Tucked away in our Head and Neck Center are three artists. But instead of choosing the perfect color for a painting, they select the perfect tooth from tray after tray of various artificial ones – about 1,000 in all.
While not traditional works of art, the custom prosthetics created by these prosthodontic lab technicians are invaluable masterpieces for our patients.
“Each person’s mouth is unique, similar to a fingerprint,” says Cong Nguyen, lead dental laboratory technician. “So everything we create is customized to perfectly match each individual patient.”
The lab technicians partner with our oncology and maxillofacial prosthodontic doctors, who care for patients with some of the most complex cases of oral loss and reconstruction. Restoring what’s lost due to cancer and cancer treatments often goes well beyond implants done at a local dentist office. Many times, the prosthetics made here include structures such as the roof or floor of the mouth.
These sophisticated implants, called obturators, help restore proper air flow and enhance patients’ abilities to eat, drink and speak.
The intricacies involved in this work require specialized training. It’s a career that runs in William Graham’s family.
“My dad did this in Mississippi, and I started working with him when I was 18,” says Graham, who joined MD Anderson in December 2015 as a prosthodontic lab technician.
Teeth as art
Our dental artists make about 20 custom obturators each week.
Following surgery, a u-shaped tray filled with a thick liquid is pressed into the patient’s mouth to create an impression of the remaining teeth and tissues. The technicians create an exact replica of the patient’s mouth by pouring plaster into the impression to make a stone cast.
This is used to build the base of the prosthesis and make a second, customized impression tray to form a mold of the patient’s soft tissue.
A wax-like material is used for the prosthetic’s soft tissues. Then the teeth are hand selected and inserted to complete the prosthesis. A series of fittings and adjustments takes place during the process to ensure perfect fit and optimal function for the patient.
“It typically takes one to two weeks to complete each obturator, but we accelerate the process under some circumstances, such as for out-of-town patients so they can return home as quickly as possible,” Nguyen says.
More than cosmetic dentistry
Nguyen came to MD Anderson in 2009 after working for a commercial lab for many years.
“This doesn’t feel like work. It’s so rewarding to interact with patients and see how our work helps them,” he says.
“What we do isn’t just cosmetic. It improves patients’ quality of life, such as allowing them to eat again and quit relying on a feeding tube,” Graham says. “Our patients go through so much. It’s wonderful to see them happy with the outcome.”
In addition to the patient interactions, Mayra Morales, prosthodontic lab technician, says she really enjoys the collaboration and continual learning offered in her job.
“The work done here isn’t something you see in most places, and I really enjoy getting to build my skills while helping patients,” Morales says.
Don’t get radiation without it
Obturators are just one of these artists’ creations. They also make fluoride carrier trays and radiation stents. These are Morales’ specialty, and she’s affectionately called the “stent maker.” Every day, she makes three to four custom mouth guards, called stents, for patients undergoing radiation in the head and neck region.
These stents protect tissues that don’t need radiation and confine the tongue, making the treatment more effective.
Just like the obturators, each stent is custom-made to fit the individual.
“It’s wonderful working with my colleagues, the doctors and fellows and dental hygienists, but it’s most rewarding to interact with patients,” Morales says.
A longer version of this story originally appeared in Messenger, MD Anderson’s quarterly publication for employees, volunteers, retirees and their families.
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