as well as from many of the surrounding clinics in Gauteng, Limpopo and Mpumalanga. The restorative work undertaken by the team to date has included implanting jaw prostheses, manufacturing dental prostheses and obturators (which are dental prostheses used to seal openings in the palate, such as is needed in babies with cleft palates) and constructing extra-oral appliances such as prosthetic eyes, ears and noses. Regular follow-up treatments for maintenance or replacement of prostheses due to normal wear and tear, or in some cases due to the changing shapes of the defects after healing or following recurrences, are an integral part of the service offered by the team.

Current research in the Department includes investigations into advances in the use of computer-aided treatment planning. This technology will enable surgeons to better plan the best course of treatment and could potentially minimise the number of times a patient has to go under the knife for complex surgeries. Closely related to this is research in 3D framework design and fabrication of prostheses, rapid prototyping and 3D printing, as well as the design of new materials that can be used in the manufacturing of prostheses. These technological advances are useful aids in the treatment and planning of complex surgical cases and will allow specialists to manufacture prostheses that can better fulfil the complex needs of maxillofacial patients. Another area that is being investigated by researchers at the Department is Zygomatic implants. These are used in the upper jaw when there is insufficient bone for conventional implants. They provide support for implant bridgework where there has been a substantial amount of bone loss in the upper jaw.

The work done by the team at the Department of Prosthodontics draws from many different academic disciplines, but the overarching goal of the surgical work they do and the research they undertake remains to effect a lasting change in the lives of the patients they treat.