University of Michigan School of Dentistry
Graduate Prosthodontics
Maxillofacial Prosthodontics

Students in the Graduate Prosthodontics program at the University of Michigan School of Dentistry will receive the bulk of their training in Maxillofacial Prosthodontics during their second year. This training will have both a didactic and clinical component and an optional research component. It is understood that this is not a maxillofacial training program, but our goal is that each student feel comfortable treating basic cases and be familiar with the literature in this area. Students who wish further experience in their third year will be given the opportunity.

Learning objectives

Upon completion of their second year, students should be able to:

1. Describe locations of head and neck cancer and explain various treatment modalities

2. Describe the velopharyngeal complex and explain its role in speech and swallowing.

3. Give indications for a soft palate obturator and palatal lift prosthesis and fabricate these prostheses.

4. Describe the anatomy of the resected maxilla patient. Explain ways in which the surgeon can improve the defect site to improve the prosthodontic prognosis.

5. Explain the sequencing of surgical, interim, and definitive obturators and fabricate them, includes bending wires and tracing defects with various impression materials.

6. Explain unique aspects of partial denture framework design for the partially edentulous obturator. Describe ways to gain retention for edentulous obturator.

7. Understand the role of palatal contour and size in speech and swallowing. Give indications for palatal augmentation prosthesis and fabricate them.

8. Describe methods of reconstruction of mandibular resection patient.

9. Describe occlusal function in the patient with the resected mandible and the fabrication of removable prostheses. Discuss use of dental implants in these patients.

10. Give indications for facial prostheses for facial defects and explain their limitations.

11. Make an impression of a facial defect. List advantages and disadvantages of different impression materials for this purpose.

12. Draw face and facial structures. Sculpt nose in clay.

13. Describe development of molds and processing technique used for facial prostheses.

14. Describe materials and adhesives used in facial prostheses.

15. Color a facial prosthesis to provide acceptable esthetics.

Didactic Portion

Second-year students will participate in a weekly conference which will be comprised of lectures, literature review seminars, and presentations by the students. Guest lecturers will be asked to lecture on specific topics. Approximately 30 sessions will be provided.

Topics:

Head and Neck Cancer Series
1. Head and Neck Cancer: Introduction
2. Tumors involving mid-face, palate, maxilla
3. Anatomy of maxillectomy
4. Tumors of mandible, tongue, tonsillar region
5. Anatomy of glossectomy and neck dissection
6. Radiotherapy: Introduction
7. Radiotherapy: Use of stents, etc.
8. Chemotherapy, chemoprevention. Fluoride. Osteoradionecrosis

Speech series
1. Introduction to speech and swallowing
2. Velopharyngeal functioning
3. Articulation and tongue movement; palatal contour

Obturator series
1. Surgical obturator: fabrication and insertion
2. Interim and definitive obturators. Review of impression materials and reline materials
3. Interim and definitive obturators: Clasp materials and design

Mandibulectomy series
1. Occlusion in the dentulous and edentulous mandibulectomy patient
2. Restoration of the edentulous mandibulectomy patient
3. Restoration of the partially edentulous mandibulectomy patient
4. Surgical reconstruction of the mandibulectomy patient; use of dental implants

Facial prosthesis series
1. Impression materials and technique with demonstration
2. Sculpting: Anatomy of nose, eye, ear
3. Silicones, polyurethanes, etc.
4. Adhesives and magnets
5. Processing of facial prosthesis
6. Intrinsic and extrinsic coloring

Each student will give two presentations. The first presentation will be on anatomy: Anatomy of the maxillary resection, Anatomy of neck dissection, Anatomy of the soft palate. Slides or overhead projection may be used. The second presentation will be a case report of a patient treated in the maxillofacial prosthodontics section. This presentation should be no longer than thirty minutes and include slides. Ample advice will be provided upon request. Please realize that these presentations serve as an opportunity for you to develop skills in preparing and giving a talk.

Students will learn the fabrication of a facial prosthesis in a pre-clinical scenario by fabricating a '"'party nose'"' for themselves.

Clinical Portion

Each student will spend one day per week with Dr. Zwetchkenbaum providing clinical care for maxillofacial prosthodontic patients at University Hospital. Students are expected to complete all laboratory work on patients with whom they are participating in the treatment, with the exception of any metal or fixed work. Initially, students will observe and assist with treatment. As experience increases, students will be assigned patients to develop treatment plans and treat alongside Dr. Zwetchkenbaum. Students can expect to go to the operating room when this is part of patient treatment. Occasionally, a patient they have worked up may have treatment in the operating room on another day. Students may choose to attend for that procedure. Students are encouraged to carry pagers.
Graduate students will also participate in treatment of any other hospital dentistry patient referred for prosthodontics. This means that you may do other things besides maxillofacial prosthodontics, such as conventional removable and fixed, and implant-supported prostheses. Laboratory work for these patients may be sent out, just as is done at the dental school.
The students will be provided advance notice of which days Dr. Zwetchkenbaum will be out of clinic. On those days, the student should plan to see other patients at the dental school or do other needed work.

Research Portion

Students may wish to do their research in an area of maxillofacial prosthodontics. This can best be discussed on an individual basis.